Dave Ricks Ceo Of Eli Lilly How A 150 Year Old Company Keeps Winning
read summary →TITLE: Dave Ricks, CEO of Eli Lilly: How a 150 Year Old Company Keeps Winning CHANNEL: inSpired Podcast URL: https://youtu.be/aN-GJTt1y8k DATE:
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I like to win a lot, and I don’t find a lot
of satisfaction in coming in second. Over the
last decade, Dave Ricks led Lilly to become
the most valuable health care company in the
world. Is 100 million patients possible? Today,
we have probably 20 million people in the world
probably going to like 30 this year. We’re just
like scratching the surface on the volume side.
I think we’re seeing growth acceleration with
price cuts. So that that can be a very big number.
Conversations with executives building
tomorrow’s great companies. For investors,
by an investor. I actually like investor
interactions because I think the questions
either teach you what the Street is talking about
that makes no sense, which is frequent. Yeah. Or
like really good questions where you’re like,
you know what? We need to be sharper on that.
Very few companies have stood the test of time
like Eli Lilly. It is the epitome of durable.
Which one of these later stage assets you think
will be the biggest opportunity for Lilly. There’s
a lot of buzz on retatrutide and I think there
should be. I think that could be a very big
drug. I like eloralintide, you get almost 20%
weight loss and almost no GI side effects. That
could be a big product. Yeah. Yeah. So, you know,
offer choice basically and if it says Lilly on it,
we’re good. I’m Mike Rockefeller, Co-Chief
Investment Officer of Woodline Partners,
and this is inSpired.
\
It’s great to be
here. It’s your 150 year anniversary. That is just
remarkable. Eli Lilly is definitely the epitome of
durable. Yeah. As we think about it, what do you
think it is about Lilly? How has the company been
able to not just survive, but thrive for this
many years? Yeah, it’s a good and important
question, actually.
\
And I think, of course, there’s no straight
line. You know, maybe like investing, you know,
but if there’s a couple through-points that have
been pretty constant. And then I think the other
thing is the adaptability. But then what are those
through-points? I think we’ve always had a very
strong scientific orientation.
\
The company was founded on that idea.
Colonel Eli Lilly was, he was purpose driven
and he saw in the Civil War, he was a colonel
there, you know how most medicines were, like,
made up. You know, like there was no evidence.
There was no quality. So he wanted to fix those
problems and be based on science. His first hire
was a chemist. Like, not in the small c, but like
a real trained chemist to make medicines that
actually do what they say. And that’s, I think a,
that’s a through-line for us. We’ve invested in
science probably more than most cumulatively over
the years and that’s not going to change going
forward. I think the second thing is like the\
type of employer we are like, I think we tend to
keep people a long time and in a business with
pretty long cycles, I think that’s an undervalued
trait. To actually see a full, you know,
cycle of a medicine, see failure and learn from it
and iterate and improve. That’s the core, I think,
to success. Most things don’t work the first
time and if you’re just chasing the next wave,
I don’t think you actually really understand how
the business works. And then I think, you know,
leadership and long-term focus kind of go
together. We’92ve only had I think I’m the
12th CEO in the history of the company.
\
That’s one less than popes in that period of
time. And that gives a lot of continuity. And
it allows the company, I think, to think longer
term, which is critical in our sector, because,
you know, if you’re chasing trends or worried
about financial management as a primary outcome,
you’re kind of missing the point.
\
It’s an innovation business and sometimes you have
to weather out storms. We’ve certainly done that.
And like now things are going great, you’ve got
to have the humility to say that’s not going to
last forever. We’ll be a little bit paranoid
and think about the next decade. So those have
been consistent.
\
But then, you know, adapting to the times,
the science, to the methods, technologies,
like that’s important. And when we’ve been at
our best, we’ve done that well. And when we’ve
been down, we haven’t done that well. So yeah, I
think about those things. And you’re coming up on
your ten-year anniversary of CEO. Ten-year, yeah.
It’s been a great run. Yes. It’s been exciting. A
lot has changed. I was thinking about it the other
day because it was like July of ‘9116 I was named
in the job. And where was the company? And like,
where was the world that was like before the, you
know, the first Trump administration, you know,
like a lot of things were different. Yeah. But
you know, the, company was in stable shape. We had
gone through a pretty rough time before I was on
the lead team during that with our patent expiries
and sort of dug deep and kind of refound our soul,
which was like organic R&D. And I think what
we’ve tried to do during my tenure is like, take
like good and go to great, you know, and that’s
about tuning up the science engine, being super
competitive with people, projects, thinking about
being at the edge of things versus a laggard,
speeding up R&D. Like, that’s a kind of an old
story for us now, but it’s still pretty sticky
and true. We can run the drill faster than any
scaled competitor and faster than most biotechs.\
China is a new vector we can talk about. They’re
quite fast, so that’s giving us more motivation
to go quickly. You know, turning like the teamwork
and like common good feeling in the company into
like competitive edge. That’s something I try to
focus on. And then, you know, external innovation
has been a theme as well. Like going outside,
making smart bets and allocating capital a little
more aggressively. Where are you now in terms of
R&D timelines versus industry? I think in 2013 or
‘9114 we started a project, so it pre-dated my
time, this is when John was CEO, to cut the time
in half and at the time we were like 11 years in
clinic. That’s from IND to FDA approval on average
and the industry was like ten. The industry’s come
down to like eight, eight or nine and we’re
six and change. So we haven’t quite halved it,
but pretty substantial step up. And we do look
at like, is that stable across TAs, did you just
shift to faster moving things. Like if you just do
virology you can go faster. And the answer is no.
Actually we materially sped up our cardiometabolic
stuff, our oncology stuff as well. And I think
those have made the biggest differences. So you’re
now the largest health care company in the world.
And as we both know, a lot of that value is
in your incretin and obesity portfolio. Yeah.
There are a billion people in the world, globally
with obesity. I read a report recently that said
that there would be 4 billion people by 2035,
which is just a staggering number. Probably
doesn’t include Lilly obesity medicines. Right.
Right. That’s the placebo arm. Yeah. So. Exactly.
But just help us think about this from an investor
lens. How many patients realistically could be on
a Lilly product for obesity.
\
Yeah. That’s I mean it’s obviously a question
we don’t know the answer to. But you know,
we have some clues and I think some framing around
that. So first you know on the billion number it’s
likely to grow. I agree with that. I think what
drives overweight and obesity, its abundance of
food, and that’s a wealth effect.
