Some Future Day

Marc Beckman: [00:01:00] This is a real, real treat to have Mr. Lou Reese on Some Future Day. Lou is a new friend, but he's definitely philosophically aligned with me and. Uh, I think we are from the same spirit as well, but Lou mostly does some incredible [00:02:00] work. Uh, people aren't familiar with his work and that's why it's really an honor to have you join me today, Lou, on Some Future Day.
Lou Reese: Marc, thanks so much for having me. It's great to be here.
Marc Beckman: Lou, you're very intellectual. You cross different, uh, business sectors from finance into pharmaceuticals, but at the core, you're a caring human being. And what really caught my attention in getting to know you as of late is that your passion for humanity might outweigh everybody else's passion, and in some cases combined, it's really the most legitimate passion that I've ever seen for humankind. I'm curious, in your opinion, why are we not doing well enough for humanity as it relates to health in general? I.
Lou Reese: I mean, I think, uh, I think about this all the time, right? And, uh, and I have kids and, and I think, uh, I think that when I look at the kids and I look at the way that they work, [00:03:00] you, you get to see it through really, uh, kind of unbiased and unadulterated eyes, right? And, you know, if a, if a kid sees another kid fall down.
They help that other kid up. They don't ask what team they're on and they don't get into all of these, all of like what country they're from and all this other stuff. It, it, like kindness actually permeates much broader than we realize. Right. Um, and so that's, that's like a big motivating factor and what I saw.
Um, and, and I'll, I'll tell you what, my son, bearer, he's my oldest son, he's 14. What he, what he taught me about 10 years ago, we had gone from Hawaii to this, to this other place, and the average income was about a dollar 50 a day. And, uh, our guide Christian, we were in a dugout canoe, um, single piece of wood and using like a piece of that as an OR and, uh, and Christian was making three times that, right?
So he was making two or [00:04:00] $3,000 a year. And so he was doing well in this area. And my son looked at me and he said, dad, I have a question. And he was very perturbed, you know. I said, okay, what's up there? And he said, when we were in Hawaii, you bought a $3,000 ukulele from your friend, and Christian makes less than that a year.
What's up with that? And without even really thinking about it. I just, my reflex was to say that we're we're liars and hypocrites and, and it applies to every, every one of us to some degree. Right? And the reason is that we, we say every life is worth the same. And we say that all of these things are, are the way that we communicate with our kids, but then when they, when they show it to you.
It was so, it was so, um, interesting to me. And, and so I've taken that lesson and looked at our existing medical system and if you look at it, I mean, it's broken and it's not broken a little bit. It's not like got a [00:05:00] flat tire and we have to pump it up. This is like wholesale broken. Um, and. The way that you, you see that the absolute brokenness is in the fact that in the US we spend over two times what any other country in the world spends per person for health.
And in those same countries, they live seven or eight years longer. Right? The level of chronic disease in this country is higher than in any of those other countries in the OECD, right? Any other developed country. And yet we're spending on average four times more. Than those countries are on, per person, per year on health.
So if you said, you know, what does that look like? That looks like a broken system, right? It looks absolutely broken. And so, so the stats there are, are overwhelming and, and. You know, we, we see it now not only in increasing rates, in in chronic diseases with kids, but you know, for the first [00:06:00] time in history, um, less than a decade ago, chronic diseases started killing us more than famine, pestilence, bacteria, viruses, all those things combined.
So, so we actually are dying from chronic diseases that are, uh, that are right now not being managed. And that's the reason why we're seeing this, this broken system. So what's happening? There's not, um, and, and so I think that there's this solution there. And that's kind of the way that I've worked my, my whole career, is looking at, you know, whether it was lowering the price of alternative energy with one of the world's first solar funds or, or creating, uh, the first lead multifamily project to lower, you know, energy usage and, and, uh, and to streamline construction in a way that was, was, uh, was built for the future.
You know, if you could, if you could do that. In this system, in the healthcare system, then it's like, it's a, it's a really massive [00:07:00] opportunity. And today, the way that it works is that big pharma strangles innovation and slows it down. And they do that, um, because the costs of the late stage trials and the redundancy and all of these different systems that they've built in through decades of, of, of setting up the system.
And the outcome is that over 90% of the drugs are created by small biotechs, but they then have to sell to big pharma at some stage. And when it gets put into that big pharma system. Then you end up with higher prices, less access. Um, and, and the system is, it's, it's an unbelievably opaque system. There's no transparency whatsoever.
Um, you know, there are reimbursements, there are disclosed reimbursements, there are insurance companies there. There's all these things. So it's not like when you go to the grocery store and you buy a lemon and it's a dollar. Not, [00:08:00] it's, it's, it's, it's like you go to the grocery store, the lemon's $5 and $3, go to some guy that you've never met that hasn't, that never saw the lemon, and then a dollar goes to, you know, this other thing.
And like, it's, it's that opaque. And so the problem is when you explain it and you've, you've seen this and heard it, it turns into like a, a, it looks like alphabet soup, right? It's just a bunch of acronyms and letters and things and tears and all this stuff. And that's not necessary. It's, it's just not, it's built to obfuscate the truth, right?
