80 – Where You Live Could Impact Your Alzheimer’s Risk

[00:00:00] Marcus: If you enjoy this content, please take a moment to rate and review it. Your feedback will greatly impact our ability to reach more people. Thank you. All right. I’m a pretty wrecked from nonstop travel. Yeah. You’ve been all over the country. Yeah. Yeah. Went to New York city for about 24 hours for my godfather’s funeral.

[00:00:20] Marcus: Um, which was really special. I do want to talk about that, but, um, I’ll, I’ll, uh, move on to the rest of the trip, which flew from there to. Long Beach, connecting back through Nashville, uh, to Long Beach, California, then drove to Laguna Beach for the, uh, HFMA summer board retreat, which was great. Laguna Beach was beautiful.

[00:00:41] Marcus: Um, we had dinner up on a bluff and, uh, it was the night of the super moon. It’s like, Oh, cool. Crazy watching the moon come up over the water. Um, Great meeting, always a good time with the folks at HFMA on the board, uh, but my godfather’s, um, funeral, so he was 90, he [00:01:00] was a week away from being 91. I’ve been hearing for years about how he Mentored young people like it was just sort of a thing, you know, oh yeah Friday He’s always like mentoring young people blah blah blah stuff and go to his funeral and I mean there there must have been 30 of these young people who were who now, you know who

[00:01:22] Vic: now have have grown up They’ve grown up.

[00:01:25] Vic: Yeah,

[00:01:25] Marcus: they’ve grown up and um, they were all there Acknowledging the incredible role that he played in their life. I mean it was so inspiring That’s really cool

[00:01:37] Vic: for you to see, um, cause you hear that and you don’t necessarily know like, okay, he, maybe he did that. Maybe he didn’t come to his, uh, funeral or wake, whatever it was, um, really, it means he made an impact.

[00:01:52] Marcus: It was powerful. It was really powerful. And it was, it was just key. It was just clear that that was. [00:02:00] That was his life’s work. Like his life’s work was being present in people’s lives, um, in an uplifting and encouraging way that, you know, and I think at really critical points in their life, right, you know, like meeting them at critical forks in the road and helping them to find the right.

[00:02:19] Marcus: Path. Yeah. You know, so that was, it was just super cool. And, um, did you travel

[00:02:22] Vic: up there with your parents?

[00:02:24] Marcus: No, I, I went up there to represent my parents. Oh. You know, didn’t travel. You know, my parents can travel,

[00:02:27] Vic: can’t travel, can’t do that trip now. You

[00:02:28] Marcus: know, it’s just,

[00:02:29] Vic: yeah, because I was gonna ask about that.

[00:02:30] Vic: ’cause that would’ve been a lot of travel logistics. No, no,

[00:02:33] Marcus: no, no, no. I, I was up there, obviously you were before myself, but representing our, our family. So, um. Anyway, kind of a, kind of a crazy week and, uh, and I’ll be out next week because, you know, going to Worlds finally. Been talking about it for like weeks now.

[00:02:48] Marcus: Here it is, everybody. So I’ll stop talking about it after this. Uh, headed to Worlds out in Vegas next weekend. How about you?

[00:02:55] Vic: I’m, I’m good. Nothing, nothing like that. Very, uh, quiet. I’ve been traveling a lot [00:03:00] over the summer. So. Here, just getting stuff done. Um, I’m trying to get two investments done, you know, normal work, but nothing special.

[00:03:08] Marcus: Yeah. Okay, good. All right. Well, look, we got a good show to, to go over. So let’s dig in.

[00:03:22] Marcus: So starting with a continuation on the demography conversation last Show, we talked about millennials and how the narrative around them forever was that millennials are not doing that great in the economy. And wall street journal did a, uh, a cover piece on how millennials who bought a home prior to 2020 actually have real, I think 3x their, uh, their net worth, uh, for the generation in a

[00:03:50] Vic: few

[00:03:50] Marcus: years,

[00:03:50] Vic: maybe

[00:03:50] Marcus: like five years.

[00:03:51] Vic: Right. And,

[00:03:52] Marcus: and, and then, you know, sort of showing the dividing line between those who were able to buy a house before 2020 and those who were not right. And now you’re [00:04:00] kind of boxed out between not just the increase in the prices, but also now you layer on the interest rates and it’s just kind of, you know, it’s hard to catch up, hard to catch up.

[00:04:08] Marcus: So this week you found a story also in the journal that covers our generation, generation X. And, um, The headline is, is not as optimistic as the millennial one says as generation X approaches retirement reality still bites. So tell us about the story.

[00:04:23] Vic: Yeah. I mean, I think this, the millennial one was, was pretty surprising and positive, at least for the, for the cohort that were able to buy, buy a home or buy stocks and bonds.

[00:04:34] Vic: This one was not surprising. Uh, cause, cause I’m living it. We’re living it. Um, it’s been, you know, we, we kind of came of age, um, You know in the in the 90s is when we both got our first jobs, but we were junior um, and then there was the dot com crash and then the 08 great financial crisis. So the x generation I think has [00:05:00] been um, you know working hard very independent generation Um, we’re the first generation with sort of two working parents, which caused us I think to be pretty independent, right?

[00:05:11] Vic: um, but the story is about um, Us coming of age sort of right after 401ks were the predominant retirement. There are no pensions anymore. And yet the chance to really save a lot of money and really build your retirement You know, you had several setbacks. You had these significant corrections, the dot com, and then the global financial crisis, um, and so we are sort of, um, in our fifties and retirement is a long way away.

[00:05:44] Vic: So that, that’s the basic story that there’s several, like, like with the millennials, I think the journals may be covering all the generations, potentially. They have several stories, but. Everyone is sort of representative of that, that mantra that they’re, they’re still working towards [00:06:00] retirement, but they didn’t save as much as they wanted.

[00:06:02] Vic: They, they had setbacks in their portfolio and they have a 401k. Everyone has a 401k, but it’s not. The size that they were hoping for.

[00:06:12] Marcus: Yeah. Um, I mean, there are some interesting graphs in here, uh, you know, as you would expect each 10 year cohort, you know, 45 to 55, 55 to 64, 65 to 74. Um, so it’s sort of a stair step in terms of net worth, uh, across the years, but.

[00:06:28] Marcus: You know, there were definitely some, some years there where it went down, this, this particular graph is tracking post, uh, GFC. And you can definitely see, you know, 2007, you know, things were looking pretty good, but basically, between then and 2022, it was flat because it, it, it dipped so significantly because of the great financial crisis.

[00:06:50] Vic: Yeah, we’ve sort of come back, but with just to where we were

[00:06:52] Marcus: before. Right. You know, Fifteen years ago. Right. We’re talking about the median household net worth in the US. So I mean, obviously those, those years are sort [00:07:00] of moving along, but if we track who is, you know, 45 now, uh, in 2022, and then you track, you know, cost of living, inflation, all these other things, our generation is poorer, um, than the generation before us, uh, at this same time.

[00:07:22] Marcus: Yeah.

[00:07:22] Vic: Yeah. And this period. So, for me, I was born in 1970, so in 2010, uh, 40 years old. That 40 to 53, you know, 2010 until now, is your prime, that’s your prime earning, maybe like 40 to 60 is your prime earning years. Yeah.

[00:07:43] Marcus: Yeah.

[00:07:43] Vic: And as a cohort, Generation X really treaded water. We, we, we lost ground and then we’ve got back to where we were.

[00:07:52] Vic: You know, that’s a great financial crisis and that sets you back. If you miss that big earnings period, you’re not socking away a lot of retirement [00:08:00] savings,

[00:08:01] Marcus: you know, it, it’s not, it’s not that heartwarming to read this, but I think it is also helpful for a generation that does think largely, um, as individuals and independently to sort of understand the force of demography, the force of us all having the shared experience of these different financial Um, collapses both dot com bust and then the great financial crisis.

[00:08:24] Marcus: And then look, I mean, I, you know, COVID hasn’t fully played out yet, but I think if you, if you were well positioned asset wise, you probably did well. But if you were working class where your home was like your only real asset and outside of that, it was just wages. I don’t think these have been, you know, for good years, um, for, for many people in the economy, it’s the same story from the millennials.