\
But it is objectively true there’s a lot less
starvation in the world than in the past,
and there’s a lot more wealth even over the last
50 years. Both of those things have changed very
dramatically, and unfortunately, we evolved as
organisms. Our evolution is much slower than the
speed of the world and we evolved in a world of
scarcity. We don’t really have that many defenses
against abundant food to kind of keep us in
homeostasis. One of them is, you know, incretins
and GLP-1s. So that’s what we’ve harnessed,
and that’s why these have turned out to be,
I think, such good medicines. I think that the
tailwinds here are, you know, the technology
itself. So like our oral medicine, the ability to
produce at scale, safety data at scale. Of course,
price points is important. If we had a billion
people times the current prices in the US that
doesn’t really work for the world. So they’ll come
down. We should expect that. But penetration will,
I think, far exceed the price points. And then,
you know, the medicines will get better and more
customized to different things, whether it be
convenience things like oral or monthly, people
like to talk about that. Or what your weight is
to begin with and your probability of getting to a
healthy body weight or maybe indications, because
although there’s a big opening aperture on sort
of this preventative self-care kind of thing, and
we should come back to that because I think this
is really the first use case that’s really kind
of shown that. I think there are other use cases,
by the way. But, you know, a lot of people get to
medicine through the normal health care system,
which is like, I have a symptom and I see a
doctor, and then I am prescribed a medicine
to address that - and of course, incretins do
that too. And that list will expand to, you know,
inflammatory conditions, mental health. Other
things that will grow it. So I think, you know,
we should think of it approximating on the
one hand maybe some big consumer markets,
on another, maybe the biggest medicine
market. Look at those together and say,
okay, are they, is that close? One important
note which I always run into with investors is:
generalist investors always are like, well, what’s
the persistence? As if we’re going to get like the
billion people forever.
\
That’s not a reality, right? I think people
use medicine episodically, and that’s a normal
thing we model in other disease states. People
miss that. So there’s a question behind your
question is what’s like the prevalent number of
people taking the medicine versus the possible
and I think that’s the way to look at the TAM
here is there we’ll be drop outs and drop ins,
you know. Is 100 million patients possible? I
mean, you’re obviously building the company now
for the next ten years. You’ll have to plan. So
is that is that even a number that’s possible.
Yeah. Today we have probably 20 million people
in the world probably going to like 30 this year.
So that’s certainly achievable.
\
I think that in the developed markets, the kind of
theoretical use versus total is still in the low
single digits. So but if you look at something
like statins or beta blockers or ARBs and like
chronic disease, you’re getting into the 20s to
40s. So that’s a probably a high end to what we’ll
achieve but it’s against a bigger denominator.
So that that can be a very big number. Yeah. So
there’s a lot of focus on Zepbound and Mounjaro,
the key value drivers now, but you have a whole
wave of assets that are that are coming on
here: Orforglipron you mentioned, retatrutide,
eloralintide. Can you maybe just frame how you
see each one of those assets fitting into this
therapeutic paradigm? Yeah and maybe just to step
back, so 20 years ago, we launched the first GLP-1
exenatide Byetta. And you know, I think if you
asked us then like, okay, was this, like the
master plan? Of course it wasn’t. I think we had
two insights that kind of caused breakthrough.
One of them was the idea that you could give more
drugs. So here’s a natural pathway. There aren’t
too many things like that where if you just give
more, you get a beneficial effect without a lot of
detrimental effect. But this is one of them. And
we only could discover that when we got flat peak
to trough medicines, you could dose up because
there’s a tolerability for the side effects.
If we just kept dosing up exenatide people would
vomit more like they wouldn’t get the weight loss
effects. So you know, Trulicity and semaglutide
explored that. The second big one was that it’s
more than one receptor, that GLP-1 is important,
but there’s a super family here and they tend to
be synergistic and they also have different like
pharmacologic properties when you drug them. So
GIP of course plus GLP equals tirzepatide. GIP
actually tolerizes the GI effects and it has its
own independent weight loss effect not as potent
as GLP but does something. And so you get this,
you know increase in efficacy and actually
decreasing in side effects. That makes for
a great blockbuster. That’s what Zepbound and
Mounjaro is. But you know, amylin, which is
what eloralintide addresses, is another kind of
one of these super family that has been around
a while. Actually there was a marketed drug for
amylin sometime ago from a company called Amylin,
which is an interesting story. But, you know, it
wasn’t focused on weight loss and it certainly
didn’t, similar story to exenatide, it had peak
trough effects and other problems. Glucagon we’ve
known about for a while.
\
We have marketed glucagon for decades for, in
an acute sense, what about chronic dosing? Now
we can get a lot of weight loss when we add that.
And there’ll be others too. So I think this story
will keep playing out. I, we made that bet, you
know, in the middle part of the last decade,
right around when I started that this probably
isn’t like a Keytruda situation where people
hypothesized, oh, there’d be all these checkpoint
inhibitors for cancer. Turns out there’s like
maybe one other that works, right? CTLA-4 is okay,
but it was PD-1. Here it isn’t just GLP-1. And I
think that’s pretty clear at this point. That’s a
happy fact for us because a while back we started
building medicines against all these. And our
strategy was look, if that is the if that is
the hypothesis, we best cover every square and
we should use our skill in engineering the best
drug-like properties for these medicines to do
that. And I think we can now look at it and say,
okay, pretty much every one of these ideas that’s
working, we have a medicine for and with maybe one
exception, we have the first one.
\
So that’s that’s exciting. We’ll see how adding
those together, whether it be physically in one
medicine or kind of stacking them for different
effects, what that does. But I suspect there’ll be
a fair amount of appetite for them. One I wanted
to drill in on is retatrutide. Yeah. This is a
unique situation. Coming soon. Yeah. There is a
lot of buzz in Silicon Valley. In the Bay Area.
It’s the epicenter of off label retatrutide use.
