Eli Lilly CEO's explains how failing fast leads to success

“Itâ€s a hugely technical industry. Itâ€s also a hugely important human industry. And so we canâ€t lose through that why weâ€re doing what weâ€re doing, which is somebody today is being told you have a terrible neurodegenerative condition or you have obesity and you really should do something about it,†said Ricks. “And I think we often have lost our way as an industry or even as a company when we donâ€t pay enough attention to that, which is how we show up in those markets, how we think about introducing our medicines, about integrity, about truthfulness.â€

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Transcript

Diane Brady: Leadership Next is powered by the folks at Deloitte who, like me, are exploring the changing roles of business leadership and how CEOs are navigating this change.

Welcome to Leadership Next, the podcast about the changing rules of business leadership. Iâ€m Diane Brady.

From transformative weight loss treatment to a potential blockbuster for Alzheimerâ€s, Dave Ricks of Eli Lilly is having a banner year. All that innovation, of course, is expensive, as we know, because drug company CEOs are often pilloried in the court of public opinion. But take a listen as I talk to Dave about the innovation process, how theyâ€re using AI, and most importantly, the developments he sees that could truly transform human health. 

[Interview begins.]

Dave, to start first, thanks for joining us. Youâ€re the worldâ€s largest pharmaceutical by market cap. Was that ever a goal or is that, Iâ€m never quite sure how to read market cap as a measure of success. 

Dave Ricks: Well, thanks for having me on, Diane. Great to be here. Of course, weâ€re really proud of the success of the company, but I think of that is more like an outcome that is derived from focusing on the things that create the value, not a goal by itself. I think we have other goals, like how many new medicines we want to introduce per year and how big a difference weâ€re going to make in conditions like Alzheimerâ€s and obesity. But if those lead to investors thinking weâ€re creating more value, thatâ€s great. But thatâ€s not the end result. 

Brady: Of course. And, you know, one of the things I grew up in a time when youâ€d think of big pharma and it would be judged by the pipeline, the late stage pipeline, the early stage pipeline, obviously thatâ€s critical. Youâ€ve had a terrific pipeline. But tell me, if youâ€re to step back to 30,000 feet a second, how would you like us to think about drug companies and how theyâ€re run? Because it seems like a very simplistic way to just look at the lineup and then sort of do a check or not. 

Ricks: Our industry is really, to me, very complicated but very interesting. And itâ€s so complicated often we reduce it to little soundbites. We talk about like a portfolio as if weâ€re buying and selling assets, but we create the assets. So it all starts in laboratories and we have many thousand PhDs at the company and they come to work and put on lab coats and they try to find basically new matter. So we invent new chemical entities or biologic entities that interfere with a disease process. And they have to do that first in like a piece of glass, and then they do it in an animal model, and then when itâ€s safe enough and weâ€ve proven usually after four or five years that that idea is good enough to try in people, we try it in early stage studies and then we do mid-stage studies in a late-stage studies, all to show that this new matter, this substance, a chemical or a biologic, can actually change a disease in a safe and effective way for someone. In total in the industry that takes 13 or 14 years. Most of our scientists, the thousand people who work here, actually never work on something thatâ€s successful in their whole career. 

Brady: How do you make the judgments then, when? Because youâ€re making these massive bets to your point, some of which you donâ€t know if theyâ€re going to pay off for a decade plus? 

Ricks: Actually Iâ€m pretty involved in that. I probably spend, I donâ€t know, 25, 30% of my time working with the scientific team to point that capability in the right direction. And maybe a few things we do differently at Lilly, so one of the things Iâ€ve focused on extensively in my tenure is speed. So you mentioned failing fast. Weâ€re not engineering a product, right? We canâ€t make anything. Like Iâ€m on the board of a software company and they can manipulate digits and probably do almost anything you could imagine. Itâ€s really the imagination thatâ€s the barrier. Here weâ€re dealing with biology, which is still mostly a mystery. I mean, we know a lot about how biology works in the human body, but not nearly as much as we want. So we have to try things that we think will work and prove they do in a controlled way. But we can affect the speed at which we run those experiments. And thatâ€s been something thatâ€s been a hallmark of Lillyâ€s success, is speeding up both preclinical work and in clinic development. I mentioned that 13, 14 years. We canâ€t so much maybe predict what will work and what wonâ€t, but we can go faster and weâ€ve cut our times in roughly half. So weâ€re failing a lot faster than others and thatâ€s an advantage. The other thing we can control is where we look. So Iâ€m pretty involved in this. Like, where should we direct the scientist to examine? And here we focus on big human health problems because I think thatâ€s what Lilly is for, doing things at scale, but also focusing on where the most suffering is in a way, not where the market is today. Because if we focus where people are making success today, well, thatâ€ll be gone in 13 or 14 years. You know, we need to go just where the basic human health problems are. 

