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Invest Like the BestInvest Like the Best

GLP-1s Are a Bigger Business Than AI

In this episode of Invest Like The Best, Patrick O'Shaughnessy sits down with Zach Reitano, co-founder and CEO of Ro, for his first long-form podcast in nine years.

Zach ReitanoguestPatrick O'Shaughnessyhost
Nov 11, 20261h 24mWatch on YouTube

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Transcript

  1. 0:00 – 0:34

    Welcome to Invest Like the Best

    1. ZR

      If I had to say, like, what is the problem with our healthcare system, it is that the patient is not the customer. Whoever controls the flow of money at the point of purchase, that's the customer. That's the stakeholder that everyone builds around. We just are not the customer in the majority of the interactions, right? You have, like, $1,300 drugs that people are paying behind the scenes three, $400 for. No industry could survive with its prices not being public.

    2. PO

      [upbeat music]

  2. 0:34 – 4:59

    How Much Should We Spend on Health?

    1. PO

      I've got a first question based on our last phone call, which was something you told me which just really stood out. What percent of GDP do you think healthcare could or should be 10, 15 years from now?

    2. ZR

      I think it should be as high as possible, 50, 70-

    3. PO

      Everyone's always complaining it's too high.

    4. ZR

      Eighty... Everyone's always complaining it's too high, and I think that, uh, it's missing the forest for the trees. If you think about healthcare, I think it's the sine qua non of life. It's without which there is none. And it's actually, depends how AI-pilled you are, but your audience is probably pretty AI-pilled. If you imagine a life of pure abundance, and you imagine Jevons paradox does its thing, then the only good in our lives that does not have any diminishing marginal return, uh, is another healthy year. And so to me, at the limit, you should be spending every single dollar towards the health of your society. And so when we look at, uh, the US and say, "Oh, we spend eighteen percent of our GDP, that's a problem," my question is like, well, why? We've never used absolute numbers like that as a problem. The question is: Are we getting what we want from that dollar amount, right? And that's the whole premise of Jevons paradox, is actually, like, the market size increases as the cost per unit decreases. Now, the cost per unit, the challenge is in the US healthcare system, the reason why it's eighteen percent is because the cost per unit has been rising. We spend probably fifty percent of our healthcare costs on five percent of people. The US doesn't give up on a single person in that way. A lot of people look at the US healthcare system as this great anomaly relative to other healthcare systems, and I'm actually of the belief that the US healthcare system is actually like a preview of what's to come for a lot of other countries. You look at the UK, its GDP, percent of healthcare spent on GDP went from six to twelve. You look at Germany, went from nine to twelve. Uh, you look at the US, it, you know, went from nine to eighteen. And same thing with our obesity rates. And, and so to me, again, back to, like, what is more important for a society to spend its money on, I couldn't imagine something that's more important than our health. But what we get for it should just be far greater.

    5. PO

      Yeah. So if you ground us in today's reality-

    6. ZR

      Yeah

    7. PO

      ... I, I'm very curious for your state of the union of the system itself.

    8. ZR

      Yeah.

    9. PO

      And you know, the ob- you can picture the obesity rate chart that has for the first time in a while-

    10. ZR

      Yeah

    11. PO

      ... kind of flat lined or kinked the other direction.

    12. ZR

      Yeah. Yeah.

    13. PO

      I, I think GLP-1's the primary-

    14. ZR

      Yeah

    15. PO

      ... primary reason why. Um, obviously that's driven your business to an extraordinary degree.

    16. ZR

      Yeah.

    17. PO

      But give us beyond just that. Like, give us your sort of state of the union, here's what health is like in the US today.

    18. ZR

      Could be a whole podcast by itself.

    19. PO

      Yeah.

    20. ZR

      Um, it's interesting to think about, like, first where does the money go. Usually if you wanna, like, understand an industry, you just, like, follow the money.

    21. PO

      Yeah.

    22. ZR

      So let's say thirty to thirty-five percent is about hospital systems. Twenty to twenty-five percent might be doctor's office. Um, another nine, ten percent would be drugs and pharmaceuticals, and then you see the remainder sort of, or sort of chopped up there. A lot of people will talk about, and back to our, our question a little bit around percent of GDP, the US healthcare system I would say is really fantastic, better than people give it credit for at acute care, right? So yes, it's more expensive, but we have higher cancer survivor rates than, than the NHS. Like, if you get cancer, you wanna get cancer in the US, right? If you have a heart attack or a stroke, you wanna have it in the US. Your, our survival rates are higher on average than other OECD countries. And we don't use more healthcare than other OECD countries. We have s- uh, we have fewer hospital stays. Our hospital stays are shorter. We have slightly more procedures and scans, which whereas it sort of nets out on a per unit basis, and then our prices are higher, and our administrative burden is much, much, much, much higher, right? Um, and then a lot of people will talk about life expectancy in the US. It hasn't increased in the last sort of ten, fifteen years. To me, a lot of that is not a reflection of our healthcare system, right? So there's kind of, uh, two buckets of the way we die. Um, the first is like this fast clock, right? And that will bring down the average of the US, uh, life expectancy relative to other OECD countries. So the, that fast clock is like gun deaths, car accidents, overdoses, things like that that'll bring down an average. Um, but it's not the majority of the way we die. We actually, the majority of the way we die is with a slow clock, right? Chronic disease, and that is, has massively been rising over the last, as, as you mentioned, the last, like, twenty, thirty, forty years.

    23. PO

      Yeah.

    24. ZR

      So those two things are really like the makeup of how illness happens in the US and how people die, and then that's how the, the money gets

  3. 4:59 – 10:24

    The Patient Is Not the Customer

    1. ZR

      spent.

    2. PO

      As you think about the whole thing, what is the most surprising thing that you've come to learn about the system that you think people may not appreciate fully?

    3. ZR

      There's probably, like, two things that I would say. One is I do think our sen- our healthcare system has one, if not two, but, like, one central flaw from which all other problems stem. And the second is that the entire healthcare system is based on time horizons that are almost irrelevant to the individual, right? So that's what I think of the surprising thing, which is like, when you go into the healthcare system, there's a fundamental mismatch of incentives, and I think that that is... If I had to say, like, what is the problem with our healthcare system, it is that the patient is not the customer. That's the problem that we're trying to solve at Ro, and I think you see it working, but that is the fundamental problem. And then, and the reason being is, and you probably, y- I mean, you see this in every business that you talk to, whichever, whoever controls the flow of money at the point of purchase, that's the customer, right? That's the stakeholder that everyone builds around. And patients, individuals, we pay for our health, our healthcare. We just are not the customer in the majority of the interactions, right? So we... Our out-of-pocket expense is the minority of our expenses, and we pay through our taxes, and we pay through suppressed wages with arm. And so you then look and say, "Okay, well, where's healthcare working? Like, where does it feel really good?" And it feels really good where it's cash pay, um, where the, the patient is the customer.

    4. PO

      Favorite example of that?