It reminds me of the buzz around tirzepatide but
even more so and I wanted to just understand,
you know what is all the excitement about? What
is it about that profile, why people think this
will be such an important product? Well, more.\
I mean, if you, it’s a triple agonist and
I think people are, you know, kind of probably
mostly off-label ordering Chinese. So we don’t
recommend this, by the way. But, you know, you can
see in our studies people lose a profound amount
of weight really easily. In fact, the number
one dropout problem we have is people lost too
much weight. So they started obese. So I think
you can now see sort of the end of the efficacy
curve in a way like we probably don’t need drugs
that have more weight loss than this. If we have
dropouts for too much weight loss, we probably
need strategies to taper and tailor. The second
thing is like the third ingredient, it’s really
tirzepatide plus glucagon. Glucagon has a very
central obesity role. It really depletes fat
in the gut. And people like that. It’s actually
there’s a lot of data that visceral fat is kind
of the worst fat you can have, and that’s the
fat under your stomach wall. So that’s quite good
for health reasons. Liver, kidney, heart failure
probably is going to be a great medicine. But
also people like flat stomachs. And when they lose
weight they, you know, want to feel lean. That’s
what this does. I suspect that’s part of it,
too. This drug, though, is not for, you know,
unassisted self-care. Like, I think it’s got more
side effects that come with it. And probably low
doses are safer. But, you know, I would recommend
most people talk to their doctor.
\
And the good news is the phase three studies will
all be in hand within the next few months. We’ll
submit to the FDA, and maybe this time in a year
we’ll have that approved and then people can get
it, get the real thing, number one, and get it
under supervision, which would be a little safer.
So you’ve been positioning this as an over 35 BMI
type product. Seems like it. Yeah. Now there’s
theories about a category that doesn’t really
exist now, but people are sort of experimenting
with, which is the category of like, okay, either
my starting body weight is lower or it was higher,
but now it’s low and what do I do to kind of
keep that situation or, you know, have more
slower. So we’re thinking about low dose regimens
of different multi acting incretins. That’s one of
them. There’s also studies on clinicaltrials.gov
of tirzepatide plus eloralintide which is like a
triple agonist and without making a single kind
of chemical entity. That could be interesting
too. I think there will be needs for this in the
future. And while, Orforglipron is going to be a
great maintenance medicine, some people will want
different properties, and that’s what we can offer
here. Which one of these later stage assets do you
think will be the biggest opportunity for Lilly?
Well, there’s a lot of buzz on retatrutide and
I think there should be. I think that could be
a very big drug. But if you look at the injectable
space and I think, you know, Orforglipron is going
to be a big drug, not because of the efficacy but
because of reach. You know, it’s going to be less
expensive. We can market it to every corner of the
world. It’s pretty effective. You know, if people,
you know want to lose 30 pounds, that’s going
to be a great solution. And that’s most people
who want to lose weight. But you know, the
frontier of why did tirzepatide do so well
against semaglutide? So it’s an unusual situation
where there’s a first entrant, market leader,
tons of momentum, and then three years later
we wake up and, you know, we have a 70 share,
they have a 30 share. And probably if you
subtract out the payer stuff they did, it’d
be probably 80-20. Why? Well, because the drug
dominates that drug. We did a head-to-head. You
can look at the data. It’s both easier to take,
less side effects, and markedly more effective.
So I think if we can move both of those lines,
you’ll get better drugs and better selling drugs.
So retatrutide more effective, probably giving
up a little bit on tolerability because glucagon
has that property. I like eloralintide because
I think it approximates. I mean, the data we
showed is a little better than GLP-1 with amylin
and that’s interesting by itself. An important
note is eloralintide is not like the other amylins
which are kind of this, there’s a receptor in that
family that they all hit that also is shared with
another protein and that causes some GI that’s
the calcitonin receptor. We pushed that out. We
dialed that out. So you just get sort of like a
pure selective amylin inhibitor and you get almost
20% weight loss and almost no GI side effects.
That feels like a very appealing value proposition
and not a bunch of titration, because there’s you
don’t need to titrate into the side effects. That
can be a big product. Yeah. Yeah. So, you know,
the good news is we don’t have to care which
one gets really big. I think our focus is really
about, okay, get more choices out there. Deepen
the depth chart on indication use because still
medical use is a primary way into this market.
Build out our consumer capability because self
care and prevention is a real thing, and it seems
unlikely to have broad coverage in most markets
for a while, just because of the affordability
in health care. And people are animated to do it
anyway, so that’s fine. And then, you know, offer
choice basically. And if it says Lilly on it,
we’re good. Speaking of choice, some of your
competitors are developing a once monthly.
Some are trying to go longer. Where are you with
a once monthly. And how important is that to have?
I think our strategy is, you know, something on
every square. So we definitely have that idea.
Sometimes the standards are different, you
know? So like I get the question of like,
well, why didn’t you develop tirzepatide in
a SNAC formulation? That’s the technology
Novo uses for the Wegovy pill. And it’s because
for us, like the profile wasn’t good enough. I
think the convenience factors, if the oral is
really about convenience, then if you make it
inconvenient oral, what are we doing? So we took
a different strategy. That doesn’t mean we won’t
try that at some point for oral, but I think for
us that technology needed to improve a little bit.
Same for monthly. I think if we have yet to see a
day by day PK curve from any of these monthlies,
and I suspect there’s a reason, is they’92re not
monthly, that you can lose weight during a month,
but in effect, you’re sort of going two and a half
weeks, or your half life might be 10 or 12 days.
I mean, some have published the half-life. So,
you know, by the time you get to day 30 or down
to like 20% of the original dose, and then you
re-dose and you’re going to get a little more
weight loss, side effects again. And the key for
the weeklies semaglutide and dulaglutide was flat
like because then you can actually tolerize and
titrate if you’re reliving that curve every time,
I think you get more GI and then you’re
back to that efficacy tolerability curve,
you’re sacrificing some efficacy because you’re
not really effectively dosing therapeutically
the whole month. You’re restarting
tolerability every first of the month.\
So not ideal. So we’d like
a flatter profile that could last a month. That’s
it. You know we’ve got ideas similar to the ones
that you’ve seen. We just don’t choose to disclose
everything. And we’re working on other solutions
that would be flatter. You have to ask like okay,
you said longer like what are the benefits of like
spreading out dosing. And I think there is a
diminishing return anyway. Certainly monthly
is probably better than weekly. Is two months
better than one month? I mean, not really. If
you look at other markets, is three months better
than one, maybe marginally; six months better than
three? I think you’re starting to get where
the other properties will dominate that sort
of increment of convenience. One other area that
is really interesting is these areas outside of
obesity - immunology and brain health. Yeah. What
are you most excited about? Where can incretins
really play a really big role there? I think those
two are super fascinating. There’s a third which,
you know, it’s very hard to do studies on but I’ll
touch on. So you know, immunology is here now. We
published data actually this last weekend at the
dermatology conference of Taltz plus Zepbound. And
you know that effect size, which, by the way, you
get the ACR20 benefit on psoriatic arthritis, you
get the PASI 50 improvement way before the weight
loss. So and you can see this with like CRP which
dives within a week or so. So there is this like
other mechanism happening. It definitely is an
anti-inflammatory and it’s a pretty good one.