Brady: Let me go back to that speed question, because I would imagine AI could have a transformative impact. Iâ€m already hearing about, you know, companies when they talk about the speed coming up with the right molecules, testing, etc. What impact do you think is going to have on drug discovery? 

Ricks: I think significant and Iâ€m pretty optimistic on that. That said, I think weâ€re in very early innings. People give speeches on this topic from the tech industry and sometimes I worry that they donâ€t understand the complexity of what weâ€re talking about. I mean, there is a big breakthrough on protein folding that Alphabet led in AlphaFold and itâ€s really interesting and it solves a pretty discrete problem really pretty well. Not perfectly, not good enough actually, for drugging the target, but for helping us decide which targets can be drugged, etc.. But that is one of hundreds, maybe thousands of steps that need to get solved, and even that one, it needs a human to do the last ten yards, if you would, to make it useful for drug discovery. So weâ€ll knock down these walls one by one and machine aided drug development and drug discovery I think in 10 years will be the way and it will be faster and better. But itâ€s not like you can like write some code, turn on a computer, and make a new drug. 

Brady: I want to, before we get into some of the specifics of the drugs, which I know are fascinating to people. This is a podcast about leadership, and I often think we treat leadership like itâ€s some generic concept that can transfer from industry to industry. But there are sort of unique idiosyncrasies, especially youâ€re in an industry, of course, where youâ€ve got big customers, youâ€re managing scientists, very creative people doing work in the lab. What do you think are some of the hallmarks to be a successful leader in the pharmaceutical sector? 

Ricks: I suspect every sector has some idiosyncrasies that really matter. I also think there are some general things that really matter. So itâ€s probably overlapping those two ideas that leads to highly successful leaders. You know, in medicine, I think thereâ€s two or three things that stand out to me. One is the highly cross-functional, technical nature of what we do. So I think in other industries, there maybe arenâ€t so many different technical disciplines that need to thread together. We just talked about AI and we have many, many people who are experts in that who donâ€t know anything about a human liver cell, letâ€s say. Then we have experts who know a lot about that but donâ€t know anything about AI. And then we have experts that know how to make organic chemicals that are safe to metabolize in humans who donâ€t know anything about those other two topics and on and on and on. So we really have to thread together almost like a table made of like strong individual parts to make it even stronger like united thing. All of these technical disciplines at scale, appreciating that and paying attention to that I think is maybe a little bit unique in our space. And then on the other side, itâ€s a hugely technical industry. Itâ€s also a hugely important human industry. And so we canâ€t lose through that why weâ€re doing what weâ€re doing, which is somebody today is being told you have a terrible neurodegenerative condition or you have obesity and you really should do something about it. And I think we often have lost our way as an industry or even as a company when we donâ€t pay enough attention to that, which is how we show up in those markets, how we think about introducing our medicines, about integrity, about truthfulness, etc., is incredibly important. And really preserving the trust we have with health care practitioners and patients is critical. Those two skills in our sector have not always flown together and when they donâ€t, I think you can get into a lot of trouble. 

Brady: Where are we in the conversation around drug costs, Dave? Even the fact that youâ€re a global company and of course the U.S. is such a different market from other parts of the world. But thatâ€s something that comes up as a political issue, as a personal issue, and thereâ€s this tendency to look to the drug companies, even though youâ€re just one player in a broader ecosystem. But how do you think we should be feeling about it right now? 

