HLTH 2025: Vegas, Pharma, and the Illusion of Good Intentions

Tons of pics and vids from the trip!

Original posted at obesity.news/ on Oct 23, 2025

Have you ever gone to something, or visited somewhere and been so completely overstimulated by that it was hard to function? That was me initially at HLTH 2025. Not only was this my first HLTH, but it was my first time “doing Vegas”.

The sights, the sounds, the smells, all of it was inflammation for the senses. And all of that was before I even set foot onto the conference floor.

I can still hear the dull roar of the crowd, even in the silence of my office. It took me the first evening just to get my bearings from the travel, and overwhelm of the activity around me. Even though I spent 10 plus years traveling the country for work, I can truly say that none of it compares to Vegas. It’s in a class all it’s own. One of one, as they say.

In tow with me was this 6’6’’ Stallion, Ike Boettger. Like Vegas, Ike is also one of one, not only is stature, but in character. Just the kind of friend you want to do Vegas with. Even if we looked like the odd couple walking around (me at 5’10’’) we had an absolute blast! I always joke that if he is a Stallion, I think that makes me a Shetland Pony. Shout out, lil’ Sebastian (forever in our hearts).

Ike recently came on the OTP live podcast to share his story of fighting for his way back to the NFL, after falling victim to medical negligence (my words, not his) when a doctor prescribed a cocktail of meds for an infection that led to a torn achilles. Needless to say, this experience and his road to eventual recovery sparked within Ike a passion for personalized medicine and self-advocacy, a passion ripe for HLTH. You can watch Ike’s episode here to learn more about Ike.

From an On The Pen perspective, my main goals in attending HLTH were two-fold:

• To get a feel for the future landscape in obesity care by connecting with the folks who are shaping it.

• To bring what I learned back to you

While I did accomplish these objectives, what I took away was far more profound. The tension at this show between big pharma and the meteoric rise of little pharma could be cut with a knife. About 30 feet from eachother were the Eli Lilly exhibit and the Strive Pharmacy exhibit. If you have followed our coverage of the lawsuit between these two players, you can appreciate the irony. This was a sort of microcosm of the entire experience at HLTH.

Peppered in between were a smattering of notable names in big and little pharma, from Noom and compound pharmacies, to Mayo Clinic and Walgreen’s. There are now even companies that offer turnkey solutions to start your own telehealth company, like little telehealth factories that let you put your name on a product they assemble at your direction.

I met with policymakers and shapers, entrenched industry professionals, disruptors, and those who are trying to build something new, and I believe something better. Not to entirely replace the old system, but to complement it.

You see, I just don’t see the current landscape the same way the super entrenched industry people do. I’ll do my best to explain.

What are industry people ultimately fighting for? At the end of the day, they’re fighting for their industry. In this case, healthcare. They’re fighting for their very existence in a space that is moving so fast that it will make your head spin. Whether it’s big pharma or little pharma (i.e. Lilly or Strive).

Little pharma sees themselves as the altruistic knights in shining armor, here to save patients from a system that left them behind. Big pharma sees themselves as true innovators, the only indispensable names in the room.

From the patient perspective, the one I’m coming from, there are shades of truth and self-preservation baked into both points of view.

Because here’s the thing, little pharma isn’t all that little. While they’ve aggressively positioned themselves as the antidote to Big Pharma greed, their halo shines a little too bright when you look closely at their balance sheets.

Still the undeniable fact is that the success compounders have seen has forced Big Pharma to move around a broken system that they were all too comfortable with, and move toward pateint accessibility. Lilly Direct, NovoCare, direct-to-consumer meds, patient-first messaging… Patient access did not suddenly trump investor demands, competition simply upended the status quo.

In doing so, the entire system is being rewritten.

All of this, I believe, has been good for patient access. A statement I rarely have the pleasure of uttering.

So when I stood on the floor of HLTH 2025, somewhere between the gleaming corporate towers of Eli Lilly and the scrappy disruptors like Strive, I couldn’t help but think... This tension is exactly what’s needed. The fight between old money and new ambition might just be what pushes this entire field forward.

The question that lingers for me is who will remember the patient in all of it? Because in this industry, profit often masquerades as progress.

We were able to capture a ton of excellent interviews from some of my favorite people who attended HLTH. I hope you will give this week’s podcast a watch. I know you won’t be disappointed!

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