Look at retatrutide in OA pain that had more
than four point shift in this WOMAC score we
used to measure pain. That’s the biggest shift
ever recorded in OA pain. So these are really
good anti-inflammatories. I think that story is
going to continue to play out. What people haven’t
figured out is like branded inflammation drugs are
super expensive. So how do you value capture in
this space and what’s the right combinations? But
you know, that’ll get figured out. And hopefully
we’re the ones who figure that out. And then brain
health is even more fascinating. We don’t actually
know all the mechanisms as well. There’s theories
on like brain metabolism. Right. So that’s a real
thing. But, you know, you saw a couple big studies
from our competitor with the EVOKE program
in Alzheimer’s, and you did get movement in
biomarkers, but no change in outcomes. Was that
the wrong setting, the wrong time point in that
disease process, the wrong disease? We don’t know.
But, you know, there’s more risk here for sure,
is what I’d flag. But the promise of changing
dementia. We’re more bullish on vascular dementia,
which is more of a pure cardiovascular disease,
causes a lot of dementia, compounds other
dementias. You know, you look at kind of hedonic
behavior, things like smoking and drug abuse,
even gambling and online shopping. There’s these
like anecdotal reports. Those are all, you know,
opportunities to look here. And we’ve got some
studies going in these spaces already. Phase
two primarily. And then to me, the one that
would be what would really be a home run, not
just economically, but like moving human health
pretty dramatically forward are these NeuroSci
conditions. We have really no good explanation
for this. But when you look at large databases in
retrospect. You see big shifts, big. Like the VA
study was the biggest one. But in schizophrenia,
bipolar and major depressive disorder, very big
shifts in outcomes for people who happen to be
on GLP-1s and have these conditions. That’92s
worth noting and we better figure that out. So
we’re looking at that as well. Cancer is the one
just the teaser at the end. And it’s just hard
to study cancer prevention. But probably these
are not treatments but preventative. There’s
a lot of use in breast cancer already, mostly
because estrogen blockers cause weight gain.\
So it’s more like a symptom
management tool oncologists are using. But I’d be
personally surprised if we don’t wake up in five
years and see cancer surveillance rates dropping
in a number of cancer types because of uses. Now,
proving that and getting an indication that’s
a tough proposition. But the studies have been
done the other way where you look at, you know,
cohort match groups that have obesity and those
that don’t, and cancer rates are quite a bit
higher in obese populations, so that would be
great news as well.
\
Let’s talk about selling because this is getting
really interesting with Lilly Direct. Yeah. So
you launched this in January of 2024. Yeah. And
it is now a big part of your obesity business.
Yeah. It’s like a third of all obesity in the
United States is Lilly Direct. I’d love to just
understand where you see this going because it
seems, you know, really fascinating, a real shift
in how we are distributing. I think, you know,
this was one of these like perfect I guess what
in in the Bay Area you’d call a product-market
fit, right. That’s like which we a little bit
stumbled into. But we had some clues. You know,
I think though five years ago there weren’t many
large manufacturers talking about, like, selling
directly to consumers. In fact, like, funny story,
my predecessor, we had, like, a series of meetings
in this room. In that period before he left and I
officially started, but I was named and he’s like,
I have like a list of lessons and one of them was
like, never be in retail. He literally said
that to me. And it’s like, why? Well, because,
you know, you have all this like apparatus
you have to build to deal with the variety of
complaints and, you know, knowledge levels, etc.
but I disagree with that conclusion. Actually,
I think there’s been huge benefits for us.
\
So of course we’ve reached more people and
sold more. That’s great. That will continue
and will grow. We’ve launched, by the way,
in the UK. That’s off to a commanding start,
I’d say. We’ll introduce, I was just in
China here. You know China internet world
is different but we have a couple partners and
like a store within a store Lilly Direct like
on JD and Ali and pretty impressive start. So
you know, I think this is a universal thing.
It’s not just a US shopping phenomenon. And
we’ve gotten so much better at understanding
consumers because you have this first party
real time interactions. What are people buying?\
What are they complaining about? How do
we learn about how to use our medicines better?
Inform consumers? I think that’s so good for
the company’s competitiveness long term. I think
investors are intrigued by stickiness. If you have
that information, if you have a relationship with
someone one on one, do they stick around longer?\
Of course, that needs to be proven, but the theory
is there and it’s worked in other industries. And
then, you know, I think not being reliant on third
parties as health care kind of rearranges itself
has proven useful. At a minimum, having your own
channel creates price discipline, right? So you
don’t get excessive markups. You set a kind of a
benchmark price in the market that payers like
insurers can expect, but so can consumers.\
And it just sort of controls
that critical variable here. But also you have a
route to market and I think that’s strategically
pretty important. I think also on the consumer
side, discretion and sort of not my regular health
care system have not been a bug, but a feature.
Most people with obesity have doctor shopped to
get someone to help them.
\
So that means they’ve been told no or just, you
know, here’s a diet sheet. Why don’t you follow
the diet? You know, and they have followed the
diet and it doesn’t work. I think that’s the
consumer perception. So getting out of that is
actually a benefit. And then of course discretion
because people report stigma when they go to the
pharmacy counter and they’re waiting and then
their dispensed Zepbound and, you know, people
roll their eyes, they don’t like this. Right. And
that’s an unfortunate fact of our society, that
people view obesity often as a personal failing,
not a kind of a genetic predisposition and an
environmental situation we find ourselves in.
That’s wrong. But I think those factors drive
people to the platform. And that, again, those
aren’t just US factors we see, you know, really
sort of geometric growth in many markets online.
You have over 50% of your new prescriptions
for Zepbound going through this channel in the
US. Yeah. Where do you see this business going?
What percent of obesity scripts will go through
this channel? I think in the end state it’ll be
meaningful. I don’t know if it’ll be stable at
that rate. I’m hopeful, actually, that insurance
coverage in this sort of medical route will grow
more. And probably the consumer piece is going to
be, you’ll see more switching. It will act like
consumer products.
\
You’ll see loyalty, yes, but also trial and error.
You know, I think it’s going to be a little bit
different than what we’re used to in sort of like
a chronic med that sort of takes seven years to
get to peak. And then there’s lots of carryover.
