9 – SCOTUS strikes down Affirmative Action | MDMA PTSD treatment Creative Financing | A Ray of light in VC fund formation | Ozempic Concerns

Marcus: [00:00:00] All right. Welcome back. Episode nine of, uh, Health Further. First and foremost, just want to apologize about the audio last week. We’re still dialing in this remote, uh, model and, uh, I think this week will be, will be better. Although we are still remote, uh, as I continue to be on the road on this conference run.

Uh, but Vic, how you doing, man?

Vic: I’m doing well. I think we have, we at least definitely better. I now have my earbuds in and I feel like a real podcast.

Marcus: You’re a pro. You’re a pro now, man. Um, Yeah, you know, I should, I should always be the one when i’m on the road. I should always be the one that that’s That’s creating the problem because I got the hotel wi fi and the room.

I got music going on outside So but anyway, I am right.

Vic: So you’ve been you’ve been in three different conferences in the last week or 10 days or something

Marcus: Yeah, yeah, it’s been where are you right now? It’s been a run i’m On Mackinac Island, uh, in Michigan for the Michigan Health and Hospital Association meeting.

I keynoted this morning. Uh, it went great. Thanks for asking. [00:01:00] Um, and, uh, it’s a beautiful island. That’s way

Vic: up there. That’s way up there by Canada. It is. It

Marcus: is. It’s up here. It’s up here. So, so I think the smoke mostly cleared out before I got here. Um, but it was, it was, it was pretty smoky. Um, and it’s still a little bit overcast.

It’s not terrible though. Uh, but it’s, it’s beautiful out here. I mean, you know, super picture picturesque, there’s horses everywhere and no cars on the road and, you know, they make you dress up at the grand hotel and all that kind of stuff. Um, but it’s been, but it’s been a great event. I met, met a lot of great people out here, so that’s always good.

And yeah. And then, you know, before I was here, I was at HFMA, which at least was at home. So in Nashville. Um, at the Gaylord, uh, Opryland, and I was there, uh, Our listeners may not know, but I’m on the National Board of HFMA, so I didn’t speak or anything like that, but as a board member, um, I was in attendance.

And another, another great event, uh, I’m not sure if it was a record, but they had about four, 4, 100 people in attendance. Um, so, so, you know, big showing, big showing. So, [00:02:00] you know, kudos to the, to the group who, uh, who put on the event. Um, you know, the team at HFMA does a great job. And yeah, last week I was in Aspen for the Aspen Ideas Health Festival.

So it’s been, it’s been a run.

Vic: Yeah. So we talked about the Aspen Festival last week in detail, but give me like a summary of these two healthcare focused. HFMA is really focused on finance. It’s a lot to unpack in health system finance. Uh, and then you’re with the Michigan Hospital Association, also big hospital groups. Uh, what, what, what, what are the trends?

What are you seeing out there? Let’s just talk about what you’re finding. What’s happening on the front lines.

Marcus: Yeah. So, you know, for, for HFMA, I would say there were, there were two big things I walked away with. One is that the revenue cycle industry is a really big industry. [00:03:00] Um, you know, this is, this is an industry that I’m not sure when it really started, uh, in terms of like all the rebadging.

That that was happening. I know it’s been happening pretty much as long as I’ve been in health care, you know, so it’s been happening at least since 2015 back when health further was a conference. We had rebadgers there. So I’m not sure when this started, but Vic, the, the health, Oh,

Vic: it started 20 years ago.

It’s been, it’s been a Nash. Nashville’s been pretty strong in it for a long time. It’s

Marcus: massive. Okay. It’s massive. It’s massive. Okay. That, that is a massive part of the healthcare industry. And I think, um, it’s so. It’s so obscure and so not understood, you know, outside of the HFMA world, it’s really not well understood that I don’t know if people actually know how big it is from a, from a dollar perspective, like how much of the overall industry is kind of made up inside of [00:04:00] Revcycle, but it’s, it’s massive.

That that’s, that’s kind of one big takeaway. Um, the other big takeaway is. We’ve talked about this, but it was, it has not been as clear to me. And I don’t know why, as it was this, this weekend and early this week at HFMA, there really are three kinds of hospitals today. There’s, there’s for profit hospitals.

We know a lot of them because we’re in Nashville. Um, you know, H HCA is, is the sort of poster child for that. Bill Rutherford was, was on stage in the opening panel. You know, CFO for HCA. You know what I didn’t know is that, is that Bill has been at HCA his entire career. Did you know that?

Vic: Yeah, yeah, yeah, yes.

Marcus: It’s incredible.

Vic: Yeah, he’s a lifer. He’s, and he’s, he’s incredible. He’s probably one of, maybe the best CFO in the country, but one of the best.

Marcus: It’s incredible. It’s incredible.

Vic: And HCA is really good at operations and finance.

Marcus: Yeah. Yeah. So, so, so there’s, there’s the for profits, right? And we can just sort of say, you [00:05:00] know, exemplified by HCA, but many, many other for profits and we sort of know how they operate.

Then there, and I, and I’m going in order of what I would say are, Stability in this time, right? You know, 3 plus years of of some form of emergency, whether it was the pandemic or whether it’s, you know, inflation driven by, you know, high labor costs and, you know, fed rates, you know, going through the ceiling.

Right? So, so for profit, then there’s nonprofits that have a health plan. And I think there are actually a lot more of those than people realize. There are there. There’s a really good number of health plans out there that are making a real push to be fundamentally or at least 50 percent value based.

Health plans or health systems health systems health systems, but health right,

Vic: right But

Marcus: health systems that have a health plan component to them This is this is critical. I I don’t see any health systems without a health plan that are talking about going full on value based care I I don’t see any of them doing that.

Uh, just because I [00:06:00] the capability the core capability Is the risk management piece, and that’s tied to being able to structure the payer contracts and capture the data on the actuary capabilities. So, you know, so much of the value based care capability. I know they talk about data, you know, care coordination and quarterbacking and being able to be responsible for the full episode of care.

And I get all that, but at the scale of a health system. Right. Not not a PCP, but at the scale of a health system, I don’t really see any health systems doing that that don’t have a health plan. Okay. Don’t have that capability. And how

Vic: that’s right. I think it’s also, um, you kind of need some density. In your population, right?

So, typically, the ones that do well are, um, in a geography where they have a reasonable percent. Of the patient volume, and then they also have a lot of the insured. Uh, members. And that, that sort of density is [00:07:00] really helpful. So like my bet

Marcus: is those two things go hand in hand, the health plan and the density.

Vic: Yes, that’s right. So I think it is, um, it’s more difficult for a nationwide nonprofit like Ascension common spirit to put a health plan in place because they don’t have the density. And I think it’s easier for, you know, Kaiser and Geisinger. It’s probably the classic example, but there’s, there’s lots of examples that they’re in a region.

And they have four states and Banner, for instance, or someone like that, who is, you know, that they’re not in every state, but they have a lot of density in the in the Southwest.

Marcus: Yes. So that’s kind of the 2nd, kind and, you know, I will say I’m seeing more of those, um, that are that are doing. Okay. You know, they seem to be operating.

They seem to be innovating. They seem to be navigating the situation. They seem to have been able to really marshal the culture [00:08:00] necessary to make changes early on that are now starting to pay off. Right. Um, and I, I can’t fully connect the dots on that. It’s, it’s probably worth somebody doing a study on it, but just anecdotally, as I’m just talking to leaders in the industry, that’s what I was sort of picking up.

