A Journey to CEO | Michael Castagna, PharmD, MBA, MannKind

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Mike Koelzer, Host: Michael, for those who haven't come across you online, introduce yourself and tell our listeners what we're talking about today.

Michael Castagna, PharmD, MBA: Sure. My name is Michael Castagna. I'm the CEO of MannKind corporation. And for those that don't know our company, we make inhaled insulin. We also own a little insulin delivery device called Vigo and our second product just got approved by the FDA, called Tyvaso dry powder inhalation, or just a manufacturer.

But our part of United therapeutics will be launching that over the next month. And that's for a rare disease called pulmonary hypertension. And that's really what mankind's been building. We have dry powder inhalation technology. We've been around literally 30 years in publicly traded almost 20 years now.

And, um, we're located in Danbury, Connecticut where we make our product here in the us. And, we have offices here in California and Massachusetts.

Mike Koelzer, Host: Michael, I've been over your history. And I know that you've come through the ranks and working in a retail chain and things like that five years ago you stepped in as CEO. What was that jump like for you?

Michael Castagna, PharmD, MBA: I always dreamed of being a CEO and running a company. That was my goal. And whether I was gonna own a pizza chain with my mom or do something big, but I always went to

move to the top. And so the real debate as I went through pharmacy school was, is it a retail setting? Is it a hospital setting? Is it the pharmaceutical industry? And ultimately, getting to that jump, to me is there's nothing that really prepares you for it, right? When you're running a store, you have budgets and things, but you're not worried about the shareholders.

You're not worried about the paychecks. You're not worried about where the money's coming from. And I think. All that is on your back as a CEO. And generally you're the complaints department. Meaning everyone that comes to you is all about the negatives. I need more budget. I need more people.

I need a raise. I need this. you never get congratulations today. You did a good job. when we give out awards, you never get an award because you're the CEO. 

 It's a good job. I enjoy it. I think we help a lot of people. I love the challenge. It brings me. But I think being a CEO is something you gotta prepare for whether it's mentally or physically. It's as much of a mental job as it is a physical, demanding job of travel and being on the road.

I would never trade it for anything. I'd love what I do every day.

Mike Koelzer, Host: The one thing you don't get anymore, which I still get occasionally is the little note from some of the little old ladies and maybe even a plate of cookies. I still get that occasionally at the pharmacy. And maybe you did your retail chain thing, but you don't get that anymore.

Little old ladies saying thank you with a plate of cookies. I imagine.

Michael Castagna, PharmD, MBA: the one part of my job, I do try to talk to patients, still and doctors. And, I remember I'll never forget a couple years ago, I was talking to a priest who had type one diabetes and he was struggling with it. I Switched over to our product and wanted to talk to somebody.

And it had to be like the holiday of July 4th week. And so I called them and, in that discussion, he goes, I learned more from you in 20 minutes than I have in 20 years living with this disease. And that was very rewarding for me. I'm like, okay, hopefully there's a special place for me in heaven.

Um, but, but,but just getting that feedback from the patient and hearing about how our product was changing their life and, he was under basal, it had nothing to do with our product.

It had to do with his doctor, not fixing his basal and as a pharmacist, I'm able to have those conversations. I'm able to understand the science and what's going on with the patient. and I find that to be very rewarding and that's something, most CEOs don't have a science background and they can learn it.

But, being able to retail pharmacy taught me a lot about dealing with people and patients. And what's going on. I always think about today when we talk about, oh, copays, everyone can afford $15. Yes. If they're only taking one drug, they take seven to nine drugs when they're 65, 75 years old.

and hopefully not everybody, but, as a pharmacist, those are the scripts I remember filling,here comes Betty again with her nine prescriptions and they're

all in different refill schedules and it's very hard being a patient and you always gotta put yourself on the other side of how do we change our packaging?

How do we make it more user friendly? How do we make the copays low? We do everything we can to really focus on patients here.

Mike Koelzer, Host: I was going through your LinkedIn, Mike, and, thank goodness for the technology, because that's still

Michael Castagna, PharmD, MBA: Still

Mike Koelzer, Host: touching the outside, the customers and things like that.

And your stuff was everything from, seeing you on the NASDAQ floor to then, saying, Hey, we're looking for this person to help out in this part of the company and things like that. And I think that's a cool touchpoint that LinkedIn allows for us.

Michael Castagna, PharmD, MBA: Yeah. I was on Twitter for a while and then I realized there's a lot of haters in the world and, you gotta deal with that. And it was more mental stress than anything. And so I found that was not mentally healthy. I actually got off Twitter completely. I barely use Facebook, but I like LinkedIn because I'm one. My job consumes most of my free time and my life and my weekends. and And I think that's part of the sacrifice that comes with being a CEO. And so LinkedIn is a way for me to either attract talent, communicate with our employee base, communicate with partners, and communicate with patients.

