Dave Ricks, CEO of Eli Lilly | The All-In Interview

Friedberg welcomes Eli Lilly CEO Dave Ricks (0s)

• Dave Ricks is the CEO of Eli Lilly, the world's most valuable pharmaceutical company and the leader in the GLP1 drug market, which is expected to grow to as much as $150 billion in annual revenue over the next 10 years (42s).
• Eli Lilly's market capitalization has grown significantly under Ricks' leadership, from $70 billion in January 2017 to an astounding $878 billion today (1m1s).
• The company's revenue and operating income have also seen substantial growth, with projected figures of $46 billion in revenue and $15 billion in operating income for the current year (1m7s).
• Few companies in history have experienced such an extraordinary rise in revenue, profit, and market value at this scale, with Nvidia being one of the few exceptions (1m18s).
• Ricks became CEO of Eli Lilly in January 2017, when the company had a revenue of $20 billion and an operating income of $3.5 billion (51s).
• The discussion will focus on Eli Lilly's work in addressing chronic health problems such as obesity and diabetes, particularly through GLP1 products (1m36s).
• The conversation will also delve into the business of Eli Lilly, providing a deep dive into the company's operations and growth (2m2s).

The obesity problem: a global chronic health epidemic (2m6s)

• The obesity epidemic is a significant global health issue, with 74% of Americans being overweight or clinically obese, according to the CDC, and this condition is driving the largest health epidemic in human history, with associated diseases like type 2 diabetes having numerous negative health implications (2m10s).
• The average daily calorie consumption by Americans has increased from 2800 to 3600 since 1961, leading to a dramatic increase in obesity rates, and this is correlated with the availability and consumption of calories in a population (2m52s).
• The United States has the largest caloric supply of any developed nation and also has the highest percentage of people who are overweight or obese, and improvements in agricultural technology and food systems have made calories cheaper, resulting in a surplus problem that has led to the obesity epidemic (3m24s).
• Obesity rates are climbing in every developed nation, including Brazil, Mexico, and India, as calorie supplies increase around the world, making this a global problem (4m17s).
• The scale of the problem is significant, with 35% of Americans being obese and 51% being either obese or severely obese, and this is not just a US issue, but a global one, with a billion people on the planet having clinical obesity or overweight (4m0s).
• The forecast for the obesity epidemic is concerning, with the problem expected to grow more in the developing world than the developed world, driven by wealth accumulation and surplus food abundance (5m49s).
• The ultraprocessed food story is also a key part of the equation, with two-thirds of calories in the US coming from ultraprocessed foods, compared to 35% in Europe, and this is likely contributing to the obesity epidemic (5m24s).
• The cause of the obesity epidemic is complex, involving both excess calories versus expenditure and the ultraprocessed food story, but the impact is clear, with a significant and growing global health problem (5m9s).
• India is projected to have a significant increase in obesity, from 11% of the population to 30% in the next 20 years, which would add almost half a billion people to the global obesity statistics (6m2s).
• The global obesity rate is expected to affect about a billion people by 2030 (6m18s).
• Obesity has a significant impact on various systems of the human body, leading to chronic health conditions such as cardiovascular disease, stroke, and fatty liver disease (6m28s).
• Fatty liver disease, also known as non-alcoholic steatohepatitis (NASH) or MAFLD, is a condition that was rare 30 years ago but is now common among obese people, leading to fibrosis of the liver and potentially requiring a transplant (7m6s).
• Obesity-driven fatty liver disease is more prevalent than alcohol-driven fatty liver disease, resulting in severe health outcomes (7m51s).
• The obesity epidemic is linked to over 230 diseases, including type 2 diabetes, obstructive sleep apnea, and mood disorders (8m14s).
• Type 2 diabetes is a chronic health condition that can lead to various complications, including nephropathy, diabetic retinopathy, and an increased risk of heart attack (9m13s).
• Research has shown that people taking GLP-1 drugs, such as semaglutide, have lower rates of new clinical depression diagnoses (8m59s).
• The obesity epidemic is a significant contributor to various chronic health issues in modern society, with many health problems rooted in the epidemic (8m7s).
• Eli Lilly was the first American company to produce insulin, initially by processing pigs or cows to obtain the insulin, and later through a partnership with Genentech to create the first biotechnology product, human insulin made in a bacterial cell, in 1981 (10m9s).
• The company's head of science met with Toronto researchers who discovered the mechanism of insulin, but they couldn't make it into a medicine, so Eli Lilly produced the process that made it available at scale (10m51s).
• The history of the industry involved taking things in nature and refining them into medicine, which was the case with insulin, derived from the pancreases of slaughtered meat animals, primarily cows and pigs (11m7s).
• The development of human insulin made in a bacterial cell solved a public health problem, as the risk of scarcity of insulin was a concern due to rising type 2 diabetes rates and the potential shortage of animal pancreases (12m36s).
• The use of recombinant systems, where DNA is put in microbes to make a protein, has led to significant advancements in the field, with biologic drugs now worth hundreds of billions of dollars (12m57s).
• The development of human insulin was a major milestone in the history of Eli Lilly and its relationship with competitor Novo, a Danish company (10m36s).
• The company's history is intertwined with that of Novo, and the development of insulin is an interesting story that highlights the collaboration and competition between the two companies (10m48s).

