Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468]

My guest today is Alex Karnal. Alex is the co-founder and managing partner of Braidwell, a life sciences investment firm he built after spending 15 years at Deerfield Management. The frame we use throughout the episode is the health stack. Alex talks about how most of the diseases that will claim most of our lives are already addressable with medicines that exist today. We work through the five layers of what a defensive health strategy looks like, why GLP-1 medicines represent the first commercial proof that people are ready to be proactive about their health, and why PCSK9 inhibitors may ultimately be the more important drug class even though they get far less attention. We also get into the science and business of drug discovery itself — why most of the published literature that AI companies are training on cannot be replicated, what it would mean to have a truly agentic scientific lab running 24 hours a day, and why Alex believes we are now on a deterministic curve toward scientific superintelligence in biology. For the full show notes, transcript, and links to mentioned content, check out the episode page ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠. ----- Become a Colossus member to get our quarterly print magazine and private audio experience, including exclusive profiles and early access to select episodes. Subscribe at ⁠colossus.com/subscribe⁠. ----- ⁠Ramp’s⁠ mission is to help companies manage their spend in a way that reduces expenses and frees up time for teams to work on more valuable projects. Go to⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠ramp.com/invest⁠⁠ to sign up for free and get a $250 welcome bonus. ----- Trusted by thousands of businesses, ⁠Vanta⁠ continuously monitors your security posture and streamlines audits so you can win enterprise deals and build customer trust without the traditional overhead. Visit ⁠vanta.com/invest⁠. ----- ⁠WorkOS⁠ is a developer platform that enables SaaS companies to quickly add enterprise features to their applications. Visit⁠⁠ ⁠WorkOS.com⁠⁠⁠ to transform your application into an enterprise-ready solution in minutes, not months. ----- ⁠Rogo⁠ is the AI platform for finance. They're building agents for Wall Street that are trained to understand how bankers and investors actually do work: from diligence and modeling, to turning analysis into deliverables. To learn more, visit rogo.ai/invest. ----- ⁠Ridgeline⁠ has built a complete, real-time, modern operating system for investment managers. It handles trading, portfolio management, compliance, customer reporting, and much more through an all-in-one real-time cloud platform. Visit⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ridgelineapps.com⁠. ----- Editing and post-production work for this episode was provided by The Podcast Consultant (⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://thepodcastconsultant.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠). Timestamps: (00:00:00) Welcome to Invest Like the Best (00:02:29) Intro: Alex Karnal (00:03:15) State of the Union: GLP1s and Life Sciences (00:07:01) The Health Stack Framework (00:12:49) Breaking Down the 5 Defensive Layers (00:21:18) GLP-1: What's Driving the Inflection (00:28:28) Diet vs. Drugs: Is Food Enough? (00:31:15) Barriers to Access: Complexity, Cost & Compliance (00:35:04) PCSK9: The Closest Thing to a Free Lunch (00:44:10) Alzheimer's & Neurodegenerative Disease (00:46:59) Cancer: Early Detection & New Treatments (00:54:49) Body Imaging & Diagnostic Trade-offs (00:56:31) How Drugs Are Discovered (01:02:39) AI in Drug Discovery (01:10:57) The Automated Lab of the Future (01:13:05) Peptides & Citizen Pharmacology (01:16:45) Alex's Background (01:28:25) Braidwell's Investment Approach (01:30:39) The Kindest Thing