I have over 10,000 connections and, and I get a lot of random ones. I try to accept people. I either met through business school or conferences or work. so I feel like most of my connections know me and, and therefore, Post or follow have comments they're really authentic, which I think is important.

 Some people use LinkedIn to market themselves. It's not me. it's it's really about the company and what we're trying to build

here. 

Mike Koelzer, Host: What I liked hearing from you, Mike, was that your goal was to become a CEO because too many people you talk to in leadership, there's this? I wanted to. Help out mankind plant words, but I wanted to help out mankind. This is mankind in the Neil Armstrong [00:05:00] kind of way. I wanted to help out mankind and here I am, I raised up to where I could do the most good, but I love the thought of you saying I wanna be a CEO.

That's just a cool thought. When did that hit, if you could pick an age out, whether it's 18, 20, 2, 28, when did that thought finally cross your mind? 

Michael Castagna, PharmD, MBA: I think, my, the story came out the other day in my family when I was back home is I think I was in sixth grade and my grandfather answered the door and there's a guy with a suitcase and glasses says, I'm here to see Mike Caston. My grandfather goes, what? And he goes, who are you? And he goes, I'm an accountant.

And my grandfather goes, he's 12 years old. What's he needing an accountant for? But I didn't trust the government taking all my money. I was like, I gotta make sure I pay my taxes. I always heard his mom complain about the government and taxes and my grandfather. So I hired my own accountant for 45 bucks because back then I had my own paper route.

I had a lawn business. I had a snow removal business. 

And, so I was always trying to find a way to build something right. And create something. and then I just watched how hard my mom worked. She was a single mom raising me and she had no help. And, she sacrificed a lot. We never had a family vacation.

My whole life. We never had a paid vacation. We never had health benefits. we didn't have anything, we barely had a house. and so I watched how hard she worked and I just knew I wanted to go to college and if I didn't get into college, I was gonna go into the air force. That was like my backup plan, or starting a business.

And so, you know, once I got into college, it was the happiest day of my life. I'll never forget that day. And that, to me, how I got in, I have no idea who you are. Took a liking to my essay, I guess I was really lucky. but, from that moment on, I was like, I wanna do good in society.

And the best way I can do good is run something. and therefore, everything I did was about training me and I never had a timeline. I didn't say I'd get there by 30 or 50 years. I didn't care. I tried to make sure that when I got there, I was really ready 

and it happened sooner than I thought I was 40 years old when I became CEO, a public company, which, if you're an athlete, you're training for 20 years to become a professional athlete that happens when you're 22 and you're done at 30, 35 in this case, you train for 20 years and you get it when you're 40 to 55. and you gotta be able to be strong, and have a long term vision of what you want for yourself, your family, your employees, and, and that leads to. Topic here, which is managing your career. I remember in 2005, I was at Bristol Myers Squibb. Everything was great, I just finished business school.

And I went up more and Bristol Myers would've been a very easy pathway for me. I knew I could have kept growing. I was getting paid a decent living. My wife was pregnant with our first child at the time and I made a decision to switch companies. And then it was like, do I go to a J and J, which gave me a beautiful offer with a 40% raise or do I take the startup opportunity, which I couldn't afford.

And at that point in your life, I was, I was like 29. and, I wasn't sure what to do. And I just said, I wanna do the startup. I wanna take that bet because I think I can always get a job in a big company. And, and so I took that risk. And so that was just an example where I thought I'd learn more by taking on more risk, maybe making less money.

But that skill set would teach me how to take a company public, how to deal with 33 employee companies versus 30,000. I learned so much there and I loved it and I didn't let the company wound up, not, they wound up doing very well in the end. It became the cure for SVDI, but, for hepatitis C with Aldi, but at the time we were running outta money, all of our programs died.

It was a very dark time and they didn't need me. So I wound up moving on. They wanted to keep me, but I didn't want it to be the head guy. And they said, no, Mike, you're 29. We can't go public with you. You're too young. We need a gray haired executive. And I said, I'm not gonna let you put some guy above me that I'm gonna make look good.

Like I'd rather go out and do something else and wind up learning about biologics. So that turned into a whole nother career, which was great. so you never know where your career takes you, but you gotta have the goal and you gotta be able to make the sacrifice, Mike and I find that's the biggest challenge.

No one hands people things. Yes. sometimes things are easier for others than some, but,I had to move multiple times around the country with kids in school and young kids

 and I find that's a big challenge for people these days. I was always shocked when I was growing my career. I started out in sales. I did sales for about three years and then moved up into the ranks of the pharmaceutical industry. And, I thought I was competing with sales reps and pharmacists and medical and I didn't realize probably 80, 90% of people would never move beyond their 20 square miles.

