E193: GLP-1s, AI & the End of Sick Care: The Next $10B Health Tech Giant

So, what is Maximus?

It's a great question.

So, Maximus is a consumer healthcare technology startup that I started in 2020.

We are basically an online clinic that is pioneering performance medicine, which is a whole new paradigm shift.

As you know, we really don't have a healthcare system.

We have a sick care system.

So, if you break a bone, you have an infection, you have cancer, we actually have a very

high-quality healthcare system that helps sick people get better.

But that is really not

enabled to prevent illness, and it's really not enabled to enhance quality of life and health span, which is the number of quality years that you have.

And so, performance medicine is really a new paradigm shift.

A lot of people obviously know that athletes, for instance, use performance-enhancing drugs and substances in order to enhance their competitive performance in order to win.

Increasingly, kind of the thesis of Maximus is that the average consumer also cares about how they perform, whether as an employee or founder of a company, whether as, you know, a father or spouse, or whether as an amateur athlete, just trying to get the most out of their gym gains.

All of the protocols that we provide are not just for people who have an illness or a medical condition, but for people who can be completely healthy, essentially, have no major diagnosable medical problem, but just want to look, feel, or perform their best.

And just full disclosure, I invested multiple times alongside ABC, Founders Fund, and others.

One of the reasons I invested in you is you're on the founding team of Omada, which has now gone public and it's a billion-dollar public company.

What lessons did you learn from Omada that you apply to Maximus every day?

It's a really great question.

I was privileged to be part of the founding team at Omada and I was the medical director and led clinical innovation at the company.

And one of the first things that I did did was to really establish Amada as a science-backed, science-based company.

There's literally a video of me on Amada's website back in the day talking about how, you know, we hold ourselves to the highest gold standard of running clinical trials to prove that what we do works.

Now, you have to remember, you know, I joined the company in like 2012.

You know, online therapy was like not a thing.

You know, people thought it was like this crazy concept.

I come from the world of working in hospitals where I'd run in-person treatment programs.

So, Sean Duffy and I, the CEO of AMADA at the time, flew out to the CDC.

We met the woman who ran that particular division named Dr.

Ann Albright.

And we said, Hey, do we have to run a randomized clinical trial to prove that online therapy is as effective as in-person therapy?

And she said, Well, we know it's the same thing.

Just prove that it's comparably efficacious, that it, you know, you can get the same weight loss results.

And we said, all right, let's do that.

So, I actually published three papers for OMADA looking at

basically an online weight loss program lead to clinically meaningful weight loss results at one year, two years, and three years, which we showed people lost about 5% of their body weight, reduced their A1C or blood sugar levels, and kept off the most of that weight for the course of three years.

I was actually the first person to publish the term digital therapeutics in a pub peer-reviewed research paper.

That became an entire field.

There's literally conferences now that are dedicated to digital therapeutics, meaning using software as treatment.

That really enabled OMADA to do a lot of its early enterprise sales because I would go to my counterpart, chief medical

officers at large healthcare systems like Kaiser's or Carolina's, or to large self-insured employers like Home Depot and Lowe's.

And they're like, well, how do I know this is going to help my employees or my patients?

And I said, well, we have the research.

We published it.

Look at the data for yourself.

It's as good as any other basically weight loss treatment out there, but it's incredibly convenient because you can do it all in the comfort and convenience of your own home.

So that lesson was a very powerful one, and that's what really makes Maximus, I would say, different from the HIMS and other telemedicine companies of the world.

None of these companies publish research, they'll just put out products.

You have no idea whether they work, and half the time they don't.

And I'll give you an example of this.

So, the GLP1 medications, people probably know Ozempic or WeGovi, you've heard the brand names.

There are companies out there that are selling oral versions of them, they do not work.

They literally sell them as gummy bears.

It's literally a crime that it should be criminal, in my opinion, or certainly unethical or immoral

because none of these companies are actually testing whether they work.

Maximus, on the other hand, we actually run clinical trials.

You can go to our website, for instance, don't take my word on enclomiphene.

There are a lot of pre-existing research studies on enclomiphene as they were going through clinical trials, but we also published our own because we showed, for instance, the lower dosages that we pioneered and innovated on also work.

Also, it works in a healthier population.

So, we had to do de novo or novel research to prove that.

Same thing with the oral testosterone.

We show that oral testosterone, counter to everyone's expectations, is not suppressive, and maintains fertility markers such as LH and FSH.

And so, you can kind of have your cake and eat it too, as I was mentioning.

Obviously, the health and wellness world is full of snake oil, unfortunately, in this day and age.

You have crazy people like Brian Johnson literally scamming

people as a con artist, you know, pretending that you can't die or you'll live forever, making completely unsubstantiated claims.

But I think there are high-integrity companies.

Maximus is not the only one.

But to me, if I was a consumer, I'd be like, you know,

how do I know this is safe?

