RealPharma: Conversations with Pharma Pathfinders

The Opioid Reckoning (Part 1): Paul Farrell Jr.

The Opioid Reckoning (Part 1): Paul Farrell Jr. on Litigation, Accountability, and the System That Failed
West Virginia has had the highest drug overdose death rate in the United States for over a decade. In a state with fewer than 2 million people, 780 million prescription opioids were distributed in just six years.
For Paul Farrell Jr., a Huntington, West Virginia native and mass tort attorney, those numbers weren’t abstract statistics. They were neighbors. Friends. Family members.
In Part 1 of this two-part episode, hosts Na-Ri Oh and Ian Wendt sit down with Paul to unpack how the largest civil litigation in American history — the opioid multidistrict litigation (MDL 2804) — came together, and how it reshaped the conversation around corporate accountability in the pharmaceutical supply chain.
This is not just a legal story. It’s a story about systems failure — across manufacturers, distributors, regulators, policymakers, and healthcare stakeholders — and what happens when transparency finally forces a reckoning.
In This Episode
Growing up in Huntington, WV as the opioid crisis escalated
The investigative journalism that exposed 780 million pills — and the moment Paul decided to act
What “public nuisance” law is — and why it became the legal breakthrough strategy
The role of distributors as the “choke point” in the opioid supply chain
How 3,000+ cases consolidated into the largest MDL in U.S. history
Why abatement — not just financial damages — became central to the settlement strategy
Internal company communications that revealed troubling attitudes toward affected communities
The intersection of regulation, enforcement, and corporate responsibility
How transparency and subpoena power changed the trajectory of the crisis
Why This Conversation Matters
For those working in pharma, healthcare, commercialization, policy, compliance, or distribution, this episode challenges us to examine difficult questions:
Where does responsibility truly lie in a complex healthcare ecosystem?
What happens when financial incentives distort oversight?
And how do we prevent the next Pandora’s box from opening?
This episode sets the foundation for a deeper conversation about accountability, culture, regulation, and reform.
Coming Next Week: Part 2
There was simply too much to cover in one episode.
In Part 2, we’ll explore:
The evolution of the litigation and key tipping points
The role of state attorneys general and settlement frameworks
The ongoing PBM litigation
The documentary The Bitter Pill
And what lasting change should look like for the industry
Make sure to subscribe so you don’t miss it.

Ending The Diagnostic Odyssey with Josh Resnikoff

Ending the Diagnostic Odyssey: Rare Disease, Employers & Reimagining Health Plans
Hosts: Na-Ri Oh & Ian WendtGuest: Joshua Resnikoff, Founder & CEO, Sunstone Health
Episode Overview
What if the biggest innovation in rare disease wasn’t a new drug—but a new way to navigate the system?
In this episode, Na-Ri and Ian sit down with Joshua Resnikoff, biomedical engineer turned founder of Sunstone Health, to explore how employers can fundamentally rethink healthcare spending—while dramatically improving outcomes for families facing rare diseases.
Josh’s journey into healthcare reform wasn’t academic—it was personal. After years navigating the healthcare system to diagnose his son’s rare periodic fever syndrome, Josh experienced firsthand the emotional, financial, and systemic toll of what’s known as the diagnostic odyssey. That experience sparked a mission: compress a seven-year diagnostic journey into just 12 weeks.
This conversation dives into rare disease, employer-sponsored health plans, insurance mechanics, and why aligning incentives might be the key to transforming care.
🔬 From Scientist to System Builder
Josh’s background as a biomedical engineer at Harvard’s Wyss Institute
The rare disease journey that reshaped his career
Why getting a diagnosis—even without treatment—changes everything
The emotional and economic cost of delayed diagnosis
🧬 The 7-Year Diagnostic Odyssey
On average, it takes:
7 years from first symptom to effective treatment for rare disease patients
Countless ER visits, specialist referrals, medication trials, and escalating costs
Significant emotional strain—rare disease families face dramatically higher stress and divorce rates
Sunstone’s model reduces that timeline to approximately 12 weeks using:
Whole genome sequencing
AI-powered clinical interpretation
Expert clinician review (human-in-the-loop model)
Direct coordination with local care teams
The result?Earlier intervention. Reduced healthcare utilization. Better outcomes.
💼 Why Employers Are the Key
Josh explains why self-funded employers—not traditional commercial insurers—are uniquely positioned to drive change.
Key insights:
~2/3 of Americans receive insurance through employers
Many large employers are self-funded, meaning they pay claims directly
Employers think in long-term employee retention (not 12-month insurance cycles)
Better healthcare = healthier employees = higher retention & productivity
Sunstone’s innovative model:
No per-employee-per-month subscription fees
Employers only pay when a family receives actionable results
High ROI through reduced ER visits, unnecessary treatments, and delayed care
🛡 Insurance 101 (Made Understandable)
The episode breaks down:
Fully insured vs. self-funded plans
Third-party administrators (TPAs)
Stop-loss / reinsurance
How high-cost cases (like $2M gene therapies) are financially managed
The takeaway:When diagnoses happen earlier, total system costs often decrease—even when advanced therapies are involved.
🤝 Mission-Driven Innovation
A powerful theme throughout the conversation:
Many leaders in the rare disease ecosystem—including Josh—entered the field because of their own children.
That lived experience shapes:
Sunstone’s patient-first data ownership model
Continuous reanalysis of patient data
Clinical trial matching
Ethical alignment with families
As Josh says:
“Even if this whole thing went belly up, we will have helped hundreds of families—and I’d feel good about that for the rest of my life.”
🚀 Recent Milestones
Successfully raised Series A funding
800+ community investors via WeFunder
Integration with Broad Clinical Labs
Expanded epilepsy and autism-focused programs
Rapidly growing employer pipeline
🔗 Learn More
🌐 Sunstone Health: https://sunstonehealth.com
💼 Connect with Josh on LinkedIn