We can value that. We understand that I think this
will be a little bit different, but not worse
different. Just different. I think we can also
drive early adoption in a very significant way
in this channel. And I suspect that’s a that’s
a global thing. In fact, there are some markets
where that medical chain is even more choked off,
more broken, and will probably have a higher
proportion online. I would expect outside the US,
you’ll see more business than in the US, in terms
of self-pay. And that’s a good diversification
thing for us. And it’s good for those consumers
who like, if they went to their doctor,
they wouldn’t get the medicine. They can
use telehealth, they can buy it online,
they can make decisions about their own health. I
do think I alluded to this earlier, that this is a
capability that can serve us well in the future.
\
I’m going to jump to this. But
like in my time in the industry,
in addition to like working on more preventative
interventions, which the industry is shifting
that way, the drug technology has improved a lot
to do it. So if you don’t have a doctor around
to monitor side effects and carefully titrate
doses, etc., it’s difficult to think about this,
but if you had therapies that were very
infrequent, that were really preventing disease,
and yet the person had no symptoms.
\
That’s like a perfect line up. And you think
about technologies like siRNA, which are like
so pristinely targeted and very infrequent and
often being developed for chronic diseases in
a preventative setting. That’s a great use case
for this as well. And if you have enough volume, I
mean, some of these, these new modalities, people
are always thinking about orphan or specialty.\
You know, I think the first big
medicines using RNA silencing were like you had
to inject into your spinal column for, you know,
very rare congenital conditions. But if you
think of something common like Lp(a) reduction,
which is like probably a third of all adults
on the planet. Are you really going to get a
high price point, even if you have only maybe
10% penetration. Is that the right model?\
Or should you
try to reach the vast majority of those and lower
the price points? COGS isn’t really an issue here,
and do it in a direct way, kind of outside of
the health system payment. And that seems like
a pretty viable idea to us. So we’re looking at
that in a serious way and building the capability
around obesity It’s sort of the perfect use case
now, but I think there’ll be other ones. What do
you need to do to add to this Lilly Direct program
to make this an even more valuable asset for the
company? Yeah, automation, globalization. You
know, right now it’s if you knew how we built
this thing, you’d be like, wow, that’s not
really how software companies like will go to
market e-commerce engines. It was very, you know,
duct tape, baling wire. And the first instance,
we’re sort of in version 2.0 now, it’s better.
It’s smoother. Like we have integrations into
e-prescribing systems across the country. And
it’s, you know, need like a lot of paper or
phone calls. We’ve auto renewal, which is like an
SMS message consumers get. They click like three
buttons and the box shows up in two days. So we’ve
really worked on that but it’s not Amazon. You
know, it’s not best in breed e-commerce, but it
can be. So we need to continue to invest in that
and we’ll get there. We’re making some moves this
year to kind of up that game. And then as I said,
you know, we sort of relearned this lesson when we
launched Mounjaro, which is the name for Zepbound.
We just had one name outside the US in all these
other markets like Brazil or, you know, Germany,
and they have their own telehealth environments
and those players aren’t as sophisticated or
organized. So we need to get in those markets
and kind of upgrade that and we’ll do that.
One topic of concern from investors is price
these GLPs and I think there’s a concern that
the prices will just keep falling and there’s
no floor. Yeah. What would you say to that.
Yeah I think there are competitive effects,
right, that’s for sure. I think there’s like
two potential bets we’re making and people can
bet against that. That’92s what investors do.\
One is that,
you know, we’re just like scratching the surface
on the volume side. And unlike other drug markets,
which you and I have valued, you don’t really have
elasticity in pricing. So price down equals cash
flow down 1 to 1. That is not what happens here.
Actually I think we’re seeing growth acceleration
with price cuts.
\
So that’s acting more like a consumer market.
Now is there a logical point where you should
not be doing that? Yes. We’re a pretty disciplined
actor I think we’ve studied this and we understand
consumer choices and preferences. But so far, I
think the move from like 1,000 a month to about
350, mostly positive for us. By the way, we were
already launching in diabetes at about that net
price anyway. So, you know, if you value the
if you look the gross to net appropriately,
it’s not really a price concession. It’s like a
volume expansion in the cash channel, which is
probably good. Can it go too low? Yes. But I think
what prevents that is innovation. On the one hand,
newer things typically get priced higher. If
you look at unit pricing in drugs, there’s
like a minus seven on every chronic drug for the
ten years I’ve been doing this job. But prices
on average are going up. Why? Because you have
innovation launching at premiums and then it gets
on that decay curve. So if we can keep innovating
eloralintide, retatrutide, Orforglipron and post
up higher starting points over the innovation,
that data has to be justified. I think you can
see a price, more of a price stable picture as
the mix grows and options are presented. Will
there be like a generic segment? Sure. That’s
going to happen to semaglutide first. We’ll
learn about that in some overseas markets in the
next couple of years and eventually in the US.\
And we’ll have to have enough difference
versus that to justify the price. Sure. That’s not
a new factor in our industry. What is new is that
elasticity and the rate of innovation. There’s
one other constraint which, you know, I think our
competitors should take note of, which is if you
have pipeline bets stacked against this, like you
don’t want price erosion, that’s not a great idea,
right? Because you have to compete with the thing
you just you just did. So, you know, we’ll see if
they’re paying attention to that. We pay attention
to that. The FDA recently came down pretty hard
on Hims for attempting to come out with an oral
version of Wegovy. Yeah. Where are we in the
battle between innovators, compounders, the FDA?
I don’t know, honestly, I’m honestly shocked this
has gone on this long. It really makes zero sense.
And of course, there’s an industry point
of view. Let’s put it on the table. Like,
yeah, it’s cannibalizing some of our business. Not
that much, actually. But if we look at, you know,
maybe there’s a couple hundred thousand people
on compound tirzepatide, maybe a few 10,000 on
retatrutide mostly in San Francisco. You know,
you know, that’s not changing our EPS number on a
quarter to quarter basis but it does open a policy
door that’s kind of frightening and frightening
for our business model, of course. Like if you
don’t have an incentive to invest in R&D, if
someone can just copy what you made without paying
a royalty, a license, or having to do the work
themselves, that’s not fair. Number one. Number
two, it’ll just destroy the incentive to invest
in innovation. I think that’s a terrible outcome
for our country and for the world, actually. But
even for, like, for consumer, like, why do we have
an FDA? It was, you know, more than 100 years ago,
Food, Drug and Cosmetic Act. Why? Because the
very reason Lilly was founded. There were too
many fake snake oil things that, we’re back there
now. And when we test stuff which we buy online,
which we do, a meaningful percentage of the stuff
does not contain tirzepatide. Okay. And then those
that do often there’s mistakes in the amino acid
sequence. So it’s not. It’s like tirzepatide like.
