YouSaid · the spoken record

Alex Karnal

lines on the record: 88
first: 2026-04-21
most recent: 2026-04-21
sittings or episodes: 1
sources: podcast

Every line below is reproduced as it was said and linked to the record it came from. Nothing here is summarised or generated. Directory · Search · Corrections

“My wife. I'm pretty darn hard at it every day, every minute of the day I can be hard at it. That drives me to different levels of stress, and I could be so myopically deep down trying to figure something out that I kind of just lose track of everything else around me. And my wife Cass has this amazing ability to just know when I'm at that, like just on the precipice of that breaking point and she could find some way to distract me, make me laugh and kind of get me back to neutral. And I think that's a big force and an advantage for me because I don't have to worry about going so hard because I've got a partner that's right there by my side that can help make sure that I could not just be going after the things I really care about doing, but having some fun along the way.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Where medicine should exist, but they don't yet. To me, being in that room is the most fun part of the day. And I think it very much epitomizes what our philosophy is, which is that in order to be a great backer of innovation, we essentially need to be able to answer three questions. Are the innovations we're getting behind going to work or fail? Are they ultimately going to be relevant from a market potential or not? And is there a way by which we could back this company, invest in this company, enable this company to move forward faster with capital that produces a return that's attractive enough for the investors that are trusting us with their capital? We want to bring together the most talented minds at each of those different areas of domain expertise to give us an advantage that we can, in a replicable manner, deploy day after day after day to both be backing the companies that should be moving forward faster and making exist the companies that don't but should.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“I think I just bring you into what we call our morning meeting. So at Bradewell, we get together as a team every morning from 9.15 until we're done. And I want you to imagine, like, so you're in this room. You've seen it. So you're in this room. It's a big room. And we've got an amazingly talented team of scientists, biostatisticians, commercial experts, AI experts, investors, operating people, traders, structured finance people. We have a pretty significant team. Everybody on the team has some special superpower that they contribute to us trying to figure out what companies have amazing technologies that we should be getting behind and backing and helping them to go as fast as possible to have human impact that cuts at some of those big unlocks that would be the difference between having something and having it have its impact. And then as we get to look across the ecosystem of everything that is moving forward today, where do we also see the major gaps?”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“System for human health looks like and what could we do to be the driving force behind making that happen? How could we be the force that is not just okay with a once in a decade $100 billion GLP1 revolution, but how do we be the force behind making sure that this once in a lifetime trillion dollar cost savings revolution happens because we can be the force behind medicines having their moment where they could prevent diseases that are already preventable today And that really inspired us. And after kind of seeing it, we couldn't unsee it. And then we spent many more months thinking about, well, how do we go do it? How would we build it? And that became Braidwell, where I'm spending my time today and we're having the most fun that we've ever had.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“And be able to point those talents not just at the discovery side of being able to have invention, but be able to point that at the impact that's required to actually see these medicines have the impact that they're intended to have. A lot of that was my inspiration for leaving Deerfield and wanting to go build Bradewell. I'm so fortunate because one of our dear friends, Brian Kreiter, who's an incredible person. He's an amazing husband, father, incredibly talented business person was also just as inspired as I was about where we found ourselves in the world and the type of impact that could happen but wasn't yet happening. He was the chief operating officer for Bridgewater. I was co-running Deerfield and we decided to spend some really deep time trying to put our lessons learned and our insights together and tried to design from a first principles perspective what would the operating”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“As I went forward, and I was like, Well, what lessons would I be teaching my daughters? And I got to the point where the combination of thinking across all those dimensions made me the question, am I just doing the wrong thing? Do I need to go in a different direction? The answer was no. What I needed to do was take sort of”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“But they weren't. That was a really dark period for me in my own journey because as I was reflecting on all the time and effort and capital that I was a part of putting behind innovation, it became pretty quickly evident to me that you have to start asking the questions, well, for what purpose if people need to be on a medicine for the rest of their lives and they're taking it for a year on average and then quitting, are we just optimizing for maximum expected returns but no impact on public health? I had been married at the time. I got married in 2012. So I'd been married for some number of years and I started thinking about what does my life mean and how am I as a partner to my wife if I'm spending my time just focused on making money and not actually doing something that can move the world forward? We had had our first baby at that point and I was reflecting on just how impactful my parents were in terms of teaching me and what they armed me with.