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The Future of Healthcare Technology with Eli Lilly and Company's Diogo Rau · Revisionist History

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  Speaker 1: Pushkin. Hello, Hello Revisionist History listeners, Happy New Year. Twenty
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  Speaker 1: remember last season, we did a series of interviews with
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• 1:01
  Speaker 1: Over here at Pushkin, we've been hard at work all
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  Speaker 1: with the goal of bringing you a little bit of
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  Speaker 1: audio happiness. Stay tuned, everyone, Welcome to Revisionist History. We
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  Speaker 1: have a special treat today. I had a chance to
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  Speaker 1: sit down with a guy named Diego Rao who worked
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  Speaker 1: for years at Apple Way UPI and then left to
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  Speaker 1: become the chief Information and Digital officer at Eli Lillian Company.
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  Speaker 1: One of the biggest drug makers in the world. Diogo,
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  Speaker 1: as you will learn, is irreverent and fascinating and sees
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  Speaker 1: a good ten years ahead of the rest of us.
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  Speaker 1: At the end of our conversation, Diego said to me,
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  Speaker 1: you know, we never got to AI, which is true.
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  Speaker 1: Can you imagine a conversation about technology so interesting that
• 1:45
  Speaker 1: you never get to the subject of artificial intelligence? That's
• 1:50
  Speaker 1: what you're about to hear. We're going to talk about
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  Speaker 1: a whole number of things, but I wanted you to
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  Speaker 1: start because you're a very unusual figure. You work it
• 2:01
  Speaker 1: for Eli Lily, but you are a very unusual figure
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  Speaker 1: at Eli Lilly. Is that a fair statement.
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  Speaker 2: I think I have that reputation of being unusual at
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  Speaker 2: least I like to try to do things a little
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  Speaker 2: bit differently.
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  Speaker 1: You know, I was talking about your background. Yeah, you
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  Speaker 1: you worked in the tech industry for how many years?
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  Speaker 2: I worked in the tech industry Well, really my whole life,
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  Speaker 2: But I the last ten years before I came to Lily,
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  Speaker 2: I was at Apple, and before that I was doing
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  Speaker 2: technical other kinds of technology work and McKenzie and before
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  Speaker 2: that I was in the startup world. So I've really
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  Speaker 2: spent my whole life in technology.
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  Speaker 1: How many people do you think have moved from Apple
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  Speaker 1: to a life sciences company?
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  Speaker 2: About five? I think I know them all.
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  Speaker 1: Do you guys get together reading most of them? And
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  Speaker 1: how did So this is a kind of I want
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  Speaker 1: to start this little on this little tangent, but how
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  Speaker 1: did that work? Exactly? So somebody comes to you and says,
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  Speaker 1: have you ever thought to work for a pharma company? Well?
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  Speaker 2: Yeah, And that's the way a lot of these things start.
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  Speaker 2: It's you know, there was a recruiter that I worked
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  Speaker 2: with who who gave me a call and said, hey,
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  Speaker 2: I've got this this opportunity. It's in life sciences, and
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  Speaker 2: I was like, I've never done anything in life sciences before.
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  Speaker 1: It's like, that's okay.
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  Speaker 2: So I look at the spec and the spec is,
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  Speaker 2: you know, it's pretty interesting. So I'm like, okay, it's
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  Speaker 2: worth a phone call. And then I meet our CEO
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  Speaker 2: and our head of HR and like, these people are
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  Speaker 2: really nice. And so that's like the second thing that
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  Speaker 2: I noticed is that they're really, really, really nice. And
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  Speaker 2: that's that's a big difference, by the way, coming from
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  Speaker 2: versus the tech world. I have to say a little
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  Speaker 2: more about that. And then I start talking to our
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  Speaker 2: head of research and development about some of the problems
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  Speaker 2: that we're trying to solve in life sciences, and I realized, Wow,
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  Speaker 2: this is like a fascinating space. I kind of thought
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  Speaker 2: that like everything exciting in the world was happening in tech,
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  Speaker 2: and then I then I came to realize, no, actually,
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  Speaker 2: there's a lot of exciting stuff that's happening outside of
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  Speaker 2: just the tech world.
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  Speaker 1: Yeah, so let's start. So you make this when did
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  Speaker 1: you start your job at.
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  Speaker 2: Lily May seventeenth, twenty twenty one.
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  Speaker 1: So go through, just off the top of your head,
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  Speaker 1: the most surprising things you learned moving from Silicon Valley
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  Speaker 1: to a life sciences company.
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  Speaker 2: Well, the number one thing that I actually saw was
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  Speaker 2: actually the nice people parts. But you know, the second
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  Speaker 2: thing that I noticed was really long time scales, Like
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  Speaker 2: the size in the duration of things is just it
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  Speaker 2: is just beyond belief. My first executive committee meeting in
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  Speaker 2: twenty twenty one, we were talking about a revenue forecast
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  Speaker 2: that was for two thousand and thirty and that was
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  Speaker 2: nine years out, like in tech, like, looking like eighteen
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  Speaker 2: months out of revenue is ridiculous.