Ricks: Yeah, well, thatâ€s an example of the second thing I spoke about, which is like personally, I think we should make products that we can charge a premium for because theyâ€re so valuable. That they create value for the health care system and for people as individuals. We have though, a strange way to finance medicines, particularly in the U.S. Outside the U.S., they have also strange ways. You have two very different situations. So outside the U.S., the discussion is all about affordability to the system. And almost every developed country has decided we are going to largely shield individuals from any responsibility financially for medicines. So it becomes the burden shifts to the taxpayer, essentially, or the insured, whoever is paying the insurance. And we have a lot of discussion and debate about whether a new medicine is worth it. Meaning, is it producing enough excess benefit in the health system to justify its use? On the other hand, in the U.S., we have hardly any discussions about that question. We have decided to not shield people from the cost of their medicines in the same way that, for instance, Europe or Canada have. People have enormous out-of-pocket responsibility not just for medicine, but actually disproportionately for medicine. So if you go to the hospital, we pay 3% of that cost out of pocket in the U.S. on average. If we go to the pharmacy, we pay 20% out of pocket. So people are much more exposed to the cost of medicines, even if theyâ€re hugely valuable. So we have to play in both those worlds and be very sensitive to that. Again, if we create inventions that are so useful that itâ€s obviously helpful for the system and obvious that people are benefiting directly, this conversation, the temperature drops. When you create medicines that are not so obviously useful, itâ€s a tougher one, but we always have to be sensitive to this. And then recognizing in the long term medicines go generic and become very cheap commodities. We never really take enough credit for that, but we should. I mean, we invented Prozac, which is the standard of care to treat depression globally. Itâ€s almost free. Itâ€s really cheap to use because itâ€s generic. And thatâ€s something we did. Thatâ€s part of the value equation as well. 

[Music starts.]

Brady: Generative AI has been a transformative force in the business landscape for the last 18 months. According to the latest Fortune Deloitte CEO survey, more than half of CEOs are experimenting with generative AI in their own daily activities and, of course, trying to spread it throughout their organizations. Iâ€m joined by Jason Girzadas, the CEO of Deloitte US, which is the long time sponsor of this podcast. Jason, good to see you.

Jason Girzadas: Hi, Diane. Itâ€s great to be with you.

Brady: How are businesses integrating AI into their organizations? Where do you see the most substantial benefits?

Girzadas: I think itâ€s true, as you say, that every organization wants to capitalize on the benefits of AI, particularly generative AI. The benefits have been largely around efficiencies today and looking for ways to automate routine tasks. The promise is there for more insight-driven use cases and innovation use cases. Thatâ€s the next stage. Weâ€re seeing organizations looking to move from proofs of concept and pilots to see these technologies and models put in place in true operational uses at scale.

Brady: When you think about how much change thereâ€s been in the last 18 months, really curious, how do you think itâ€s going to evolve in the next 18 months, 36 months?

Girzadas: I think weâ€re actually needing to change our timing horizon. By all indications, weâ€re more in six month intervals and I think thatâ€s exciting, but also a challenge. Enterprises arenâ€t accustomed to working in that type of cadence and with that type of pace. And so the winners, if you will, will be those that can assimilate this technology that quickly, which I think is putting real strain on organizations†ability to adapt quickly. This is a perfect instance where leadership has to be in sync to assimilate technology that quickly. I think as a CEO, itâ€s important that we lead by example. So Iâ€ve been through all the training. Iâ€ve been through all the productivity tools that we have available within our organization. But then more broadly, weâ€ve embarked upon a significant investment to deploy this across all we do.

Brady: Iâ€m feeling the urgency. Jason, thanks for joining us.

Girzadas: Well, thank you, Diane.

[Music ends.]

Brady: Letâ€s go to what the hottest drug is right now, at least among certainly from the headlines, which is those GLP-1, you know, I think is it tirzepatide? Am I pronouncing it correctly, the weight loss…

Ricks: Yes.

Brady: …drugs. I mean, yeah. First of all, we see itâ€s a category versus a drug, right? Talk about the impact that that has had. 

Ricks: Well, obviously huge impact. But just to go back, so the category we would call is so-called incretins. These are hormones produced by our gut when we eat. The first one we identified and made a drug out of was GLP-1. Actually, we did that in 2005. 

Brady: Yeah. 

