Dr. Peter Attia

It's not intuitive to people why it costs a billion dollars to get a drug to market and why it can take a decade. And then within that, if you could just embed enough of the details about decisions that you can make that will make or break you, how many times has a drug failed because the experimental design the wrong patient selection, the wrong disease selection.

It's not intuitive to people why it costs a billion dollars to get a drug to market and why it can take a decade. And then within that, if you could just embed enough of the details about decisions that you can make that will make or break you, how many times has a drug failed because the experimental design the wrong patient selection, the wrong disease selection.

You have got to line up four pieces of Swiss cheese just right to get the pen through to hit it. Sorry to interrupt, but let's go back to, you got Judah Folkman talking about VEGF, VEGF, VEGF, that then turns into, well, if we made an antibody to VEGF, okay, so there's your idea. Now start the clock and start the dollars.

You have got to line up four pieces of Swiss cheese just right to get the pen through to hit it. Sorry to interrupt, but let's go back to, you got Judah Folkman talking about VEGF, VEGF, VEGF, that then turns into, well, if we made an antibody to VEGF, okay, so there's your idea. Now start the clock and start the dollars.

Tell folks the difference. How do you think of small molecule versus antibody? Where do we draw the line?

Tell folks the difference. How do you think of small molecule versus antibody? Where do we draw the line?

I do this through cardiovascular medicine to explain to people the difference between a statin and a PCSK9 inhibitor. You have these two very common drugs that are used to lower cholesterol, but a statin is a small molecule. I don't say this in an insulting way, but we use the terminology, it's dirty. It does block an enzyme, but it's got all these off-target things.

I do this through cardiovascular medicine to explain to people the difference between a statin and a PCSK9 inhibitor. You have these two very common drugs that are used to lower cholesterol, but a statin is a small molecule. I don't say this in an insulting way, but we use the terminology, it's dirty. It does block an enzyme, but it's got all these off-target things.

And your liver function gets whacked. You get insulin resistance. Some people get horrible muscle soreness. So 5% to 10% of people taking this drug are going to have a side effect that prevents them from taking the drug. I've never seen a person yet who couldn't tolerate a PCSK9 inhibitor where you inject an antibody into them that binds to a protein and shuts it off.

And your liver function gets whacked. You get insulin resistance. Some people get horrible muscle soreness. So 5% to 10% of people taking this drug are going to have a side effect that prevents them from taking the drug. I've never seen a person yet who couldn't tolerate a PCSK9 inhibitor where you inject an antibody into them that binds to a protein and shuts it off.

Right. Who would take an injection for cholesterol?

Right. Who would take an injection for cholesterol?

Did you guys have to have somebody in parallel developing a CLIA-certified assay that a pathologist was going to use, or did you do that in-house?

Did you guys have to have somebody in parallel developing a CLIA-certified assay that a pathologist was going to use, or did you do that in-house?

And you could quality control the hell out of it?

And you could quality control the hell out of it?

So whose responsibility is, like, how do you encourage the world to make that happen?

So whose responsibility is, like, how do you encourage the world to make that happen?

Now, why didn't you guys do that in parallel? Was the cost too great? And did you want to de-risk the drug before you sunk the cost into that?

Now, why didn't you guys do that in parallel? Was the cost too great? And did you want to de-risk the drug before you sunk the cost into that?