Kalshi wants you to bet on drugs
and I think everyone should have an Albanian princess in their life
WHAT I’M INTO
Press Play: “Wink Wink” by Charli XCX
I don’t know why you don’t think I could be an angel girl?
Build Literacy: The Garden of Eden by Ernest Hemingway
If you love Hemingway, you may not love The Garden of Eden. The prose is less austere than his usual, and it’s rife with controversies over editorial intrusion, given its posthumous publication. He wrote The Garden of Eden between 1946 and 1961, amassing 48 chapters and 20,000 words. I chose it as my beach read in May because it is set in 1920s Spain and the Côte d’Azur, and I was traveling to Albania, Marseille, and Spain. On the surface, it’s a story about an American writer (David) honeymooning with his very tan, beach-loving, trust fund wife (Catherine). They have it all! But all the swimming, drinking, and eating in the world can’t satisfy them. Catherine yearns to bend gender norms—chopping off and bleaching her hair to role-play as androgynous brothers with her husband. (NRZ, is that you??) When they meet a French woman who’s interested in them both (Marita), Catherine sees it as an opportunity to explore her fantasies further. At some point, it’s hard to tell whether Catherine is more jealous of David’s connection to Marita or his connection to his writing. The book explores gender as Marita steps into the more traditional “wife” role while Catherine and David’s relationship implodes.
Let me curate ur news: “Where Billionaires Summer, a Gardener Died in the Snow” by Rukmini Callimachi (NY Times)
While on Shelter Island for my birthday, I gasped in delight at the beautiful landscaping and wondered how they keep their effulgent hydrangeas in such great shape. Mine barely survived this frigid winter and is now fighting for its life against infernal heat and hazardous air. The answer, of course, is professional landscapers. In the Hamptons, many of them are undocumented day laborers who can’t afford to live where they work. This heartbreaking piece covers the challenges and resilience of the gardeners who keep the East End trimmed, hedged, and picturesque. The math didn’t math when I read that Hamptonites spend $1M a year on landscaping, yet some of their gardeners live in makeshift tents in the woods because they’re not paid a living wage. Others share a room with 1 or more other men for $1k/month. Let’s not forget that their labor directly contributes to high property values out East. Consider donating to Hamptons Community Outreach if you’d like to support one of their few direct lifelines in town.
PULSE CHECK!
“Pulse Check” is your quick hit of what’s going on in healthcare + pharma, complementing the longer, more in-depth “On Health” newsletters.
Trump Tariffs strike again—and will raise generic drug prices. This matters because people don’t take their drugs as prescribed when they’re expensive! ICYMI, Trump threatened generic drug manufacturers with 200% tariffs if they don’t re- or on-shore production to the US. This will raise drug spending on two fronts:
Pharma companies have market exclusivity/patent protection when they launch a new drug. Once this expires, generic drug makers undercut brand prices by capturing market share at a $ignificant di$count. Brand drug products also tend to drop after patent expiry in response. Generic drug makers could exit the US market if the economics don’t make sense, leaving Americans with branded therapeutic options only—even after loss of exclusivity, driving drug spending up, up, UP!
Active pharmaceutical ingredients for generic brands are often produced outside of the US (mostly in India and China, some in Europe) because it’s more cost-effective. They can be exempted from Trump Tariffs if they commit to building manufacturing plants in the US, but making generic drugs is more expensive in the US. This will yield higher prices, as generic manufacturers already operate on slim profit margins.
Kalshi would like you to bet on drugs. In partnership with AppliedXL, they want you to bet on things like whether a late-stage trial will succeed and when a drug will secure FDA approval. Big Pharma invests in late-stage trials when they’re confident the drug works. These have a higher probability of success than early-phase trials (many of which do fail). So what is this solving for, exactly? Supporters pitch that investors can bet on specific drugs rather than the entire company’s stock and that such betting activity could signal which drugs are about to pop off. No, bestie! This is ripe for insider trading at best and bad for patients at worst:
Anyone who sees trial data early (e.g., doctors/nurses at clinical trial sites, investors who meet with FDA in closed-door meetings, biostatisticians) may place bets based on data regular people don’t have, AKA insider trading.
Kalshi aims to mitigate this risk through employment verification. Okay, I’ll bite. Can they guarantee that their family, roommates, lovers won’t bet on their behalf? Even if Kalshi’s employment verification succeeds in blocking employees, trial site investigators, and anyone they associate with from betting on their own drugs, I don’t think that the public opinion of gen pop without clinical trial expertise should influence whether a drug program should be deprioritized.