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Figure out how to finance their innovation all the way through to spending time with our team on how do we design and help a company design a clinical study in a way that would give them an advantage to showing something that's really special. That stayed true for about the first decade of my time at Deerfield and then something just really, really tragic happened. At Deerfield, we were constantly building capabilities and constantly wanting new sources of data. And one of the sources of data that we had acquired and had built out was now taking us deeper and deeper into understanding a patient's journey from the moment where they are prescribed a medicine to where they actually get the insurance approval to get that medicine and then how long they stay on the medicine. And of course we all know medicine only works if we take it. And what I was quickly learning about a decade into my obsession for all the amazing work that was going on around me is that yes, medicine only works if people take it.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“After going and presenting on my ideas there for that point, which was a tiny team of about 12 people, I got hired to join Deerfield. And I spent then the next 15 years of my career helping to build Deerfield into that dream state of being the go-to source of capital for the industry. I didn't realize that at the time, but I guess I was 24 when I joined. And I think the next youngest person at the firm was probably 40. These were all people that were super seasoned, had incredible experience. And I think I was a bit of a novelty in the room because I would ask like almost a thousand questions every single day. And these amazing people would spend the time to teach me. And so the apprenticeship that I was able to get from my time at Deerfield was like nothing I could have ever imagined. And I was all in fully in love with investing in building and backing anything, whether that was a medical device, a diagnostic, a medicine, anything that could move human health forward. That spanned everything from helping these companies.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“The same amount of reward, but with lower risk or produce more reward for same, it didn't make any sense to me. It turns out that months went by before my phone finally rang, but then one day it did. And it was today a dear friend of mine and mentor, Jeff Kaplan, who was the head of trading at that time in 2005, a tiny little firm named Deerfield Management in its early days where Jim Flynn had just taken over its general partner. Jim was a really unique leader of Deerfield because one of the things that I learned from spending time with him was he obsessed over what is every which way by which our investment firm can have every type of advantage in producing our returns so that we can attract more and more capital and have more and more impact on the future of human health. How do we create advantages that would allow Deerfield to become the epicenter of capital to move innovation? I got lucky. I found like the one person in the world who cared about the things that I had to say.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Select securities ways in which we might be able to either maintain a type of return that they needed for their investors but at lower risk or maintain the risk and produce a higher rate of return. I went off and I spent my nice and weekends writing this beautiful deck that I thought had really cracked the code on what portfolios needed to look like in the life sciences sector would allow a scale of capital to get behind these amazing medicines that had never before been achieved. And when it was done, I could not wait to send it out. I remember telling my roommate, Dom was like, Dom, I'm ready to send us out. I'm going to send it to everybody and you just watch. My phone is going to be ringing off the hook. Everybody in the world is going to want to do this and put this strategy to work. And my days at Merrill Lynch are numbered. I'm going to be out of here soon enough. I sent it out crickets. I didn't get one single response and I couldn't believe it. I'm like, how does nobody want to do this? How does nobody want to run a portfolio that can produce?”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“I am through total serendipity. I find myself at the epicenter of needing to understand these companies deeply enough to price risk and getting a chance to be in front of all of the buy side investors that are building and backing these companies that I became inspired by the work that they were all doing. I was so inspired by it that in my seat, I got to be out with these people a lot because they were curious what activity was going on the trading desk and what it meant for them and their investments. And I was always interested in learning more about how did they build and back these companies. And what I came to quickly realize in talking to all these people from all these different investment firms was that their strategies were actually very similar. I said, huh, knowing what I know about derivative securities and that I had learned from my days at MIT, my time at Merrill Lynch, and recognizing that most people in the life science investment world were just using equity securities, it struck me that there was a better way to build these portfolios.