So all of a sudden, once you realize you're willing to move you open up your aperture for all kinds of job opportunities. And that's what I tell people, it's, some people are very focused on their family and being close and I've met friends all over the country. Now, anytime I travel to Boston Philly, Maryland, I have friends everywhere.

so that's been a great part of my life. but I've, I'm a nomad that way. and so that's part of what people gotta decide, what they want in life. What are you willing to do to get to where you want? And are you willing to make the sacrifice that it's gonna take? Because nothing comes easy.

If it's gonna be that hard it's, gotta 

be worth it. can you talk about that kinda 

Mike Koelzer, Host: When you talk about that movement, is that going? in general, would that be going to different companies or even in a company, they send you over to Europe for six months and then do this both. so either way moving up the corporate ladder either way, you've gotta 

Michael Castagna, PharmD, MBA: gotta be mobile.

You gotta be mobile in my mind. If you build your own company, obviously you set it wherever you want. In oh five. I made that choice not to go up one corporate ladder. I made the choice to switch companies and that's how I was gonna build my career, and back then, people didn't switch companies a [00:10:00] lot, right?

Oh my God, you're crazy. You got a great job. my mom's what the hell are you doing?

 But I made a decision. I didn't want to have what I even knew golden handcuffs were, but I would hear this term golden handcuffs and what I realize now, as I'm older, you get stock and that stock builds and then you just can't leave.

Cuz they got so much stock and then you're miserable because you're stuck in the job. You may not like, or a boss you don't like, or a company you may not like. And then, but you make a lot of money and it's a good living and you gotta provide for your family. So people wind up getting stuck. And then I think that's part of the challenge of people's careers.

I've always made a conscious choice to not worry about titles or money. and I've taken title cuts. I've taken pay cuts to get my jobs or move around. And, because I always went for the experience and I always felt that if I got all the right experiences, I'll be more valuable in the next 20 years. And it was never that one or two year window that I worried about. And so many people are not willing to make those types of sacrifices. I have these young ponies all the time. Hey Mike, I was making 90,000 and you're asking me to make 80. I'm like, okay, but you're gonna, it's 10 grand to go work part-time as a pharmacist.

That's what I did. I always worked part-time as a pharmacist cause I could make an extra 20 to 40 grand a year work and nights, weekends and holidays.

and that's what supplemented my income cuz I took a pay cut to come to the industry and all my friends are buying Mercedes and condos and having nice cars and I'm driving my used whatever.

but that was like a 10 year sacrifice. It wasn't for one or two. but now I talk to them and they're not as happy. In some cases, what can I do to grow my career? How do I get outta I'm stuck at night shift? And I feel bad because it's hard at 45 to make a career shift.

you can do it, but it's.

Mike Koelzer, Host: For our kids, one of the things that we've done for all of them is they've got themselves through two years of community college in town and they can work at the pharmacy or do whatever for two years. And then we've helped them with their third year of state college.

And then the fourth year they're on their own. But basically all of them so far have graduated with minimal debt, maybe under $5,000. What that does is that allows that freedom for 10 years, where you don't have to think a whole lot about your salary.

You can get that experience and not have any handcuffs on you, basically.

Michael Castagna, PharmD, MBA: That's a really good point. and I tell people all the time, like the first thing I did was pay off. I know I was getting married and I said, I wanna go into my marriage, debt free. Because my wife didn't have any debt. I had a hundred thousand dollars in school debt. And every bonus I got every extra, I worked 68 hours a week just to pay down my school loans in two years.

and I lived in an apartment and, I just did whatever I could, I didn't buy anything. I bought used furniture, yard sale. and so I, cause I also realized as I got older, like once you're debt free, you can take more risk. and I always kept my pharmacy cuz I'm like, okay, I can always make a hundred grand being a pharmacist.

Like you can always.

Makeand pay your bills. And so I always kept my pharmacy license act probably till about three, four years ago. And I finally realized that chances of me having to go back full time as a pharmacist today, you probably don't want me, but B it's probably not likely I can do many other things now.

but I was always worried about a recession or depression, keeping me unemployed. And so that fear kept me debt free. And in California, you can't afford to live. This place is crazy expensive out here.

Mike Koelzer, Host: Let's say you're giving advice to somebody who started a company. Is there any value? I know this is very simple, but is there any value in going public except for raising the funds with stock? Is there other value to that?

