Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.468]
episodePreviously titled “Alex Karnal - The Trillion-Dollar Health Revolution - [Invest Like the Best, EP.467]” — renamed by the publisher on Aug 3, 2026
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What is the health‑stack framework and why does it matter?
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Hello and welcome everyone. I'm Patrick O'Shaughnessy and this is Invest Like the Best. This show is an open-ended exploration of markets, ideas, stories, and strategies that will help you better invest both your time and your money. If you enjoy these conversations and want to go deeper, check out Colossus, our quarterly publication with in-depth profiles of the people shaping business and investing. You can find Colossus along with all of our podcasts at Colossus.com.
Patrick O'Shaughnessy is the CEO of Positive Sum. All opinions expressed by Patrick and podcast guests are solely their own opinions and do not reflect the opinion of Positive Sum. This podcast is for informational purposes only and should not be relied upon as a basis for investment decisions. Clients of Positive Sum may maintain positions in the securities discussed in this podcast. To learn more, visit psum.vc.
My guest today is Alex Carnell. Alex is probably the most talented bio and healthcare investor that I've ever met. And as you'll see, he is an encyclopedia of all things going on in life sciences. Alex has been teaching me this topic for more than five years, and every single one of our conversations is about as deep as this one that you hear today. We cover every single aspect of what makes today's life sciences world so interesting, starting with this concept of the health stack. The thing That we can do, both offensive and defensive, to extend our life based on the evidence that he sees in the most exciting companies of today. We talk about cardiovascular disease, neurodegenerative disorders, metabolic disorders, cancers, and beyond.
And finally, we finish with his remarkable personal story. I hope you enjoyed this great conversation. You and I have had these conversations now for many, many years. We've been partners and friends for a long time. And so it's hard to know where to begin the conversation because I suspect we'll go for hours talking about drugs and bio and healthcare and outcomes and a million things that affect us all. You have this cockpit like view into what's going on in the state of medicine today. How would you describe the state of the union? The daily cockpit view that you get of the whole industry. Give us a dispatch from that room. What do you see today?
When I look at this moment in terms of where we are in medicine, and I look back over my 20 years of building and backing biotech companies, I would say that 2025 was probably the single most exciting year in my entire journey. So to unpack that, what we're seeing is GLP one medicines are showing us what happens when we get to the root of disease.
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Chapters
8 chapters
1
What is the health‑stack framework and why does it matter?
0:01–13:36
2
How does Alex define the five defensive layers of a proactive health strategy?
13:36–29:25
3
Why are GLP‑1 medicines considered the first commercial proof of a proactive health revolution?
29:25–43:34
4
What are the main barriers—complexity, cost, and compliance—that limit access to life‑saving drugs?
43:34–59:00
5
How do PCSK9 inhibitors work and why might they be a “free‑lunch” for cardiovascular health?
59:00–1:13:37
6
What is the current state of AI in drug discovery and why does most published data fail to replicate?
1:13:37–1:26:51
7
What would an automated, 24‑hour scientific lab look like and how could it accelerate breakthroughs?
1:26:51–1:30:54
8
How does Braidwell’s investment approach evaluate a biotech company’s chance to succeed?
1:30:54–1:32:36
Speakers
1 identifiedMore from Invest Like the Best with Patrick O'Shaughnessy
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