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“We're really inspiring to me. I had two major stops at Merrill, one on the Capital Market side, and then after doing that for a while, I wanted to go see how these crazy securities, derivative securities traded. And so I had a chance to move to the Maryland's derivatives desk. I think what was just so fun for me about reflecting back on that time is I actually never picked biotech. When I got moved over to the derivative desk, I was just put into biotech. I was assigned to the biotech subgroup of the derivatives desk and knew nothing about it, but I fell in love with it so quickly because the risk reward in that setting was about life and death. And when I was looking at what was going on and the companies that I needed to be understanding to be able to price risk, it was like wild to me what was going on. I had no idea about this entire field of the development of medicine. I had no real appreciation for just the sheer capital that's required to move it forward.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Being at MIT and learning more and more about business and economics and science and connecting it back to my early days of working alongside my dad and getting a chance to at the time not realizing but put money into some of the deals that my dad was doing. I could put $2 into a rocking chair that we bought. And if we sold it for 200 bucks, I thought that was amazing. And if we didn't sell it, I was pissed. I didn't realize I was learning in these early days about risk and reward from my dad. And then when you get to a place like MIT and you start to see the black and white version of the equations associated with that, it was a real major step forward for me that inspired me to want to then go on to New York City and to Wall Street. I thought to myself, no better place to really learn about business and how capital connects to business and what it takes than to come to the epicenter of that here in New York City. And so I end up at Merrill Lynch and had some amazing mentors.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“I learned that lesson from watching him in real life and kind of being in business with him. But you pair my dad with my mom who's been an absolute force in my life. My mom is this incredible, ever optimist. From my earliest memories of my mom, I can remember her drilling into my mind. We always commit and we never quit. She pretty much convinced me that I could do anything I wanted if I put my mind to it. And so I feel like from my dad, I got to experience and see what it means to take risk and that you can fail and life goes on. And from my mom, I developed this sense of resilience. And I think both of those attributes are very much probably connected to why when I found medicine, I fell in love with it, particularly the discovery and the development of it. So from that early childhood, I was the first in my family that got a chance to go to college. I graduated from MIT and had just an amazing experience there. For me,”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Just been super lucky reflecting back in my childhood, I guess my parents were training me to be a biotech builder and investor since the time I was five, but I had like the greatest childhood ever grew up in a typical American home. My dad was this relentless entrepreneur. He was the type of person that worked harder than anybody I knew. And he was so all in and any business endeavor he was pursuing like our entire family was all in on it. Mom was doing the billing. My brother and I were in the garage refinishing furniture. kind of grew up around business by being around my dad and he was just such an inspirational force in my life despite the fact that he was such a relentless businessman he was never successful really at any of those and i think if he were sitting here today sadly he passed the parkinson's over a decade ago one of the things he told me in those last few days is that he felt like he never stuck with anything long enough to see it through over the tougher moments and we just quickly move on to the next thing and the next thing”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“That sponsors behind medicines have to submit in record time versus the armies of people that would have to comb through that and the days and days of days of time that are wasted all the way through to starting to challenge every aspect of, okay, well, in what settings do we not need nearly as much evidence in animals and we could rely on cell-based experiments? In what settings do we no longer need multiple redundant studies that show us the same thing? We can cut through it with one study. I think across anywhere you look. We are seeing a movement to be able to do things more efficient, faster, and having a greater impact. And in some ways that circles back to where I began. To me, 2025 was such an exciting year because we saw not just amazing medicines doing amazing things for people's health, but we saw a real movements across the consumerization of this medicine, across people wanting to take health into their own hands and across every layer of what we just described.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Matter, and people have a hypothesis and they want to test it. And so they're fighting really hard to go and get those hypotheses tested. At the same time that you see what I would call like that grassroots peptide movement, you also have a recognition by the FDA that we've got to move a lot faster. So long as we have all these frictions in the system of going from a hypothesis for a medicine to the testing of a medicine in people and then ultimately in approval, disease is going to keep winning. I think we're seeing under Marty Macari real leadership to want to go and try to break down those barriers and those frictions that are making the drug discovery and the drug development process be incredibly time consuming and incredibly complex. And some of the manifestation of the real world impact of that spans everything from Marty brought in an AI system to help them be able to comb through the thousands of pages of file.