Michael Castagna, PharmD, MBA: If you own your own company, and you can survive without going public, either through that. Debt or selling equity to, and, and, you know, smart investors or, money that's, private equity, things like that. I have lots of friends that do private equity, VC, IPOs.

and so I hear all these horror stories. and so what I say is part of a CEO group locally, I'm the only one that runs a public company. Other eight have all private companies. And actually one just went public. and I say to them, be careful what you wish for. My one friend went public.

His company came out, took off, went up two, 300%. Now the stock's down 90%. Now you feel like shit, right? you were doing fine. You didn't have all these stresses of the public's markets. And it's very stressful being a public CEO because you have the burden of the board, you have the burden of shareholders, you have the burden of the bankers calling you.

if you got debt, you got the debt holders calling. You got, so everyone, all of a sudden, you go from running your business. To servicing all the investors. And that's what people always ask me is I probably spend 50% of my time with investors and whether that's raising money, business development, buying products, selling products, like it's all around business development and wall street stuff.

And that's, and then you spend about 20, 30% of your time on your employees and the other remaining part on your strategy and what you're working on and the quarterly stuff. it takes a focus away when you're public that I'm not sure is as beneficial unless you need the money, you have this big idea and you wanna grow exponentially faster and you wanna scale something.

Public markets, I think are great for that, but I think if you can build a very successful privately held company and finance it and keep it growing internally, I would always tell people to stay private as long as you can. because I think you've more focused on building a great culture, keeping your product good and differentiating yourself from your competition.

Um, cuz wall street just expects double digit growth forever. So there's never any, I always say what's the end game here. There is no endgame for wall street. It's always double digit growth forever. And so you always gotta think [00:15:00] about, if you're an Amgen doing 24 billion to grow 10% means you need 2.4 billion in revenue next year.

And by the way, you're losing a biosimilar taking away 2 billion in sales. So what do you do? It means you gotta grow 4 billion next year. and that's what's really hard about the drug industry right now. I think it's a very tough time you're gonna see in the industry, these days where everyone thinks pharmaceuticals make a lot of money.

The middlemen have really taken a chunk out of whether it's pharmacy or us. The middlemen have been a big problem and those rebates just keep going up. The wholesaler fees keep going up. and that's really, when you got inflation at 9% and your whole, your contracts are stuck in price protection, 

and your fees are going up, you can't make any more money, so you either gotta reduce cost or I don't know what, You 

I don't have a choice.

Mike Koelzer, Host: when you talk about the 10% you have to go it's gotta be revenue. You can't just increase your profit that much, it's revenue. And if you're making a certain percent, basically on the revenue, you've raised it. So is that 

Michael Castagna, PharmD, MBA: Yeah. 

Mike Koelzer, Host: A lot of mergers come into play?

Michael Castagna, PharmD, MBA: Yeah. I think that's where people realize they can't keep growing at the same rate or to grow at a faster rate. You need more scale. And that was one of the reasons we bought a product this year. We bought a second product in diabetes because we need more sales reps at the end of the day to cover more physicians.

We only cover about 35% of the insulin market. And so in order to expand those reps, we needed more products to sell. And so we bought a product that was doing pretty well and was being ignored by the owner and they were excited in the us. We were able to get a decent deal, but that was really, when they do about 1200, 1300 scripts a week that gives our reps a reason to go in and help those patients and doctors.

and so now we have two reasons to go in. Not everybody's gonna want inhaled insulin, not everybody's gonna want. This device is called Vigo, but between both products, you can service more than an easier customer. That's really what I think good M and a is about, is one plus one gonna be three, or is it 1.5?

And,

I would tell you most M and never result in any value. mankinds only made two acquisitions in 30 years, so it's not something we, we go after,

Mike Koelzer, Host: Whenever I hear of a merger, I'm always thinking, they're growing, but you're saying it doesn't bring much value unless there truly is value in it.

Michael Castagna, PharmD, MBA: Yeah. I think people, and I have always been very conscious, when you're in the heat of a business development discussion or buying a company emerging, there's a lot of excitement for both parties. Here's what's gonna happen. Here, our employees are gonna benefit. 

 And all of a sudden you're like, okay. Yeah. And then, someone started. We had one discussion where someone was like, I'm gonna be the CEO. And I'm like, you're 65, I'm 40, whatever. I was working for the next 20 years. You're not. And he's the other, and we were the bigger acquire.

And I was like, that's not gonna work. We'll walk away. so being able to walk away, it's not that I have an ego. It's just that I plan to be here 20 years, building a great company, even hiring, hopefully thousands of people one day. and so I have a long term vision. I'm not worried about the next quarter next week.

I know we'll be fine. and that's what you gotta realize as a CEO, everything I, everything that's happening this year, I made those decisions four years ago. 

