Jan 22, 2024 · 3h 45m · acquired

Novo Nordisk (Ozempic) · Acquired

Ben Gilbert · 1h 43m spoken David Rosenthal · 1h 40m spoken Theme Music Singer · 17s spoken
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Acquired hosts Ben Gilbert and David Rosenthal chronicle the 100-year history of Novo Nordisk, detailing its journey from early Danish insulin pioneer to Europe's most valuable public company through blockbuster GLP-1 medications Ozempic and Wegovy. The episode explores the unique foundation governance, scientific discoveries, healthcare economics, and persistent competitive duopoly with Eli Lilly that defined modern metabolic medicine.

How this conversation actually went

Every chapter scored 0–10 on four independent dynamics. Hover any point for the reasoning behind the score. Ben and David hold 99.7% of the talking time here. How this is scored →

Ben and David as informed peer 6.2 Guest teaching 1.1 Guest disagreement 1.0 Ben and David pushing back 1.2
05100:0020:0040:001:00:001:20:001:40:002:00:002:20:002:40:003:00:003:20:003:40:005:29–16:42 · Ben and David as informed peer 6/10 The 1921 Discovery of Insulin at the University of Toronto Ben and David collaboratively narrate the 1921 discovery of insulin in Toronto. Ben brings in detailed context from Thea Cooper's book 'Breakthrough' and the mechanics of early pancreatic extraction.16:43–25:42 · Ben and David as informed peer 5/10 August Krogh, Marie Krogh, and the Danish Connection David details August and Marie Krogh's journey to the US and Toronto, while Ben adds color on Niels Bohr's father and early diabetes treatment dynamics.25:43–37:28 · Ben and David as informed peer 6/10 The Animal Supply Bottleneck and Lion Chemical Factory Ben presents exact quantitative figures on the massive number of animal pancreases required to produce human insulin, while David explains the Lion Chemical Factory partnership.37:29–46:41 · Ben and David as informed peer 5/10 The Petersen Brothers' Split and the Birth of Novo David recounts the dramatic fallout between Hagedorn and the Petersen brothers leading to the creation of Novo, while Ben draws parallels to classic corporate rivalries.46:41–57:09 · Ben and David as informed peer 5/10 Rapid Innovation, Liquid Insulin, and Supreme Court Battles The co-hosts explore Novo's formulation of shelf-stable liquid insulin, the Danish Supreme Court patent battle, and the diverging fortunes of Novo and Nordisk during WWII.57:09–1:07:46 · Ben and David as informed peer 6/10 Post-War Breakthroughs, Lente Insulin, and Enzyme Diversification Ben explains the biological kinetics of sustained-release formulations while David traces the post-war enzyme diversification and Nordisk's unexpected comeback under CEO Henry Brennum.1:07:47–1:13:23 · Ben and David as informed peer 4/10 The 1980 Insulin Landscape and Silicon Valley's Biotech Dawn David sets the stage for 1980 market share numbers and the dawn of recombinant DNA, transitioning into the Genentech turning point.1:13:24–1:22:15 · Ben and David as informed peer 6/10 Genentech, Recombinant DNA, and the Synthetic Insulin Race David explains Genentech's synthetic insulin partnership with Eli Lilly and Novo's ill-fated chemical modification of pig insulin, with Ben highlighting market cap dynamics.1:22:15–1:31:57 · Ben and David as informed peer 8/10 Decoding the US Healthcare and Pharmacy Benefit Manager Machine Ben delivers a structured breakdown of the US pharmaceutical supply chain, detailing the complex interplay between manufacturers, wholesalers, pharmacies, insurers, and PBMs.1:31:57–1:37:26 · Ben and David as informed peer 6/10 The 1989 Novo Nordisk Merger and Explosive Global Growth David details the 1989 Novo-Nordisk merger terms and the combined entity's rapid 1990s revenue compounding.1:37:26–1:43:48 · Ben and David as informed peer 6/10 The 2004 Serono Sale Attempt and the Foundation Veto David and Ben discuss the 2004 Serono buyout attempt and the crucial veto exercised by the Novo Nordisk Foundation board.1:43:49–1:51:07 · Ben and David as informed peer 7/10 Lotte Bjerre Knudsen and the Invention of Liraglutide Ben and David review Lotte Bjerre Knudsen's breakthrough in stabilizing GLP-1 by attaching a fatty acid chain to bind with albumin.1:51:08–2:00:30 · Ben and David as informed peer 6/10 Gila Monster Venom and Eli Lilly's Byetta David and Ben discuss Daniel Drucker and John Eng's research on Gila monster venom, leading to Byetta, alongside clinical trial phase mechanics.2:00:30–2:07:24 · Ben and David as informed peer 6/10 Overcoming the Obesity Stigma and the Fen-Phen Legacy The hosts analyze historical obesity stigma, the catastrophic Fen-Phen fallout, and the shift toward recognizing obesity as a metabolic disease.2:07:25–2:16:45 · Ben and David as informed peer 6/10 Victoza, Saxenda, and the 10% Weight Loss Threshold The hosts discuss Victoza's blockbuster sales, Saxenda's moderate weight loss results failing to hit the 10% threshold, and the 2016 stock drop.2:16:46–2:27:19 · Ben and David as informed peer 7/10 Ozempic, Wegovy, and Global Supply Shortages Ben and David cover semaglutide's launch as Ozempic and Wegovy, the biological mechanisms of satiety and gastric emptying, and unprecedented supply constraints.2:27:19–2:34:44 · Ben and David as informed peer 7/10 Healthcare Economics, Misaligned Payer Incentives, and Medicare Ben breaks down the misalignment between the average 3.7-year private insurance tenure and lifelong chronic disease prevention, alongside Medicare Part D restrictions.2:34:45–2:44:50 · Ben and David as informed peer 7/10 Eli Lilly's Tirzepatide, CagriSema, and Patient Adherence Challenges The hosts discuss Eli Lilly's dual-agonist Mounjaro/Zepbound, patient adherence data showing 68% drop-off within a year, and the erosion of insulin profitability.2:44:51–2:56:38 · Ben and David as informed peer 6/10 Hamilton Helmer's 7 Powers Analysis of Novo Nordisk Ben and David apply Hamilton Helmer's 7 Powers framework, debating whether Ozempic exhibits genuine network economies or exceptional word-of-mouth marketing.2:56:39–3:06:56 · Ben and David as informed peer 6/10 Playbook: Extreme Concentration, Foundation Structure, and Executive Alignment The hosts analyze Novo's unique foundation ownership, lack of stock option compensation for executives, and multi-decade research horizon.3:06:57–3:13:44 · Ben and David as informed peer 7/10 Playbook: Mass Population Drugs vs. Specialty Pharma Venture Economics Ben outlines the contrast between broad-population primary care drugs and high-priced specialty orphan drugs, citing the 'better-than-the-Beatles' regulatory barrier.3:13:44–3:22:38 · Ben and David as informed peer 7/10 Playbook: Healthcare Macroeconomics and the Shift to Chronic Illness Ben challenges the conventional narrative that healthcare costs are purely waste, arguing that society simply consumes significantly more complex, life-enhancing interventions today.3:22:39–3:33:08 · Ben and David as informed peer 8/10 Value Creation vs. Value Capture and the Role of Healthcare Intermediaries Ben and David contrast the genuine scientific R&D risk taken by pharmaceutical companies against the rent-seeking insulation of PBMs and health insurers.3:33:09–3:42:30 · Ben and David as informed peer 6/10 Bear and Bull Cases for Novo Nordisk and GLP-1 Supercycles The hosts outline the bull and bear cases for Novo Nordisk and Eli Lilly, discussing next-gen triple agonists and potential adverse side effects like lean muscle mass loss.5:29–16:42 · Guest teaching 1/10 The 1921 Discovery of Insulin at the University of Toronto Ben and David collaboratively narrate the 1921 discovery of insulin in Toronto. Ben brings in detailed context from Thea Cooper's book 'Breakthrough' and the mechanics of early pancreatic extraction.16:43–25:42 · Guest teaching 2/10 August Krogh, Marie Krogh, and the Danish Connection David details August and Marie Krogh's journey to the US and Toronto, while Ben adds color on Niels Bohr's father and early diabetes treatment dynamics.25:43–37:28 · Guest teaching 1/10 The Animal Supply Bottleneck and Lion Chemical Factory Ben presents exact quantitative figures on the massive number of animal pancreases required to produce human insulin, while David explains the Lion Chemical Factory partnership.37:29–46:41 · Guest teaching 1/10 The Petersen Brothers' Split and the Birth of Novo David recounts the dramatic fallout between Hagedorn and the Petersen brothers leading to the creation of Novo, while Ben draws parallels to classic corporate rivalries.46:41–57:09 · Guest teaching 1/10 Rapid Innovation, Liquid Insulin, and Supreme Court Battles The co-hosts explore Novo's formulation of shelf-stable