Um, and then the third bucket are the pure nonprofit. Health systems and, you know, you already talked about the national ones, but I think this is also true for even even regional ones that do not have a health plan. Okay. Um,

Vic: oh, yeah, I mean, I, you know, I, I got, um, I spent a lot of time with those groups. Uh, trying to raise a fund a year ago, there’s a lot of them and they’re suffering, really have a lot of challenges.

Marcus: Yeah, there, there’s so many challenges there. And, and just to go back to our, um, our episode where we, where we, Broke down common spirits, you know, third quarter financials, um, pair mix. I mean, you really [00:09:00] can sort of just start there. What is the pair mix? And we, we were talking about, you know, their pair mix being 67 percent and we were kind of astounded.

I think we haven’t spent enough time actually looking at the pair mix of these nonprofits because I was hearing several that were over 70%. Uh, this weekend. Okay. I even heard a couple of people. None of this is attributable, right? So, you know, I mean, uh, you’re not gonna be able to figure out who told me these things, but like, I even heard somebody say, you know, listen, we’re gonna go to the government and just sort of say, listen, you’re gonna have to change this stuff or we’re gonna have to stop taking care of these people.

Right. I mean, I mean, so, so I think I think we really are heading towards something. We’re heading towards something serious. That’s going to have to happen. And you and I talk a lot about the imperative of innovation, but I don’t believe this is like something you can solve with innovation. The fundamentals of the business model are just so upside down, you know, they were 3 years, [00:10:00] Have just fast forward at that process.

Um,

Vic: yeah, I mean me bringing a new, uh, tech innovation that will save them a few basis points is not going to change the fact that they’re losing a billion dollars a year.

Marcus: No,

Vic: it’s just too big. It’s too big. And, and I think they have already gone to the federal government. I know. That a group, a big lobbying group went last summer and tried to get relief and they were not happy with the results.

I’m sure they’ll go back. I don’t know that it’s going to be, um, very well received. I understood because you have these other groups, the for profits and, uh, kind of integrated health systems with the payer that are. You know, doing pretty well. I think HCA stock is a buy right now. It’s doing really well.

And so it’s, it’s kind of a weird thing for a politician to, to, to give hint, give support, give subsidies when [00:11:00] the hospital down the street is doing well. Okay,

Marcus: yes, yes, until the people stop being able to get care because I like everything you’re saying is correct politically, like the difficulty there politically, everything you’re saying there is correct.

However, it’s also true that HCA is not in those markets. They’re not taking care of those the same people, right? So, um, It’s a false equivalent in that way, right? They’re not the same thing. And, um, you know, I understand how Byzantine this industry is and politics and Byzantine industries don’t go along very well in terms of, you know, politicians caring about what the public thinks in that case.

But once people stop being able to get care, that’s going to be an entirely different situation. Now, we are generally talking about the, You know, the poor and the vulnerable, right? And, and the poor and the vulnerable, and the seniors. [00:12:00] So we’ll see whether or not we can galvanize enough, enough political will to support that population.

But, um, yeah, I, I, I, I just feel like something, something very serious is going to go down in the next 12 months on this front because the, uh, the, the, the, the, the trends are getting to a very, very scary place.

Vic: Yeah. And so what would we recommend or do we, do we, I don’t, I don’t,

Marcus: I don’t have an answer. I, you know, to me, um, that is a part of the industry.

I mean, look, I’m not, I’m not saying that I’m, I’m not raising my hand to help as an innovator and on behalf of all. You know, innovators in the health care industry. So all the venture funds, all the private everybody who wants to help. I’m not saying we’re putting our hands down. I’m simply saying, I think it’s insufficient.

So, you know, it’s certainly necessary. There needs to be more technology. There needs to be more more innovation. The time the time that we have to [00:13:00] solve this problem just doesn’t line up with the time it would take to absorb that innovation. Right. Um, you know, there’s going to be some bridge that’s going to need to be built here.

Um, if we want these systems to be able to be trans, if we want them to have a chance to transform. Right. Uh, we’re going to need a bridge to that transformation. So that’s, to me, that just seems unavoidable.

Vic: It’s interesting. I think that there’s, uh, there’s two things that I’m frustrated about. It’s like, it’s very clear to me that.

Nonprofit health system should have an integrated payer period. Like, you, you, you have to have that. And so, if, if the government’s going to provide a bridge or support or subsidies. We should say like that is part of the equation and then the other thing which is a personal thing But I have an exchange student from Spain staying with me now and the data Transparency data [00:14:00] portability.

I mean, it’s in bed. She’s she’s 16 years old, right? So she’s young. I’m Embarrassed talking to her about our health system because she she’s 16 years old And she will pull out and she pulled out her phone at our dinner table and showed me all of her health records You On her phone from Spain and I, and I can’t show her that I don’t, I don’t have my health records and I can’t get them even though I have insurance.

I have multiple doctors. And so the other part of this, I think, is trying to. Enforce the statutes that are already out there that we create transparency. We, we allow. And it’s not that I expect. Every patient to be shopping, but I, I think you don’t need that. There will be groups that come in and collect reports and show lots of people where to build extra services because they’re not efficiently [00:15:00] delivered and you just have a more functioning market.

Anyway, so there’s a lot that could be done. I don’t have a lot of confidence that it will be done, but, but yes, that we’re going towards this. Um, it’s unsustainable with these health systems that are. In one metro area, or maybe they’re in one state, they employ a lot of people. They take care of a lot of people and they are burning money every quarter.

Uh, when I was looking at this six months ago, the average health system had about, you know, eight months of cash and that was. Several months ago. Yeah, and so they’re gonna be out of cash this fall.

Marcus: Yeah, it’s it’s uh, it’s a huge problem So anyway, you asked for my my my rundown on hfma. I mean those are the two big points and uh, Yeah, those are the two big points.

Um, I don’t really have that much to report from the michigan Um health and hospital association. Honestly, I mean I was I was a performer here. So, you know, I [00:16:00] did the keynote And uh, you know Right below me. So I’m up in the room recording this right below me. Uh, there’s everyone’s dressed to the nines having cocktails, uh, you know, enjoying themselves.

And so, you know, I’m, I’m still kind of at work, not really enjoying the festivities. Right?

Vic: Right. Right. Yeah. Yeah. Well, we can, uh, We will continue and then get you down there to the, to the, um, but, but I want to talk about the breaking news at the Supreme Court today, which is, you know, coming out, uh, like an hour before we started recording.

So I’m still absorbing, and I’m sure you’re still absorbing it. Uh, but let’s talk through that, even just our quick takes on what this means. For society, but then try to tie it to health care if we can.

Marcus: Yeah, well, I think we definitely can tie it to health care. I mean, this is the 2nd, uh, really, truly significant, um, SCOTUS ruling, uh, that reverses a [00:17:00] previous, um, SCOTUS ruling and, uh, you know, from similar eras and, uh, is, is really short, sort of demonstrating a change in the current, uh, view of the Supreme Court on, uh, on, on the, on what’s, what is constitutional and what is not constitutional.

These are really, these are really big fundamental changes. And the first one is clearly a healthcare issue. Um,

Vic: yeah, the jobs is clearly, clearly

Marcus: healthcare. Uh, this one is also healthcare, right. Because It’s about education. It’s about higher education and higher education is Uh, inextricably linked to health care are our clinicians all get, you know, are all of our clinicians of the highest licensure must go through higher education institutions.

They must. [00:18:00] And, um, you know, there, there, there’s clearly, uh, some serious disparities in the profession today where we don’t have the, uh, requisite diversity. Of doctors, I think the American association of medical colleges, uh, has recognized this and has an entire initiative right now around black men, um, in medicine, specifically around black men becoming doctors.