It's built as a smokescreen to be so complicated that that's that, and, and, and, and it basically covers up the fact that it's broken, right? Why would a cream, that's a prescription drug that we make in the United States costs 10 times more in the same bottle and the same cardboard packaging with the same label as it does in Canada, right across the border?
Why would that be? Right. And the answer is three letter, three [00:09:00] letter acronyms and all these different things and all this stuff. But, but the truth is like, how do you solve that? You solve that and, and this is the big hairy thing that I'm doing and thinking about now as my, as my, like, my purpose here for fixing the, the, the system is actually really elegant, right?
Instead of all of that. Allow, uh, like an America First Pharma plan where you literally get to go and do a direct negotiation with these biotechs for disruptively low prices, right? We're talking less than 1% of the existing price structure, and in so doing you, you actually create a path where, where the natural flow of innovation is opened up through another channel. So Instead of the only path going through big pharma and into that system and into the next system and into the next system, you actually get to create a another waterway, right? Another, [00:10:00] another stream of innovation. Um, and honestly for me, the reason I like it is the ability to force real innovation in the biggest areas of need. And in so doing, um, you know, big pharma will do that once they see that they can, they can potentially participate in it. Maybe they'll, maybe they'll do that in the future, but at the moment, they're not gonna do things like that because it, it affects their profit and it affects the system that they've, they've built.
Um, so that's, that's what I'm, that's what I'm thinking about.
Marc Beckman: So, so that's a lot, right? There's a ton to unpack there, but just to, uh, you know, for exemplary purposes to, to become a little bit more simplistic for the audience and those who. Might not be familiar with what you're talking about. Can you give us a concrete example of a chronic illness that is being, um, the treatment or a drug for a [00:11:00] chronic illness is being hindered as it relates to development?
Because of what I understand when you talk about the system, it looks like the three letter word and acronyms are the government. You have big pharma. You have these patients and doctors, and then the scientists who are creating drugs. So like what's in the pipeline right now? Um, or what could be in the pipeline in the future to help solve this issue of like this murky system that you're describing.
I.
Lou Reese: Well, so, so right now we have, uh, the world's only privately controlled phase three Alzheimer's prevention asset. Alzheimer's in the US cost over half a trillion dollars a year. Um, and I believe that we can prevent the majority of that expenditure, like the vast majority of it. Now, the money is one thing, but the suffering is actually, uh, really like the key here, the patient suffering and the family suffering.
The, the, one of the leading causes of [00:12:00] bankruptcy is actually this long-term patient care and medical bankruptcy, right? So it's destroying families. It's, it's, it's destroying people's lives. It's, uh, it's a horrible disease. 7 million people in the US currently have Alzheimer's, and it's, uh, the six leading cause of death in the country, and the only one in the top 10 that's going, that's growing.
I. Right. Um, so there's, uh, there's a really unique opportunity there to create a pilot project for this America First Pharma idea. And we at Axiom, uh, would, would love to, would love to forego the traditional system and actually do something really disruptive here. And I can't imagine a better first step because you're going after the most feared disease in the country.
So it's, it's passed cancer, it's passed all these things. It's the most feared disease in the country, and it's the most expensive single chronic disease in the country. Right? So, uh, and the current treatments, not prevention, but the current [00:13:00] treatments are, uh, on average over a hundred thousand dollars a year cumulatively for the administration and for the drugs.
Um, and they come with a, with a hefty side effect profile. Right. Um, and this goes back to the acronyms where it's not just government, it's also scientists do this too to some degree. Um, but there's something called Aria E, which is, which if you look it up, it's, it's drug induced brain swelling. Right? But if you write drug induced brain swelling, it sounds much worse than Aria E.
Um, and so, so these drugs have that as a side effect. It's listed, it's known, um, and they're also, uh, cumbersome on the patients because you have to get IV infusions on a regular basis and you, and these are only approved for treatment because of those limitations, because of the, the, you can't. You can't go into prevention with something that costs, you know, a fortune every year.
And it's extremely cumbersome. You gotta get IV infusions and, uh, and it [00:14:00] causes these side effect profiles, so you're not gonna do that. But in our case, um, uh, it's, we're, we're ideally situated to, to be able to prevent, right? And that's really the solution here is, is let's prevent this from, from happening in the first place.
Let's prevent, you know, you don't wanna wait until your brain has problems. To solve it. You wanna make it so your brain doesn't have problems. And so on a very like, simple basis, that's what we're trying to do. And um, and what's disruptive is, you know, what should Lou do right now? If I were doing it like everybody else in the existing system, let me show you how broken it is.
Big pharma has come to us and they've tried to buy the drug. They've tried to shelve the drug. And wait so that they could keep making profits from their existing approved treatments, even knowing that this would be safer or better. They've tried to buy it again. So there's been multiple approaches now from this, from this angle.
And then what would happen? I would lose control of the ability to negotiate the price. So they would make the price more and they would make the access less. [00:15:00] So, you know, all I believe is that we should figure out a way to make the right thing easy and the wrong thing hard. And what we are doing now in the system is making the wrong thing easy and the right thing hard. Now getting, you know, hundreds of millions of dollars and huge amounts of money from the pharma for selling the product to them, or billions of dollars for selling the product to them and, and licenses and fees and all these great things. That's why people do that. And what I'm saying is I don't wanna do that. This is a historic opportunity with historic leadership to make a really massive change, not a little change, not fixing a flat tire, you know, like putting a motor on the bicycle, like this is a different thing and we're doing it in a way that is, is fundamentally disruptive. So without those pieces. You can't do something this big to the system, and it won't just be us.