liquid insulin, the Danish Supreme Court patent battle, and the diverging fortunes of Novo and Nordisk during WWII.57:09–1:07:46 · Guest teaching 1/10 Post-War Breakthroughs, Lente Insulin, and Enzyme Diversification Ben explains the biological kinetics of sustained-release formulations while David traces the post-war enzyme diversification and Nordisk's unexpected comeback under CEO Henry Brennum.1:07:47–1:13:23 · Guest teaching 1/10 The 1980 Insulin Landscape and Silicon Valley's Biotech Dawn David sets the stage for 1980 market share numbers and the dawn of recombinant DNA, transitioning into the Genentech turning point.1:13:24–1:22:15 · Guest teaching 2/10 Genentech, Recombinant DNA, and the Synthetic Insulin Race David explains Genentech's synthetic insulin partnership with Eli Lilly and Novo's ill-fated chemical modification of pig insulin, with Ben highlighting market cap dynamics.1:22:15–1:31:57 · Guest teaching 1/10 Decoding the US Healthcare and Pharmacy Benefit Manager Machine Ben delivers a structured breakdown of the US pharmaceutical supply chain, detailing the complex interplay between manufacturers, wholesalers, pharmacies, insurers, and PBMs.1:31:57–1:37:26 · Guest teaching 1/10 The 1989 Novo Nordisk Merger and Explosive Global Growth David details the 1989 Novo-Nordisk merger terms and the combined entity's rapid 1990s revenue compounding.1:37:26–1:43:48 · Guest teaching 1/10 The 2004 Serono Sale Attempt and the Foundation Veto David and Ben discuss the 2004 Serono buyout attempt and the crucial veto exercised by the Novo Nordisk Foundation board.1:43:49–1:51:07 · Guest teaching 1/10 Lotte Bjerre Knudsen and the Invention of Liraglutide Ben and David review Lotte Bjerre Knudsen's breakthrough in stabilizing GLP-1 by attaching a fatty acid chain to bind with albumin.1:51:08–2:00:30 · Guest teaching 1/10 Gila Monster Venom and Eli Lilly's Byetta David and Ben discuss Daniel Drucker and John Eng's research on Gila monster venom, leading to Byetta, alongside clinical trial phase mechanics.2:00:30–2:07:24 · Guest teaching 1/10 Overcoming the Obesity Stigma and the Fen-Phen Legacy The hosts analyze historical obesity stigma, the catastrophic Fen-Phen fallout, and the shift toward recognizing obesity as a metabolic disease.2:07:25–2:16:45 · Guest teaching 1/10 Victoza, Saxenda, and the 10% Weight Loss Threshold The hosts discuss Victoza's blockbuster sales, Saxenda's moderate weight loss results failing to hit the 10% threshold, and the 2016 stock drop.2:16:46–2:27:19 · Guest teaching 1/10 Ozempic, Wegovy, and Global Supply Shortages Ben and David cover semaglutide's launch as Ozempic and Wegovy, the biological mechanisms of satiety and gastric emptying, and unprecedented supply constraints.2:27:19–2:34:44 · Guest teaching 1/10 Healthcare Economics, Misaligned Payer Incentives, and Medicare Ben breaks down the misalignment between the average 3.7-year private insurance tenure and lifelong chronic disease prevention, alongside Medicare Part D restrictions.2:34:45–2:44:50 · Guest teaching 1/10 Eli Lilly's Tirzepatide, CagriSema, and Patient Adherence Challenges The hosts discuss Eli Lilly's dual-agonist Mounjaro/Zepbound, patient adherence data showing 68% drop-off within a year, and the erosion of insulin profitability.2:44:51–2:56:38 · Guest teaching 1/10 Hamilton Helmer's 7 Powers Analysis of Novo Nordisk Ben and David apply Hamilton Helmer's 7 Powers framework, debating whether Ozempic exhibits genuine network economies or exceptional word-of-mouth marketing.2:56:39–3:06:56 · Guest teaching 1/10 Playbook: Extreme Concentration, Foundation Structure, and Executive Alignment The hosts analyze Novo's unique foundation ownership, lack of stock option compensation for executives, and multi-decade research horizon.3:06:57–3:13:44 · Guest teaching 1/10 Playbook: Mass Population Drugs vs. Specialty Pharma Venture Economics Ben outlines the contrast between broad-population primary care drugs and high-priced specialty orphan drugs, citing the 'better-than-the-Beatles' regulatory barrier.3:13:44–3:22:38 · Guest teaching 1/10 Playbook: Healthcare Macroeconomics and the Shift to Chronic Illness Ben challenges the conventional narrative that healthcare costs are purely waste, arguing that society simply consumes significantly more complex, life-enhancing interventions today.3:22:39–3:33:08 · Guest teaching 1/10 Value Creation vs. Value Capture and the Role of Healthcare Intermediaries Ben and David contrast the genuine scientific R&D risk taken by pharmaceutical companies against the rent-seeking insulation of PBMs and health insurers.3:33:09–3:42:30 · Guest teaching 1/10 Bear and Bull Cases for Novo Nordisk and GLP-1 Supercycles The hosts outline the bull and bear cases for Novo Nordisk and Eli Lilly, discussing next-gen triple agonists and potential adverse side effects like lean muscle mass loss.5:29–16:42 · Guest disagreement 1/10 The 1921 Discovery of Insulin at the University of Toronto Ben and David collaboratively narrate the 1921 discovery of insulin in Toronto. Ben brings in detailed context from Thea Cooper's book 'Breakthrough' and the mechanics of early pancreatic extraction.16:43–25:42 · Guest disagreement 1/10 August Krogh, Marie Krogh, and the Danish Connection David details August and Marie Krogh's journey to the US and Toronto, while Ben adds color on Niels Bohr's father and early diabetes treatment dynamics.25:43–37:28 · Guest disagreement 1/10 The Animal Supply Bottleneck and Lion Chemical Factory Ben presents exact quantitative figures on the massive number of animal pancreases required to produce human insulin, while David explains the Lion Chemical Factory partnership.37:29–46:41 · Guest disagreement 1/10 The Petersen Brothers' Split and the Birth of Novo David recounts the dramatic fallout between Hagedorn and the Petersen brothers leading to the creation of Novo, while Ben draws parallels to classic corporate rivalries.46:41–57:09 · Guest disagreement 1/10 Rapid Innovation, Liquid Insulin, and Supreme Court Battles The co-hosts explore Novo's formulation of shelf-stable liquid insulin, the Danish Supreme Court patent battle, and the diverging fortunes of Novo and Nordisk during WWII.57:09–1:07:46 · Guest disagreement 1/10 Post-War Breakthroughs, Lente Insulin, and Enzyme Diversification Ben explains the biological kinetics of sustained-release formulations while David traces the post-war enzyme diversification and Nordisk's unexpected comeback under CEO Henry Brennum.1:07:47–1:13:23 · Guest disagreement 1/10 The 1980 Insulin Landscape and Silicon Valley's Biotech Dawn David sets the stage for 1980 market share numbers and the dawn of recombinant DNA, transitioning into the Genentech turning point.1:13:24–1:22:15 · Guest disagreement 1/10 Genentech, Recombinant DNA, and the Synthetic Insulin Race David explains Genentech's synthetic insulin partnership with Eli Lilly and Novo's ill-fated chemical modification of pig insulin, with Ben highlighting market cap dynamics.1:22:15–1:31:57 · Guest disagreement 1/10 Decoding the US Healthcare and Pharmacy Benefit Manager Machine Ben delivers a structured breakdown of the US pharmaceutical supply chain, detailing the complex interplay between manufacturers, wholesalers, pharmacies, insurers, and PBMs.1:31:57–1:37:26 · Guest disagreement 1/10 The 1989 Novo Nordisk Merger and Explosive Global Growth David details the 1989 Novo-Nordisk merger terms and the combined entity's rapid 1990s revenue compounding.1:37:26–1:43:48 · Guest disagreement 1/10 The 2004 Serono Sale Attempt and the Foundation Veto David and Ben discuss the 2004 Serono buyout attempt and the crucial veto exercised by the Novo Nordisk Foundation board.1:43:49–1:51:07 · Guest disagreement 1/10 Lotte Bjerre Knudsen and the Invention of Liraglutide Ben and David review Lotte Bjerre Knudsen's breakthrough in stabilizing GLP-1 by attaching a fatty acid chain to bind with albumin.1:51:08–2:00:30 · Guest disagreement 1/10 Gila Monster Venom and Eli Lilly's Byetta David and Ben discuss Daniel Drucker and John Eng's research on Gila monster venom, leading to Byetta, alongside clinical trial phase mechanics.2:00:30–2:07:24 · Guest disagreement 1/10 Overcoming the Obesity Stigma and the Fen-Phen Legacy The hosts analyze historical obesity stigma, the catastrophic Fen-Phen fallout, and the shift toward recognizing obesity as a metabolic disease.2:07:25–2:16:45 · Guest disagreement 1/10 Victoza, Saxenda, and the 10% Weight Loss Threshold The hosts discuss Victoza's blockbuster sales, Saxenda's moderate weight loss results failing to hit the 10% threshold, and the 2016 stock drop.2:16:46–2:27:19 · Guest disagreement 1/10 Ozempic, Wegovy, and Global