We’ve recently published a study that if you
commingle it with vitamin B12, which is a very
common thing to do to skirt around the legalities
of compounding, it actually forms a new complex
molecule that’s not tirzepatide. Never been tested
in man, although except for the people taking it
today, they’re testing it. Yeah. This is actually
crazy. And it’s not what we should be doing. And
you understand well what we have to do to get a
medicine that’s safe and effective. Most public
does not. I mean, we, the tirzepatide is, I think,
series number 7,023, which means we made 7,022
other versions of tirzepatide we threw away.
\
Amazing. To get the one with these properties.
Do you really want to mess with that? Like that
seems like a nutty proposition. Now there’s noises
that this will be closed off, at the same time,
we hear noises that, like peptides that are not
proven to do anything, may be unleashed through
this channel. Let’s see what plays out. I
think we just have to keep communicating.\
And honestly, the only reason this
exists is pricing. And, you know, I feel sorry for
those consumers who think they’re getting the same
thing at half the price. They’re not. But as our
offerings get better, as coverage gets better,
I think this this gets reduced. There is a big
expansion in access this year on the federal side,
which is part of our MFN deal with the Trump
administration. I think that’s going to be
interesting to see what happens there. $50.
There’s nobody using compounding who’s going to
use compounding when they get $50 Zepbound. That’s
not going to occur. So we’ll, we’ll see. That’ll
be interesting experiment to measure. Okay. Is it
really just that and, and, I suspect that’s going
to start the end along with hopefully some policy
response from this administration. Let’s hope so.
Yeah. Okay. Maybe shifting from obesity. What’s
the next big opportunity for Eli Lilly? Yeah we
need to find it. Of course we run a base business
that is like pretty similar to the company like
when you first started following us, you know, we
valued, and then I took over. That’s still going
and growing you know, mid-teens actually. That’s
a good drug business. In fact, if we peel it out
ourselves, you know, I think you’d put it in the
top three out there. It just gets overshadowed by
this, you know, sort of generational opportunity
- and that makes sense. But our job is to keep
that going and grow it faster if we can. The most
mature part of that franchise is oncology. We’ve
got, I think, more substrate in phase three
now than ever. I think we have four phase
three projects going right now, and they’re not
against small things. You take, like, our oral
SERD program, we’ve got a really key study reading
out in the next year in the adjuvant settings.
EMBER-4 study for imlunestrant. And I think that’s
a giant opportunity. Duration of therapy is very
long. A surprising fact is that degraders seem
to be more effective than other modes of blocking
estrogen. If that’s true for imlunestrant, that’s
a big opportunity. We’re building out some other
capabilities. Of course, everyone’s working on,
um, the ADC platform as we are, but also, you
know, radioligands, other things, I’m optimistic.
None of those are going to be drugs, anything like
the ones we just spoke about in terms of size, but
by historic standards could be quite meaningful
drugs in the industry. And so I think we have
to be this in this like two mode method of like
in that category, be the winner, even though that
may mean it’s still a lot smaller than our leading
category. I think brain health and neuroscience
has the most, like, upside potential in it,
both because the amount of human suffering and
the lower competitive density. Lilly’s got a
long history there. We’ve got some important
studies going. We’ve got more to do. Actually,
today we announced the deal with Centessa. Looking
at this orexin pathway, which is very interesting
for wake and sleep, maybe in some ways like a
little bit of a corollary to GLP-1 because here
you have like this nodal pathway that has a lot
of other disease impacts. Could be interesting if
the drugs are safe enough. If it turns out that
overstimulating a natural pathway like GLP-1
turns out to be useful and safe, but, you know, we
need to look for those opportunities. Of course,
you know, neuropsych is huge on mandate still. And
I’ve been saying that for like a decade. And we
sort of retreated from that like 15 years ago. But
other than like ketamine, I don’t know of any real
step up there. That’s kind of sad because ketamine
is not a new idea. Really? Um, maybe that changes.
If it does, we’d like to be a part of that. And
those that can make for a very big category.
So that one’s probably has the best chance of
competing with our cardiometabolic franchise,
at least in my tenure. How about Alzheimer’s?
\ Yeah. I put that in that one. So dementia that’s here now. I mean, we’re treating people. That’s pretty linear uptake. I’m encouraged by that. Kind of like diagnostic drives use. So that’s our focus now. And of course we have a prevention study running that has people with amyloid positive but symptom negative to see if we can reduce conversion to symptom positive.\
Uh, I think that’s a seminal study for the industry actually, because if that turns out to be true in this neurodegenerative condition, there’s a lot of parallels in Parkinson’s and other things that could be a big category of drugs for the industry. And hopefully we’d be a part of that growth as well.\
So we need that data, but that’s an exciting one too. I’d put that in the neuroscience. Again, another, another thing that could get really big and help a lot of people. Yeah, that’s an interesting study. So these are in patients pre-symptomatic to Alzheimer’s. Yeah p-tau217 positive. We didn’t even scan them. We just blood tested. And so that’s in the in the noise of the, of the signal. And then the question is after a period of time can you reduce the odds ratio of converting to symptomatic. I think it’92s a very compelling value proposition for consumers. Here again, maybe like a more consumer thing. It’s a preventative. It’s a, you know, walking well, people with a precursor to the disease, amyloid signature for Alzheimer’s.