After this pilot [00:16:00] program, uh, works, other programs for major chronic diseases could come in and be examples where you were directly challenging the, the existing model and actually encouraging a model that supported low cost drugs as opposed to the most expensive drugs possible for the least amount of people you'd go after the least.
Like how, how, how many people can you access that need it? And how can you make it as affordable as possible so that you're actually doing something. That's right. You know? And, and what blows my mind? You said this earlier, which is really, really funny, but like, you know, I can't think of it any other way.
Like I just, I I, when people are like, wait, but what's the other thing? I'm like, if you, it wouldn't the, why wouldn't we do this if it's, if it's gonna help all these people, like.
Marc Beckman: Well, let me ask you May, so just, just so the audience understands, I think what you're talking about here, and correct me if I'm wrong, but the disruptive nature of what you're talking about as it relates [00:17:00] to this New America first. Approach with pharmaceuticals, with treatment, with drugs is to align with the government, essentially to create a new channel of distribution.
And then in turn what you're doing is giving more access at a better, more affordable price point to drugs that are imp for drugs that are, are going to beat major illnesses such as Al Alzheimer's. Correct.
Lou Reese: Yeah, absolutely. And, and by pre-negotiated directly with the government. So right now, most people don't know this because again, it's, it's hidden, right? It's not transparent. So every dollar we spend in the United States on drugs right now, on average 70 cents. Go to the middlemen that are doing nothing.
They're meant to be there to negotiate the prices and get fair prices for the American public. These are the pharmacy benefit managers, the PBMs and the insurance companies, okay? And that's where the money goes. So they're not, it would be the equivalent of you going to [00:18:00] buy a, um, a car and the car costing $10,000 and then you pay the $10,000 and $7,000 of it.
Go to the the car salesman. It's, it's an unimaginable outcome, but that's actually what's happening.
Marc Beckman: So you're saying the cost of goods with regards to a lot of these farm. Pharmaceuticals and new drugs that are coming out should be significantly less.
Lou Reese: so the, the cost of the consumer should be significantly less.
Marc Beckman: How much lower?
Lou Reese: For, for us, what I'm offering in the America First Pharma pilot for Axiom with Alzheimer's is less than 1% of the existing costs. So I'm, I'm offering for a thousand dollars per patient per year to prevent Alzheimer's, um, and, and the existing treatments, treatments.
Are over a hundred thousand dollars a year combined costs, and they are, and they have that side effect profile. So I'd like to save, you know, 95% plus on, on the biologic drugs. And right [00:19:00] now in the, in the country, 60%, about a little bit more, 60% of all of our drug spend is on biologic drugs, which are these.
These, uh, ex, like these more expensive drugs that are, uh, usually, uh, innovative. So they're not, they're usually not generic. Um, and so by tackling that and lowering the cost of that by 95%, you know, these are huge amounts of savings for the government. If we, if we unleash the innovation that's currently being strangled by bigg pharma and the existing system.
Marc Beckman: So, Lou, I gotta ask you, I mean, it begs the question, what you're doing is not just disrupting the pharmaceutical ecosystem, but you're also disrupting capitalism. It becomes to a sense, if you have this private sector, public sector partnership, I. And the government is helping fund these new treatments that you're, that you're developing.
Isn't it a form of socialism, essentially.
Can't it hurt innovation? Um, can't it hurt the concept of capitalism? Not just with [00:20:00] regards to capturing profit margin, but unlocking innovation advances, not just by the way, with drugs and treatment medicines, but also with, um, uh, I would, I would imagine that, uh, the next thing to follow beyond, uh, drugs would be, uh, equip medical equipment and beyond.
Lou Reese: the current system because of all of these layers of complexity that have been added. Is actually, uh, is actually not allowing, um, the natural flow of capital and entrepreneur, um, and entrepreneurial output from the United States. Right? And the reason it's blocking it, um, is actually that, that it's, it's directly beneficial to big pharma to be necessary in that equation. I mean, it directly benefits them to control that equation. Um, and so, so what happens now?
Marc Beckman: I
Lou Reese: Um, and, and what I think we, [00:21:00] I think we do here is instead of the government, um, like, you know, they're not going to subsidize anything. They're going to pre-negotiate disruptive pricing that's very low based off of the success of the drug.
So in the event that the drug does these things, the government agrees that they will buy them. The reason that matters is that it allows for the, the capital, the, the public markets and the private markets to say there's a market there. When this succeeds, and if this succeeds, there's not the insurance company negotiation.
There's not the negotiation with the PBMs. There's not all these middlemen that are directly affected and in the pocket and in collusion, in effect with big pharma, right? Because big pharma might have 50 products on that, on that, uh, reimbursement list, right? And so they can actually exclude things from the reimbursement list at the insurance level and the PBM level.