Beyond Survival: Why Empathy Is the Missing Prescription in Pharma with Matthew Zachary

 
🎙️ Beyond Survival: Why Empathy Is the Missing Prescription in Pharma
Episode Summary:
In this no-holds-barred conversation, Na-Ri Oh and Ian Wendt sit down with Matthew Zachary—brain cancer survivor, founder of Stupid Cancer, host of Out of Patients, and a relentless disruptor in patient advocacy.
At 21, Matthew was diagnosed with brain cancer and faced a life-altering decision: take chemotherapy and lose his identity as a musician, or reject treatment and risk everything. That decision became the first of many moments where he saw the cracks in the healthcare system—specifically, the glaring absence of empathy.
Now, nearly three decades later, Matthew shares how his experience transformed into a mission to fix what’s broken: in pharma, in media, in patient engagement—and in how we talk about what matters most.
This isn’t your typical Pharma Podcast. It’s a masterclass in calling out BS, rethinking metrics that matter, and re-centering real human lives in healthcare strategy.
What You’ll Hear in This Episode:
🎹 The life-defining decision Matthew made at 21—and why he turned down chemo
💊 How a lack of empathy almost cost him everything
🧠 The problem with patient engagement that’s all talk and no trust
🎤 The rise of Stupid Cancer and the “Howard Stern of Healthcare” era
📺 Why DTC ads may be a $28 billion distraction
🧵 The missing link between pharma marketers and patient communities
🔥 How compliance is killing creativity—and what to do about it
🗳️ Why Matthew is building a voter movement out of patient voices
Memorable Quote:
“If there is no empathy, there is no conversation.” – Matthew Zachary
Mentioned in the Episode:
Stupid Cancer
Out of Patients Podcast
Matthew’s upcoming book: We the Patients: How to Understand, Navigate, and Survive America’s Healthcare Nightmare
WeThePatients.org
Guest:
Matthew Zachary (@MatthewZachary)
 
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Breaking the Silence: Why Pharma Needs to Speak Up with Brian Reid