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“I think it's hard to know whether it's the commercial success of GLP ones or you look to the massive movement around peptides. Honestly, it's not even limited to just peptides. Like you go on Reddit, you can see people are experimenting across all sorts of different dimensions. And I think what's happened is we live in a world where people want to go and figure things out that help other people. And now we've got platforms that allow people to share that. And so we see the creation of groups that can exist today that couldn't exist in the future before we had the technology like we have today and the communities that can get formed. Whether you're looking at it from the perspective of people coming together under shared missions, that's happened throughout the history of all of humanity. This is a shared mission where people are saying like, I want to take my future health into my own hands. And I'm not willing to wait for scientists to go take on this problem independently, for it to go down the traditional pathways. Like I don't have the time. I need to know the answers now because I think for myself this is going to really matter.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Exactly. And so now superstar, brilliant, amazing scientists who go down their life journey to become a scientist that wants to fight against disease, wants to do work that matters is no longer going to spend two-thirds of their career at the side of a bench pipetting all day long. He's going to have all that time back to point their energy and their enthusiasm, their optimism towards trying to figure out how do I use the systems and machines that I have and point them in the right direction at the codes that we should be cracking. That's really enabled when you have the combination of brilliant human scientists force multiplied by the ajentic power of these systems that are being built. And the more those egentic systems can be fully automated where all of that lab experimentation is happening in real time and without the need for human interaction, I think the quicker and quicker it can scale. And I think the quicker and quicker we can achieve that level of scientific super intelligence.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“These would be completely automated. Up at Lila Sciences the other day, and you go into their labs and what you see is all of these robotic arms and you see petri dishes that are moving around in an automated fashion, moving from one spot to the next spot. To me, I think what that means is the scale of data that's going to be required. Robotically, and for that to be done, it has to have an ajentic engine behind it and needs to produce data at a scale that's kind of unprecedented. What I think the future of Discovery looks like is a gentic systems that can drive robots to do most of the experimentation that we're doing today with human hands. And I think that's a big unlock for the ability to track.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Benefit of those tokens, and we're starting to see that. So we've got one company that we're really close to today that's actually starting to show the bending of that curve and helping us to see that the idea of getting to scientific superintelligence is one that is likely to follow pretty deterministic set of scaling loss.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“LLMs have been and how impactful they are across so many different areas of life because they've been trained on trillions and trillions of novel tokens. So data ends up being a big part of what drives to advanced levels of intelligence and drives an intelligence revolution. Well, the same has to be true in science. And so the AI companies that I believe are going to be most set up for success are the companies that have incredible AI talent, have access to significant amounts of capital and can combine both of them with a novel way by which they can generate science tokens that don't exist in the public domain. In fact, the generation of those tokens becomes a big driver of their moat, not only the driver of the moat, but actually what enables them to be able to get to an increasing and increasing level of scientific intelligence that starts to separate from that of which can be achieved with the LLMs without having”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Very recently, for most of my career, there's been some version of machine learning and the hopes of AI really driving drug discovery and the development of novel medicines against those discoveries. And I always worried that in order for that paradigm to be true, it required data that didn't actually exist in any easy place. If all you do is train AI models based on the research that's available, unfortunately have a paradigm of a lot of garbage and garbage out. And I think one of the things that people don't appreciate when I start talking to them about what data exists is that unfortunately a lot of the recorded literature is actually incorrect and has been tons of studies that show if you go try to replicate the experiments that are in the literature, you don't even get the same results. Definitionally, if that is true and these AI companies don't have a source of creating novel data, what are you going to do? How are you going to train? We've seen just how powerful.