Right. Um, [00:22:00] and so by going directly to the largest consumer, which is the government and pre-negotiated the best deal possible, you are giving visibility, you're giving transparency to the capital flow, and so that will fund innovation. That will drive a whole new generation. Of people that actually would give lower prices to the government, would give more access, but are currently being strangled by the existing system.
Right. And so, so, um, I actually think of it as, as an increase in transparency and, uh, and I think the natural flow of ca, I'm a, I mean, I'm a capitalist, right? Like I'm,
Marc Beckman: I know you are.
Lou Reese: So, so, uh, I, I believe that the natural flow of, of capital will respond to that and what we need to do now, and it goes back to this incentivizing, making the right thing easy, right?
This is so obviously the right thing. We want lower prices for the people that need it. That's it.
Marc Beckman: For humanity. It's the way we started our relationship and this conversation for sure. It's great for humanity. Like, [00:23:00] so let's go back to the human side because there's tremendous benefit to what you're talking about. How many focusing on Alzheimer's right now? How many like. What percentage of the population who suffers with Alzheimer's do you think are not getting proper medical treatment?
Proper medical care because of the high price.
Lou Reese: Um, that's actually, that's a really,
Marc Beckman: that's what you're focused on. You're focused on the person that's suffering from the disease.
Lou Reese: I mean, so this is gonna sound totally insane, but the answer is virtually no one. getting, even, even those treatments that have the side effect profiles, it's the, the saturation in the market is extremely low. Um, and it's growing right. And it's growing because the, they're figuring out ways that it's being reimbursed and all of these other things.
Um, but it's cumbersome and it's challenging and the side effect profile is challenging. And so, so there's, there's real [00:24:00] limitations. I mean, if, if you. And, and, and I know I told you this before, but you know, one of the things that I am both grateful for and that causes a lot of like real pressure is when you're in a position like we are and you have, you know, the, uh, a bunch of these, um, really unique drugs that are doing things that other PE that just nobody else is doing yet.
Um. A lot of people reach out to me and ask for help for the, for themselves, for their, their partners, for their parents, for their, you know, brothers and sisters. And it's like, um, you know, it, it, it's amazing because at some point, uh, that's, that's all I wanted to be able to do right. Was be able to help.
When you have these few tangible manifestations, it's amazing when you talk to a patient that actually got better from Parkinson's. You know, like all these things are amazing achievements that I'm super proud of, and finally get to feel like the impact. [00:25:00] But, um. When you know that those are just the people that have my phone number and that I know and that are reaching out and that they might have had to go through three or four different friends to find out how to get to me or whatever it was, and then finally they, they're talking to me to try to get access to, to a trial or to get more information or whatever it is.
And then you think of the millions of people. Right. One every 60 seconds that gets Alzheimer's in the United States alone. And it's a, it's a lot of suffering, right? It's a lot of people that are going through, uh, you know, the, the hardest disease that I, that I can imagine. Um, and my grandmother died of Alzheimer's.
Um, and watching it. Watching it change someone from being, you know, the person you, that you love, your bama or whatever, into a person that doesn't recognize you. Um. Is, is [00:26:00] one of, and the agitation and the, and the, the, the manifestations in between that, um, it's, it's one of the hardest things that I've ever seen.
And, and I believe that it robs us of what makes us human right, which is our ability to think and our minds and our experiences. Um, so I really do think of the. The most feared and the most expensive disease as also something that is, is, is battling to, to devour the consciousness of humanity to some degree.
Right. In these individuals and in the patients. And what's a, what's a better thing to, to fight for than preserving their humanity, right? Like it's a, it's so, it's so clear. Um, and, and I think that's a big part of it, you know, and, and. It's funny, again, I didn't realize that this was something that everyone didn't do, but like, you know, you talk to our kids and you say, what do your parents [00:27:00] do for, for, uh, you know, what do they do?
They'll say, oh, uh, they work to save people. And, and I and, and I had some friend over and they were like, wait a second. When I asked my kid, he's like, dad goes to work so he could make money so that I could pay for school. 'cause school's IPOs like really expensive and you know, apartments are expensive and blah, blah, blah.
It was like this whole like, you know, hedge fund mentality. In, in, uh, in, in New York on the Upper East side. And, and so the kid had a good value system. He knew that like, he was grateful for all those things and grateful that his dad was working hard to, to do it. I mean, it was, it was better than saying like, I don't know.
Um, so it's not bad, but, uh, but it was interesting how he jumped on that and was, you know, so the dad jumped on it and was like, wait, I want my kid to say that he's, I work at a safe
Marc Beckman: Yeah, I mean it's definitely, you know, it's great. I believe you. It's noble. I mean, you and I have created a relationship, so for the audience, there's no doubt that Lou is really mission oriented to save humanity. There's no doubt about it. [00:28:00] But Lou, going back to something you just stated, I wanna make sure I understand because I.
It's, um, the, the, the number you just threw out as far as the amount of individuals suffering from Alzheimer's receiving the maximum optim amount of treatment and care that they can have it, it's blowing my mind. Did, am I correct? You said 0%?
Lou Reese: You know, it's, it's, uh, it's, I'll, I'll tell you exactly the percentage, but it's, uh, it's, it's, it's a, it's, it's less than 1% are currently on the, the, the, the, the key treatment.
