Cheeky Pint: Dave Ricks, CEO of Eli Lilly, on GLP-1s and the Business of Pharma

Podcast: Cheeky Pint
Host: John Collison (cofounder of Stripe), with Patrick Collison
Guest: Dave Ricks, CEO of Eli Lilly
Date: November 11, 2025

Overview

This episode features an engaging and highly technical conversation between Stripe's John and Patrick Collison and Dave Ricks, the CEO of Eli Lilly—the world’s most valuable pharma company. The discussion ranges from the company’s GLP-1 leadership (diabetes and weight loss drugs), innovations in drug discovery and development, the economics of pharma, regulatory and pricing debates, the rise of direct-to-consumer drug models, the state and culture of U.S. healthcare, global competition (notably from China), and the distinct interplay between biotech and big pharma.

Key Themes & Discussion Points

1. Eli Lilly’s Supercomputing & AI-Driven Drug Discovery

• Eli Lilly’s Nvidia Partnership: The company has partnered with Nvidia to build a massive, proprietary, biology-focused supercomputer for drug discovery using B300 chipsets.
  • "We think it's the biggest biologically focused supercomputer there is... Scientists use it to sort of co-invent, co-develop, focus mostly on chemistry to begin with." (Dave Ricks, 00:41)
• AI’s Current Limitations in Biomedicine: Dave stresses AI’s promise but notes the field’s limitation due to incomplete biological data—biology's language model hasn't been built yet.
  • "I would estimate we might know 10 to 15% of human biology. The machine's not going to be good at all until we get way above 50%." (Dave Ricks, 03:26)

2. Learning, Leadership, and Scientific Decision-Making at the Top

• Self-Education: Despite not being a scientist by training, Dave voraciously learns via medical journals, conferences, and now LLMs—favoring Claude and xAI over ChatGPT for scientific queries.
  • "Now I have at least one or two AIs running every minute of every meeting... I just am asking it science questions." (Dave Ricks, 04:46)
  • "I tend to use either Claude or the XAI one. I find it more terse and the references actually check out more often." (Dave Ricks, 05:09)
• Decision-Making Style: Lilly’s top decisions are increasingly quantitative and process-driven but still require judgment, wisdom of crowds, and rules like “never decide in one meeting.”
  • "I think the system does a lot of the Billy Beane [Moneyball]. We've actually put together a decision process that's quite a bit more rigorous... That's sort of like the bumpers on the bowling alley." (Dave Ricks, 06:44)

3. Clinical Trials: Costs, Duration, and Reform

• Why Trials Are So Expensive: Major cost drivers are providing gold-standard care to enrollees (often the sickest), regulatory demands, and healthcare system inefficiencies.
  • "We're taking the sickest slice of the healthcare system... we are literally running the healthcare system for those individuals." (Dave Ricks, 09:55)
• Enrollment Challenges: Half of drug development time is waiting for enrollment—a problem Dave analogizes to Taylor Swift selling out concerts in seconds, but there’s “no easy way” to fill an Alzheimer’s trial.
  • "If Taylor Swift can sell out a concert in a few seconds, why can't I fill an Alzheimer's study?" (Dave Ricks, 14:38)
• Innovations in Recruitment: Direct-to-patient and database-driven recruitment has shown promise, especially in preventative and early-stage studies.
  • "We've executed one of these at scale... our Alzheimer's prevention study... fastest accrued Alzheimer's study in history." (Dave Ricks, 16:59)

4. The Regulatory “Ratchet,” Risk Aversion, and Societal Tradeoffs

• Delays and Overregulation: Regulatory responses to past drug scares (e.g., Vioxx, Avandia) have led to ever-increasing evidence and process requirements, often not reassessed as technology improves.
  • "Each time [a problem] occurs there was intervention ... Let's require more information or rebalance the risk benefit." (Dave Ricks, 20:26)
  • "Regulatory are added but never taken away." (Dave Ricks, 22:03)