\ But we do know people have high amyloid and don’t ever develop Alzheimer’s, but can we reduce those that do? And if we can, that’s a major breakthrough. Do you think the efficacy could be better than what you saw in TRAILBLZER 2 in your symptomatic patients. That’s our hope, I think, because if you look at the TRAILBLAZER 2 study, no matter how you slice severity, whether you look at like tau burden, which is the secondary protein of Alzheimer’s or age or symptomatic symptomatology, so people with more, more advanced symptoms. If you go earlier and earlier in that slice, the effect size gets bigger and bigger. And it sort of flies with the theory of amyloid that it is sort of the triggering pathway and that it’s not actually doing the direct damage like tau is, but without amyloid you don’t get the tau accumulation. So it kind of makes sense with the cartoons and the textbooks that we’ve read about. But you got to prove it in the real world, that’s different than the compounding world. Like you have, we have to do the study, and if it works, we would expect quite a bit of use. You mentioned Centessa. How has your M&A strategy evolved now that you’re scaling the business and we’re going to continue to scale the business? Yeah, it needs to evolve. I think we’ve you know, when I started it was sort of nascent, I would say occasionally when we looked at stuff, the bias internally was internal over external. There wasn’t like a stood up motion to do this continuously. And part of that is, you know, I think what John tried to do is really sort of reinvigorate the organic engine. That’s a necessary actually to be a smart buyer externally. So maybe this had to go in steps. What we did was create a systemic motion. So we’re every week huddled up on every data room, every deal in play, many deals not in play.\
So we, we instigate deals. We like to trade in front of data. We have ideas about what we’re interested in that is not in our labs. So we made that a very proactive motion. And it’s constant. But by definition it’s become more of a string of pearls kind of approach. You can tolerate more failure that way. That’s good because we can take risk. We do a lot of deals. We did like 40 deals last year. That’s a lot, way more than anyone else. But we deployed like the 10th most amount of capital. So cheaper deals, but many of them. Probably that cheaper part will change. Purely if we have a growth ambition, which we do, I think we want to be priced like a growth stock. We don’t want to get to some terminal state on GLP-1. Which will happen at some point where the inflow of new patients equals the outflow and we stop growing so aggressively and not have a path to growth that feels - it’s not defeat. We did a lot of good, but that’s not what we’re going for. We’re going for finding the next big things, or a whole series of bigger things that amount to more growth on top of that and that’s going to require external innovation and internal.
\ We just need more ideas. Internal probably scales a bit, but there’s a lot of data in our industry that scale drives inefficiency, not creativity, and so I worry a lot about that. We’ll moving it forward there. We have different ideas there. But then, you know, we need to get smarter about buying. So we’ll open up the aperture therapeutically. That’s one way without changing the strategy, but probably lift up a little bit the price number and by definition then the phase of development where we really scrub things down. Yeah, it’s unusual because you haven’t, I don’t think you’ve done a transaction over 10 billion since you’ve. Loxo was the biggest. It was eight. Eight. So size of deals could go up? Centessa is big for us. It’s like six. Yeah. Yeah. I mean, look, as you know, in the in the drug space, it’s a weird industry in a way, because you have maybe 20 pretty scaled legacy companies. Lilly’s one of those. 150 years. The names we all know. And those are almost, well, except for Lilly, they all trade like, you know, countercyclical, you know, stable stocks, basically. And then you have a pretty big gap in the middle, and then you have like 500 biotechs, probably 200 of them shouldn’t be public, but you know, you have that. But there’s only like ten companies in the middle. It’s less than the big ones. It’s weird. So there aren’t that many, like, mergers where you’d say, okay, I’m getting a revenue line and marketed products that are that interesting to me. I think it’s more like at the top of that biotech thing, where in the past we did have a belief that if something’s mature enough that everyone can see it, it’s probably hard to get some sort of value out of that transaction. You’re going to pay the prior investors. They like that, Woodline probably likes that when we do that. But it’s hard to create value for your shareholders that way. It’s just tighter. Unless you have some big like commercial unlock or some other thing, they screwed up and you can fix. But you know, we might have to look for more of those and I think if we widen our therapeutic aperture, maybe, maybe we’ll find more. Makes sense. Does the Lilly Direct channel change your view on what you may look at? It does. Yeah. I think because if you say okay, let’s not use therapeutic space, but use like, a different frame. Like we have common medical conditions where people use their primary care doctor, you have referred to medical conditions like Alzheimer’s today or oncology where your primary care doctor to a referral. Those markets behave pretty differently. Higher price points, a much lower volume. And then you might have this like self-care prevention segment. Okay. So we looked at our business that way. We’re kind of a leader in that middle one now because of obesity.
\ We’re trying to make headway here. We’re also leader over here. But it’s growing. And so what else could grow it? There’s a whole list of preventative things that are interesting that need to get drugged. And if they get drugged safely, that could be great kind of portfolio items for us. There’s also kind of non-medical, not medically covered, but medically proven things like in cosmetics that could be interesting where people are self activating as well.\
So we to get there you’d really have to have like one compelling idea. I think the kind of list of like McKinsey decks that turned into real businesses is pretty low. I think you need like a great drug and then you can enter. So we’re open to that idea too.
\ On a personal level, true story. A couple of weeks ago, I was having a dinner with a bunch of different investors, and I sat next to a Lilly employee who I had never met before and so I mentioned to him that you and I were going to be talking. And I asked him, I said, what do you want to know from Dave? Oh, great, here we go. And he said, I’d really love to understand what makes him tick, what inspires him?
\ And I said, well, awesome, because that’s the name of this podcast actually. So I have to ask you, you know what? What makes you tick? What inspires you each day? Yeah. It’s a good question. I mean, I think there’s like a couple of layers to it. I’m someone who probably I would be accused of being, like, loyal to a fault. I have a, for whatever reason, like a, I like the things I participate in. I tend to stick with them a long time. And, I definitely feel that about Lilly. I’ve been here for 30 years, and that’s something that I’m really adhered to. Making sure, Lilly, you know, carves out its place in the world and keeps it because I care a lot about the place.\
Another thing, it’s like if you gathered around, like, our kitchen table with our, our kids are adults now, but even now, okay, it is even worse now. You know, on a Saturday night and we broke out a board game, you would have sworn, like we hated each other and we were, this was war. I’m a very competitive person and so are my kids. We, you know, we have fun with that because you can kind of simulate that and then the game gets put away and you’re all happy. But I like to win a lot. And I don’t find a lot of satisfaction in coming in second. And that’s a big like inspiration for me is it’s a competitive industry, but the competition doesn’t just reward us. It actually has a much bigger effect on our purpose. This is what we do.