Marc Beckman: When you say key treatment, what does that consist of exactly
Lou Reese: So, so the, uh, the, the key treatments right now are monoclonal antibodies, which are biologic drugs, and they're infused. In, uh, it through, through like IV infusions on either a two week or monthly [00:29:00] basis. So every two weeks or every month. Um, and you don't take them until, uh, you have cognitive impairment of some kind. So they're only for treatment of Alzheimer's. They're not for prevention of Alzheimer's. Um, and the, uh, and so those, there's one that's, um, that's owned by, uh, Lilly, and then there's another one that's an E side Biogen product. Um, and, um, it's interesting also that the reason that they, Hey Tony, can you check real quick and find out how many doses of monoclonal antibody for Alzheimer's were sold between Lily and Biogen isi?
My, my belief is that it's gonna be, I think it's like a hundred thousand maybe total between all of them around the world. So, so it's, it might even be less, it might be 60.
Marc Beckman: And, and you said, how many people suffer
Lou Reese: 7 million have Alzheimer's currently in the US and 40 [00:30:00] million are at risk.
Marc Beckman: So you're saying you, you, we'll get the number exactly from Tony in a minute, but you're saying that it's less than a hundred thousand of these drugs have been
Lou Reese: Yeah. And it's horrifying. I mean, these are, you know, these are people that just,
Marc Beckman: How expensive is it, Lou?
Lou Reese: uh, the, the actual, uh, drug cost is about $27,000 a year. The infusion cost of going to the centers brings the total up to around a hundred, just over a hundred thousand dollars per patient. Per year?
Marc Beckman: okay. Whose fault is it? I know you looked at the ecosystem a couple of minutes ago, but let's break it down. Let's get, let's get direct here. Whose fault is it, Lou?
Lou Reese: Okay. So it's, it's actually a dance between the pharma companies. The pharmacy benefit managers and the insurance companies, and that dance is whose fault it [00:31:00] is. Um, and it's, it's really that straightforward right now, how they do it in each lever. Again, we could talk for four hours and go through the way that they manifest it, which sounds impossible, but that's how complicated they make that, that actual transaction.
But when you boil it down, it's the pharmacy benefit managers, the insurance companies, and pharma working together to get the pricing as high as possible.
Marc Beckman: Okay, so your strategy of going directly to the United States government, this America First policy. Sounds interesting and important as it relates to saving lives. I understand this is a great example with regards to Alzheimer's. Have you approached the new administration yet? Have you been discussing this concept with anyone in the government?
Lou Reese: You know, I have, uh. I've been doing my best to educate, um, the key members of the government that we can, we can, uh, that are, that are actually the, the pertinent figures here, you know? [00:32:00] Um, and, uh, and I believe that only in an administration like this would I even be trying to do this. Right. Like I said, this is not about changing the tire on a bicycle.
This is building a whole new machine and doing it by just putting an engine on that bicycle instead. Right. It's a whole different thing and I. Like I said, if you, you said, how's the system broken? It's broken in all these ways. If you don't do something that's fundamentally disruptive and that actually allows for the flow of innovation and capital to the areas that, that we want, and we make the right things easy it, no one's gonna do it.
And what I saw, you know, and um, and I saw this over and over, right? I was disappointed almost my entire life. With the, the direction of, of, uh, of actually like the, the pro corporate, uh, morass that became the [00:33:00] Democratic Party. And when I saw that. Um, it, it wasn't my party anymore, right? Like, it was like this major moment where it became clear that all the, think about it, how many elections have we heard the exact same things.
We want to help all these people. We wanna make, we want to do all these great things and like nobody did 'em. All the big stuff never happened. It was like still, it was like this slow motion morass. And I think that, you know, I, I do think, uh, I think direct social media, I think podcasts, I think direct information from people as opposed to having it all be filtered all the time.
And you actually got to hear from, from the people that you, that were being, you know, misrepresented or being, uh, or, or, or not really. You got to see where the news wasn't lining up and where it was. And you also got to see where policy was lining up and where it wasn't. And so I, there's never been an opportunity Marc in, in our lifetimes where you could [00:34:00] actually change the system fundamentally, um, and go after the biggest things and help as many people as possible by, by actually changing the structure.
And so, so what I'm excited about is, um. Is that again, like, you know, I, I would've never done this with another administration because I never believed there was a real opportunity to change systems for the better of the American people. Uh.
Marc Beckman: philosophically, the individuals in this administration that you've sat down with and explained how this disruptive business model would work, are they aligned with you? Do they see this as a, as a positive opportunity and something actually that's feasible to execute? Because Lou, the, the issue with government is that, uh, well there are multiple issues, but over and over again, you, you, I'm sure you would, you would agree.
Private sector typically executes at a much higher, better level than government. Um, do you think the government in this instance is really, uh, qualified to execute with this vision and are they [00:35:00] willing to,
Lou Reese: You know, absolutely. Um, I absolutely, a hundred percent actually, I, I've never felt more confident in, in anything this complicated and big. My lifetime, right? So I sincerely believe that everybody is trying to do the right thing. I, the reception has been, uh, like people understand where the system is broken and that this is possible.