You know, when I was at Aspen ideas, health last week, 1 of the 10 big ideas, they opened up the event with. Was what if we recruited, um, black boys to be doctors the way we recruit them to be athletes. It was a tremendous idea and it sort of made everyone just think and realize, uh, you know, the way

Vic: that that that kind of initiative.

If you shoot to be a professional basketball player and miss. You don’t have a great future, but if you [00:19:00] shoot to be a doctor and miss, like my mother wanted me to be a doctor, she was like whipping me and trying to get me to be a doctor from the time I was five years old and I missed that. I didn’t want to be a doctor.

I had a lot of doctor friends, but it wasn’t right for me. But then you still have gotten all that training and there’s plenty of other things. So like that culture change of training, a thousand young black boys to be doctors. They can do things, things if they decide they don’t wanna be a doctor.

Marcus: That’s exactly right.

Vic: Versus if they blow through, if they blow out their knee and they can’t play basketball anymore, there’s not that much they can do. That’s

Marcus: exactly right.

Vic: And,

Marcus: and look,

Vic: I

Marcus: mean,

Vic: I

Marcus: know, um, I know some incredible black doctors who, uh, will directly say that, uh, they, they wouldn’t be where they are if it were not for, uh, affirmative action.

So, you know what, what was interesting, I think for me, for me today was this has been. Rumbling around for a [00:20:00] while. Um, I I knew It was going to happen. I wasn’t tracking what day it was going to happen And it happened today. I actually I actually got the got the notification on my phone while I was watching.

Dr Alicia jackson, uh, who is one of the top docs at um, common spirit. Um, She and I basically we kind of co keynoted the event this morning Um, she went on then I went on and then we we did a panel i’m watching her i’m watching her tell her story You About, you know, basically coming out of a very low income, all black neighborhood and beating all the odds because people, you know, cared about her and gave her a chance, you know, um, and now she’s one of the most, you know, important influential, uh, doctors in America right now, right at top docket at, at common spirit.

And while I’m watching her, I’m literally, I’m watching her on stage. And then I get this, you know, this notification, uh, of this happening. And I have to just say that. [00:21:00] Uh, it made me way more sad than I thought it would. Um, you know, I’m on this beautiful island and, uh, you know, I’ve mostly, you know, I went and took a walk.

I got, I got lunch, but I came back and went to my room and took a nap. Uh, I’ve just been, um, I think just as a, as a black man in America, the, the, the importance of affirmative action. Uh, not, not just in my life, but in, in my, in my family and my friends and my community’s lives has just been this ever present thing.

And I think I kind of, I think I kind of got a little bit of an understanding of how many women felt when, when, when the Dobbs ruling came down, um, you know, which was something that was just there for your entire life. It’s now, it’s now removed, it’s now gone, right? And, um, I don’t know [00:22:00] that Yeah, you’re grieving, or it’s a loss.

Yeah, for sure, for sure. And I don’t, you know, and I’ve also engaged in some conversations, um, and, you know, there’s definitely different opinions on it, different people are having different experiences, um, You know, with it, so I’m just articulating mine. Um, but, but clearly, uh, this, this is, this is going to impact health care.

I don’t think there’s any question about it. It’s going to impact health care. And I guess 1 of the biggest things, you know, when I was talking to you earlier, and I want to hear you talk about this, but you sort of asked the question, how is this actually going to be implemented? And, you know, like, We could say the same thing about doves.

How was that implemented? Right? I mean, it was so severe and so sharp because it’s coming from the Supreme Court, right? It like instantly changes our world and the health care industry that doesn’t change quickly doesn’t adopt innovation. You know, laws can be innovative too, right? And this new ruling it, there was no glide path off, you know, [00:23:00] there was no, okay, okay.

For the next 12 months, here’s how we’re going to deescalate and we’re going to create new processes and we’re going to create new best practices. And no, none of that. It was just, it’s over, it’s illegal, can’t see you. And the next thing you know, we’re hearing all these, you know, stories about women having really, really terrible encounters with the healthcare industry.

Right. Because, you know, it part, partially because of the law, but partially because there was no time to adjust to the law. Right. And I think this is a very similar situation where. Yeah, I

Vic: think it’s, I think it’s similar, but, but worse. I mean, DAWBS, it was pushed to the states and each state is different.

Many states didn’t have ruling, didn’t have laws that were, that were very accommodating, some didn’t really weren’t prepared that well, a lot of states. Unfortunately, if. Like, Tennessee, they were prepared to be very, very restrictive, [00:24:00] but this is different in my mind because, uh, I mean, I went to, I went to Amherst college.

It’s a very small. Exclusive school, um, I get in because I play football. I could not have gotten in. Otherwise, and it’s not a real, it’s not a significant to division 3 school. And so it’s not like we’re on TV or football. Is that important, but they want to have a balanced class. They let in people who play.

music instruments. They let in people in debate. They let it, they want a balanced class with all different interests because the people in admissions think that leads to a more healthy, diverse, you know, interesting four year experience. And race is part of your life, part of your life, part of your perspective, where you come from.

It’s hard to separate race from who the people are. And saying [00:25:00] that you cannot use race as part of the input, I think is going to lead to a much less interesting student body. And unfortunately, a lot of foreigners that have. Better test scores because they all because they have, there’s a lot of people outside this country that have spent a lot of time trying to get access to schools because it’s there.

It’s their way out. So it’s like at Harvard, which was, you know, the named one. Carolina with the two schools named in the suit. They have a Chinese and Asian. Um, that was the complaint really that there were two, there was. There were not enough, um, Chinese nationals getting in compared to their, their qualifications.

[00:26:00] And whether, whatever side of the, of the balance sheet or the decision one is on that, I don’t know what they do tomorrow. They still have to figure out a way to create a class at Harvard or at Amherst or at any school. That is going to be able to, you know, live together and learn from each other and do all the things that make the school run.

And I, I don’t think it’s going to be easy to, to make that race blind. I don’t, I don’t know how that’s going to work. Um, and unfortunately, I think probably Harvard will be fine. I think that they will figure out something, but I think what you’re sad about, or what, what I, what I believe you’re sad about is the unintended consequences are going to be other programs.

Are not as high profile, that are, that have [00:27:00] been really helpful to black and brown communities that now are gonna be cut off for, for no reason really. Um, and so like how we, how we navigate that, I don’t know. But it’s not gonna be good,

Marcus: you know, Vic, I think, I think that the thing and, and then I, I, I, I wanna move on ’cause we’ve got some other stories, but I, I think one of the things that just.

Most makes me sad is that as we came out of the pandemic and we, we had this, this entire narrative around racial reckoning, you know, there was a pendulum swing and there was sort of a backlash against that. And, you know, I’ve noticed a lot of people, particularly white people, sort of, you know, questioning whether or not systemic racism is, is, is even a thing, you know, and if you, if you bring up something like redlining to many of them, they wouldn’t even know what, what it is.

Many of them don’t like, literally don’t know what redlining is. Right. [00:28:00] Um, and so, like, there are many people who simply think that, like, once the Emancipation Proclamation was put into effect, like, that was it, you know, or, or after Martin Luther King, you know, there’s a lot of people who like to evoke the name of Martin Luther King Jr.

Right. And just like after that, it was, it was sort of all good. Not understanding the actual history. Of of of, uh, discrimination, you know, that that’s happened in this country and what and what happens when you have compounding, uh, generational discrimination, right, you know, and, and, and, uh, and so what we now just are

Vic: putting the red, the red, most people’s.

Net worth is in their home and the redlining tactics, which went on for decades, you probably know how long, but for decades, maybe, maybe a hundred years, they are,

Marcus: you want to hear something crazy. I have friends who have gone to buy houses in certain neighborhoods and it’s still on the deed.