People don't realize that in drug development, how long it takes, yeah, I can impact the next quarter to a little bit, but the reality is my, the reason you're paying me is cuz you want me to be here in 10 years, not me, but the company.

and you want us to continue to sustain? So the decisions I made three years ago, you're gonna start to see later this year, next year. And that's when people are like, oh, that's great, I can't believe you guys did that. I'm like we made that four years ago. You haven't seen all the other decisions we made each year.

We'll start rolling out now cuz we, you, it takes time That's really, decision making and being disciplined and M and a is part of that journey is what I would say. is, if you can find something, if you're a pharmacist, you wanna get to another town and you could decide to build or buy, if you got a guy who's retiring and you get a good price and give him some kind of earn out, then he might be better to buy.

if you wanna go to California from New Jersey, I don't know. You're not gonna be there enough. And then you gotta have a good team and then you're adding expenses. And does that really work out? Um, and, and so most of the time when you study the history of M and a, like I did in business school, there's tons of case studies and meta-analysis that very few M and a pay off,the, I'll say 70% never deliver what they say.

Mike Koelzer, Host: 

is that price factored into the price or is, or is that lost because people have sold on potential.

Michael Castagna, PharmD, MBA: I think everyone always goes into it with the right assumptions. And then once you buy something, you realize, oh, they cut their expenses really to the bone. then I gotta add back all these people or the economy splatters. And then, I know someone just bought a company and they bought a mortgage company last year.

guess what's happening this year, they laid off 98% of their people 

so at the time it seemed like a great idea. I was gonna build this mega mortgage thing and interest rates were low forever. that didn't pan out. So things happened that you couldn't control at that time. and I think that's, it's not necessarily, like the Vego device we bought, I felt like we got a good deal that even in the worst case scenario will get back our money.

And,that was a good deal for shareholders. It's a good deal for our employees. And having that discipline,I think, is something companies do. You can choose to scale up and buy things and, and, but I think you see Google's been pretty self grown, right?

They're not out there buying a lot of things. Apple's been pretty self grown. and these companies become the biggest companies in the world from nothing. and apple almost went bankrupt once or twice. and I think you just gotta build a good, strong culture, good strong values.

What do you want from your employees and what product or service are you solving for society? And I think, if you find Boltons along the journey, great, BA and Bauch and health, I [00:20:00] don't know if you looked at BHC,they built through acquisitions. They did not do R and D and they would buy something, take up the price, buy another thing.

and that worked for about 10 years until it all collapsed. And now they have tons of debt. They can't grow their revenue as fast. They have no R and D engine. That's not a sustainable strategy. And that's what I mean, I watch that as an outside experiment saying, who's right. If these guys are right, that's amazing.

Cause you, do you spend, Amgen spending probably five, six, 7 billion a year on R and D and you could ask yourself like, if I just bought something every year, is that better? 

and the reality is the debt's expensive. At some point it catches up to you.

Mike Koelzer, Host: I come across my kids sometime and they're cramming, for an exam or something, or a paper. They had the semester due and they got three hours now as a CEO of the public company. Do you have times when you ramp up with a little bit more tension because it's, maybe you have to present to the board every quarter or when you're

quarter data is coming out. If you can think of a time where there's some uneasiness in your soul, when is that? Through the year?

Michael Castagna, PharmD, MBA: I think as a CEO, it's always

Mike Koelzer, Host: yeah,

Michael Castagna, PharmD, MBA: I don't 

think. Yeah, I don't think there's ever a day or a moment where you feel like you're not at 180%

it's, there's always gonna be something, 

 you're terminating an employee and you're worried about what's gonna happen. You're,

You know, building out a manufacturing plan is gonna work when you build it.

you're hiring a hundred employees that they all get along. Like we had a fight in the parking lot last year, who thought I had to worry about people fighting now I need security. There's always something that's gonna happen. And I think how CEOs handle that stress is really important because if they overreact to every situation, you're gonna drive your employees crazy.

And there's a balance between digging in and managing the people in the situation and letting the people work through it. And that's probably my hardest job, I used to be a pretty hands on person. And I think the biggest thing I've had to develop is how do I pull back a little bit?

How do I let people fail a little bit? Because they're not gonna learn if I'm always there babysitting them and just like your kids, if you're always rescuing them from falling and scraping their knees, they're never gonna learn how to fall. And, I have four kids and. and my wife, I'm like, it's okay, they'll be fine.

let them learn how to walk up on the steps because otherwise they're just gonna fall on the other head one day. and so I think that's the balance of being a co is when do you go in, when do you not? But you're usually in the hard parts of the year investor season. So that usually starts in the fall.

if there's a lot of conferences back to back, so I'll be on, I was on the road for eight weeks this year already back to back. And, I think from March until June, I was home for about five days, including weekends. And so I think that's really hard. If you're trying to fit in a family vacation or a work schedule, it's some international travel, so that takes up a lot of time.

so I just think there's never a dull moment as a CEO that thinks that's the beauty of the job. There's always something different. and, and when everything's calm is when something happens, you didn't

expect. And so I think it's how you deal with those situations and how you turn those.