[00:08:49] Marcus: Did you have assets prior to 2020? If so, those assets have been inflated. There’s no question. Um, but if you did not, if you weren’t well positioned asset wise, [00:09:00] probably not as well.

[00:09:01] Vic: Yeah, the, um, I don’t know. I have this image of like trying to grab a ladder to pull yourself up to retirement. And if you, if you had assets, you’re sort of rising with all the, all the boats.

[00:09:13] Vic: And if not, that ladder is getting further and further away every year with. 3 percent inflation gets harder. And then, you know, if we have a correction or if there’s a problem, the go to plan now that was done in COVID and in the great financial crisis is for fiscal and monetary stimulus to come in and help.

[00:09:37] Vic: And the result of that is financial assets would, would be increased, but it also would lead to inflation. And so if you don’t have enough financial assets, it doesn’t help you in a dramatic way. Maybe it’s better than the alternative of the government not helping, but, but I don’t know. Last week was a happier story.

[00:09:56] Vic: I think, I think it’s important for us to cover this. [00:10:00] Because one, you and I are Gen Xers for sure. A lot of audiences, a lot of the leaders in healthcare and investment are Gen Xers. Um, and we’re going to go through this as a cohort in retirement. It’s going to be at least bumpy.

[00:10:14] Marcus: All right. Next story is a story about the collapsing, uh, credit environment.

[00:10:21] Marcus: Um, there are many companies, I think, especially in specific industries, uh, media is featured here where the, the debt has just. Piled up and piled up and piled up and the valuations are now coming down and things are going to be sold for a song and revenues are not returning and, uh, the headline here is pretty hilarious.

[00:10:42] Marcus: Coming to a cash strapped company near you, creditor on creditor violence. Yeah. I mean, that’s, that’s, that’s some great, uh, headline writing there.

[00:10:50] Vic: Yeah. Yeah. The journal’s trying to make, uh, You know, very complex financial engineering, entertaining and doing a pretty good job at it, really. So, [00:11:00] um, we’re getting to the later stages of this debt problem.

[00:11:06] Vic: Yep. We’ve had stories about real estate issues. These are operating businesses that have raised several different rounds of debt. So you have senior debt, then you have more. Junior subordinated debt all the way down to junk. Typically you’d pay a higher interest rate and then some warrants um, and then the voting um Agreements are typically fairly complex over like how who gets governance control, right?

[00:11:35] Vic: And in these boards and these companies they are approaching Uh default So, so the board’s responsibility shifts to the creditors and the creditor agreements are complex and you need to get the right number of votes by class. And so this story is about, uh, creditors that are either have a [00:12:00] lot of power, have a lot of the dollars that have been loaned, or they’re higher up on the stack, kind of negotiating deals, side deals with.

[00:12:09] Vic: More junior creditors and picking sides and being very aggressive. Many of them are private equity funds that own these, but, but even there’s plenty of other institutional investors or hedge funds or other people that would buy them. None of which are super friendly, right? And they’re doing, you know, pretty aggressive kind of Game of Thrones like Machiavellian tactics to get control over the limited supply of cash that’s going to be there.

[00:12:36] Vic: It’s not going to be enough to pay everyone. So how do we figure out how to get our investors paid as much as possible? Right. And I think it’s, you know, the reason to cover it is we’re, we’re starting to see the end, the end chapters to this debt problem. And it’s going to be, you know, I think messy.

[00:12:55] Marcus: Yeah, I mean, well, I, I think, I think we’re just trying to identify where could the [00:13:00] next shoe fall, right?

[00:13:01] Marcus: Yeah,

[00:13:02] Vic: and try to watch it.

[00:13:03] Marcus: Yeah, we, we, we’ve talked a lot about the commercial real estate space, so we don’t need to, you know, beat that, that drum. Uh, but the media space has pretty significant problems. Um, all of, and, and I, and I think that you can, uh, you know, also look at the Google antitrust, um, you know, Monopoly situation as an indicator of the problems that the media world has right now I mean Google and Facebook and maybe you can add an Amazon because their ad network has actually become become pretty strong Have really closed out the category I mean, yeah, they are getting all the dollars and the Walmart’s

[00:13:42] Vic: Walmart’s ad network is growing at like 40 percent I’m sure I’m sure so the traditional media groups Are suffering, they just don’t, their, their monetization model is no longer working the way it used to work.

[00:13:58] Vic: That’s right.

[00:13:59] Marcus: That’s right. [00:14:00] So, um, this is, it is a problem because a lot of capital, both investment capital, but. Also, a lot of debt has been layered on these businesses. And, you know, if that stuff goes belly up, then that’s a pretty big problem. Uh, going on, on more on that, that, uh, that thread, the journal came out with a story talking about, uh, Elon Musk and Twitter and how that takeover is, is, uh, the worst buyout for banks since the financial crisis.

[00:14:31] Marcus: Now, this is what’s hilarious about this is, uh, the, the financial crisis. Buyout was, uh, a Fed and White House driven buyout. Uh, and this was just people following Elon because they think he’s got magic pixie dust, dust. Uh, and look, he’s done incredible things on engineering. You know, last week we were talking about Neuralink and what’s happening with that.

[00:14:54] Marcus: And, and obviously if you follow SpaceX Tesla. The engineering prowess [00:15:00] cannot be questioned, right? What he is able to do at a company level, not just, you know, academically, but advancing and commercializing engineering is unbelievable.

[00:15:10] Vic: Yeah, we haven’t talked about it, but the, the poor astronauts on the space station, they’re going to need space space X to go up and save them because Boeing can’t do it, can’t do it.

[00:15:21] Vic: That’s right. And so he’s, he’s great on some things.

[00:15:24] Marcus: But X, X has been hard, worse than hard, uh, you know, that they were saying that I think it was, I think it was the journal, um, or the New York Times got access to some financials that said that in Q2, they made like under 150 million in revenue. I mean, that is a massive cratering out of value.

[00:15:50] Marcus: Right. Massive cratering out of value. So you can talk all about, okay, we’re, we’re at this rating on the app store. We’ve got this many engaged people and we’ve got this many [00:16:00] views and all this other kind of stuff, but the advertisers have left the building. They have left the building. And

[00:16:07] Vic: I believe in free speech and I’m happy that, uh, Exists, but I don’t know that it’s, you know, Sort of getting to the end point and self sustainable that like He’s running it.

[00:16:24] Vic: Maybe like a non profit where he’s just like he has this belief system that more speech including Crazy speech is the solution for censorship and I don’t know if I believe that or not, but even if I do believe that He’s not running it in a way that is very sustainable. It’s just like destroying value everywhere

[00:16:46] Marcus: Yeah, which would be one thing if it was all his money

[00:16:50] Vic: Yeah, he borrowed

[00:16:51] Marcus: money from a bunch of banks right but billions 13 billion That’s exactly right what this article reminds us all because everyone keeps talking about You know the charity and he’s running it like a non [00:17:00] profit.

[00:17:00] Marcus: He didn’t put up all the money All right, you know he got this thing bankrolled by a bunch of banks and injuries and Horowitz aped in and, you know, a bunch of other folks, 13 billion. And this is, it’s going to, it’s being lit on fire. I mean, and I, and it doesn’t feel to me as we, as we go further into the election, it’s going to get worse.

[00:17:20] Marcus: It’s going to get worse. It’s going to get worse. Right. I mean, you know, maybe it is a place where, uh, you know, Advertisers on the right drop a bunch of dollars, but but let’s be honest. I mean, that’s all that’s over on X anyway anymore, right? It’s it has become a largely right wing platform with, you know, activists on the left sort of pointing out how right wing it has become.

[00:17:48] Marcus: Yeah, but you know, It’s no longer like this neutral. Everybody is here sharing information. Very tech oriented. It’s become a real political platform. Um, [00:18:00] I mean, it’s

[00:18:00] Vic: where I go to see the, you know, how the fakes are coming along. I mean, it’s all kinds of, right? It’s maybe it’s not. It’s entertaining to see how sort of fake, fake videos and fake things are proceeding.

