July 30, 2025 • 43 mins
What if your healthcare wasn't about just treating sickness, but maximizing your potential?
In today's episode on How I Invest, I spoke with Dr. Cameron Sepah, founder and CEO of Maximus, a performance medicine company pioneering a new paradigm in healthcare. Cameron previously helped build Omada Health, now a billion-dollar public company, and coined the term “digital therapeutics.” Now he's productized his unique medical expertise into a next-gen men's health platform.
We talked about the evolution of performance medicine, why testosterone and GLP-1s are changing how Americans manage their health, and how AI is reshaping clinical decision-making. We also dug deep into the personal and systemic failures of the traditional healthcare model — and what the next 10 years will look like as proactive medicine goes mainstream.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
So what is Maximus?
(00:01):
It's a great question.
So Maximus is a consumer healthcare technologystartup, that I started in 2020.
We are basically an online clinic that ispioneering performance medicine, which is a
whole new paradigm shift.
As you know, we really don't have a healthcaresystem.
We have a sick care system.
So if you break a bone, you have an infection,you have cancer.
(00:24):
We actually have a very, high qualityhealthcare system that helps sick people get
better.
But that is really not enabled to preventillness.
And it's really not enabled to enhance qualityof life and health span, which is the number of
quality years that you have.
(00:44):
And so performance medicine is really a newparadigm shift.
A lot of people obviously know that athletes,for instance, use performance enhancing drugs
and substances in order to enhance theircompetitive performance in order to win.
Increasingly kind of the thesis of Maximus isthat the average consumer also cares about how
they perform, whether as an employee or founderof a company, as a father or spouse, or whether
(01:12):
as an amateur athlete, just trying to get themost out of their gym gains.
All of the protocols that we provide are notjust for people who have, an illness or a
medical condition, but for people who can becompletely healthy, essentially have no major
diagnosable medical problem, but just want tolook, feel, or perform their best.
(01:32):
And just full disclosure, I invested multipletimes alongside ABC, Founders Fund, and others.
One of the reasons I invest in you is you're onthe founding team of Omada, which has now gone
public and it's a billion dollar publiccompany.
What lessons did you learn from Omada that youapply to MAXIMUS every day?
It's a really great question.
I was privileged to be part of the foundingteam, at Omada and I was, the medical director
(01:56):
and led clinical innovation at the company.
And one of the first things that I did was toreally establish Omada as a science backed
science based company.
There's literally a video of me on Omada'swebsite back in the day talking about how, you
know, we hold ourselves to the highest goldstandard of running clinical trials to prove
that what we do works.
(02:16):
And you have to remember, you know, I joinedthe company in like 2012.
You know, online therapy was like, not a thing.
You know, people thought it was like this crazyconcept.
I come from the world of working in hospitalswhere I run-in person treatment programs.
So, Sean Duffy and I, the CEO of Ahmad at thetime flew out to the CDC.
We ran, met the woman who, ran that particulardivision named Doctor.
(02:40):
Ann Albright.
And we said, Hey, do we have to run arandomized clinical trial to prove that online
therapy is as effective as in person therapy?
She said, Well, we know it's the same thing.
Just prove that it's comparably efficacious,that, you know, you can get the same weight
loss results.
And we said, alright, let's do that.
So I actually published three papers for Omadalooking at, does basically an online weight
(03:01):
loss program lead to clinically meaningfulweight loss results at one year, two years, and
three years, which we show people lost about 5%of their body weight, reduce their a one c or
blood sugar levels, and kept off the most ofthat weight for the course of three years.
I was actually the first person to publish theterm digital therapeutics in a, in a pub peer
reviewed research paper that became an entirefield.
(03:22):
There's literally conferences now that arededicated to digital therapeutics, meaning
using software as treatment that really enabledOmada to do a lot of its early enterprise
sales, because I would go to my counterpartchief medical offer officers at large
healthcare systems like Kaiser's or Carolinasor to large self insured employers like home
(03:43):
deep on Lowe's.
And they're like, well, how do I know this isgoing 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 losstreatment out there, but it's incredibly
convenient because you can do it all in thecomfort and convenience of your own home.
So that lesson was a very powerful one.
And that's what really makes Maximus I wouldsay different from the HIMSS and other
(04:07):
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 thetime they don't.
And I'll give you an example of this.
So the GLP one medications people probably knowOzempic or WeGovi, you've heard the brand
names.
There are companies out there that are selling,oral versions of them.
(04:28):
They do not work.
They literally sell them as gummy bears.
It's literally a crime that it should becriminal in my opinion, or certainly unethical
or immoral because none of these companies areactually testing whether they work.
Maximus on the other hand, we actually runclinical trials.
You can go to our website, for instance.
Don't take my word on incloma feed.
There are a lot of preexisting research studieson incloma feed, as they were going through
(04:52):
clinical trials, but we also published our ownbecause we showed for instance, the lower
dosages that we pioneered and innovated on alsowork.
Also it works in a healthier population.
So we had to do, de novo or novel research toprove that same thing with the oral
testosterone.
We show that oral testosterone counter toeveryone's expectations is not suppressive and
maintains fertility markers such as LH and FSH.
(05:13):
And so you can kind of have your cake and eatit too, as I was mentioning.
Obviously the health and wellness world is fullof snake oil, unfortunately, in this day and
age.
You have, crazy people like Brian Johnson,literally scamming con, people as a con artist,
you know, pretending that you can't die oryou'll live forever, making completely
unsubstantiated claims.
But I think there are high integrity companies.
(05:34):
Maximus is not the only one, but to me, if Iwas a consumer, I'd be like, you know, how do
you, how do I know this is safe?
How do I know this is effective?
What is the research that has been published onthis 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 clinicaltrials, Show me the data.
(05:58):
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 andwhy not go through FDA clinical trials.
So testosterone is a great example.
So testosterone as a drug or a compound, it'sbeen around for half a century, maybe a whole
(06:19):
century.
Pharmaceutical companies really can't patentsomething that's been around forever.
It's a generic essentially.
And so they're no longer kind of doing researchon it unless they're developing a completely
new sort of delivery system for it.
And then they're trying to patent that andthey're trying to protect it.
Like for instance, there are companies thathave been trying to do this with oral
(06:41):
testosterone coming up with their own specialformulations.
I believe there's three FDA approved forms oforal testosterone as well.
But you know, from our perspective, ifsomething has already been FDA approved to
known compound, like we understand, you know,the benefits and side effects of testosterone
very well because it's like probably close to acentury of use.
You know, our job is to just come up withbetter delivery systems or like I said, coming
(07:04):
up with different dosage schemes or using it inhealthier populations.
And then that way we can run very quick trialsbecause the trials are not designed to go
through a multi stage FDA approval process.
It's just to prove that something that wealready know is safe, already know is FDA
approved can be used for a different sort ofpurpose.
And in that way, you know, we can do this very,very lean to sort of startup speak.
(07:26):
And in a way that's really catered to ourtarget consumer, which is generally generally
younger, healthier folks who are not using it,like I said, for necessarily the treatment of a
medical condition, but they just want toenhance themselves.
And they want to know that does this work forme?
Last time we chatted, you told me that peopleare GLP-1s.
I looked into this.
I'm now a very happy Maximus customer.
(07:48):
Full disclosure, I pay full price.
Tell me about GLP-1s.
What is the purpose?
What's the second order side effects of them?
And also why are people microdosing them?
It's a really great parallel example to thetestosterone story that I was telling you about
that back in the day you'd only injecttestosterone and you'd only inject it if you
were drastically low in testosterone becauseyou have to be dependent on the rest of your
(08:11):
life.
And so it's kind of a niche thing, obviouslywith the fertility safe, oral and topical
forms, non injectable forms, also, protocolsthat are lower dosed for healthier populations.
Basically any adult male that's otherwisehealthy that wants to be better can take
testosterone.
(08:31):
I really think that there's going to be asimilar paradigm shift with GLP ones.
If you understand the history of GLP ones,they're originally medications that were
prescribed for diabetes, which is the fieldthat I come from at Omada.
GLPs are basically glucagon like peptide onereceptor agonist, which is just a mouthful of
way of saying they're medications that mimic anatural hormone to increase insulin secretion.
(08:54):
It decreases appetite.
It slows digestion.
And by doing so, it promotes weight loss andbetter blood sugar control.
So originally they were using diabetics.
They noticed, Hey, these guys are losingweight.
We should probably use this for weight loss.
And so they actually went through new FDAapprovals, which is why literally the same drug
is called Ozempic and Wegavi, which is thegeneric name is semaglutide or semaglutide
(09:18):
because it was approved for diabetes and thenit was reapproved for weight loss.
Under the sick care system that I was tellingyou about, it's very hard to get your insurance
to cover it because these are very expensivedrugs that cost like $1,000 to $1,500 a month,
which is crazy if your insurance is notcovering it fully.
But if your insurance is covering it, you haveto have a BMI over thirty.
(09:40):
So you have to be essentially obese.
And there's some provisions if your BMI is overtwenty seven, but you have pre diabetes or
diabetes, they'll let you slide.
You often have to go through a weight lossprogram like Omada to qualify for it because
they want to prove that you've tried to loseit, you know, the old fashioned way, so to
speak.
(10:01):
Because you know, insurance is basically in thebusiness of denying care.
They don't want to pay $1,500 a month if theycan avoid it.
So they're to make you jump through a bunch ofhurdles and they're going to limit it to the
sickest portion of the population ever.
Now what's happened is because these drugs, thedemand was so high and they weren't able to
produce enough.
These drugs are basically on shortage.
(10:21):
And then the FDA basically allows compoundingpharmacies to produce, these drugs at lower
costs, as if they were generic or if they'rebeing used for personalized dosages.