    5. ZR

      You look at LASIK eye surgery, right? Cost comes down, quality improves, convenience improves. You look at breast augmentation, you look at cosmetic surgeries, costs come down, quality improves, convenience improves. You look at GLP-1s, right? Take GLP-1s, and they are like this beautiful foil for the rest of the healthcare system. Politicians and regulators have been trying to get transparent prices for 20, 25 years, right? What happens? Pharma goes direct. What happens to the prices? Well, this, as my loving Jewish mother would say, the fakakta prices of, like, list to net.

    6. PO

      [laughs]

    7. ZR

      Right? You have, like, $1,300 drugs that people are paying behind the scenes three, $400 for. What happens when those go direct to consumer? That list to net gap gets entirely eliminated. That, like, when people are pointing fingers between insurance companies and PBMs and pharma and who's to blame, they go direct, you remove the PBM and insurance company entirely, and normally branded drugs every year, systematically, they go up six, seven, eight percent year over year over year until the patent cliff. My hope, and I think you're already starting to see this, more middlemen that do absolutely nothing are getting removed from the process, so they are able to capture the same if not more gross profit-

    8. PO

      Mm-hmm

    9. ZR

      ... right, while prices come down. If you look at Lilly's earnings, prices come down, volume far outstrips it, right? And you know, PB- PBMs to me are like, they are like the appendix of the healthcare system. Like, at one point in time, they might have served some purpose, but it was, like, so long ago that people can't remember what the heck it was.

    10. PO

      Mm.

    11. ZR

      And turns out when you remove them from the equation, software can do exactly what they would've done-

    12. PO

      Yeah

    13. ZR

      ... historically. And so you even see with GLP-1s, like, PBM goes away, insurance company largely goes away. People can debate that and whether or not it should and what they should cover. But for cash pay purposes, PBMs and insurance companies go away, prices go from $1,300 to $149, and the people making the drugs are making more money, right? And so you can see that where it's working, uh, the patient is in control and at the center. And then you usually have people give this criticism like, um, one of the most common is asymmetry of information. In my mind, it's a little bit similar to, like, the best form of government. So, like, democracy's the worst form of government except for all the other ones.

    14. PO

      Yep.

    15. ZR

      In my mind, like, the patient's the worst person to make their, uh, to own their healthcare decisions except for literally everyone else.

    16. PO

      Yeah.

    17. ZR

      And when you go into our healthcare system today, they'll say there's asymmetry of information. You have to sign on the dotted line away anything a- and everything, and you're not reading that. But imagine you had rescor- recourse, which is you get to vote with your feet. So if hypothetically, like, wh- when we as a society... Well, sometimes you have the price transparency laws for hospitals, and people thought that that was, like, this amazing thing. That is, like, epic lipstick on a pig, right? No industry could survive with its prices not being public. Any company that did that wouldn't get any customers, right? So rather than us praising that, we should see that as a symptom where if, if you hypothetically gave, let's say, I don't know what you give your employees for healthcare, what you spend on them, but let's say we spend 20 to $25,000 a year per person. If I magically gave them a credit card that could only be used for healthcare and let's say $20,000 of it could be used on their healthcare expenses and it would just roll over every year and then some portion on catastrophic care, which is I think the ideal form of insurance, but you wouldn't have to make a law that says you have to make prices public. Businesses do that to earn a customer's money, and if they don't do that, if, A, if they don't make the prices public, they won't get their money, and then if they don't do a good job, they won't get their money. And so one of the reasons why in healthcare there's very little trust is because, A, there's very, very little transparency, and they don't say what they're gonna do and then deliver it time and time again. And so where you see people feel that way in healthcare is actually where they're in control in that, in that cash pay environment-

    18. PO

      Yeah

    19. ZR

      ... or where insurance is 100% accepted, and it covers 100% of the cost, and it's basically like they have free money, and they have choice and foresight. So the idea to me is what we're trying to do at Ro is if we can aggregate patient spend, I think we can bend the healthcare system to the will of

  4. 10:24 – 18:28

    Inside Ro's Business

    1. ZR

      patients.

    2. PO

      I'd love to use Ro as just, like, a great example since you know all the data like the back of your hand. Give us a sense of, like, the lineup of products right now.

    3. ZR

      Yeah.

    4. PO

      And, like, what the pie chart look like, looks like today.

    5. ZR

      Yeah.

    6. PO

      Like, what, what percent are they spending on each of the major categories?

    7. ZR

      Yeah, yeah, happy to. So we have four main categories. So Ro is the leading provider of GLP-1s in the country. Cardiometabolic health is our number one category, then sexual health, dermatology, and fertility. The, the fastest growing part of the business is GLP-1s, and oftentimes people will say, uh, as this has happened, right? 'Cause we've grown, uh... Over the last four years, we've gone from about a $250 million run rate to ov- over a $3 billion run rate, and we've done that actually with fewer people than we were in 2021, which is-

    8. PO

      We'll tell the whole story

    9. ZR

      ... But the majority of growth, what's interesting is people will often say, "Well, you're... Like, those are just weight loss drugs." And that's really f- like, that's both fascinating for, for me when it's, like, one it's, like, they were approved for diabetes, then they were approved for obesity and overweight, then they were approved for heart disease, then they were approved for sleep apnea and liver disease and kidney disease, and they're being studied for neurodegeneration and pain management and addiction and mental health and cancer prevention. And so you look and you're saying, like, "Yes, we are, you know, the leading part, the leading part of our business is just treating the leading causes of why humans die on Earth today," right? That slow clock that we talked about. So I, like, used to be frustrated by that just moniker, and now it's like a badge of honor, but it is... It's by far and away the fastest and leading, uh, part of our business. [upbeat music]

    10. PO

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    11. ZR

      Yeah.

    12. PO

      Obviously starting with GLP-1s. Why have you been ef-- so effective? Like, what has made you the leader? Why don't people just go to these new direct services that the-

    13. ZR

      Yeah

    14. PO

      ... pharma companies have? Like, what, what is it about Ro that has allowed it to be the place of choice to go get this stuff?

    15. ZR

      Yeah. It's a, it's a great, great question 'cause people often ask about, like, competition and differentiation, and so there's, there's a bunch of different ways to talk, talk about it. Like, the first, to your point, is, like, the proof's in the pudding, right? So Ro is the leading provider of GLP-1s in the country. We're probably signing up two, three, four, five times as many patients every single day as our competition. So there is clearly... Like, there's some difference.

    16. PO

      Something's going on.

    17. ZR

      And so what is that? And then when you think about, like, differentiation, a lot of times people, and I would love if this were the case, want this, like, very specific answer. Like, "We offer this feature, and someone else doesn't." The thing is, is if I were to say that right now, I could point to those things and say, "Well, Ro is the most affordable to start, and Ro has the strongest formula. We're integrated with both Novo and Lilly. Well, Ro also has Cash Pay, and we help people check their insurance." So we've helped actually over one percent of the US population check their insurance for free, done that entirely with AI. You can get it mailed to your door. You can pick it up in person. We also have worked with our pharma partners to offer multi-month subscriptions where we can actually save patients six hundred to eighteen hundred dollars a year. That's not available, uh, i, in, in an infinite number of places, right? So for many people, the membership actually pays for itself. But truth is, is that differentiation in my mind, I, I'm a big believer that the only, only, only source of differentiation is continued innovation, right? Like, we must be in, in search constantly of that next checkbox, and so we have to invent that next check every single time 'cause if we stayed still, if the companies you love stayed still, Apple, Amazon, Google, whatever it may be, if they stay still for six or twelve months... You see this even in the A- AI race, is like every four weeks there's another company beating another company.