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  Speaker 1: Well wait, wait, so when you see that, what's your
• 4:46
  Speaker 1: what's your reaction?
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  Speaker 2: Oh? Yes, there's no way we can predict our revenues
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  Speaker 2: for you know, for nine years from now. And of course,
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  Speaker 2: now I realize that I'm in here, that there are
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  Speaker 2: a lot of things that you can predict and it
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  Speaker 2: is actually very predictable. It's a big bed. If it works,
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  Speaker 2: you'll know you'll you'll hit it. But it's much less volatile.
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  Speaker 2: It's these time scales are crazy though, because like at
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  Speaker 2: our last Executive Committee meeting right before the break, we
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  Speaker 2: were talking about a product launch. I'll ask you a question,
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  Speaker 2: when guess when our product launch is that we were
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  Speaker 2: talking about in December.
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  Speaker 1: Well, now that you've prime Prime three, it's going to
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  Speaker 1: be five, six, seven years.
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  Speaker 2: No, twenty and thirty six, Oh my god. And so
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  Speaker 2: there is I can guarantee you that there are zero
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  Speaker 2: tech companies right now talking about what they're going to
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  Speaker 2: launch in twenty and thirty six.
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  Speaker 1: Yeah. Yeah, and wait there not only so there is
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  Speaker 1: certainty that this this product will be approved, but just
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  Speaker 1: the the you can be you can be ten years
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  Speaker 1: away and be certain will be approved, but know that
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  Speaker 1: you still have ten years worth of work to do.
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  Speaker 2: Yes, you can't be certain, of course, that anything is
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  Speaker 2: going to be approved, and so we apply a probability
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  Speaker 2: of technical success. This phrase I'd never heard of before
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  Speaker 2: I got here, But every step ale of the way
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  Speaker 2: has probability of technical success, and so you factor it
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  Speaker 2: in and you you know, you take all that into account.
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  Speaker 2: But you know, when you have a good medicine and
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  Speaker 2: you know what it's going to take. But it just
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  Speaker 2: takes ten years to bring a medicine to life, and
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  Speaker 2: it's and I don't think that was one of the
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  Speaker 2: things that I realized before I came into this, just
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  Speaker 2: how long it takes and how much money it takes.
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  Speaker 1: So it is possible that you will work on things
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  Speaker 1: that you will never see come to fruish.
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  Speaker 2: In fact, most of our scientists that work here will
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  Speaker 2: never see their medicines that they're working on come to life,
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  Speaker 2: which is kind of crazy to think of.
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  Speaker 1: And it's affect the culture of organization.
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  Speaker 2: It gives it a really long term perspective, like crazy
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  Speaker 2: long term perspective when we when we're talking about things
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  Speaker 2: making decisions, we're really not thinking, you know, like at
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  Speaker 2: an executive committee level, there are some things that we're
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  Speaker 2: doing on a you know, on a this year basis.
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  Speaker 2: But there are a lot of things that we're doing
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  Speaker 2: that we're really talking about, like the twenty thirties, like
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  Speaker 2: just just a much different timescale from from anything else.
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  Speaker 2: And so we're not going to do anything stupid. I
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  Speaker 2: think it's one of the one of the good things.
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  Speaker 2: We're not going to trade off some of the long
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  Speaker 2: term to get a little bit of a benefit in
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  Speaker 2: the short term. So I think it makes us much
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  Speaker 2: more rational all that way. I guess I would say
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  Speaker 2: we play the long game.
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  Speaker 1: But I want to go back to so you come
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  Speaker 1: to Lily and I'm curious, so what did they want
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  Speaker 1: from you?
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  Speaker 2: My boss, our CEO, gave me a mandate to really change,
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  Speaker 2: to bring in technology into everything that we that we did,
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  Speaker 2: So it was not a caretaker role, sort of a mandate.
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  Speaker 2: You know, we want you to just keep running the things.
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  Speaker 2: We want you to really figure out, like what can
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  Speaker 2: you do to shake things up? And so that was
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  Speaker 2: really that was really the goal. And I think a
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  Speaker 2: big part of it was bringing a consumer orientation as well.
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  Speaker 2: And I think this is an industry that has largely
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  Speaker 2: worked the same since the nineteen fifties, I mean, if
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  Speaker 2: you look at it, the way you get medicines today
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  Speaker 2: as a patient is basically unchanged. You go to your doctor,
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  Speaker 2: they write a form. Maybe now they submit your prescription electronically.
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  Speaker 2: You still have to make sure you can pay for
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  Speaker 2: You still have to go to a retail pharmacy in
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  Speaker 2: most cases. None of that's really changed since the nineteen fifties,
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  Speaker 2: even though we have so much more. So a big
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  Speaker 2: part of what we're trying to do is actually a
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  Speaker 2: big part of my mandate is to really bring this
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  Speaker 2: into the twenty first century, or at least the late
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  Speaker 2: twentieth century.