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“way been able to discover a target that didn't exist yet but what we can do is for targets that we know exist but that we have really struggled to be able to develop medicines against those targets we're starting to see that code be broken by AI and AI being a big force multiplier it's enabling that to happen what we have today are companies that can go from what would historically been running these massive screens that are incredibly time consuming to doing all of that screening work in silico and can go from model to molecule and what would have taken a couple years time in a month that's already true today already true today there are companies like Lila Sciences Anabla these are companies that you can basically ask the Agentic system to develop you a molecule against a certain target and it can crack that code and give us something that we can work with and start running an experiment”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“All n number of hypotheses that could exist and should exist. And then figure out what is the greatest and best next experiment to go run, run that, and run those in real time, 24 hours a day, seven days a week. The sheer ability to be more comprehensive and complete in our hypothesis set, and then the sheer ability to run experimentation at a scale that's unprecedented, I think practically means we are going to be able to speed breakthroughs from timelines that would typically take three to five years to timelines that can take less than a couple of years. The other important element when we think about AI and its impact on drug development is not just the potential of what could be from that conceptual frame, but where are we today? I think it's really exciting. Today, I would say we're in the early innings of being able to discover novel targets. And I would say that we have not yet in a systematic”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“By what we can retain in our human minds and constrained by our ability to use our human hands to go run those experiments. There are super talented, incredibly smart people that can retain a volumes and volumes of scientific papers can't retain all of them. AI can. And if humans are running experiments, not AI driven robotics, there's just a certain throughput that is going to be limited by human hands that would be unlimited if you had an agentic robotically driven system. At the simplest level, AI coming into the discovery of medicines is one of the biggest unlocks that we will see in the history of medicine because it means that we're no longer constrained by our minds. We're no longer constrained by our hands. We can generate not just a few hypotheses for what the answer can be from the total sample set of knowledge that exists.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Absolutely. So I think what you're basically describing on the AI side is our quest to try to get to a level of scientific superintelligence. You can imagine that from an AI perspective, if scientists are armed with an ajentic infrastructure that has a scientific intelligence that's like at an Einstein level or multiple of Einstein level, the force multiplication that can occur between a superstar scientist armed with that agentic resource means that they will do science faster and with higher probability for lower cost and have greater impact. So that's an important conceptual framing. And so then practically how does that manifest and why does it matter? Well, you can imagine that any human scientists on their own tinkering in the way that I just described, scientific method and that wheel of science spinning and spinning and spinning, us as human scientists are always going to be”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Then go and actually test that in a person for the first time. And so this is incredible. And that process that I just described, you can imagine most of them fail. But for the ones that do succeed and get the chance to then go into toxicity studies and then ultimately into humans, those are the ones that get really excited, but they take years and years of iterating and looping to go from that beginning idea through the literature ultimately to the animal study that makes you believe you've actually cracked that code. And then Of course, from there, this is so much of a marathon than a sprint because you've spent years trying to crack the code. And now that you have, guess what? Now you've got another five to seven years worth of clinical studies you have to do to prove that in people, the idea you had for medicine actually has the effect that it's intended to and that prior our discussion earlier, that benefit to risk equation is favorable to the point the regulator's”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“The point where the totality of the data and the evidence that you've collected from a hypothesis perspective to cell-based experiments to the animal-based experiments, you put that all together in a beautiful package that you present to regulators and you say, I think I've cracked the code. I think I can move us forward against disease A, B, or C. And here's the hypothesis that we had. Here's how we tested it. Here's all of the data we've generated that helps me, the scientific team, to believe that we might have cracked this code. And now we would like your approval to go start and agree on what studies should look like to test how toxic or how dangerous this breakthrough could be for somebody. And if we can show that there's good margin between really high doses and where that toxicity starts to come in and the doses that we've proven from our experiments are likely to help somebody live a longer, better healthier life, we want your permission.