    18. PO

      Yeah.

    19. ZR

      So if you stay still-

    20. PO

      Good for consumers.

    21. ZR

      It's great for consumers. And so again, that's where I l-love like the consumers. I love competition, especially in healthcare, 'cause we have to fight every single day to continue to serve. Even when we started the company and the way we built the technology, right? Like, we, we built an EMR from scratch. We built our own CLIA-certified and ACPA-accredited lab. We built our own pharmacies. We built our own pharmacy software. We built our own provider network. All of those are seamlessly integrated, and they are built in a condition agnostic way. We had been building this incredible platform for the previous four, five years before GLP-1s came out, leaned very, very hard into it, but we were able to quickly expand. And so when people think about us like a condition by condition, they actually should just think about a world-class, like, care and treatment distribution platform that is all vertically integrated, custom-built software, uh, in service of helping that patient achieve their health goals.

    22. PO

      Is there anything interesting to double-click on the options you have for serving something like a GLP-1 which is made by a couple different companies, but not by fifty?

    23. ZR

      Yeah.

    24. PO

      Is there anything interesting in that dynamic that, um, because there's relatively few suppliers, they you would think would have some sort of power and be able to capture more of the total margin that's being, you know, earned by all companies that are serving a customer GLP-1?

    25. ZR

      I think your assumption is right, and by the way, I think that should be the case.

    26. PO

      Yeah.

    27. ZR

      Like, I think the inventors of GLP-1s-

    28. PO

      Should earn margin

    29. ZR

      ... should grab more margin-

    30. PO

      Yeah

  5. 18:28 – 25:46

    The Future of GLP-1s

    1. ZR

      of the marketplace.

    2. PO

      What do you think the impact of GLP-1s is gonna be perspectively? Like, there's been lots written about what it's done so far, the flattening of that cur-

    3. ZR

      Yeah

    4. PO

      ... of the obesity curve, like the data is all very interesting. But if you think about going forward-

    5. ZR

      Yeah

    6. PO

      ... as I don't know what percent maybe you could tell us if Americans are on one of these things.

    7. ZR

      People say like 10 to 15%.

    8. PO

      Yeah, it's a big, big percentage-

    9. ZR

      Yeah

    10. PO

      ... of Americans on the drug.

    11. ZR

      Yeah.

    12. PO

      What, what do you think the perspective story of GLP-1 class drugs will be?

    13. ZR

      Yeah.

    14. PO

      So I'm interested both in the broader impact, but also the generations of technology that seem to-

    15. ZR

      Yeah

    16. PO

      ... um, there's new ones coming out soon.

    17. ZR

      Yeah.

    18. PO

      Seems really fascinating. Be welcome your thoughts on that. Like, what's the story from here look like do you think?

    19. ZR

      There's the individual healthcare impact, there's the impact to the healthcare system, and then I think there's the societal impact. On the individual health impact, we talked a little bit about this, but they are upstream of the leading causes of death, right, what they're approved for, diabetes, obesity, liver disease, kidney disease, sleep apnea, heart disease. They're approved for all of those things already. Four years ago, they were just approved for diabetes. So that impact is tremendous. Then there's the, uh, healthcare system impact, right, which we talked about, which is I think they are fundamentally rewiring the healthcare system. Industries get rewired when large amounts of buyers care about one thing for an extended period of time. Right? So we saw a lot of the healthcare system suddenly find out that telemedicine was a good thing during COVID. And what happened during COVID, actually, as a specific example, you saw a lot of states relax the regulation that a healthcare provider could treat someone without being licensed in another state. So one of the reason-- one of the problems of our healthcare system is we have a fundamental supply shortage. We have too many people who, who need care and too few to provide it. It's one of the things we were trying to do at Ro is turn a luxury into commodity by turning a service into a product. So when you see that... But COVID ended, and suddenly we went back to thinking that when the human body crosses state lines, it's suddenly wildly different. You are going to see GLP-1s rewire. They've already started to rewire and ask the questions of like, well, why does your employer get to decide what is covered by your health insurance and have such great influence on your healthcare? 'Cause again, back to incentives in that first problem that we discussed. Your employer, they care about you. You care about your employees. I'm sure you do. I, I, I deeply, deeply care about our employees, but that is plural. An employer cares about many employees over a shorter time period than their entire life, right? An individual cares about their themselves and maybe the-- and their family over their entire lifetime. That mismatch in incentives will naturally create suboptimal outcomes. So what you're seeing with GLP-1s is you are actually seeing the most popular drug of our lifetime or drug class of our lifetime, seeing the most popular drug. The majority of the growth is direct-to-consumer cash pay. Patients are able to vote with their feet, and what happens? All of the things regulators have been dreaming about for a really long time. Prices are transparent. They're coming down. There's more competition and all of the amazing things. And then the third and last one is the societal impact beyond the healthcare system. If I can go on like a little bit of a tangent on this-

    20. PO

      Please

    21. ZR

      ... societal one, which is the reason we started Ro, um, is very personal to me. And it's I deeply believe-- like very simply, we help patients achieve their health goals because when we do, we think we unlock the full- their full potential. If you do that at scale, you unlock the full potential of humanity. And I was very, very lucky. I grew up with my dad, who is a doctor, and he saved my life. Having a general heart condition, I had a heart procedure when I was eighteen. Um, but he helped me achieve my health goals to go chase after my life goals. And so he helped me navigate that procedure when I was eighteen. Right after, actually, the main side effect of my heart medication was erectile dysfunction, which is obviously every eighteen-year-old's dream in their first semester of college, like calling up, "Hey, Dad." And he helped me navigate that. And I was actually-- I've never shared this publicly, but when I was twelve, um, I didn't grow for about a year. I was already quite small, bullied a lot, and, uh, my parents fought with the healthcare system to get, to get it covered, but to help me get growth hormone. So I took a injection in my leg every single day for about six years until I-- Uh, so I entered high school like four-eight, four-nine, and I left like six-six-one. And so those three paths, if you think about it from my perspective, there was either a world where I was like dead at eighteen, five-three with erectile dysfunction-

    22. PO

      [laughs]

    23. ZR

      ... which is like not great.

