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Alex Karnal

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2026-04-21
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2026-04-21
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  1. “And it turns out that LDL is produced in lots of different places in our bodies. It turns out that you can basically pin that PCSK9 bad protein down to zero. The best we can do in terms of reduction of our LDL from really not even in humans, but in animal models is something in the 80 to 90 percent zone. And because we have people that are walking around with mutations where they don't produce any PCSK9 and they live incredibly long, healthy lives and don't have the vicious fate of having a heart attack or stroke. I think we've got the combination of animal model evidence that suggests we really can't get LDL to zero combined with the fact that we've got genetically advantaged people walking around that aren't even producing the protein to the same degree as others, that this one is very much a free lunch.”

    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

  2. “Not only will they protect us from developing diabetes, obesity, and cardiovascular disease, when you look at the implication of those diseases on expected human lifespan, we're talking about the aggregate of those diseases costing us five to 10 years. It's very much well worth it for people to take the risk of developing these other sub-liabilities that you can do something about by just stopping the medicine for the benefit. There is a real trade-off. Without a doubt, it is not a free lunch for GLP1s. But for PCSK9, it's pretty much a free lunch. There was a ton of concern in the early days. What happens if your LDL goes down to zero?”

    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

  3. “I think PCSK9s are very much more that free lunch than GLP ones. GLP1s have real toxicity associated with them. We see in the clinical studies significant rates of nausea, vomiting, and diarrhea are the first symptoms that emerge that cause a lot of people to quit these medicines early. And if you look past that and you look at the people that have been on these medicines for longer and longer periods of time, you look at the labels of these medicines and the clinical studies, there's risk of the development of gall zones and pancreatitis. And of course, these are issues that would emerge just from having weight loss in general, which adds that list muscle decline as well. These are all consequences of losing weight and losing weight quickly over a period of time. But when you look at the other”

    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

  4. “Exactly. How do we get that advantage into the hands of people? And so they came up with injectable biologic medicines at first that you can inject and would go and find their way in your body to that PCSK9 protein and bind to it and make it so that protein couldn't bind to your LDL receptor. And that was the beginnings of those medicines. But what innovators then sought to do next was how do we make it easier for people to take those medicines and get the benefit? And so the next big innovation in that space was moving from injectable biologics or monoclonal antibodies to what's a new modality called RNA interference. And what these are is another form of subcutaneously injected medicine that makes its way down into your liver. And it had the attributes of these being very long duration molecules and made it so that we didn't have to inject ourselves 26 times a year, but maybe only twice.”

    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

  5. “Is that the production of this PCSK9 protein interferes with our body's own ability to clear LDL cholesterol? And so what happens is the more PCSK9 we're producing, the fewer particles of LDL that we can clear, the higher our cholesterol grows over time, the more those little particles are invading our vasculature and starting to mount up until we get to a point where there's a blockage. Recognizing the import of that PCSK9 protein driven from the observation of human genetics and from data that showed in these populations of people with longitudinal studies over 15 years, the fact that they were genetically deficient in the production of the PCSK9 protein led to them having an 88% reduction in the risk of ever developing cardiovascular disease. That was miraculous. And so what the pharmaceutical industry So I had to do was how can we”

    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

  6. “And so these are incredible medicines, particularly because heart disease is still the number one killer in the US today. These medicines are profound because they hit right at the heart of the biological driver of high cholesterol. The way these medicines were discovered is from human genetics, what we can do from a human genetic perspective is go around the world and look at different populations of people and study what are some of the attributes and some of the advantages of different populations. It turns out that there's a population of people that have a genetic mutation that conveys a massive advantage. They have a mutation in their PCSK9 gene, which means they don't produce the PCSK9 protein. Now, what we've learned from both observing that village and understanding the cardio protective nature of that genetic defect, what we learned”

    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

  7. “The headline here is PCSK9 medicines are amazing because what they do is they today can lower our bad cholesterol, that LDL cholesterol, by 50%. And we now have outcome studies in patients at different degrees of having high cholesterol, having significant protection from ever-developing and having a heart attack or a stroke. And so in patients that have previously had a heart attack or stroke, we can reduce that risk by over 20% in the future. And for people that are at high risk of having a heart attack or a stroke, the medicines that are approved and on the market today can lower that risk by about 25%.”