Vic: Yeah. [00:29:00]

Marcus: Yeah.

It’s still sad.

Vic: But like, if you don’t start, Building equity in your home three generations ago. I mean, so for, for me, for instance, again, like when I, obviously I’m white from Boston, my grandfather came over from Italy, went to Harvard night school, and then he was a realtor. So he was selling houses and then bought houses and made some money.

He was. He was Italian, but that was close enough to white at that point that he was fine. And then I got out of college and wanted to buy rental property and my grandfather had passed away, but my grandmother co signed for me. And that’s just an example of where like my privilege of being able to have the ability for my grandfather to buy houses then allowed me to build net worth in a way that.

If you [00:30:00] didn’t have that family history, if you were a black family and were redlined, your grandmother couldn’t help you in that way. And that’s a small example, but like, it’s, it affected my life in a way that I, I got to buy this rental property. And then, you know, I was paying the mortgage with the rental income.

And then I got her off the loan five years later. If you were, if I was black, That wouldn’t have been possible and, and that’s not fair. And I got a, I personally got an advantage because I’m white or more to the point. My grandfather was white and that’s, you know, now that’s right now. And so these things are certainly real.

The pendulum swung a long way towards fairness because of how terrible the pandemic was and George Floyd and [00:31:00] all of the really bad things that happened. And I think, um, people just get, um, they just forget. And, and I don’t know that the Supreme Court, I don’t know what they were thinking. I’m not party to that.

But, um, I think a lot of the complaints were from, you know, rich white guys that wanted to go to Harvard and, uh, couldn’t get in or, or Chinese nationals that couldn’t get in. There were fights that had nothing to do with black America, but it’s going to really impact poor people, black people, brown people.

Like everything does it’s and so anyway, we can move on. But I agree. I don’t know how to fix it, but I agree.

Marcus: Yeah. Well, thanks for bringing it up. Um, you know, it does. Yeah, it feels better to talk about it. That’s for sure. Um, you know, so so so I appreciate that. All right. What’s next? What are we talking about?

Next? [00:32:00]

Vic: Yeah, I got side facts. So, uh, just to just to circle back on a metasys, a metasys. Um, agreed to move away from option care, pay 106 million termination fee in order to sell or merge with, uh, United Health Group in the Optum division. So Optum continues to be very strong and I guess that’s not surprising, but that is sort of related to this, um, payer is an important component of the health system.

I feel like UnitedHealth groups come in from the other direction. They are, they are assembling ways to deliver care, um, maybe not in the ICU or in the OR suite, but in everything around that.

Marcus: Well, listen, if you’re, if you’re truly thinking about moving to a value based care future, Right. The [00:33:00] OR and the ED are the last things you’re focused on.

Vic: Yeah. You know what I mean? Yeah, you don’t want those. Those are the

Marcus: last things you’re focused on. That’s, you know, there’s no value there. There’s just expense there, right? I mean, there’s massive, massive expense there. So you’re trying to move away from that. Um, I think you’re absolutely right. I think People, hopefully people are waking up to the true significance of the, of the ambition of United Health Group.

Um, and, and by the way, I don’t say that in a bad way. Um, some organization has to step up and get serious about the future of healthcare in America. Like seriously, it cannot be this, you know, like the idea that this model continues, it’s just not, that’s not a real idea. You know, that’s not a real idea.

Yeah. Um, you know, that, that, that healthcare continues to eat more of the [00:34:00] GDP, like a Pac Man. That cannot be, you know, that just cannot be an idea. Okay. So, you know, to me, it’s like, when you see them not just acquire LHC, but then go after a medicist, it’s like, okay, fine. You know, there’s certainly. A anti monopoly view that one could take given.

Those are clearly the two largest enterprise home health operations in the country. Certainly. But at the same time, we talked about this before. They’re both still pretty small in a hyper fragmented market at the end of the day. And look, we got to cobble together the system of the future, you know, and we’re, and we’re quite frankly, nowhere near it.

We’re nowhere near it. So if we’re looking at this as a roadmap, I’ve kind of just say, man. You know, more power to them. Let them, you know, let people keep complaining and let them keep building the system of the future, whatever. I mean, I, I don’t, I don’t know what else to [00:35:00] say. Uh, cause I’m sure if we, you and I are not privy to it, but if we were privy to the UHG roadmap, you know, this would be step, I don’t know, 27 out of 207.

Right. I mean, you know, There’s years of components that they need to build and add on to truly get us to, um, a healthcare model that’s going to turn around the curve on life expectancy, turn around the curve on health outcomes, turn around the curve on the absolutely morbid stats on maternal health, regardless of race, and then absolutely shameful when we talk about women of color, you know, to turn around the swelling cost of care in this country, you know, yeah.

Why are we, why would, why, why would I be more outraged about UHG buying? I would be outraged about any of those things.

Vic: I’m not, I don’t, I don’t fault you HG. I think, uh, I would like there to be multiple competing [00:36:00] players. I like a world where there’s Apple and Android and, you know, HBO and Netflix,

Marcus: these other players need to get serious then.

Vic: Yes. Yes. That’s right. They need, and it’s, it’s all going to be from the payer side. There is no health system that is even trying to do it. Maybe

Marcus: Kaiser, maybe Kaiser, um, we, we, we, we, we need to watch what they do. They’re not going to have the scale, but we need to, we need to continue to watch and see what they do.

Right. We need to continue to watch, do what they do because they’re, they’re, they’re super vertical in terms of like a medical school. Right. So, I mean, you know, I think, I

Vic: think, yeah, they could be really good. If they, if they grew in their geographies. Just on the East Coast, it would be. Yeah, I didn’t, I didn’t bring, I didn’t bring it, but we can just talk through it, um, CMS and then the actuarial group that helps CMS.

They, they projected out the [00:37:00] next 10 years of healthcare spend, and it’s going to, it’s projected to grow to 7 trillion. I mean, to your point about like, come on, 7 trillion, this is not real.

Marcus: Like, what are we doing?

Vic: That is there. I mean, I don’t know how many accountants worked on it. A bunch. That’s their best projection that going from 4.

3 today to 7 trillion in 10 years.

Marcus: So, so, now, how unbelievable is that? Because when you and I really started working on this stuff, the number was 2. The number was 2 trillion. We have not been working on this 10 years. The number is now 4. So the idea that in the next 10 years the number is going to be 7.

That’s just, that’s looking back. That’s literally just rear view mirror math. That’s not even a, that’s not [00:38:00] even a crazy model.

Vic: No, no, no. It’s a, it’s a straight line model. Like it’s a, I looked at it and I got tired of looking at it. It’s basically, I mean, if, if a startup came in and gave me this projection, I would throw them out of the room, but it’s just, just everything grows at the same rate. It’s been growing to 7 trillion. Um, so yes, it’s not possible in my mind that that happens.

Um, and you know, health group is. It’s really good. And I have nothing bad to say about United Health Group. I’d like someone else to also keep them honest and

Marcus: yeah, and look, I think, I think, I think CVS bought signify. So I think they’ve already kind of made their, you know, they’ve decided what their play is going to be in the space.

They’ve got far more of a consumer front door. Then the United does. So, you know, they, they’ve got different assets, a [00:39:00] different asset mix, but I, but I, I, I don’t think you can discount them. I don’t think you can discount Walmart. I don’t think you can discount Amazon. I think there are players who are, you know, Amazon obviously has, has, has an incredible path to the home.

Their boxes come to my home all the time. So, you know, uh, you know, if their boxes come to my home, then they’ve got cars that come to my home. If they’ve got cars that come to my home, they can get all sorts of stuff to my home, including people. So, you know, I, I think, I think that we’ve got, we’ve got a cohort of players, right.