    24. PO

      [laughs]

    25. ZR

      Or six-one and married to the most incredible person in the entire world. And I do think that it was because my parents and my dad were constantly fighting with the healthcare system. Like, they set me on an entirely different trajectory as an individual. And then on the societal impact, whenever we as a society, whenever we attack like the leading causes of death, just upstream, not downstream, but upstream when we attack those, you see the shape of society dramatically shift on the other side. So from year zero to eighteen hundred, our life expectancy is thirty. And a lot of people will say, "Yeah, it's, it's, it's infant mortality." It's like, yes, it was infant mortality. It's also maternal mortality. It's also infectious disease, those big three. What ends up happening when we largely combat infectious disease and infant mortality and maternal mortality, they're no longer mourning the loss of children and spouses every single day. They invest in the kids that they have. Those kids go to high school. They go to college. Women enter the workforce. We have the Industrial Revolution. Forty percent of the population goes from making food to four. We get electricity from ten percent of pe- homes to a hundred percent. And all of that happened, I believe, because health is a precondition to progress. And so right now, if we think of the leading causes of death as the thing I just mentioned, those chronic diseases, if we can attack those upstream, I think we can shift the trajectory of our society in ways that we cannot predict, in ways that will be beautiful and amazing and Can't wait to see what happens.

    26. PO

      Do you think that if you had to predict the percent of people on some form of a GLP-1-

    27. ZR

      Yeah

    28. PO

      ... 10 years from now or something-

    29. ZR

      Yeah

    30. PO

      ... what would you, what would your prediction be from 10 or 15 today?

  6. 25:46 – 30:02

    Jobs Over Lives

    1. PO

      Before we close out this chapter of, like, the State of the Union and the system-

    2. ZR

      Yeah

    3. PO

      ... um, I love this, this notion of jobs over lives as-

    4. ZR

      Okay

    5. PO

      ... like, one framework.

    6. ZR

      Yeah.

    7. PO

      Um, talk, talk to us about what you're thinking here.

    8. ZR

      Yeah. So there's, there's one of those that might, uh, be a little bit more controversial, but we can, we can do it. There's a conversation in healthcare that's happening right now, I also think you see it in other industries, where people say things like, "Healthcare must remain human." I think it's the entire wrong question to ask ourselves. Not that I don't think parts of it will, but it's an obsession over inputs instead of outcomes, right? And, and I think that when you do that, you are not prioritizing patient health outcomes above everything else. And so I think tools, both humans and new technology, must earn their place, and the status quo does not get a pass just because its, of its current existence, right? And so I think driverless cars are a great example in my mind, where we are having quite a bizarre conversation, in my opinion, which is about 40,000 people, uh, a year die from car accidents. That is almost the same exact number as the people who die from breast cancer every single year.

    9. PO

      Nuts.

    10. ZR

      Nuts. Absolutely nuts. Driverless cars in pockets have proven to be 10, 20 times safer than a human driver. So we basically for certain types of cancer have a cure, and the conversation is not, how do we have operation warp speed for this cure for cancer? It is a lot about and more about job displacement, and it's not that I wanna diminish job displacement, it's that we should not, and this is what we were talking about, we should not and we cannot prioritize jobs over lives. If we were talking about a cure for cancer and someone said like, "But what about the people currently treating cancer patients without the cure?" I don't even know that they would be able to a-

    11. PO

      Stupid idea

    12. ZR

      ... It was the stupidest idea ever. There's a story that I heard a CEO of a driverless car company say. They were speaking to a regulator, and the regulator asked the CEO, when they told them about the reduction of deaths, the regulator said, "But what about the organs?" And the CEO was like flabbergasted, and they... What, what the regulator was referring to is the organs from people who are dying in car accidents that can save other people's lives. A beautiful thing, having said that, what the CEO's response was, I don't know whether they said it out loud, but at least when they told me this is what they had in their head, was hopefully they're still in the original person.

    13. PO

      Yeah.

    14. ZR

      Right? And so I think that we as a society, especially when it comes to health, must prioritize outcomes over inputs. The new thing must prove its worth. So it's not that, hey, technology automatically gets a free pass. It doesn't. It must prove not that it's 1% better, but that it is substantially better than the status quo, but we as a result cannot give the status quo a pass, and I think we see that with driverless cars right now, and it's a very painful conversation, and I do believe that the people impeding driverless cars where they are proven to be safe should have a body count attached to their name, truly, and I think we will look back on it as such. And I think that my... one of my biggest worries is related to healthcare, that we will have that same level of prioritizing inputs over outcomes.

    15. PO

      There was that great chart a couple days ago showing the total revenue of GLP-1s-

    16. ZR

      Yeah

    17. PO

      ... versus like AI revenue.

    18. ZR

      Yeah.

    19. PO

      And it's like bigger. You know, the GLP-

    20. ZR

      It's bigger

    21. PO

      ... 1s are bigger.

    22. ZR

      That's right.

    23. PO

      It's kinda crazy.

    24. ZR

      Well, there's, there's two cool things here. One is, um, not only were GLP-1s larger from a revenue perspective, but individuals pay for GLP-1s. Twice the number of people, uh, pay for GLP-1s than, than pay for AI.

    25. PO

      Yeah.

    26. ZR

      So from a consumer's perspective, I think they're telling you. I think that's a, that is a problem with the AI narrative right now, that there's not enough of a consumer impact day to day. Um, so the, the gap of like real ter- real-time impact to the, uh, tens or hundreds of millions of people hopefully can be, can be bridged.

  7. 30:02 – 47:43

    The Turnaround

    1. PO

      I'd love now to tell the story about this crazy company turnaround-

    2. ZR

      Yeah

    3. PO

      ... that you've been through. Company's been around nine years, and about four or five years ago you went through a really fascinating-

    4. ZR

      Yeah

    5. PO

      ... period of time. And you said the number kinda casually earlier, but the company's like 10 times the size it was-

    6. ZR

      Yeah

    7. PO

      ... not that long ago.

    8. ZR

      Mm-hmm.

    9. PO

      Obviously GLP-1s is a, is a big part of that. And, um- The company's charts look kind of like the GLP-1's charts.

    10. ZR

      Mm-hmm.

    11. PO

      And so that, that's one explanatory factor.

    12. ZR

      Yeah.

    13. PO

      But that, that hides a very fascinating-

    14. ZR

      Yeah

    15. PO

      ... story.

    16. ZR

      Yeah.

    17. PO

      That I'd love you to tell in some detail because when I've heard it from you in the past, I just think it's, like, such a cool, fun example.

    18. ZR

      Yeah.

    19. PO

      And I think you're willing to be kinda-

    20. ZR

      Yeah

    21. PO

      ... uh, raw about the details of it for what entrepreneurship is like.

    22. ZR

      Yeah.

    23. PO

      Like, oh, cool, three billion bucks. That, you know-

    24. ZR

      Yeah

    25. PO

      ... that's a great business.

    26. ZR

      Yeah.

    27. PO

      But, like, nine years and a lot of-

    28. ZR

      Yeah

    29. PO

      ... blood, sweat, and tears to get here. So yeah, maybe tell-

    30. ZR

      Sure

  8. 47:43 – 51:55

    Where Healthcare Goes Next

    1. PO

      Yeah. Speculate a little bit on where you think we go next as a healthcare system in the US. There's all these amazing companies discovering drugs using AI. I'm sure the things that, the medicines that help you achieve your mission for your customer are gonna proliferate-

    2. ZR

      Yeah

    3. PO

      ... like crazy. Yeah, just speculate on like where you think things are going. What has you excited? What has you worried?