And so let's say you're not grossly obese.
You obviously, if you're half the body weightof someone who's obese, you may still have body
(10:42):
fat to lose.
You may have, excess visceral fat that'ssurrounding your organs.
You may have excess subcutaneous fat that youcan see, obviously, if you have sort of the
beer belly that guys have and you 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,
etcetera, who, are not limited by insurance,paying cash out of pocket and using GLP-1s to
(11:08):
lose weight.
Now these are typically people who are likeoverweight, they may be not obese and wouldn't
qualify for their insurance.
Interestingly, as a lot of these people wereusing GLP-1s, they noticed a lot of benefits in
addition to weight loss.
So for instance, a lot of people noticeimproved impulse control.
So it was improving their addictions, which isreally interesting and I think emerging, but
(11:28):
early research in terms of like psychiatric andaddiction medicine.
And a lot of people who had comorbid medicalconditions notice a really significant
improvement in inflammation.
So if they had arthritis, if they had PCOS, alot of these, inflammatory mediated conditions
notice, Hey, my inflammation is lower.
I have less pain.
I'm a lot more mobile.
(11:48):
And so a lot of people are using it for sort ofthese off label use cases, meaning that the
drugs are originally approved for diabetes inthe 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 improveyour metabolic conditions.
Those are sort of off label indications, but adoctor can still under their clinical
(12:09):
discretion and judgment prescribe it for thosereasons.
So what we did is we had a lot of, you know,clients coming to us and said, Hey, I'm not,
you know, overweight, but I still like to use,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.
So for instance, if your BMI is at least over20 two, so you're not necessarily overweight,
but you still have some body fat that you'dlike to use because of your, you know, central
(12:33):
adiposity, etcetera.
You can take a much lower dose.
So for instance, the dose that we use, ofsemaglutide is 40% lower than the typical
starting dose.
And we're not titrating it up like you would ona typical obesity protocol, because you know,
those folks often get a little nauseous becausethe dose is so high and you have to, ramp up
(12:54):
basically every single month.
If you're taking a microdose, you don'ttypically run into as many of the typical side
effects that you do, in GLP-1s, which often arenauseas.
Most people have heard about slow gastricemptying.
Sometimes people get a little bit ofgastrointestinal distress because obviously
that's part of the way that it works.
But on a very, very tiny microdose, it reallyhelps, control, the food noise as people call
(13:17):
it, sort of those, cravings for late night foodand snacks.
And it just helps people kind of fight thewillpower battle.
Would argue, in helping them make betterchoices, obviously lifestyle intervention,
which is, you know, what I've done my wholecareer, including at Omada in terms of getting
people to eat right exercise, sleep, and managetheir stress are always foundational and first
(13:38):
line therapies.
But, you know, 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 themost effective.
The drugs help people make the necessarybehavioral changes, whether with testosterone
or GLP ones, because when you just have moreenergy, more drive, more motivation, better
appetite control, you're not fighting this,this willpower battle.
(13:59):
As I mentioned, that's just really hard toobviously with the stressors of life.
I have a very, you know, kind of radicalperspective on kind of what the future of
America will look like.
And here it is.
Number one, the majority of Americans in thenext five to ten years are going be on GLP-one.
First of all, it's because America is so fat.
Seventy percent of the country is overweight orobese.
And so they, they absolutely from a clinicalperspective, that's justified.
(14:23):
But a lot of the, even the thirty percent ofpeople who are not, I think increasingly are
going to be on it because what's going tohappen is I think GLPs are revolutionary in
that people are going to take the just rightpersonalized dose to get to their optimal
state.
So for instance, if you look at kind of thecross section of America now, right?
You have thirty percent of people who are notoverweight, about thirty five percent of people
(14:45):
who are overweight, about thirty five percentof people who are obese.
So about a third, a third, a third, and almostnobody's really at their optimal level of
health, or aesthetics.
If you look at, if you include sort ofmetabolic disregularities, including high blood
sugar, high blood pressure, high cholesterol,dyslipidemia, eighty eight percent of the
(15:06):
country has some metabolic abnormality, meaningonly twelve percent of the country is actually
perfectly healthy from a metabolic perspective.
Are these comorbidities to being overweight?This
This eighty eight percent or are theyunrelated?
Yes.
Being fat makes everything else worse as you'vekind of common sense dictates.
The major driver for why people, for instance,have high blood sugar is being overweight.
(15:29):
That's why the treatment for prediabetes anddiabetes, as we did at Omada, is to lose five
to 10% of your body weight.
Now, obviously, are genetic factors as well.
Some people with certain racial categories, andgenetic predispositions can be kind of skinny
fat.
They're not overweight or obese, but they'restill prone to diabetes.
So there are multi factors.
But in America, if you look at the prevalenceof diabetes, hypertension, it's mostly
(15:53):
lifestyle, driven in terms of being overweightand 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 ten people are healthy,
how do we get the other ninety percent ofpeople on board?
Obviously, I've spent my whole career trying toget people to change their behavior.
I do think on an individual level, it'sabsolutely possible.
All of us know people who have turned theirlives around through pure willpower, coaching,
(16:17):
therapy, and made changes.
At a population wide level of 300 plus millionpeople, It has not worked.
We have not made a dent.
We have failed essentially as a medical system,as a society, public policy, etcetera.
What I think is going to happen is if you offerthese medications at personalized dosages,
there's going to be a contingent of people whodon't need them at all.
Right?
(16:37):
They're the thin coastal elites, highlyeducated, high willpower people.
Great.
If you can do it without medications, perfectideal case scenario.
For the rest of the country, 90, you know, twopercent of people who need some help.
I think there's going to be some people whoneed it to kickstart a weight loss journey.
They'll maybe take it for twelve to sixteenweeks.
(16:59):
They'll lose the weight and they'll highlymotivated.
And then once they're able to fit into theirjeans or their high school dress, won't need it
for the rest of their lives.
There'll be a contingent of people who they'lllose the weight.
Life stress happens.
You go through a divorce, you're starting togain the weight back.
You'll go back on it whenever you need it tojust get back down to the ideal weight.
(17:19):
And for the rest of the population, probablythe 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 amaintenance dose to maintain the weight loss
forever.
But no matter how much you need, which is zerooccasional use or chronic use of the
medication, I think the majority of the peoplewho literally have at least the financial means
(17:41):
and the psychological willingness can all getdown to an ideal state of low body fat
metabolic health, and are looking and feelingtheir best.
And it's really the medications that incombination with the behavior change that it's
gonna get us there.
What I observed in myself, the way that I kindof look at the GLP-1s is essentially puts your
body into cruise control.
(18:03):
They kind of, like, take over your body, and itshows to you that if you don't eat as much, you
could lose weight, which sounds like the mostobvious thing except people kind of have this
learned helplessness that they could never loseweight, almost like it's impossible for them
specifically, but it kind of takes over yourbody, shows you that it's possible, and then
you know, okay, if I eat once a day or I eatthese types of foods, I'm gonna lose weight.
(18:26):
You reconnect yourself to cause and effect whenit comes to foods and its effect on your body.
Absolutely.
And I'm really glad that you shared that sortof personal anecdote.
I've spent my career working with people andhelping them lose weight.
And the struggle is real because, you know, Iactually, I take also kind of a little bit of a
radical point of view that basically allobesity is psychologically driven.
(18:47):
There's very few people, maybe a few percentageof people where there's some genetic serious
medical condition that's driving it.
But if you look at how quickly, literally overtwo generations, the rate of obesity has
skyrocketed, you can't say that's genetic.
That's an environmental illness essentially,because we, essentially sixty six percent of
the American diet comes from ultra processedfoods.
(19:09):
That's really the root cause.
The problem is we're not getting rid of it.
People are not going to eat a 100% whole foods.
People don't cook anymore.
The lifestyles that we have, the convenienceand the cost, you know, issues that are driving
all this, you know, definitely should beaddressed on a public health level.
It's not gonna happen anytime soon in any waythat's sort of, gonna save America.
(19:29):
So if you're basically, you know, out in theworld and you have these designer drugs, if you
will, these ultra processed foods that areconstantly tempting us, you can't just sit
there and shame people and say, well, justavoid avoid temptation, avoid, addiction, when
essentially the majority of the country is tosome degree addicted or reliant on packaged
processed foods.
Really the only time you can be is you can'tyou buy anything with the nutritional label.
(19:53):
Anything that has a nutritional label is bydefinition processed.
Right?
If you think about meats, fruits, andvegetables are basically the only produce, that
doesn't have a nutritional label becausethere's one ingredient.
It's a banana.
You know what it is.
But, I don't know anyone, even, like, thepeople who have a lot of, you know, means,
personal chefs that that eat nothing that'sprocessed.
And obviously, there's there's some things thatare minimally processed that could be healthy,
(20:15):
yogurt, you know, etcetera, things that youtheoretically could make at home.
But that that world is gone, except, like Isaid, on an individual level.
But on a societal level, given that we havethese things that are not optimal, there has to
be something that helps support choice andwillpower so that we don't overeat.
Right?
And fundamentally weight loss is about acaloric balance issue.
(20:38):
You know, it's an excess calorie issue.
Obviously, it's easier said than done, though.
When you have sort of emotional, psychologicaland environmental factors that are driving
people to eat excess amounts, you know, if youcan regulate your appetite to me, that is in
essentially in some way addressing the rootcause, not an environmental root cause, but
individual root cause in that it helps justavoid that temptation and really help people
(21:00):
make better choices.
Tell me about the research, what the researchsays in terms of people going on these GLP-1s
and then they come off them, how much of thatweight do they, regain and in what cases do
they regain more than they initially lost?
So here's the fascinating thing, having been apublished, you know, weight loss treatment, you
(21:21):
know, author and researcher.