[00:18:13] Vic: But it’s not just the sort of the public comment where everyone is talking freely. Yeah. And

[00:18:19] Marcus: the bottom line is, uh, where you spend your dollars is also free speech, right? Yeah. You know? And advertisers have simply decided they’re not going to do it. So, you know, Musk and, and X along with, uh, rumble, which is a video platform, also very right wing are all suing Google and suing advertisers and suing a bunch of people.

[00:18:39] Marcus: But in the meantime, the value has been totally carved out of this platform and, and largely by the way he has chosen to manage the asset.

[00:18:49] Vic: I think it was poorly run before he took over, but he also has run it poorly. So it’s both.

[00:18:54] Marcus: He’s run it worse. He’s run it worse. It was, it was at least stable. Yeah. It was publicly [00:19:00] traded.

[00:19:00] Marcus: So we have this data. Yeah. Twitter was stable, not growing. In the way that everyone thought it should grow, but it wasn’t like it was

[00:19:08] Vic: much better for the advertisers. Yes, definitely.

[00:19:10] Marcus: Yes, it wasn’t cratering out. Um, okay, moving on, uh, labor, labor dispute halts rail freight in Canada, raising supply chain concerns.

[00:19:20] Marcus: So we have another big, uh, Dispute in Canada, um, with, with the labor force before it was the truckers. Now it’s, it’s the rail, it’s the rail workers. Um, we have a supply chain threat and concern here. Uh, and this pairs nicely or not very nicely, uh, depending on how you want to think about it with the, the looming AI.

[00:19:44] Marcus: Walk out from the port workers. Yeah. And we are, I don’t know, 30 or 60 days away from that deadline. Yeah. Right?

[00:19:53] Vic: Yeah, it’s in late September. Yeah, yeah. Roughly 30 days. Yeah,

[00:19:56] Marcus: about 30 days away from that. So, so tell us about this story, because you found out, I [00:20:00] didn’t even know this was happening.

[00:20:01] Vic: Yeah, so, um, they could not come to a new contract agreement.

[00:20:06] Vic: And threatened to go on strike and the company locked them out, basically confirming the strike. No one is talking to each other and so no, no freight is moving by rail in Canada. And it’s a problem for Canada because they, they don’t have the same nationwide network of roads that we have. And they, they rely on rail a lot more.

[00:20:38] Vic: And there are windows of time when they bring. food in and bring supplies out before winter, um, that they’re going to potentially miss. And so it’s a big issue in Canada. It also, of course, is adjacent to the United States. So it’s going to affect us. Um, and it’s going to [00:21:00] be And then you’re right, the next story is the one, um, about the United States port workers who have not come to an agreement for the new contract.

[00:21:13] Vic: They are being very clear that they don’t want any AI in the operations. And I, I think that would be hard for jumpstart to agree to. It’s hard for a port to agree to no AI at all. And they’re also not talking to each other. The chance they come to an agreement in the next 30 days seems like a long way away.

[00:21:34] Vic: And so we’re looking at the potential. I mean, something could happen positive and I’m hopeful, but by October 1st, you have like almost 80 percent of the freight in North America is not moving. Now the West coast is under a different. Port agreement, um, like all the way from Houston [00:22:00] up through, you know, Florida, DC, Philadelphia, Baltimore, New York, Boston, and then up to both sides of Canada would be shut down right as we’re doing our elections and all it’s going to be.

[00:22:16] Vic: It’s a story to watch, I guess, is why I wanted to bring it up.

[00:22:19] Marcus: Yeah. It feels like somebody might get a call here pretty soon, given the proximity to the election. I think

[00:22:25] Vic: they’re already been trying to call.

[00:22:26] Marcus: Yeah. Yes. All right, one to watch, one to watch, uh, and then we, we are saving the, the thing we normally lead with till the end because by the time this episode goes live, what we’re going to talk about right now will have already happened, which is we are going to hear from Jerome Powell by the time you listen to this, we’ve already heard from him.

[00:22:49] Vic: Yeah, he is. At Jackson Hole enjoying himself and he’ll speak tomorrow as we’re recording this yesterday as you’re listening to this. Um, [00:23:00] I, you know, I don’t have a direct text messaging relationship with Jerome, but I think it’s, I think the entire market thinks he’s going to send. favorable signals to a rate cut.

[00:23:12] Vic: If you go down, uh, a little bit, they had a pretty good graphic, uh, right there. Um, there’s a lot of things that are going to happen between now and September 17th when they do the, they make the decision about the next rate cut or not. Right. Of course, we had the, the CPI report and the retail sales. Um, he’s speaking tomorrow in the minutes, but then we have the GDP, um, The second quarter GDP numbers, um, PCE is, is another pricing thing.

[00:23:44] Vic: Jolts is the, you know, people, um, changing jobs, moving around, right. Payrolls and CPI again. So there’s a lot of data coming out. I’m sure my guess is he’s going to say that he’s data driven and watching everything [00:24:00] everyone thinks is going to be 25%, 25 basis point cut. Yeah. And many people think it’ll be 50 basis points.

[00:24:09] Vic: Yeah. Yeah. So, but I mean, I wanted to mention it because it’s going on, you know, right as this drops, but, but we don’t have this ability because it hasn’t happened yet.

[00:24:17] Marcus: I love this graph. Uh, it’s, it’s very, very good. So link in the show notes, make sure to click on the, the articles Reuters. Um, and it’s great.

[00:24:26] Marcus: It really does lay out. We, and we had the FOMC minutes that, that laid out a lot of indications we would get the right cut. Powell will have spoken by the time you’re listening to this, and then you’re right. GDP, second quarter results, PCE, jolts, payroll, and CPI all basically come the end of next week. So starting with next Friday is, is GDP numbers all the way through, uh, sort of the, the first full week of September is when we get the rest of those reports coming out.

[00:24:55] Vic: Yeah, and I think it seems like it’s going to be, um, [00:25:00] still. okay on the jobs and CPI front where meaning there is, you know, not a huge hiring binge and CPI is not going to run away. So, um, as we get into the later fall, the comparisons get much more difficult. So whether we get a series of rate cuts, I think is more in question, but this first One, whether it’s 25 or 50, I think is pretty well, pretty likely.

[00:25:27] Marcus: Yeah. I mean, I, I expect they’d make a cut and then they sit and watch for a second. Um, yeah, the market won’t like that, but that’s, that would be why it seems to be their posture, right? That seems to be what they would do. Um, all right, moving into the VC market. So open water raises 54 million for open source medical research technology.

[00:25:47] Marcus: And so this is pretty interesting. Uh, 20 years ago. Open source software emerged. I think largely people will remember if they know anything about it, a company called [00:26:00] Red Hat, uh, that, that basically commercialized enterprise Linux, you know, they, they took the open source software of Linux, they wrapped a support packaging, uh, consulting business around it.

[00:26:14] Marcus: And they rose to prominence very quickly because, uh, as Linux became a more popular, uh, software platform for servers. Uh, people like the idea of not having to pay a license to Sun Microsystems and Microsoft, um, but they did not like the idea of having no support and having to rely on message boards.

[00:26:34] Marcus: Yeah. And they

[00:26:35] Vic: had support contracts with, with Sun and Microsoft. That’s right.

[00:26:38] Marcus: So can I just use better software? That has no license, but still get a support contract, right? Um, and the answer is yes, you could buy Red Hat Linux. And that was how you, how you went about that. So here we are 20 years later.

[00:26:51] Marcus: And I think what’s so interesting is that, you know, necessity is the mother of invention. Um, we have been talking about how, how difficult the. [00:27:00] The capital markets are right now for life sciences and also for medical devices, right? Anything that’s got a regulatory pathway and requires research, both on the NIH side, as, as that, that funding is drying up, as well as in the private markets, you know, that capital has, has really dried up.

[00:27:17] Marcus: We did talk about sort of the resurgence of a couple of 500 million funds, I think two weeks ago, but largely for the last two years, it’s been rough.

[00:27:24] Vic: Yeah.

