No Mercy / No Malice: America’s Best Bet

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0:01:04 When a child is in the hospital, visitors come to say hello.
0:01:06 And when visiting hours are over, they leave.
0:01:10 But family, family does whatever it takes to stay.
0:01:14 At Ronald McDonald House, we believe families shouldn’t have to fight alone.
0:01:17 So we make sure they have everything they need,
0:01:20 with a community of support, warm meals, and a place to rest.
0:01:23 Because when a child is sick, family stays.
0:01:26 And Ronald McDonald House stays with them.
0:01:34 I’m Scott Galloway, and this is No Mercy, No Malice.
0:01:37 America has become a giant bet on AI.
0:01:39 A better bet?
0:01:41 GLP1.
0:01:44 America’s best bet.
0:02:00 America is now one giant bet on AI.
0:02:03 If not for the magnificent 10,
0:02:06 the markets would be flat for the year.
0:02:11 There’s a different technology that offers more asymmetric upside.
0:02:16 If we want to transform the economy and the well-being of Americans,
0:02:21 we should focus on GLP-1, not GPT-5.
0:02:27 More than 40% of American adults, 100 million people,
0:02:28 are struggling with obesity.
0:02:34 By 2060, half of U.S. adults may be obese.
0:02:37 The health care costs of all that extra weight
0:02:42 could exceed $20 trillion over that period.
0:02:49 Our debt, $5 trillion in receipts versus $7 trillion in spending,
0:02:52 has become the IED of our economy.
0:02:56 We don’t know when or why it will detonate.
0:02:59 If we’re going to have an adult conversation regarding spending,
0:03:02 all roads lead to the same place,
0:03:03 health care.
0:03:08 We spend $13,000 per person
0:03:12 versus $6,500 in the rest of the G7.
0:03:15 Matching the efficiency of our peers
0:03:18 would save us $2 trillion a year.
0:03:22 Why do we spend double to die sooner
0:03:26 while experiencing more anxiety, depression, and chronic illness?
0:03:30 Our problem isn’t vaccines, food dyes, or Tylenol.
0:03:32 It’s fat.
0:03:35 The Milken Institute and McKinsey
0:03:37 have estimated that obesity costs us
0:03:40 about $400 billion annually
0:03:44 in direct medical costs and lost productivity.
0:03:47 U.S. health care isn’t about caring for health.
0:03:49 It’s about monetizing it.
0:03:52 Just as big tech found the gangster app
0:03:53 for shareholder value,
0:03:55 rage,
0:03:58 the industrial food, hospital, and pharma complexes
0:04:00 have found obesity.
0:04:03 They get you addicted to sugar and salt,
0:04:06 then hand you to the non-health complex
0:04:09 for replacements, dialysis, and statins.
0:04:13 They’ve even rebranded disease as identity.
0:04:15 You’re not obese.
0:04:16 You’re living your truth.
0:04:19 No, you’re finding diabetes.
0:04:23 McDonald’s and Coca-Cola celebrate obesity
0:04:26 so UnitedHealthcare can monetize it.
0:04:28 These stocks aren’t equities.
0:04:30 They’re obesity indices.
0:04:34 We know exercise, healthier food,
0:04:36 and less screen time help,
0:04:38 but they’re not enough.
0:04:40 The good news?
0:04:43 Obesity may have peaked in the U.S.,
0:04:46 and we have the tools to actually reverse it.
0:04:49 Pushing for a radically lower price
0:04:51 and rolling out weight loss drugs
0:04:53 to tens of millions of Americans
0:04:55 could be revolutionary,
0:04:58 possibly the best civic investment
0:04:59 in recent history.
0:05:01 In sum,
0:05:04 our instincts have not kept pace
0:05:05 with industrial production,
0:05:07 and we gorge.
0:05:10 GLP-1s put scaffolding on our instincts.
0:05:13 Most of us have friends or colleagues
0:05:14 we barely recognize
0:05:17 after they’ve taken novel weight loss drugs.
0:05:21 By mimicking a hormone called GLP-1,
0:05:22 the medicines suppress hunger
0:05:24 and make us feel fuller longer.
0:05:27 The results are dramatic.
0:05:31 15% to 20% reductions in body weight.
0:05:33 Yet, uptake remains small
0:05:35 relative to the tens of millions
0:05:36 who could benefit.
0:05:40 Coverage is patchy.
0:05:43 Only 30% to 40% of commercial plans
0:05:46 and 14 state Medicaid programs
0:05:48 cover the cost of GLP-1s for obesity.