I’m also concerned that this could manipulate the market by influencing company decisions on FDA approval submission or drive patients to drop out of clinical trials with low betting odds (that are grounded on nothing but vibes).
RFK Jr. would like you to stop taking SSRIs. Curious. Does he know that women tend to respond better to SSRIs and have a worse time on tricyclic antidepressants than men?
Pete Hegseth wants to test our military’s testosterone levels. If you’re a 30+ year-old male Department of War asset, they want you high-T. Everything is gender! He claims high testosterone levels will fuel longevity and combat-ready, resilient soldiers. What our Defense Secretary overlooks is that excess testosterone can be antithetical to his vision. When someone who doesn’t need testosterone supplementation takes it, their pituitary gland is like “omg no need to work make our own, we’ve got store-bought testosterone at home.” So their body stops producing testosterone naturally, instead relying on an exogenous (i.e., not produced in your body) source of testosterone. When the body stops producing testosterone, fertility plummets and the testicles shrink. Will the VA cover lifetime testosterone therapy if service members can’t produce their own? Beyond that, excess testosterone leads to oily skin, acne, blood clots, balding, man boobs (as surplus testosterone gets converted to estrogen), enlarged prostate, and more fuel for existing prostate cancer. Does Pete Hegseth want our military to be chopped & unc?
Speaking of prostate cancer: a common treatment for aggressive/advanced prostate cancer is starving it of androgens like testosterone. A recent study showed estrogen patches may be an alternative to standard luteinizing hormone-releasing hormone agonists (LHRHa) for androgen-deprivation therapy when treating locally advanced prostate cancer. The challenge with LHRAs is they deplete both estrogen and testosterone (men, women, etc. need a balance of both hormones to function, btw!), and people report hot flashes, bone density loss, and fatigue. Estrogen patches, on the other hand, seem to suppress testosterone without depleting estrogen and without the risk of blood clots and liver burden associated with oral estrogen. They’re also more cost-effective, realizing savings to the health system as a whole.
Meta’s developing technology to read our minds. Or at least decode brain waves into text for now. When I look at this from a pure heart, I see this as incredible technology that could improve the lives of people who can’t speak or have limited mobility. And yet.
Last week, the FDA published a final draft guidance for drug sponsors developing psychedelic treatments for psychological conditions, substance use, etc. I don’t blame you if you didn’t take public health/admin law and aren’t privy to Federal Agency rule-making requirements, but TL;DR: they must publish guidance drafts and collect public comments before finalizing any rule/guidance. In this case, the FDA updated an initial 2023 draft guidance and is signaling optimism for psychedelics. This administration is rooting for drug makers in the psychedelic space, and so am I. The guidance covers challenges in psychedelic clinical trials that I’ve previously flagged, such as functional unblinding AKA when you can tell if you got a placebo or active drug because you are/are not tripping balls. The agency will also hold a public hearing on September 14th, should you prefer to share your thoughts IRL.
A couple of days later, Lilly announced plans to acquire AtaiBeckley—a clinical-stage biopharma company best known for BPL-003, a synthetic 5-MeO-DMT nasal spray in development for treatment-resistant depression. IMO, this is a smart move to diversify their neuroscience pipeline and further validates psychedelics as a viable treatment modality. Other recent psychedelic bets include Otskuka Pharma’s $700mil acquisition of Transcend Therapeutics and AbbVie’s $1B bet on Gilgamesh’s short-acting psychedelic asset, bretisilocin.
Your grocery store eggs didn’t need to be that expensive. The DOJ claims it was a price-fixing scheme by Big Egg whereby they bid aggressively on the Egg Clearinghouse to drive up prices artificially.
WHAT I’M UP TO
Have you been to Albania? I crashed Sindi’s trip to visit her teze and am convinced everyone must visit Albania with an Albanian princess—a great travel companion and perfect host who built a perfect itinerary of active and chill days with room for spontaneity.
Upon landing, she messaged to inform me her aunt’s driver was there to pick me up. It was easy to find him because she told me what he was wearing (fashun!!!), and I was the only non-Albanian at the Tirana airport wearing head-to-toe black (tourist!!!), so he walked up to me and asked, “Susana?” I was she.