Ricks: So thatâ€s a long time ago. You may say, Well, jeez, it seems like a much more recent conversation. Thatâ€s true. We use them for diabetes, but until we had weekly acting ones that we learned to titrate up, we didnâ€t see the weight effect. Novo Nordisk actually did those studies and we followed, we had a drug called Trulicity. Still do. Thatâ€s a GLP-1. Tirzepatide is a dual acting, so it uses two hormones. Thatâ€s why itâ€s a little better, actually, at helping people lose weight and controlling diabetes than only GLP-1s. And because of that, I think we see really breakthrough results in a lot of people, both in diabetes, but also now in obesity management or chronic weight management. This is a, when I spoke about problems we want to work on, we want to work on problems that are scaled problems for mankind and make drugs that are super useful. And here tirzepatide is a great example of that. Itâ€s a scale problem. A billion people on planet Earth have obesity or overweight. Thatâ€s a lot. A hundred million Americans. And itâ€s a condition that causes other diseases: 230 recognized diseases stem from overweight or obesity in adults. So if we can arrest obesity, we can have a big impact on human health. Maybe 40% of U.S. health care spending is tied to obesity. So this is a big problem. Thatâ€s what Lillyâ€s for. And tirzepatide is super effective. And itâ€s our third iteration in the class. We had the first GLP-1, which was daily than a weekly, and now we have a GLP-1 GIP. And so itâ€s really helping reduce weight on average, 20% of body weight. And now weâ€re demonstrating it also affects the downstream diseases like we just showed. It reduced new diabetes diagnosis by 94%. So hugely important medicine. 

Brady: You know, there is conversation as well around some of the moral hazard, if thatâ€s the right way to put it, that these are drugs that people may have to stay on for life, that they are drugs to address what really fundamentally may be lifestyle issues for some people. How do you respond to that, especially in those markets where taxpayers are bearing the brunt of the cost? 

Ricks: In the U.S., itâ€s important to note the taxpayers are bearing none of the cost. The U.S. doesnâ€t reimburse these. Yeah, and actually few countries do so far for a condition which is identified by experts as a disease but not recognized as such by payers in every case. You know, in the U.S. also about half of commercial payers, so people, employers pay for these because they are recognizing itâ€s a disease. Thatâ€s an important discussion. We can come back to stigmatizing people with obesity and treating it not like a disease when the science says it is. Yeah, So thatâ€s my first response, is that you donâ€t have to listen to Lilly about this. You can just read what experts say is once you develop overweight or obesity, itâ€s pathologic, itâ€s difficult to very difficult to use traditional tools like diet and exercise to lose weight. 

We see this in our own clinical trials where we put people on strict diet and exercise, and after about a year, they lose about 5% at most of their body weight. Thatâ€s what dieting does. And by the way, they have trouble staying in the regimen. People donâ€t like it. They donâ€t feel good. Whereas on the drugs, people lose 20% or more of their weight on tirzepatide specifically. So the drugs work and they add to the diet exercise regime for people who are already overweight. But thatâ€s different from people who donâ€t want to become overweight or people who arenâ€t overweight and want to lose weight. And here we recommend not using these drugs. We donâ€t have data, number one, so itâ€s not proven to be safe or effective. Number two, we have a situation where weâ€re weâ€re now caught up with supply [shortages]. So if we have too many people who arenâ€t obese or overweight using the drugs, we wonâ€t be able to help those that are and really need the drugs. 

Brady: Do you ever think about this concept of almost healthcare apartheid comes to mind? But, you know, youâ€re talking about some very real issues where when you think about obesity, itâ€s also something thatâ€s quite linked to poverty and that, you know, really the reality is a lot of people canâ€t afford drugs when the cost is borne solely by them. 

Ricks: Yeah, Iâ€m really concerned about that issue. Weâ€re concerned about that in every disease. And I think one of the things that thereâ€s no perfect healthcare system. One of the things that in our country, in the U.S., we do a poor job of is managing what we call health equity. Other countries make that tradeoff pretty well. They shield people, as I mentioned earlier, from most of the cost if they get sick with a disease. Here Iâ€m including obesity as a disease that people should be shielded from. And the systems arenâ€t doing that. But mostly they do that. I think thatâ€s an area for improvement in the U.S. and we do see big differences in reimbursement levels. And it is mostly a regressive system that the better job you have, the better health care you get. And that seems wrong on many levels, and weâ€d like to see that changed. Yeah. And medicines in particular, you see more differences in that. So better medical coverage for pharmaceuticals is really skewed toward better jobs. Medicaid for people who have not a good job or not a job at all, has some of the worst coverage. So thatâ€s something that should change. We feel strongly about that. We speak out about that and weâ€re willing to sit down and negotiate to help make that happen. And we do do that routinely. But itâ€s not a pharmaceuticalâ€s job to make everything affordable. Thatâ€s the health care systems job. Thatâ€s important. Thatâ€s why we have health care. We pay in advance of getting sick so that when we do get sick, weâ€re shielded from the costs. I think our system doesnâ€t work as well in that manner. 