    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

  8. “Move from where we are today, which is waiting until there's a problem, waiting until it's almost too late, and reactively treating it, to proactively getting out ahead of disease. The final part of that is compliance. And we alluded to that a little bit, but the reality of it is we all know that medicine only works if we take it. And it turns out that because of the complexity of the system and getting it, because of how expensive these things are, and at the end of the day, because we're all human, the more frequently we have to take a medicine, the harder it is to go get it, the more times we have to go to the pharmacy, the more times we have to make that decision over the course of the year, the higher the probability we're just going to quit. And that's just human nature, myself included. Your compliance is like this invisible barrier to all of us realizing our best health outcome. On one hand, wow, I mean, GLP1 Medicines is an example. It's miraculous. We went from twice a day to once a week.”

    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

  9. “But it takes me an incredible journey, hundreds of phone calls, multiple doctor visits, being pricked and prodded multiple times just to protect myself from having a heart attack. That doesn't make sense. I think we have to balance the opportunity for health impact of this amazing medicine that we have with just the reality of how darn complicated it is to navigate through our system. Next is cost. Most medicines that we need to be on for the rest of our lives that are going to be providing the chronic care, the different layers of that defensive health stack that will protect us from these diseases, those medicines today are priced as similarly to acute treatments, yet they need to be taken over decades. So we have a timeline problem. We have a horizon problem. And I think that there's a lot of innovation that can occur around pricing models. If the world is”

    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

  10. “Only six weeks out, and then I go. And of course, I want to redo the blood test, the friction in our system mounts and mounts and mounts. And eventually, I think a lot of people just give up. It is really hard to navigate that system. Given what we're seeing with GLP wanted medicines and what we're seeing, that the direct-to-consumer side of that is driving most of the adoption today. I think we have to start asking ourselves, why is it that I can go on my iPhone? I can go to Amazon, I click.”

    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

  11. “The other aspect to it is we want to start chipping away, what are the layers that exist in between that could prevent people from actually getting the benefit of JLP1s. When I think about that continuum, and I think about that gap, there are basically three different dimensions that are preventing people from getting maximal benefit of a breakthrough medicine that exists and is right here for all of us. Those break up into, in my mind, complexity, cost, and convenience. I started on my journey like two years ago and to practically have to deal with our health system, all of the different branches that it took from recognizing that I had a cholesterol problem to two years later finally getting access to the medicine that could help protect me from that problem. It's everything from you want to go see a doctor because you get a blood test that says, hey, I got a problem to learning that, well, the next appointment.”

    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

  12. “Food in terms of the addiction data that'll start coming out over the next year or so, you would lose that benefit. You would lose the free gift of protecting yourself from being addicted to drugs, alcohol, or gambling. There's an open question on what just consuming food would do for cardiovascular outcomes. We've got compelling data right now at a Nova Nordisk over the last year that basically shows that by taking GLP1 medicines There is a north of 20% reduction in our risk of having a heart attack or a stroke. And what I thought was pretty profound about the full data that they put out is that that was independent of weight loss. That speaks to me that there's just another axis and another biological driver that's driving this cardio protective result. We might forfeit that. But without a doubt, if we could actually get access to great food and we can eat the right amount of it and stay distant.”

    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

  13. “You wouldn't really need these medicines for the purposes of managing our weight. But I think that's only going to cut at the weight part of it. I think, unfortunately, if your biology is wired such that you have a family history of diabetes and you are pre-diabetic and on the precipice of turning diabetic, we're starting to be in a place where we're just not producing the insulin that's required to be able to take up that glucose that's coming from the food that we're eating. So yes by consuming fewer calories and less food, we can hit part of that. I think it's unknown as to whether that'll be enough to be able to undo your progression to diabetes. And so I might say you probably still need those medicines for that. I think on the other side of the equation, connected to that has to do with addiction. In some sense, you could say that food is a form of addiction while consuming fewer calories will help protect us from the vicious cycle of over.”

    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

  14. “Eating is definitely a part of it, and it's a major part of it. So look, if we could all be disciplined and we could all get on a proper diet where we're selecting the right foods, eating the right amounts of them, and staying disciplined.”