How do I know this is effective?

What is the research that has been published on this compound, this drug, this therapeutic paradigm?

And how do you know your version of it works if you're using a different delivery system, such as an oral or topical form, a different dosage that's been done in the clinical trials?

Show me the data.

So double-click on that.

Why is it that you're able to, as a startup, without hundreds of millions of dollars in funding, actually publish research?

How does that work?

That's a great question.

Well, there's the publishing the research and why not go through FDA clinical trials.

So testosterone is a great example.

Testosterone as a drug or a compound, it's been around for half a century, maybe a whole century.

Pharmaceutical companies really can't patent something that's been around forever.

It's a generic essentially.

And so they're no longer kind of doing research on it unless they're developing a

completely new sort of delivery system for it.

And then they're trying to patent that and they're trying to protect it.

Like, for instance, there are companies that have been trying to do this with oral testosterone, coming up with their own special formulations.

I believe there's three FDA-approved forms of oral testosterone as well.

But, you know, from our perspective, if something's already been FDA approved, it's a known compound, like we understand, you know, the benefits and side effects of testosterone very well because it's like probably close to a century of use.

You know, our job is to just come up with better delivery systems, or like I said, coming up with different dosage schemes or using it in healthier populations.

And then that way we can run very quick trials because the trials are not designed to go through a multi-stage FDA approval process.

It's just to prove that something that we already know is safe, already know is FDA approved, can be used for a different sort of purpose.

And in that way, you know, we can do this very, very lean to use sort of startup speak and in a way that's really catered to our target consumer, which is

younger, healthier folks who are not using it, like I said, for necessarily the treatment of a medical condition, but they just want to enhance themselves.

They want to know that, does this work for me?

Last time we chatted, you told me that people are micro-dosing GLP-1s.

I looked into this.

I'm now a very happy Maximus customer.

Full disclosure, I pay full price.

Tell me about GLP1s.

What is the purpose?

What's the second-order side effects of them?

And also, why are people micro-dosing them?

It's a really great parallel example to the testosterone story that I was telling you about.

That back in the day, you'd only inject testosterone and you'd only inject it if you were drastically low in testosterone because you have to be dependent on

the rest of your life.

And so it's kind of a niche thing.

Obviously with the fertility safe oral and topical forms, non-injectable forms, and also

protocols that are lower dosed for healthier populations, basically any adult male that's otherwise healthy, that wants to be be better can take testosterone.

I really think that there's going to be a similar paradigm shift with GLP-1s.

If you understand the history of GLP-1s, they're originally medications that were prescribed for diabetes, which is the field that I come from at OMADA.

GLPs are basically glucagon-like peptide 1 receptor agonists, which is just a mouthful of way of saying they're medications that mimic a natural hormone to increase insulin secretion.

It decreases appetite, it slows digestion, and by doing so, it promotes weight loss and better blood sugar control.

So originally they were using diabetics.

They noticed, hey, these guys are losing weight.

We should probably use this for weight loss.

And so they actually went through new FDA approvals, which is why literally the same drug is called Ozempic and Wegovi, which is the generic name is semaglutide or semaglutide, because it was approved for diabetes and then it was re-approved for weight loss.

under the sick care system that I was telling you about, it's very hard to get your insurance to cover it because these are very expensive drugs.

It costs like $1,000 to $1,500 a month, which is crazy if your insurance is not covering it fully.

But if your insurance is covering it, you have to have a BMI over 30.

So you have to be essentially obese.

And there's some, you know, provisions if your BMI is over 27, but you have pre-diabetes or diabetes, they'll let you slide.

You often have to go through a weight loss program like OMADA to qualify for it because they want to prove that you've tried to lose it, you know, the old-fashioned way, so to speak.

Because, you know, insurance is basically in the business of denying care.

They don't want to pay $1,500 a month if they can avoid it.

So they're going to make you jump through a bunch of hurdles and they're going to limit it to the sickest portion of the population ever.

Now, what's happened is because these drugs, the demand was so high and they weren't able to produce enough, these drugs are basically on shortage.

And then the FDA basically allows compounding pharmacies to produce these drugs at lower costs, essentially as if they were generic, or if they're being used for personalized dosages.

And so, let's say you're not grossly obese.

You obviously, if you're half the body weight of someone who's obese, you may still have body fat to lose.

You may have excess visceral fat that's surrounding your organs.

You may have excess subcutaneous fat that you can see, obviously, if you have sort of the beer belly that guys have, and you'd benefit both from a health perspective and maybe even cosmetically from weight loss.

And so, a lot of people, obviously, in private, we're going to private practices, medical spas, et cetera, who are not limited by insurance, paying cash out of pocket and using GLP-1s to lose weight.

Now, these are typically people who are like overweight, but maybe not obese and wouldn't qualify for their insurance.

Interestingly, as a lot of these people were using GLP-1s, they noticed a lot of benefits in addition to weight loss.