5. GLP-1s: Metabolic Disease, Prevention, & Broad Therapeutic Potential

• Glucose-Lowering Superstars: GLP-1 drugs (including tirzepatide/Mounjaro/Zepbound) are blockbuster diabetes and obesity treatments. Lilly is a market leader.
• Economic Payoff: New studies show GLPs are cost-effective—offsetting costs in as little as two years—undermining the “prevention is hard to pay for” insurance argument.
  • "Within a two year time frame... you can break even basically on total medical costs." (Dave Ricks, 24:27)
• Stigma & Coverage: Stigma around obesity affects coverage; Dave pushes back, arguing for recognition of genetic/environmental roots.
  • "We're conditioned to think of someone who's overweight as someone who is not disciplined. The data does not show that." (Dave Ricks, 26:00)
• Mechanisms & Non-Weight Loss Effects: The team explains how GLP-1s modulate gut/brain signals, reducing inflammation and improving risk profiles for cardiovascular, neurodegenerative, and possibly joint and autoimmune conditions.
  • "Inflammation markers drop precipitously early ... There's a marker called CRP... in weeks, that starts to drop really like 60, 70%." (Dave Ricks, 86:30)

6. Business Models: GLP-1s, Gene Therapies, and Pricing Innovation

• Recurring vs. One-Time Revenue: Traditional drugs are recurring; gene therapies are “one and done” and challenge how value is priced and recouped.
  • "It would be...like a shrink wrap software world...all your value has to be captured upon that invoice. That is how we price all medicines." (Dave Ricks, 29:37)
  • "[Gene therapy]...it's conceivable one could create a licensing concept...like SaaS: we'll do the procedure for free, and as long as it's working, you will deposit X." (Dave Ricks, 30:39)

7. U.S. Pharma Pricing, Global Cost-Sharing, and Perverse Incentives

• The “Spread” Problem in U.S. Drug Distribution: Dave exposes how U.S. drug pricing mediates huge cost disparities, rewarding middlemen (PBMs), penalizing cash payers, and causing public distrust.
  • "Why [was insulin $275 list]? We were competing on the spread. And so you have the spread." (Dave Ricks, 40:49)
• Free-Rider Problem: U.S. pays for global R&D; other countries “free ride” and get drugs cheaper post-U.S. launch. Dave proposes a “One Fair Price” concept tied to GDP per capita for global pricing equity.
  • "The idea would be that manufacturers introduce at the price they want...restricted by only a couple things: [price tied to GDP per capita in other countries]." (Dave Ricks, 45:31)
• Opaque Healthcare Economics: The U.S. system is riddled with prices that “mean nothing,” undermining true market function.
  • "One of the biggest shortcomings...none of the numbers mean anything. Like just a number that you see, they're all lies and that kind of has to lead to market failures." (David Ricks, 47:35)

8. Direct-to-Consumer Disruption: Lilly Direct

• Building Direct Relationships: Eli Lilly's move to sell directly (e.g., Zepbound, Insulin) is a critical business model evolution, disintermediating PBMs/pharmacies and mirroring how Stripe enables direct digital commerce in other industries.
  • “Today we'll annualize in the billions of dollars. I think it's the largest prescription platform online in terms of revenue." (Dave Ricks, 102:32)

9. Biotech vs. Pharma & The Rise of China

• Three Models: Biotech explores, big pharma scales; Lilly uses a hybrid org: small, autonomous discovery units (like 400-person centers in San Diego) inside a scaled global org.
  • "The act of invention has diseconomies of scale." (Dave Ricks, 60:41)
  • "Let them cook school of pharma innovation." (Dave Ricks, 62:26)
• China’s Advances: Chinese biotech now accounts for nearly 30% of drug pipeline activity; Dave expresses concern about patent “clones” and U.S. IP vulnerability, especially with “first to file” patent rules and widespread patent publication.
  • "You've created basically a shadow generic industry and undermined the patent system itself. I don't think that's a great thing." (Dave Ricks, 71:14)

10. Generic Industry, Quality Concerns, and Global Supply

• Generics as a Success and Vulnerability: While generics have democratized access and reduced prices, almost all are made offshore (India, China), and quality/fraud concerns persist.
  • "There are no generics manufactured in the U.S. really...most of what you're taking is not actually the active ingredient." (Dave Ricks, 77:50)

11. Talent, Succession, & Organizational Longevity

• Internal Talent Pipelines: Dave attributes Lilly’s success in part to its 150-year discipline of internal development and succession, frequent role rotation, and a blend of internal and select external hires.
  • "We've had 150 years of that and I'm the 11th CEO of the company. That's one less than popes in that period of time." (Dave Ricks, 121:04)
  • On personal development: "Probably four or five times I was put in a job I had no business being in, but somebody thought I could learn it." (Dave Ricks, 123:29)