    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

  15. “Being able to take a medicine, even at low doses, even though they haven't been tested in those populations, I'm willing to bet would help protect people from that five-point increase that puts them in harm's way and puts that to bed. But when we look at the market today, pretty much from that BMI of 25 to 39, they are well served with any of the available options on the market. I think where we still need some help, and I think where there's a right to win is really in that BMI zone of 40 and above. Sadly, these people are at a level of body weight that requires incredibly long titration to get up to these high levels of the hormone. And they need to have much more dramatic reduction in their food noise to be able to bring their weights down from a zone that is incredibly dangerous, just given the amounts of visceral fat that they're carrying around down to levels they're going to give them much more sustainable life.”

    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

  16. “Medicine is going to really have a differential impact for people such that people should choose it. The right to win analysis comes down to also the different segments of the market that we're thinking about and to put a framework around this. We always think about the obesity market as having three main segments, people that are overweight, which are basically BMIs between normal, roughly 25 and 30 obese, which is between 30 and 40 and morbidly obese, which is north of 40. When we look at the aperture from BMI of 25 up to a BMI of just under 40, that's where most of the patients are today that require reactive treatment. I would argue in the future, we could talk about why GLP1s might be appropriate for just about everyone. And that's because the reality of it is, as you go from your adolescence to your 50s and 60s, on average, people are going to pick up about five BMI points.”

    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

  17. “Not just the duration of the dosing, or else we take every day. Today, The duration of time between those doses is really important because the easier it is to take a medicine, the more likely it will be to stay on these medicines and have the longest term benefit from them. The next important access to then focus in on is how do we think about dose and the tradeoffs between semaglutide and terzepatide, semaglutide being ozempic and wigovy, terzepatide being zepound and manjaro, our team's fundamental perspective is that they all achieve the same goals. They were just novel IP strategies to achieve those same goals. They're all pretty much interchangeable. That leads to the question of how do we think about them from an investment perspective and a human impact perspective. Both of those perspectives come together because when we think about investing in medicine, the key question that we're focused on is why does a medicine have a right to win? And of course, for medicine to have a right to win, what we're essentially saying is that this”

    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

  18. “Bit of a virtuous cycle in terms of lowering her blood pressure. So when you look across the five axes, the five layers of defense that are mission critical for us maximizing the number of years that we can live and having the most life in those years, I fundamentally believe there's no molecule that's more important than GLP1 across that entire axis. When we think about the different forms that it's available to us in, we're already cracked the most important code, which was moving from something impractical 30 shots an hour to the early days with amlin pharmaceuticals of a twice-a-day shot to where we are today, which is not just longer acting once a week versions, but far more potent, meaning we need far less of it. And it actually starts to get to levels that we can inject that have incredible pharmaceutical properties to them. The next access to think about is not just the form by which you get it, oral or injectable.”

    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

  19. “In addition to that, it does an important role in regulating the production of our insulin. It interacts with receptors on our pancreas that triggers the release of insulin. It plays a big role in not just having that sugar not affect our vasculature, but also making sure that that sugar is not destroying our kidneys. The mechanism and the science behind it is actually pretty well elucidated. Biologically, we know how it's produced. We understand all the different places in the body that it interacts. And when you think about all the places in the body that it interacts, it then becomes no surprise that it's had such an incredible range of effects, both from protecting us from becoming diabetic to reducing the risk of having heart attacks and strokes, to lowering our level of inflammation because we're consuming less food. And so we're having less of an inflammatory response to that, all the way through to helping us to lose weight, which is a”

    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

  20. “Transformation. So, what's good about that is it is a hormone that's already in our bodies and it's a medicine that we've got data on for over 20 years. And so we know a remarkable amount about it, not just because it's been around for 20 years, but it's now been in millions and millions of people. What happens is when we eat food, at some point that food makes its way to our small intestine. And when food gets to our small intestine, it's what triggers the release of JLP1 in our bodies naturally. That GLP1 molecule travels all over our bodies. It interacts with receptors in our stomachs that helps to slow the digestion of food. It also interacts with receptors in our brains that help us to feel fuller, longer, to feel satiated. The combination of those two mechanisms of action are what allow us to turn off the food noise, that allow us to seek out and consume far fewer calories than we've ever done.”