The history of discovering GLP-1s (13m7s)

• GLP1 is a protein expressed by L cells in the small intestine, which recognizes food in the intestines and pumps out the protein into the bloodstream, regulating various cell functions, including insulin secretion and hunger suppression (13m24s).
• GLP1 is a hormone and a regulator of different cells, telling them to perform specific actions when the intestines are full of food (14m12s).
• There is a superfamily of hormones, including GLP1, that signal the body to perform different actions when fed, which is essential for human survival (14m55s).
• The discovery of GLP1 was preceded by the observation of the incretin effect in the 1970s, where giving nutrients intravenously resulted in a higher spike in glucose than giving them via the GI tract (14m30s).
• GLP1 was the first hormone in its superfamily to be made into a drug, with its discovery in 1987 that it stimulates insulin production and secretion (15m18s).
• Both Eli Lilly and Novo Nordisk played a role in the early work with GLP1, but it took time to develop a drug that could last longer than the native form's half-life of minutes (15m58s).
• Eli Lilly launched the first GLP1 drug, which was a significant development in the treatment of diabetes (16m52s).
• Exenatide, a medication for diabetes, was discovered in the saliva of a Gila monster, and its unique amino acid structure made it last longer in the human body, allowing for twice-daily injections (16m55s).
• The discovery of exenatide led to the development of other GLP1 agonists, including dulaglutide (marketed as Trulicity) and semaglutide (marketed as Ozempic), which have different kinetics and functions (17m43s).
• By engineering changes in the amino acid structure of these proteins, researchers were able to create new medications with improved functions, such as once-weekly injections and increased efficacy (18m1s).
• The transition from daily to weekly injections allowed for higher dosing, which enabled the glucose-lowering effect to occur at a lower dose than the weight loss effect (18m6s).
• The reduction of side effects, such as nausea and diarrhea, was achieved by maintaining a steady state of the medication in the body, rather than experiencing peak-to-trough effects (18m27s).
• The development of tepati (marketed as Mounjaro), a dual-acting medication that combines two hormones, is the latest example of this research process (18m41s).
• Proteins are composed of chains of amino acids, and researchers can create new proteins that mimic the function of existing ones, such as GLP1, by designing similar structures (18m50s).
• The research process involves identifying new proteins that can have a similar or more beneficial effect than GLP1 in the body, and this process has led to the development of various GLP1 agonists (19m44s).
• The discovery of GLP1 agonists has involved a combination of finding native human hormones, discovering analogs in nature, and engineering changes in amino acid structures to create new medications (20m0s).
• Eli Lilly has a significant event or milestone that occurred in 1986 (20m37s)

Impact of GLP-1s on different human functions (20m38s)