Brady: Is there anything you would do if I were to put whichever hat, policy hat you picked? What would you do to change things? I mean, obviously weâ€re talking about a very complex set of variables here and systems that are in place and hard to dislodge. But is there anything in the immediate term that you think would help to address an issue that tends to make people kind of feel sad and look at their feet, which is the word healthcare? 

Ricks: Yeah, well, thatâ€s a big question, Diane. I mean, first of all, I think we have to be careful in sometimes, weâ€re in an election season and people say things that sound good but are very difficult to do. So first of all, I think it would be good if we had less politics in the health care discussion and we agreed on the goals of what the system should be. One thing we do well in the U.S. is if you have good insurance, itâ€s easy to get innovation. And so, you know, I spent some time running our Canadian business and lived there, and I knew lots of people when they got a serious condition would just drive to the U.S. because in that country it is difficult to get whether a new medicine or a new procedure. If you had cancer, you go to the Mayo Clinic in Minnesota, you wouldnâ€t go to the Quebec hospital where you were living. So we donâ€t want that, right? We like that part of our system. 

On the other hand, as you just mentioned, for common conditions for people who donâ€t have good jobs or a job at all, we donâ€t do a very good job. If we just try to fix one of those problems, like a Whac-A-Mole, we might have a tertiary problem emerge. So we have to be careful and move more incrementally through time. Iâ€d like to see more of a group of people who are focused over the long term on making subtle improvements over time and embracing experiments that naturally occur in the health system and letting those become the policy after theyâ€re proven to work. 

One example of this, by the way, that is in the election cycle is this idea of $35 cap on out-of-pocket expenses for insulin. So whatâ€s the history here? Actually, Lilly invented that. We started doing that in 2019 for the markets where we could, which is the employer market. We then took that to the prior administration and said, Why donâ€t we try this as an experiment in Medicare? And they did it and it worked. And then now this administration has embraced that as the law. I think thatâ€s the kind of policymaking we should have, but on hundreds of issues so that we can evolve the system toward something thatâ€s more just and doesnâ€t give up innovation. I think we kind of wildly jerk back and forth. 

Brady: And allows a company to make money, right? I mean, not in a bad, youâ€re not a charity. Youâ€ve got shareholders to deliver…

Ricks: No no, there wonâ€t be innovation if people donâ€t have an incentive to invest at risk. Embracing that capitalist idea I think is highly consistent with better health care. But I think a system that promises easy solutions is probably too good to be true. 

Brady: Let me just follow up with one quick thing I think about, which is the demographic trends in this country and others is really skewing older and many of those people going into the category, frankly, of Medicare, which to your point, doesnâ€t compensate you for drugs to the same extent that private employers do. As the country becomes older on average, how do you think about that in terms of your customer base and also the revenue shifts? 

Ricks: Well, thatâ€s a global issue, actually. So I think if we look at developed markets everywhere, actually the U.S. is moving its demography slower than Europe or Japan, for instance, or China. So these huge countries with a lot of economic power are actually faced with it much more, so I think weâ€re going to learn from them. Thatâ€s the first thing Iâ€ll say. The second thing is we need to make healthcare delivery in the federal system more efficient. I think thatâ€s hard. I think governments struggle with that. Thereâ€s a lot of calcification of old rules that get in the way of efficiency. And one of the benefits of a market driven healthcare system, which thereâ€s a lot of critique of that, is that it is more responsive and dynamic. And I think we could use a little more of that in the federal program so it could evolve or something more efficient and effective, more experiments would be a way to do that from the center. And one of the ways to think about efficiency would be to use more technology, biotechnology, but also information technology. I think, you know, one little example is we allowed for a lot of telehealth visits during the pandemic. Those then got cut. One of the first thing, even though thatâ€s probably a lot more efficient way to see a doctor. So I think we just need to embrace innovation. 