[00:27:25] Marcus: If you’re doing high science in, in, in healthcare, it’s been pretty rough. And so the idea, well, okay, part of the reason why we can’t get more things through is just the cost of developing.

[00:27:35] Marcus: These things is too high. There’s a limited number of providers out there who are providing the basic building blocks to get these devices off the ground and a proven solution. Especially for, you know, a technology is let’s open source, right? So open water is taking that same playbook. They’ve got open source, uh, building blocks, a combination of hardware and software.

[00:27:59] Marcus: And [00:28:00] now whether you’re a researcher or you’re a startup company, or you’re a large, you know, multinational, you can leverage this, this, uh, this kit of hardware and software. And it gets you from zero to 30 miles an hour, uh, at no cost. This company right now is pre revenue. I imagine at some point, they’re going to figure out how to actually monetize it, especially if they’re raising, you know, 50 plus million dollars.

[00:28:24] Marcus: Some, but they have a business model. Uh, but I think, I think this is great. This, this is, this is what should happen, right? We, we, we have a business model that has worked and Oh, by the way, Open source also ends up creating the better technology because everyone has access to it. Everyone can work on it.

[00:28:42] Marcus: I’m sure you can go to GitHub and find open water having a page there where you can comment and contribute and give feedback. And there’s probably a really robust community building around their platform. So I think this is great. This is really cool. And I think it makes it a much more investable [00:29:00] environment again for medical devices.

[00:29:02] Marcus: If this company can actually get some breakout wins. Yes,

[00:29:06] Vic: no, I agree with all of that completely. The other thing that I’ll just add on is that one of the issues in biotech research or life sciences research in my mind is, um, the concept that you don’t publish failures, right? So like you do, you do a research study and you have a thesis and when it comes back that you learn my thesis was not correct, right?

[00:29:31] Vic: A lot of times you file that research away and you don’t publish it because it. It’s counterintuitive, but it, but it hurts your ability to get the next grant, right? And that is really inefficient. It means that we, we do the same mistakes over and over and over again. And one of the things that open source is great about is you’re forced to show your work and show what’s there and other people can build on it.

[00:29:57] Vic: For good and bad, and learn what not to do, [00:30:00] and maybe that then allows us to spend time and money and resources. on something else that really makes a difference. So I think this is could be really impactful for all the reasons you said, and because it will like bring some transparency to the process and let’s not do the same study on something that 15 labs have shown is is not that fruitful.

[00:30:22] Vic: Let’s just publish it and then figure out something else to do.

[00:30:25] Marcus: Yeah. And look, you can see a world where things like open water, Combined with things like, um, alpha fold, right, you know, and that that database that’s got, you know, research from around the world contributing to it, uh, really dramatically changed the cost of getting, uh, something into a stage one clinical trial.

[00:30:48] Marcus: I mean, yes, it’s, it’s just, it could be like an order of magnitude cheaper in the future. I mean, and in the near future, not like in the future future, but in the, in the near future. So, [00:31:00] uh, that is a, that’s a bright spot.

[00:31:01] Vic: Yeah. And it’s going to be great for entrepreneurs, for founders, for venture markets and for patients.

[00:31:07] Vic: It’s in everyone. So I think it’s positive.

[00:31:09] Marcus: Very good. PreciseDX picks up 20. 7 million to advance AI based breast cancer risk assessment. So this is uh, good news. More work in the diagnostic space and the cancer diagnostic space specifically. Um, love to, See AI being applied in the diagnostic space, especially the cancer diagnostic space.

[00:31:27] Marcus: This is a real opportunity to save lives, um, series B funding. And, um, you know, I think a lot of people have been concerned about these lab based, um, diagnostic businesses, just because of the overhang with what the FDA is doing right now. Uh, they do have CLIA, uh, approval. So they, they’re running a CLIA lab, which is kind of how you need to do.

[00:31:49] Marcus: Diagnostic pathology model. Um, and look, I think this is more good news. Yeah, this is, I

[00:31:56] Vic: mean, I wanted to highlight it because it’s, you know, it’s a good [00:32:00] size 20 million funding round and we’re using AI for detecting breast cancer more clearly earlier. It’s a great thing. I think it’s difficult to get the data from a lot of labs.

[00:32:14] Vic: into a digital form where AI can, can ingest it. Uh, but in this case it is, it is digitized. So that, that’s, uh, I think why we’re seeing it here first.

[00:32:24] Marcus: And then Clarion secures 10. 5 million for an AI powered hospital supply chain. So this deal is backed by, uh, general catalyst and, uh, some other key folks, the general catalyst, uh, Kaiser Ventures, Texas TMC, uh, venture fund, Yale, New Haven health.

[00:32:41] Marcus: So, you know, good. Good list of real healthcare investors around the table. Um, AI supply chain makes sense for sure. Um, seems like the kind of thing I was just at the HFMA meeting. Yeah, I think I look, I think the health systems are all in on using AI for ops all in. Yeah,

[00:32:59] Vic: yeah, definitely. [00:33:00] And I think we talked about care.

[00:33:02] Vic: ai last week. Yep. And this is adjacent to it. I think it’s, um, it’s not exactly that space because it’s more in the supply chain, but we’re starting to see now. platforms. They have an entire platform. They’re trying to pull in all the different vendors that feed into the supply chain. And that’ll be great.

[00:33:20] Vic: And we’ll see what we learn, but it could be really powerful.

[00:33:23] Marcus: All right. So probably the biggest policy story of the week, another in a stream of, uh, regulatory body slash court stories that we’ve been covering here on the show. The FTC’s ban on non compete agreements, uh, is tossed out in court. So, not really that surprising.

[00:33:43] Marcus: Eventually, this was going to find its way to a circuit court that has a Trump loyal judge that was going to say this is nonsense, throw it out. That was obvious, um, but it does seem like this is the kind of case that will be appealed, find its way to a different [00:34:00] court, and ultimately could land in the docket of the Supreme Court.

[00:34:03] Vic: Yeah, I think one district, uh, maybe in New England somewhere. upheld it, Texas has now thrown it out. And when you start getting different federal districts disagreeing, I think that’s the natural time the Supreme Court has to come in and decide. Right. Um, I think it’s really important for healthcare because, you know, when you hire a physician, Typically, there’s a non compete that is signed there, and that would be really challenging to figure out how we would organize ourselves if doctors can just go in and out of facilities.

[00:34:42] Vic: I think it would be hard to, It’d be hard to do a private equity deal, it’d be hard to sell a practice to a large hospital, it’d be, it’s hard to just do the business of healthcare without the non compete, you either wouldn’t pay very much for the [00:35:00] business, or you would pay money and then immediately the, you know, the physicians Practicing there is a lot of the way that you monetize it to right.

[00:35:11] Vic: It’s not just not that functional without a non compete And I think that it is good that the supreme court will talk it through I don’t know how the fdc can just decide that all non competes are Now disallowed it has been sort of a state by state policy certainly California takes a very different view than tennessee does every state has their own view And that to me has always seemed like the better, the better recipe, but, but we’ll see how it, how it plays out.

[00:35:45] Vic: I don’t know.

[00:35:46] Marcus: I mean, what’s, what is interesting about this particular case is I think there are two things. One, it’s not focused on a particular [00:36:00] company or even a particular industry, right? It is focused on a particular way of doing business that crosses all industries. Yeah. Um, and that is an,

[00:36:14] Marcus: It’s, it’s, it’s an interesting vector for the FTC to Seek to apply their regulatory authority. Uh, yeah, I, I, I would say interesting or I would say an overreach. It, it, it, it seems, it seems like it’s questionable as to whether or not this is actually in their regulatory purview. Right? Yeah. So, um, that. And obviously when you get to the Supreme Court that just overturned Chevron, I think we, I think we kind of know where this Supreme Court is likely to lean on this type of decision if this happens to make it to this Supreme Court.

[00:36:48] Marcus: So that’s, that’s maybe first. Uh, I, I think the second thing is, I don’t know that this necessarily. Makes a lot of friends, [00:37:00] right? It is, it is such a fundamental part of the way that our economy has been stitched together for decades now. Um, and the way that businesses fundamentally operate that, you know, it’s one of those things you try to pull this out.