Supply Shortages Ben and David cover semaglutide's launch as Ozempic and Wegovy, the biological mechanisms of satiety and gastric emptying, and unprecedented supply constraints.2:27:19–2:34:44 · Guest disagreement 1/10 Healthcare Economics, Misaligned Payer Incentives, and Medicare Ben breaks down the misalignment between the average 3.7-year private insurance tenure and lifelong chronic disease prevention, alongside Medicare Part D restrictions.2:34:45–2:44:50 · Guest disagreement 1/10 Eli Lilly's Tirzepatide, CagriSema, and Patient Adherence Challenges The hosts discuss Eli Lilly's dual-agonist Mounjaro/Zepbound, patient adherence data showing 68% drop-off within a year, and the erosion of insulin profitability.2:44:51–2:56:38 · Guest disagreement 2/10 Hamilton Helmer's 7 Powers Analysis of Novo Nordisk Ben and David apply Hamilton Helmer's 7 Powers framework, debating whether Ozempic exhibits genuine network economies or exceptional word-of-mouth marketing.2:56:39–3:06:56 · Guest disagreement 1/10 Playbook: Extreme Concentration, Foundation Structure, and Executive Alignment The hosts analyze Novo's unique foundation ownership, lack of stock option compensation for executives, and multi-decade research horizon.3:06:57–3:13:44 · Guest disagreement 1/10 Playbook: Mass Population Drugs vs. Specialty Pharma Venture Economics Ben outlines the contrast between broad-population primary care drugs and high-priced specialty orphan drugs, citing the 'better-than-the-Beatles' regulatory barrier.3:13:44–3:22:38 · Guest disagreement 1/10 Playbook: Healthcare Macroeconomics and the Shift to Chronic Illness Ben challenges the conventional narrative that healthcare costs are purely waste, arguing that society simply consumes significantly more complex, life-enhancing interventions today.3:22:39–3:33:08 · Guest disagreement 1/10 Value Creation vs. Value Capture and the Role of Healthcare Intermediaries Ben and David contrast the genuine scientific R&D risk taken by pharmaceutical companies against the rent-seeking insulation of PBMs and health insurers.3:33:09–3:42:30 · Guest disagreement 1/10 Bear and Bull Cases for Novo Nordisk and GLP-1 Supercycles The hosts outline the bull and bear cases for Novo Nordisk and Eli Lilly, discussing next-gen triple agonists and potential adverse side effects like lean muscle mass loss.5:29–16:42 · Ben and David pushing back 1/10 The 1921 Discovery of Insulin at the University of Toronto Ben and David collaboratively narrate the 1921 discovery of insulin in Toronto. Ben brings in detailed context from Thea Cooper's book 'Breakthrough' and the mechanics of early pancreatic extraction.16:43–25:42 · Ben and David pushing back 1/10 August Krogh, Marie Krogh, and the Danish Connection David details August and Marie Krogh's journey to the US and Toronto, while Ben adds color on Niels Bohr's father and early diabetes treatment dynamics.25:43–37:28 · Ben and David pushing back 1/10 The Animal Supply Bottleneck and Lion Chemical Factory Ben presents exact quantitative figures on the massive number of animal pancreases required to produce human insulin, while David explains the Lion Chemical Factory partnership.37:29–46:41 · Ben and David pushing back 1/10 The Petersen Brothers' Split and the Birth of Novo David recounts the dramatic fallout between Hagedorn and the Petersen brothers leading to the creation of Novo, while Ben draws parallels to classic corporate rivalries.46:41–57:09 · Ben and David pushing back 1/10 Rapid Innovation, Liquid Insulin, and Supreme Court Battles The co-hosts explore Novo's formulation of shelf-stable liquid insulin, the Danish Supreme Court patent battle, and the diverging fortunes of Novo and Nordisk during WWII.57:09–1:07:46 · Ben and David pushing back 1/10 Post-War Breakthroughs, Lente Insulin, and Enzyme Diversification Ben explains the biological kinetics of sustained-release formulations while David traces the post-war enzyme diversification and Nordisk's unexpected comeback under CEO Henry Brennum.1:07:47–1:13:23 · Ben and David pushing back 1/10 The 1980 Insulin Landscape and Silicon Valley's Biotech Dawn David sets the stage for 1980 market share numbers and the dawn of recombinant DNA, transitioning into the Genentech turning point.1:13:24–1:22:15 · Ben and David pushing back 1/10 Genentech, Recombinant DNA, and the Synthetic Insulin Race David explains Genentech's synthetic insulin partnership with Eli Lilly and Novo's ill-fated chemical modification of pig insulin, with Ben highlighting market cap dynamics.1:22:15–1:31:57 · Ben and David pushing back 2/10 Decoding the US Healthcare and Pharmacy Benefit Manager Machine Ben delivers a structured breakdown of the US pharmaceutical supply chain, detailing the complex interplay between manufacturers, wholesalers, pharmacies, insurers, and PBMs.1:31:57–1:37:26 · Ben and David pushing back 1/10 The 1989 Novo Nordisk Merger and Explosive Global Growth David details the 1989 Novo-Nordisk merger terms and the combined entity's rapid 1990s revenue compounding.1:37:26–1:43:48 · Ben and David pushing back 1/10 The 2004 Serono Sale Attempt and the Foundation Veto David and Ben discuss the 2004 Serono buyout attempt and the crucial veto exercised by the Novo Nordisk Foundation board.1:43:49–1:51:07 · Ben and David pushing back 1/10 Lotte Bjerre Knudsen and the Invention of Liraglutide Ben and David review Lotte Bjerre Knudsen's breakthrough in stabilizing GLP-1 by attaching a fatty acid chain to bind with albumin.1:51:08–2:00:30 · Ben and David pushing back 1/10 Gila Monster Venom and Eli Lilly's Byetta David and Ben discuss Daniel Drucker and John Eng's research on Gila monster venom, leading to Byetta, alongside clinical trial phase mechanics.2:00:30–2:07:24 · Ben and David pushing back 1/10 Overcoming the Obesity Stigma and the Fen-Phen Legacy The hosts analyze historical obesity stigma, the catastrophic Fen-Phen fallout, and the shift toward recognizing obesity as a metabolic disease.2:07:25–2:16:45 · Ben and David pushing back 1/10 Victoza, Saxenda, and the 10% Weight Loss Threshold The hosts discuss Victoza's blockbuster sales, Saxenda's moderate weight loss results failing to hit the 10% threshold, and the 2016 stock drop.2:16:46–2:27:19 · Ben and David pushing back 1/10 Ozempic, Wegovy, and Global Supply Shortages Ben and David cover semaglutide's launch as Ozempic and Wegovy, the biological mechanisms of satiety and gastric emptying, and unprecedented supply constraints.2:27:19–2:34:44 · Ben and David pushing back 1/10 Healthcare Economics, Misaligned Payer Incentives, and Medicare Ben breaks down the misalignment between the average 3.7-year private insurance tenure and lifelong chronic disease prevention, alongside Medicare Part D restrictions.2:34:45–2:44:50 · Ben and David pushing back 1/10 Eli Lilly's Tirzepatide, CagriSema, and Patient Adherence Challenges The hosts discuss Eli Lilly's dual-agonist Mounjaro/Zepbound, patient adherence data showing 68% drop-off within a year, and the erosion of insulin profitability.2:44:51–2:56:38 · Ben and David pushing back 3/10 Hamilton Helmer's 7 Powers Analysis of Novo Nordisk Ben and David apply Hamilton Helmer's 7 Powers framework, debating whether Ozempic exhibits genuine network economies or exceptional word-of-mouth marketing.2:56:39–3:06:56 · Ben and David pushing back 1/10 Playbook: Extreme Concentration, Foundation Structure, and Executive Alignment The hosts analyze Novo's unique foundation ownership, lack of stock option compensation for executives, and multi-decade research horizon.3:06:57–3:13:44 · Ben and David pushing back 1/10 Playbook: Mass Population Drugs vs. Specialty Pharma Venture Economics Ben outlines the contrast between broad-population primary care drugs and high-priced specialty orphan drugs, citing the 'better-than-the-Beatles' regulatory barrier.3:13:44–3:22:38 · Ben and David pushing back 2/10 Playbook: Healthcare Macroeconomics and the Shift to Chronic Illness Ben challenges the conventional narrative that healthcare costs are purely waste, arguing that society simply consumes significantly more complex, life-enhancing interventions today.3:22:39–3:33:08 · Ben and David pushing back 1/10 Value Creation vs. Value Capture and the Role of Healthcare Intermediaries Ben and David contrast the genuine scientific R&D risk taken by pharmaceutical companies against the rent-seeking insulation of PBMs and health insurers.3:33:09–3:42:30 · Ben and David pushing back 1/10 Bear and Bull Cases for Novo Nordisk and GLP-1 Supercycles The hosts outline the bull and bear cases for Novo Nordisk and Eli Lilly, discussing next-gen triple agonists and potential adverse side effects like lean muscle mass loss.