    4. ZR

      Yeah. I think we are, we are at the beginning of this patient revolution. I do, do believe that partially because of a systemic failure that, that, um, is happening. But there's three... Like you talk about tailwinds, there's the GLP-1 tailwind, but I actually think there's like three tailwinds to our business. The first is that human biology is coming online, right? So that's everything from self-reported symptoms to your lab test, to your genetics, to your wearable data, but your biology is coming online. So number one tailwind, biology coming online. Number two, what used to require a specialist now requires a prompt. When we first started, people would ask us questions like, "Well, what ty- like, who am I gonna... What type of doctor am I going to get online?" First, they dramatically underestimated how flawed the existing healthcare system was and how many doctors were burnt out and fed up and needed an alternative way of life. So we have really high quality doctors who get to work from home and see their kids in the same way that we see that today in tech.

    5. PO

      Yeah.

    6. ZR

      But I think what's interesting is to see investor sentiment change, where they're paying 100K a year for a concierge doctor, and they ping Claude for 20 bucks a month, and it's way better. So used to require a specialist, now requires a prompt. Third is there are now treatments that do radically shift the quality and quantity of people's lives, right? They're just not evenly distributed, right? Like some people live in the future, it's just not evenly distributed kind of thing. Think about Ro being the largest provider of GLP-1s in the country. Some of the questions that we start to ask ourselves is, okay, well, why do men lose less than women when they weren't on GLP-1s? Why do people of Hispanic descent lose less than, uh, Caucasian people? Why do some people lose 35% of their body weight and other people lose five? Why do some people experience side effects and others don't? You add on genetic data, you add on wearable data, you add on ongoing lab tests, you add on self-reported data. So you add on all of these, and the question that you constantly ask yourself back with medicine being sort of trial and error is like, can you get at, can you get at like the, the faintest footsteps of a disease? Like, just like a whisper, right? 'Cause if you can do that, that's where you can really shift the trajectory. Those three tailwinds of biology coming online, AI, what used to require a specialist now requires a prompt, and w- n- current and new treatments that both leverage that but then, uh, allow you to actually turn the service of concierge care into a commodity anyone can access, that can create that patient revolution. And I think we can go even further than that. Like not just concierge care online, but I think we can get a whole new form of healthcare for the price of Netflix.

    7. PO

      Vanta automates compliance so your team can spend less time on security reviews and more time getting customers. Vanta cuts audit prep by 82% and gives you instant up-to-date proof of trust without all the manual work, so you can close deals faster and with less friction. Customers report a 526% return on investment, and more than 16,000 companies use Vanta, including Ramp, Harvey, and Snowflake. Get started with $1,000 off at vanta.com/invest. Ridgeline is the only AI-native investment management platform that brings the front, middle, and back office together in one system. It gives firms one place for their data and uses AI agents to automate repetitive work like onboarding, reconciliation, post-trade compliance, and reporting so teams can spend more time on investing, serving clients, and growing the business. Ridgeline is built to give you time back that can change the trajectory of your firm and be the inflection point that takes your growth from incremental to accelerated. Ridgeline also wants to help asset and wealth managers understand and improve their firm's growth trajectory. So they built an interactive dashboard that lets you see how your firm compares to 16,000 peers. If you file a Form ADV, your firm is already in it. Visit ridgeline.ai/trajectory to see where your firm stands. Then talk to Ridgeline about how you can do more with the team you already have.

  9. 51:55 – 1:00:27

    Pitch Me on a GLP-1

    1. PO

      I think you're on a GLP-1.

    2. ZR

      I am on a GLP-1, yeah.

    3. PO

      So what is your pitch to the person... Actually, pitch me. I'm not on a GLP-1. I don't like... I, I, w- I, I don't think I traditionally would have been-

    4. ZR

      Yeah

    5. PO

      ... the form factor of a person [chuckles] that would be on one.

    6. ZR

      Yeah.

    7. PO

      Like how would you pitch people kind of in the general populace that are curious about this technology, let's call it this, um-

    8. ZR

      Yeah

    9. PO

      ... this method?

    10. ZR

      So I'm, I'm a big believer in taking, uh, in both all of the things, diet, exercise, sleep, drugs and supplements, community. Those are basically the five things you can do for your health. So back to sort of that incentive structure, which is, first, the time horizon that I am looking to reduce risk for myself is radically different than the typical healthcare system is measuring risk. They're measuring risks on ten, fifteen-year time horizons. I'm pretty confident I'm gonna be good when I'm forty-five. I'm worried about fifty-five, sixty-five, seventy-five, and a lot of chronic disease are area under the curve problems. How long do you spend at elevated LDL levels? Or how long do you spend with metabolic dysfunction or insulin resistance? So they're area under the curve problems. As far as like the pitch that I would make to you, I wouldn't say like you must be on a GLP-1 or you shouldn't. There would be first like, what are your health goals, right? Then you would say, what are, you know, some family history, trying to understand, and then also the, your risk tolerance, your risks and benefits, right? And then ultimately, you're gonna have to ideally work, you work with a provider to understand what combination of treatments might be right for you. Um, and I don't give that answer of like, "Hey, work with a healthcare provider to see what might be right for you," like sounds like an ad at the end of it. But it's actually because that's truly how it should, it should, uh, should function. My quote unquote like health stack has been built up over the last ten, fifteen years, like with my dad, A/B testing different drugs, adding them on top of each other, taking some off, adding others on, measuring my blood test values and other, uh, metrics along the way to dial in for me based working backwards for my, for my health goals.

    11. PO

      Mm-hmm.

    12. ZR

      My dad had his first heart attack and stroke when he was actually thirty-nine, had to stop practicing medicine. And there's sort of blessing and a burden about that, which is, uh, he got the thing that he loved the most taken away from him at that time, but, uh, he also became a stay-at-home dad, and I got to spend a lot of time with him. Um, and in many ways, I'm, I'm sure a therapist would have a lot to say about this, but in many ways I feel like I'm trying to recreate him with software. I'm trying to give him to, to everyone, keep him alive forever in, in some way, shape, or form. But, uh, but as a result, I've been very aggressive as when it comes to heart disease. So I'm on... My cholesterol when I was about thirty years old was two thirty. My ApoB was a hundred plus. My LDL was a hundred and thirty, a hundred and forty. And I was eating and exercising and doing all of the things that are in your control. But my, uh, uh- ... genetics were such that I needed additional support. And so I started a statin. Then I started, uh, Zetia, which is the brand name for ezetimibe. Then I added Repatha, uh, which w- which we've talked about, and then I added a GLP-1. And my LDL went from 130 to 70 to 80 to 60 to 10, right? My ApoB went from 90 to 60 to, when I s- get my ApoB, I have a less than in front of it. There's like a search party out for my ApoB-

    13. PO

      [laughs]

    14. ZR

      ... and I'm very proud of that. Um, so I'm willing to be disproportionately aggressive here relative to maybe the, the population. And so that to me would be like the conversation that you would ideally have.