If you look at any treatment for weight loss,including behavioral treatments,
pharmacological treatments, the majority of thepeople 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 sixteen week
exercise plan, are you going to get in shape?
(21:41):
Course.
And if you stop exercising, are you going tostay in shape?
Of course not.
Same thing with vitamin D.
It's like, if you're deficient and you get sunsunlight slash supplementation, your levels
will go up.
Then the last, do I need to be on this forever?
Of course you do.
If you need to maintain everything in order tomaintain the benefits.
So for the majority of people, they will needto remain on medications to some degree or some
(22:04):
dosage to maintain the weight loss gains thatthey have.
Now, again, individual results always vary.
There are lots of people that I know evenpersonally that have lost the weight and have
used that as a catalyst to make the behavioralchanges.
But I would argue they're not getting off ofeverything.
What they've done is they've kind of used theweight loss medications to be the catalyst and
(22:26):
then they're switching to another therapeutic,which is lifestyle slash behavioral medicine in
that they've, for instance, increased theirprotein 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 thisparadigm of, Oh, I have to be reliant on these
medications forever.
(22:47):
It's a crutch.
And somehow it's a, it's a stigma or a problemto be on something forever.
Like the reality is most people should be on avitamin D supplement for the rest of their
lives.
Why is that?
Because we don't, we're not laborers who areoutside in the sun all day.
We actually did a research study where welooked at men in Los Angeles.
It's sunny here.
I literally go outside and tan on purpose.
(23:08):
Sixty six percent of people were literallydeficient in vitamin D and a hundred percent
were suboptimal.
Our lifestyles and our modern environments arenot conducive essentially to that.
So yeah, you got to take a vitamin D pill forthe rest of your life if you want to be
optimal, but there's no issue with that unlessyou want to radically like become, you know, an
agrarian farmer like your ancestors.
So I think the same thing with GLP-1s.
(23:30):
Like I said, if you cannot take it throughbecause you've substituted it with behavioral
medicine, more power to you, and you shouldabsolutely do that.
But if you need to occasionally take a dose toget kind of back on the train, or you need to
take a micro or maintenance dose to maintain itforever, 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.
(23:51):
And so to me, I leave it up to the individualpatient.
I'm like, Hey, you want to get off themedication?
I fully support you.
If you can do it, do it.
And if you can't, there's nothing wrong withyou.
It's the same boat.
The majority of people in take the minimaleffective dose.
I call it the med in order to get you to theoptimal state rather than thinking about this
black and white, like, I'm gonna be on or offforever.
(24:13):
Most effective people that
I know, they pick their battles.
Some Right.
Want to spend all their willpower on gettinginto good shape.
Some wanna work.
Some want to spend time with their kids.
In many ways, not choosing what to be bad at isa way to be bad at everything.
So not choosing what to kind of outsource orwhat to put into autopilot hurts your ability
(24:36):
to do other things to a high degree.
But also if you substitute medications forbehavioral interventions, you realize how silly
that logic is.
It's like saying, oh, I gotta be dependent onexercise 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 ofexercise are a completely weird and foreign
(24:58):
invention.
Nobody was lifting weights at a gym.
We usually just physically labor through ourwork.
Like, jogging was essentially invented by, Ibelieve, a New Zealand coach named Arthur
Littered in the nineteen sixties.
He published a book called jogging, and then,like, nobody used to jog.
Like, even in the nineteen nineties when I rantrack and cross country and I was running
through the neighborhood, people thought it wasweird back then.
(25:18):
Like people thought you stole something if youwere running.
They're like, are you doing?
Right?
Like this people forget we have very short termmemories as a society that these interventions
are essentially modern, you know, concoctionsor inventions.
But obviously they're really healthy.
Nothing wrong with exercise.
Probably the best health intervention,essentially that you can do for anything,
(25:39):
including the prevention of Alzheimer's anddementia in particular.
But nobody thinks, oh, I'm dependent on it forthe rest of my life.
Of course you are.
Everything needs right?
Our bodies need maintenance, whether it'sthrough food, food, supplementation,
medication.
I think it's a particularly male paradigm.
I just want to actually point this out.
This is kind of a down solid down side of guysis, guys are obviously have this kind of rugged
(26:01):
American Marburlot notion of self reliance.
I don't want to be reliant on anything.
Right?
I should be a self sustaining man is kind ofthe machismo paradigm that comes from that sick
care system.
Because back in the day, if you were on amedication, again, it means something's wrong
with you under the maximus paradigm whereyou're not taking medication because anything's
(26:21):
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 yourperformance.
That's the great thing.
A lot of our clients literally they go telltheir friends, Hey, I'm on testosterone.
I could 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 outthere, the traditional telemedicine companies
(26:42):
that push a lot of erectile dysfunction andpremature ejaculation medications, no one's
gonna wanna tell their friends about thatbecause it means obviously there's something
wrong with you in that particular case.
As the shift happens from sort of stigmatizedsick care to, know, pro social performance
(27:02):
medicine, I think people are going to get overthe stigma of medications.
And in fact, it'll be bragging rights.
I'll tell you a funny anecdote.
In certain Middle Eastern countries, getting arhinoplasty or a nose job is no longer
stigmatized.
In fact, people fake getting surgeries byputting a band aid on their nose to pretend
that they got the surgery because it basicallymeans you have money.
(27:25):
Right?
So it's almost become a badge of honor orprestige 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 orbad thing, but essentially, it's been
completely destigmatized and maybe even it'sbecome prestigious.
I think the same thing will happen essentially.
That's happened with personal training.
It doesn't just mean you're fat anymore.
(27:46):
A lot of people are literally professionalathletes that have a trainer or coach.
It's a prestigious thing to have one because italso means you have the means to do so, but it
also means that, you know, you're someone whoprioritizes their health.
I think that's happening with psychotherapy.
It used to mean that you had a mental illness.
Starting in the nineteen sixties, a lot ofpeople started doing, psychotherapy for self
actualization, for personal growth.
It's become a badge of honor.
(28:07):
In fact, a lot of women on dating apps willsay, I want a guy green flag if they're in
therapy because it means that they've worked onthemselves.
I literally think it's the same thing withpharmacology.
You're not gonna be hiding it from your wife orgirlfriend or your boyfriend or husband.
You're gonna be like, hey.
Help me inject my GLP ones because, you know,I'm not gonna have a dad bod or a mom bod for
the rest of my life.
(28:27):
In fact, I will maintain my weight forever.
And I actually think it's gonna help a lot ofrelationships in the long term.
I do think we'll see it probably within thisdecade.
So as I mentioned, nothing on the market rightnow, is really efficacious, orally.
There is one version of semaglutide.
There is an oral version actually on themarket.
(28:48):
It's not very popular.
I think, like, the benefits of side effectratio is just not as good as the injection.
And the other thing too, I I just wanna pointout this, most people are afraid of injections
who've never injected themselves.
I even had this notion.
I was like, I I'm a health care practitioner.
I'm not afraid of needles.
I've got my blood drawn, like, literally, like,over a 100 times.
I don't have any problem with it, but I justdidn't like the idea of injecting myself on a
(29:11):
regular basis.
The 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 getinjections.
It's an intramuscular injection.
It's in the shoulder.
It kinda goes deep.
The the paradigm shift is as opposed to usingthese big scary needles that do kinda hurt, you
can use insulin needles.
They're very thin.
(29:31):
They're very small, and they're very painless.
And the other thing is you don't inject it intoyour 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, a one to two out of10.
It really doesn't hurt.
And most most of the time when people do it,unless they literally have, like, a a needle or
(29:54):
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'tmind 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 peoplewill take it.
But the injectables are really not as bad, andI think there there's something for everyone.
(30:17):
And and we know this from testosterone.
There's some people who just prefer theconvenience of injecting once a week.
That's great.
We offer injectable testosterone.
And there's lot of people who are like, great.
I I just like the oral form.
I don't like sticking myself.
And I I think the best, you know, paradigm isthat if you offer both, there's gonna be
something for everyone, and you're gonnaaddress the largest population possible.
Obviously, AI is disrupting every industry.
(30:39):
We just saw Grok4 come out with their new LLM.
For a company like Maximus in the health carespace, how does AI change the projections and
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, itwas actually psychologists who pioneered
(30:59):
artificial intelligence, you know, like fiftyyears 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 isliterally based on behavioral psychology.
GPUs allow us to have sort of the computationalhorsepower to make a lot of the vision of sort
(31:20):
of the early AI pioneers and psychologists cometrue.
For instance, the Turing test of being able tohave, you know, pass a test of how do you tell
if, you know, how you're having a conversationwith a human being or a robot and and being
indistinguishable essentially is passable nowwith ChatGPT.
So there's a couple examples in which we useAI.
So first of all, for internal researchpurposes, as I mentioned, like we're an R and D
(31:42):
driven company.
We repurpose essentially FDA approved drugs fornovel optimization use cases.
We'll it's very efficient as opposed to goinginto PubMed, finding research studies to to
troll the existing essentially research, andvery, very quickly come up with insights, pull
data, help us write our research papers.
(32:03):
Once we've collected the data, makes the kindof the research and publication process a lot
faster, which allows us to obviously innovateon a faster time scale.
So that's a huge paradigm shift that'shappened.
The second thing is increasingly, I think AIwill supplement and support doctors, not
completely replace them.
I think people still want a human being that'sin charge of their health, especially when
(32:28):
things go wrong.
AIs are not perfect in handling sort of,especially like emergencies, edge cases,
etcetera.
For instance, you know, we are the largestprescriber of enclomiphene 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, forinstance, through the art of medicine, that
(32:48):
maybe if you're heavier to start with, yourlower testosterone to start with, you probably
need a higher dose.