• Research on glucagon-like peptide-1 (GLP-1) has led to a greater understanding of its effects on the human body, including its role in stimulating insulin secretion and regulating other organs such as the brain, heart, pancreas, and liver (20m40s).
• GLP-1 acts as a messenger hormone, signaling to the body that it is fed, which triggers various physiological responses, including increased heart rate, decreased lipid levels, and changes in metabolism (21m34s).
• The hormone has primary and secondary effects, with some secondary effects potentially being intermediate signals that are not yet fully understood (22m21s).
• GLP-1 analogs have been shown to have beneficial effects, including reducing hunger and improving nutrient absorption, particularly in a nutrient-rich environment (22m54s).
• The potential therapeutic applications of GLP-1 and other hormones, such as GIP (glucagon insulinotropic peptide), are being explored for indications beyond obesity and diabetes (23m6s).
• Other hormones, including GIP, amaline, and glucagon, are being investigated for their potential therapeutic effects, with some, like tepati, showing promise in releasing fat energy and promoting weight loss (23m27s).
• The development of triple-acting and other combination therapies is a significant part of the innovation story in this field, with the goal of determining which therapies are best suited for specific indications and patient populations (24m3s).
• Maintenance and inducing rapid weight loss in severely obese individuals are significant issues in this therapeutic class, with tepati showing an average weight loss of 23% in individuals with a BMI of 50 (24m16s).
• Eli Lilly is working on increasing the potency of their weight loss treatments, such as tpde or semaglutide, to help individuals with a higher body mass index (BMI) achieve a normal weight (24m26s).
• The company is also addressing the issue of maintaining weight loss over time, as some people may be able to reach a normal BMI with weekly injections but struggle to sustain it (24m38s).
• There are over 200 diseases correlated with obesity, and Eli Lilly is conducting studies to determine if their weight loss treatments can have a positive impact on these conditions (24m50s).
• The company has not had an unsuccessful study in measuring an outcome in a chronic disease using their weight loss treatments, with 105 studies currently underway (25m3s).
• Eli Lilly is investing heavily in clinical trials, with each trial costing around $100-200 million, in an effort to convert weight loss into sustained health benefits in chronic diseases (25m26s).
• The company is exploring various indications for their weight loss treatments, including sleep apnea, Alzheimer's disease, and chronic kidney disease, using combination therapies (25m40s).
• A recent study using the treatment tirzepatide showed a 94% reduction in new diagnoses of type 2 diabetes over a three-year period, highlighting the potential for early treatment of obesity to reduce the risk of developing diabetes (26m46s).
• Eli Lilly is pursuing dozens of use cases for their weight loss technology, with the goal of addressing various chronic diseases and improving national health outcomes (27m8s).

Understanding the commercial aspect of drug discovery, pricing for GLP-1 drugs (27m9s)

• Once a drug is approved through clinical trials, a doctor can prescribe it for a specific condition, and insurance typically covers it, although the process can be complex and influenced by various factors, including the novelty of the treatment and existing biases towards reimbursing established treatments (27m10s).
• In the US, there is a strong bias towards reimbursing treatments for obvious conditions, and new treatments may face challenges in getting accepted and reimbursed by insurance and healthcare practitioners (27m42s).
• Eli Lilly's products, including those for treating type 2 diabetes and cardiovascular conditions, are likely to be adopted and reimbursed quickly due to their focus on treating outright diseases (27m54s).
• However, the real promise of these treatments lies in preventing diseases, but the current system in the US does not typically pay for prevention, and people often need to develop a condition before they can access the medication (28m16s).
• The federal government's rule is that Medicare will not pay for these medications for people who are obese but do not have related conditions, and they must develop a condition like diabetes before they can access the drug (28m26s).
• The evidence base needs to be built to show that these treatments can abate, slow, or eliminate chronic illnesses, and Eli Lilly is investing in this effort (28m40s).
• The company's job is to demonstrate that these treatments can safely help people lose a significant amount of weight, which can prevent or reverse chronic illnesses (28m50s).
• The idea of paying for prevention is controversial because actuaries underwriting insurance programs may see it as a financial risk, as they would need to pay for the treatment upfront but may save money in the long run by preventing future diseases (29m3s).
• However, some insurance companies are starting to change their actuarial tables to account for the benefits of these treatments, which is a positive sign (29m43s).
• Despite this progress, there is still a stigma associated with obesity, and some doctors may not prescribe these treatments due to misconceptions about the causes of obesity (29m54s).
• Losing weight as an adult is extremely difficult, with some studies showing that less than 5% of people can reach a healthy body weight through diet and exercise alone once they become obese (30m16s).
• As a result, the current standard of care for obesity is often ineffective, and new treatments like tepati (also known as Zep bound) are needed to address this issue (30m29s).
• About 50% of employer-sponsored insurance plans cover obesity medications, with companies like Eli Lilly covering them for their employees, as they consider obesity a disease (30m47s).
• Smaller businesses with lower margins, such as retailers, often do not cover these medications, leaving many people to pay out of pocket (31m12s).
• In the US, federal benefit rules prohibit accepting savings cards from manufacturers, but commercial benefits allow for cost reductions, which Eli Lilly offers to buy down out-of-pocket costs for those with commercial benefits (31m44s).
• Eli Lilly has launched a directed consumer model called "Lilly Direct" to address stigma and cost issues, allowing patients to receive prescriptions and fulfill them directly via mail, at the lowest available price (32m5s).
• Lilly Direct solves two problems: reducing stigma by providing a non-judgmental platform and ensuring consistent, low pricing, as some pharmacies mark up the drugs due to supply issues (32m21s).
• The list price for the medication is around $1,000 per month, but Eli Lilly offers a savings card program for about $600 per month, and recently launched a vial form for the lowest two doses at $399 and $550, respectively (32m43s).