So, for instance, a lot of people noticed improved impulse control.

So, it was improving their addictions, which is really interesting and I think emerging

early research in terms of like psychiatric and addiction medicine.

And a lot of people who had comorbid medical conditions noticed a really significant improvement in inflammation.

So, if they had arthritis, if they had PCOS, a lot of these inflammatory-mediated conditions noticed, hey, my inflammation is lower, I have less pain, I'm a lot more mobile.

And so, a lot of people are using it for sort of these off-label use cases, meaning that the drugs are originally approved for diabetes and the treatment of obesity.

But if you're using it to lose belly fat, you're using it to reduce inflammation, you're using it to reduce your blood sugar and improve your metabolic conditions, those are sort of off-label indications.

But a doctor can still, under their clinical discretion and judgment, prescribe it for those reasons.

So, what we did is we had a lot of

clients coming to us and said, Hey, I'm not overweight, but I still like to use it, I still have some body fat to use, or I want to use it for these other reasons.

And so, we developed a micro-dosing protocol.

So, for instance, if your BMI is at least over 22, so you're not necessarily overweight, but you still have some body fat that you'd like to use because of your

central adiposity, et cetera, you can take a much lower dose.

So for instance, the dose that we use of samaglutide is 40% lower than the typical starting dose.

And we're not titrating it up like you would on a typical obesity protocol because those folks often get a little nauseous because the dose is so high and you have to

ramp up basically every single month.

If you're taking a micro dose, you don't typically run into as many of the typical side effects that you do in GLP ones, which often are nausea, as most people have heard about, slowed gastric emptying.

Sometimes people get a little bit of gastrointestinal distress because obviously that's part of the way that it works.

But on a very, very tiny micro dose, it really helps control the food noise, as people call it, sort of those cravings for late night food and snacks.

And it just helps people kind of fight the willpower battle, I would argue,

in helping them make better choices.

Obviously, lifestyle intervention, which is what I've done my whole career, including at OMADA, in terms of getting people to eat right, exercise, sleep, and manage their stress, are always foundational and first-line therapies.

But instead of this argument of, well, you should do behavior change or you should take a drug, what we find is that the combination is the most effective.

The drugs help people make the necessary behavioral changes, whether with testosterone or GLP ones, because when you just have more energy, more drive, more motivation, better appetite control, you're not fighting this willpower battle, as I mentioned, that's just really hard, obviously, with the stressors of life.

I have a very, you know, kind of radical perspective on kind of what the future of America will look like.

And here it is.

Number one, the majority of Americans in the next five to 10 years are going to be on a GLP1.

First of all, it's because America is so fat.

70% of the country is overweight or obese.

And so they absolutely, from a clinical perspective, that's justified.

But a lot of even the 30% of people who are not, I think are increasingly are going to be on it because what's going to happen is I think GLPs are revolutionary in that people are going to take the just right personalized dose to get to their optimal state.

So, for instance, if you look at kind of the cross-section of America now, right, you have 30% of people who are not overweight, about 35% of people who are overweight, about 35% of people who are obese.

So, about a third, a third, a third.

And almost nobody's really at their optimal level of health or aesthetics.

If you look at, if you include sort of metabolic dysregularities, including high blood sugar, high blood pressure, high cholesterol or dyslipidemia, 88% of the country has some metabolic abnormality, meaning only 12% of the country is actually perfectly healthy from a metabolic perspective.

Are these comorbidities to being overweight,

or are they unrelated?

Yes.

Being fat makes everything else worse, as you've kind of common sense dictates.

The major driver for why people, for instance, have high blood sugar is being overweight.

That's why the treatment for pre-diabetes and diabetes, as we did at OMADA, is to lose 5 to 10% of your body weight.

Now, obviously, there are genetic factors as well.

Some people with certain racial categories and genetic predispositions can be kind of skinny, fat.

They're not overweight or obese, but they're still prone to diabetes.

So there are multi-factors.

But in America, if you look at the prevalence of, you know, diabetes, hypertension, it's mostly lifestyle.

driven in terms of being overweight and obviously the street and sleep and stress that you sort of talked about.

So, if we start with the paradigm of like basically only one in 10 people are healthy, how do we get the other 90% of people on board?

Obviously, I've spent my whole career trying to get people to change their behavior.

I do think on an individual level, it's absolutely possible.

All of us know people who have turned their lives around through pure willpower, coaching, therapy, and made changes.

At a population-wide level of 300-plus million people, it has not worked.

We have not made a dent, we have failed, essentially, as a medical system, as a society, public policy, et cetera.

what I think is going to happen is if you offer these medications at personalized dosages there's going to be a contingent of people who don't need them at all right they're the thin coastal elites highly educated high mo high willpower people great if you can do it without medications perfect ideal case scenario for the rest of the country the 90 you know

two percent of people who need some help there I think there's going to be some people who need it to kickstart a weight loss journey they'll maybe take it for 12 to 16 weeks they'll lose the weight and they'll highly motivate it.