[00:37:14] Marcus: It’s like Jenga, you know, you, this might be the Jenga thing that just collapses an economy like unknowingly unwittingly, but like, you just, It’s very, it’s very hard to think through all the implications of removing this.

[00:37:30] Vic: I, I disagree with you there. I mean, I agree that it’s not a good policy, but I think it’s a popular thing that gets votes.

[00:37:40] Vic: So, like, there’s a lot of individual doctors that would like to be free to move wherever. There’s a lot of salespeople that like to be free wherever. It’s not functional. That’s, that’s, that’s, that’s a good point. Now. And you think about how would we actually manage the [00:38:00] delivering care? Yeah, it doesn’t make sense, but I think it gets votes.

[00:38:03] Vic: If you don’t think about it, you’re just like. Hell, I’d like to, I’d like to not have that over my head. I’d like to get free money from the government. I’d like to pay lower taxes. I’d like to get, there’s a lot of things that happen in elections that aren’t necessarily functional. They just happen.

[00:38:20] Marcus: No, no, no.

[00:38:20] Marcus: Listen, I think you, you, you made a good point and I’m, I’m, I’m following. And there are certainly more people who, uh, Are likely to think this is good, then are not. Yeah, it’s good for them. Popular vote. Yeah, popular vote. Uh, not, not the management class, not the business owner class. It’s not, it’s not good for those people.

[00:38:39] Marcus: Right. Um, but that’s a, that’s a smaller number. Yes. That’s a smaller number. So that’s okay. Okay. Point taken. I, I, I agree with that. All right. Let’s, uh, let’s keep moving on. Alaskans can virtually manage their diabetes risk for free with Omada. What is this? So the

[00:38:55] Vic: state of Alaska. Yeah. Okay. funded for a model [00:39:00] to take care of every citizen in this state.

[00:39:03] Vic: Whoa. And, you know, there’s not that many citizens in Alaska and they have the oil money. So they’re different than a lot of states, but I had not seen a state contract like that directly. I haven’t seen that before. And so I, that’s, I put it in the payer. I mean, they’re acting as a payer. They’re, they’re hiring a vendor, but, um, it’s just interesting and it could be great.

[00:39:31] Vic: I don’t know. Um,

[00:39:33] Marcus: you know what’s, you know, what’s super interesting about this? Um, so first of all, I guess it’s not new because they’re apparently saying that, uh, 30, 000 pounds have been lost across the programs by, um, Alaskans. So I guess, I guess the story.

[00:39:47] Vic: Just came out, but maybe it’s been going on for a while.

[00:39:49] Vic: Yeah, 2019. Yeah, yeah.

[00:39:51] Marcus: So they established this in 2019. So here’s what’s really interesting about this. A big part of the OMADA value [00:40:00] proposition is the importance of community, right? And, you know, A lot of companies work with Omada, right? So, you know, the company is the community, but that’s not necessarily really a community, right?

[00:40:16] Marcus: I mean, in some cases it can be, in some cases it’s not, but if you think about all of the citizens in the state, having a fundamental shared experience, the same as getting your driver’s license from the DMV, just like getting your driver’s license, you got your Omada package, right? That’s just part of what it means to be an Alaskan, right?

[00:40:37] Marcus: You know, you can see how that can. Really bump up the effectiveness of the value proposition, because the community, the, the sense of community is so much stronger when you think about you being a citizen of a state and this being a benefit that every single citizen gets. Yes, that’s powerful.

[00:40:57] Vic: Yeah. And then in Alaska, there’s a [00:41:00] lot of rural communities.

[00:41:04] Vic: largely, uh, technology based and virtual and, and builds community, but does it in a way that you don’t have to be able to drive into your doctor to, to access. That’s right. And I think in Alaska that might be more valuable than other states. Yeah. Yeah. Um, and then the, the winners there have got to be tough.

[00:41:26] Vic: And so I don’t know, it’s, it’s not like every state, like you wouldn’t have. The same issues in, in Tennessee, but I think a state taking the action, almost like a public health initiative, let’s take care of our citizens

[00:41:41] Marcus: is pretty interesting and they’ve had good results. That’s, that’s a powerful case study.

[00:41:46] Marcus: I can’t believe we’re just hearing about it, but I, I would love to read more about how this came about, you know, how long they plan on continuing doing it.

[00:41:54] Vic: Fierce Healthcare put it out two days ago. Maybe they published the results. [00:42:00]

[00:42:00] Marcus: I don’t know. It’s gotta be. It’s gotta be. This is something I want to dig into more.

[00:42:03] Marcus: Because that’s, that’s just really, really powerful. All right. Now, moving into the provider sector. So, uh, Mayo Clinic continues to have good news. Um, volumes, income, surging. I mean, the Mayo brand.

[00:42:15] Vic: Yeah.

[00:42:15] Marcus: Just powerful. Powerful.

[00:42:16] Vic: It’s, it’s, it’s interesting. Um, we have a couple stories that the volumes, patient volumes and patient acuity is up across the country.

[00:42:24] Vic: Yep. Yep. And so Mayo is benefiting from that. Every health system is benefiting from that. Mayo, uh, operates their business incredibly well. And so they also have, you know, really strong profit margins. Um, I don’t think that’s true in all of these stories, but we’re seeing, um, Just really strong revenue growth at every health system.

[00:42:49] Vic: Yep

[00:42:49] Marcus: Next story is about mass general mass general

[00:42:52] Vic: brigham. They have the same revenue growth. They don’t have the same Uh operating efficiencies. Yeah. Yeah, the margins are [00:43:00] not

[00:43:00] Marcus: not quite as good.

[00:43:01] Vic: They’re profitable I I don’t think it’s a it’s a like they’re not in jeopardy or anything, but but they’re just not the same Strength in the operations as may have now they have a different environment So maybe that’s part of it, but but I think it’s It’s also partly that they operate differently.

[00:43:18] Marcus: Yep. The University of Illinois Health nurses go on strike near the DNC. I’ve been hearing about a lot of different strikes happening near the DNC. Well, not just strikes, protests.

[00:43:28] Vic: Protests. A lot of protests. There’s a lot of protests. A lot of protests

[00:43:30] Marcus: going on near the DNC. That’s, that’s typical. Yeah.

[00:43:32] Marcus: That’s typical. Uh,

[00:43:33] Vic: but And we had a decent number of nurse strikes a year ago? A year

[00:43:38] Marcus: ago. A year ago. And this is the

[00:43:40] Vic: first one for a while that I’ve seen. Yeah. Yeah. And, um, they are frustrated with the same things that the nurse population always structured. They’re they’re overworked. They’re burnt out.

[00:43:52] Vic: They’re not. Their pay is not keeping up with inflation. Um, and. [00:44:00] Again, like I just said that the revenue is up and other health systems have settled with nurse populations. Mm hmm. Um, Kaiser and, and there’s been several. Yep. They have to figure out a way to pay, pay the nurses and that you cannot let the nurses go on strike.

[00:44:20] Vic: They have gone on strike. I don’t care if it’s near the DNC or not. There are patients that need to be cared for and they have really strong revenue growth. Because every health system has revenue growth and they got to figure it out. And so I don’t have a lot of sympathy. Uh, a year ago, we didn’t really know how it could be negotiated, but now there’s pretty clear.

[00:44:45] Marcus: Well, I don’t, I think this is probably really bad brand for UI health, unfortunately. Yeah, I mean,

[00:44:52] Vic: I’m, I’m, I like health systems and I’m not, I don’t have a lot of sympathy for them. So yeah, it’s not a good, it’s not a good look for UI health. [00:45:00]

[00:45:00] Marcus: Um, yeah, so I, I expect this will get resolved, uh, here pretty quickly, you know.

[00:45:06] Marcus: You should. You know, you know, look, I mean, I mean, I think, I think these things are kind of interesting, right? Because we don’t, we don’t know the backstory. So, so, so one, one potential thing might be, okay, we know that there’s going to be a strong labor contingent at the DNC.

[00:45:19] Vic: Yeah, let’s go and strike right during that week.