So they're probably using maybe like a coupledifferent variables looking at patients' charts
and medical histories in order to decide whatthe initial dose is.
We measure their baseline testosterone levels.
We measure it again after thirty days, and thenwe look, okay, doubled your levels, or maybe
(33:10):
you got up to like 1.5 x, so you might need alittle bit of a higher dose.
Or maybe someone triples their levels, butthey're starting to run into some side effects.
Okay.
Maybe we need to decrease your dose.
And so it usually will take two or threeiterations to get people to the optimal dose
through kind of trial and error.
Because you know, you're testing labs, you'relistening to patients in terms of their
(33:32):
symptomatic improvement side effect response.
But because we have all this data, can train anAI model and say, okay, input all of the data
that we have on this patient, not just basicdemographic variables like their weight and
starting testosterone level, and then suggestdosage that is most likely to result in the
(33:53):
optimal outcome.
And they'll can suggest it to the doctor.
The doctor can obviously choose to accept it oroverride it.
So increasingly, we're gonna instantiateessentially like AI to help with dosing and
dose titration so that we can get it rightperhaps 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 particularlyexcited about its use in coaching.
(34:16):
So at Omada, I trained over 150 health coaches,human beings, nutritionists, nurses that would
provide individualized one on one coaching topatients because the social accountability, the
social support are a big part.
Obviously a lot of people, they know they needto eat less and eat better, but having that
sort of social reinforcement is particularlyeffective in helping people get to those
(34:38):
outcomes.
Obviously with GPT and conversational, you havea 20 fourseven health coach in your pocket that
is smarter, quite frankly, than most PhDsnowadays.
Can analyze, you know, I was talking to Googlelike ten years ago about, can you take a
picture of your food, and analyze the contentsand the macronutrients and micronutrients?
(34:58):
This is all reality nowadays, Right?
And so it can provide even more, more specificcoaching than ever.
So one example of this that we're working onright now is using visual AI to analyze
people's body fat.
So you can take front and side pictures or likea 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 a
(35:22):
$100.
And now through AI essentially can give you avery accurate assessment of your body
composition, which is obviously useful ifyou'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 whichAI I think is going to really complement the
pharmacological means because it'll help thecoaching, it'll help the tracking, it'll help
(35:43):
the dose titration and just providing anecosystem where it it just makes the the entire
process better.
What diagnostic tests should a otherwisehealthy male or somebody that's not, obese or
morbidly obese be doing in order to optimizetheir health?
It's a really great question.
First of all, I actually encourage everyone tohave a primary care physician.
(36:04):
It's crazy, like, of the percentage of peoplewho don't have a doctor at all.
I think you need a basic doctor.
And the utility of, I think, a primary carephysician that you can see in person is like
literally when you're sick and you need to havesomeone like listen to your lungs, prescribe
you an antibiotic if necessary, determine if anantibiotic is necessary.
It's really important to have that.
(36:25):
Unfortunately, a lot of people don't.
I encourage people, you know, obviously useyour health insurance.
If not, you can kind of find people, to havethat, but you know, like they're not going to
do performance medicine, right?
They're going to just make sure that you're notsick.
So take care of the foundation, take care ofthe fundamentals first.
So it's not a replacement for basic sort ofhealthcare.
Now on top of that, the problem is like thetraditional healthcare system doesn't do
(36:46):
routine blood testing.
They'll really only blood test you if you'resick.
And then the crazy part is they don't test forroutine things.
Like, I'll give you a personal example.
You know, I have a family history of diabetes.
My my doctor never asked to ever check my bloodsugar levels.
Right?
Even though they know they knew my familyhistory.
Had to literally ask them.
I say, hey, like my dad has type two diabetes.
(37:06):
I should know what my blood sugar levels arebecause I want to obviously avoid it.
They're like, okay, sure.
Know, but I had to literally convince them todo so.
Same thing.
Unless you're like, feel like you're dying, noone's gonna check your testosterone levels,
even though obviously hormonal health isfundamental to your health.
So unfortunately our sick care system and thereason for this honestly is because insurance
companies don't want to pay for testing.
They're like, unless you're falling over,you're deathly symptomatic, there's probably
(37:31):
nothing wrong with you.
That's obviously foolish.
Right?
We know that like thirty seven percent ofAmericans are pre diabetic and eighty nine
percent of them don't know it because they'venever tested their blood sugar levels.
And similarly, a ton of people are lowtestosterone these days that nobody knows
because nobody ever checks.
And so what I tell people is like, look, get anannual physical exam from your primary care
(37:51):
physician.
You know, you should be checking your prostate,make sure you don't have testicular cancer.
These are the in person exam stuff that youneed.
But you can go to a company like Maximus, andthere's other companies too.
I don't wanna just promote our own, and do a anannual blood test.
At the very least, every six to twelve months,you should get a
blood test done.
We'll get right back to interview.
(38:11):
But first, we're looking for the next greatguest.
If you or someone you know is a capitalallocator and would make for a great guest,
please reach out to me directly atdavid@WeisbergCapital.com.
There's basic things.
There's called the CBC CMP comprehensive, youknow, blood count, comprehensive metabolic
panel.
And this measures the the basic things,including your blood sugar levels, for
(38:33):
instance.
You should get that done.
I do think it's helpful to get a hormone paneldone.
So you should be measuring your totaltestosterone, your SHBG.
Use those things.
You can calculate your free testosterone.
You wanna measure your LH and FSH, which areyour essentially, fertility markers.
That's a signal from your brain to your testesto produce testosterone and sperm.
(38:54):
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 bloodpanel.
A lot of times people can do that through theirprimary 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 acompany like us, or there's a lot of lab
(39:16):
testing companies, get that done every six totwelve months and just make sure, that you're
obviously maintaining.
And if there are problematic things, like forinstance, 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'taware that they're vitamin D deficient or at
least suboptimal.
Get that measured, and then you can do anintervention.
(39:36):
So for instance, we offer a prescriptionmultivitamin called building blocks.
It has a prescription dose of vitamin D, whichis ten thousand IUs.
So people are, you know, deficient, which isbelow 30.
I believe it's nanograms per milliliter, orsuboptimal, which is below 50.
You know, we put people on the overwhelmingmajority of people get above 50, which has been
shown by the way to, like, reduce the incidenceof COVID related death to basically zero.
(40:00):
There's literally a paper came out that said ifwe gave everyone vitamin d supplementation,
almost nobody would die from COVID except for,like, maybe this super, you know,
immunocompromised essentially.
Yeah.
That's basically the best thing to do, routineblood testing.
I don't think you need to go crazy.
I think there are some companies that arepromoting these like, oh, you gotta test like
100 plus markers all the time.
It's sometimes interesting to do once maybe tosee, for instance, do you have like heavy metal
(40:24):
toxicity if you're, I don't know, exposed to alot of it.
But most of the time, people are fine.
You can test at once.
I I really am more of a a fan of just kinda,routine testing the basic things, the things
that I mentioned before and making sure thatthose are really dialed in, because those are
the things that are most responsive tolifestyle intervention.
Like obviously your lipids are influenced bywhat you eat.
(40:44):
Your blood sugar levels are influenced by whatyou eat.
Your hormone levels are influenced by theamount of sun exposure, your stress and your
sleep.
And so these are modifiable things.
The other things are a little bit exoticmarkers and they're not very actionable.
I've seen a lot of like founder colleagues justpay $500 to get this humongous panel done.
They're like, what do I do with thisinformation?
I don't even know what's a problem, what's not.
(41:05):
I do think AI is helpful in helping peopleunderstand their biomarkers.
But like I said, you wanna really kinda measurethe ones that are critical for health span and
the ones that are really modifiable.
One of the big paradigm shifts of MAXIMUS isgetting blood testing is a pain in the ass.
You gotta go to a Questra Labcorp.
They stick a giant needle in your arm.
It's painful.
It's hard to get an appointment.
You gotta or you gotta sit in the waiting roomwhen you walk in.
(41:27):
It is helpful to do when you do comprehensivetesting, like you're measuring, like, like, 50
plus markers.
But if you're measuring a handful of markers,we've really innovated at home testing.
We use a little device.
It looks like a a CGM.
You stick it on your shoulders.
It uses actually microneedle technology.
It doesn't hurt because it's not going intoyour veins.
(41:48):
It's literally actually superficially just, youknow, going in into your fat and drawing out
capillary blood.
And you can get about a half a pinky full of,blood.
And, obviously, you can't measure a millionthings.
We're not trying to be like Theranos here.
You can measure about up to about a dozenmarkers.
So like I said, if you need to measure 50 plus,go get a traditional blood draw.
(42:11):
But if you're just trying to measure yourhormones, 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, andit's 99% as accurate as, venipuncture draw
through Quest and LabCorp.
So this has been validated.
It's way better than the fingerprint tests, butway better than the saliva tests that are out
there in terms of its accuracy, reliability,validity.
(42:32):
And so this is a huge paradigm shift for us aswell in that
Cam, don't know if I ever told you, the reasonI invested in you, because I was very excited
when you started Maximus that you essentiallyproductized yourself.
You were talking about all this, and then youturned into a business.
It's one of my favorite theses, and I've seen alot of success investing to people that
productize themselves into a company.
So it's, thank you for having me along thejourney, and I look forward to sitting down
(42:55):
live soon.
Thank you so much for your support.
Yeah.
I mean, Maximus is is a labor of love.
Like, you know, I've I've been practicing as aclinical psychologist, and as a psychiatry
professor, you know, like working with CEOs andVCs, I kind of a concierge practice, a half day
a week where I have been optimizing theirhealth and performance.
It's never meant to be scalable, but Maximusessentially to your point is a scalable version
(43:17):
of that, you know, as opposed to payingthousands of dollars to see a concierge doctor.
How do you democratize essentially performancemedicine?