And then, once they're able to fit into their jeans or their high school dress, they won't need it for the rest of their lives.

There'll be a contingent of people who they'll lose the weight.

Life stress happens.

You go through a divorce, you're starting to gain the weight back.

You'll go back on it whenever you need it to just get back down to the ideal weight.

And for the rest of the population, probably the majority of the population, they'll take a higher dose to get down to their ideal weight.

And then they might need a micro dose or a maintenance dose to maintain the weight loss forever.

But no matter how much you need, which is zero occasional use or chronic use of the medication, I think the majority of the people who literally have at least the financial means and the psychological willingness can all get down to an ideal state of low body fat, metabolic health, and are looking and feeling their best.

And it's really the medications that, in combination with the behavior change, that it's going to get us there.

What I observed in myself, the way that I kind of look at the GLP wands, it's essentially puts your body into cruise control.

They kind of like take over your body and it shows to you that if you don't eat as much, you could lose weight, which sounds like the most obvious thing, except people kind of have this learned helplessness that they could never lose weight, almost like it's impossible for them specifically.

But it kind of takes over your body, shows you that it's possible.

And then you know, okay, if I eat once a day or I eat these types of foods, I'm going to lose weight.

You reconnect yourself to cause and effect when it comes to foods and its its effect on your body.

Absolutely.

And I'm really glad that you shared that sort of personal anecdote.

I've spent my career working with people and helping them lose weight.

And the struggle is real because, you know, I actually take also kind of a little bit of a radical point of view that basically all obesity is psychologically driven.

There's very few people, maybe a few percentage of people, where there is some genetic, serious medical condition that's driving it.

But if you look at how quickly, literally over two generations, the rate of obesity has skyrocketed.

You can't say that's genetic.

That's an environmental illness, essentially, because essentially 66% of the American diet comes from ultra-processed foods.

That's really the root cause.

The problem is we're not getting rid of it.

People are not going to eat 100% whole foods.

People don't cook anymore.

The lifestyles that we have, the convenience and the cost

issues that are driving all this definitely should be addressed on a public health level.

It's not going to happen anytime soon in any way that's sort of going to save America.

So if you're basically, you know, out in the world and you have these designer drugs, if you will, these ultra-processed foods that are constantly tempting us, you can't just sit there and shame people and say, well, just avoid temptation, avoid addiction when essentially the majority of the country is to some degree addicted or reliant on packaged processed foods.

Literally, the only time you can be is you can't buy anything with a nutritional label, right?

Anything that has a nutritional label is by definition processed, right?

If you think about meats, fruits, and vegetables are basically the only produce that doesn't have a nutritional label because there's one ingredient, it's a banana, you know what it is.

But I don't know anyone, even like the people who have a lot of, you know, means personal chefs that eat nothing that's processed.

And obviously, there's some things that are minimally processed that can be healthy, yogurt, you know, et cetera, things that you theoretically could make at home.

But that world is gone, except like I said, on an individual level.

But on a societal level, given that we have these things that are not optimal, there has to be something that helps support choice and willpower so that we don't overeat, right?

And fundamentally, weight loss is about a caloric balance issue.

You know, it's an excess calorie issue.

Obviously, it's like easier said than done, though.

When you have sort of emotional, psychological, and environmental factors that are driving people to eat excess amounts, you know, if you can regulate your appetite, to me, that is in essentially in some way addressing the root cause, not an environmental root cause, but individual root cause in that it helps just avoid that temptation and really help people make better choices.

Tell me about the research, what the research says in terms of people going on these GLP ones and then they come off them.

How much of that weight do they

regain?

And in what cases do they regain more than they initially lost?

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It's a fascinating thing, having been a published weight loss treatment

author and researcher.

If you look at any treatment for weight loss, including behavioral treatments, pharmacological treatments, the majority of the people will regain the weight if they stop the treatment.

But that kind of makes common sense.

It's like if you ask, if you tell people, well, I'm going to put you on a 16-week exercise plan, are you going to get in shape?

Of course.

And if you stop exercising, are you going to stay in shape?

Of course not.

Same thing with vitamin D.

It's like if you're deficient and you get sun, sunlight/slash supplementation, your levels will go up.

And then they'll ask, well, do I need to be on this forever?

Of course you do.

If you need to maintain everything in order to maintain the benefits.

So for the majority of people, they will need to remain on medications to some degree or some dosage to maintain the weight loss gains that they have.

Now, again, individual results always vary.

There are lots of people that I know, even personally, that have lost the weight and have used that as a catalyst to make the behavioral changes.

But I would argue they're not getting off of everything.