[00:45:22] Vic: Yeah, I mean,

[00:45:22] Marcus: because I just read an article, it said the strike is going to last for the entirety of the DNC. Yeah. You know, I mean, could be a great time for you to make your statement to get the best negotiating. Posture you can, you know, look, I mean, because we know the deal is going to get worked out.

[00:45:39] Marcus: Yeah. So it’s really just like, okay, how do you get the best leverage out of the situation? And I will, I guess I’ll just say, it seems to me that the nurses in this case, were being pretty strategic. That’s all. Say

[00:45:53] Vic: the nurses and labor in general have gotten really strategic in how they do [00:46:00] their, their strikes.

[00:46:01] Vic: They just have and management needs to get their act together. ‘

[00:46:04] Marcus: cause it, well, look, I mean, I mean, it, it takes two, right? I mean, you know, they, the nurses may have decided, I don’t wanna go with a one way narrative. We’re not,

[00:46:13] Vic: we’re not gonna agree to anything.

[00:46:15] Marcus: Yeah. Yeah. The nurses may have just said. We’re not doing anything until after we get our strike to the DNC because, you know, it’s, it’s one and done, right?

[00:46:23] Marcus: When, whenever we’re, whenever we, whatever we negotiate is going to last for kind of four years, something like that. Right. So we’re going to get our day in the sun. We’re going to. Leverage the DNC happens once every four years and then coming back to Chicago for who knows how long let’s leverage it Look, i’m just saying it wouldn’t be a dumb strategy if that’s what they decided to do.

[00:46:46] Marcus: Yeah, that’s all uh Santa clara county is buying a 258 bed hca hospital for 175 million dollars to preserve trauma services

[00:46:54] Vic: Yeah, so there’s two stories back to back that have Um, the government, [00:47:00] aspects of the government buying a hospital or a few hospitals from a for profit entity, HCA cut back on their trauma services at this facility.

[00:47:14] Vic: I don’t know why they made that decision, but in general, HCA is, I think of them as pretty good operators. And I don’t think they ever do something that would risk patient care. I don’t know the details, but I have a lot of faith and trust in HCA leadership and the San Jose regional kind of group, Santa Clara County didn’t want to lose the facility.

[00:47:42] Vic: And so they, they turned around and bought it and they’re going to do it with You know, public dollars and float a bond and, you know, all the stuff you do to raise money. And I don’t know if that makes sense or not. I think HCA [00:48:00] probably runs a pretty tight ship, but they run a good ship too. And so just buying something from them, I’m not sure that makes a lot of sense.

[00:48:09] Vic: I don’t know that the Santa Clara County can run it better than HCA, but. But they can run it for their population, and maybe that’s important.

[00:48:17] Marcus: Well, they may not be that far over their skis from a bond perspective. It’s

[00:48:22] Vic: not a huge amount of money.

[00:48:23] Marcus: Yeah, yeah. One hundred seventy five million to avoid a much bigger storyline that, you know, and it’s in California, right?

[00:48:31] Marcus: I mean, you know, you can you can see them making the case that, yeah, our community has to have health care. And if a for profit is not going to manage it and maintain it, it’s the it’s the. County’s job to make sure that something is in place here. Yeah, that’s the

[00:48:46] Vic: storyline that I disagree with. Every county does not need a trauma center.

[00:48:51] Vic: No, no, no. I’m saying you can see how I can see how it would come up to this. Yes. To this conclusion. And I think it’s a good way to destroy money.

[00:48:59] Marcus: Well, [00:49:00] look, I mean, it may just be that they are preserving it for a transitional plan, right? Yeah. You know, and they’re just saying, look, we’re not, we’re not ready to like go full stop.

[00:49:10] Marcus: No trauma services today. Maybe there is a roadmap to sort of a decreased footprint, more sort of spread out freestanding eds, et cetera, et cetera.

[00:49:18] Vic: Yeah, maybe. Sometimes it’s ego based. Like we want to have this. Yeah.

[00:49:23] Marcus: I mean, if HCA is shutting it down, the volumes were not sufficient. That’s what I think.

[00:49:27] Marcus: That much we know. Yeah. Right. So. The 258 beds maybe gets repurposed. That’s another thing, right? You know, maybe they decided to repurpose it for some type of innovation platform for the county or yeah, I don’t think we know enough about it. But I mean, I think what we do know is HCA is getting out of Santa Clara and the county is buying, buying, buying the building.

[00:49:48] Vic: Yeah.

[00:49:48] Marcus: Yeah. Okay. That much we know.

[00:49:50] Vic: Now here. So this is a whole different operator. Steward. Steward health. It’s selling six hospitals to the state of Massachusetts [00:50:00] because, you know, ain’t nobody else going to buy them. And they. are not good operators, and who knows what the proper design of this health system is, but, but I’m not confident saying that it’s not, they don’t need these hospitals.

[00:50:19] Vic: And so in this case, the state is, there’s no other buyers in the bankruptcy. So the state has to come in and buy it. Um, and it’s, it’s just a sad outcome and maybe the least bad that could happen. Thank you. But I wanted to cover this may hopefully the end of this story. Uh, I don’t know. I’m telling

[00:50:40] Marcus: it’s it’s the end of the story.

[00:50:41] Marcus: And so far as, um, look, the state of Massachusetts is known for being a state that, that really does a good job, relatively speaking. Um, In health, in terms of health care for their citizens, really, like, like they are known for had the first, [00:51:00] uh, I’m going to call it universal coverage. I don’t that’s close to you as you can get to it in America.

[00:51:05] Marcus: I mean, that’s just is known for doing a great job in health care for their citizens. And so. This would be one of the situations where I would trust the government in Massachusetts to take this over and ensure continuity of care for those communities, right? And I’m sure they made a fiscal assessment of it and said, you know, the, the outcomes are going to be way worse in the longterm if we don’t kind of keep these facilities up and running.

[00:51:31] Marcus: Um, and it’s a pretty wealthy state, you know, I think financially they can, they can handle it. So,

[00:51:36] Vic: but, but you understand, I understand at least why it puts private equity in the Crosshairs of politicians totally because you had a for profit system to a bunch of deals and then the state has to come in and backslap it.

[00:51:54] Marcus: Yeah. Well, this is, this is, uh, this is wildly [00:52:00] different from the HCA. Oh yeah. Yeah. I know you’re not comparing the opposite. Uh, you’re not comparing the two wildly different. One is for profit, very, very high bar company. Just is making a decision for their platform that this, this, this assets, not high probably not utilized

[00:52:17] Vic: enough.

[00:52:17] Vic: Yeah.

[00:52:18] Marcus: Yeah. I guess. Yeah. That doesn’t meet the criteria and we’re going to, we’re going to wind down.

[00:52:23] Vic: Well, they weren’t pulling out all together. They just were shutting down. The trauma level services, right?

[00:52:28] Marcus: Right. Yeah. So we’re gonna wind that down and in this situation, you know Quote unquote business was going on as usual and then one day they said hey, we can’t keep the doors open, right?

[00:52:41] Marcus: You know and you know anytime that happens that’s just complete mismanagement breach of trust And you’ve probably done a bunch of illegal stuff, you know, so yeah,

[00:52:50] Vic: I think that I think That’s a good summary.

[00:52:53] Marcus: Yeah. So anyway, it is good that that this is, uh, coming to a close [00:53:00] as far as the citizens of those, uh, those areas are concerned.

[00:53:05] Marcus: Yeah. And

[00:53:06] Vic: I can understand why the senators in Massachusetts are really upset about that.

[00:53:10] Marcus: And now they’re going to have a lot of leverage in the narrative, right? Yeah. We’re having to put those hospitals into receivership now. Now it’s a taxpayer issue. Right. And they’re going to be able to drive that point home.

[00:53:23] Vic: Yes, and all the well run private equity. Companies and the deals are going to unfortunately be subject to more scrutiny. Yep.

[00:53:33] Marcus: All right, uh moving on to pharma So lily continues to just have really really really good news with their clip one

[00:53:42] Vic: They published the report 94 of people that took zep bound or I guess I don’t know how to say the other one majorno weekly, 94 percent that had sort of pre diabetes did not move into [00:54:00] diabetes.