Responding to criticism and research of GLP-1 dependency (33m11s)

• Research has shown that when patients stop taking certain weight loss drugs, they tend to regain weight, leading to a chronically drug-dependent population (33m13s).
• The mission of Eli Lilly is to solve human health problems, ideally allowing people to have a course of therapy and then not need to take medicine (33m48s).
• The physiology of GLP-1 and GIP currently requires long-term treatment, as the body restores itself to its previous position when the medication is stopped (33m58s).
• There is a theory that sustaining low body weight for a long time can reset the body's "thermostat," allowing it to stop defending against perceived starvation (34m10s).
• Some people have successfully lost weight, changed their lifestyle, and stopped taking the medication, but this is not the most probable outcome for most people (34m33s).
• Eli Lilly is working on new drugs in their pipeline that aim to reset the metabolic switch and potentially allow for a treatment course without long-term medication (34m48s).
• The company is also exploring a brain mechanism that could help reset the body's weight thermostat, allowing for a treatment course without long-term medication (34m57s).
• When patients stop taking weight loss medication, their base metabolism drops, leading to weight gain even if they eat a healthy number of calories (35m15s).
• Some patients are experimenting with taking lower doses of the medication or using it intermittently to maintain a healthy weight without being on a regular schedule (35m42s).
• Eli Lilly is seeing this trend in the clinic and in practice, and while they have no problem with it under doctor supervision, they need to conduct more studies in this area (36m3s).
• The company is also developing a new chemical drug called ororon, which mimics the activating part of a peptide and may be an important development due to its scalability (36m28s).
• Eli Lilly is working on an oral GLP-1 medication that is currently in phase three trials and is expected to read out next year, with the benefit of being easier to take and not requiring refrigeration or injection (36m42s).
• The oral GLP-1 medication has the potential to be a product for the masses, as the current systems for making these drugs are complicated to scale, leading to shortages (37m4s).
• Eli Lilly has approvals in over 40 countries but has not launched in all of them due to supply issues, making the phase three project for the oral GLP-1 medication crucial (37m11s).
• The oral GLP-1 medication is being studied as a maintenance option, which could make sense for people who have lost weight through injection and want to keep it off with a easier-to-take medication (37m39s).
• The impact of GLP-1 medications on the food industry is expected to be significant, with analysts predicting damage to food companies (37m49s).
• However, some companies are launching products that complement GLP-1 medications, such as high-resistance starch fiber products, which can help people during the period of time they are taking the medication (37m57s).
• The CEO believes that the GLP-1 category is changing the food industry in the United States and around the world, with people buying fewer calories and more fruits and vegetables (39m5s).
• A study by Walmart found that people taking GLP-1 medications were buying about a third fewer calories and fewer salty snack foods, but more fruits and vegetables (39m8s).
• While the impact on food companies' bottom lines is not yet significant, enterprising companies are launching products that cater to people taking GLP-1 medications, such as protein shake companies and restaurants with GLP-1-friendly menus (39m41s).

Stock performance, dealing with political pressure related to successful drugs (40m4s)

