Alex Karnal, co-founder of Braidwell and former Deerfield Management investor, calls 2025 the most exciting year of his career because GLP-1 drugs show disease can be addressed at its root.
Karnal argues GLP-1 sales will easily exceed $100bn a year, proving a trillion-dollar shift toward proactive public health.
Karnal says AI, robotics and proprietary data could compress drug discovery timelines from three to five years to under two.
GLP-1s Point to a Trillion-Dollar Shift Toward Preventive Health
GLP-1 medicines show what happens when disease is treated at its root, and Karnal argues this opens a trillion-dollar move toward proactive health. Better drugs, earlier detection and AI-driven discovery all feed it. His firm Braidwell is built to back the innovations that will work, matter commercially and pay.
Takeaways
GLP-1s signal a trillion-dollar shift to prevention. Karnal expects GLP-1 sales to easily exceed $100bn a year because they treat disease at its root. Novo Nordisk data show over 20% lower heart attack or stroke risk, independent of weight loss.
Direct channels and cheaper pills drove adoption. Monthly cost sat above $400 or $500 through most of 2025. Lilly Direct brought in over half of new patients by year end, and 15% to 20% of the market flowed outside prescriptions. Oral Wegovy at about $150 a month is next.
A health stack pairs offense with five defenses. Offense means nutrition, strength training and tracked testing. Defense covers lipid, cardiometabolic, neurocognitive and inflammatory health plus blood pressure. PCSK9 inhibitors cut LDL by about 50%, and RNA interference versions may reduce injections from 26 a year to maybe two.
Earlier action improves Alzheimer's and cancer outcomes. Biogen and Lilly drugs slow late Alzheimer's decline about 30%, and earlier amyloid treatment might reach 40% to 50% or more. Karnal expects multi-cancer early detection tests within five years, and new cell medicines fully shrink tumors in over 70% of patients.
More testing brings false-positive risk. Karnal is cautious about full-body imaging from firms such as Prenuvo, though the images show progression over time. Each added test with a material false-positive rate raises the odds of a disruptive false alarm. He is not pursuing it yet.
AI and robotics could compress discovery timelines. Karnal says AI, robotics and proprietary data could cut discovery from three to five years to under two. Lila Sciences and Nabla can produce a candidate molecule in about a month, and the FDA under Marty Makary is trimming redundant studies.
Karnal's path to Braidwell
He grew up around his father's entrepreneurship and studied at MIT.
He worked on the biotech derivatives desk at Merrill Lynch.
He pitched Deerfield Management and was hired at 24, when the next youngest person was probably about 40.
He left Deerfield after 15 years, having seen that patients were not staying on their medicines.
He co-founded Braidwell with Brian Kreiter, formerly chief operating officer of Bridgewater.
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On this episode 2
Show 1
A daily morning meeting of scientists, traders and AI experts judges whether an innovation will work, matter commercially and offer an attractive return.