What they've done is they've kind of used the weight loss medications to be the catalyst, and then they're switching to another therapeutic, which is lifestyle slash behavioral medicine, and that they've, for instance, significantly increased their protein intake, significantly decreased their refined carbohydrate intake, and that's what's maintaining them over time.

So I think we should need to get out of this paradigm of, oh, I have to be reliant on these medications forever.

It's a crutch, and somehow it's a stigma or a problem to be on something forever.

Like the reality is most people should be on a vitamin D supplement for the rest of their lives.

Why is that?

Because we don't, we're not laborers who are outside in the sun all day.

We actually did a research study where we looked at men in Los Angeles.

It's sunny here.

I literally go outside and tan on purpose.

66% of people were literally deficient in vitamin D and 100% were suboptimal.

Our lifestyles and our modern environments are not conducive essentially to that.

So yeah, you got to take a vitamin D pill for the rest of your life if you want to be optimal, but there's no issue with that unless you want to radically like become an agrarian farmer like your ancestors.

So I think the same thing with GLP1s.

Like I said, if you cannot take it because because you've substituted it with behavioral medicine, more power to you and you should absolutely do that.

But if you need to occasionally take a dose to get kind of back on the train or you need to take a micro or maintenance dose to maintain it forever, to me, it doesn't matter.

Whatever gets you to that end goal of looking, feeling your best, maintaining a six-pack, maintaining optimal health, you should do that.

And so to me, I leave it up to the individual patient.

I'm like, hey, you want to get off the medication?

I fully support you.

If you can do it, do it.

And if you can't, there's nothing wrong with you.

It's the same boat the majority majority of people in.

Take the minimal effective dose.

I call it the med, in order to get you to the optimal state rather than thinking about this black and white, like, I'm going to be on or off forever.

Most effective people that I know, they pick their battles.

Some want to spend all their willpower on getting into good shape.

Some want to work.

Some want to spend time with their kids.

In many ways, not choosing what to be bad at is a way to be bad at everything.

So not choosing what to kind of outsource or what to put into autopilot hurts your ability to do other things to a high degree.

But also, if you substitute medications for behavioral interventions, you realize how silly that logic is.

It's like saying, oh, I got to be dependent on exercise for the rest of my life in order to be healthy.

Duh.

And what's wrong with that?

If you think about it, modern instantiations of exercise are a completely weird and foreign invention.

Nobody was lifting weights at a gym.

We used to just physically labor through our work.

Like, jogging was essentially invented by, um, I believe a New Zealand coach named Arthur Littard in the 1960s.

He published a book called Jogging.

And then, like, nobody used to jog.

Like, even in the 1990s, when I ran track and cross-country and I was running through the neighborhood, people thought it was weird back then.

Like, people thought you stole something if you were running.

They're like, what are you doing?

Right?

Like, this, people forget, we have very short-term memories as a society that these interventions are essentially modern,

you know, concoctions or inventions.

But obviously, the really healthy, there's nothing wrong with exercise, probably the best health intervention essentially that you can do for anything, including the prevention of Alzheimer's and dementia, in particular.

But nobody thinks, oh, I'm dependent on it for the rest of my life.

Of course, you are.

Everything needs maintenance, right?

Our bodies need maintenance, whether it's through food, food, supplementation, medication.

I think it's a particularly male paradigm.

I just want to actually point this out.

This is kind of the

downside of guys:

guys are obviously have this kind of rugged American Marlboro notion of self-reliance.

I don't want to be reliant on anything, right?

I should be a self-sustaining man is kind of the machismo paradigm that comes from that sick care system because back in the day, if you were on a medication, again, it means something's wrong with you.

Under the maximus paradigm, where you're not taking a medication because anything's wrong with you, it's because you just want to be better.

You want to be more optimal.

You want to be enhanced in terms of your performance.

That's the great thing.

A lot of our clients literally, they go tell their friends, hey, I'm on testosterone.

I, because, not because I particularly need it, it's because I want it and I'm better for it.

And you should look into this too.

As opposed to, I think, a lot of companies out there, the traditional telemedicine companies that push a lot of erectile dysfunction and premature ejaculation medications, no one's going to want to tell their friends about that because it means obviously there's something

wrong with you in that particular case.

As

the shift happens from sort of stigmatized sick care to,

you know,

pro-social performance medicine, I think people are going to get over the stigma of medications.

And in fact, it'll be bragging rights.

I'll tell you a funny anecdote.

In certain Middle Eastern countries, getting a rhinoplasty or a nose job

is no longer stigmatized.

In fact, people fake getting surgeries by putting a band-aid on their nose to pretend that they got the surgery because it basically means you have money.

right or you so it's almost become a badge of honor or prestige that you have the the the you know the means essentially to get cosmetic surgery.

And now you can argue whether that's a good or bad thing, but essentially it's been completely destigmatized and maybe even it's become prestigious.

I think the same thing will happen essentially.

It's happened with personal training.