0:05:51 The administration is considering a pilot
0:05:54 to expand coverage under Medicaid and Medicare,
0:05:56 a shift in policy after rejecting
0:05:57 a Biden-era plan
0:05:59 that would have cost $35 billion
0:06:01 over 10 years.
0:06:03 Prices need to fall
0:06:04 for the math to work.
0:06:08 If Medicare began covering GLP-1s,
0:06:10 researchers estimate
0:06:12 3 million beneficiaries
0:06:13 would start using them
0:06:14 over the next decade
0:06:16 at a gross cost
0:06:18 of $66 billion
0:06:20 and savings
0:06:22 in avoiding healthcare spending
0:06:24 of $18 billion
0:06:26 for a net price tag
0:06:28 of $48 billion.
0:06:31 Costs are moving
0:06:32 in the right direction.
0:06:33 Wagovi and Ozempic
0:06:36 now run under $7,000 a year.
0:06:38 Costco offers a monthly supply
0:06:39 of obesity drugs
0:06:40 for $499
0:06:43 and competition from Lilly
0:06:44 and others
0:06:45 is driving prices down.
0:06:47 More than 100
0:06:49 next-generation obesity drugs
0:06:49 are in development,
0:06:51 including pill versions.
0:06:53 President Trump
0:06:54 on October 16th
0:06:56 vowed to slash
0:06:57 GLP-1 prices
0:06:59 to $150 a month
0:07:00 to match the expense
0:07:02 in other developed nations,
0:07:04 but no deal yet exists
0:07:05 with drug makers.
0:07:07 Investors, however,
0:07:08 took him seriously.
0:07:10 Shares of Novo Nordisk
0:07:11 and Lilly
0:07:12 dropped sharply
0:07:14 on the news.
0:07:17 Economist Emily Oster
0:07:19 argues the budgetary worries
0:07:20 of expanding access
0:07:21 are overstated.
0:07:24 Medicaid tends to pay
0:07:24 far less
0:07:26 than private insurers,
0:07:27 and a typical
0:07:29 53% discount
0:07:30 could drop
0:07:31 monthly costs
0:07:32 to $235.
0:07:35 If 10%
0:07:37 of eligible patients
0:07:38 took the drugs,
0:07:39 it would raise
0:07:40 Medicaid spending
0:07:41 by just
0:07:44 0.4%.
0:07:46 The concerns
0:07:46 also missed
0:07:47 the upside.
0:07:49 About 5 million
0:07:50 U.S. adults
0:07:52 use GLP-1s today.
0:07:54 If 30 million did,
0:07:55 Goldman Sachs
0:07:56 estimates
0:07:58 GDP would rise
0:07:58 as much as
0:08:00 0.8%.
0:08:02 At 60 million,
0:08:03 the increase
0:08:04 could exceed
0:08:04 1%.
0:08:08 America isn’t the only
0:08:09 country fighting
0:08:09 this epidemic.
0:08:11 In Britain,
0:08:12 obesity costs
0:08:12 the economy
0:08:14 31 billion pounds
0:08:14 a year
0:08:16 in lower productivity,
0:08:17 sick days,
0:08:18 and early deaths.
0:08:19 We’ve created
0:08:20 a food system
0:08:21 that’s poisoning
0:08:22 our population
0:08:23 and bankrupting
0:08:24 the state,
0:08:26 says Henry Dimbleby,
0:08:27 co-founder of
0:08:28 Leon Restaurants,
0:08:29 which bills itself
0:08:30 as a purveyor
0:08:31 of fast
0:08:32 but healthy
0:08:32 meals.
0:08:35 These drugs
0:08:36 aren’t a silver
0:08:36 bullet,
0:08:37 but they are
0:08:38 a bullet.
0:08:39 Many people
0:08:40 quit taking them
0:08:41 within a year
0:08:41 or two,
0:08:42 often because
0:08:42 of cost
0:08:43 or gastrointestinal
0:08:44 side effects,
0:08:46 and lasting success
0:08:47 still requires
0:08:47 exercise
0:08:49 and diet changes.
0:08:50 But alongside
0:08:51 those measures,
0:08:53 GLP-1s
0:08:54 may be the key
0:08:55 to fighting
0:08:56 a complex disease
0:08:57 rooted in
0:08:58 physiology,
0:08:59 environment,
0:09:00 and policy
0:09:01 as much
0:09:02 as behavior.
0:09:04 In a society
0:09:05 addicted to
0:09:06 ultra-processed
0:09:06 food and
0:09:07 sedentary hours
0:09:08 lost in front
0:09:09 of screens,
0:09:10 we need new
0:09:10 weapons.