speaking balance: gold is Ben and David, purple is the guest (3 minute bins)

0:00 · Ben and David 90.4% · guest 9.6%0:00 · Ben and David 90.4% · guest 9.6%3:00 · Ben and David 100% · guest 0%3:00 · Ben and David 100% · guest 0%6:00 · Ben and David 100% · guest 0%6:00 · Ben and David 100% · guest 0%9:00 · Ben and David 100% · guest 0%9:00 · Ben and David 100% · guest 0%12:00 · Ben and David 100% · guest 0%12:00 · Ben and David 100% · guest 0%15:00 · Ben and David 99.7% · guest 0.3%15:00 · Ben and David 99.7% · guest 0.3%18:00 · Ben and David 100% · guest 0%18:00 · Ben and David 100% · guest 0%21:00 · Ben and David 99.9% · guest 0.1%21:00 · Ben and David 99.9% · guest 0.1%24:00 · Ben and David 99.6% · guest 0.4%24:00 · Ben and David 99.6% · guest 0.4%27:00 · Ben and David 100% · guest 0%27:00 · Ben and David 100% · guest 0%30:00 · Ben and David 100% · guest 0%30:00 · Ben and David 100% · guest 0%33:00 · Ben and David 99.7% · guest 0.3%33:00 · Ben and David 99.7% · guest 0.3%36:00 · Ben and David 99.7% · guest 0.3%36:00 · Ben and David 99.7% · guest 0.3%39:00 · Ben and David 99.8% · guest 0.2%39:00 · Ben and David 99.8% · guest 0.2%42:00 · Ben and David 100% · guest 0%42:00 · Ben and David 100% · guest 0%45:00 · Ben and David 100% · guest 0%45:00 · Ben and David 100% · guest 0%48:00 · Ben and David 99.5% · guest 0.5%48:00 · Ben and David 99.5% · guest 0.5%51:00 · Ben and David 99.5% · guest 0.5%51:00 · Ben and David 99.5% · guest 0.5%54:00 · Ben and David 99.6% · guest 0.4%54:00 · Ben and David 99.6% · guest 0.4%57:00 · Ben and David 99.9% · guest 0.1%57:00 · Ben and David 99.9% · guest 0.1%1:00:00 · Ben and David 100% · guest 0%1:00:00 · Ben and David 100% · guest 0%1:03:00 · Ben and David 99.9% · guest 0.1%1:03:00 · Ben and David 99.9% · guest 0.1%1:06:00 · Ben and David 99.8% · guest 0.2%1:06:00 · Ben and David 99.8% · guest 0.2%1:09:00 · Ben and David 99.9% · guest 0.1%1:09:00 · Ben and David 99.9% · guest 0.1%1:12:00 · Ben and David 99.6% · guest 0.4%1:12:00 · Ben and David 99.6% · guest 0.4%1:15:00 · Ben and David 99.5% · guest 0.5%1:15:00 · Ben and David 99.5% · guest 0.5%1:18:00 · Ben and David 100% · guest 0%1:18:00 · Ben and David 100% · guest 0%1:21:00 · Ben and David 100% · guest 0%1:21:00 · Ben and David 100% · guest 0%1:24:00 · Ben and David 100% · guest 0%1:24:00 · Ben and David 100% · guest 0%1:27:00 · Ben and David 100% · guest 0%1:27:00 · Ben and David 100% · guest 0%1:30:00 · Ben and David 99.9% · guest 0.1%1:30:00 · Ben and David 99.9% · guest 0.1%1:33:00 · Ben and David 99.7% · guest 0.3%1:33:00 · Ben and David 99.7% · guest 0.3%1:36:00 · Ben and David 99.6% · guest 0.4%1:36:00 · Ben and David 99.6% · guest 0.4%1:39:00 · Ben and David 99.7% · guest 0.3%1:39:00 · Ben and David 99.7% · guest 0.3%1:42:00 · Ben and David 100% · guest 0%1:42:00 · Ben and David 100% · guest 0%1:45:00 · Ben and David 99.9% · guest 0.1%1:45:00 · Ben and David 99.9% · guest 0.1%1:48:00 · Ben and David 100% · guest 0%1:48:00 · Ben and David 100% · guest 0%1:51:00 · Ben and David 99.8% · guest 0.2%1:51:00 · Ben and David 99.8% · guest 0.2%1:54:00 · Ben and David 99.5% · guest 0.5%1:54:00 · Ben and David 99.5% · guest 0.5%1:57:00 · Ben and David 100% · guest 0%1:57:00 · Ben and David 100% · guest 0%2:00:00 · Ben and David 99.9% · guest 0.1%2:00:00 · Ben and David 99.9% · guest 0.1%2:03:00 · Ben and David 99.6% · guest 0.4%2:03:00 · Ben and David 99.6% · guest 0.4%2:06:00 · Ben and David 100% · guest 0%2:06:00 · Ben and David 100% · guest 0%2:09:00 · Ben and David 99.7% · guest 0.3%2:09:00 · Ben and David 99.7% · guest 0.3%2:12:00 · Ben and David 100% · guest 0%2:12:00 · Ben and David 100% · guest 0%2:15:00 · Ben and David 100% · guest 0%2:15:00 · Ben and David 100% · guest 0%2:18:00 · Ben and David 99.7% · guest 0.3%2:18:00 · Ben and David 99.7% · guest 0.3%2:21:00 · Ben and David 99.8% · guest 0.2%2:21:00 · Ben and David 99.8% · guest 0.2%2:24:00 · Ben and David 99.8% · guest 0.2%2:24:00 · Ben and David 99.8% · guest 0.2%2:27:00 · Ben and David 100% · guest 0%2:27:00 · Ben and David 100% · guest 0%2:30:00 · Ben and David 99.9% · guest 0.1%2:30:00 · Ben and David 99.9% · guest 0.1%2:33:00 · Ben and David 99.9% · guest 0.1%2:33:00 · Ben and David 99.9% · guest 0.1%2:36:00 · Ben and David 99.8% · guest 0.2%2:36:00 · Ben and David 99.8% · guest 0.2%2:39:00 · Ben and David 100% · guest 0%2:39:00 · Ben and David 100% · guest 0%2:42:00 · Ben and David 99.8% · guest 0.2%2:42:00 · Ben and David 99.8% · guest 0.2%2:45:00 · Ben and David 99.8% · guest 0.2%2:45:00 · Ben and David 99.8% · guest 0.2%2:48:00 · Ben and David 100% · guest 0%2:48:00 · Ben and David 100% · guest 0%2:51:00 · Ben and David 99.6% · guest 0.4%2:51:00 · Ben and David 99.6% · guest 0.4%2:54:00 · Ben and David 100% · guest 0%2:54:00 · Ben and David 100% · guest 0%2:57:00 · Ben and David 99.9% · guest 0.1%2:57:00 · Ben and David 99.9% · guest 0.1%3:00:00 · Ben and David 100% · guest 0%3:00:00 · Ben and David 100% · guest 0%3:03:00 · Ben and David 100% · guest 0%3:03:00 · Ben and David 100% · guest 0%3:06:00 · Ben and David 100% · guest 0%3:06:00 · Ben and David 100% · guest 0%3:09:00 · Ben and David 99.3% · guest 0.7%3:09:00 · Ben and David 99.3% · guest 0.7%3:12:00 · Ben and David 100% · guest 0%3:12:00 · Ben and David 100% · guest 0%3:15:00 · Ben and David 100% · guest 0%3:15:00 · Ben and David 100% · guest 0%3:18:00 · Ben and David 99.7% · guest 0.3%3:18:00 · Ben and David 99.7% · guest 0.3%3:21:00 · Ben and David 99.9% · guest 0.1%3:21:00 · Ben and David 99.9% · guest 0.1%3:24:00 · Ben and David 99.9% · guest 0.1%3:24:00 · Ben and David 99.9% · guest 0.1%3:27:00 · Ben and David 99.9% · guest 0.1%3:27:00 · Ben and David 99.9% · guest 0.1%3:30:00 · Ben and David 99.9% · guest 0.1%3:30:00 · Ben and David 99.9% · guest 0.1%3:33:00 · Ben and David 99.8% · guest 0.2%3:33:00 · Ben and David 99.8% · guest 0.2%3:36:00 · Ben and David 100% · guest 0%3:36:00 · Ben and David 100% · guest 0%3:39:00 · Ben and David 100% · guest 0%3:39:00 · Ben and David 100% · guest 0%3:42:00 · Ben and David 100% · guest 0%3:42:00 · Ben and David 100% · guest 0%3:45:00 · Ben and David 36.5% · guest 63.5%3:45:00 · Ben and David 36.5% · guest 63.5%
Sharpest disagreement ▶ 2:53:05 David pushes back on Ben's network economy framing