Like, when I became CEO mankind, the company at one quarter of. think about that. You're running a public company, 200 employees and you were outta money in 90 days. and no one wanted to give you money because this company burned through $3 billion in capital, over 20 years. And so people were like, no, I'm not giving mankind money.

and so that was a very scary time. And there's times when we got down to one month of cash, and so rumors are going, you're going bankrupt. My employees get scared. all these things were always things you had to deal with all the time. I'll never forget. I jumped on a plane. I did the earning call.

I jumped on a plane to Australia that night with my family and 20 other people. I landed the next day, Friday evening. And our stock was down 40%. 

This is like August, probably three or four years ago. And. I was like, what happened? Stocks never dropped 40%. I just said we were fine. Everything was good. It was 2018.

And, and people, there was an article that came out and said, man, KIS going bankrupt. And all my employees were gonna be laid off. And it was like, oh my God. And so I jumped on an urgent town hall with the company and I said, guys, I'm on vacation. If we're going bankrupt, I'm an asshole. I'm gonna go enjoy my vacation and you guys should go enjoy your jobs and just do what you're doing.

And don't worry about it. We're fine. I know you've read a stupid article online, but there's no accountability to these news streams anymore. There's so much fake news that what is the truth and what isn't, and what's the validation source. I used to love reading Motley full and, seeking out when somebody's, but they're all written by people that have no experience and no accountability.

They could say whatever they want in short stock and tank it. and that's pretty scary that you can manipulate markets. Like we've seen with games, game stock and things like that.

Mike Koelzer, Host: back in the old days, and I'm talking back in the, I don't know this very well, but Milkin and all these things, those guys the way I understand it, they actually were in charge of publishing at like these kind of not fake, but they were in charge of publishing at these publications.

They owned and they could slant it this way and that made the stock go up. then you have, 20 years of, where you maybe call it solid reporting, but now it's gone the other way. where again, it's not true to life, but it's not necessarily the company doing it. It's some other company doing it, some publishing company

That's gonna benefit them by having these crazy stories out there, if not just selling more advertisements to get more eyes on things.

Michael Castagna, PharmD, MBA: Yeah, no, it's true. there, no, no one wants to pay for news. I was just buying a [00:25:00] magazine subscription the other day and I'm like, oh my God, 20 bucks. And I'm like, it's probably 20 bucks because they don't take a lot of ads. They're still trying to stay alive. Like it's a good magazine.

so I appreciate that they were trying to protect their brand and I'll just give it away for a dollar subscription. but I think that's right. people just wanna click on things. how many articles these days, you read just a headline, you click on it and it's just a stupid ad. Like it's not really a real article.

and so I think the Internet's just full of junk mail anymore, and your mailbox is full of junk mail. And I think as a human being, it's harder and harder today to sift through all that noise and it's just hard. So that's why I tell people the biggest thing is how do you focus on what's important every day?

Because there's lots of distractions coming at you, whether it's from kids or kids' problems or their friends or your friends, and everybody's got problems in the world, I don't care how rich or poor you are. We all have problems, how you deal with those problems, how you sift through that information to get to where you want to go is what's important.

There's always gonna be drama and there's things you can dwell about, but. And unfortunately the political stuff in the last couple years really created more of a divide. And, I hope all that gets better. America's a great country and I'm not Republican or Democrat. I just 

I want a great country to live in.

Um, you know,I get the luxury to see the world and guess what? I still think this is one of the best places to live, for as many imperfections we may have, it's still one of the best countries to live in. 

Mike, you were mentioning the stock price. I've always wanted to know this.you kind of alluded to that. You could have a time where your company's doing great. And you've got a lot of stuff on the fire in a good way.

Mike Koelzer, Host: You have a good future coming and your sales are up, whatever yet stock can almost be external to that. Your stock can be doing a lot of different stuff unrelated to your company.

Or would you say that in general stock is pretty close to what a company's doing? 

Michael Castagna, PharmD, MBA: no, because mankind was undervalued. We traded at a dollar, a share for $50 for three years, and it got to a point where I'm like, Hey, the board is gonna fire me because I've done everything I can, I've fixed a debt. I've built a pipeline, I've gotten a sale, and then all of a sudden, probably about 18 months ago, the pipeline asset we've been talking about publicly for three years,was filed and all of sudden be like, oh, you're really gonna have a pipeline asset.