 
🎙️ Real Pharma – Episode Title: Breaking the Silence: Why Pharma Needs to Speak UpHosts: Na-Ri Oh & Ian WendtGuest: Brian Reid, Founder & Principal at Reid Strategic
🔍 Episode Summary:
In this episode of Real Pharma, Na-Ri and Ian sit down with Brian Reid—a healthcare communicator, strategist, and former journalist who's worked across government, pharma, and media—to explore a provocative question: Why is the pharmaceutical industry so quiet when it comes to telling its own story?
Together, they unpack the communication failures shaping drug pricing, PBMs, the Inflation Reduction Act (IRA), biosimilars, and the broader healthcare system. Brian argues that the problem isn’t a lack of data or platforms—it’s a lack of courage, clarity, and commitment to narrative.
From the importance of speaking up in a noisy media environment to the myth of reputational risk, this conversation is a must-listen for anyone in life sciences, policy, or healthcare storytelling.
🧠 What You’ll Learn:
Why pharma’s “default to silence” is damaging public trust—and what the industry can do instead
The communications trap around complex topics like PBMs, pricing, and benefit design
How public perception problems could have been avoided with smarter storytelling (hello, Hep C)
Why simplicity is power—and how “pharm-to-table” and Mark Cuban are reframing the narrative
The case for overcommunication in the face of misinformation and AI-driven “slop”
Why the Medicare Prescription Payment Plan was a missed communication opportunity—and how to fix it
🔊 Quotable Moments:
“We're in a 30-year experiment of what happens when pharma steps back from the policy debate—and the results are in.” – Brian Reid
“I just want pharma to beat Bigfoot in public trust. That’s my goal.” – Brian Reid
“When in doubt, just shout. Say something. Do something.” – Na-Ri Oh
“It’s not always about having the perfect message—it’s about showing up and making the case.” – Ian Wendt
🧭 Resources Mentioned:
Cost Curve – Brian Reid’s daily newsletter on healthcare policy: ReidStrategic.com
KFF’s piece on complexity as a barrier to affordability
Examples from Mark Cuban’s Cost Plus Drugs and Eli Lilly CEO Dave Ricks’ public podcast appearances
👥 Connect with Brian Reid:
💼 Website: ReidStrategic.com
📬 Newsletter: Cost Curve
💬 LinkedIn: Brian Reid
 

Formulation as Strategy: Why CDMOs Matter More Than Ever

Episode Title: Formulation as Strategy: Why CDMOs Matter More Than EverGuest: Elizabeth Hickman, President & CEO, Austin Pharmaceutics
Episode Overview
In this episode of RealPharma, hosts Nari Oh and Ian Wendt sit down with Elizabeth Hickman, President and CEO of Austin Pharmaceutics, to unpack one of the most critical—and often misunderstood—elements of drug development: formulation and the evolving role of CDMOs.
As drug molecules become more complex and solubility challenges grow, CDMOs are no longer just manufacturing vendors. They are strategic partners helping biotech and pharma companies bridge the gap between discovery and commercialization. Elizabeth shares her journey from commercial pharma leadership to running a science-driven CDMO, and explains why formulation decisions made early can determine whether a promising molecule ever reaches patients.
🔍 Key Topics Covered
The expanding role of CDMOsWhy CDMOs are shifting from executional partners to strategic extensions of pharma and biotech teams.
Why formulation is make-or-breakHow solubility and bioavailability challenges derail up to 80% of modern drug candidates—and why these issues must be addressed early.
From “undruggable” to developableHow AI-driven discovery and structure-based drug design are unlocking new targets while creating new development hurdles.
Inside Austin Pharmaceuticals’ approachA look at Austin’s proprietary Kinetisol® technology and how amorphous solid dispersion can improve bioavailability, scalability, manufacturability, and sustainability.
Small biotech vs. big pharma dynamicsWhat early-stage companies should look for in a CDMO partner—and the most common mistakes teams make when selecting one.
Patient impact starts with formulationHow pill burden, dosing frequency, and manufacturability directly affect adherence, cost, and competitiveness.
The future of CDMOsReshoring, cost pressures, AI adoption, and the growing need for talent with both scientific depth and entrepreneurial mindset.
💡 Memorable Takeaways
“Formulation is where promising molecules either become viable drugs—or stall out.”
Solving in-vivo performance alone isn’t enough; scalability and manufacturability must be designed in from day one.
The best CDMO relationships are built on transparency, urgency, and shared long-term vision.
Advanced formulation isn’t just a technical advantage—it’s a competitive and economic one.
👤 About the Guest
Elizabeth Hickman is President and CEO of Austin Pharmaceutics, a U.S.-based early-phase CDMO specializing in formulation development for challenging small-molecule drugs. With a background spanning commercial strategy, drug launches, and executive leadership, Elizabeth brings a sponsor-centric mindset to CDMO partnerships—helping clients accelerate innovation while reducing risk.

