Amir Motmaen

Alex Karnal (@alex_karnal) is the most talented bio and healthcare investor I've ever met. He's spent 20 years in the industry and says 2025 was the single most exciting year he's seen. The start of a once-in-a-lifetime, trillion-dollar revolution in public health. He explains how few people realize we already have the medicines to prevent our deadliest diseases. The problem is that almost no one takes them. There's a population of people born with a mutation that means their bodies don't produce a protein called PCSK9. Their lifetime risk of cardiovascular disease is 88% lower than yours. Pharma turned that genetic advantage into a drug. It's been approved for years, but the number of people taking it is still vanishingly small. Partly because high cholesterol is a silent killer. You feel nothing, right up until you have a heart attack. And partly because the health system makes it punishingly hard to stay on a preventive drug like a PCSK9 inhibitor. In other words, the medicine works, but the system around it doesn't. That's what's starting to change, and in this episode, Alex explains why. We discuss the "health stack" he believes can add a decade to most lives, why oral GLP-1s are breaking every adoption record in pharma, peptides and citizen pharmacology, and what AI is doing to drug discovery. I wish I had an "Alex" for every interesting topic. We've been having versions of this conversation for over five years, and every single one is as clear and as useful as this one. Enjoy! Timestamps: 0:00 Intro 1:00 The State of Modern Medicine 5:00 Designing the Modern Health Stack 12:17 The GLP-1 Inflection Point 19:18 The Biological Mechanisms of GLP-1 30:36 Overcoming Frictions in Healthcare 34:19 Cardiovascular Disease 44:04 Addressing Alzheimer's 47:04 The Future of Cancer 57:33 Drug Discovery 1:05:25 AI and Scientific Super Intelligence 1:14:40 Citizen Pharmacology and the Peptide Movement 1:18:13 Background and Career Journey 1:31:09 Braidwell's Investment Approach 1:33:30 The Kindest Thing

This is Masoumeh Ebtekar, the 1979 U.S. Embassy hostage-taker spokeswoman, once ready to “shoot American hostages in the head, here she responded to my investigation into her son’s luxury life in Los Angeles. She laughs, nervously and claims her son is “just another student” like thousands of Iranians in America, and says he plans to go back. That’s not just misleading. It’s a big lie because he stayed. He benefited. And he represents something very different. There is NO comparison between the children of regime insiders living freely in the West… and Iranian students and professionals who fled repression, risked everything, and are victims of the same regime, I hope the US hear their voices and protect the victims while revoking the visa of the children of Islamic Republic, who support terror. I asked the Biden administration to investigate these networks, just as they investigated Vladimir Putin’s inner circle but No action. Thank you @SecRubio for finally hearing the voice of Iranians.

While Iran is under war and repression, regime affiliates freely live in the U.S. with green cards and even citizenship, laundering money and promoting the IRGC. Reviewing these cases is reasonable. But don’t punish the wrong people. Thousands of Iranian students and legal immigrants, many who fled the regime, are now at risk because of the USCIS pause. Protect them. #USCISPause #LiftTheHold

Mr. @SecMullinDHS, as you step into your new position I ask you to provide particular consideration to the status of Iranian students and professionals in the United States who may be at risk of immigration complications due to Presidential Proclamations 10949 and 10998. Many of these individuals fled the Islamic Republic’s because they believe in freedom, democracy, and the values this country stands for. They are also contributing to the United States every day. They arrived in this country legally, followed the rules, respect this country and its system of law and order and are among the most dedicated and accomplished contributors to American society. I ask that you and your department consider these factors, plus the personal and political risk many of these young people would face if sent back to the criminal regime in Iran. America’s concerns for its national security and the threat posed by the Islamic regime to the homeland are entirely justified. To that end, my office stands ready to provide you and your colleagues with regime operatives, propaganda agents, and influence networks for investigation and removal from the United States. Thank you for your consideration.