And that's really what we've done with Maximus.
And I really appreciate the support of greatinvestors like yourself, in helping us realize
that vision.
Thanks, Scott.
Thanks for listening to my conversation.
If you enjoyed this episode, please share witha friend.
This helps us grow.
(43:37):
Also provides the very best feedback when wereview the episode's analytics.
Thank you for your support.
So what is Maximus?
(00:01):
It's a great question.
So Maximus is a consumer healthcare technologystartup, that I started in 2020.
We are basically an online clinic that ispioneering performance medicine, which is a
whole new paradigm shift.
As you know, we really don't have a healthcaresystem.
We have a sick care system.
So if you break a bone, you have an infection,you have cancer.
(00:24):
We actually have a very, high qualityhealthcare system that helps sick people get
better.
But that is really not enabled to preventillness.
And it's really not enabled to enhance qualityof life and health span, which is the number of
quality years that you have.
(00:44):
And so performance medicine is really a newparadigm shift.
A lot of people obviously know that athletes,for instance, use performance enhancing drugs
and substances in order to enhance theircompetitive performance in order to win.
Increasingly kind of the thesis of Maximus isthat the average consumer also cares about how
they perform, whether as an employee or founderof a company, as a father or spouse, or whether
(01:12):
as an amateur athlete, just trying to get themost out of their gym gains.
All of the protocols that we provide are notjust for people who have, an illness or a
medical condition, but for people who can becompletely healthy, essentially have no major
diagnosable medical problem, but just want tolook, feel, or perform their best.
(01:32):
And just full disclosure, I invested multipletimes alongside ABC, Founders Fund, and others.
One of the reasons I invest in you is you're onthe founding team of Omada, which has now gone
public and it's a billion dollar publiccompany.
What lessons did you learn from Omada that youapply to MAXIMUS every day?
It's a really great question.
I was privileged to be part of the foundingteam, at Omada and I was, the medical director
(01:56):
and led clinical innovation at the company.
And one of the first things that I did was toreally establish Omada as a science backed
science based company.
There's literally a video of me on Omada'swebsite back in the day talking about how, you
know, we hold ourselves to the highest goldstandard of running clinical trials to prove
that what we do works.
(02:16):
And you have to remember, you know, I joinedthe company in like 2012.
You know, online therapy was like, not a thing.
You know, people thought it was like this crazyconcept.
I come from the world of working in hospitalswhere I run-in person treatment programs.
So, Sean Duffy and I, the CEO of Ahmad at thetime flew out to the CDC.
We ran, met the woman who, ran that particulardivision named Doctor.
(02:40):
Ann Albright.
And we said, Hey, do we have to run arandomized clinical trial to prove that online
therapy is as effective as in person therapy?
She said, Well, we know it's the same thing.
Just prove that it's comparably efficacious,that, you know, you can get the same weight
loss results.
And we said, alright, let's do that.
So I actually published three papers for Omadalooking at, does basically an online weight
(03:01):
loss program lead to clinically meaningfulweight loss results at one year, two years, and
three years, which we show people lost about 5%of their body weight, reduce their a one c or
blood sugar levels, and kept off the most ofthat weight for the course of three years.
I was actually the first person to publish theterm digital therapeutics in a, in a pub peer
reviewed research paper that became an entirefield.
(03:22):
There's literally conferences now that arededicated to digital therapeutics, meaning
using software as treatment that really enabledOmada to do a lot of its early enterprise
sales, because I would go to my counterpartchief medical offer officers at large
healthcare systems like Kaiser's or Carolinasor to large self insured employers like home
(03:43):
deep on Lowe's.
And they're like, well, how do I know this isgoing 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 losstreatment out there, but it's incredibly
convenient because you can do it all in thecomfort and convenience of your own home.
So that lesson was a very powerful one.
And that's what really makes Maximus I wouldsay different from the HIMSS and other
(04:07):
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 thetime they don't.
And I'll give you an example of this.
So the GLP one medications people probably knowOzempic or WeGovi, you've heard the brand
names.
There are companies out there that are selling,oral versions of them.
(04:28):
They do not work.
They literally sell them as gummy bears.
It's literally a crime that it should becriminal in my opinion, or certainly unethical
or immoral because none of these companies areactually testing whether they work.
Maximus on the other hand, we actually runclinical trials.
You can go to our website, for instance.
Don't take my word on incloma feed.
There are a lot of preexisting research studieson incloma feed, as they were going through
(04:52):
clinical trials, but we also published our ownbecause we showed for instance, the lower
dosages that we pioneered and innovated on alsowork.
Also it works in a healthier population.
So we had to do, de novo or novel research toprove that same thing with the oral
testosterone.
We show that oral testosterone counter toeveryone's expectations is not suppressive and
maintains fertility markers such as LH and FSH.
(05:13):
And so you can kind of have your cake and eatit too, as I was mentioning.
Obviously the health and wellness world is fullof snake oil, unfortunately, in this day and
age.
You have, crazy people like Brian Johnson,literally scamming con, people as a con artist,
you know, pretending that you can't die oryou'll live forever, making completely
unsubstantiated claims.
But I think there are high integrity companies.
(05:34):
Maximus is not the only one, but to me, if Iwas a consumer, I'd be like, you know, how do
you, how do I know this is safe?
How do I know this is effective?
What is the research that has been published onthis 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 clinicaltrials, Show me the data.
(05:58):
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 andwhy not go through FDA clinical trials.
So testosterone is a great example.
So testosterone as a drug or a compound, it'sbeen around for half a century, maybe a whole
(06:19):
century.
Pharmaceutical companies really can't patentsomething that's been around forever.
It's a generic essentially.
And so they're no longer kind of doing researchon it unless they're developing a completely
new sort of delivery system for it.
And then they're trying to patent that andthey're trying to protect it.
Like for instance, there are companies thathave been trying to do this with oral
(06:41):
testosterone coming up with their own specialformulations.
I believe there's three FDA approved forms oforal testosterone as well.
But you know, from our perspective, ifsomething has already been FDA approved to
known compound, like we understand, you know,the benefits and side effects of testosterone
very well because it's like probably close to acentury of use.
You know, our job is to just come up withbetter delivery systems or like I said, coming
(07:04):
up with different dosage schemes or using it inhealthier populations.
And then that way we can run very quick trialsbecause the trials are not designed to go
through a multi stage FDA approval process.
It's just to prove that something that wealready know is safe, already know is FDA
approved can be used for a different sort ofpurpose.
And in that way, you know, we can do this very,very lean to sort of startup speak.
(07:26):
And in a way that's really catered to ourtarget consumer, which is generally generally
younger, healthier folks who are not using it,like I said, for necessarily the treatment of a
medical condition, but they just want toenhance themselves.
And they want to know that does this work forme?
Last time we chatted, you told me that peopleare GLP-1s.
I looked into this.
I'm now a very happy Maximus customer.
(07:48):
Full disclosure, I pay full price.
Tell me about GLP-1s.
What is the purpose?
What's the second order side effects of them?
And also why are people microdosing them?
It's a really great parallel example to thetestosterone story that I was telling you about
that back in the day you'd only injecttestosterone and you'd only inject it if you
were drastically low in testosterone becauseyou have to be dependent on the rest of your
(08:11):
life.
And so it's kind of a niche thing, obviouslywith the fertility safe, oral and topical
forms, non injectable forms, also, protocolsthat are lower dosed for healthier populations.
Basically any adult male that's otherwisehealthy that wants to be better can take
testosterone.
(08:31):
I really think that there's going to be asimilar paradigm shift with GLP ones.
If you understand the history of GLP ones,they're originally medications that were
prescribed for diabetes, which is the fieldthat I come from at Omada.
GLPs are basically glucagon like peptide onereceptor agonist, which is just a mouthful of
way of saying they're medications that mimic anatural hormone to increase insulin secretion.
(08:54):
It decreases appetite.
It slows digestion.
And by doing so, it promotes weight loss andbetter blood sugar control.
So originally they were using diabetics.
They noticed, Hey, these guys are losingweight.
We should probably use this for weight loss.
And so they actually went through new FDAapprovals, which is why literally the same drug
is called Ozempic and Wegavi, which is thegeneric name is semaglutide or semaglutide
(09:18):
because it was approved for diabetes and thenit was reapproved for weight loss.
Under the sick care system that I was tellingyou about, it's very hard to get your insurance
to cover it because these are very expensivedrugs that cost like $1,000 to $1,500 a month,
which is crazy if your insurance is notcovering it fully.
But if your insurance is covering it, you haveto have a BMI over thirty.
(09:40):
So you have to be essentially obese.
And there's some provisions if your BMI is overtwenty seven, but you have pre diabetes or
diabetes, they'll let you slide.
You often have to go through a weight lossprogram like Omada to qualify for it because
they want to prove that you've tried to loseit, you know, the old fashioned way, so to
speak.
(10:01):
Because you know, insurance is basically in thebusiness of denying care.
They don't want to pay $1,500 a month if theycan avoid it.
So they're to make you jump through a bunch ofhurdles and they're going to limit it to the
sickest portion of the population ever.
Now what's happened is because these drugs, thedemand was so high and they weren't able to
produce enough.
These drugs are basically on shortage.
(10:21):
And then the FDA basically allows compoundingpharmacies to produce, these drugs at lower
costs, as if they were generic or if they'rebeing used for personalized dosages.
And so let's say you're not grossly obese.
You obviously, if you're half the body weightof someone who's obese, you may still have body
(10:42):
fat to lose.
You may have, excess visceral fat that'ssurrounding your organs.
You may have excess subcutaneous fat that youcan see, obviously, if you have sort of the
beer belly that guys have and you 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,
etcetera, who, are not limited by insurance,paying cash out of pocket and using GLP-1s to
(11:08):
lose weight.