That are, that are working on the system of the future. And I just don’t think, uh, I don’t think we can knock them because as you said, 4 trillion going to 7 trillion should be unacceptable for all Americans. Like that should just be unacceptable. We should just say, that’s just not acceptable.

Vic: Especially with the outcomes that we have.

Yeah, it’s ridiculous. Okay, let’s go to our sponsor.

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Thank you guys, now back to the show.

Marcus: Alright, we’re back. What’s next, Dory?

Vic: Okay, next, um, MAPS. Multidisciplinary Association for Psychedelic Studies. M A P S. Was in the Wall Street Journal today. Uh, so they have been around for, gosh, 20 years or so. They’re [00:42:00] really one of the two leaders in bringing psychedelics.

Um, ecstasy, uh, mushrooms, all the different psychedelics trying to show that they can really have a therapeutic benefit in mostly in behavioral health, PTSD, uh, depression. And so they are likely to have the 1st FDA approved, uh, treatment MDMA, which is ecstasy, uh, used to treat PTSD. The estimate is it will be approved by the FDA sometime next year.

We will have had a tire segments of the show talking about FDA. That may or may not happen. Uh, but the interesting thing today was that they are going to raise money from private investors and VC firms, even though they’re, they are a nonprofit. Um, kind of similar to [00:43:00] how, uh, open AI. Did it where they changed, they dropped down a public benefit corporate sub, and they raised money in that sort of limiting the payouts, but it can be lucrative to the investor.

So, uh, there’s sort of 2 aspects that I wanted to talk through. One is it seems like psychedelics are, I mean, I’m, I’m a believer in psychedelics, especially for, um, really challenging behavioral health issues. I think they can, they can have a pretty dramatic effect. And my bias is that they haven’t been adopted by pharmaceutical companies because, because they’re not really typically an ongoing treatment forever.

It’s, it’s more of a one, two, three times and you are, you’re better. And that that’s not as good a business model as take this pill forever. Um, I think there’s going to be lots of approved treatments in the next five years. So that’s interesting to talk about. And then it [00:44:00] seems like there’s a new financing mechanism for nonprofits now, which is also interesting, given that we’re VCs and need to decide if we want to participate in those markets, but it’s certainly something that seems like it’s trending now.

Marcus: Yeah. Okay. So two things there to talk about, let’s, let’s start with the MDMA. Um, and and just psychedelics more in general. Um, and I’m going to divert a little bit and then I’m going to circle back. So, uh, In the last show, the one big talk that I didn’t get to talk about because it hadn’t happened yet was the Surgeon General.

Um, so we talked about the FDA Commissioner and the HHS Secretary last time, but the Surgeon General spoke at Aspen Ideas Health as well. He spoke on Saturday morning. Um, might have been my favorite of the three talks. Um, he is a very, very, Uh, eloquent speaker, uh, communicates very effectively and it’s just so authentic and endearing that like, what is his name?

I don’t know if I know, uh, I think it’s his name. [00:45:00] Okay. Okay. So, um, Just awesome. And his, his big thing is behavioral health, mental health. And he went through a long thing, um, on, on social media and sort of really highlighted the fact that social media is an untested, is an untested, uh, experiment on our, on our mental, on our mental, on our mental health.

And

Vic: yes.

Marcus: And this brought me back to. Digital therapeutics, right, uh, which brought me back to, uh, learning that all digital therapeutics and all things digital are regulated by the FDA under an act from 1976. The medical device act, right? So that’s that’s that’s how old the legislature is, [00:46:00] um, that the FDA is basing their ability, uh, and even their models for how they regulate things in the digital space.

Okay,

Vic: right? Yeah, in 1976, NASA had computers that were about as strong as my right writing this law just with a frame of reference. That is not

Marcus: right. So the thing about MD and a is the reason it’s got a bad public rap, right? Because generally speaking, it’s in the classification of street drugs. And I think that people don’t like about what people don’t like about street drugs.

Well, um, they can impair your functions and they are addictive.

Vic: Yeah. Yeah. I mean, if you’re driving on MDNA, that’s really bad for society. Or, yeah, it’s not. Yes. So, but that’s different than the clinical use of it. I think.

Marcus: Yeah. Yeah. But let me, let me, let me circle back. Right. Let me circle back. [00:47:00] Yeah. So. You and I both listened to the Lex Friedman podcast with Mark Andreessen, right?

Vic: Yes,

Marcus: and We we I think we can both recommend if you all who are listening listen to Lex Friedman or you listen to other podcasts Go find that episode and listen to it It’s pretty interesting Mark Andreessen’s a pioneer in the internet built Netscape and also is you know One of the largest VCs we’ve we’ve had critique and commentary about a16z Um, but also think You know, fascinating, intelligent guy.

Vic: But Mark is, Mark is really smart and he’s worth listening to. Yeah,

Marcus: definitely worth listening to. So the part of the show I want to bring up is where they were talking about AI, right? They’re talking about AI and they’re talking about the advancement of tools. And Mark says, you know, we have the best tools we’ve ever had right now.

Where are the hyper productive people? Right. Where are the hyperproductive authors? And when he said that I thought about Isaac Asimov and I’m like, this guy wrote like a thousand books when you just had like pen and paper, you know what I mean? [00:48:00] And it made me think about myself. It was like, why am I not more productive?

Why am I not more hyperproductive? I literally have the best tools. I was a programmer. I know all this stuff. Literally. Why am I not even more productive? Right. And so then Lex Freeman and him kind of mirrored the question back and forth. And then Mark answered, well, it’s too easy to be distracted. It’s too easy to be distracted, and it’s too easy to consume, and we’re sort of defaulting to that, right?

So, Vic, I want you to know, like, after I listened to that, I looked at my own screen time on my Apple phone, which I never look at. I never look at screen time, because I view myself as a very productive person. Okay? I view myself as a very productive person. So I just feel like, basically, I don’t need to look at screen time.

Vic: You are relative to other people, but that doesn’t mean that you are relative to, like, I don’t know. Your brain,

Marcus: or my best self, or my, or my best self, right? So I look on my, I look at screen time. You know what the number one app was? Instagram.

Vic: Uh, Instagram. Instagram. [00:49:00] Yeah.

Marcus: And by a large margin. Like, it was shocking.

It, it actually shocked me. Yeah. How, how large the margin was. Okay? Um, I mean. Yeah,

Vic: you think you’re just killing time. Yeah. While you wait for the elevator. Killing time while you wait for something. But you end up getting sucked in and it’s 15 minutes later. Yes.

Marcus: So, where, where am I going with this? Right?

I’m taking you around the world. To kind of, to try, to try to make a point. Where am I going with this? We have these apps on these phones. You talked about driving with MDMA. How many people are driving with Instagram? Everyone. And dying.

Vic: I mean, Instagram and text and TikTok. Everyone. All the time.

Marcus: So, so, so somehow it’s okay for our society To have totally become addicted to this thing, this unregulated algorithm that pumps all the wrong things into our minds, makes us compare ourselves to other people, makes us [00:50:00] hyper sexualized, makes us, you know, hyper politicized.

Right? Makes us unhappy, makes young people more suicidal, okay? And these are, these are at this point all empirical facts that I’m saying. This is not like,

Vic: yeah,

Marcus: you know, there’s not anecdotes, okay? These are things that are, we, we, we’ve got studies on this stuff at this point. Somehow that’s okay, but MDMA is not.