[00:54:00] Marcus: 94%!

[00:54:03] Vic: Which is incredible and compared to 2 percent with the placebo. So it’s not that people don’t move into diabetes, they do. They mostly do. And if you give them a placebo that They move into diabetes. Yeah. And with Zep Bound, or the other Majorno, 94 percent didn’t. And so, yes, it’s expensive, and yes, you gotta take it the rest of your life, yes, yes, yes, but diabetes is also really bad.

[00:54:35] Vic: And so, uh, yes, Lilly is, uh, Really operating at a high level.

[00:54:41] Marcus: And, you know, one of the things I think is so interesting about this, I mean, to me, this is really, really tight execution, right? Because if you follow sort of the narrative here with Lily, it really started with. Insulin. I mean, [00:55:00] the company started on insulin, right?

[00:55:02] Marcus: But I would say this, this, uh, this surge in value really started with them being sort of the brand tied, you know, at the hip with the, with the government, lowering the cost and increasing the accessibility of insulin. And so that creates a, Oh my God, what is this company going to do? And here’s what we’re going to do.

[00:55:24] Marcus: We’re going to get out of the insulin business. We’re getting into the Glip1 business. Right. Yeah. And. And their Glip1 is turning out to be the best one, right? I mean, it’s, it’s not just all Glip1s. Well, I, I No, no, no, I’m, it’s been, it’s been measured. Theirs is having an outsized performance compared to the Norvo Nordisk.

[00:55:46] Marcus: Yeah, variant. I mean, it’s, it’s like they, they are just crushing it. And I think their narrative around the whole LilyDirect and being sort of the diabetes management pharma brand that, like, [00:56:00] that, that

[00:56:00] Vic: packaging. They’re really good at strategy and operations. They’re incredible. I mean, what I would say is that their products are, the best.

[00:56:12] Vic: And it’s, I don’t think it’s because of the biochemistry. I think it’s because the way they have done the trials, the way they’ve rolled it out, the way they’re finding, you know, the progression of type of prediabetes to type two, that they’re very targeted and they’re getting incredible results. And, and like building them on top of each other in a very like a creative accumulation where people think, gosh, I should go with Louie.

[00:56:36] Vic: They have all the, the best science. I think a GLP one pretty much acts in a similar way, but they’ve designed their branding, their strategy. The Louie direct, it was incredible. And so they’re getting better results because it all, it all makes a difference. It all matters.

[00:56:53] Marcus: And they’re not really playing the weight loss game.

[00:56:55] Marcus: They’re playing the health, the diabetes prevention [00:57:00] game, right? Yeah. You know, which is a, it, that’s a, that’s a very specific chronic disease focus. And I, and I think you’re right. If to the degree that you’re focused on that, then you can measure. In this way, and you can say, Hey, 94 percent of results, you know, who were prediabetic or not progressing to type two diabetes, right?

[00:57:17] Marcus: That’s, that’s the focus. This is not vanity weight loss. Although, of course, you can use it for that, but that is not sort of the purpose here, right? The purpose is, is a hard focus in a

[00:57:26] Vic: much, uh, just a much better place for the lily brand. No, it’s a less likely to be attacked by Hymns and all the other compound you can definitely get it less expensive.

[00:57:39] Vic: Oh, yeah compound But but the lily brand is definitely a health care. It’s it’s the pure health care, right? Right,

[00:57:46] Marcus: right Yep, and again because of its legacy with insulin. Yeah, it’s the diabetes right right brand Right. Uh, okay. So this is something I found out this week. Um, one of my co [00:58:00] board members, uh, for HFMA, Robin Damschroder, who’s the chief financial and business development officer at Henry Ford.

[00:58:07] Marcus: Um, she’s involved with Truvetta along with many other health systems, right? And she was sharing with the Me and others, this research from Truvetta, so Truvetta is a consortium of health systems that are all pooling their data, um, to participate in research and collaborate in clinical trials. It’s, it’s sort of a new revenue stream and leveraging data as an exhaust value, um, commodity and, and, uh, I think it’s, it’s a very, very smart business model.

[00:58:37] Marcus: But, um, they, they basically were tracking GLIPP 1, uh, discontinuation and re initiation. And I think the trends that they found here are really pretty interesting. Did you get a chance to read this? Yeah, I read it, but there’s a lot

[00:58:52] Vic: to

[00:58:52] Marcus: it. Yeah, yeah. So, so the first thing is that there are [00:59:00] some pretty disturbing discontinuation trends.

[00:59:03] Marcus: Uh, with Glip O M’s.

[00:59:05] Vic: Yeah. Um, It has side effects. People don’t, people would prefer not to be on it. That’s what you mean, right? People are just continuing it.

[00:59:12] Marcus: Well, yeah, I mean, I have a reason people are discontinuing it at a, at a rate that I did not necessarily understand. Um, so let’s, let’s, let’s, let’s just, you know, review some of these.

[00:59:22] Marcus: Yeah. Um, so first of all, going back to the whole type two diabetes, but so discontinuation was significantly higher for patients without type two diabetes of the 96, 544 patients initiating a lip one medication, 46 percent of patients with, and 65 percent without type two diabetes. Discontinued within one year.

[00:59:42] Marcus: Those are really high rates. Like I, I did not. And I know people that have discontinued it. The side effects are basically one and two. One in two people will, will, will discontinue in the first year. I [01:00:00] was not expecting those kinds of discontinuation rates.

[01:00:05] Vic: And you gain the weight, you gain it back.

[01:00:07] Marcus: Yeah. Yeah. That’s, that’s, that’s pretty problematic. And so then they, then they also study, uh, re initiation. Um, so re initiation was significantly lower for patients without type 2 diabetes. So again, this is vanity. It’s not for vanity, right? Exactly. So of the 28, 142 who discontinued and had a discontinuation weight available, 51 percent of patients and 35 percent without type 2 diabetes re initiated within a year.

[01:00:35] Vic: What does that mean? Discontinuation wait available? Not exactly sure. I wasn’t sure

[01:00:38] Marcus: when I read it. Yeah. Uh, I, I think it’s, I think it’s, it’s probably some, uh, threshold for the study. They had enough wait that they

[01:00:45] Vic: could, they could go on and begin if they wanted to or something like that. That’s what I think.

[01:00:48] Vic: That’s what I

[01:00:49] Marcus: think. I think we’re going to find over the course of five years with this, how many people are actually able to stick with it. We’ll [01:01:00] see how much scale this actually has, right?

[01:01:05] Vic: I, um, I think that’s right. It’s a, it’s a difficult medication to take the rest of your life. It just is. I mean, it has Now, if you titrate it right, you get the dosage right, you can, you can live with the side effects, but there’s a lot of side effects and it’s just hard.

[01:01:26] Vic: So, but, you know, diabetes is hard too. Diabetes is hard too. And so if you have diabetes already and you know how hard that is. And especially if you start seeing the, the symptoms related to diabetes, um, it’s maybe it’s worth it, but the weight loss for vanity or even the pre diabetic cohorts, it’s a hard thing to keep up with.

[01:01:53] Marcus: Alright, we got a story here about AstraZeneca. They are a cancer leader, but obesity could be a bonus. What’s the, what’s the story [01:02:00] here?

[01:02:00] Vic: Yeah, so they are, um, really crushing it in cancer. Go down a little bit to their, uh, chart there. Um, and the CEO set a goal to get to 80 billion in annual sales. Um, and yeah, right now he’s at 45.

[01:02:22] Vic: And

[01:02:23] Marcus: he’s, he’s tracking to 52 this year. Yes. Kind of what the projection is. Yeah. The analysts say

[01:02:28] Vic: and the, the cancer sort of group, it was 3 billion in sales in 2014 and it’s a 17 billion today. They are in cancer is a huge space. Lots of issues. Uh, they also have. GLP 1 optionality. Um, but really just I wanted to mention it just quickly because they really seem to be like Lily is is sort of Diabetes and then lots of other stuff, right?