Brady: Let me turn to the personal. What do you do yourself to stay healthy? 

Ricks: Yeah, well, I work hard at it. 

Brady: I mean, on a macro level. 

Ricks: Yeah, Iâ€m fortunate. I have enjoyed good health. And I worry about, you know, I have aging, my mother passed a few years ago. My fatherâ€s in a nursing home and has illnesses, chronic illnesses. Iâ€m 57. Like a lot of people in my age bracket, you begin to realize, well, thatâ€s not too distant for me. So let me work hard at this. Iâ€ve always been physically active. I think when I turned 50, I started to learn I canâ€t produce enough calorie output to manage this if I donâ€t manage my food input. Yeah, and increasingly Iâ€m focused on what I eat, not just how much I eat. And I think thereâ€s a lot of literature and science I read about that. My wifeâ€s a physician and she really likes this topic, so it helps me make better choices on that. And then mental health is super important. What do you do to get away from it? You know, Iâ€m in a job that probably looks stressful from the outside, and I think thereâ€s a lot of stressful jobs in the world, not just the CEO ones, but you have to manage stress and anxiety with relationships and faith. And here I think activity and movement helps me do that, too. Alone time, you know, having hobbies and other things. So I do all those things like probably many other people, but being disciplined about it is the most important thing. 

Brady: So Dave, what have you removed from your diet? 

Ricks: Yeah, Iâ€m focused currently on removing basically processed foods. Thereâ€s a lot of literature on the obesity crisis, by the way, and a lot of theories about why 40 years ago we had, obesity was a pretty rare condition and now itâ€s so common. One of them is we exercise less. But actually thatâ€s not totally true. Movement in our society dropped maybe 80 years ago when we had cars and mass transportation, but itâ€s been pretty stable actually since. Another one is that the quantity of food that that we eat has changed. Thatâ€s a little bit true, but the biggest thing is change is processed foods. So for all kinds of reasons, Iâ€m trying to avoid putting ultra processed and processed foods in my body. So eating more vegetables and fruits and meats that, you know, kind of or havenâ€t been through a factory.

Brady: Things you recognize to be food. Itâ€s very good advice for everyone…

Ricks: Yeah. Yeah. 

Brady: Itâ€s interesting you mentioned alone time and Iâ€m not, this is not a therapy session here but Iâ€m always intrigued. A lot of CEOs I meet are actually introverts, you know, and that by that I mean taking energy from being having that alone time versus energy from the crowd. I know itâ€s hard to classify yourself necessarily as one or the other, but do you think of that in terms of how you energize and refresh? 

Ricks: Yeah, all the time. I think maintaining energy for CEOs is a really important topic because when you walk in the door, badge in the building, youâ€re on and youâ€re not really off until youâ€re in your private space, which could be 14 hours later. For some people thatâ€s energizing. I think probably most CEOs over-represent how energizing that is and underrepresent, how much they have to charge the batteries to get ready for that. Yeah, whether it be in a media interview like this or just going to the cafeteria, like people make judgments about how the companyâ€s doing as employees or investors every time they look at you. So thatâ€s a responsibility we have. Iâ€m, like on Myers-Briggs, like, Iâ€m like right on the line of an E or an I. So Iâ€m in the middle, right in the middle. And for me, I need a little bit of both. I enjoy being around people who Iâ€ve known before I was here because I feel like I can relax a little bit and thereâ€s less of a kind of that onstage thing. And I like social engagement, of course, with family, but my kids are all out of the house now, so thereâ€s less of that and at the same time, I do need some time, like in my little bubble. Often thatâ€s when Iâ€m working out or sometimes going for a walk with my dogs or, you know, for fun. I like to get really away. Like I go to the woods and like hike through mountains and stuff or ski in the backcountry and those moments give me sort of solitude. Thatâ€s good too. So like at work, it has to be a balance. Yeah. 

Brady: Letâ€s look around the corner bit to end, because I know Iâ€m fascinated with some of the things youâ€ve said about the next decade really being the decade of the brain, so to speak, and the work that youâ€re doing in that area. Such a huge issue, such a fear factor for so many people and by brain, I mean not just Alzheimerâ€s, but you mentioned mental health. What excites you there? 