Untangling the IRA with Emma Cousin

🎧 Hosts: Na-Ri Oh & Ian Wendt🎓 Special Guests: Emma Cousin (PhD Candidate, Choice Institute – UW), Amos Fung (RealPharma Intern & Student Pharmacist)
🔍 Episode Summary:
In this thought-provoking episode, hosts Na-Ri Oh and Ian Wendt sit down with Emma Cousin, a PhD candidate at the Choice Institute, University of Washington, to unpack the real-world implications of the Inflation Reduction Act (IRA)—particularly the Medicare Drug Price Negotiation Program.
Joining them is Amos Fung, a RealPharma intern who brings a front-line pharmacy perspective to the policy conversation.
Together, they discuss:
📜 A primer on the IRA’s healthcare provisions—what it is, how it came to be, and why it matters now.
💊 How CMS selects drugs for Medicare negotiation and whether this process constitutes true “negotiation.”
👩‍⚕️ The ripple effects on pharmacists, pharmacies, and patient care.
💸 The looming concerns around cashflow, operational readiness, and access as the 2026 implementation date approaches.
🧠 How researchers like Emma are modeling long-term effects—and what metrics we’ll need to track to assess the IRA’s success.
🔄 Unintended consequences and who might be left behind—especially independent pharmacies and vulnerable communities.
📈 A candid discussion on myths around drug pricing and why “good intentions” in policy still need strong evidence and thoughtful execution.
🎯 Key Takeaways:
The IRA marks the first time Medicare can directly negotiate drug prices—albeit in a tightly structured format that raises questions about the fairness of “negotiation.”
Pharmacies face operational and financial strain, particularly smaller or independent ones, due to rebate lags and implementation complexities.
Patients will benefit from caps on out-of-pocket costs, but awareness and education are lacking—many don’t realize what the law offers.
Stakeholders like pharmacists, researchers, and policy influencers need better communication and clearer technical standards from CMS.
Evidence-based policy should be the north star for drug pricing reforms, but real-world implementation remains messy and evolving.
🧠 Resources & Mentions:
Brian Reid & Adam Fein – Top newsletters to follow for updates on drug pricing policy.
CMS Guidance Documents – Frequently updated, but often inaccessible to non-policy experts.
National Pharmaceutical Council, Milliman, Portal (Harvard) – Organizations doing forward-looking modeling and policy impact research.