And I'm thinking in my head. How many times we talked about this. Yes, it's real. It's not a fake product, but the company had a history of not delivering. And so even though we've been talk, I appreciate I've been buying stock at a dollar 50 for, you know, years, five

years. Um, so I never not bought stock.

I've never sold a share unless I had to for tax reasons. But, so I spent almost every free dollar. I had been buying mankind stock for the last five years at pretty good values. And today we're at four hours a share. and so all of our employees who did the employee stock purchase plan, they've done very well and hopefully have held onto those shares.

but I think we were undervalued for a long time and now people ask me what's the real value. And I said, look, we're gonna keep growing. As far as I can tell, there's no guidance for people's portfolios, but you know, when I look and say, you. a financial advisor always tells me to diversify. I said, Jeff Bezos and Elon didn't get rich by diversifying.

They got rich by concentrating their position and taking a bet at that one themselves. And for me, mankind is something I'm gonna trust what I'm doing every day, rather than some CEO, I don't know, running a company. And I know we're gonna keep growing for as far as I can see the next 10, 15 years, how many companies can you save?

Will reliably grow for the next 10, 15 years consistently. and I do believe that's our company. and we got a pipeline, we got our inline brand. Everything we're doing, is gonna keep growing for the next decade. and maybe even 20 years, if we're lucky. it's got a lot of patents, it's got a lot of complexity.

It's very difficult to do what we do. Someone even to make a generic, or probably have to spend 10 years and $500 million. It's a very complex process. It's very hard to make dry powders and as a pharmacist system, I'm like, oh, it's an inhaler. What's the big deal? you don't realize getting that thing to be stable, being able to deliver as accurate as a dose.

You do, being able to scale that up manufacturing wise, there's a lot of science and technology behind all that and failures. That's all part of it. Everyone of our employees gets a bonus and they all get stuck. and so it doesn't change what we do.

Um, it really doesn't. I just, I tell people, I remember, I don't know if you had this pitch from Walgreens. If you worked for Walgreens for 20 years, you would get a 401k match. That'll be great. Your base salary, you maximize, you'll be able to retire millionaire. I was like, that's pretty appealing.

And that's what I want my employees to feel . If you stay here and invest in us, we should do a great job in turn. You should do okay for your career and your family. but so many people don't look at the five and 10 year view. They look at the one to two year view these

And, um, and so that, that's where you just gotta recognize. I'm always sometimes irritated by our employees, especially young ones who quit because I'm like, guys, you don't know what you're walking away from. Cuz they don't put as much value on stock or stock options. they're looking at their base salary in their bonus saying, someone's offering me five grand more.

Mike Koelzer, Host: Yeah. For sure. You know, you 

Michael Castagna, PharmD, MBA: I like after tax, I don't know. It's 50 bucks a week. I'm not sure it's worth it. you gotta really ask yourself, now you're commuting an hour. Is that really worth the extra money? Um, for sure. And these people don't think that way. 

Mike Koelzer, Host: Michael, I ain't no genius, but your product inhaled insulin, you talk about having this future. It seems that. Your product is the product that is used in cliches. Like in other words, when people are talking about,oh, you know, they can send a man to the moon, 

but people still have to, you know, [00:30:00] stick themselves with insulin, you think they could just inhale the damn thing. I've heard this for years. And then here is your company fulfilling that cliche. And as far as I know, there was some competition earlier, and that's a way now that, that, was it Pfizer or something had something, but now here you are, as the only product fulfilling the cliche.

And it sounds like a good thing to me.

Michael Castagna, PharmD, MBA: Yeah, no, it's amazing. Pfizer and Santa Fe both failed at inhaled insulin, right? And then Novo and Lilly both tried and also didn't keep going. And so only because of the history of our company's name mankind, because our founder was Alfred eman and Al man many don't realize on the podcast here, he helped build the cochlear implant CGM.

As we know today with Dexcom and Libre, the technology behind that, he made an insulin pump, which was a mini med sold by Medtronic. So all these,spinal cord stimulation, neuro stimulation, he built cochlear, I eyes for people to see bionic arms. This guy built so many innovations in his 91 years of life.

And so he was a billionaire and he took a billion dollars of his own money and built mankind, 1 billion of his own cash. 

And then borrowed, the company borrowed and raised another 2 billion. . And that's what people don't realize. it's two to 3 billion minimum for a drug these days to get to market.

And that's for the ones that make it, that's not counting the ones that actually failed. and so we're at a point in society where it's very difficult and you think about Afrezza, the inhalant insulin we make. it took us 20 years of dosing and trials and 75 trials to take a hundred year old injectable product, 3 billion in over 20 years to make it inhaled.

