Alex Karnal, founder and CIO of Braidwell, a life sciences investment firm, spent 20 years building and supporting biotech companies before announcing Invest Like The Best podcast that “2025 may be the single most exciting year of my entire journey.” Catalyst: GLP-1 drugs. His claim deserves scrutiny because the investment and personal health implications are huge.
Karnal’s argument has two parts. First, the business case: “This is a class of drugs that will easily reach $100 billion a year in revenue.” Second, the structural case: The adoption of GLP-1 is “the first commercial evidence that we’re ready for what I think we’ll look back on as a once-in-a-lifetime trillion-dollar revolution in all of society.” He does not present this as a pharmaceutical success story but as a behavioral change, with consumers “voting with their feet” from active disease treatment to active health protection.
The structural case is difficult to quantify: The adoption of GLP-1 as a behavioral shift towards active living is a compelling framework, but the timeline and policy space remain truly uncertain.
Eli Lilly (NYSE: LLY ) has generated combined GLP-1 drug sales of $36.5 billion by 2025, comprising approximately 56% of the company’s total revenue. Its stock has gained 11% over the past year and a staggering 407% over five years. A peer-reviewed study published in 2025 confirmed that GLP-1 drugs “improves results in people with cardiovascular, kidney, liver, arthritis, and apnea disorders” by using anti-inflammatory and metabolic mechanisms, with certain benefits that occur without weight loss itself.
GLP-1 drugs are designed to control blood sugar in people with type 2 diabetes, but their benefits in heart disease, kidney disease, and metabolic liver disease came from testing rather than objective, which is part of what makes the field unusual.
Karnal’s annual revenue floor of $100 billion is credible, but the trend is worse than the podcast’s outline suggests. Jefferies analysts revised their forecast for the weight loss market to a peak of $80 billion from a previous estimate of $100 billion in the early 2030s. Goldman Sachs put global drug sales at $105 billion by 2030, down from an earlier forecast of $130 billion, citing rising price erosion. The $150 billion figure that Wall Street once treated as low has shifted to a 2035 target for some analysts.
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The winds are straight. Novo Nordisk (NYSE: NVO ) stock is down about 20% year-to-date and 29% over the past year, hit by a clinical trial in which its drug CagriSema showed a 23% weight loss compared to Lilly’s tirzepatide’s 25.5%. Medicare coverage of the obesity drug GLP-1 remains unresolved, and major insurers, including CVS, are pulling out at least this spring. Semaglutide’s patent expires in India in March 2026, allowing generic competition at steep discounts.
The trajectory of the market depends largely on policy decisions, patent tenures, and which companies perform best.
Karnal’s framework is most useful for investors with a long time horizon, especially those positions that are comfortable to hold for a decade or more. Oral pill format accelerates adoption: Lilly’s newly approved Foundayo drew 1,390 orders in its first week on the market, removing barriers to injection and expanding the target population. For the long-term investor, the structural argument that GLP-1s represent a platform for active health management rather than a single-indication drug should be taken seriously.
For investors with short-term exposures or concentrated positions in one GLP-1 name, the risk is equal. Novo Nordisk shareholders holding CagriSema failure in February 2026 fell by 15% in one day. The intensity of the competition between Lilly and Novo, and the entry of new competitors, including the e-commerce platform management system GLP-1 and the monthly injection candidate of the comb company in Phase 2b, means that choosing the right company is as important as choosing the right sector.
Host Patrick O’Shaughnessy introduced the concept of the “Health Stack” during the discussion, borrowing from technology, where “your technology stack is all the different parts you use to create your whole thing.” The framework places GLP-1 adoption as one layer in a comprehensive individualized health promotion program, which includes glucose monitoring, cardiovascular screening, and preventive interventions.
For investors, the real implication is that the GLP-1 opportunity extends beyond drug manufacturers. Diagnostic companies, service delivery platforms, and insurance companies that are acquiring structures will be built in the same way that Karnal describes. His point is that “the gap doesn’t necessarily require more medication, it actually points those medications to the effect they can have” the debate is for the entire ecosystem around drug delivery and patient discovery, not just the molecules themselves.
What is often debated is the timeline, the winners, and whether the policy environment will accelerate or delay adoption – the scientific basis is strong, but that alone does not determine who benefits or when. Investors who treat GLP-1s as a guaranteed trillion-dollar outcome rather than a trillion-dollar opportunity with risk to make sense are the ones likely to be surprised by the volatility already present.
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