    15. PO

      Yeah.

    16. ZR

      And so we'd, we'd go from there and saying, "What's really important to you? What are you trying to achieve? What are sort of your risks?" And then you'd analyze the risks and benefits of each decision.

    17. PO

      So for that one, a- as, as an example, um, I'm fascinated by the LDL thing and the area under the curve. Like, I have no history of heart disease in my family luckily, but I take Repatha 'cause my LDL is really high. And so you and others have, have convinced me of the merits of this along with pr- you know, great doctors, et cetera. But something like that, let's just stick with that example. Okay, so you're on several things to bring it from 130 to 10.

    18. ZR

      Mm-hmm.

    19. PO

      What are the trade-offs in your mind associated with that specifically? And like how do you think... Like, how do you think about what the benefit is?

    20. ZR

      Yeah.

    21. PO

      Probably years of life or quality of life.

    22. ZR

      Yeah.

    23. PO

      But how much?

    24. ZR

      Yeah.

    25. PO

      And then what the costs are or the risks are associated.

    26. ZR

      Yep. Um, so with any one of them, they have risks and benefits, and I've actually dialed in the dose to where I don't experience day-to-day side effects from any one of those.

    27. PO

      This stuff, yeah.

    28. ZR

      Yep. But I have tried where up, when I started with a statin, um, and I first asked myself, "Oh, should I increase the dose of my statin? Should I add Zetia? Should I add Repatha?" And so I dialed in each one of those things independently, went off some, went on some to saw- to see the m- the, the marginal impact of each one, as well as, um, to make sure I could isolate if I w- if I were experiencing side effects. Was it dose related? Was it drug related? Was it potentially a combination of certain treatments? Um, and so was able to find the regimen with my doctor to be able to navigate that. Um, so with anything, the downside is really, like, costs and side effects. Um, and then I think about it, which is interesting to me, which is the, like, asymmetric downside of getting a heart attack or a stroke for me, right? So to me when I think about it, like, I take these medications. They're remarkably safe. Um, the side effect profile for me is incredibly favorable, and it's a couple hundred dollars a month. And that is worth decreasing my risk of heart disease by, like, literally whatever percentage it ends up doing.

    29. PO

      Yeah.

    30. ZR

      That might not be the case for everyone, but I actually think you're going to see... Like Repatha's a great example, uh, of where I hope you're going to see, one, prices come down. What happened when it went direct? It went from $600 a month to 200, right? Went down like 60, 70%, and hopefully it gets lower. There's a new oral coming out and, uh, an oral PCSK9. It's actually an oral peptide PCSK9. And the way that that was discovered, and I think this is a great example of where AI can be tremendously helpful from a healthcare perspective. So where AI is, like, really, really good, as we all know, it's where there's a ton of structured data, when there's a verifiable reward, and there's a really tight feedback loop, right? That's where math and coding really thrive, right? Problem with medicine is it's trial and error. A lot of the data's unstructured, and the feedback loop of, like, death or heart disease takes a really long time, right? And so the PCSK9 is sort of a beautiful example of can we do A, more of that, and can we do it faster? So there's a Dallas Heart Study. It was the year 2000. They had about 3,500 patients, half Black, half white. Those patients get genetic testing, they get scans, they get imaging, and they get cared for on an ongoing basis. 2006, the researchers realized, so six years later, the researchers realized that it turns out there's a group of people in this study that have a faulty PCSK9 gene, and they have basically LDL levels in the 30s to 40s, and they have a 85 to 90% risk of, uh, r- risk reduction of heart disease no matter what they did.

  10. 1:00:27 – 1:06:33

    Recreating His Dad in Software

    1. ZR

      get there.

    2. PO

      Seems like the right time to ask more about this comment you made that you're trying to recreate your dad in software.

    3. ZR

      Yeah.

    4. PO

      Say more about that.

    5. ZR

      You know, he-- I think he's changed my life in so many different ways. It's hard to I've never been asked the follow-up question on that, and it's hard to put into words the impact that I think he's had on my life, um, and how much he inspires me, but I, I guess at my core, I do believe that the best way that I can have a positive impact on the world is to give people more healthy happy years, and if you can do that, then they can chase their life goals. And I guess I grew up around someone who... in my dad, who devoted his entire life, every second of every day, that man is just trying to give additional healthy years to people because I think that's who he thinks, and I believe this to be the case, like, that's who he was born to be. And I've seen up close and person the impact that that's had on myself and loved ones. And the idea of... I love, like, the written word, and I love technology because it is an incredible form of leverage, right? I'm still reading books that were written 2,000 years ago, and technology obviously scales. A small group of people can have a tremendous impact on the world. And so I saw the impact that my dad had on the loved ones, myself around us, but he was limited by those he could speak to directly or those whose, you know, hands he could, uh, hold. And so if I can recreate that with software and operations and technology and give that to other people, it's hard for me personally, I'm sure others can, whatever it is for them, but it's hard for me personally to... It's, it would be hard for me to think about a life better spent than trying to do what he did for many, many people, for millions of people.

    6. PO

      Can you say more about this idea of bor- thing you were born to do as, as a notion, what you've observed in others that seem to have found that thing, why you believe that that's a thing in the first place, what it's like being in that versus, and I'm sure at points of your life you weren't, you know, in that state. Anything else you could share about that idea?

    7. ZR

      I think a lot of stories make more sense in retrospect than during. Like, I don't know that when I was younger I felt that I was born to do what I'm doing today. But when I look back and see how I got here, it kind of makes perfect sense to me.

    8. PO

      Mm-hmm.

    9. ZR

      And I think the same thing actually about my wife too. She runs a, a YouTube channel. Actually, after everyone here has fully watched all of Invest Like The Best, every single one, and you're looking for something else to watch, um, she runs a YouTube channel called Huge If True.

    10. PO

      Not just a YouTube channel, like one of the best and biggest ones.

    11. ZR

      I would actually argue that she's the best journalist on the internet.

    12. PO

      She's very good.

    13. ZR

      She's very, very good. Uh, she's definitely my better half. But the incredible thing is when, when, when she talks through, like, why she does it, she will say, uh, "When people see a better future, they help build it." And people will ask her all the time. They'll say, you know, "Why... How did you get into this? Why do you, why do you love to explain things to people?" And she said she's only realized this in retrospect that I think she was born to do the thing that she's doing today, which is she grew up, her two parents were lawyers, and her dad, uh, was a corporate litigator, but also did pro bono death penalty cases. And he would talk about them, uh, the two of them, both of, both of their parents would talk about them at the dinner table with Cleo when she was a little girl, 9, 10, 11, 12. Death penalty cases. But he would obsess over opening arguments, closing arguments, and every little phrase. And what she saw, though, was if you could explain something to a group of people, to 12 people of your peers, if you could explain something to them where they understood something new about the world, that you could change the trajectory of someone's life, and that is why her dad was so passionate about what he did. And so she grew up in a household understanding that education and doing... a- and educating people in a powerful, simple way, uh, can change the future. And so she now to this day, you know, wakes up and gets to try and do that at scale. And I think only as we've talked about, like, kind of, you know, 'cause we both are founders, and I think look back and say, "Well, it kind of makes sense how we ended up here," but didn't... it was less intentional than this is what we were meant to do.