David directly challenges Ben's assertion that Ozempic has network economies, arguing that people becoming walking billboards is powerful word-of-mouth rather than a structural network effect.

Hardest push from Ben and David ▶ 3:21:05 Ben challenges the simplistic critique of rising healthcare GDP

Ben pushes back against the standard narrative that rising healthcare expenditure is entirely inefficient, pointing out that individuals consume far more advanced procedures and preventative screenings than in previous decades.

Biggest teaching moment ▶ 1:14:00 David explains why Type II diabetes was historically called non-insulin dependent

David educates Ben on the historical context of diabetes treatment, explaining that Type II was originally labeled non-insulin dependent simply because animal pancreas supplies were too limited to treat it.

Ben and David hold their own ▶ 1:25:00 Ben details the hidden rebate dynamics of PBMs

Ben provides a deep, expert walkthrough of how PBM formulary rebates work, citing data from Eli Lilly where rebates made up 75% of the list price of insulin.

the scores for every segment, with the reasoning behind each
ChapterTopicBen and David as informed peerGuest teachingGuest disagreementBen and David pushing backWhy
The 1921 Discovery of Insulin at the University of Toronto 6111 Ben and David collaboratively narrate the 1921 discovery of insulin in Toronto. Ben brings in detailed context from Thea Cooper's book 'Breakthrough' and the mechanics of early pancreatic extraction.
August Krogh, Marie Krogh, and the Danish Connection 5211 David details August and Marie Krogh's journey to the US and Toronto, while Ben adds color on Niels Bohr's father and early diabetes treatment dynamics.
The Animal Supply Bottleneck and Lion Chemical Factory 6111 Ben presents exact quantitative figures on the massive number of animal pancreases required to produce human insulin, while David explains the Lion Chemical Factory partnership.
The Petersen Brothers' Split and the Birth of Novo 5111 David recounts the dramatic fallout between Hagedorn and the Petersen brothers leading to the creation of Novo, while Ben draws parallels to classic corporate rivalries.
Rapid Innovation, Liquid Insulin, and Supreme Court Battles 5111 The co-hosts explore Novo's formulation of shelf-stable liquid insulin, the Danish Supreme Court patent battle, and the diverging fortunes of Novo and Nordisk during WWII.
Post-War Breakthroughs, Lente Insulin, and Enzyme Diversification 6111 Ben explains the biological kinetics of sustained-release formulations while David traces the post-war enzyme diversification and Nordisk's unexpected comeback under CEO Henry Brennum.
The 1980 Insulin Landscape and Silicon Valley's Biotech Dawn 4111 David sets the stage for 1980 market share numbers and the dawn of recombinant DNA, transitioning into the Genentech turning point.
Genentech, Recombinant DNA, and the Synthetic Insulin Race 6211 David explains Genentech's synthetic insulin partnership with Eli Lilly and Novo's ill-fated chemical modification of pig insulin, with Ben highlighting market cap dynamics.
Decoding the US Healthcare and Pharmacy Benefit Manager Machine 8112 Ben delivers a structured breakdown of the US pharmaceutical supply chain, detailing the complex interplay between manufacturers, wholesalers, pharmacies, insurers, and PBMs.
The 1989 Novo Nordisk Merger and Explosive Global Growth 6111 David details the 1989 Novo-Nordisk merger terms and the combined entity's rapid 1990s revenue compounding.
The 2004 Serono Sale Attempt and the Foundation Veto 6111 David and Ben discuss the 2004 Serono buyout attempt and the crucial veto exercised by the Novo Nordisk Foundation board.
Lotte Bjerre Knudsen and the Invention of Liraglutide 7111 Ben and David review Lotte Bjerre Knudsen's breakthrough in stabilizing GLP-1 by attaching a fatty acid chain to bind with albumin.
Gila Monster Venom and Eli Lilly's Byetta 6111 David and Ben discuss Daniel Drucker and John Eng's research on Gila monster venom, leading to Byetta, alongside clinical trial phase mechanics.
Overcoming the Obesity Stigma and the Fen-Phen Legacy 6111 The hosts analyze historical obesity stigma, the catastrophic Fen-Phen fallout, and the shift toward recognizing obesity as a metabolic disease.
Victoza, Saxenda, and the 10% Weight Loss Threshold 6111 The hosts discuss Victoza's blockbuster sales, Saxenda's moderate weight loss results failing to hit the 10% threshold, and the 2016 stock drop.
Ozempic, Wegovy, and Global Supply Shortages 7111 Ben and David cover semaglutide's launch as Ozempic and Wegovy, the biological mechanisms of satiety and gastric emptying, and unprecedented supply constraints.
Healthcare Economics, Misaligned Payer Incentives, and Medicare 7111 Ben breaks down the misalignment between the average 3.7-year private insurance tenure and lifelong chronic disease prevention, alongside Medicare Part D restrictions.
Eli Lilly's Tirzepatide, CagriSema, and Patient Adherence Challenges 7111 The hosts discuss Eli Lilly's dual-agonist Mounjaro/Zepbound, patient adherence data showing 68% drop-off within a year, and the erosion of insulin profitability.
Hamilton Helmer's 7 Powers Analysis of Novo Nordisk 6123 Ben and David apply Hamilton Helmer's 7 Powers framework, debating whether Ozempic exhibits genuine network economies or exceptional word-of-mouth marketing.
Playbook: Extreme Concentration, Foundation Structure, and Executive Alignment 6111 The hosts analyze Novo's unique foundation ownership, lack of stock option compensation for executives, and multi-decade research horizon.
Playbook: Mass Population Drugs vs. Specialty Pharma Venture Economics 7111 Ben outlines the contrast between broad-population primary care drugs and high-priced specialty orphan drugs, citing the 'better-than-the-Beatles' regulatory barrier.
Playbook: Healthcare Macroeconomics and the Shift to Chronic Illness 7112 Ben challenges the conventional narrative that healthcare costs are purely waste, arguing that society simply consumes significantly more complex, life-enhancing interventions today.
Value Creation vs. Value Capture and the Role of Healthcare Intermediaries 8111 Ben and David contrast the genuine scientific R&D risk taken by pharmaceutical companies against the rent-seeking insulation of PBMs and health insurers.
Bear and Bull Cases for Novo Nordisk and GLP-1 Supercycles 6111 The hosts outline the bull and bear cases for Novo Nordisk and Eli Lilly, discussing next-gen triple agonists and potential adverse side effects like lean muscle mass loss.