    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

  21. “A lot of people don't realize these medicines have actually been around for 20 years. Some of my first exposure to GLP1 as a drug class actually happened in my early days entering the industry as a young biotech investor back in 2005 with Amlin Pharmaceuticals having what we thought at the time was the most miraculous breakthrough. GLP1 is a hormone that our bodies naturally produce. The problem with this naturally produced hormone is that once it's produced by our bodies, it only lasts for about two minutes before it's gone. So if you just pause there, what does that mean practically? Okay, if you were to take human GLP1 and we would be injecting it, we'd have to inject ourselves 30 times an hour for the rest of our lives to get the benefit of what we can today with either one pill a day or one injection a week. The science behind moving from protein that lasts for two minutes to a protein that can last over a week is a dramatic.”

    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

  22. “And the most logical conclusion is that people are ready and people do want to go and be proactive and arming them with the stack that can help us to all live an extra decade, really focusing on hard on what does it take to close that gap between invention and impact. When I say this trillion dollar revolution, what that means really is this trillion dollar reduction in our annual health care spend. And I think that that's really possible now.”

    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

  23. “4x relative launch cycle for the Oral Wagovi versus the most recent injectable launch Z bound, people that want these medicines, then the lowest end of the curve, that doesn't cost 500 a month. It doesn't cost 250 a month. It costs 150 a month. And so now we've seen that the lower end of the curve, if we get to an $1,800 a year cost, these medicines fly off the shelves. And to put that in context prior to the launch of the Oral Wagovi, just a few months ago, the GLP1 market was moving at about 200,000 recorded new scripts per week, 200,000 new people getting on these medicines per week. The most recent data that I looked at this past Friday says that that has now moved from 200,000 a week to 300,000 a week in just a few months' time. We have to take these incredible learnings from the commercialization of GLP.”

    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

  24. “Gone through any clinical trials, you know nothing about the manufacturing, but you know that these medicines are so important to your health that you're willing to take the risk, not only the safety risks of the medicine, but all these risks of these unknowns of where this is even coming from. And because you can afford it, go take it. And so I left 2025 thinking to myself, oh my goodness, we're finally starting to see people step up and vote for the thief. They said, I want the benefits of these medicines. And now you get to 2026, and this is the absolute game changer. In 2026, we now have an oral version of Agovi. And this medicine has launched over the last couple months. We are seeing every week the oral version of Ugovei is setting record after record after record. And you might think, yeah, of course, like who wants to inject themselves once a week for the rest of their life? I don't really think that's what's driving an almost.”

    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

  25. “Was north of four or five hundred dollars thanks to our administration, those prices are coming down, and I think that's really good. And it's particularly good because what we learned from the compounded versions of GLP1s was that there is massive price elasticity in this market. Compounded GLP1s cost about half as much per month as the traditional approved GLP ones by Lillianovo. We were collecting data that was suggesting to us somewhere between 15 to 20% of the market that you couldn't capture through scripts was actually flowing through groups like Hims and Hers and other sources where people knew they wanted the benefits and wanted to be proactive about their health. They wanted to get these GLP ones, but they couldn't possibly afford $400 or $500 a month, but they could afford $200, $250 a month. And so to me, that's profound because you've got a compounded version that has”

    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

  26. “Joining are coming in directly. So hold that with the third point that comes from 2025, which was all sorts of theater and dramatics around compounded GLP ones. What we learn from the compounded GLP ones was that not only do people want something that's going to defend them and be tolerable, not only do they want something that they can get through all the frictions of the system and just hit a button and have it come to their homes, a real consumer-like product. But price matters a ton. Through most of 2025, the average month”

    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

  27. “Their medicines pitching the attributes and why they're the best in class and why there's no other option that their patient should be pursuing than their medicine. And as you can imagine, that's a very capital intensive exercise. It's a very human talent intensive exercise. And what we saw, interestingly, is that Eli Lilly, pretty early on last year, pushed more aggressively into a non-traditional way to get these medicines into the hands of people. They added to their legions of salespeople a digital front end in Lily Direct that allowed people to get a prescription from their doctor and go get the medicine direct from you like Lily. It was one of the first big insights that the consumers want to be able to get these medicines themselves and not have to go through traditional means to get them is you fast forward towards the end of 25, what we started to see was that, oh my goodness, more than half of the new 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

  28. “People really want is something that's going to give them a health advantage, but it's going to be incredibly tolerable. And what we find is that you go higher and higher in doses, the unintended consequence of that is, yeah, you're going to have more weight loss. There's going to be a whole host of other side effects that come with it. That is different than in most medicines where we're trying to maximize the efficacy of the medicine, really where Wall Street mind typically tends to go. What people are maximizing for here is like, how do I get on these things and then stay on them? So that to me was one of the big unlocks for 2025 was this idea that people want to protect themselves. If you marry that with the next big discovery from 2025, is that typically the way medicines are commercialized is you have big pharmaceutical companies, Eli Lilly, Novrinortis, that have armies of sales reps that are out everywhere calling on doctors, making sure they know about.”