And the best part is that this can be done without, uh, like changing laws and doing all these different things. This is, this is meant to be, um, an elegant and real and immediate solution.
Marc Beckman: So what happens fast forward now, let's say you execute on this America first pharma concept and, and it disrupts, especially with major drugs, for example, with with Alzheimer's, what happens to Big Pharma at that point and their business? Model their profit uh, centers, they have this fiduciary duty to provide value to their shareholders.
Are they gonna be forced [00:36:00] to go to the government and cut side deals with the government as well?
Lou Reese: You know, when I saw the President's historic executive order on, most favored nations status with, uh, with drugs, which basically means that you can't sell drugs anywhere else for less money than you sell 'em in the US I. is a brilliant, a brilliant step. like I said, it's true, it's historic.
It's a, it's a, it's a massive thing. Um, now what's interesting though is that it's the reason that Big Pharma's prices didn't crater. I. the stock market is because the implementation of it is, is, is hard. Right. You know, it, it goes after. Um, and, and it's, it's hard because, um, it, it's gonna happen. I believe it will happen.
Um, but it's, it's, you know, there's a lot of rules and things like, you, you, like, you, uh. Like you alluded to, um, government is is hard, right? It's slow in some ways. There's a lot of pieces. It's like, you know, so, so how you navigate all of that is tricky. What, what I think is [00:37:00] amazing is giving. At the same time, giving a sword to innovation on the largest areas.
Because if you do that, um, what you're gonna be doing is, is you're gonna be, uh, you're gonna be driving that innovation and big pharma will respond. They're going to have to. Um, and maybe that means that in the future they'll be, uh, they'll be, uh, they'll be more amenable to the most favored nation's pricing.
Maybe it means that it'll drive innovative drugs to be directly negotiated. It could be any of these, these super positive outcomes, but ultimately it's going to change the system. 'cause, uh, the immediate sense will be, uh, it'll be a highly credible threat. To an existing system. That will be the immediate, the immediate reaction.
Marc Beckman: Well, Lou, let me ask a question. It will, the, will the patient, the Alzheimer's patient, still have to go to their local drug store to purchase the [00:38:00] medication.
Lou Reese: So the current Alzheimer's system, they have to go to either a hospital or an infusion center and sit for three hours and get an IV infusion. I. With a nurse and the nurse has to be certified as a phlebotomist and all these other things. And I think those centers have to be monitored by, um, um, overarching medical license as well.
So there's a lot of, there's a lot of infrastructure to that. Um, for, for what we are talking about, um, you know, the, uh, with prescription, you could do this at. Your pharmacy, right? These are simple intramuscular injections. Um, so, so the, the, the nature of the administration is also much more accessible. Um, and for this platform, which we call the active immunotherapy medicines platform, aim for that entire platform, the next generation of drugs that we're already working on would be actually potentially mailed to the house and could be applied as like transdermal stickers.
Um, which would be, yeah. So we've been [00:39:00] testing a lot of that, um, which is super
Marc Beckman: Huge advances with regards to delivery system. That's amazing, Lou.
Lou Reese: yeah,
Marc Beckman: But I, so I guess I was gonna ask you, like, as it relates to disrupting, why don't PI guess whether it relates to this Alzheimer's treatment or, or any other drug, why don't, uh, companies similar to yours approach? Um, the, uh, retail pharm pharmacies, uh, you know, from Walgreens to CVS, to Dwayne Reed and beyond, and set up like these direct to retail deals where.
You know, perhaps it's a good way for a brand like Walgreens to get exclusivity and attract market share from its, uh, competitor if they have some of the most critical types of drugs, treatments available, uh, at the launch of a new drug cycle or something like, ha, have you considered going down that route where it's a private, private partnership, but a different type of distribution model?
Lou Reese: So, so yes, on the, on the, on the final [00:40:00] distribution, I think that that's all absolutely possible. Right. Um, in terms of, in terms of how you get it to the consumer, totally possible. You know, I believe that one of the things that'll happen, um, the, the primary provider of. Of Alzheimer's care is still gonna be the government to some degree.
And, uh, because, because of me, the Medicare and Medicaid system, right? Um, and so that's, that's a fundamental outcome. I mean, if you look at the combined expenditures for Medicare and Medicaid on Alzheimer's, I think it was $353 billion last year. Um, so in direct expenditure. Um, and so, so there's still going to be.
One of the largest customers because they serve the most patients, right? I mean, just based on the way it's, the system is. Um, and I don't think that's fundamentally bad. Um, [00:41:00] I think that what we would do with, uh, with a direct to consumer approach is, you know, my goal would be to be transparent. Uh, and actually, uh, actually kinda share, um, uh, the, the patient experience.
Um, and I think that you could do that in the interim through the, the partnerships with pharmacies for distribution. I. I think that the, uh, the direct to, uh, the direct to patient mailing of the patches would be, would be like the next step in terms of access and convenience. Um, and you know, I was talking about that almost 10 years ago and everybody would make fun of me.
And then, um, and then the FDA allowed at-home prescription drug shipping. Then the, these drones are now allowed to do some of these deliveries. So it, the accessibility component and the cost structure drops even further, [00:42:00] um, as
Marc Beckman: thing is
Lou Reese: happen.