It doesn't just mean you're fat anymore.

A lot of people are literally professional athletes that have a trainer or coach.

It's a prestigious thing to have one because it also means you have the means to do so, but it also means that you're someone who prioritizes their health.

I think that's happening with psychotherapy.

It used to mean that you had a mental illness.

Starting in the 1960s, a lot of people started doing psychotherapy for self-actualization, for personal growth.

It's become a badge of honor.

In fact, a lot of women on dating apps will say, I want a guy green flag if they're in therapy because it means that they've worked on themselves.

I literally think it's the same thing with pharmacology.

You're not going to be hiding it from your wife or girlfriend or your boyfriend or husband.

You're going to be like, hey, help me inject my GLP ones because,

you know, I'm not going to have a dad bod or a mom bod for the rest of my life.

In fact, I will maintain my weight forever.

And I actually think it's going to help a lot of relationships in the long term.

I do think we'll see it probably within this decade.

So as I mentioned, nothing on the market right now is really efficacious orally.

There is one version of semaglutide.

There is an oral version actually on the market.

It's not very popular.

I think like the

benefit to side effect ratio is just not as good as the injection.

And the other thing too, I just want to point out this.

Most people are afraid of injections who've never injected themselves.

I even had this notion.

I was like, I'm a healthcare healthcare practitioner.

I'm not afraid of needles.

I've got my blood drawn like literally over 100 times.

I don't have any problem with it, but I just didn't like the idea of injecting myself on a regular basis.

The thing that people don't realize is unfortunately people's association with injections is getting vaccines.

That's usually the only time that people get injections.

It's an intramuscular injection.

It's in the shoulder.

It kind of goes deep.

The paradigm shift is, as opposed to using these big, scary needles that do kind of hurt, you can use insulin needles.

They're very thin, they're very small, and they're very painless.

And the other thing is you don't inject it into your muscle for most of these things, including testosterone and GLP ones.

You can inject it into your subcutaneous fat.

Literally, you just pinch your belly fat, you inject it right into there.

I would say the pain is like a one to two out of 10.

It really doesn't hurt.

And most of the time when people do it, unless they literally have like a needle or blood phobia, which is rare, they get over it.

It's literally exposure therapy.

We know this is from psychotherapy.

The idea is worse than the reality of it.

And so I think most people, in fact, they don't mind it actually.

Oral GLP will be a game changer.

And like I said, in the next maybe five years, probably a new one will come to the market.

That's pretty efficacious and a lot of people will take it.

But the injectables are really not as bad.

And I think there's something for everyone.

And we know this from testosterone.

There's some people who just prefer the convenience of injecting once a week.

That's great.

We offer injectable testosterone.

And there's a lot of people who are like, great, I just like the oral form.

I don't like sticking myself.

And I think the best

paradigm is that if you offer both, there's there's going to be something for everyone and you're going to address the largest population possible.

Obviously, AI is disrupting every industry.

We just saw Grok4 come out with their new LLM.

For a company like Maximus in the healthcare space, how does AI change the projections and the future of your space?

That's a great question.

I'm very bullish on AI.

If you kind of understand the history of AI, it was actually psychologists who pioneered artificial intelligence, you know, like 50 years ago.

Because, you know, a lot of these concepts, like, for instance, like a neural network is based on how the brain works.

The concept of reinforcement learning is literally based on behavioral psychology.

GPUs allow us to have sort of the computational horsepower to make a lot of the vision of sort of the early AI pioneers and psychologists come true.

For instance, the Turing test of being able to have,

you know, pass a test of how do you tell if, you know, how you're having a conversation with a human being or a robot and being indistinguishable essentially is passable now with chat GPT.

So there's a couple examples in which we use AI.

So first of all, for internal research purposes, as I mentioned, like we're an RD-driven company, we repurpose essentially FDA

approved drugs for novel optimization use cases.

It's very efficient as opposed to you.

going into PubMed, finding research studies to trawl the existing essentially research and very, very quickly come up with insights, pull data, help us write our research papers once we've collected the data.

It makes the kind of the research and publication process a lot faster, which allows us to obviously innovate on a faster time scale.

So that's a huge paradigm shift that's happened.

The second thing is increasingly, I think AI will supplement and support doctors, not completely replace them.

I think people still want a human being that's in charge of their health, especially when things go wrong.

AIs are not perfect in handling sort of, especially like emergencies, edge cases, et cetera.

For instance, you know, we are the largest prescriber of enclomaphene in the United States.

We have the largest database.

So we know, in fact, what dosages tend to work.

And so the doctors have kind of learned, for instance, through the art of medicine that maybe if you're heavier to start with, you're lower testosterone to start with, you probably need a higher dose.

So they're probably using maybe like a couple different variables, looking at patients' charts and medical histories in order to decide what the initial dose is.