    14. PO

      May- maybe even pitch a little more, like, the, what the benefits are when you find that thing, like how it feels to be doing the thing.

    15. ZR

      Oh, it's such a gift. You don't feel like you're working. It is, uh, it's so energizing. Like, I skip to work every single day. My team at this point knows to never, on Friday, never say, "Have a good weekend," because I will respond, "I can't wait till Monday." And I think there's, like, no greater gift than working with other people to have a positive impact on the world. And so when you find that, like a lot of people, there's, of course, there's, like, personal and professional life, but when you find harmony between those two things and you don't feel like you are, quote-unquote, like, working, it's like a bizarre phrase to me. Um, it's how we spend the majority of our waking hours. That's why I think at Ro, like, where talented people work is a gift. You have to earn that gift, and you take that responsibility super seriously. So when you find the thing that you, to your point, like, when you find the thing that you were meant to do, I think you stop thinking about it like work.

    16. PO

      Yeah.

    17. ZR

      And it's just, you just follow the rabbit hole of your brain.

  11. 1:06:33 – 1:19:06

    Marketing Into Stigma

    1. PO

      D- one of the things that's i- interesting to me today is there aren't that many great, new, well-known consumer businesses. Building them is extremely difficult.

    2. ZR

      Yeah.

    3. PO

      But when you have consumer distribution-

    4. ZR

      Yeah

    5. PO

      ... it's like one of the most powerful things in business.

    6. ZR

      Totally.

    7. PO

      So if I go back to that original-

    8. ZR

      Yeah

    9. PO

      ... beachhead-

    10. ZR

      Yeah

    11. PO

      ... um, with Viagra or whatever, what- whatever the other drugs were What were all-- T- talk about all those aspects around that first beachhead.

    12. ZR

      It's a gr- it's a great question. In healthcare, there's this thing that a lot of digital health has this graveyard of startups where people focus on need, and need and need alone. And I think the key that we have always believed at Ro is we start with what patients want and find the overlap with need. It's not that they just want it and it doesn't-- they don't need it. They-- we find the overlap, we find-- we start with want, and it's very specific that it's want to start overlap with need. Because if I went to your doctor and I said, "Hey, Patrick's doctor, um, what does Patrick need?" Right? They would say, with all of the confidence in the world, exactly what you needed. Now, if I went to them and said, "Hey, what does Patrick want?" Well, they'd say, "I don't know. You gotta ask him." So it naturally puts you in a patient-centric position and one of, like, selflessness and egolessness, um, where you are in service of what the patient wants. And that's how I think we have activated consumers in healthcare, is we are completely willing to be misunderstood. Um, when we first started, um, the New York Times called us, like, restaurant men-menu medicine as if this was, like, a bad thing. I was like, "People have great experiences at restaurants."

    13. PO

      [laughs]

    14. ZR

      You go, you have a menu, and then there's prices, and then you select what you want. Um, so I think we were very, very comfortable being wildly misunderstood as long as the patient outcomes and the patient was at the center of everything we do. People of- often ask us, like, "Well, how do you assess risk at the company?" And I will always say, "Never at the expense of a patient, always on their behalf." We will push, we will take risk as, as a company if we are fighting on behalf of patient health outcomes. And the new thing, again, the new thing, the data, the new model, it always has a higher burden of proof, as it should. So we bring the data. We've published data on the outcomes. We've published data on our side effect response times. Basically, every single time you send a message to Ro that's routed through an LLM, we've analyzed the topic, we've analyzed the issue. If you've mentioned a side effect, that side effect gets structured, a task is created, it's assigned to a healthcare provider, an SLA is attached, and we have a twenty-four seven sub thirty-minute response time for your side effect. That's an entirely, like, new form of healthcare. So you gotta bring the receipts if you're gonna ruffle feathers. And then on the marketing side, like, I was into commercials early on. It's not something that, like... It, it wasn't where I said, "Hey, I need to be a, uh, like, self-promotional CEO." Um, this is, like, my first extended podcast ever in nine years. But it was more actually where I was into commercial because with marketing and how we think about a lot of these things is there's sort of two components here, and we do this to this day. One is we talk a lot about you need data to move the brain, you need a story to move the heart, and you need both to move a human. And so that was one component to our marketing where I challenged the idea for many people of, like, who could have erectile dysfunction. And then the second thing is with great marketing, I do think, particularly with things that have stigma attached to them, weight loss, reproductive health, mental health, ED, whatever it may be, to what our marketing does is it tries to create permission structures on behalf of people who need that product or service b- by, uh, doing two things. Massively shifting the Overton window so that we're the extreme, so that they never have to be. Right? And the second is by telling stories that, that deeply resonate with them. So, like, Serena Williams is a great example of this. She's a, uh, ambassador for Ro Body for GLP-1s. She is one of one as a human being. Greatest of all time tennis player. But she's one of millions when it comes to her health journey. Right? Mother of two, was doing everything right, diet, exercising. The scale wouldn't budge, and she was having health challenges on the other side of having two kids. The number of people... I was speaking to a patient this week who was almost in tears saying what seeing Serena Williams did for them. They felt comfortable, and they said, "If Serena needs this, then it's okay if, if I need it." Right? And you've seen us with the same thing with Charles Barkley or the same thing with Chrissy Metz or the same thing with Megan Fox and ED. Right? M- Megan Fox for a certain generation could tell people to get a colonoscopy, and they'd be like, [clapping] "Done," you know? And the fact that she's like, "Hey, sex is an important part of relationships. It's okay if you need support. The fact is you're taking a step forward, and that actually shows a commitment to your partner," and I love that. So that just creates a permission structure for someone who sits there and say, "Well, I don't know what my partner's gonna think." And so I think all of these things try to really touch on each one of those.

    15. PO

      May- maybe say one bit more, too. I'm so intrigued by these methods about, I would phrase it as, like, stigma as a signpost towards latent demand.

    16. ZR

      Mm-hmm.

    17. PO

      Like unmet demand.

    18. ZR

      Yeah.

    19. PO

      What, what have you learned about that idea of, like, stigma-

    20. ZR

      There's a lot of potential energy there.

    21. PO

      Yeah.

    22. ZR

      And when there's a lot of tension on a subject, that's something that a lot of consumer founders can, like, tap into.

    23. PO

      Yeah.