[01:02:59] Vic: They’re really [01:03:00] cancer, right? And then, of course, a bunch of other things, too. And they seem to be operating really well in that space. So,

[01:03:08] Marcus: I mean, Pharma seems to be doing pretty well. You know, you take out the vaccine companies, but the big ones. I think Pfizer is hard. Well, I’m not talking about Pfizer.

[01:03:17] Marcus: They’re a vaccine company. Well,

[01:03:18] Vic: okay. If you call them just a vaccine company. That’s what I call them. Okay. That’s what I

[01:03:22] Marcus: call them. I call them a vaccine. I mean, well, they overplayed their vaccine hand. Right? So. Right. They bought something big

[01:03:28] Vic: in cancer. They, they have a cancer play too, but yes, they, they are.

[01:03:32] Vic: They’re not, they’re not doing, yes, and that’s not a good place to be. It’s not a good place to be. Yeah, but I mean, but other than, other than that, I think, uh, Novo doing well, Novo’s doing well. GSK

[01:03:43] Marcus: is doing well. AstraZeneca is doing well. Lily’s doing really well. I mean, it seems like pharma is doing pretty well right now.

[01:03:50] Marcus: A new Alzheimer’s study suggests where you live can affect the odds of a diagnosis. This is both somewhat understandable and also shocking. To see [01:04:00] the map associated with this story. Uh, I don’t even know what else to say. Just scary, scary.

[01:04:10] Vic: Um, the. the prevalence of dementia is pretty different in different zip codes around the country.

[01:04:21] Vic: Um, and maybe go to the map so we can talk about, I, I sort of expected it to be the normal, um, if you did this with diabetes or heart disease, or there are parts of the country that don’t, they have diet and exercise issues. But those are much

[01:04:39] Marcus: more understandable, right? I mean, the way that we think about dementia is, you know, some type of.

[01:04:45] Marcus: Neurological thing and, and a lot of people talking about the ties to genetics and epigenetics, you know, that should

[01:04:51] Vic: not be geographically, maybe epigenetics,

[01:04:56] Marcus: but

[01:04:57] Vic: yeah, maybe if Jess would be there, but, but then the thing, so [01:05:00] I was expecting to see the normal chronic disease map where, you know, the South doesn’t eat that well, you know, is there’s healthy people out in the Bay Area.

[01:05:13] Vic: They’re all healthy, um, and that’s not what the map shows. And so, one, I was surprised that there is a map about dementia, and then two, it wasn’t the, the distribution I was expecting. Yeah. There’s a strange band across Texas that kind of goes from, I don’t know, I guess the little hook part in the, the Western part of Texas up to really the Dallas area, pretty high prevalence of, of dementia.

[01:05:43] Vic: There’s lots of hypotheses in the study of how, what this might be attributable to, but no one really knows. And so I just think it’s worthwhile to track and try to try to understand.

[01:05:56] Marcus: I mean, it’s just crazy to look at this map and see that [01:06:00] the areas that are clearly above the mean from a ratio of cases.

[01:06:05] Marcus: Are largely in Texas like that. I mean, you know, there are a couple of other states, but Texas really takes the cake and it’s like, why, what is going on there? Um, like there’s, there’s only one little area that is below the mean area in, in Texas. Yeah. The vast majority of it is on the high end or the very high end or the, or the highest end in the country.

[01:06:30] Marcus: Right. What is going on there? Environmentally that. Is leading to more dementia. I mean, is that water air quality? Like what is that?

[01:06:41] Vic: I don’t know. And then New Orleans is Um, and then there’s little pockets that could be a genetic thing or could be epigenetic with something that we can’t track. And then Oregon too, like, I don’t know what’s happening in Oregon, but I don’t know.

[01:06:58] Vic: It wasn’t the map I [01:07:00] expected. And so there’s a lot more research, of course, to be done. I think it’s a positive thing that we are uncovering this, but until we figure out the source more, it doesn’t really help very much.

[01:07:12] Marcus: It’s terrifying. I mean, my wife is always worried about environmental stuff. And yeah, this, this is kind of one of those, like, really scary.

[01:07:18] Marcus: My father in

[01:07:19] Vic: law lived in Houston and died of Alzheimer’s. Wow. And I mean, a lot of people die of Alzheimer’s and dementia across the country. Sure, but, but, but now seeing this data. It’s a red area. Yeah. Yeah. Seeing

[01:07:32] Marcus: this data makes you think differently about it, right? So here’s the whole study. Well, we’ll put it in the show notes.

[01:07:38] Marcus: Yeah, we’ll put a link to this in the show notes. Alright, let’s wrap up the show. Epic touts a new AI application to streamline charting and bring research insights to the point of care. If there’s one thing that I learn every time I spend time at HFMA, it doesn’t matter if it’s a board meeting or the annual conference, Epic is [01:08:00] winning.

[01:08:00] Vic: Yes.

[01:08:01] Marcus: Epic is winning.

[01:08:03] Vic: They have pretty good products and they’ve convinced hospital leadership just to trust them with everything.

[01:08:11] Marcus: Forget it. And, and, and listen, hospitals have enough problems and it does seem like Epic is best of breed. It’s dependable enough. They, they have a good roadmap that they deliver on.

[01:08:26] Marcus: They integrate health system leadership into that roadmap and health systems are just like, If epic offers it, we’re using it. So it’s just, you know, it really has, for me, it really has severely closed out the hospital technology category. Um, If it has anything to do with clinical stuff and a, and a growing body of this is moving into the rev cycle.

[01:08:52] Marcus: Yeah. I mean, you know, epic is, people think of Epic as like a, you know, just the, the health record. They’re not just the health record.

[01:08:59] Vic: Well, [01:09:00] the, the, I mean the, the electronic medical record is a billing tool. Yes. And so they, they

[01:09:06] Marcus: have a, people

[01:09:06] Vic: think

[01:09:06] Marcus: about it as the doctor’s interface. Yes. They don’t think about it as the, the, the finance team’s interface.

[01:09:11] Marcus: Right. Right. It is the finance team’s interface.

[01:09:14] Vic: Yeah. Yeah. And so go down a little bit for people that are watching the video, because no, no, show the picture. Oh, okay. Because Judy Faulkner dressed up like Mother Goose is worth, worth seeing. And that’s part of their secret too, is that, I mean, they’re doing this story time and the billionaire CEO who’s built the whole company is dressed up.

[01:09:38] Vic: With like a goose cape on, and it’s great. I mean, I hate competing against them, but, but it’s hard to argue that, I mean,

[01:09:47] Marcus: let’s be real. We’re not competing against them anymore. No. We’re just avoiding, we have decided. I’m just decided to stay away from them. We’re just find other ways

[01:09:54] Vic: to integrate with them or work around them,

[01:09:57] Marcus: you know, whether we think it’s right or we think it’s wrong.

[01:09:59] Marcus: [01:10:00] It’s not changing. It just is. Yeah. It’s not changing. Right. Anytime soon.

[01:10:02] Vic: So, and then they, they, you know, so this was their developer and customer con conference with each Yep. unveil all their stuff. They have a whole bunch of tools, a lot of AI tools. The one that caught my eye is they are responding to patient, uh, inquiries.

[01:10:22] Vic: They put it in draft form for the physician or the nurse to easily respond. A million a month or that they are creating, um, docs and nurses don’t like, don’t want to respond. And the results have been much better. So like the, the, um, customer feedback, the patient feedback, patient satisfaction is, is much higher.

[01:10:47] Vic: They’re doing it all with AI. Um, and it’s real, it’s really powerful and that they’re going to, they’re going to keep extending. So they’re moving into not really care, but the, the explanation of [01:11:00] care to patients and what they should expect or what questions they have, they’re answering. So they’re, they’re moving closer and closer to the care plan.

[01:11:08] Marcus: Makes sense. Makes sense. All right. Good show. Um, Godspeed next week. Yeah.

[01:11:14] Vic: Hope you figure it out. I will. I’ll have a show. I don’t know if I’ll have a guest host. I’ll be a solo, but either way it will be, we’ll be back.

[01:11:21] Marcus: You will figure it out. All right, man. I’ll, uh, and, uh, good luck with the event. Thanks.

[01:11:25] Marcus: Appreciate it.