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  Speaker 1: But is there within the portfolio of things that Lily does,
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  Speaker 1: do you touch on everything or just are you? Are
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  Speaker 1: you focused on the consumer side of the business. I mean,
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  Speaker 1: what's the kind of not to remit?
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  Speaker 2: The great thing is that I get to focus on
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  Speaker 2: all of that stuff, So everything that's technology related. I
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  Speaker 2: do cover everything from the discovery side through the consumer side,
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  Speaker 2: and actually those are probably some of my favorite parts.
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  Speaker 2: And I'm going to because of course I shouldn't be
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  Speaker 2: say favorites, but you know, I love the discovery side
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  Speaker 2: and discovering new molecules and what we can do there
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  Speaker 2: a lot of cool stuff, especially with AI, we could
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  Speaker 2: talk for hours about. And the consumer side is also
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  Speaker 2: the place where I see where I have a passion
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  Speaker 2: coming from my prior life at Apple and just seeing
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  Speaker 2: the potential we have to change everything there. I think
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  Speaker 2: this whole industry hasn't really focused on, like how do
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  Speaker 2: we make it an amazing experience and work backwards. I
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  Speaker 2: think the kinds of things that you see at Apple
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  Speaker 2: and a lot of other consumer rinan companies just haven't
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  Speaker 2: haven't arrived here yet.
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  Speaker 1: And how does putting the customer first in that chain
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  Speaker 1: of the h in that chain of kind of interest
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  Speaker 1: groups change the way you do business or change the
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  Speaker 1: way you think about what you're doing.
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  Speaker 2: That was the most fundamental thing that I learned from
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  Speaker 2: my time at Apple. And I think most companies will say, oh,
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  Speaker 2: we care about the customer. But you know, whenever you
• 9:40
  Speaker 2: start a project, people will have I don't know, they'll
• 9:43
  Speaker 2: have five pillars or five things they need to go after. Well,
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  Speaker 2: maybe there's the business case, the product, the customer, the
• 9:48
  Speaker 2: you know, you know, you'll have like five or six
• 9:50
  Speaker 2: different things. And the way you'd always do things that
• 9:52
  Speaker 2: Apple was was different. You would always start by like
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  Speaker 2: what's the customer the consumer experience that you want to create,
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  Speaker 2: and then work backwards and then figure out business. You know,
• 10:03
  Speaker 2: can you make a can you make it a financial
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  Speaker 2: case around it? Well maybe you can't, Okay, so we
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  Speaker 2: need to maybe we can see how we can change
• 10:09
  Speaker 2: the back and forth. But it really was everything was
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  Speaker 2: centered on the customer experience. It wasn't like a pillar
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  Speaker 2: of one thing of five. It was like the thing
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  Speaker 2: that was that was guiding everything. And I think that's
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  Speaker 2: we're not there yet, but that's like that's the kind
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  Speaker 2: of thing we need to do. Like every single time
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  Speaker 2: we need to go, uh, we need to go back
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  Speaker 2: and see what's what's the customer experience? Like we need
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  Speaker 2: to actually focus on like making a customer experience better.
• 10:43
  Speaker 1: You have a whole table full of goodies over there.
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  Speaker 1: We need to pick a goodie and let's let's use
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  Speaker 1: uh uh this as a specific walk me through the
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  Speaker 1: kind of thinking behind the product, uh, the kind of challenge,
• 11:00
  Speaker 1: the specific challenges, how it represents this process that you've
• 11:03
  Speaker 1: been talking about. You pick great not just so people
• 11:08
  Speaker 1: know this about but a couple of feet from from
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  Speaker 1: diego is there, there's about looks like eight to ten. Uh,
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  Speaker 1: mysterious boxes that are so.
• 11:20
  Speaker 2: I have to I have to have to share with
• 11:22
  Speaker 2: everybody that like. Uh, Malcolm and I had a little
• 11:24
  Speaker 2: prep call before, you know, a couple of weeks ago,
• 11:27
  Speaker 2: and it was only about ten minutes because he just said, okay,
• 11:29
  Speaker 2: you know, if you got any toys, any goodies, like,
• 11:32
  Speaker 2: bring them along, and so like, my team gave me
• 11:34
  Speaker 2: a box of goodies here which is all slayed out
• 11:36
  Speaker 2: on the table. And then uh, and then I think
• 11:38
  Speaker 2: you said, okay, and I want to talk too much more,
• 11:39
  Speaker 2: Let's not do any more prep.
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  Speaker 1: Well, the thing is, if you have small children, as
• 11:43
  Speaker 1: I do, you think exclusively in terms of of shiny
• 11:47
  Speaker 1: little gifts, you'd be sprung. I almost said, can you
• 11:50
  Speaker 1: bring snacks? That would be only stop awesome?
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  Speaker 2: All right, so let me grab a box. All right,
• 11:57
  Speaker 2: I'm going to show you something that's that is now.