• Eli Lilly's stock price has seen an extraordinary rise, and the company's portfolio of products has contributed to its success, with $11 billion in revenue and $3 billion in net profit in the last quarter (40m21s).
• The company faces criticism for its high gross margin of 81% from selling products to sick people, with some senators questioning how the company can justify such profits (41m4s).
• Eli Lilly's CEO views the political heat as a top priority, acknowledging that the company's success has led to increased scrutiny (41m21s).
• The CEO attributes the company's success to its long investment cycle, with the company spending over $11 billion on R&D this year, which is a significant investment that allows the company to push forward new medicines (41m51s).
• The CEO believes that the pressure to justify the company's profits is a privilege, as it means the company has created something useful that many people need and want (42m17s).
• Eli Lilly sees it as its responsibility to work with the healthcare system to sustainably adopt its medicines, and the company aims to create enough value that patients benefit, health plans lower costs in the long term, and shareholders make a reasonable profit (42m30s).
• The CEO notes that the company's competitor, Novo Nordisk, was recently hauled before Congress to discuss similar issues, highlighting the dysfunctions in the US healthcare system (43m5s).
• Eli Lilly's medicine can augment 100-200 adult diseases in a meaningful way, but it is expensive, with a net pricing of around $3,000-$4,000 per year per person in the steady state (43m25s).
• The CEO believes that the company will create more value than the cost of the medicine, saving the system more money than the cost per year per user (43m33s).
• Biologic products, including insulin, are advancing steadily, but the issue with insulin pricing is that the molecule remains the same while the price has increased significantly, leading to accusations of price gouging (43m41s).
• Eli Lilly has reduced the price of insulin every day since the insulin pricing scandal in 2017, despite having a system in the US where two-thirds of the gross price goes to PBMs and insurance companies (44m34s).
• The company has to unwind this system to value innovation, and some revenue from insulin is invested in the next generation of therapies, including new insulins and GLP-1 drugs (45m19s).
• Eli Lilly launched a product at a 20% discount to Novo's product, despite having better efficacy data, and has only cut the price since then, seeing a generational opportunity for the company (45m40s).
• The company has invested heavily in manufacturing in the United States, including a $5 billion investment in Indiana to build new facilities, which will be the largest API site in the history of the US (46m4s).
• Analysts are projecting that Eli Lilly's operating income could grow to $32 billion, a 4X increase in 3 years, driven by the pipeline of indications, combo therapies, and new modalities (46m30s).
• Internal forecasts were reportedly too conservative in terms of the company's progress with tepati, with actual results exceeding expectations (47m1s).

Eli Lilly's portfolio of drugs outside of GLP-1s, what science Dave is excited about (47m19s)

• Eli Lilly's portfolio of revenue is primarily composed of GLP-1 GIP drugs, which are expected to be the main contributor to growth in the coming years (47m28s).
• Despite the success of these drugs, the company must invest in other opportunities to address diseases, as the patent life of these products is limited and will eventually go generic (48m17s).
• The company views its business as an options business, where it must lay down bets across various areas, including unmet medical needs and technological advancements (48m52s).
• Eli Lilly is investing in cancer, immunology, and brain disease, with a focus on the latter, as it is becoming more tractable and accounts for approximately 40% of global suffering (49m44s).
• The company has divided its organization into four business leaders, each with their own agenda, to compete and win in different areas (50m4s).
• In Q2, Eli Lilly's non-GLP-1 business grew 17% on a large base, indicating a healthy business outside of its main franchise (50m17s).
• The company is excited about various scientific advancements, including peptide manufacturing, cell therapies, and gene therapies, which offer new mechanisms for altering genes and treating diseases (50m40s).
• Eli Lilly has a diverse portfolio of ways to make medicines, which includes a rapidly expanding field of genetic medicine, such as gene therapy and gene editing, where cells are edited to do specific things, like CAR-T cells or gene inserts. (51m50s)
• The company has made significant progress in genetic medicine, including a treatment for congenital deafness disorders that has shown promising results, with patients going from having no hearing to being able to hear. (52m10s)
• Eli Lilly is excited about the potential of its portfolio to make a significant impact on a large scale, with techniques like CAR-T and gene therapy having the potential to benefit millions of people. (52m32s)
• The company is also working on a new family of medicines called RNA-based therapies, which can knock down aberrant proteins that cause problems, and do so safely and surgically. (52m43s)
• One project in phase three is focused on knocking down the production of a lipoprotein particle called Lp(a), which is thought to be a major contributor to cardiovascular disease, and has the potential to be a once-a-year dose. (52m55s)
• Eli Lilly's investment strategy involves making small deals through its corporate venture group, investing in small biotechs, and taking a seat at the table to learn and follow science. (53m55s)
• The company also engages in M&A and writes checks directly to venture funds, taking a multi-faceted approach to accessing new technologies and innovations. (54m22s)
• Eli Lilly has a project called Catalyze 360, which aims to help incubate small companies by providing not only space but also a service layer, sometimes in a Cost Plus way or sometimes for downstream royalties (54m35s).
• The service layer offers expertise from Eli Lilly, allowing small companies to access consulting services without having to hire a consultant or a full-time employee, thereby cultivating an ecosystem around the company (55m5s).
• Eli Lilly engages in mergers and acquisitions, having bought around two dozen companies last year, which was the most of any pharmaceutical company, but with relatively low capital deployment of around $3 billion (55m17s).
• The company's strategy is to make many small bets, which allows them to add more value to the companies they partner with or own, and also enables them to trade in front of the drisking event, thereby potentially increasing their value (55m28s).
• By betting on the probability of a company's success, Eli Lilly believes they can make better investments than the market, and if they are correct, they will be better off buying early (55m53s).