    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

  29. “Maybe one of the things most people don't realize is that there are a couple different injectable GLP ones that are on the market today. And we have some of the first orals that are coming to the market now and more that are coming. These medicines exist at lots of different doses. And I think one of the most interesting discoveries that I made over the past year in just looking at all of the data that we get to consume as investors, I wanted to know the answer to Wall Street is very focused on the next GLP1, having more weight loss and more weight loss and more weight loss. And I'm sitting back and thinking to myself, I don't know if that's the right focal point. One of the most interesting findings from diving into the data is people are not solving for this massive bazooka. People are solving for something that helps them to lose some weight, stabilize, and be there. I think that's really interesting because what that means to me is that what”

    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

  30. “We are living high stress lives, if we're not working out, if we are developing obesity, we have this high glycemic environment. So our vasculature is brittle, our LDL is mounting. And on top of that, the pressure going through that system is going higher and higher as we're aging and doing nothing about it. Oh my God, that's just another force multiplier here. So all of these axes that I define as the five key layers to the defensive side of a health stack, each of them has medicines available to help us control our fate. Each of them has medicines available that if we could get on them early and be proactive about where we're going with our health, they will undoubtedly add an extra decade of life to our expected lifespan and have the potential to take curves that have been dead flat for decades and drive one of the first inflections ever.”

    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

  31. “To being able to have as much access to pop tarts as we want. I love them too. Don't get one, you get two. We overeat to a point where it drives an inflammatory response in our bodies. You can think about that whole equation of if we have both lipids accumulating and our body has a high glycemic environment making our vasculature brittle and the same food that we're eating is driving an inflammatory environment around it. Oh my goodness, it's like a ticking time bomb for all of that to go off. And not only is the inflammatory environment of our body implicated in driving an increase in cardiovascular events, strokes and heart attacks, but also a whole set of inflammatory diseases that span everything from atopic dermatitis to ulcer of carditis and Crohn's disease. Finally, blood pressure, and maybe this one's very intuitive to people, but you can imagine that both if”

    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

  32. “It's a game changer in terms of our long term health. Moving down to neurocognitive health, the data is not out yet, but later on this year, we're going to see the next step for what are called anti-amyloid medicines, medicines that can go right at the heart of the accumulation of plaques, this time not in our vasculature, but in our brains that lead to all sorts of damage and cognitive decline. And we've got medicines today that can go right at those plaques and bust them. And what Lily is going to probably show later on this year, it's my guess, but I think the data really supports it. We'll see. What they're going to show is that getting at those plaques earlier before they accumulate significantly is going to show dramatic effects on protecting us from developing Alzheimer's. Moving on to inflammatory health, one of the things I think people don't appreciate is that the food we eat is actually quite inflammatory. And because we have over time moved from being hunters and gatherers,”

    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

  33. “The more brittle it's making our vasculature, and so if you are both having lipids accumulate in your body and your vasculature is getting more brittle, your only force multiplying the risk that you ultimately have one of those horrific heart attacks or strokes. But we can do something about that. We've got amazing JLP1 medicines that I started with that from clear data at an Eli Lilly show a 94% reduction in your risk of moving from being pre-diabetic to diabetic. We see amazing data in terms of what it does to both help us to lose weight and have category shifts going from obese to overweight, from overweight to normal weight”

    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

  34. “And cardiometabolic health, what we're talking about. Environment in our bodies combined with visceral fat. These are two.”

    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

  35. “And to me, that's tragic because we have the medicines that exist that can help us to dramatically lower that risk to sub 10%.”

    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

  36. “Find most interesting about it is if we think about five core dimensions, not only are they within our hands to be able to be proactive about protecting ourselves,”

    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

  37. “One of the things a lot of people don't appreciate when I meet them and we start talking about where medicine is and what it can do.”

    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

  38. “Protect us from being diabetic after being pre diabetic all the way through lowering our risk of having a heart attack or a stroke.”

    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