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  Speaker 2: Let me grab that one, yep, and I'm I'm going
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  Speaker 2: to hide it here for just a second. Tell you
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  Speaker 2: what the what the problem is that we're going after.
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  Speaker 2: One of the big challenges in the world right now
• 12:10
  Speaker 2: is medicine and medicine safety. When I was at Apple,
• 12:16
  Speaker 2: I saw counterfeit iPhones, and I couldn't believe it. You
• 12:20
  Speaker 2: wouldn't know that they were counterfeit until you actually picked
• 12:23
  Speaker 2: them up and played with them for like half an hour.
• 12:26
  Speaker 2: And sometimes we would have to send them in and
• 12:27
  Speaker 2: have them get X rayed to know that they're they're fake. Well,
• 12:32
  Speaker 2: that was on those were on products, you know, that
• 12:35
  Speaker 2: was like a thousand dollars product that Electronics very hard
• 12:38
  Speaker 2: to make counterfeit, but the economics were there. Medicines are
• 12:41
  Speaker 2: a lot easier to fake or at least make them
• 12:43
  Speaker 2: look fake. All you need to do is copy the
• 12:45
  Speaker 2: box and you know, if it's in a vial, you know,
• 12:48
  Speaker 2: put a label on it something like that. And with
• 12:51
  Speaker 2: some of the medicines that are out there right now,
• 12:53
  Speaker 2: there's a huge financial incentive for people to have to
• 12:55
  Speaker 2: make to say that they're making medicines that they really
• 12:59
  Speaker 2: are not and they're faking them.
• 13:01
  Speaker 1: What would be just just just fascinating. What is there
• 13:04
  Speaker 1: a particular kind of medicine for which the counterfeiters motivation
• 13:10
  Speaker 1: is greatest?
• 13:11
  Speaker 2: Well right now, uh, in chronic weight management, we have
• 13:14
  Speaker 2: the g LP one medicines and so above for for
• 13:18
  Speaker 2: us and the other leading maker of g LP one medicines.
• 13:24
  Speaker 2: Counterfeiting is a real, real threat and back to formularities
• 13:28
  Speaker 2: and things like that. A lot of insurance plans do
• 13:30
  Speaker 2: not cover uh, chronic weight loss management. Uh. And so
• 13:34
  Speaker 2: there's a huge financial incentive on the black market to say, hey,
• 13:37
  Speaker 2: we're going to go and.
• 13:38
  Speaker 1: Some uncertainty about outcomes. So you would take you a
• 13:40
  Speaker 1: while to figure out you're taking a fake correct it.
• 13:43
  Speaker 2: And I mean it's not only I mean it's not
• 13:46
  Speaker 2: only fake, it's actually many of these cases are risky
• 13:49
  Speaker 2: because once you see, uh, once you see like the
• 13:51
  Speaker 2: sterile environments that these medicines go through to be made,
• 13:55
  Speaker 2: you know that it could in the best case, it's harmless, right,
• 13:59
  Speaker 2: I mean, the best case is you don't get any effect.
• 14:02
  Speaker 2: And so what I've got here as a product, I'm
• 14:04
  Speaker 2: gonna uh, this can be any product and uh it's
• 14:09
  Speaker 2: so don't pay attention to what product this actually is.
• 14:13
  Speaker 2: And I've got the product right here, and I can
• 14:15
  Speaker 2: tap my phone against it and I will get it
• 14:19
  Speaker 2: in an an NFC tag. And that n f C
• 14:23
  Speaker 2: tag is just like when you do a contact list
• 14:26
  Speaker 2: payment and it will bring up, it'll bring up a
• 14:28
  Speaker 2: page to show you that you could actually verify that
• 14:30
  Speaker 2: the packaging matches something that we've produced. Unlike a QR code,
• 14:35
  Speaker 2: it can't be copied. It's cryptographically secure. And this is
• 14:38
  Speaker 2: where the technology part gets interesting, because they can copy
• 14:41
  Speaker 2: the box, they could do all kinds of things like that,
• 14:42
  Speaker 2: but they can't copy that tag. There's one and only
• 14:45
  Speaker 2: one tag that you can that you can tap and
• 14:47
  Speaker 2: then we can verify it.
• 14:48
  Speaker 1: Yeah, so how how how long did it take to
• 14:51
  Speaker 1: develop that particular technology?
• 14:53
  Speaker 2: So it took uh, this is something we did within
• 14:56
  Speaker 2: my first few months that coming here. Uh, and we
• 14:58
  Speaker 2: haven't launched it yet, so they the designing it is
• 15:02
  Speaker 2: very easy, the developing it is very hard.
• 15:04
  Speaker 1: So you could you could do. What you're saying is
• 15:06
  Speaker 1: what you have is a technology that could be a
• 15:08
  Speaker 1: platform or for building an interaction between the consumer of
• 15:14
  Speaker 1: the bill, the patient correct and the manufacturer.