Now these are typically people who are likeoverweight, they may be not obese and wouldn't
qualify for their insurance.
Interestingly, as a lot of these people wereusing GLP-1s, they noticed a lot of benefits in
addition to weight loss.
So for instance, a lot of people noticeimproved impulse control.
So it was improving their addictions, which isreally interesting and I think emerging, but
(11:28):
early research in terms of like psychiatric andaddiction medicine.
And a lot of people who had comorbid medicalconditions notice a really significant
improvement in inflammation.
So if they had arthritis, if they had PCOS, alot of these, inflammatory mediated conditions
notice, Hey, my inflammation is lower.
I have less pain.
I'm a lot more mobile.
(11:48):
And so a lot of people are using it for sort ofthese off label use cases, meaning that the
drugs are originally approved for diabetes inthe 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 improveyour metabolic conditions.
Those are sort of off label indications, but adoctor can still under their clinical
(12:09):
discretion and judgment prescribe it for thosereasons.
So what we did is we had a lot of, you know,clients coming to us and said, Hey, I'm not,
you know, overweight, but I still like to use,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.
So for instance, if your BMI is at least over20 two, so you're not necessarily overweight,
but you still have some body fat that you'dlike to use because of your, you know, central
(12:33):
adiposity, etcetera.
You can take a much lower dose.
So for instance, the dose that we use, ofsemaglutide is 40% lower than the typical
starting dose.
And we're not titrating it up like you would ona typical obesity protocol, because you know,
those folks often get a little nauseous becausethe dose is so high and you have to, ramp up
(12:54):
basically every single month.
If you're taking a microdose, you don'ttypically run into as many of the typical side
effects that you do, in GLP-1s, which often arenauseas.
Most people have heard about slow gastricemptying.
Sometimes people get a little bit ofgastrointestinal distress because obviously
that's part of the way that it works.
But on a very, very tiny microdose, it reallyhelps, control, the food noise as people call
(13:17):
it, sort of those, cravings for late night foodand snacks.
And it just helps people kind of fight thewillpower battle.
Would argue, in helping them make betterchoices, obviously lifestyle intervention,
which is, you know, what I've done my wholecareer, including at Omada in terms of getting
people to eat right exercise, sleep, and managetheir stress are always foundational and first
(13:38):
line therapies.
But, you know, 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 themost effective.
The drugs help people make the necessarybehavioral changes, whether with testosterone
or GLP ones, because when you just have moreenergy, more drive, more motivation, better
appetite control, you're not fighting this,this willpower battle.
(13:59):
As I mentioned, that's just really hard toobviously with the stressors of life.
I have a very, you know, kind of radicalperspective on kind of what the future of
America will look like.
And here it is.
Number one, the majority of Americans in thenext five to ten years are going be on GLP-one.
First of all, it's because America is so fat.
Seventy percent of the country is overweight orobese.
And so they, they absolutely from a clinicalperspective, that's justified.
(14:23):
But a lot of the, even the thirty percent ofpeople who are not, I think increasingly are
going to be on it because what's going tohappen is I think GLPs are revolutionary in
that people are going to take the just rightpersonalized dose to get to their optimal
state.
So for instance, if you look at kind of thecross section of America now, right?
You have thirty percent of people who are notoverweight, about thirty five percent of people
(14:45):
who are overweight, about thirty five percentof people who are obese.
So about a third, a third, a third, and almostnobody's really at their optimal level of
health, or aesthetics.
If you look at, if you include sort ofmetabolic disregularities, including high blood
sugar, high blood pressure, high cholesterol,dyslipidemia, eighty eight percent of the
(15:06):
country has some metabolic abnormality, meaningonly twelve percent of the country is actually
perfectly healthy from a metabolic perspective.
Are these comorbidities to being overweight?This
This eighty eight percent or are theyunrelated?
Yes.
Being fat makes everything else worse as you'vekind of common sense dictates.
The major driver for why people, for instance,have high blood sugar is being overweight.
(15:29):
That's why the treatment for prediabetes anddiabetes, as we did at Omada, is to lose five
to 10% of your body weight.
Now, obviously, are genetic factors as well.
Some people with certain racial categories, andgenetic predispositions can be kind of skinny
fat.
They're not overweight or obese, but they'restill prone to diabetes.
So there are multi factors.
But in America, if you look at the prevalenceof diabetes, hypertension, it's mostly
(15:53):
lifestyle, driven in terms of being overweightand 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 ten people are healthy,
how do we get the other ninety percent ofpeople on board?
Obviously, I've spent my whole career trying toget people to change their behavior.
I do think on an individual level, it'sabsolutely possible.
All of us know people who have turned theirlives around through pure willpower, coaching,
(16:17):
therapy, and made changes.
At a population wide level of 300 plus millionpeople, It has not worked.
We have not made a dent.
We have failed essentially as a medical system,as a society, public policy, etcetera.
What I think is going to happen is if you offerthese medications at personalized dosages,
there's going to be a contingent of people whodon't need them at all.
Right?
(16:37):
They're the thin coastal elites, highlyeducated, high willpower people.
Great.
If you can do it without medications, perfectideal case scenario.
For the rest of the country, 90, you know, twopercent of people who need some help.
I think there's going to be some people whoneed it to kickstart a weight loss journey.
They'll maybe take it for twelve to sixteenweeks.
(16:59):
They'll lose the weight and they'll highlymotivated.
And then once they're able to fit into theirjeans or their high school dress, won't need it
for the rest of their lives.
There'll be a contingent of people who they'lllose the weight.
Life stress happens.
You go through a divorce, you're starting togain the weight back.
You'll go back on it whenever you need it tojust get back down to the ideal weight.
(17:19):
And for the rest of the population, probablythe 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 amaintenance dose to maintain the weight loss
forever.
But no matter how much you need, which is zerooccasional use or chronic use of the
medication, I think the majority of the peoplewho literally have at least the financial means
(17:41):
and the psychological willingness can all getdown to an ideal state of low body fat
metabolic health, and are looking and feelingtheir best.
And it's really the medications that incombination with the behavior change that it's
gonna get us there.
What I observed in myself, the way that I kindof look at the GLP-1s is essentially puts your
body into cruise control.
(18:03):
They kind of, like, take over your body, and itshows to you that if you don't eat as much, you
could lose weight, which sounds like the mostobvious thing except people kind of have this
learned helplessness that they could never loseweight, almost like it's impossible for them
specifically, but it kind of takes over yourbody, shows you that it's possible, and then
you know, okay, if I eat once a day or I eatthese types of foods, I'm gonna lose weight.
(18:26):
You reconnect yourself to cause and effect whenit comes to foods and its effect on your body.
Absolutely.
And I'm really glad that you shared that sortof personal anecdote.
I've spent my career working with people andhelping them lose weight.
And the struggle is real because, you know, Iactually, I take also kind of a little bit of a
radical point of view that basically allobesity is psychologically driven.
(18:47):
There's very few people, maybe a few percentageof people where there's some genetic serious
medical condition that's driving it.
But if you look at how quickly, literally overtwo generations, the rate of obesity has
skyrocketed, you can't say that's genetic.
That's an environmental illness essentially,because we, essentially sixty six percent of
the American diet comes from ultra processedfoods.
(19:09):
That's really the root cause.
The problem is we're not getting rid of it.
People are not going to eat a 100% whole foods.
People don't cook anymore.
The lifestyles that we have, the convenienceand the cost, you know, issues that are driving
all this, you know, definitely should beaddressed on a public health level.
It's not gonna happen anytime soon in any waythat's sort of, gonna save America.
(19:29):
So if you're basically, you know, out in theworld and you have these designer drugs, if you
will, these ultra processed foods that areconstantly tempting us, you can't just sit
there and shame people and say, well, justavoid avoid temptation, avoid, addiction, when
essentially the majority of the country is tosome degree addicted or reliant on packaged
processed foods.
Really the only time you can be is you can'tyou buy anything with the nutritional label.
(19:53):
Anything that has a nutritional label is bydefinition processed.
Right?
If you think about meats, fruits, andvegetables are basically the only produce, that
doesn't have a nutritional label becausethere's one ingredient.
It's a banana.
You know what it is.
But, I don't know anyone, even, like, thepeople who have a lot of, you know, means,
personal chefs that that eat nothing that'sprocessed.
And obviously, there's there's some things thatare minimally processed that could be healthy,
(20:15):
yogurt, you know, etcetera, things that youtheoretically could make at home.
But that that world is gone, except, like Isaid, on an individual level.
But on a societal level, given that we havethese things that are not optimal, there has to
be something that helps support choice andwillpower so that we don't overeat.
Right?
And fundamentally weight loss is about acaloric balance issue.
(20:38):
You know, it's an excess calorie issue.
Obviously, it's easier said than done, though.
When you have sort of emotional, psychologicaland environmental factors that are driving
people to eat excess amounts, you know, if youcan regulate your appetite to me, that is in
essentially in some way addressing the rootcause, not an environmental root cause, but
individual root cause in that it helps justavoid that temptation and really help people
(21:00):
make better choices.
Tell me about the research, what the researchsays in terms of people going on these GLP-1s
and then they come off them, how much of thatweight do they, regain and in what cases do
they regain more than they initially lost?
So here's the fascinating thing, having been apublished, you know, weight loss treatment, you
(21:21):
know, author and researcher.
If you look at any treatment for weight loss,including behavioral treatments,
pharmacological treatments, the majority of thepeople 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 sixteen week
exercise plan, are you going to get in shape?
(21:41):
Course.
And if you stop exercising, are you going tostay in shape?
Of course not.
Same thing with vitamin D.
It's like, if you're deficient and you get sunsunlight slash supplementation, your levels
will go up.