\ And that’s the last piece is I kind of stumbled into Lilly. I don’t know if you know this story, but you know, I only worked here because my wife was going to med school in Indianapolis and we were fianc’e9e at the time, and I’m like, I need a job, so I’ll go there and work for Lilly. I worked in the BD M&A group for a couple of years, and I thought when she, two years, she was going to graduate med school and then go to a residency somewhere, and I’d leave. She ended up matching here in Indianapolis. So I stayed, which was like a pretty prophetic thing. And then it was five years here, and then that loyalty thing kicked in and Lilly was great to me. But early in my career, I worked on a business development deal and the medicine that I brought into the company, we completed phase three. Then I went and launched in the US as the brand manager and shortly after that, my own mother called me and said I was diagnosed with the disease and I got this medicine and it has Lilly on it. And I think if you work in this industry and you have those like personal moments where it’s, I mean, you know, objectively, yeah, we’re improving health conditions, but when it actually helps someone in a profound way that you care a lot about, like your mother, it’s like, that’s why we’re here. That’s a pretty good way to go through life is like doing that over and over again, and you just want more of it. Like when you succeed at that, it’s like, I want to do that more. So that’s a big driver. That was a turning point for you. That that was like the lock in point. I loved Lilly. I was surprised at what I found here. I was like, but the industry seemed kind of underdeveloped, like sleepy and Lilly, too. So it seemed like a place where if you were good at business, you could make a difference. And I started in business development, so I always had this, like, external focus. And it was a great way to learn the industry and I was excited by biotechnology at the time. This was like 1996. So, you know, we were just getting monoclonal antibodies and like waves of innovation were coming. And then the culture, you know, I thought the people were smart and wanted to work hard.
\ We were talking about the Midwest earlier. And there was a lot to like about running a company in the Midwest. Kind of no fuss, no mess. People just come to like you’ve come to, it’s still true, you come here like, I don’t know how many corporate America cafeterias serve breakfast at scale, but we serve breakfast at scale.
\ People come here early and eat breakfast. I think that’s an interesting thing. That’s not that common in my estimation. So people like to work here. They’re proud of being part of Lilly. There’s obviously a big halo in the community of what this company’s meant to the state and the city. And you tell your neighbors, yeah, I work at Lilly. Oh, that’s great. And then people come here and they try to live up to that obligation. What’s been the most difficult aspect of being CEO? Well, you know, I think actually the job’92s changed a lot, even with me in it, like in the ten years that we’ve become companies, big companies especially have become this sort of place people want to turn to for like truth and connection. And it’s a little bit of a weird, there’s a guy who does a podcast like this, and he writes for The Atlantic and he talks about this workism. I think it’s an interesting turn of phrase. It’s like it kind of replaces your sense of community outside of work. That’s true. And so your employees demand you take positions on lots of stuff and I don’t like that. Like I actually think a company has massive positive spillover effects. I don’t think intervening in like public policy per se is one of them. I think that’s actually a problem. People should vote and they should, you know, guide society in that way. I think that health care and like, drug pricing and all this is a mess. And it’s hard to be in the middle of that mess and sort of go forward. You can come off and hurt your company’s brand. You know, by being a jerk about it. You can also be so uncentered on it that like it is, we do deserve reward for what we do, and what we do creates a huge amount of value in the health care system. I’d guess more than any other thing in the health care system. So, maybe combined. So we shouldn’t apologize either. And yet a lot of the problems we have aren’t even our fault. It’s like government rules and so forth. So you got to wade in. But it’s, boy it’s painful. That’s just tough going. And it gets personal because you’re the face of the company. Those aren’t fun things. Some people say like investor interactions, but I actually like investor interactions because I think the questions either teach you what the Street is talking about that makes no sense, which is frequent. Yeah. Or like really good questions where you’re like, you know what? We need to be sharper on that. Like it’s a, it’s a surface area to bounce ideas off of. But you know, most CEOs don’t get a lot of. So I actually like that one. But yeah. Anything you would have done differently over these ten years?
\ Sure. The longest list is like on the people side. Like most of us, probably, in our judgment, some people aren’t perfect. Either moving faster on problems or who we brought in and then didn’t work. And, you know, that’s probably for managers, like we all can relate to that. That’s probably one of the hardest things is like admitting you’re wrong and you’re kind of the last to admit it when you have someone that’s just not working out. Yeah. Those are. And then, you know, there were some other tough situations that I won’t go into here, but it’s just like, ugh, you know, that stuff’s emotional and sticky and no matter what level you are, whether you’re that employee sitting next to you at dinner or mine like that doesn’t really change. You know? We’ve taken bets that didn’t work. I don’t regret any of those. That’s part of the business. You got to take swings and you don’t get home runs unless you swing. And, you know, I think how we’ve run the business. I’m proud of that. I don’t have too many regrets in terms of the discipline and choices we’ve made. This has been a great interview. Thank you so much. Maybe to end it. If we’re sitting here ten years from now, which would be great, I would love that. I’m sure this room will look exactly the same. It was this way ten years ago. Yeah, yeah. But you’re 160. What do you want to have accomplished at that time? I think there’s like three big things. One is like, make incretins not like, like PD-1s. Prove the case out that this is more like antibiotics. I often draw this analogy, and people like what? But, you know, antibiotics made modern medicine. It took the focus of modern medicine really on treating acute disease poorly, and shifted the focus to chronic disease and made chronic disease possible. You can’t even do surgery without antibiotics. And Lilly was at the forefront of that. We marketed penicillin and vancomycin, still the backbone of hospital care was the Lilly invention, and I think GLP-1s and this category, this is like for chronic disease, the same thing. We can afford to talk about longevity because we’re going to be able to solve obesity. I think that’s a vision we have to have.\
But we need the runway to do it. If you know generics come and wipes out the economic incentives, we won’t see that. So, you know, we’ve got to innovate faster so that we can keep the replacement cycle going and keep improving the standard of care. The second thing is like build the rest of the business, we have kind of a gift here if we think the best capital is the Lilly R&D value in the industry, I think that has been the best capital.
\ Can we keep that going and can we make other diseases obsolete? And I think we have to try. We also have to not have hubris. We need to have the courage to say, okay, we tried and failed, and then we’ll be buying back a ton of stock for a while. But that’s less satisfying. But the truth. But I think we’ve got a 3 or 4 year window to sort of try that. And we’re certainly going to flex, flex into that. The final thing is like the way Lilly works. We talked a lot about consumer. I think that’s been such a gift to us to like, really learn about health care and not be so insulated. But I, I wish for a company with like leaders and people that will take over when I’m gone, that really own the customer and love innovation. I think at the end of the day, that’s what we do.
\ We connect science to people with problems, and if you can see both sides clearly and know both and make good decisions, you know, then you can be a great leader in this, in this industry and hopefully in this company and we just need more of those.\
Well thank you. It’s been an honor. You’ve done such a great job for patients and for shareholders, so we really appreciate it. Thanks. Thanks. Good to be with you.
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