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  Speaker 2: That's absolutely right. And you know, we actually don't even
• 15:20
  Speaker 2: care about it necessarily being just for us, Like this
• 15:22
  Speaker 2: is the kind of thing where we'd say, this is
• 15:24
  Speaker 2: a great thing. If adherence can improve for patients across
• 15:27
  Speaker 2: all medicines, all manufacturers, that would be fantastic.
• 15:30
  Speaker 1: Yeah, how but you've put that RFID tag on the box. Correct,
• 15:35
  Speaker 1: But now there's still a thing inside the box.
• 15:38
  Speaker 2: Still up staying inside the box. So this is version one,
• 15:40
  Speaker 2: which is on the box, and then version two, which
• 15:43
  Speaker 2: we'll come to later, will be on the individual medicine itself.
• 15:46
  Speaker 1: What about protecting against an unauthorized use of the medicine?
• 15:50
  Speaker 1: What if the wrong person taps to your phone?
• 15:52
  Speaker 2: Against absolutely then you could actually make sure that you're
• 15:56
  Speaker 2: taking the right medicine. I also think making sure that
• 15:58
  Speaker 2: you haven't taken your medicine more than once in a
• 16:00
  Speaker 2: day is also an important thing because, you know what,
• 16:02
  Speaker 2: it's actually very easy to do. And I also think
• 16:05
  Speaker 2: that in a hospital environment it also is you know,
• 16:08
  Speaker 2: you could tie it into systems and make sure that
• 16:10
  Speaker 2: you're actually administering the correct medicine. Uh, not something that
• 16:14
  Speaker 2: you can imagine a work flashing up on on the
• 16:18
  Speaker 2: health healthcare provider's device if it's the wrong medicine.
• 16:20
  Speaker 1: So this is beta with the box. Yeah, how long
• 16:23
  Speaker 1: how many years before you think you could be actually
• 16:25
  Speaker 1: in the pill itself? The pill itself.
• 16:28
  Speaker 2: I don't know if we'll ever get past the consumer
• 16:33
  Speaker 2: acceptance of r f I D like if like actually
• 16:36
  Speaker 2: being in the pillow soft. But if we could get there,
• 16:38
  Speaker 2: that's that's not super far out, that's probably you know,
• 16:42
  Speaker 2: probably five years out of Yeah. Yeah, but it's not
• 16:46
  Speaker 2: the technology.
• 16:47
  Speaker 1: Your better version is that you point your phone at
• 16:49
  Speaker 1: your gut and you find all the stuff that's in there. Goodness,
• 16:53
  Speaker 1: what do they have for dinner?
• 16:55
  Speaker 2: Yeah? Exactly, it might not be good to find that out.
• 16:59
  Speaker 1: Pick another wearable because now I'm interested. First of all,
• 17:03
  Speaker 1: has literally ever done a wearable before?
• 17:06
  Speaker 2: Uh? No, We've not produced a wearable of our our own,
• 17:10
  Speaker 2: and it ends up being a little bit challenging as
• 17:12
  Speaker 2: a manufacturer. Be a lot easier if we didn't make
• 17:14
  Speaker 2: drugs to actually launch a wearable. But because you make
• 17:18
  Speaker 2: drugs and then then and then the question is as well,
• 17:21
  Speaker 2: are you using this too? Does it have to be?
• 17:24
  Speaker 2: Is it required for somebody taking to medicine? So there's
• 17:26
  Speaker 2: a whole host of things that makes it really complicated
• 17:29
  Speaker 2: for us to do it. So the most, for the
• 17:31
  Speaker 2: most part, where we use these things are in clinical trials.
• 17:34
  Speaker 1: So how many wearables take me ten years into the future? Yeah,
• 17:38
  Speaker 1: how many wearables am I wearing? If I want to
• 17:41
  Speaker 1: be completely you know, if.
• 17:44
  Speaker 2: You're a nerd out on all of this. You know,
• 17:48
  Speaker 2: I think it's probably on the scale of two to three.
• 17:52
  Speaker 2: I think I think there are only so many places
• 17:54
  Speaker 2: that that you're willing to put a wearable, you know.
• 17:59
  Speaker 2: I you know, you can imagine there's your ring, there's
• 18:02
  Speaker 2: a watch, and you know that you might be able
• 18:05
  Speaker 2: to if you've ever had like a ziopatch or anything
• 18:08
  Speaker 2: like that, part catch. Those are not terribly uncomfortable insuls.
• 18:13
  Speaker 2: You know, you could, you could imagine, But after that,
• 18:16
  Speaker 2: you don't have that many more places I think that
• 18:18
  Speaker 2: you would you'd be willing to wear something. So I'll
• 18:21
  Speaker 2: go I'll go with those three tops.
• 18:23
  Speaker 1: I was gonna say eyes I was reading eyes. Yeah,
• 18:26
  Speaker 1: but really I was really a really fascinating study that
• 18:29
  Speaker 1: was looking trying to figure out what the difference is
• 18:31
  Speaker 1: between a novice police officer and an expert police officer.