0:09:12 Former FDA
0:09:13 Commissioner
0:09:14 David Kessler
0:09:15 calls GLP-1s
0:09:16 a way to
0:09:18 diffuse the
0:09:19 ultra-formulated
0:09:20 food bombs
0:09:21 that have
0:09:21 hijacked
0:09:22 our health.
0:09:24 RFK Jr.
0:09:25 has called
0:09:26 for lifestyle
0:09:27 changes while
0:09:28 cutting NIH
0:09:28 funding.
0:09:29 the moral
0:09:30 equivalent
0:09:30 of telling
0:09:31 people to
0:09:31 lift weights
0:09:32 while closing
0:09:32 the gym.
0:09:34 The administration’s
0:09:36 Secretary of War,
0:09:37 Pete Hegseth,
0:09:39 has shamed fat
0:09:40 generals but
0:09:41 offers no help
0:09:41 other than
0:09:42 performative
0:09:42 masculinity.
0:09:45 Scaling access
0:09:46 could prevent
0:09:47 adult obesity
0:09:48 from topping
0:09:49 50%
0:09:51 and push it
0:09:51 back toward
0:09:53 30%.
0:09:54 giving 10
0:09:55 million Americans
0:09:57 GLP-1s
0:09:57 and lowering
0:09:58 their monthly
0:09:59 cost to
0:10:00 $50
0:10:01 would run
0:10:02 $12 billion
0:10:03 over two
0:10:03 years.
0:10:05 That’s a
0:10:05 bargain.
0:10:07 Targeting the
0:10:08 patients most
0:10:09 likely to benefit
0:10:10 would improve
0:10:11 returns further.
0:10:13 Obesity
0:10:13 shortens life
0:10:14 expectancy by
0:10:15 up to 10
0:10:16 years,
0:10:17 partly because it
0:10:18 increases the
0:10:18 risk for more
0:10:19 than a dozen
0:10:20 types of
0:10:20 cancer.
0:10:22 Reducing its
0:10:23 prevalence would
0:10:24 yield massive
0:10:25 health and
0:10:26 productivity gains
0:10:27 over the next
0:10:28 30 years.
0:10:29 I’m sticking with
0:10:30 the thesis I
0:10:31 shared with Bill
0:10:32 Maher two years
0:10:32 ago.
0:10:34 GLP-1s will
0:10:35 have a bigger
0:10:36 impact on the
0:10:36 real economy
0:10:37 than AI.
0:10:39 OpenAI’s
0:10:40 Sam Altman
0:10:41 calls Sora
0:10:42 the most
0:10:43 powerful
0:10:43 imagination
0:10:44 engine ever
0:10:45 built.
0:10:47 In reality,
0:10:47 it’s an endless
0:10:48 feed of digital
0:10:49 slop.
0:10:50 further blurring
0:10:51 the truth.
0:10:52 The real
0:10:53 engine of
0:10:54 progress comes
0:10:55 in a syringe.
0:10:56 Maybe we
0:10:57 should put it
0:10:57 in the water.
0:10:59 Researchers are
0:11:00 aiming to
0:11:01 preserve muscle
0:11:02 and overcome
0:11:02 one of the
0:11:03 drawbacks with
0:11:04 the first
0:11:04 treatments,
0:11:05 or eliminate
0:11:06 injections
0:11:07 altogether.
0:11:08 They’re also
0:11:09 testing GLP-1s
0:11:10 to treat
0:11:11 conditions beyond
0:11:11 obesity.
0:11:13 Novo Nordisk
0:11:14 is betting its
0:11:15 drugs can work
0:11:16 against Alzheimer’s.
0:11:17 Whether or not
0:11:18 these efforts
0:11:19 succeed,
0:11:20 the trajectory
0:11:21 is clear.
0:11:23 This technology
0:11:23 could reverse
0:11:24 the most
0:11:26 expensive disease
0:11:27 in history.
0:11:30 America’s two
0:11:31 great growth
0:11:32 engines are
0:11:33 rage and
0:11:34 carbs.
0:11:36 AI monetizes
0:11:37 the former,
0:11:38 the food
0:11:38 complex the
0:11:39 latter.
0:11:41 GLP-1s may
0:11:42 finally break
0:11:43 the loop,
0:11:44 shrinking our
0:11:45 waistlines,
0:11:46 cutting costs,
0:11:47 and reminding
0:11:48 us that
0:11:48 progress isn’t
0:11:49 digital,
0:11:51 it’s biological.
0:11:52 The next
0:11:53 great platform
0:11:54 isn’t the
0:11:55 neural net,
0:11:56 it’s the
0:11:57 needle.
0:12:01 Life is so rich.