Statements from this episode (82)

Assertion Supported
Novo Nordisk is controlled by a non-profit foundation
“This pharma giant is unique in that they are owned and controlled by a non-profit foundation.”
Ben Gilbert Jan 22, 2024 ▶ 1:29
Assertion Supported
Novo Nordisk surpassed LVMH as Europe's largest company by market cap
“Novo Nordisk has become Europe's largest company, surpassing even LVMH last year”
Ben Gilbert Jan 22, 2024 ▶ 2:11
Assertion Contradicted
Historical consensus credits Banting and Best for discovering insulin
“The historical consensus at this point now being that it really was Banting and Best who did all the work.”
David Rosenthal Jan 22, 2024 ▶ 6:30
Assertion Supported
Only 5% of diabetes patients today have type 1
“Only five percent of diabetes sufferers have type one today.”
Ben Gilbert Jan 22, 2024 ▶ 7:10
Assertion Supported
1920s academic culture viewed commercializing medical breakthroughs as unethical
“This is foreshadowing a little bit, but the era that we're in here in 1921, there is a firewall between industry and medical science, and it was perceived to be unethical to make money on taking your medical breakthroughs and sort of turning them into companie…”
Ben Gilbert Jan 22, 2024 ▶ 12:20
Assertion Supported
The University of Toronto gave Eli Lilly an exclusive insulin license
“Is they license production and development rights to a large American drug company based in Indiana, Eli Lilly. And they give Eli Lilly a one-year exclusive development license to try and mass produce this substance.”
David Rosenthal Jan 22, 2024 ▶ 13:16
Assertion Supported
Eli Lilly traded manufacturing improvements for brand rights in early deal
“The other interesting thing to note about the Eli Lilly license, David, which I thought was really clever, is it's a one-year exclusive license where there's two conditions, and the conditions are a trade. One, Eli Lilly has to report back any advances that th…”
Ben Gilbert Jan 22, 2024 ▶ 15:18
Assertion Supported
Eli Lilly remains larger than Novo Nordisk by market capitalization
“This moment, this insulin moment, this is what really turbocharges them and makes them into one of, if not the first kind of leading American and international pharmaceutical company, which it still is to this day, still bigger than Nova Nordisk. Although not …”
David Rosenthal Jan 22, 2024 ▶ 16:10
Assertion Supported
Novo Nordisk's founder nominated Banting and Macleod for the Nobel Prize
“The actual nomination for that prize was put forth by a previous Nobel Prize winner in physiology or medicine. The 1920 Nobel Prize winner from Copenhagen, Denmark, a animal biologist named August Crowe. Who also happens to be the founder of Novo Nordisk.”
David Rosenthal Jan 22, 2024 ▶ 17:01
Assertion Contradicted
Marie Krogh was Denmark's first female medical doctorate recipient
“She is a physician, so she's the first woman in Denmark to earn a doctorate in medicine”
David Rosenthal Jan 22, 2024 ▶ 19:31
Assertion Supported
Danish law prohibited patenting pharmaceutical drugs in the early 1920s
“Now, funnily enough, at this particular point in time, it turns out you actually can't Patent drugs in Denmark.”
David Rosenthal Jan 22, 2024 ▶ 23:45
Assertion Supported
Producing one pound of animal insulin requires 23,500 animals' pancreases
“It takes 8000 pounds of pancreatic glands from 23,500 animals to make a single pound of human insulin.”
Ben Gilbert Jan 22, 2024 ▶ 26:12
Assertion Supported
Treating 30,000 diabetes patients in 1980 required one million animals annually
“To put that in more real numbers, that means that even by 1980, with all the advances, it took one million animals annually for 30,000 diabetes patients.”
David Rosenthal Jan 22, 2024 ▶ 26:25
What-if
Novo Nordisk survived only because of its foundation ownership structure
“And, foreshadowing, there is a moment much later in history where, absent the control of this foundation, Novo Nordisk would have ceased to exist. It is only because of this structure that Novo Nordisk survived, and that we have GLP-I's and everything we have …”
David Rosenthal Jan 22, 2024 ▶ 34:48
Assertion Partly supported
Lego and Maersk share Novo Nordisk's foundation ownership model
“By the way, this is not that uncommon in Danish companies. Lego, same structure. Maersk, the shipping company, same structure.”
Ben Gilbert Jan 22, 2024 ▶ 35:07
Assertion Supported
The Novo Nordisk Foundation controls 77% of voting shares
“The operating company is now publicly traded, but still, that foundation controls 77% of the voting shares of Novo Nordisk and 28% of the economic shares.”
David Rosenthal Jan 22, 2024 ▶ 36:53
Assertion Supported
Novo and Nordisk competed head-to-head for 65 years before merging
“And for the next 65 years, these two companies would compete In blood sport, head to head, hated each other, absolutely hated each other until they finally merged in 1989.”
David Rosenthal Jan 22, 2024 ▶ 40:52
Insight
Insulin is the only product besides food with lifelong recurring demand
“There's basically nothing other than food that you can sell someone for their entire life, but for diabetics, insulin absolutely has that scenario with a customer.”
Ben Gilbert Jan 22, 2024 ▶ 43:02
Assertion Supported
Early Nordisk insulin required dissolving solid tablets before injection
“What Nordisk was originally producing, were insulin tablets Solid insulin tablets. Now, until recent times, you can't take insulin in tablet form. It doesn't get absorbed by the gut. You have to inject it. So what patients had to do was take these solid tablet…”
David Rosenthal Jan 22, 2024 ▶ 44:03
Assertion Partly supported
Novo invented the modern insulin pen in the 1980s
“It's Novo in the 19 eighties that invents the insulin pen.”
David Rosenthal Jan 22, 2024 ▶ 44:59
Assertion Supported
Novo launched shelf-stable liquid insulin at half the price of Nordisk
“So they go to market, Novo goes to market with their Novo insulin as insulin at half price because it's so much more efficient.”
David Rosenthal Jan 22, 2024 ▶ 47:55
Assertion Supported
Nordisk licensed NPH insulin globally while refusing to license to Novo
“So Nordisk, rather than building up production facilities around the world, what they decide to do is license it back to basically any interested pharma company. So like Eli Lilly back in the States, other companies in Continental Europe. It's the new, widely …”
David Rosenthal Jan 22, 2024 ▶ 49:00
Insight
Narrow molecule patents let pharma competitors design around drug protections
“The thing about pharma patents, which is interesting, is they're fairly narrow. You can patent a molecule. I don't think this is quite true at the time, but the way it sort of works today is you patent a molecule, which is extremely specific. It's different th…”
Ben Gilbert Jan 22, 2024 ▶ 50:03
Assertion Supported
Nordisk founder Hagedorn represented his company at the Supreme Court
“It actually ends up going to the Danish Supreme Court, where Hagedorn represents Nordisk himself. You know, in the lower courts, they had lawyers, and I think they lost the case in the lower courts, and Hagedorn's like, screw this. I'm gonna be my own lawyer. …”
David Rosenthal Jan 22, 2024 ▶ 51:00
Assertion Contradicted
Germany directed Novo to supply insulin across Nazi-occupied Europe
“They are now essentially the official Nazi-sanctioned insulin provider for all of Nazi-occupied Europe. So, the German government basically directs Novo To massively expand production and supply insulate, you know, not only to Germany, but to France, to Poland…”
David Rosenthal Jan 22, 2024 ▶ 54:01
Assertion Partly supported
Denmark required Novo to repay World War II profits
“It is important to note, though, after the war, the Danish state did require both Novo and the Peterson brothers personally to repay most of the profits that they made during the war back to the Danish state.”
David Rosenthal Jan 22, 2024 ▶ 55:45
Assertion Partly supported
Nordisk grew sales at 30% annually throughout the 1970s
“So for the entire decade of the 19 seventies, Nordisk's sales grow at 30% compounded annually, which is amazing.”
David Rosenthal Jan 22, 2024 ▶ 1:07:04
Assertion Supported
Eli Lilly, Novo, and Nordisk dominated global insulin sales in 1980
