Alex Karnal - The Trillion-Dollar Health Revolution

**Patrick O'Shaughnessy** (0:00)
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Hello and welcome everyone. I'm Patrick O'Shaughnessy, and this is Invest Like the Best. This show is an open-ended exploration of markets, ideas, stories, and strategies that will help you better invest both your time and your money. If you enjoy these conversations and want to go deeper, check out Colossus, our quarterly publication with in-depth profiles of the people shaping business and investing. You can find Colossus along with all of our podcasts at colossus.com.

**SPEAKER_2** (2:00)
Patrick O'Shaughnessy is the CEO of PositiveSum. All opinions expressed by Patrick and podcast guests are solely their own opinions and do not reflect the opinion of PositiveSum. This podcast is for informational purposes only and should not be relied upon as a basis for investment decisions. Clients of PositiveSum may maintain positions in the securities discussed in this podcast. To learn more, visit p-s-u-m dot v-c.

**Patrick O'Shaughnessy** (2:27)
My guest today is Alex Karnal. Alex is probably the most talented bio and healthcare investor that I've ever met. As you'll see, he is an encyclopedia of all things going on in life sciences.
Alex has been teaching me this topic for more than five years, and every single one of our conversations is about as deep as this one that you hear today. We cover every single aspect of what makes today's life sciences world so interesting. Starting with this concept of the health stack, the things that we can do both offensive and defensive to extend our life based on the evidence that he sees in the most exciting companies of today. We talk about cardiovascular disease, neurodegenerative disorders, metabolic disorders, cancers and beyond, and finally, we finish with his remarkable personal story. I hope you enjoy this great conversation.
You and I have had these conversations now for many, many years. We've been partners and friends for a long time, and so it's hard to know where to begin the conversation because, I suspect, we'll go for hours talking about drugs and bio and healthcare and outcomes and a million things that affect us all. You have this cockpit-like view into what's going on in the state of medicine today. How would you describe the state of the union, the daily cockpit view that you get of the whole industry? Give us a dispatch from that room. What do you see today?

**Alex Karnal** (3:44)
When I look at this moment in terms of where we are in medicine, and I look back over my 20 years of building and backing biotech companies, I would say that 2025 was probably the single most exciting year in my entire journey. So to unpack that, what we're seeing is GLP-1 medicines are showing us what happens when we get to the root of disease. These medicines have the potential to do everything from protect us from being diabetic, after being pre-diabetic, all the way through lowering our risk of having a heart attack or a stroke, protecting our kidneys, and soon we're going to see the opportunity to protect us from developing addictions to alcohol and drugs. So a profoundly important single medicine. Of course, because these medicines are incredibly powerful and they can do wonders for people's long-term health, what we're seeing is that the adoption of these medicines have exceeded almost everyone's expectations, including my own, which were pretty darn high. I think it's easy now to conclude that this is a class of medicines will easily be in excess of $100 billion a year in revenue. And so what gets me fired up about that is not necessarily this once-in-a-decade $100 billion revenue opportunity that exists within GLP-1s. What gets me fired up is that it's actually the first commercial proof that we are ready for what I think we're going to look back on in time as a once-in-a-lifetime trillion-dollar revolution in all of public health. In order for that to be true, there's going to be layers of attack that are needed to help us live our longest and best lives. I think 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 is that incredible scientists have already cracked the code on most of the medicines we need to protect us from most of the diseases that will claim most of our lives.