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Out from that experiment will either confirm your hypothesis and you move forward or it will reject your hypothesis and then you go back through and you loop to your next hypothesis and your next set of experiments and you continue to loop and loop and loop. So a scientific method generally looks like is hypothesis, experimental design, execution of that experimental design, review of the data that comes from that experiment reading out, test that data result versus your original hypothesis, either confirm the hypothesis or reloop and reloop and reloop and reloop. And so there's this iterative process that tends to begin its journey from the literature very quickly move into what we call in vitro experiments or experiments that are done in petri dishes. And as we start to develop evidence and support for a hypothesis in cell-based experiments, it tends to move on to small animals and then larger animals. And then it gets.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“That's a deep literature view. And so, you know, fortunately, there are tons of papers that exist on successes or tiny steps to successes that exist and are available for anybody. The unfortunate part of the literature is that what's often missing is all the failures, which would be even more informative than the successes. So generally speaking, when a scientist wants to go solve that problem, they're either going to observe a population, they're going to start reading a ton of research. They're going to probably put both of those insights together and use that foundation to form their first hypothesis for what could be the solution to the problem. So from having a hypothesis, then the amazing scientists can then go figure out what experiments do I need to run to test that hypothesis and even more, what's my prediction for what should happen in those experiments? And those are really important steps because the design of the experiment and the quality of the data that comes.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“History of humanity called the scientific method, which is the systematic way by which a scientist moves from focusing on a problem they want to solve to actually solving it. And there's a couple of discrete steps in that scientific method and tremendous amount of iteration that leads to cracking that code. Once you've identified the problem that you want to solve, the first step to solving that is come up with a hypothesis for what could be driving that disease. And the way scientists tend to do that is everything from like the PCSK9 example where scientists are observing nature. Where are there populations of people that have an advantage? Okay, let's go figure that out. That's cool. Let's go understand it. All the way through to like combing through thousands and thousands of pages of the literature to understand what people have tried to crack a code that still exists today that you want to go crack.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Of all, what are the two key ingredients for discovery to happen? You need scientific instinct married with tremendous amounts of capital. And I think you need both of those to converge in order for there to be a breakthrough that allows us to live healthier and longer lives. Let's break those into their pieces. The science of medicine and the business of medicine, because I think they're both independently interesting. Oftentimes what ends up happening to discover a medicine is a scientist for whatever reason in their journey gets inspired to spend their lives trying to crack the code in a certain disease. What tends to happen is you've identified a problem that you want to solve, just like in any consumer or tech proletariat. What's the problem we're trying to solve? You then have to go through a tremendous amount of research to understand every single thing you can about that problem. And most importantly, what can be driving it? What's developed over time is a method probably one of the most important methods in the”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“For how we deal with whatever information comes from taking that test. So for me personally, I'm not yet pursuing those. I'm very much focused on areas where if we're going to go and do a test, it's going to have a high probability of capturing what I'm testing for and a low probability of giving me a false reading. And I think the more information that we can accumulate with really high fidelity, the better we'll be at being proactive about our health.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Me, more data is worth it so long as you could put in the right context. When we get the result of a colorectal cancer test screening test, we know the context for that and we actually know whether we have something that's useful or not. The pictures that we can get from groups like Prunovo and others are powerful because we can see progression over time and we can use that data, particularly as AI is going to increasingly become our medical home. arming our AI system with that information will be super helpful. The thing that I worry about though is as you measure more and more different dimensions with each of them having a material false positive rate, the odds that you come out of that experience with a false positive that can be disruptive in life becomes material. It's not to discourage anybody from doing these. It's just to make sure that any data that we're collecting, make sure we put it into the right context set so that we can have a framework.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Plus of patience and to keep them at bay for really long periods of time. While we haven't yet cured cancer, to me, I think the slope of the line is really exciting, both from the testing angle and the earlier we can identify these cancers and from the increasing range of modalities and options that we have to go after and destroy them.