“Novo's annual global insulin sales, this is Novo, they're still much larger. They're about a hundred million dollars annually. And Nordisk's are about thirty million annually. That makes them the number two and number four producers in the world by market shar…”
David Rosenthal Jan 22, 2024 ▶ 1:08:00
Assertion Supported
Type 2 diabetes cases quadrupled globally between 1980 and 2016
“And just to put some numbers on that, the number of type two diabetes patients quadruples from 1980 to 2016.”
David Rosenthal Jan 22, 2024 ▶ 1:13:38
Assertion Supported
Insulin was the first genetically engineered drug in biotech history
“The first drug that they genetically engineered And that started this whole revolution was insulin.”
David Rosenthal Jan 22, 2024 ▶ 1:15:01
Assertion Supported
Novo rejected Genentech's offer to partner on recombinant human insulin
“Genentech had actually approached them about being a partner in Europe. Novo had turned them down because they didn't think the science was ready yet, and they were wrong.”
David Rosenthal Jan 22, 2024 ▶ 1:16:52
Assertion Supported
Genentech was the largest venture-backed IPO until Apple's debut
“They go public and it is, I believe the largest venture backed IPO ever at that time. Until it's eclipsed two months later when Apple goes public.”
David Rosenthal Jan 22, 2024 ▶ 1:18:41
Assertion Supported
Novo Nordisk, Eli Lilly, and Sanofi control the entire insulin market
“Sanofi today, yeah, the three of those companies are essentially the entire insulin market.”
Ben Gilbert Jan 22, 2024 ▶ 1:20:31
Assertion Supported
Pharmacy benefit managers managed benefits for 266 million Americans in 2016
“PBMs manage pharmacy benefits for two hundred and sixty-six million Americans, and that number's old. That's as of twenty-sixteen.”
Ben Gilbert Jan 22, 2024 ▶ 1:28:12
Assertion Supported
Three pharmacy benefit managers control 80% of the United States market
“Despite there used to being hundreds of PBMs, there's now fewer than 30, and there's essentially three that cover about 80% of the market, and those are Express Scripts, CVS Caremark and OptumRx, which is actually owned by UnitedHealth Group.”
Ben Gilbert Jan 22, 2024 ▶ 1:28:23
Assertion Supported
Eli Lilly claimed rebates account for 75% of insulin's sticker price
“Eli Lilly has publicly claimed that the cost of these discounts and rebates accounted for 75% of the sticker price of insulin.”
Ben Gilbert Jan 22, 2024 ▶ 1:30:33
Assertion Partly supported
Novo Nordisk and Eli Lilly controlled 95% of the insulin market
“So the new combined company has roughly a billion dollars in insulin revenue and 50%, five zero percent global market share with Eli Lilly just behind at 45% and host at five percent.”
David Rosenthal Jan 22, 2024 ▶ 1:33:27
Assertion Partly supported
The global insulin market quadrupled to $2 billion during the 1980s
“You know, that puts the total market size at roughly around two billion for insulin. 10 years ago, the total market size was five hundred million.”
David Rosenthal Jan 22, 2024 ▶ 1:33:49
Assertion Supported
The Novo Nordisk Foundation blocked a proposed Serono merger in 2004
“Management comes in, they present in two board meetings, first in August, 2004, and then the second one in September where they get a do over and they fail to convince the foundation board. So they block the merger.”
David Rosenthal Jan 22, 2024 ▶ 1:39:49
Assertion Supported
Liraglutide extends GLP-1 half-life to 13 hours in humans
“Liraglutide ends up having a half-life in the human body of 13 hours compared to, you know, like, a half-life of two and a half minutes for straight up GLP-I.”
David Rosenthal Jan 22, 2024 ▶ 1:49:05
Assertion Supported
Eli Lilly's Byetta became the first GLP-1 drug on market
“Eli Lilly develops it into Bayetta, and Bayetta hits the market in 2005. It's FDA approved, and it works. It's not poisonous. It doesn't kill people. And it is the world's first GLP-I analog to come to market.”
David Rosenthal Jan 22, 2024 ▶ 1:54:11
Assertion Supported
Phase 3 clinical trials account for 29% of drug R&D spending
“29% of all R&D for a drug is spent right here. So phase one is nine percent, phase two is 12%, phase three is 29%.”
Ben Gilbert Jan 22, 2024 ▶ 1:56:33
Assertion Supported
Only 8% of drugs entering clinical development pass Phase 3
“So of the 69% that even make it into clinical development, you've got 36% left at graduating phase one, then 13% left graduating phase two, then all the way at the end, eight percent graduating out of phase three.”
Ben Gilbert Jan 22, 2024 ▶ 1:57:54
Assertion Supported
Earlier diabetes medications commonly caused patient weight gain
“Many other anti-diabetic drugs up until this point had actually caused patients to gain weight.”
David Rosenthal Jan 22, 2024 ▶ 1:59:48
Assertion Contradicted
Annual global obesity drug sales were under $750 million until 2020
“The annual obesity drug sales were only seven hundred and forty-four million dollars up until twenty-twenty.”
Ben Gilbert Jan 22, 2024 ▶ 2:03:12
Insight
Weight loss drugs require safely achieving 10% reduction to create markets
“So there is sort of this, like, magic number around if you can actually safely enable someone to lose 10% of their body weight or more, then there's a market. But otherwise, it basically rounds to zero, because people just don't think it's worth the trouble, a…”
Ben Gilbert Jan 22, 2024 ▶ 2:03:44
Assertion Not yet assessed · timeframe Dec 2005
Novo Nordisk's CEO declared in 2005 that obesity was not a business
“As recently as 2005, 2005, like same year Baeta came out, Novo Nordisk's own official position on the obesity category, as articulated by the then CEO Lars Sorensen, was quote, Obesity is primarily a social and cultural problem. It should be solved by means of…”
David Rosenthal Jan 22, 2024 ▶ 2:04:09
Assertion Partly supported
Novo Nordisk's Victoza reached $1 billion in sales in 2011
“So year one in the first year that it's on the market, Victoza does roughly three hundred million dollars in sales. The next year, the first full year it's on the market in 2011, it does over a billion dollars in sales. Just in that year.”
David Rosenthal Jan 22, 2024 ▶ 2:08:44
Assertion Supported
Semaglutide requires once-weekly injections compared to daily liraglutide doses
“One, it is much, much longer lasting in the body, so it only needs to be injected once per week instead of once per day.”
David Rosenthal Jan 22, 2024 ▶ 2:15:37
Assertion Supported
Semaglutide is twice as effective as liraglutide for weight loss
“Two, and much more important for the near term, it is twice as effective as liraglutide for weight loss.”
David Rosenthal Jan 22, 2024 ▶ 2:15:53
Assertion Supported
Ozempic exceeded $1 billion in revenue during its first full year
“Ozempic does over a billion dollars in revenue in 2019. It's first year on the market.”
David Rosenthal Jan 22, 2024 ▶ 2:19:23
Assertion Contradicted
Wegovy matched Saxenda's lifetime United States doctor prescriptions in one month
“So when Wegevee finally launches in the U.S. In 2021 as the official FDA sanctioned weight loss version of semaglutide, it gets the same number of prescriptions written for it by doctors. In the first slightly over one month than Saxenda had in its entire drug…”
David Rosenthal Jan 22, 2024 ▶ 2:20:57
Assertion Partly supported
Novo Nordisk revenue grew from $20 billion to $30 billion recently
“Revenue goes from twenty billion in 2019 to 25 in 2021, Thirty billion in twenty-twenty-two, and in twenty-twenty-three, so far, and the first three quarters that they've reported, it is up another 30% year on year.”
David Rosenthal Jan 22, 2024 ▶ 2:22:51
Assertion Supported
GLP-1 drugs generate 69% of Novo Nordisk's total revenue
“51% of their revenue comes from diabetes-focused GLP-I drugs, and an additional 18% from obesity-related GLP-I. So 69% of their revenue comes from semaglutide or liraglutide.”
Ben Gilbert Jan 22, 2024 ▶ 2:23:21
Assertion Supported
Novo Nordisk's 84% gross margins surpass Microsoft and Google
“Gross margins are better than software. They run about 84%. Lilly is also a very high margin company, running about 80%. For context, Microsoft has a gross margin of 70% and Google is 56%.”
Ben Gilbert Jan 22, 2024 ▶ 2:24:28
Assertion Supported
Novo Nordisk tests semaglutide for Alzheimer's and kidney disease treatments
“So currently, Novo has clinical trials going for semaglutide, like same drug, same GLP-I's, use case in treating cardiovascular disease, in treating Alzheimer's, in treating kidney disease, many others.”
