Dave Ricks: Inside the GLP-1 Gold Rush: Eli Lilly CEO on New Breakthroughs, Addiction & Mental Health, Pricing

The episode opens with a montage of claims about Eli Lilly's GLP-1 business. Since Dave Ricks became CEO, the company's market capitalization is said to have risen by about 860%, and the stock price by a little more than a thousand percent. The montage also points ahead to an experimental Lilly pill that "appears to work as well as the injected drug."

The interview begins with a personal note. One participant says that three years earlier on the podcast he weighed 213 pounds and now weighs 172, and credits Lilly's drugs for the change. Another participant is said to have lost 20 pounds.

Asked how Lilly made its bet on this class of drug, the conversation pushes back on the idea that GLP-1s were an overnight success. Lilly launched its first GLP-1 drug in 2006. It was a twice-a-day injection for diabetes, and few people knew its name. The cover of the company's 2007 annual report quoted a patient saying her diabetes was under control and she was losing a little weight. Over the following 18 years, Lilly kept developing new versions: it made dosing more convenient and raised the dose, and people tended to lose more weight at higher doses.

drug development is hard and long and requires a fair amount of failure and discipline, a huge amount of capital.

The commercial scale is stated in concrete numbers. In Q2, tirzepatide's global sales (the transcript spells the drug "terseptide") passed Keytruda's, making it the best-selling drug in the world, and the conversation adds that it was the best-selling drug of all time in that quarter. It brought in $8.1 billion in revenue that quarter and was growing at 80%. About 20 million people are estimated to take prescription GLP-1s, plus an unknown number who take non-prescription versions: compounded, synthetic, or not intended for human use.

The story of how the molecule was found is told in detail. In 2014, four Lilly scientists combined GLP-1 with another peptide that the stomach produces during eating and that suppresses appetite. The result was a single molecule, tirzepatide, now sold as Mounjaro. In the fall of 2016, the year Ricks was named CEO, a chief scientist called to say an early-phase study had to stop. A stopped study is usually bad news, but this one was not. The trial had enrolled healthy male volunteers in Singapore, who were not overweight, and they were losing too much weight too quickly because they were basically not eating. The scientists concluded the dose could be tuned down. From then on, the conversation says, Lilly "knew it was going to be huge" and moved to building supply chains, factories and a large clinical program. More than a hundred clinical studies of the medicine are now under way, many for uses beyond weight loss.

The interviewers raise a very active gray market, particularly peptide synthesis in China, that makes what they describe as close equivalents of Lilly's drug. The response calls it an unusual situation. Counterfeit medicines have always existed, but Americans are not used to them, because for most people insurance subsidizes much of the cost and there is little reason to go outside the system. These drugs are different because insurance coverage for them is poor.