We measure their baseline testosterone levels, we measure it again after 30 days, and then we look, okay, you doubled your levels, or maybe you got up to like 1.5x, so you might need a little bit of a higher dose.

Or maybe someone triples their levels, but they're starting to run into some side effects.

Okay, maybe we need to decrease your dose.

And so it usually will take two or three iterations to get people to the optimal dose through kind of trial and error because you're testing labs, you're listening to patients in terms of their symptomatic improvement, side effect response.

But because we have all this data, you can train an AI model and say, okay, input all of the data that we have on this patient, not just basic demographic variables like their weight and starting testosterone level, and then suggest

the dosage that is most likely to result in the optimal outcome.

And they can suggest it to the doctor.

The doctor can obviously choose to accept it or override it.

So increasingly, we're going to instantiate essentially like AI to help with dosing and dose titration so that we can get it right perhaps on the second iteration versus the third iteration, right?

And get people to an optimal state even faster.

And then the third thing is I'm particularly excited about its use in coaching.

So at Amada, I trained over 150 health coaches, human beings,

nutritionists, nurses, that would provide individualized one-on-one coaching to patients because the social accountability, the social support are a big part.

And obviously a lot of people, they know they need to eat less and eat better, but having that sort of social reinforcement is particularly effective in helping people get to those outcomes.

Obviously with GPT and conversational, you have a 24-7 health coach in your pocket that is smarter, quite frankly, than most PhDs nowadays.

Can analyze, you know, I was talking to Google like 10 years ago about can you take a picture of your food and analyze the contents and the macronutrients and micronutrients.

This is all reality nowadays, right?

And so it can provide even even more specific coaching than ever.

So one example of this that we're working on right now is using visual AI to analyze people's body fat.

So you can take front and side pictures or like a three-dimensional scan, just literally using your phone and doing this, that is within 2% accuracy of a DEXA scan, which you have to go to a clinic, pay 50 to 100 bucks.

And now through AI, essentially it can give you a very accurate assessment of your body composition, which is obviously useful if you're tracking, you know, are you gaining muscle on testosterone?

Are you losing body fat on a GLP?

So all of these are example use cases in which AI, I think, is going to really complement the pharmacological means because it'll help the coaching, it'll help the tracking, it'll help the dose titration, and just providing an ecosystem where it just makes the entire process better.

What diagnostic tests should a otherwise healthy male or somebody that's not obese or morbidly obese be doing in order to optimize their health?

It's a really great question.

First of all, I actually encourage everyone to have a primary care physician.

It's crazy, like the percentage of people who don't have a doctor at all.

I think you need a basic doctor.

And the utility of, I think, a primary care physician that you can see in person is like literally when you're sick and you know, you need to have someone like listen to your lungs, prescribe you an antibiotic if necessary, determine if an antibiotic is necessary.

It's really important to have that.

Unfortunately, a lot of people don't.

I encourage people, you know, obviously use your health insurance.

If not, you can kind of find people

to have that.

But, you know, like they're not going to do performance medicine, right?

They're going to just make sure that you're not sick.

So take care of the foundation.

Take care of the fundamentals first.

It's not a replacement for basic sort of healthcare.

Now, on top of that, the problem is like the traditional healthcare system doesn't do routine blood testing.

They'll really only blood test you if you're sick.

And then the crazy part is they don't test for routine things.

Like I'll give you a personal example.

You know, I have a family history of diabetes.

My doctor never asked to ever check my blood sugar levels, right?

Even though they knew my family history, I had to literally ask them: I say, hey, like, my dad has type 2 diabetes.

I should know what my blood sugar levels are because I want to obviously avoid it.

They're like, okay, sure.

But I had to literally convince them to do so.

Same thing.

Unless you feel like you're dying, no one's going to check your testosterone levels, even though obviously hormonal health is fundamental to your health.

So, unfortunately, our sick care system, and the reason for this, honestly, is because insurance companies don't want to pay for testing.

They're like, unless you're falling over and you're, you know, deathly symptomatic, there's probably nothing wrong with you.

That's obviously foolish, right?

We know that like 37% of Americans are pre-diabetic and 89% of them don't know it because they've never tested their blood sugar levels.

And similarly, a ton of people are low testosterone these days that nobody knows because nobody ever checks.

And so what I tell people is like, look, get an annual physical exam from your primary care physician.

You know, you need to be checking your prostate, make sure you don't have testicular cancer.

These are the in-person exam stuff that you need.

But you can go to a company like Maximus, and there's other companies too.

I don't want to just promote our own, and do an annual blood test.

At the very least, every six to 12 months, you should get a blood test done.

We'll get right back to interview.

But first, we're looking for the next great guest.

If you or someone you know is a capital allocator and would make for a great guest, please reach out to me directly at david at whispercapital.com.

There's basic things.

There's called a CBC CMP comprehensive, you know, blood count, comprehensive metabolic panel.