Scaling and impacting culture at a 100+ year-old company (56m9s)

• Eli Lilly has a unique culture that feels like a college campus, with a track and field, a bar on campus, and other amenities that make it a great place to work, which is a key factor in attracting and retaining top talent (56m27s).
• The company's background as a family-run business for over a hundred years has contributed to its strong loyalty and social cohesion, with a friendly and scientifically rigorous work environment (57m6s).
• The company's culture is not something that can be changed overnight, but rather built upon by turning up the good aspects and turning down the less desirable ones (57m46s).
• One area of improvement has been leveraging the company's scale as a benefit, rather than a detractor, by focusing on solving problems for the company as a whole, rather than individual departments (58m1s).
• The company emphasizes speed at scale, measuring it rigorously and tracking progress carefully, with a focus on moving the drug development timeline forward, which has been reduced from 11 years to 6.1 years (58m36s).
• The company incentivizes speed by adopting a "ratchet mindset," where every time a timeline is beaten, it becomes the new norm, and internal benchmarks are continually raised (59m6s).
• This approach is supported by a thousand little things, including a focus on individual contributions to the company's goals and a culture of continuous improvement (59m4s).
• Eli Lilly has been working on reducing the time it takes to submit documents to the FDA, going from 120 days to routinely completing the process within two weeks, a reduction of 80% of the time (59m34s).
• The company has a focus on solving the problem of time to patient, with everyone in development knowing that's the big idea (59m45s).
• Eli Lilly has expanded its science operations, including a new campus in South San Francisco and a large building in Seaport Boston that will hold 500 genetic scientists (1h0m4s).
• The company is aware of the potential impact of AI on the pharmaceutical industry, with many startups working on applying AI to discover new molecules (1h0m21s).
• Eli Lilly has its own significant AI efforts internally and has partnerships with companies like Open AI, Microsoft, Amazon, and Google (1h1m3s).
• The company believes that while AI has the potential to disrupt the industry, it is unlikely to replace the entire process of drug discovery, and instead will be more valuable as a tool to help with specific tasks (1h1m50s).
• Eli Lilly thinks that the idea of using AI to invent new drugs entirely in silico is naive, and that a more valuable approach will be to use AI as a tool to help with specific tasks, such as optimizing chemical properties of drugs (1h1m47s).
• The company believes that the integration of wet lab and clinical data will be critical to the use of AI in drug discovery, and that it's unlikely that the entire process will be done in silico (1h2m38s).
• The co-pilot model is a machine learning approach that can make predictions and eliminate bad ideas that humans may not see but are obvious in hindsight, by integrating multi-source data and calculating probabilities of success, such as a 2% chance of an experiment working (1h2m45s).
• The co-pilot model can add value by helping scientists see across different domains of data, which can be challenging for humans, and by reducing the influence of human factors, such as personal biases towards certain ideas (1h3m4s).
• The CEO is glad to have taken the job seven and a half years ago and feels honored to lead the company, but acknowledges the need for continuous improvement and learning from mistakes (1h3m21s).
• The CEO's biggest disappointment is not being prepared for certain challenges and not thinking ahead, but recognizes the importance of humility and learning from mistakes in order to grow and improve (1h3m30s).
• The company is becoming a cultural icon, which brings a big responsibility to meet people's expectations, and the CEO acknowledges that the company needs to change from being a quiet Midwestern medicine company to something more, and that there is still work to be done (1h4m2s).
• The CEO appreciates the opportunity to chat and looks forward to visiting the lab in the future, and is grateful for the company's success and wishes to continue improving and growing (1h4m27s).