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Connect not just cancer but the type of cancer to the best medicine that we have today to go treat it, but the medicines are getting better and better while cancer medicines began, as many medicines do with just pills and injectable biologics, today we have an entirely new class of medicines that are these CAR T cells that are either cells that we take out of a patient's body and arm them with the ability to go attack the cancer directly or companies like Capstan just came up with the next gen version of that where they can inject on an IV basis that can attack the cancer cells directly without having even take cells out of a patient's body and have that happen within the patient's own body. And what we're seeing from these medicines is dramatic efficacy. So we're seeing that they have the potential to reduce tumors by 100% and to do that in 70%.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“To help them to move faster and faster and to be better and better, I think we're going to wake up within the next five years with really awesome multi-cancer early detection tests. And when we have them, then shame on us if we're not getting them and shame on us if we're not acting on the learnings that come from them. This will be obvious, but the earlier we know that we have a cancer, the greater the range of options are for us to go do something about it. And I think we're finding that across lots of different cancers, there's opportunities to have amazing results. Sadly, my brother-in-law's father passed from multiple myeloma maybe almost a decade ago. If he had been diagnosed today with multi myeloma, his outcome, his prognosis is dramatically different because not only is our ability to test and identify that people are developing cancers getting better, not only do we have other types of tests that we can look at, what are the mutational drivers of that cancer that help to”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Other industry around multi cancer early detection that's evolving right now and unfolding right before our eyes. These are companies moving from not just having single cancer tests, but having multi-cancer tests across large numbers of tumor types that can be really dangerous. When you think about how I described the offensive and defensive side of the health stack, the defensive medicines that we can take to keep us maximally protected, what's not in there is anything to protect us directly from cancer. But that's because I tried to attack cancer from the screening perspective and made that part of offense. Over time, I think at a minimum, people should be doing a colonoscopy. I think that the next best in class version of that is colonoscopy married with either a blood test or a stool-based test with some regular periodicity to it. And I think over the next three to five years, particularly with how AI and the evolution of these tests are really converging.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Doctors care. People care. They're getting it done. And that means we're going to be safer and safer from these. But I think it's important for people to realize that not all tests are created equally. When I look at a new diagnostic in the space, I care deeply about two metrics. One is the sensitivity and the other is specificity. One of them tells us of all the people that could have cancer what percentage of those samples are we actually getting back that is an accurate diagnosis of cancer so if there are 100 cancers in a sample what percentage of them actually get picked up as cancer that's the sensitivity and then the specificity is if there's a hundred samples that don't have cancer what percentage of those give us a false positive saying that you have cancer and when you don't i think both of those are really important metrics and at the same time i think that there's a whole”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Being at risk of cancer, same thing for garden health. Garden health took it to the next step in terms of knowing that you can go after markers that would predict colorectal cancer, but recognizing that the commercial model around being able to get people to not just receive the prescription for a stool-based test, but the complexity of people being able to complete the test and get that sample back was one that just could never have the scale as a simple blood test. And so Gardner learned from exact science's advancement and then came up with a next-gen version as a simple blood test that you can get done just about anywhere. And it's amazing to see that not only are both of those markets continuing to grow, but the blood test is inflecting, that to me is exciting because it means that, again,”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Modalities and then come back to the medicines that are associated with that. In terms of identifying cancer early, there are companies like Exact Sciences and Garden Health that have gone really hard at breakthrough innovations to help us screen for colorectal cancer. Now, of course, we have the gold standard that's available, which is a colonoscopy. And I have to go get one next year. But none of us are ever looking forward to that because it's something people don't look forward to, even though everybody should be getting them and with regular periodicity. Most people don't. And I think that's really tragic because by not getting your colonoscopy, you're putting yourself at risk for colon cancer, which is an incredibly slow-growing cancer. If you just got the colonoscopy, I think we could very much live in a world today with very low incidence of colorectal cancer. Garden health and exact sciences went directly at this problem. Exact sciences has a stool-based test that has incredible ability to predict people.