And this measures the basic things, including your blood sugar levels for instance you should get that done i do think it's helpful to get a hormone panel done so you should be measuring your total testosterone your s hbg use those things you can calculate your free testosterone you want to measure your lh and fsh which are your essentially your fertility markers that's a signal from your brain to your testes to produce testosterone and sperm probably measure your thyroid and your lipids so that you don't have you know high cholesterol and other kind of risk factors.

Those are, I would say, like a basic blood panel.

A lot of times people can do that through their primary care physician, but like I said, they usually won't measure all of those things.

And so you can go pay out of pocket for a company like us, or there's a lot of lab testing companies, get that done every six to 12 months and just make sure that you're obviously maintaining.

And if there are problematic things, like for instance, your blood sugar is high, your testosterone is low, your vitamin D is low.

That's another one, by the way.

Almost, like I mentioned, most people aren't aware that they're vitamin D deficient or at least suboptimal.

Get that measured.

And then you can do an intervention.

So for instance, we offer a prescription multivitamin called Building Blocks.

It has a prescription dose of vitamin D, which is 10,000 I use.

So people are, you know, deficient, which is below 30,

I believe it's nanograms per milliliter, or suboptimal, which is below 50, you know, we put people on, the overwhelming majority of people get above 50, which has been shown, by the way, to like reduce the incidence of COVID-related death to basically zero.

There was literally a paper came out that said if we gave everyone vitamin D supplementation, almost nobody would die from COVID except for like maybe this super, you know, immunocompromise, essentially.

Yeah, that's basically the best thing to do, routine blood testing.

I don't think you need to go crazy.

I think there are some companies that are promoting these like, oh, you got to test like 100 plus markers all the time.

It's sometimes interesting to do once, maybe to see, for instance, do you have like heavy metal toxicity if you're, I don't know, exposed to a lot of it.

But most of the time, people are fine.

You can test it once.

I really am more of a fan of just kind kind of like routine testing the basic things, the things that I mentioned before, and making sure that those are really dialed in because those are the things that are most responsive to lifestyle intervention.

Like, obviously, your lipids are influenced by what you eat.

Your blood sugar levels are influenced by what you eat.

Your hormone levels are influenced by this amount of sun exposure, your stress, and your sleep.

And so, these are modifiable things.

The other things are a little bit exotic markers, and they're not very actionable.

I've seen a lot of like founder colleagues that pay 500 bucks to get this humongous panel done.

They're like, what do I do with this information?

I don't even know what's a problem, what's not.

I do think AI is helpful in helping people understand their biomarkers.

But like I said, you want to really kind of measure the ones that are critical for health span and the ones that are really modifiable.

One of the big paradigm shifts of Maximus is getting blood testing is a pain in the ass.

You got to go to a Questor Lab Corps.

They stick a giant needle in your arm.

It's painful.

It's hard to get an appointment.

Or you got to sit in the waiting room when you walk in.

It is helpful to do when you do comprehensive testing, like you're measuring like 50 plus markers.

But if you're measuring a handful of markers, we've really innovated at-home blood testing.

We use a little device, it looks like a CGM.

You stick it on your shoulders.

It uses actually microneedle technology.

It doesn't hurt because it's not going into your veins.

It's literally actually superficially just, you know, going into your fat and drawing out capillary blood.

And you can get about a half a pinkies full of

blood.

And obviously, you can't measure a million things.

We're not trying to be like Theranos here.

You can measure up to about a dozen markers.

So like I said, if you need to measure 50 plus, go get a traditional blood draw.

But if you're just trying to measure your hormones, you can do that completely at home and you can literally mail it off.

It's mailed off via Next Day Air to a lab and it's 99% as accurate as venipuncture draw through Quest and Lab Core.

So this has been validated.

It's way better than the fingerprint tests, but way better than the saliva tests that are out there in terms of its accuracy, reliability, validity.

And so, this is a huge paradigm shift for us as well.

In that, Cam, I don't know if I ever told you, the reason I invested in you, because I was very excited when you started Maximus, that you essentially productized yourself.

You were talking about all this, and then you turned into a business.

It's one of my favorite theses, and I've seen a lot of success investing to people that productize themselves into a company.

So, it's thank you for having me along the journey, and I look forward to sitting down live soon.

Thank you so much for your support.

Yeah, I mean, Maximus is a labor of love.

Like, you know, I've been practicing as a clinical psychologist and as a psychiatry professor, you know, like working with CEOs and VCs, I kind of have a concierge practice, like a half day a week where I've been optimizing their health and performance.

It's never meant to be scalable, but Maximus, essentially, to your point, is a scalable version of that, you know, as opposed to paying thousands of dollars to see a concierge doctor.

How do you democratize essentially performance medicine?

And that's really what we've done with Maximus.

And I really appreciate the support of great investors like yourself in helping us realize that vision.

Thanks, Cam.

Thanks for listening to my conversation.

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