Reinventing Cell Therapy with Acoustics

Reinventing Cell Therapy with Acoustics, Microfluidics & High-Throughput Engineering
In this episode, hosts Na-Ri Oh and Ian Wendt sit down with Dr. Andrew Gray — immune cell engineer, biotech founder, venture capitalist, and CEO of CellEcho — to explore how a new acoustic-powered gene-delivery platform may redefine the boundaries of cell therapy.
The conversation spans the current state of the cell therapy landscape, the persistent barriers to scalability, and why CellEcho’s ASOP platform (Acoustically Stabilized Oscillatory Pockets) could unlock a new era of faster, cheaper, and more effective cell engineering.
🔬 Episode Highlights
1. The State of Cell Therapy: Breakthroughs & Bottlenecks
Despite scientific success, many pharma companies are exiting cell therapy due to cost, complexity, and manufacturing burdens.
Conversely, major players like BMS continue doubling down, acquiring companies such as Orbital Therapeutics.
Autologous therapies remain logistically overwhelming and expensive—often ~$400k per dose.
2. Why Cell Therapy Is So Hard to Scale
“Vein-to-vein” timelines are still measured in weeks, not days.
Manufacturing is bespoke: each patient’s cells must be extracted, engineered, expanded, frozen, shipped, and reinfused.
Viral vectors and current non-viral delivery methods introduce cost, complexity, and biological limits.
3. The Next Frontier: In Vivo, Allogeneic & Beyond
Allogeneic CAR-Ts remain challenging due to immune rejection and complex engineering.
In vivo CAR-T offers promise but is limited by the small genetic “payload capacity” of lipid nanoparticles.
Solid tumors remain particularly difficult: only ~9% response rates in some indications.
4. Introducing CellEcho & the ASOP Platform
CellEcho’s technology emerged from UC Irvine’s microfluidics program. By applying precision acoustic energy, the platform can:
Hold cells in place using thousands of stable micro-eddies
Open controlled, programmable “portals” in cell membranes
Sequentially deliver multiple genetic payloads with high efficiency
Achieve 1 billion cells/hour processing rates
Reduce dose production costs by ~100×
Enable high-throughput engineering, not just manufacturing
This unlocks the ability to test dozens to hundreds of engineered CAR-T variants in days—rather than the years needed today.
One academic lab spent 6 years evaluating 11 CAR-T variants.CellEcho tested 8 variants in under 48 hours — and aims for 100+ per week.
5. From Better Manufacturing to Better Medicines
While CellEcho originally targeted faster manufacturing, Andrew shares that the bigger opportunity is designing entirely better therapies, not simply making today’s ones faster.
This includes:
Engineering CAR-Ts with multiple CAR constructs
Arming cells with resistance to tumor suppression signals
Precise control over expression levels (avoiding under- or over-expression)
Unlocking new indications: autoimmunity, neurodegeneration, regenerative medicine
6. Personal Motivation & Mission
Andrew shares how his mother's struggle with myasthenia gravis sparked his lifelong journey in immunology. His 20-year career investigating immune evasion, Tregs, and tumor microenvironments culminated in his conviction that next-generation cell engineering is essential.
7. What’s Next for CellEcho
Currently initiating pre-seed fundraising
Supported by multiple federal grants (including NSF SBIR)
Expanding early partnerships with Stanford, Mass General Brigham, and industry collaborators
Building a fully automated, AI-augmented cell therapy design platform
Dual strategy:
Cell-therapy-development-as-a-service
Proprietary therapeutic pipeline in select indications
💡 Key Takeaways
Cell therapy works — but not broadly or efficiently enough.
Engineering complexity, not biology alone, is the rate-limiting step.
Acoustic microfluidics enables a scalable, programmable, non-viral way to engineer living cells.
High-throughput screening for cell therapies could transform discovery the way combinatorial chemistry transformed small molecules.
The real revolution isn’t just faster production — it’s better, more sophisticated therapies.
🔗 Learn More About CellEcho
Visit: https://cellechobio.comContact: Via the Info link on the website (messages route directly to Dr. Gray).

Food as Medicine: Promise, Pitfalls, and the Politics of the Plate

👩‍🔬👨‍⚕️ Hosts:
Na-Ri Oh & Ian Wendt
🎧 Guest:
Dr. Ron Shigeta – Biotech visionary, co-founder of IndieBio, and food innovation expert.
🧬 Episode Summary:
In this deeply insightful and refreshingly candid episode, Ian and Nari welcome back biotech veteran Dr. Ron Shigeta to explore the evolving landscape where food, health, and biotech collide. From the collapse of the lab-grown meat hype cycle to the challenges of democratizing access to functional food, Ron brings hard truths, historical context, and cautious optimism to the table.
As the U.S. federal government embraces its Make America Healthy Again (MAHA) agenda—reforming food policy to prioritize public health—the conversation asks:👉 Can we finally treat food as medicine, and make it scalable, credible, and affordable?👉 What went wrong with cultured meat—and what comes next?👉 Why does Ron really hate the term “food tech”?
If you’ve ever wondered whether the future of wellness lies in your fridge, your pharmacy, or your feed, this one’s for you.
🔑 Key Topics Covered:
MAHA & Food Policy Shifts:What the government’s new approach to food says about public health—and why it matters.
Cultured Meat's Cautionary Tale:Why the dream of lab-grown meat stumbled—and how the next wave of companies might succeed.
Ultra-Processed vs. Ultra-Useful:A frank conversation on consumer trust, marketing blunders, and what “processed” really means.
Food as Preventative Medicine:From diabetes to GLP-1s to micronutrients—why we’re ignoring the obvious.
Pharma’s Cost Spiral & Innovation Trap:$2M gene therapies, $500K cancer cures, and why food might be the only scalable solution left.
The Neuroscience of Eating:Food isn’t just fuel—it’s identity, emotion, and the deepest form of human behavior.
Why “Food Tech” is Bad Branding:Ron’s passionate take on why the tech world misunderstands how people eat.
🧠 Memorable Quotes:
“Technology for the public will always win—because once people use it, they can’t let it go.” – Ron Shigeta
“We’ve invented healthcare Americans can’t afford.” – Ron Shigeta
“Nobody buys food because it’s high-tech. Nobody. That’s not how trust is built.” – Ron Shigeta
📚 Mentioned in This Episode:
MAHA (Make America Healthy Again) policy initiative
GLP-1s and the rise of preventative obesity drugs
Blue zones and the elusive science of longevity
Golden rice and biotech’s public trust problem
OneSkin and peptide-based functional cosmetics
Ron’s upcoming book on food, neuroscience, and the future of health
 