Vic: And especially at, um, in a controlled setting with a clinician guiding you through a therapeutic process. Where you basically learn about yourself and recover from PTSD. Yeah,

Marcus: and increase your neuroplasticity. Should be

Vic: allowed.

Marcus: So, so right now, what we’re really dealing with is, and I think that the story talks about how this nonprofit has raised money because they believe that in 2024, there’ll be, you know, the, the legal framework will be in a place where they can actually start to do this stuff.

Whereas right now it’s, it’s too fraught with legal [00:51:00] peril or whatever, right? Um, And, and we’re really just fighting a, a political court of public opinion war right now, this is not a reality war, right? I mean, so it, it actually made me think back about our conversation with Aaron and about the viability of digital therapeutics, because digital can, can not just be positively therapeutic, it can be really, really negative.

It’s, I don’t think anyone would, would, Argue that we’re more connected than ever and people are more lonely than ever and people are more desperate than ever and and our behavioral health issues are larger than they’ve ever been and um you know, we we don’t but we don’t Have like a bad thing that needs to really be looked at and really be regulated right and really be thought about Differently than we’ve been thinking about it You know these algorithms and the rules and all of this kind of stuff and what’s allowed and the bots and the you know You All the crazy things that are allowed on those platforms, but we want to talk [00:52:00] about MDMA like, you know, and and all psychedelics as if they are somehow some different classification of bad thing, you know, this it’s the equivalent of refer badness.

And, um, you know, I, I’m, I’m excited for the day when we just realized we’re not going to have enough therapists to, to handle all the behavioral health issues that we have. And oh, by the way, the therapists have behavioral health issues too. Um, and we’re going to need an entirely new battery. Ways to address mental health.

So I’m off my soapbox, but anyway, all of these things have just become abundantly clear to me in, in, in, in recent days, even. And so when I saw this, this headline, I was just like, yeah, great. And I’m glad VCs are getting in, you know, this is good. Yeah. And

Vic: so I agree completely on the MDMA side. And I was like, no, it’s really in a, in a like any medication,

Marcus: a clinical

Vic: setting, a clinical

Marcus: setting.

Vic: Yes. I

Marcus: mean, [00:53:00] the fact that we have to keep saying a clinical setting, clinical setting, you know, we’re going to talk about ozempic in a minute, right? People, how many people are already on ozempic and we know it ain’t for clinical reasons, right? You know, using it completely off. That’s right. That’s right.

So, you know, cut it, cut the crap.

Vic: And then I love the new financing model. And so, um, it’s a, it’s a great innovation that, that nonprofits can, can grow. And if I never have to go one of those damn breakfast things again, you know, kind of just write a check, you know, a tear jerking speaker about something.

And then they pass the envelope around. I love the idea that, you know, they create a business plan that can pay me three times my money over the next several years. And once I get that back, it’s over. And so, um, I don’t know. Just, it might, it might [00:54:00] drive, actually, more efficiencies in nonprofits, in a way that could be healthy.

Marcus: Well, well, we, we, we, we drew the line before the show, uh, comparing this to OpenAI, and, you know, a lot of people who were not, who are not Constantly studying technology, um, may not know that open AI started as a nonprofit. Obviously now, I mean, I don’t even know what it is anymore, you know, but, um, it started as a nonprofit.

And now there’s been billions of dollars sort of plunged into it. So, um, I think this is a model. We will see more and more, you know, I think, especially with these things. Where the near term viability, that’s kind of the, the, the common thread between AI and MDMA, right. Is the near term viability is very uncertain.

So it, it, it makes sense to kind of put it in a nonprofit, right. Cause commercial viability is just not clear.

Vic: Yeah. But I think there’s a lot of, um, investments that you and I look at where it’s going to be several years. Commercial viability is not clear. The difference with these [00:55:00] two is that they had a lot of, um, public interest and they’re passionate people that will give money to a nonprofit because they have PTSD or their son or daughter or whatever.

So it started off like that, but it’s difficult to raise a hundred million. You think they’re trying to raise 85 million. It’s hard to raise that scale in donations.

Marcus: I, I kind, I a little bit disagree with you in terms of like, I don’t think we look at, I mean, this is our whole conversation about digital therapeutics, like digital therapeutics probably should be looking at, you know, this model, right.

Of like standing up a nonprofit because that’s kind of the thing. So what I mean on the AI side is the, the legal peril peril is not clear, right. The, the value that’s going to be created, I think is abundantly clear, right. But we, we can see. The productivity and the reduction in labor costs. We can see that, but we can’t really see is how is this going to work in the courts?

You know, and what’s the [00:56:00] risk of my capital investing in this thing if the courts decide to blow it up and say, it’s it’s all plagiarism, right? I think with MDMA, there’s a lot of safety issues. There’s a lot of public opinion issues. I would say digital therapeutics. You know, they don’t have the exact same issues, but they’ve got their own path to viability issues.

Um, and it might make sense to stand up a nonprofit, but then yeah, You know go round up some big vc for it, by the way, you know I was looking I was reading a crypto newsletter and I I didn’t fact check this But it had this ridiculous stat that like half of the vc that was invested over the last 12 months went into metaverse projects You know and um, I don’t know how they how they uh, I don’t know how they added that all up I mean, i’m sure they were like, you know, if it’s got this little feature It’s a metaverse thing but but the idea that they could even come close to that kind of number for the metaverse You It’s like, I’m totally fine with VCs investing in nonprofits for MDMA.

If we’re going to have a bunch of people investing in the metaverse, like, you know, It is [00:57:00] better. I’m sorry. At least it’s quote unquote the real world. It’s, you know, more the real world than all this digital stuff.

Vic: All right. Before we get to Ozempic, um, I want to just touch on Arboretum and these four seed funds.

Cause we’ve been talking about the dearth of VC. I think last week or two weeks ago, we talked about SoftBank and Tiger and lots of growth. Uh funds cutting back or not being able to raise the fund that they were hoping for in the last week we’ve had a lot of News sort of of it seemed at the face of it opposite.

I think you and I would say that they’re not opposite It’s just a different

niche

But let’s just talk about arboretum and these other Uh funds for a minute

Marcus: Yeah well You you you lead on this one because you you had done a little bit more reading on the arboretum thing and then I could Talk about what I found in the uh in the information You

Vic: Yeah.

So I, uh, I follow Arboretum cause they’re one of the oldest healthcare kind of middle [00:58:00] America, BC firms. Um, they’ve been around, gosh, probably 20, over 20 years. They raised 268 million, um, for their most recent fund. The difference in my mind, and of course I’m completely biased cause it’s what we do. But they’re early stage healthcare investors.

And I think the early stage is. Maybe not protected, but it’s not as flush with money as the growth round. So there’s kind of like for the audiences, C, A, B, it kind of goes in order. And, uh, those early stages you’re typically putting a seed might be three to 5 million, a could be five to 20. And so there, there’s significant rounds.

It’s not your rich uncle. But, but it’s not the 300 million growth now that was going on a year ago. [00:59:00] Um, so anyway, that, that was our read them. And then, and then you found, I think in the information for seed funds, I don’t know if they’re all healthcare, but they’re all early stage, um,

Marcus: Yeah. So, so, uh, this is in contrast to us talking about all the large funds not being able to land.

Uh, there was an article I was reading in the information that the headline is, um, three reasons to look past the 40 percent drop in VC funding. Uh, Kate Clark is the, is the, um, is the writer. And, uh, she reported that there were four seed stage funds. Uncorked capital, kindred ventures, correlation ventures, and unshackled ventures that collectively raised nearly a billion dollars.