Then the last, do I need to be on this forever?
Of course you do.
If you need to maintain everything in order tomaintain the benefits.
So for the majority of people, they will needto remain on medications to some degree or some
(22:04):
dosage to maintain the weight loss gains thatthey have.
Now, again, individual results always vary.
There are lots of people that I know evenpersonally that have lost the weight and have
used that as a catalyst to make the behavioralchanges.
But I would argue they're not getting off ofeverything.
What they've done is they've kind of used theweight loss medications to be the catalyst and
(22:26):
then they're switching to another therapeutic,which is lifestyle slash behavioral medicine in
that they've, for instance, increased theirprotein 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 thisparadigm of, Oh, I have to be reliant on these
medications forever.
(22:47):
It's a crutch.
And somehow it's a, it's a stigma or a problemto be on something forever.
Like the reality is most people should be on avitamin D supplement for the rest of their
lives.
Why is that?
Because we don't, we're not laborers who areoutside in the sun all day.
We actually did a research study where welooked at men in Los Angeles.
It's sunny here.
I literally go outside and tan on purpose.
(23:08):
Sixty six percent of people were literallydeficient in vitamin D and a hundred percent
were suboptimal.
Our lifestyles and our modern environments arenot conducive essentially to that.
So yeah, you got to take a vitamin D pill forthe rest of your life if you want to be
optimal, but there's no issue with that unlessyou want to radically like become, you know, an
agrarian farmer like your ancestors.
So I think the same thing with GLP-1s.
(23:30):
Like I said, if you cannot take it throughbecause you've substituted it with behavioral
medicine, more power to you, and you shouldabsolutely do that.
But if you need to occasionally take a dose toget kind of back on the train, or you need to
take a micro or maintenance dose to maintain itforever, 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.
(23:51):
And so to me, I leave it up to the individualpatient.
I'm like, Hey, you want to get off themedication?
I fully support you.
If you can do it, do it.
And if you can't, there's nothing wrong withyou.
It's the same boat.
The majority of people in take the minimaleffective dose.
I call it the med in order to get you to theoptimal state rather than thinking about this
black and white, like, I'm gonna be on or offforever.
(24:13):
Most effective people that
I know, they pick their battles.
Some Right.
Want to spend all their willpower on gettinginto good shape.
Some wanna work.
Some want to spend time with their kids.
In many ways, not choosing what to be bad at isa way to be bad at everything.
So not choosing what to kind of outsource orwhat to put into autopilot hurts your ability
(24:36):
to do other things to a high degree.
But also if you substitute medications forbehavioral interventions, you realize how silly
that logic is.
It's like saying, oh, I gotta be dependent onexercise 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 ofexercise are a completely weird and foreign
(24:58):
invention.
Nobody was lifting weights at a gym.
We usually just physically labor through ourwork.
Like, jogging was essentially invented by, Ibelieve, a New Zealand coach named Arthur
Littered in the nineteen sixties.
He published a book called jogging, and then,like, nobody used to jog.
Like, even in the nineteen nineties when I rantrack and cross country and I was running
through the neighborhood, people thought it wasweird back then.
(25:18):
Like people thought you stole something if youwere running.
They're like, are you doing?
Right?
Like this people forget we have very short termmemories as a society that these interventions
are essentially modern, you know, concoctionsor inventions.
But obviously they're really healthy.
Nothing wrong with exercise.
Probably the best health intervention,essentially that you can do for anything,
(25:39):
including the prevention of Alzheimer's anddementia in particular.
But nobody thinks, oh, I'm dependent on it forthe rest of my life.
Of course you are.
Everything needs right?
Our bodies need maintenance, whether it'sthrough food, food, supplementation,
medication.
I think it's a particularly male paradigm.
I just want to actually point this out.
This is kind of a down solid down side of guysis, guys are obviously have this kind of rugged
(26:01):
American Marburlot notion of self reliance.
I don't want to be reliant on anything.
Right?
I should be a self sustaining man is kind ofthe machismo paradigm that comes from that sick
care system.
Because back in the day, if you were on amedication, again, it means something's wrong
with you under the maximus paradigm whereyou're not taking medication because anything's
(26:21):
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 yourperformance.
That's the great thing.
A lot of our clients literally they go telltheir friends, Hey, I'm on testosterone.
I could 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 outthere, the traditional telemedicine companies
(26:42):
that push a lot of erectile dysfunction andpremature ejaculation medications, no one's
gonna wanna tell their friends about thatbecause it means obviously there's something
wrong with you in that particular case.
As the shift happens from sort of stigmatizedsick care to, know, pro social performance
(27:02):
medicine, I think people are going to get overthe stigma of medications.
And in fact, it'll be bragging rights.
I'll tell you a funny anecdote.
In certain Middle Eastern countries, getting arhinoplasty or a nose job is no longer
stigmatized.
In fact, people fake getting surgeries byputting a band aid on their nose to pretend
that they got the surgery because it basicallymeans you have money.
(27:25):
Right?
So it's almost become a badge of honor orprestige 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 orbad thing, but essentially, it's been
completely destigmatized and maybe even it'sbecome prestigious.
I think the same thing will happen essentially.
That's happened with personal training.
It doesn't just mean you're fat anymore.
(27:46):
A lot of people are literally professionalathletes that have a trainer or coach.
It's a prestigious thing to have one because italso means you have the means to do so, but it
also means that, you know, you're someone whoprioritizes their health.
I think that's happening with psychotherapy.
It used to mean that you had a mental illness.
Starting in the nineteen sixties, a lot ofpeople started doing, psychotherapy for self
actualization, for personal growth.
It's become a badge of honor.
(28:07):
In fact, a lot of women on dating apps willsay, I want a guy green flag if they're in
therapy because it means that they've worked onthemselves.
I literally think it's the same thing withpharmacology.
You're not gonna be hiding it from your wife orgirlfriend or your boyfriend or husband.
You're gonna be like, hey.
Help me inject my GLP ones because, you know,I'm not gonna have a dad bod or a mom bod for
the rest of my life.
(28:27):
In fact, I will maintain my weight forever.
And I actually think it's gonna help a lot ofrelationships in the long term.
I do think we'll see it probably within thisdecade.
So as I mentioned, nothing on the market rightnow, is really efficacious, orally.
There is one version of semaglutide.
There is an oral version actually on themarket.
(28:48):
It's not very popular.
I think, like, the benefits of side effectratio is just not as good as the injection.
And the other thing too, I I just wanna pointout this, most people are afraid of injections
who've never injected themselves.
I even had this notion.
I was like, I I'm a health care practitioner.
I'm not afraid of needles.
I've got my blood drawn, like, literally, like,over a 100 times.
I don't have any problem with it, but I justdidn't like the idea of injecting myself on a
(29:11):
regular basis.
The 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 getinjections.
It's an intramuscular injection.
It's in the shoulder.
It kinda goes deep.
The the paradigm shift is as opposed to usingthese big scary needles that do kinda hurt, you
can use insulin needles.
They're very thin.
(29:31):
They're very small, and they're very painless.
And the other thing is you don't inject it intoyour 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, a one to two out of10.
It really doesn't hurt.
And most most of the time when people do it,unless they literally have, like, a a needle or
(29:54):
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'tmind 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 peoplewill take it.
But the injectables are really not as bad, andI think there there's something for everyone.
(30:17):
And and we know this from testosterone.
There's some people who just prefer theconvenience of injecting once a week.
That's great.
We offer injectable testosterone.
And there's lot of people who are like, great.
I I just like the oral form.
I don't like sticking myself.
And I I think the best, you know, paradigm isthat if you offer both, there's gonna be
something for everyone, and you're gonnaaddress the largest population possible.
Obviously, AI is disrupting every industry.
(30:39):
We just saw Grok4 come out with their new LLM.
For a company like Maximus in the health carespace, how does AI change the projections and
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, itwas actually psychologists who pioneered
(30:59):
artificial intelligence, you know, like fiftyyears 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 isliterally based on behavioral psychology.
GPUs allow us to have sort of the computationalhorsepower to make a lot of the vision of sort
(31:20):
of the early AI pioneers and psychologists cometrue.
For instance, the Turing test of being able tohave, you know, pass a test of how do you tell
if, you know, how you're having a conversationwith a human being or a robot and and being
indistinguishable essentially is passable nowwith ChatGPT.
So there's a couple examples in which we useAI.
So first of all, for internal researchpurposes, as I mentioned, like we're an R and D
(31:42):
driven company.
We repurpose essentially FDA approved drugs fornovel optimization use cases.
We'll it's very efficient as opposed to goinginto PubMed, finding research studies to to
troll the existing essentially research, andvery, very quickly come up with insights, pull
data, help us write our research papers.
(32:03):
Once we've collected the data, makes the kindof the research and publication process a lot
faster, which allows us to obviously innovateon a faster time scale.
So that's a huge paradigm shift that'shappened.
The second thing is increasingly, I think AIwill supplement and support doctors, not
completely replace them.
I think people still want a human being that'sin charge of their health, especially when
(32:28):
things go wrong.
AIs are not perfect in handling sort of,especially like emergencies, edge cases,
etcetera.
For instance, you know, we are the largestprescriber of enclomiphene 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, forinstance, through the art of medicine, that
(32:48):
maybe if you're heavier to start with, yourlower testosterone to start with, you probably
need a higher dose.
So they're probably using maybe like a coupledifferent variables looking at patients' charts
and medical histories in order to decide whatthe initial dose is.
We measure their baseline testosterone levels.
We measure it again after thirty days, and thenwe look, okay, doubled your levels, or maybe
(33:10):
you got up to like 1.5 x, so you might need alittle bit of a higher dose.
Or maybe someone triples their levels, butthey're starting to run into some side effects.
Okay.