From Job Search to Power Move: How Top Talent’s Playing 2025

 
🎙 Episode Title: From Job Search to Power Move: How Top Talent’s Playing 2025🧠 Guests: Kristiaan Rawlings, Executive Director at EPM Scientific🎧 Hosts: Na-Ri Oh & Ian Wendt
Episode SummaryLayoffs. AI. Resume black holes. The biopharma hiring market feels noisy—and not in a good way. But beneath the doomscrolling, there’s a more nuanced story unfolding.
In this episode, Kristiaan Rawlings returns to RealPharma to deliver a data-backed pulse check on the state of hiring across the industry. Drawing from hundreds of hours of direct conversations with execs, talent leaders, and hiring managers, Kristiaan unpacks:
📈 Which therapy areas and functions are hiring (and which are not)
🧠 How AI is actually being used in recruitment—and where it falls short
👀 Why 70% of senior roles are now confidential
🤝 The traits that are getting candidates hired in 2025
💸 Sign-on bonuses: who’s getting them, how to ask, and what to watch out for
Whether you're job hunting, hiring, or just trying to read the market right—this conversation brings the clarity.
Resources & Links🔗 Connect with Kristiaan Rawlings on LinkedIn🌐 Explore non-confidential roles at EPM Scientific

Where Policy Meets the Pharmacy Counter

 
Where Policy Meets the Pharmacy Counter
Featuring Congressman Jake Auchincloss
Episode SummaryIn this episode of RealPharma, hosts Na-Ri Oh and Ian Wendt sit down with Congressman Jake Auchincloss (MA-04) to dissect the tangled web of policy, profit, and politics driving America’s drug pricing system. From pharmacy benefit managers (PBMs) to the politics of tariffs, this discussion explores the push for transparency, fair competition, and sustainable reform in healthcare.
Auchincloss, a Marine veteran and member of the House Energy and Commerce Committee, brings a rare combination of policy depth and industry fluency. Together, they unpack how entrenched middlemen have distorted the system—and what bipartisan solutions could finally restore balance between innovation and access.
What You’ll Learn:
Why PBM reform has momentum but keeps stalling in Congress
How the Pharmacists Fight Back Act could level the playing field for independent pharmacies
The purpose of the Patients Before Monopolies Act and how it targets vertical integration
Auchincloss’s vision for a “biotech social contract” that links innovation, IP protection, and insurance design
The real story behind drug import tariffs and the risks of chaotic trade policy
How U.S. innovation compares to China’s rapidly advancing biotech ecosystem
The importance of aligning drug pricing reform with patient access and national competitiveness
Memorable Moments:
“PBMs deserve to be bulldozed for their behavior over the last two decades.”“There’s no moral hazard in getting sick—no one fakes chemotherapy to get free drugs.”“The most expensive thing in the world is what hasn’t been invented yet.”
Why It Matters:As drug costs rise and innovation races ahead, the U.S. faces a defining choice: will healthcare policy reward breakthroughs or bureaucracy? Congressman Auchincloss argues that reform is not just about prices—it’s about preserving America’s leadership in biomedical innovation while ensuring patients can actually access the medicines that save lives.
Guest:Congressman Jake AuchinclossU.S. Representative for Massachusetts’ 4th DistrictMember, House Committee on Energy and Commerce
Hosts:Na-Ri Oh & Ian Wendt