• 18:35
  Speaker 1: And they use eye tracking and gave them scenarios and
• 18:38
  Speaker 1: figured out that they're looking at different things. So you
• 18:41
  Speaker 1: have a scenario of like that guy here and this
• 18:45
  Speaker 1: is happening here, and someone's throwing this here, and we
• 18:47
  Speaker 1: see the experts like looking do do do do do
• 18:50
  Speaker 1: do do doo, and the novice is looking right, Yeah,
• 18:54
  Speaker 1: one spot versus But I'm just curious about, like, you know,
• 18:58
  Speaker 1: my sense is this is kind of once you started
• 19:01
  Speaker 1: going down this road. Yeah, there's lots and lots and
• 19:03
  Speaker 1: lots and lots of things.
• 19:04
  Speaker 2: No, I thought you were going to go down a
• 19:06
  Speaker 2: different path, which is like the what you might like
• 19:09
  Speaker 2: enhancing your eyes or your hearing or things like that,
• 19:12
  Speaker 2: which is also like that's just another fascinating space of science.
• 19:16
  Speaker 1: And yeah, yeah, why one of the things you said
• 19:20
  Speaker 1: earlier big more interested when you said that if you're
• 19:23
  Speaker 1: making drugs, and the question, one of the questions that
• 19:26
  Speaker 1: comes up is are you using the something like this
• 19:30
  Speaker 1: a wearable to market the drug? But I'm wondering whether
• 19:34
  Speaker 1: that's there's another way to frame that is. Surely one
• 19:39
  Speaker 1: logical step here is that you start to you're not
• 19:43
  Speaker 1: just giving someone a drug or giving someone a drug
• 19:45
  Speaker 1: in combination with a set of wearables that allow us
• 19:48
  Speaker 1: to maximize the value of the therapeutic. Right, is that
• 19:54
  Speaker 1: what we're are we gonna be? Are we gonna be?
• 19:56
  Speaker 1: Are you gonna be getting from your pharmacist or your
• 19:58
  Speaker 1: doctor a package of things to take home along with
• 20:01
  Speaker 1: your medication?
• 20:01
  Speaker 2: We do that with some of our clinical trials, you'll
• 20:04
  Speaker 2: get like, here are the devices to take with you.
• 20:06
  Speaker 2: But if you look at weight loss medications, we've we're
• 20:09
  Speaker 2: already all doing that right now, like because we all
• 20:12
  Speaker 2: have scales in our house, right and so and so.
• 20:15
  Speaker 2: I think that is a great example of like, if
• 20:18
  Speaker 2: you give feedback to the person taking the medicine, they're
• 20:22
  Speaker 2: going to be more likely to stay on. At least
• 20:24
  Speaker 2: that's one of my hypotheses. I think that if you
• 20:26
  Speaker 2: took away if you took away scales and you took
• 20:27
  Speaker 2: away mirrors, I think a lot of people, a lot
• 20:30
  Speaker 2: more people would drop off the product weight management medicines
• 20:33
  Speaker 2: early on. But the fact is, when you get on
• 20:35
  Speaker 2: the scale and you can see, hey, I lost you know,
• 20:37
  Speaker 2: I lost some weight, you want to stay on it.
• 20:39
  Speaker 2: We don't have anything like that for staffins or anything else, right,
• 20:42
  Speaker 2: And that's again like why people people drop off. Just
• 20:44
  Speaker 2: imagine if you could just see, oh, hey, actually you know,
• 20:47
  Speaker 2: or I'm taking cholesterol medication and you know what, Hey
• 20:50
  Speaker 2: my cholesterol went down versus yesterday, not versus three months ago.
• 20:54
  Speaker 1: Yeah, who controls this data? So interesting? You began this
• 20:59
  Speaker 1: conversation in talking about the multitude of steps that exists
• 21:04
  Speaker 1: between the manufacture of some of these medicines and the user.
• 21:08
  Speaker 1: That's right. Now, you're talking about a system where presumably
• 21:12
  Speaker 1: the manufacturer can speak directly to the patient. Correct. Does
• 21:16
  Speaker 1: this mean that you cut out some of the middlemen?
• 21:18
  Speaker 2: That's my hope. But the data, ultimately the first part
• 21:23
  Speaker 2: of your question. The data really should be with the patient.
• 21:25
  Speaker 2: And I think there's a tendency to say, even still
• 21:28
  Speaker 2: today in this industry, that the data is really for
• 21:30
  Speaker 2: the healthcare provider, and I think that's I think that's
• 21:34
  Speaker 2: a mistake. I think ultimately the data is for the patient,
• 21:37
  Speaker 2: and the patient can choose to share what the healthcare provider,
• 21:39
  Speaker 2: and the healthcare provider.
• 21:40
  Speaker 1: Can look at it.
• 21:41
  Speaker 2: But it really is it's really what the abot.
• 21:43
  Speaker 1: So my mom is an interesting home has archives, yeah,
• 21:48
  Speaker 1: which acts up on and so she moves around a lot.