Maybe we need to decrease your dose.
And so it usually will take two or threeiterations to get people to the optimal dose
through kind of trial and error.
Because you know, you're testing labs, you'relistening to patients in terms of their
(33:32):
symptomatic improvement side effect response.
But because we have all this data, can train anAI model and say, okay, input all of the data
that we have on this patient, not just basicdemographic variables like their weight and
starting testosterone level, and then suggestdosage that is most likely to result in the
(33:53):
optimal outcome.
And they'll can suggest it to the doctor.
The doctor can obviously choose to accept it oroverride it.
So increasingly, we're gonna instantiateessentially like AI to help with dosing and
dose titration so that we can get it rightperhaps 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 particularlyexcited about its use in coaching.
(34:16):
So at Omada, I trained over 150 health coaches,human beings, nutritionists, nurses that would
provide individualized one on one coaching topatients because the social accountability, the
social support are a big part.
Obviously a lot of people, they know they needto eat less and eat better, but having that
sort of social reinforcement is particularlyeffective in helping people get to those
(34:38):
outcomes.
Obviously with GPT and conversational, you havea 20 fourseven health coach in your pocket that
is smarter, quite frankly, than most PhDsnowadays.
Can analyze, you know, I was talking to Googlelike ten years ago about, can you take a
picture of your food, and analyze the contentsand the macronutrients and micronutrients?
(34:58):
This is all reality nowadays, Right?
And so it can provide even more, more specificcoaching than ever.
So one example of this that we're working onright now is using visual AI to analyze
people's body fat.
So you can take front and side pictures or likea 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 a
(35:22):
$100.
And now through AI essentially can give you avery accurate assessment of your body
composition, which is obviously useful ifyou'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 whichAI I think is going to really complement the
pharmacological means because it'll help thecoaching, it'll help the tracking, it'll help
(35:43):
the dose titration and just providing anecosystem where it it just makes the the entire
process better.
What diagnostic tests should a otherwisehealthy male or somebody that's not, obese or
morbidly obese be doing in order to optimizetheir health?
It's a really great question.
First of all, I actually encourage everyone tohave a primary care physician.
(36:04):
It's crazy, like, of the percentage of peoplewho don't have a doctor at all.
I think you need a basic doctor.
And the utility of, I think, a primary carephysician that you can see in person is like
literally when you're sick and you need to havesomeone like listen to your lungs, prescribe
you an antibiotic if necessary, determine if anantibiotic is necessary.
It's really important to have that.
(36:25):
Unfortunately, a lot of people don't.
I encourage people, you know, obviously useyour health insurance.
If not, you can kind of find people, to havethat, but you know, like they're not going to
do performance medicine, right?
They're going to just make sure that you're notsick.
So take care of the foundation, take care ofthe fundamentals first.
So it's not a replacement for basic sort ofhealthcare.
Now on top of that, the problem is like thetraditional healthcare system doesn't do
(36:46):
routine blood testing.
They'll really only blood test you if you'resick.
And then the crazy part is they don't test forroutine things.
Like, I'll give you a personal example.
You know, I have a family history of diabetes.
My my doctor never asked to ever check my bloodsugar levels.
Right?
Even though they know they knew my familyhistory.
Had to literally ask them.
I say, hey, like my dad has type two diabetes.
(37:06):
I should know what my blood sugar levels arebecause I want to obviously avoid it.
They're like, okay, sure.
Know, but I had to literally convince them todo so.
Same thing.
Unless you're like, feel like you're dying, noone's gonna check your testosterone levels,
even though obviously hormonal health isfundamental to your health.
So unfortunately our sick care system and thereason for this honestly is because insurance
companies don't want to pay for testing.
They're like, unless you're falling over,you're deathly symptomatic, there's probably
(37:31):
nothing wrong with you.
That's obviously foolish.
Right?
We know that like thirty seven percent ofAmericans are pre diabetic and eighty nine
percent of them don't know it because they'venever tested their blood sugar levels.
And similarly, a ton of people are lowtestosterone these days that nobody knows
because nobody ever checks.
And so what I tell people is like, look, get anannual physical exam from your primary care
(37:51):
physician.
You know, you should be checking your prostate,make sure you don't have testicular cancer.
These are the in person exam stuff that youneed.
But you can go to a company like Maximus, andthere's other companies too.
I don't wanna just promote our own, and do a anannual blood test.
At the very least, every six to twelve months,you should get a
blood test done.
We'll get right back to interview.
(38:11):
But first, we're looking for the next greatguest.
If you or someone you know is a capitalallocator and would make for a great guest,
please reach out to me directly atdavid@WeisbergCapital.com.
There's basic things.
There's called the CBC CMP comprehensive, youknow, blood count, comprehensive metabolic
panel.
And this measures the the basic things,including your blood sugar levels, for
(38:33):
instance.
You should get that done.
I do think it's helpful to get a hormone paneldone.
So you should be measuring your totaltestosterone, your SHBG.
Use those things.
You can calculate your free testosterone.
You wanna measure your LH and FSH, which areyour essentially, fertility markers.
That's a signal from your brain to your testesto produce testosterone and sperm.
(38:54):
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 bloodpanel.
A lot of times people can do that through theirprimary 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 acompany like us, or there's a lot of lab
(39:16):
testing companies, get that done every six totwelve months and just make sure, that you're
obviously maintaining.
And if there are problematic things, like forinstance, 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'taware that they're vitamin D deficient or at
least suboptimal.
Get that measured, and then you can do anintervention.
(39:36):
So for instance, we offer a prescriptionmultivitamin called building blocks.
It has a prescription dose of vitamin D, whichis ten thousand IUs.
So people are, you know, deficient, which isbelow 30.
I believe it's nanograms per milliliter, orsuboptimal, which is below 50.
You know, we put people on the overwhelmingmajority of people get above 50, which has been
shown by the way to, like, reduce the incidenceof COVID related death to basically zero.
(40:00):
There's literally a paper came out that said ifwe gave everyone vitamin d supplementation,
almost nobody would die from COVID except for,like, maybe this super, you know,
immunocompromised essentially.
Yeah.
That's basically the best thing to do, routineblood testing.
I don't think you need to go crazy.
I think there are some companies that arepromoting these like, oh, you gotta test like
100 plus markers all the time.
It's sometimes interesting to do once maybe tosee, for instance, do you have like heavy metal
(40:24):
toxicity if you're, I don't know, exposed to alot of it.
But most of the time, people are fine.
You can test at once.
I I really am more of a a fan of just kinda,routine testing the basic things, the things
that I mentioned before and making sure thatthose are really dialed in, because those are
the things that are most responsive tolifestyle intervention.
Like obviously your lipids are influenced bywhat you eat.
(40:44):
Your blood sugar levels are influenced by whatyou eat.
Your hormone levels are influenced by theamount of sun exposure, your stress and your
sleep.
And so these are modifiable things.
The other things are a little bit exoticmarkers and they're not very actionable.
I've seen a lot of like founder colleagues justpay $500 to get this humongous panel done.
They're like, what do I do with thisinformation?
I don't even know what's a problem, what's not.
(41:05):
I do think AI is helpful in helping peopleunderstand their biomarkers.
But like I said, you wanna really kinda measurethe ones that are critical for health span and
the ones that are really modifiable.
One of the big paradigm shifts of MAXIMUS isgetting blood testing is a pain in the ass.
You gotta go to a Questra Labcorp.
They stick a giant needle in your arm.
It's painful.
It's hard to get an appointment.
You gotta or you gotta sit in the waiting roomwhen you walk in.
(41:27):
It is helpful to do when you do comprehensivetesting, like you're measuring, like, like, 50
plus markers.
But if you're measuring a handful of markers,we've really innovated at home testing.
We use a little device.
It looks like a a CGM.
You stick it on your shoulders.
It uses actually microneedle technology.
It doesn't hurt because it's not going intoyour veins.
(41:48):
It's literally actually superficially just, youknow, going in into your fat and drawing out
capillary blood.
And you can get about a half a pinky full of,blood.
And, obviously, you can't measure a millionthings.
We're not trying to be like Theranos here.
You can measure about up to about a dozenmarkers.
So like I said, if you need to measure 50 plus,go get a traditional blood draw.
(42:11):
But if you're just trying to measure yourhormones, 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, andit's 99% as accurate as, venipuncture draw
through Quest and LabCorp.
So this has been validated.
It's way better than the fingerprint tests, butway better than the saliva tests that are out
there in terms of its accuracy, reliability,validity.
(42:32):
And so this is a huge paradigm shift for us aswell in that
Cam, don't know if I ever told you, the reasonI invested in you, because I was very excited
when you started Maximus that you essentiallyproductized yourself.
You were talking about all this, and then youturned into a business.
It's one of my favorite theses, and I've seen alot of success investing to people that
productize themselves into a company.
So it's, thank you for having me along thejourney, and I look forward to sitting down
(42:55):
live soon.
Thank you so much for your support.
Yeah.
I mean, Maximus is is a labor of love.
Like, you know, I've I've been practicing as aclinical psychologist, and as a psychiatry
professor, you know, like working with CEOs andVCs, I kind of a concierge practice, a half day
a week where I have been optimizing theirhealth and performance.
It's never meant to be scalable, but Maximusessentially to your point is a scalable version
(43:17):
of that, you know, as opposed to payingthousands of dollars to see a concierge doctor.
How do you democratize essentially performancemedicine?
And that's really what we've done with Maximus.
And I really appreciate the support of greatinvestors like yourself, in helping us realize
that vision.
Thanks, Scott.
Thanks for listening to my conversation.
If you enjoyed this episode, please share witha friend.
This helps us grow.
(43:37):
Also provides the very best feedback when wereview the episode's analytics.
Thank you for your support.
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