Um, so. You know, for us to have one week where five funds collectively announced, you know, 1. 25 billion raised, and they’re all early stage, that’s a shift in the narrative. Now, I’m not sure if that’s a blip or if that’s sort of the beginning of a trend, [01:00:00] but as you and I’ve talked about off, you know, off camera, off mic, um, when we have talked to institutional VCs, they have shared with us that they were over allocated in growth, um, yeah.

And that they need to focus on, uh, they need to focus on seed and early stage. And that’s, that’s where they’re going to be concentrated in venture. And it was going to take some time, right? For them to all write down their books and all that.

Vic: They got to rotate out of that. Yeah,

Marcus: yeah. But I have been hearing through the grapevine that, you know, Q3.

Would be when checks would start to be written again, specifically in the LP world, um, that we would start to see checks being rewritten in the LP world and in Q3 and look, that would sort of mark a year right of of us processing through this because all the bad times really, really got started in Q3 of last year.

Um, yeah, so look, I mean, we’ll have to track this closely and see. It makes sense to me to [01:01:00] start to see seed funds announcing closings, that the closings are not insignificant, right? Because LP still have to deploy capital, right? So this may mean the beginning of some larger than normal seed funds, right?

I mean, I think seed funds were generally rolling out in the hundred, 150 range, you know, maybe even sub hundred for the fund ones or whatever. So to see a bunch of 200 plus seed funds, that’s not, that’s not necessarily what I was expecting. Okay.

Vic: Yeah, I agree. And I want to just, well, at least my opinion is that this won’t change the, um, reality for the existing venture backed companies out there that already raised a round of money or two rounds of money.

They are not, that’s not who the seed funds are going to be. They’re going to be investing in, uh, new companies. And so the reality of half the venture backed companies are going to fail. I stand by that. I think even though there’s these new funds coming out. I don’t think they’re going to do a C [01:02:00] round, a D round in an existing company.

So that market is still going to be really

Marcus: tight. Now, you know, there might be something like a seed recap where they like, basically take the company and buy it for a song or whatever, uh, that might happen.

Vic: Yeah. So I, so I’m, uh, I’m re I’m redoing one of our portfolio companies now, and it is the eighth or ninth round.

But we’re calling it the A3, because A3 sounds like a good, a good thing to call it. And it turns out you can call these things whatever you want, so uh, it’s an A3. Um, it’s not the third round. No, it’s the eighth round. It’s an A. It’s, it’s the A3, right? Um, okay. So, um, I’m not going to say which company that is.

Um, uh, okay. So now the last, last, last topic is Ozympic. So in the wall street journal, again, this week, I think it was yesterday. It might’ve been today. We’ll put the link in the show notes. Um, [01:03:00] the headline is Ozympic can make you thin, but not necessarily healthy. And it is part of, I mean, with Ozympic.

Gaining so much adoption. I mean, we know, everyone knows five, six, 10 people that are on a Zympic. I mean, you get incredible results, but it has, it has a decent amount of pretty nasty side effects. You don’t, well, you’re kind of ramping up. So the way that it works is you start off very low dosage and kind of ramp up over time, um, and not everyone can tolerate it.

And so you, you can get some pretty. Uncomfortable and bad side effects. Um, so that’s, that’s an issue, but what this article is talking about is you also lose a lean muscle mass, um, as the article says, as quickly as you lose the fat, and [01:04:00] so it’s, it’s saying that, um, you have to do squats and lunges and.

Eat a lot of fish, eggs, protein, uh, even though you’re not hungry on us. So, um, I read this and I just felt we should talk about it. It seems like, um, people are not going to do this. It’s it’s, you’re going to lose lean muscle mass and then you’ll be, you’ll be lighter, but you will break a hip in 10 years or there’s going to be other things that happen that are, that are, that are not good.

Yeah.

So, I don’t know. I’m not on it. Um, I still have the 15 pounds of extra hanging around me, but it just, it seems like a theme that is probably not going to end that well, I don’t know how it’s going to end, but

Marcus: well, I think the

Vic: country on [01:05:00] Olympic is probably not.

Marcus: Yeah. Um, I mean, maybe this is a time to tell you that I squatted 15, 000 pounds on Tuesday.

Vic: Wow, that is that a personal record? I’m

Marcus: fairly certain. I’m fairly certain. It was pretty intense. Congratulations. That’s incredible It’s pretty intense. It’s pretty intense. Um, so the fba commissioner, uh was 15. I’m still recovering from that 15, 000. Yeah, you okay. Hold on. Let me i’ll just tell you the breakdown and then we’ll then we’ll keep going so Uh, I did it was five sets Um, and the first set was eight reps, 415 pounds.

The second set was eight reps, four 30 pounds. The third set was six reps, 440 pounds. The fourth set was five reps, 455 pounds, and then the fifth set was eight. Reps 430 pounds,

Vic: but you didn’t go down that. I didn’t do it by myself. I’m a trainer like

Marcus: killing me, you know, um, I mean, I’m [01:06:00] training for world.

You know that, right? So, I mean, um,

Vic: yeah, yeah, yeah, yeah. Yeah. I mean, someone trying to, you know, put a strangle the air out of you can motivate you to work out. Um, but that’s a lot of weight and a lot of reps of a lot of weight. And so, um, that’s good. People are, are not going to do that. I don’t think. And so I’m usually I don’t care about this stuff.

I feel like it’s, you know, each person can make their own choice, but it feels like a pretty big trend. And I don’t know, not not like, yeah,

Marcus: so, so, uh, FDA Commissioner Califf was pretty, I need to be careful about how I characterize this, you know, Among the things he was talking about, he was asked about Ozempic at Aspen Ideas Health and, you know, he was, he was pretty positive about the findings and about the lack of drawbacks [01:07:00] to it.

And what I have generally heard from physicians who are dealing with either, you know, obesity or the related, you know, sort of comorbid diseases around obesity is they’re just happy to finally have something that works. Um, you know, and so I think people are just sort of force ranking, you know, the best of the worst of a bad set of options, right?

And just sort of recognizing we have not been able to figure out. And quite frankly, you know, with all due to respect, the fitness industry, which has gotten richer and richer and larger and larger has not been able to actually figure out how to offset. The obesity trend in America, right? And so, um, it does seem we do still need to figure out what to do here.

Uh, and, you know, I didn’t I didn’t say that the squatting stuff to try to imply people just need to, you know, get in the weight room. Um, I do understand that people have serious challenges around this stuff. [01:08:00] Um, but I do think. We are for those of us who are tracking I hate to call it this but the longevity space Um, you know, so you’re and you know, you’re andrew huberman’s you’re peter ortiz You’re on the Patrick’s, you know, people, you know, um, 1 very consistent trend in that space is that for quality of life and also length of life, there’s really nothing that replaces exercise.

Right? And so weight loss and. And the benefits from exercise are two different things, right? You know, you may need to lose weight, um, to lower your risk of heart disease and some of these other things. And at the very same time, if you’re not exercising, you still are at risk, like, like failure to exercise.

Is its own sort of disease state with its own sort of comorbidities, right? And I think you [01:09:00] probably could shorten the article on Ozempic by just saying, Ozempic is helpful if you can handle the side effects, but you better still be exercising, right? You know what I mean? Do not take this as if it replaces exercise for you.

Um, because, because it doesn’t.

Vic: Yeah, and I, we both are into longevity stuff. I’ve really started getting into the combination of VO max and zone two

training

and trying to do both, right? Like I’ve done, I’ve done sort of more high intensity training my whole life. And that’s what I’m, that’s what I know, like going on a run or biking or something that’s, you know, much more intense.