• 21:52
  Speaker 1: This is a perfect tool for her. So somebody is
• 21:57
  Speaker 1: so does she is the model here that she checks
• 22:01
  Speaker 1: her movements scores and that's a way of and she
• 22:03
  Speaker 1: can choose, she can see, oh this is time to
• 22:06
  Speaker 1: share that my data with a practitioner. Isn't it more
• 22:09
  Speaker 1: efficient for her to have someone who is or same
• 22:13
  Speaker 1: AI or something that's continuously monitoring her.
• 22:16
  Speaker 2: I think the continuous measurement part is you're you're absolutely
• 22:20
  Speaker 2: correct about it, but I think it needs to be
• 22:22
  Speaker 2: I think she always needs to be able to see
• 22:23
  Speaker 2: the data herself.
• 22:24
  Speaker 1: Yes, and see that.
• 22:26
  Speaker 2: And by the way, that's not an that sounds That's
• 22:28
  Speaker 2: one of the things that sounds obvious if you're coming
• 22:30
  Speaker 2: from outside the industry to inside. But inside the industry
• 22:33
  Speaker 2: is you know, it's like, wait, why would you share
• 22:35
  Speaker 2: the data with the patients themselves? You want to you know,
• 22:38
  Speaker 2: that's something that the healthcare provider should see first. I mean,
• 22:40
  Speaker 2: what happens if your mom misinterprets the data without the
• 22:44
  Speaker 2: advice of a healthcare provider.
• 22:45
  Speaker 1: That's kind of the big.
• 22:46
  Speaker 2: Caution that would keep keep the industry from from saying
• 22:50
  Speaker 2: your mom should be able to see that data yourself.
• 22:52
  Speaker 2: But I take a very different view on that.
• 22:54
  Speaker 1: But we're moving. What's interesting, you know a lot of
• 22:56
  Speaker 1: these things. The implication a lot of what you're talking
• 22:58
  Speaker 1: about is we are moving the uh, the primary point
• 23:04
  Speaker 1: of contact from the hospital of the doctor's office to
• 23:08
  Speaker 1: the home.
• 23:09
  Speaker 2: Right that's if you don't moment going on a tangent
• 23:13
  Speaker 2: on that too. That's one of the reasons why I'm
• 23:15
  Speaker 2: really really excited about like how we can change things too,
• 23:18
  Speaker 2: because if you look at it today, it's there are
• 23:21
  Speaker 2: so many barriers to getting medicine, you know, Like first
• 23:24
  Speaker 2: you have to get a doctor's appointment, which we've all
• 23:26
  Speaker 2: suffered through, like it can take months to get one.
• 23:30
  Speaker 2: Then even after you have one, then you also have
• 23:33
  Speaker 2: to be able to get it actually get access to
• 23:35
  Speaker 2: the medicine, which is a big problem because I don't
• 23:39
  Speaker 2: know if you've heard these stats before, about forty five
• 23:42
  Speaker 2: million Americans live in pharmacy deserts. Forty six percent of
• 23:46
  Speaker 2: the counties in the country are in pharmacy deserts, where
• 23:49
  Speaker 2: there's no pharmacy within fifteen minutes of your house. And
• 23:54
  Speaker 2: so I think and so if you add all that together,
• 23:57
  Speaker 2: it can take months from like the moment you say,
• 23:59
  Speaker 2: you know what, I'm not feeling well or there's something
• 24:02
  Speaker 2: I want to change in my life to like the
• 24:03
  Speaker 2: day that you get the medicine. I want to bring
• 24:05
  Speaker 2: that like down to like the same day. You should
• 24:08
  Speaker 2: be able to say, you know what, today's the day
• 24:11
  Speaker 2: that I want to do something, and you should be
• 24:13
  Speaker 2: able to go in, you know, get get a telehealth
• 24:15
  Speaker 2: appointment and if a medicine is appropriate, get it shipped,
• 24:20
  Speaker 2: and get it a ride delivered. You know this the
• 24:23
  Speaker 2: exact same day.
• 24:24
  Speaker 1: Well, one last question for you, define what success looks
• 24:28
  Speaker 1: like for you. So you're how old are you?
• 24:31
  Speaker 2: I just turned fifty.
• 24:33
  Speaker 1: You're a young man.
• 24:34
  Speaker 2: I can't take care of that very often.
• 24:36
  Speaker 1: So you let's assume you retire from Lily at sixty five, okay,
• 24:40
  Speaker 1: and I so take me fifteen years into the future
• 24:43
  Speaker 1: and tell me what would have to happen for you
• 24:46
  Speaker 1: to feel like your time at Lily has been a success.
• 24:52
  Speaker 2: The biggest thing for me are going to is going
• 24:55
  Speaker 2: to be the consumer side and actually making really cracking
• 24:59
  Speaker 2: this and being able to like get that vision of
• 25:00
  Speaker 2: people saying I want to take a medicine and I'm
• 25:04
  Speaker 2: going to get it the same day, and then I've
• 25:06
  Speaker 2: got the tools to stay engaged with forever. Like that
• 25:10
  Speaker 2: would be. That's millions and millions of lives touched by
• 25:14
  Speaker 2: just getting medicine and staying on this. And that's one side.