Marc Beckman: I like the, the, I guess you're calling it DTP, right? Direct to patient delivery. But what the reason that I'm suggesting the, uh, pharmacy is because they have deep pockets for the most part. And perhaps it's a way of, you know, the private sector working directly with the drug manufacturer, right?
Retail. And the drug manufacturer, private, private partnership, that could help mitigate some of the risk that you're talking about with this, um, this new disruptive approach and maybe even get some financing and cut down the cost. Is that approach feasible?
Lou Reese: You know, I You'd hope so. The reality though is that CVS is one of the largest, like PBM conglomerate things. Right. So, so it, it directly, it, it challenges their, it, it challenges their model. I. For the current distribution. And the reality is that the reason we're spending more is [00:43:00] because we structure it this way.
When the government actually handles the distribution and is on top of the distribution to a larger degree, um, the costs are lower. Because there's less people in the middle, right? So there's just less hands in it. Um, and the original goal of PBMs and insurance negotiation as a middleman wasn't bad, right?
The original goal was to keep the government and pharma, uh, with a buffer, and so that things would be negotiated in a, in a cleaner, better way for the American public. But seven or eight years less life and. At least 2.3 times more per patient per year, we're probably not succeeding, right? Like the math is overwhelming that it's not working and all of those changes.
So we were the healthiest in the one of the longest living countries in the world. Um. Uh, and, and that a lot of this legislation around PBMs and insurance, um, middlemen kind [00:44:00] of started the slow decline to, to getting a, a lower return and worse life expectancy. So, so there is, uh, there is, you know, a correlation there.
You can't really prove direct causation, but it seems that, um, you know, it seems
Marc Beckman: Capitalism is killing humanity.
Lou Reese: Yeah, it seems that there are, uh, yeah,
Marc Beckman: kind of what you're saying,
Lou Reese: I'm kind of saying
Marc Beckman: as it relates to this specifically. So there are a couple of other issues though that I wanna raise with you. Like first, for example, you mentioned the president's executive order and referenced his most favored nations with regards to existing, um.
Uh, drugs and treatments. But, uh, my question is, as it relates to what you're talking about, why can you legally take this concept through the executive branch? Wouldn't legislation have to be enacted to allocate American funds to pay for this sort of a thing?
Lou Reese: if you think about it, like [00:45:00] operation warp speed, um, there was no legislation necessary to start that. So there, there are, uh, very direct ways that this can be done, um, and where a pilot program could be started. Um, and it would involve, uh, cooperation from, uh, from HHS.
Um, and it would involve cooperation from, uh, from darpa most likely. and that. Combination would, would, would allow for something like this to happen. Um, so, so the, the structure and the path, um, and there's a number of other ones that are all, again, non legislative. Like, like I'm not trying to pass, um, significant.
Uphill legislature right now. I believe that health is a bipartisan issue. I think it's a unifying issue. I think that saving, I think saving, um, um, you know, American lives and saving, [00:46:00] uh, the taxpayers billions and billions of dollars a year are good values. Um, so.
Marc Beckman: should be no place for politics in saving lives. It's, it's
Lou Reese: I, I, yeah, I really, I just don't, I don't see it that way, you know, like, I just think this is such a, such a unifying thing. And, um, and the truth is, you know, if we can, uh. If we can do it, um, it starts immediately, right? Like it's, it's not something that, this isn't like a delayed fuse. It's like the minute that we had this agreement we would be making history with, with, with Alzheimer's and preventing Alzheimer's right away, right?
Marc Beckman: but Lou there, there's a difference, like when you talk about operation warp speed. At that point in time, everyone in the country required that, or it was, we were told that everybody in the country required that medical treatment. Right. But in this case, notwithstanding the fact that you're saying 7 million Americans suffer from Alzheimer's, everyone doesn't need it.
Right. [00:47:00] Everybody who's suffering needs it and what will happen to, you know, small town, USA, you know, blue collar worker who's not making a ton of money, and it's like, why is my tax dollar going to, uh, that, that treatment? Now I have, my family is spending a lot of money over here with all these different health issues, these different ailments.
We're spending a lot of money on drugs and I'm putting my tax dollars towards Alzheimer's, but yet no one in my family is suffering from it.
Lou Reese: I mean, if you, if you think about it like this, you know, um, the annual savings in terms of dollars for Alzheimer's that are available are over half a trillion dollars a year every year. The patient suffering. That's what we're spending now. Right. Um, the, uh, the patient suffering is obviously the, the personal part that's on top of that and the family suffering of the [00:48:00] caregivers and all of those other things.
The, the idea is that the best investments that have ever been made by the US government are investments in innovation and investments in things that ultimately become tech. And my definition of tech are things that become democratized and demonetized become accessible for everyone that benefit everyone in the country.
Um, and this is an example where by creating this path. By creating this momentum and by tackling these diseases, the return on investment should be unimaginable, right? It should be in, it's in it's direct. And no matter what happens, this, this pathway, this system for innovation is going to benefit you and it's going to benefit every American taxpayer, and it's gonna benefit our families, and it's gonna benefit our kids and our parents and our grandkids.
So no matter what. Creating that [00:49:00] pathway is a victory no matter what. Creating a way around the people that are stealing 70 cents on every dollar from the middle is a good thing to do.