    24. ZR

      Now, I think the way that we've tapped into that is always having what I would argue is, like, the moral high ground. Like, the more controversial you are but, at the same time, if you can look back and say, "In the fullness of time, history will be on our side," you can be as loud and loud and loud as possible. Right? And so that to me is like even take, take GLP-1. So r- like, when we push-- when we were pushing, we originally had this, I put in quotation, "controversial" subway campaign where the only thing that we did was show people that were clinically eligible using the medication and then said a weekly shot to lose weight. It was literally instructions, and it caused, like, this massive kerfuffle.

    25. PO

      Why?

    26. ZR

      People were very uncomfortable by the idea of people using injections to lose weight, and we knew that.

    27. PO

      Yeah.

    28. ZR

      Um, but it was... But people misunderstood the negative health impacts of carrying excess weight.

    29. PO

      Yeah.

    30. ZR

      They thought of it like a shortcut. You take myths in society, like the myth of, oh, obesity is just a lack of self-disci-discipline or willpower, and you can poke at that, right? Oh, only X, Y, or Z people need medication, or only X, Y, or Z people, um, should be treated for ED or whatever it may be. Take another one as an example that relates to GLP-1s, where people are oftentimes talking about, um Well, how do you, uh, how do you go off of them? Like, when do you go off of them? And people should be able to go off medication whenever they want. They should do it safely, and there should be no judgment if they wanna try and achieve their health goals without medication. But it's very interesting and a sign of the stigma that people want when it comes to weight loss medication, they talk about it as if they're shocked and they w- they do not want people to need the medication on an ongoing basis, unlike any other form of actual medication or behavior. So as an example, like, what do people think is gonna happen when they stop taking their cholesterol medication? Oh, they're gonna go up, right? What do people think is gonna happen when they stop taking birth control? Right? It's not gonna be a surprise. And then as opposed to, like, behavior too, you can't just do one pushup. You can't eat one salad. Basically, any medication, any behavior you need to continue to do on an ongoing basis to continue to get the benefits. The fact that, like, that makes people's stomach churn when it comes to weight loss medications is a far greater reflection of how they feel about that. And so there's ten- when there's tension in something that shouldn't be the case, when it's just intellectually wrong and societally charged, it creates an opportunity to play with that from a societal perspective.

  12. 1:19:06 – 1:20:58

    Zach's Hottest Take

    1. PO

      Are there other things that... I guess the, the prompt would be like the hottest takes you have, like differences of opinion ... versus your peers, versus the industry, versus the world, like where you feel most alone in what you believe?

    2. ZR

      Feel very lucky, but I think that there's a lot of... I understand why there is, but there's a lot of obsession over the founder and, and I think that maybe this is, maybe other founders don't, but I feel like I have an incredible, like support network. And I think in particular, I would say like my spouse, like, I don't know that founders who have very, very supportive, uh, spouses, like, talk about it, uh, a lot, to be honest. Um, like Cleo and I have taken turns, actually. We met very, very young. We met when I was 19, and she was 17, and we started dating a few years later. We've been together 13 years, and in New York City, we k- we grew up together. We have taken turns financially supporting one another, actually. So when I first started Ro, I was like, we were living in a friend's apartment together. We had the smaller room. He had the master. She was on a journalist salary, buying both of us like breakfast, lunch and dinner. And so I would not be the person I am today or be able to run Ro if, I don't if, and if we weren't together. And so I think there's just a lot of people along the way in these journeys that it's usually kind of like just assigned to one person. I would say the same thing with our team. Um, like our team is absolutely incredible. So that's probably like one of the things that I think there's a lot of founders that-

    3. PO

      A lot of worship

    4. ZR

      ... they believe their shit doesn't stink, and it's kind of exhausting. So yeah, that's probably-

    5. PO

      Not a lot of hard ass founder wife guys [laughs] .

    6. ZR

      There you go. It's true. It's true. Seems weak, seems macaroon soft, but I actually think it's the opposite.

    7. PO

      [laughs]

  13. 1:20:58 – 1:24:53

    The Kindest Thing Anyone Has Done for Zach

    1. PO

      This has been incredibly fun. It's so cool to hear all the lessons that you've learned doing this twice, I guess, if you refounded it halfway through. And I do think that these tailwinds that you've taught us about today are the two most interesting in the entire world, and I sure hope they keep, they keep blowing. You know my traditional closing question when I do this. What is the kindest thing that anyone's ever done for you?

    2. ZR

      Uh, so I've thought about this 'cause I listen to your podcast all the time. Um, and I think I was inspired by your answer, which is when I was fifteen years old, uh, I was at boarding school, and I was very homesick. I missed my parents tremendously. And they came to visit me, and my dad and mom, uh, watched me play sports, and they took me out to dinner. And my way of expressing my love to them, because I was homesick, was I was kind of mean. And my parents knew it. Uh, they knew that it was just me acting out in that way. And when they were leaving, my dad asked my mom to drive. And my mom has an autoimmune disease, and so he, he normally drives. And so, again, back to what we said before, sometimes you realize things in retrospect. Like, I didn't realize at the time that something was different explicitly, but im-implicitly I did. I was like, "That's odd." Then my dad got in the passenger seat, and he rolled down the window, and something in his voice changed where he looked at me and he just said, he said, "Tell me you love me." And I, I completely switched, and I said like, "Of, of course, I love you. I love you so much." And he said, "Good, I love you too," and he drove away. And he looks at my mom, I've only found this out later, he looks at my mom and he says, "Take me to the hospital. I'm having my fourth heart attack." And I asked him after, he fortunately made it. He didn't think he was gonna make it. I asked him after, I was like, "Hey, like, seconds matter, like, what were you doing?" And he goes, "Well, first, I... it was two seconds and I didn't think I was gonna make it. And the second is I didn't want your last words to me to be an argument. I wanted them to be I love you." And it's like one of the most selfless things that he could have done. But what it did for me, I think the gift that he gave me, was to never let the love that you feel for people go unspoken. And so to this day, when I hang up with him, my friends, I will say, "I love you." And even to this... my, I got my co-founder. It took me six years. I say I love you to him when we hang up a Google Hangout. When I hang up on the phone, I tell him, "I love you," and I do. I love him. And so I think at such a young age, feeling the fragility of that and having someone, being able to like put your hand on the stove with unspoken love and not doing that ever again is something that I think I'll always cherish for him.

    3. PO

      Incredible story. Very unique. I've done a lot of these, haven't heard one quite like that. Thank you so much for your time. [upbeat music] You know how small advantages compound over time? That's true in investing and just as true in how you run your company. Your spending system is your capital allocation strategy. Ramp makes it smarter by default, better data, better decisions, better economics over time. See how at ramp.com/invest. As your business grows, Vanta scales with you, automating compliance and giving you a single source of truth for security and risk. Learn more at vanta.com/invest. The best AI and software companies from OpenAI to Cursor to Perplexity use WorkOS to become enterprise-ready overnight, not in months. Visit workos.com to skip the unglamorous infrastructure work and focus on your product. Ridgeline is redefining asset management technology as a true partner, not just a software vendor. They've helped firms five X in scale, enabling faster growth, smarter operations, and a competitive edge. Visit ridgelineapps.com to see what they can unlock for your firm.

Episode duration: 1:24:54

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