• 25:17
  Speaker 2: The other side where I uh, where I would love
• 25:21
  Speaker 2: to make a mark is on the discovery side and
• 25:25
  Speaker 2: discovering new medicines with particular with AI. Can talk for
• 25:30
  Speaker 2: hours on that, but I think we're going to see
• 25:33
  Speaker 2: medicines no human could have ever imagined coming out over
• 25:37
  Speaker 2: the next decade. Because it takes ten years or more
• 25:39
  Speaker 2: to develop a medicine, it would take about fifteen years
• 25:44
  Speaker 2: for that.
• 25:44
  Speaker 1: To come to life. Yeah, I was thinking, you know
• 25:46
  Speaker 1: when you were talking in this is maybe a little
• 25:48
  Speaker 1: bit far fetched, but in the world of deterrence. So
• 25:52
  Speaker 1: the question is, if I have a law that punishes
• 25:56
  Speaker 1: you for a certain crime, you're The deterrent value of
• 25:59
  Speaker 1: that law is a function of three things, the certainty
• 26:02
  Speaker 1: of punishment, the swiftness of punishment, and the severity of
• 26:06
  Speaker 1: punish And of the three, we spend the most time
• 26:10
  Speaker 1: thinking about severity, secondly thinking about certainty, and the one
• 26:16
  Speaker 1: that we neglect is swiftness. Right, it takes years in
• 26:19
  Speaker 1: using us. And the argument that many people make is
• 26:21
  Speaker 1: that swiftness is actually the most potent of the three.
• 26:25
  Speaker 1: If you know you're getting punished the next day, then
• 26:28
  Speaker 1: you're now. It's funny because if you map that onto
• 26:30
  Speaker 1: what you're talking about. You were talking about the idea
• 26:33
  Speaker 1: of getting medicine the same day. What you're saying is
• 26:35
  Speaker 1: the swiftness variable is the neglected one here. And what
• 26:39
  Speaker 1: if if we improve swiftness, do you think we would
• 26:43
  Speaker 1: change the psychological circumstances around which people use drugs? In
• 26:47
  Speaker 1: other words, would the adherence problem be solved if we
• 26:51
  Speaker 1: address the swiftness problem?
• 26:53
  Speaker 2: I think so.
• 26:54
  Speaker 1: Actually.
• 26:55
  Speaker 2: I think if we got swiftness and you could actually
• 26:57
  Speaker 2: see an effect and know that something was happening, that
• 27:00
  Speaker 2: would change things. You know. And and by the way,
• 27:03
  Speaker 2: I love that model that you that you just mentioned.
• 27:06
  Speaker 2: In the technology world, we have things break all the
• 27:08
  Speaker 2: day time, and what everybody focuses on is like what's
• 27:11
  Speaker 2: the root cause, and like what's the severity and how
• 27:14
  Speaker 2: you know, how wifely is it? The thing that nobody
• 27:16
  Speaker 2: ever focuses on, which is where I try to get
• 27:18
  Speaker 2: teams to focused on, is swiftness the mitigation time to mitigate.
• 27:22
  Speaker 2: How long did it take you to mitigate that human
• 27:23
  Speaker 2: process of like how quickly did you take the feedback
• 27:26
  Speaker 2: and adapt? That's really you can. You can have all
• 27:29
  Speaker 2: kinds of risks as long as you've got as long
• 27:32
  Speaker 2: as it's reversible and you can switch. Uh, that's great.
• 27:35
  Speaker 2: So when it comes to medicines. If you can try
• 27:37
  Speaker 2: it and get feedback that it's not working or not
• 27:39
  Speaker 2: training in the right direction and change it, that would
• 27:42
  Speaker 2: be that that would be amazing, and I think you
• 27:46
  Speaker 2: would find that people would people would say, Hey, now
• 27:48
  Speaker 2: I know that you know this medicine I tried wasn't working.
• 27:51
  Speaker 2: I'm going trying a new one today. I can see progress.
• 27:53
  Speaker 2: I'm gonna I'm going to stay on it because i
• 27:54
  Speaker 2: know it's doing something well.
• 27:56
  Speaker 1: This has been really fascinating. Best of luck with all
• 27:59
  Speaker 1: the work you're doing. I hope next time I see you,
• 28:02
  Speaker 1: I will be have at least three wearables all.
• 28:06
  Speaker 2: Thank you, Malchael.
• 28:07
  Speaker 1: Yeah. Religionous History is produced by Lucy Sullivan with Nina
• 28:12
  Speaker 1: Bird Lawrence and ben Adaph Haffrey. Our editor is Karen
• 28:15
  Speaker 1: Schakerji mastering by Jake Korsky. Our executive producer is Jacob Smith.
• 28:20
  Speaker 1: Special thanks to Mount Romano, Eric Sandler and Kira Posey.
• 28:26
  Speaker 1: I'm Malcolm Gladwell.