Notable Quotes & Memorable Moments

• On the promise and limits of AI:

  • “We need to create the equivalent of what got created with human language—a more complete repository of biological knowledge to train against before the machines get a lot better.” (Dave Ricks, 03:26)

• On FDA approval ratcheting:

  • “Regulatory are added but never taken away. So the regulation is still there.” (Dave Ricks, 22:03)

• On U.S. drug pricing:

  • “Our actual net on Insulin really hasn’t changed. It’s like $30 or $40. But the list price got up to $275. Why? We were competing on the spread.” (Dave Ricks, 40:49)

• On the state of direct-to-consumer medicine:

  • “We sell more [Zepbound] than our insured business...The number one prescribed form is Zepbound self-buy.” (Dave Ricks, 93:42)

• On the challenge from China:

  • “If the monopoly [on drug IP] is debased by 30 Chinese biotechs who feed that patent into a computer...you've created basically a shadow generic industry and undermined the patent system itself.” (Dave Ricks, 71:14)

• On GLP-1’s evolving impact:

  • “If you carry around a backpack of 40 pounds extra every day, your knees will hurt more... We'll measure the inflammation in the joint plus there's a mechanical loading with being overweight.” (Dave Ricks, 87:12)
  • “Statins got to 40 million people branded...Has to be north of that.” (Dave Ricks, 94:57)

• Talent and Leadership:

  • “As a CEO, you have to do a lot of things that are very horizontal...but I learned by voraciously reading and doing and solving real problems that has made me more successful in this job.” (Dave Ricks, 123:29)

Timestamps for Major Segments

| Time | Segment | |-----------------|-----------------------------------------------------------------------| | 00:41 | Eli Lilly’s Nvidia Supercomputer for Drug Discovery | | 03:26 | How AI and Biology Fall Short—and What Needs to Change | | 04:37 | Dave Ricks’ Self-Education & Using AI for Science | | 06:44 | Quantitative vs. Taste-Based Science & Capital Allocation | | 09:55 | Why Clinical Trials Are So Expensive | | 14:38 | Clinical Trial Enrollment & Industry Bottlenecks | | 16:59 | Direct-to-Consumer & Digital Trials: Learning from Alzheimer’s Study | | 20:26 | Regulation Ratchets and the Cost of Caution | | 24:27 | GLP-1s, Prevention, and Economic Rationale | | 29:37 | Comparing Recurring vs. One-Time Drug Pricing Models | | 40:49 | U.S. Drug Pricing Disparities & the "Spread" Problem | | 45:31 | Proposal for One Fair Global Drug Price | | 47:35 | Health Care Pricing—Why Numbers Don’t Mean Anything | | 60:41 | Innovation Org Models: Scale vs. Small Teams | | 66:34 | Biotech’s Rise in China | | 71:14 | Patent Cloning, China, and U.S. System Flaws | | 77:50 | The Global Generic Drug Industry and Quality Concerns | | 83:06 | GLP-1 Mechanisms—From the Gut to Inflammation Effects | | 93:42 | Direct-to-Consumer Drug Sales & Lilly Direct | | 100:33 | The Birth & Growth of Lilly Direct | | 121:04 | Talent, Succession, and Company Longevity |

Tone & Language

• The conversation is sharp, witty, technical, and at times, irreverently honest. Dave Ricks is both visionary and pragmatic, frequently invoking metaphors across tech, sports, and organizational design. The hosts are deeply engaged, pushing on economic, policy, and technical fronts.

Summary Takeaways

• Eli Lilly’s success is rooted in relentless R&D efficiency, bold direct-to-consumer moves, and aggressive yet thoughtful capital allocation.
• GLP-1s are transforming obesity and metabolic medicine and look set to have cascading impacts across multiple therapeutic areas.
• Pharma’s future is threatened and energized by AI, regulatory inertia, and the emergence of China as a global innovation competitor.
• U.S. drug pricing is perversely structured, rewarding intermediaries and risking long-term system legitimacy.
• Organizational longevity at Lilly is driven by proactive internal talent development and hybrid models of innovation.

This episode is a masterclass in the intersection of science, business, technology, and policy as seen from the “Premier League” of drug discovery.

For further details or to explore any segment, see the timestamped index above.