Ricks: Yeah, well, first of all, if we look at back to our mission, which is to arrest human suffering, and if we do that well, we create a lot of value and that creates value for the healthcare system for individuals and the company. If we look at where the suffering is at scale around the world, without a lot of good answers from medicine, brain health is probably the biggest category. Cancer is a big problem. Cardiovascular has a big problem. But here I see a little less history, recent history of success. But Iâ€m optimistic on the future, starting with neurodegenerative conditions which sound terrible. And they are. But actually, scientifically, weâ€re starting to unwind the threads of what causes them. Therefore, we can drug those targets. We can make medicines that can arrest it. And, you know, our latest Alzheimerâ€s drug, Kisunla, was an example of that. But I think we can replicate some of the success of that program in things like Parkinsonâ€s, ALS, other terrible conditions, which nobody wants and are a big societal problem. Thatâ€s wave one, maybe. 

I think another area that is important is pain. So here in the U.S., weâ€ve had a terrible history with use of pain medicines, which are probably worse than the condition to begin with as drugs. Theyâ€re old. Opioids are built on really natural medicines that are centuries, if not more, a millennium old. And we need to stop using them at scale and for chronic pain. And weâ€ve seen the terrible consequences of that. We need innovation there. Pain is still the number one reason people go to the doctor around the world. So weâ€re working on that problem. And I think there are some things in our pipeline and others that are getting me excited that maybe in five to seven years we could have good pain drugs that can alleviate the need for opioids. 

Mental health, there was a big wave of innovation Lilly led with drugs like Prozac or Zyprexa for bipolar and schizophrenia. But we havenâ€t really had innovation beyond that cycle. I think weâ€re weâ€re just looking over the horizon here and we can see maybe some new ideas. Those might be more like a decade away. But, boy, what would be more important than that? I think, especially in young people today, Iâ€m really concerned about mental health in developed and developing world. And we can make a difference there. So Iâ€m a technooptimist as it relates to pharmaceuticals and medicine. And I think when we train our scientists, we move that engine, point them at problems, theyâ€re pretty good at solving them. They need time and money and expertise. But here we could potentially use some of the huge resources weâ€re generating from the obesity problem which weâ€re solving and train them on brain health. What a good outcome that would be for the world and for Lilly. 

Brady: Well, and investors would say, of course, there are none better. One final question Iâ€ve always wanted to ask Big Pharma, because I talk to so many people in Silicon Valley where longevity is about living longer or maybe even living forever. Letâ€s hope not. How do you think about that? Just any any advice to us when we start to look at longevity and the longevity economy? How does the CEO of Eli Lilly want us to think about longevity?

Ricks: Mostly living better. I think the idea that weâ€re prolonging life is true sort of condition by condition. We come at it sort of an atomic level like that, which is whereâ€s the suffering, solve the suffering. And as a consequence of that, people may live longer. I mean, take obesity, we know thereâ€s a difference in life expectancy if youâ€re obese versus youâ€re not. So if we can have people lose weight, reduce their exposure to long term illness like heart attacks and diabetes, great. But weâ€re not starting by saying letâ€s just have people live longer per say. Thatâ€s not what we do. We may get to the same place and anyway, I think the world is leveling up health and leveling up our food in a meaningful way in our lifetimes. And so life expectancy globally will climb. The demography is real. So if weâ€re going to live longer, we might as well live better while weâ€re living longer. And I think thatâ€s about avoiding disease and having a full life and rich life and hopefully enjoying that time. Weâ€re here on the planet and making a difference for others. Thatâ€s how I think about it. And our role is to solve the disease problem, which, you know, thatâ€s the worst day youâ€re having, is when you get told you have a new disease and we want to solve it when you have it and maybe prevent it if we can. Thatâ€s what Lillyâ€s for. 

Brady: Well said. Thanks so much for joining us, Dave. Iâ€ve enjoyed the conversation. 

Ricks: Thanks for having me. 

Brady: Leadership Next is edited by Nicole Vergalla. Our audio engineer is Natasha Ortiz and our executive producer is Hallie Steiner. Our producer is Mason Cohn. Our theme is by Jason Snell. Leadership Next is a production of Fortune Media.

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