That’s what I’m used to, um, playing sports and things, but the zone two stuff is actually more beneficial and almost harder. It’s boring to carve out the time for. It’s boring. But, but I think it maybe is more beneficial or it’s equally beneficial. [01:10:00] Um, so yes, if you used a weight loss regimen as a way to kind of jumpstart your health and then you focused on maintaining it and getting a lot of exercise.

You could probably wean yourself off it over time. Um, that could be really good. Like any tool, it probably has an important role, but not, it can’t be the only. Yeah.

Marcus: I think that’s really what it is, right? Like, like the benefits of exercise are not, I don’t think they can directly be pointed at weight loss and they also are not limited to weight loss, right?

There’s all these other, you know, there’s, there’s your lymphatic system that just works fundamentally better when you exercise. There’s all these things that are happening in exercise. Yeah. Yeah, I mean, I’m not trying to lose weight. Yeah, me either.

Vic: A lot of, I mean, all those longevity guys you mentioned, none of them are overweight.

I mean, that’s like the first thing that they have. But then they all are exercising because it, it’s sort of, yeah, I mean, it’s. [01:11:00] It’s wellness and it keeps your metabolism in the right ways. All the, all the other. That’s

Marcus: right. That’s right. I mean, you know, I think there’s even brain brain health benefits, you know, uh, to, to, to exercise, right?

There’s, there’s some, some correlation between Alzheimer’s and lack of exercise and things of that nature that are, that are starting to emerge. So I, I think, I think really, um. The larger dialogue that is, that is right now very loud in the longevity space, but that is a niche space and needs to sort of make its way into the broader sort of gen pop discussion is that exercise is not a direct, um, answer to weight loss.

It has all these other holistic physiological benefits. Um. And that we really, as humans, like, need it, like, when you really just look at the way our bodies are constructed, they, they need to be working. They need to be moving. They need to be sweating. They need to be handling resistance. They need to be pumping oxygen throughout.

And, uh, you know, [01:12:00] modern, the modern world has made it harder for us to do that naturally, right? Our environments just no longer really support that. So, again, these, you know, this discussion is not to, um. Uh, you know, hopefully this is not triggering anyone, and it’s not, it’s certainly not to shame anyone’s current state of living.

We have evolved via the, via our industrial lives and technology, um, to not, just to not have an environment that, that, uh, cues us to exercise in any meaningful way. And, um, you know, this is more sort of a, uh, uh, this is more a. A byproduct of modern life.

Vic: Yeah. I mean, I’m going to leave here, go out, get in the elevator to go downstairs, get in my car, which is in the basement, go pull into my garage inside the house.

And then, uh, and then, you know, look at it and go sit down and eat dinner. [01:13:00] And so like, if I don’t intentionally exercise, I’m not going to get it just in my day to day day to day kind of

Marcus: work. That’s right. That’s right Yeah, so, you know, I I think I think that and I think that’s another thing that’s really emerging um Is the importance of?

Designing our environment to support the habits we want and not over relying on willpower. Like there’s such a huge fallacy about willpower and then even like people, uh, establishing some sense of who’s better or who’s worse based on their ability to marshal their willpower. I mean, this is just bullshit.

You know, we, we, we, we need to find ways to better design our environment such that people in the normal course of living. Are healthier period. Like that’s that’s the, you know, that’s the that’s the goal, right? That’s the North Star. How do we just help people in their normal course of living to be healthier, right?

As opposed to go in the opposite direction.[01:14:00]

Vic: I agree. So, when are your worlds? When should our whole audience come and cheer you on on Jiu Jitsu Worlds? Uh,

Marcus: no one needs to come, but I will talk about it win or lose when I get back. Um, so it’s gonna be, uh, it’s Labor Day weekend. So, uh, I’ve got a little countdown on my phone. And it is 62 days, 62 days.

I feel I honestly, like compared to how I felt last year for worlds. Uh, and for anyone who’s listening and it doesn’t know, uh, I started competing in Jiu Jitsu last year. So pretty seriously, um, as serious as you can for 46, 47 year old, you know, uh, serious enough that I train. And I compete, you know, I don’t know, 15 or so times a year.

Yeah, I

Vic: mean, you fight people every day or every, several times a week. Yeah, yeah, yeah,

Marcus: yeah, yeah. You know, in my academy, I’m training, I’m training with, you know, a bunch of 20, 20 Yeah, yeah, that’s what I mean.

Vic: Yeah, look, it’s a controlled setting, but you’re fighting people that are not No,

Marcus: definitely not. No, no one is as old as me, uh, that I’m, that I’m [01:15:00] working with.

They’re all, they’re all younger. Uh, but then I, but then I go to So at

Vic: Worlds, how many, how many, how many fights do you have to win?

Marcus: Well, the, the, the bracket is still building. Last year it was four matches to win. So there was, there were 16 people in the, in the bracket. Um, I was, I was effectively unranked last year because I was like a brand new blue belt, but this year I’m probably going to be number one ranked because I won last year.

So you get a bunch of points and that kind of carries over into the next year. So I’m anticipating and also a bunch of the blue belts who are really, really good were promoted to purple belt. Um, And I’m still, I’m still a blue belt. I’ve got, you know, kind of another year before I get promoted to purple.

Uh, or, you know, I expect to get promoted to purple in a year, assuming I do well. Uh, so, so yeah, so that competition is in 62 days. It’s hard

Vic: to repeat, man. It’s hard to repeat. People are going to be coming after you. Yeah,

Marcus: no, dude, trust me. I feel the target on my back. That’s why I squatted 15, 000 pounds on Tuesday.

Yeah. I’m getting after it, man. But no, I, look, I feel really, really good physically. Going [01:16:00] into it, I feel pretty good mentally. I feel like I get to focus on skill development and acquisition and, um, you know, and also, and look, man, I just feel fortunate that like my body is in a place where I can go do this.

You know, it’s, um, it’s, it’s really, You know, the older we get, the more we realize what a gift it is to be able to, to move, to be able to move and to be able to move in a skilled way at 47 is just a tremendous gift. So, um, I’m going to be thankful. And there’s something about,

Vic: um, there’s something about you, you’re in a, you’re in a ring or you’re in a setting with against one other guy.

And you’re having to try to think through what is he going to do? And then what will I do? And you can’t replicate that in, in somewhere that’s not,

Marcus: no, no, no, it’s like, it’s like, you think, you know, everything. And then you get on the mat and, you know, the, the referee goes, you know, fight. And then it’s just like, you know what I mean?

It’s like the whole world shrinks to you in this [01:17:00] person. Right. You know, it’s incredible. There ain’t no Instagram there, man. It’s just, it’s just you in this person, you know? Right. Yeah, I’m looking forward to it. Well, I’m

Vic: super, yeah, I’m super proud of you for that. I am going to my very intensive training in Italy next week.

I’m proud of you. I try to hit as many, as many pasta shots, as many pasta places as we can find. Um, I’m sure I’ll do some walking. Maybe I’ll get a bike ride in. Uh, but I’ll be out next week, and so, uh, try to take care of the audience while I’m gone. We’ll, we’ll, we’ll do, Captain. And, um, hopefully I won’t gain a bunch of weight while I’m gone.

No,

Marcus: you should gain a bunch of weight. You can lose it when you get back. Go have a good time, man. Eat all the food. Italy’s the best. Uh, go, go enjoy it, and, uh, we will record. Our best show. And then you’ll have to come back and figure out how to like, work your way back into this thing. Yeah,

Vic: exactly. I’ll have to like claw my way back in.

I don’t want to look at, I’m not going to look at the ratings next

Marcus: week. I make sure to ignore them. All right, man. Look, I’m going to get some dinner. All right. Safe travels. Okay.

Vic: [01:18:00] Thanks.