David Rosenthal Jan 22, 2024 ▶ 2:26:19
Assertion Supported
Wegovy and Ozempic cost over $1,000 monthly in the United States
“The price of Ozempic to treat diabetes is north of a thousand dollars, and Wegovy for weight loss is north of 1300 dollars per month before insurance, and this is in the U.S. So expensive, right? That's a lot of money. In Canada, of course, Ozempic is 147 doll…”
Ben Gilbert Jan 22, 2024 ▶ 2:27:32
Insight
United States healthcare struggles because insurance carriers have short-term time horizons
“This is the crux of the incentive problem in our healthcare system. There is just a mismatch in Time Horizon. You are invested in your own health for your whole life, but your insurance carrier is not.”
Ben Gilbert Jan 22, 2024 ▶ 2:29:48
Assertion Supported
Medicare is legally prohibited from covering weight-loss drugs
“Medicare Part D was passed into law in 2003 and took effect in 2006. It allowed Medicare to cover drugs, not just hospital and doctor visits, which was Part A and Part B. So today, Part D, interestingly enough, is legally prohibited from paying for weight loss…”
Ben Gilbert Jan 22, 2024 ▶ 2:30:39
Assertion Supported
Eli Lilly's tirzepatide secured diabetes approval in 2022 and obesity approval
“It was approved in the US for diabetes treatment in May, 20, 22, and approval just came recently in November, 20, 23 for official FDA sanctioned weight loss use case under the marketing name Zep bound.”
David Rosenthal Jan 22, 2024 ▶ 2:35:47
Prediction Not checkable as stated
Massive GLP-1 demand will enable multiple pharma hits like insulin
“I think this is going to be like insulin all over again, where there's just going to be a series of product improvements and companies will drive innovation and increase supply. I mean, the demand is so huge out there that Monroe can be a huge hit. Ozempic and…”
David Rosenthal Jan 22, 2024 ▶ 2:36:13
Assertion Supported
Research shows up to 68% of patients discontinue GLP-1s after a year
“There's some research that points out that as many as 68% of people roll off it after a year, and part of this is related to price, or changing insurance that doesn't cover it, or that it's hard to find since they're still supply constrained, or maybe there ar…”
Ben Gilbert Jan 22, 2024 ▶ 2:39:10
Assertion Supported
United States officials alleged Novo increased insulin prices 600% since 2001
“In 2021, U.S. Officials alleged that Novo Nordisk increased prices more than 600% between 2001 and 2019 in lockstep with competitors to the detriment of diabetics.”
Ben Gilbert Jan 22, 2024 ▶ 2:41:34
Assertion Supported
Eli Lilly's United States insulin sales grew from $700M to $2.6B
“In 1999, I think it was, Eli Lilly sold seven hundred million dollars of insulin in America. 1999. By 2017, just two of their products sold 2.6 billion dollars in America.”
Ben Gilbert Jan 22, 2024 ▶ 2:44:24
Assertion Partly supported
Novo Nordisk holds the semaglutide patent until 2032
“Novo Nordisk has the patent on semaglutide until 2032.”
Ben Gilbert Jan 22, 2024 ▶ 2:45:46
Assertion Supported
Clinical studies show Mounjaro produces more weight loss than Ozempic
“The studies show Manjaro helps you lose more weight and has a very similar mechanism plus another mechanism that together work, but like, most people don't know that.”
Ben Gilbert Jan 22, 2024 ▶ 2:49:53
Assertion Partly supported
Novo Nordisk derives 85% of revenue from metabolic disorders
“85% of their revenue is dedicated to metabolic disorders. They are the second largest market cap pharma, second only to Eli Lilly.”
Ben Gilbert Jan 22, 2024 ▶ 2:56:52
Assertion Partly supported
Novo Nordisk Foundation's $120 billion endowment doubles the Gates Foundation
“Novo Holdings, which is the vehicle by which the foundation holds their stakes in Novo Nordisk and Novozymes, they're sort of assets under management and thus the endowment of the foundation. Is worth a hundred and twenty billion dollars, which makes it the si…”
David Rosenthal Jan 22, 2024 ▶ 2:59:30
Assertion Supported
Novo Nordisk awards no stock options to executives or board members
“Executives and board members are not given stock options as a part of their compensation.”
Ben Gilbert Jan 22, 2024 ▶ 3:04:13
Assertion Supported
Average drug development costs rose from $40 million to $2.5 billion
“If you just look at the cost to bring a drug to market in 1953, It costs forty million dollars for an approval, and that's an inflation-adjusted figure. Today, it averages 2.5 billion.”
Ben Gilbert Jan 22, 2024 ▶ 3:10:59
Assertion Supported
Only 10% of clinical drugs reach market, with one driving profits
“If you look at the pipeline of a hundred drugs that enter clinical development, 10 actually make it to market, and one provides, get this, half the profits.”
Ben Gilbert Jan 22, 2024 ▶ 3:12:38
Assertion Supported
Most approved pharmaceutical drugs fail to recoup their R&D costs
“Most drugs, this is also a crazy stat, even after they are approved, do not earn back their R&D costs.”
Ben Gilbert Jan 22, 2024 ▶ 3:13:03
Assertion Supported
United States healthcare spending grew from 5% to 17.3% of GDP
“The 17.3% of GDP that healthcare costs us, you should just know, as a baseline, that in 1960, that was five percent of GDP.”
Ben Gilbert Jan 22, 2024 ▶ 3:14:34
Assertion Supported
United States life expectancy declined recently despite higher healthcare spending
“The thing that isn't good is that the average life expectancies have actually declined in America the last few years, despite the fact that we're spending more money.”
Ben Gilbert Jan 22, 2024 ▶ 3:16:25
Insight
Legacy acute healthcare systems do not fit chronic illness treatments
“And so in many ways, this entire old system that we created that consumes 18% of our GDP may actually not make sense in this new world of treating the things that are more likely to kill us now, which is chronic illnesses.”
Ben Gilbert Jan 22, 2024 ▶ 3:20:04
Assertion Supported
The pharmaceutical industry ROIC is 13%, comparable to trucking and electronics
“When you actually look at their return on invested capital numbers, the ROIC, they are not through the roof. They're like 13% industry-wide, but hold for Novo for a second. It's totally in line with other industries, like trucking, broadcasting, electronics, w…”
Ben Gilbert Jan 22, 2024 ▶ 3:24:40
Assertion Supported
Pharmaceuticals account for only 13% of total healthcare revenue
“Pharma as a whole of the medical pie only occupies about 13% of revenue.”
Ben Gilbert Jan 22, 2024 ▶ 3:26:51
Assertion Partly supported
Hospitals and doctor offices make up 54% of healthcare revenue
“Hospitals, if you back out the drugs they prescribe, hospitals are 28% of the revenue in all of healthcare, which is large, but hospitals provide a crap ton of value. Professional services like doctor's offices are 26%.”
Ben Gilbert Jan 22, 2024 ▶ 3:28:12
Assertion Supported
AbbVie's Humira generated $200 billion across 11 approved indications
“Humira by AbbVie, that generated two hundred billion dollars in lifetime sales since Humira was approved for 11 different indications across this whole spectrum of inflammatory and autoimmune disorders.”
Ben Gilbert Jan 22, 2024 ▶ 3:34:14
Insight
A multi-indication blockbuster eliminates the need for a deep drug pipeline
“It turns out you actually don't need a deep pipeline if you have a drug that you can be profitable on, where there's not a lot of competitors for it, your patent actually gives you a good amount of room, you build a brand around it, you get approved for a ton …”
Ben Gilbert Jan 22, 2024 ▶ 3:34:39
Prediction Not checkable as stated
GLP-1s could surpass Humira and remain defensible for a decade
“So I think, assuming that Novo stays sort of neck and neck with Eli Lilly as they both keep coming out with better and better versions, that this could be the next Humira, or potentially much bigger than Humira. And I think the defensibility is an open questio…”
Ben Gilbert Jan 22, 2024 ▶ 3:35:25
Assertion Supported
Early studies show GLP-1 weight loss causes 40% lean muscle loss
“When you're losing weight normally, you lose, like, 25% lean muscle, and these early studies are showing it's something like 40%.”
Ben Gilbert Jan 22, 2024 ▶ 3:36:01
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