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“The cancer has a survival instinct and it redirects. And now what medicine that was working incredibly well that had shrunk a tumor completely to zero is having no effect. Because while that medicine eliminated the cells that were most vulnerable to the medicine, guess what? The cells that were left behind, even if it's just a few, now had the advantage in growing rapidly and causing a new set of harm and setting a patient on a horrific direction. And so it's hard because we tend to identify cancer too late. And then when we do, it's shifty. Now there's also the opportunity for optimism around it. And I think it gets the topic you and I have spent some time talking about, which is testing. The areas of testing today that I find most exciting are across being proactive and early identification of the risk. And then once a cancer emerges, what do we do about it? And so talking maybe across both of those.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“We are successful in mobilizing people around a health stack and we can move from reactively treating a disease to helping people be as proactive about their health as possible. I think the unintended consequence of that is people live longer. Eventually something's going to get us. The incidence of cancer being the issue that brings us down, the disease that brings us down could rise. I think the unfortunate reality is that cancer is hard both because we often identify it too late. And then when we do, cancer is like a sneaky devil.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“We might be able to wake up in a world where we live without this disease. We know that that's possible at GLP1s for diabetes and obesity. If you take them early enough, you will not become diabetic. You will not become obesity. We know that's possible for cardiovascular disease. If you start taking a PCSK9 inhibitor earlier in your life, which by the way, I think the risk reward is actually even more favorable than statins in terms of human health, but we know that you won't progress to cardiovascular disease. The same is true for Alzheimer's.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Have versus declining much more rapidly, it turns out that if we can identify a patient that's at risk for Alzheimer's disease earlier and earlier and earlier, if we do a test available to do that, well, then it makes perfect sense that if we can start giving people these medicines as early as possible, not only will you be there in the early stages before a lot of damage is done, but you can think about it as turning off the faucet. So as these new amyloid plaques are produced, you can be attacking them with a medicine that helps to accelerate their clearance. And oh my goodness, maybe that has a dramatic effect on long-term decline. Maybe it reduces those rates by 40, 50, or more percents over a longer period of time, which means the earlier we can get them and the better those medicines are at interacting with those plaques. And the easier it is for those people to stay on those medicines.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“Been a wasteland for decades. I think we finally cracked the beginning of the code, but not the full answer. What we found today is in patients that have confirmed levels of plaques that have developed over decades in their brains. We now have medicines that people can take that will start to break up those plaques and remove them. Unfortunately, and this will be intuitive, if you get to the patient that late in the disease, a lot of damage to the brain has already happened because you can imagine like these plaques are building. They have to go somewhere. They're causing death and destruction of the tissue around them. Today, we've got some amazing medicines that are both biogen and Eli Lilly that if you are late in the disease progression of Alzheimer's, you can start to slow the decline. And we can slow that decline by about 30%. And so intuitively, that just gives us a lot more years at the baseline level of cognition that we have.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“About bad cholesterol, this is to me the most dangerous setup because you don't feel anything if you have a high level of bad cholesterol. You could think of it as this silent killer that's just working in the background, slowly accumulating in our bodies. You can be doing everything right and being at your peak physical shape and then all of a sudden out of nowhere you can have a heart attack or a stroke because if we don't pay attention to the levels of this bad cholesterol in our body, they can sneak up on us and claim our lives. And so to me, because the reward is so asymmetrically favorable versus the risk, because the earlier we can intervene with the accumulation of cholesterol in our body and keep that at bay, the greater the likelihood is that we're going to get through the rest of our lives, even if other things manifest, like diabetes or high inflammation or our blood pressure goes up, we're going to be able to be right at the core of the problem and keep.”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source
“That would be a dream for me, a big dream for me is that everybody anywhere who wants to have the maximum level of cardio protection could get access to this medicine and could stay on it because it is more asymmetric. It is more in the degree of that free lunch. I would argue that if you just project down the road longer term, this medicine should be far bigger in terms of the number of people that are on it and the revenues that are associated with it than GLP ones. That's not what's playing out right now. And it's not playing out right now really for two reasons. One, GLP1s have this amazing attribute to them that you take them and very quickly, you start to have some side effects. So you know you're on them and you start to see the benefits when you compare the two, it's easier for medicines where there's an acute, clear, easily measurable benefit for people to stay on them. Unfortunately, in the setting of cardiovascular disease and particularly thinking”
2026-04-21 · Invest Like the Best · Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468] · IDENTIFIED FROM THE TRANSCRIPT · source