Marc Beckman: I, I completely agree with that point, but here's my question. When we bring politics back into this formula, which politicians do you expect will push back on this?
Lou Reese: You know, the only politicians that would push back on this are people that are in the pocket of big pharma. And the, and the reality is big pharma is one of the most powerful and one of the most broad lobbyists in the country. So these are known things. This isn't Lou saying this, this is, you know, this is this just what it is.
Um, and I'm not saying that that's good or bad or left or right. Um, I'm saying that that's, that's the reality. And so it's gonna be hard, um, you know, with some of those folks because they're literally in the pockets of, of, uh, of, of big pharma and have been for decades in some instances, right? So, uh, [00:50:00] so that's, that's a challenge, right?
I mean, you heard people. Arguing for including soda on the SNAP programs. You heard people saying that by taking pure sugar junk. Corn syrup, syrup, like horrible, horrible things and said, you're gonna starve our children in this country, which is just a lie, right? So people that are being lobbied heavily by, uh, either the food industry or by pharma, will say things that are that irrational, right?
I mean, there were some people that didn't celebrate the idea of taking petroleum based. So the same thing that you run your car on. Petroleum based food dies out of our foods, and we're the only civilized country in the world that allows 'em in our foods up until now. And people were protesting that.
People were upset about that. [00:51:00] Right? So these are things that to me, are so black and white and obvious and clear. And, and if you talk to, you know, kids or mothers and you say, would you like. You know, a little bit of diesel fuel in your Cheerios, they say no. Right? So, so it's just, it's one of those things where, you know, they're, the, those interests are strong enough that they make really smart grownup people make arguments like that.
I.
Marc Beckman: Do you think that we are in the mindset yet as a, you know, an American community where we can just be common sense based in the way that you're describing? Or do you think that it's just we're not there yet?
Lou Reese: I am.
Marc Beckman: still over on the dark side.
Lou Reese: Okay, so I, I actually am super optimistic. I believe that this is a unifying moment. I believe that the way that we're gonna do it is through, um, I think, I think medicine is a unifying [00:52:00] theme. I. I think health is a unifying theme. I think, uh, reducing waste is a unifying theme. Um, and I think that, I think that, uh, creating paths of innovation where we unlock the, uh, like really the American spirit of innovation and solving huge problems is a moment that we're in right now.
And so, so I'm, I'm excited and I think it'll be a big shift. And I think that, um, you know, I, I, I think to, to a, a thing I tell my kids, you know, if you wanna move an oil tanker, 90 degrees, you're, you're screwed. It's gonna be really hard. They don't do that. But if you put your shoulder into it and you really push it, and you change it one degree, and you look back 500 miles later, you're in a whole different place. And this is that the America First Pharma model and axiom for Alzheimer's as a, as a pilot [00:53:00] is that shoulder trying to move at one degree. And when we look back, it's gonna be in an entirely different place. Um, and, and, and it's, it's a, it's a weird thing 'cause like we can't do it all by ourselves. We have the product, the innovation, we're willing to give up the upfronts, we're willing to put it all on the table and like make it happen.
We're willing to make it as low as like the lowest price possible for the American people. We're willing to give transparency for all of that, but ultimately it takes, you know, visionary and historic leadership to do it. Um, and, and like I said, I'm optimistic. I think, I think, uh, I think it's gonna be, we're gonna look back and be in a whole new place.
Marc Beckman: Lou, when do we, when are we gonna see this whole disruptive business model kick in? If you could predict when it's gonna happen, when will it start? Will it start by the end of this calendar year?
Lou Reese: Oh my gosh. I mean, if it, if everything, uh. I mean, this, this is something, like I said, that literally all it takes is [00:54:00] somebody picking up the baton and doing it now, right? Like, there's a path. We've designed it, we've figured it out, we've got the team for it, we're ready to do it. All it takes is, is somebody picking up the baton and championing it?
Marc Beckman: Is that person RFK?
Lou Reese: it could be, um, is the answer. Um, you know, I think that, uh, I think that it's a combination of, um, under ideal circumstances, it's a combination of, um, the White House and HHS. the reason it's a combination is that this should be a unifying reality. This should be something that everybody, um, is happy about because it's, it's fundamentally providing like the. It's providing the sword that you need against big pharma to fight for innovation, right, and to fight for the patients. It's [00:55:00] providing that tool that that can happen now that is a direct threat that will get their attention. Right.
Marc Beckman: I hope you do it, Lou. I really do. So Lou, we, um, I appreciate all the time you have provided, uh, today, but I really appreciate your insight and your mind. As you know,
Lou Reese: Thanks.
Marc Beckman: everyone ends the show with me. In the same way. Essentially what I do is I incorporate the name of the show, as you know, Some Future Day into a leading question.
Maybe that's my legal background, but are you
Lou Reese: Sure
Marc Beckman: Alright, so in some future day, Alzheimer's will be eradicated when
Lou Reese: when we prevent it from starting in the first place, I.
Marc Beckman: Lou Reese, thank you so much for joining me on this awesome episode of Some Future Day.
Lou Reese: thank you so much for having me on Some Future Day, and I'm hoping that that future day is soon. Appreciate you.
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