So when we talk about the price of drugs and the cost of drugs and innovation, and we think about that, the FDA went its study after study to show that insulin that we know works, just making it into a powder, which was difficult by itself, was another 75 trials in 3 billion

in 20 some years.

And that's the frustrating part for me that I like to bring up. Cause then the question I get from payers is, why don't you sell it as cheap as the injectable? And I said, you don't give 95% market share. If you gave me 95% market share, then more people would be aware of it.

Just like you said, like they don't even know this exists. and that's, what's sad is, how many files of insulin do you dispense a day or pens as a pharmacist? And if you ask those patients, Hey, would you ever try inhaled insulin? They say, oh yeah. When it comes out, it's been out for eight years.

and we still know 80, 90% of people are not aware it exists. And that's a reflection on us as well about marketing, but it tells you how expensive it is that just because you make a product does not mean they will take it. It does not mean they go find the information themselves and we don't spend 500 million of your own marketing you probably have to spend a good, a hundred million to compete in diabetes, maybe 500 million, like it's in that range to make it a five to 10 billion drug like you see with, all the Truity and these things.

marketing years. 

Mike Koelzer, Host: need to have that in marketing over a number of years.

Michael Castagna, PharmD, MBA: Yes. Yes. So if you look at like Repatha and, Trulicity, those are G GLP one and the PCSK nine S they were probably spending about three to 500 million for the first three to five years of launch

And you see all the TV ads, TV alone on that is a hundred million a year easily.

The sales force of 500 people is about 250 million a year. the managed care of reimbursement programs and copays about a hundred million, 200 million a year. all that adds up and as you grow, it just gets more expensive. You gotta manufacture it and then you gotta build another manufacturing plant.

It takes about five years to build a manufacturing plant.

So,if you don't build it ahead of time and take the capital and it doesn't work out, that's what happened to mankind. We had a huge plant and then the drug didn't take off. And then we had this big empty facility that cost $300 million.

and it costs 30 million a year to run and you don't have any drug cells. These are the risks in drug development. I'm not complaining, it's just part of the business equation that people don't realize. Now we know we could make it grow faster, but the amount of money it's gonna take, we diversify our focus onto the pipeline.

Andreza will eventually get to a point where it'll generate enough cash and we'll invest that back into growth and help more patients. But,we wanna make sure the company's here for the next 20 years. And when you ask about shareholders, like that's the trade off, 

right? The shareholders will say, why do you still market?

Afreza didn't do well. and the reason we do is we have some good studies coming out in the next year or two, and we think they're gonna be pivotal to the transformation over the next decade. And,if you go back and look at diabetes care, a lot of it, diabetes innovation happens with children.

the insulin pumps, the CGM, the pens,that happens with kids. and so that's where we are. We're studying the product and children, and that trial should wrap up sometime next year. We'll get those results. and then we'll see if, is it better than a standard of care? Because if it's just as good as what everyone's doing, then you gotta compete on price.

And if it's actually better, this will be the first trial we've done head to head with proper dosing, or we think the drug is better. We'll be able to show it's better. And so many people are on insulin, you believe it or not for your pharmacy listeners, 80% of people taking insulin are not a goal.

Think about that. Four outta five people are failing every day. and what's that lead to heart attacks, dialysis, amputations, blindness, peripheral neuropathy, right? So many medical complications. And why are they not a goal? Because we're so afraid to push the dose of insulin because of [00:35:00] hypoglycemia. It's a life and death situation. So we'd rather run sugars high than run them low, but the high sugars cause all the complications. Then what happens? We study all these drugs that say,I'll make it in Vocon I'll pick it up for today. Let me give you this, cuz it protects your kidneys.

It protects your kidneys when you have high sugars. What if your A1C was a 6.0, like a normal human? Do you still need it? Invoca

I don't know that answer because we don't study drugs when you're healthy.

 So what we have is a treatment for the failure mentality in diabetes, which is what my, you fear me, talk publicly.

I get very frustrated because no doctors paid for outcomes. Patients are told they're failures, especially type twos, and everyone in diabetes is just depressed because whatever you do, doesn't get you any better. And you know what? Food is addictive. It's good. It gives you pleasure. And the reality is people now want to still eat and take their drugs and now type one and type two are slightly different if you're born or deal with it when you're a kid, you get diagnosed.

When it comes to insulin, it's a very complex matter because doctors don't wanna take the time to help you understand. When I talk to patients, they're like, I learned more from you in 15, 20 minutes and a simple thing, just cause your listeners are here. from the time I inject, I ask people how long before the insulin starts working.

and I say, immediately, you just injected. I go, no, it takes 45 minutes for it to break down, get through the bloodstream. And then it becomes, it's active form of a monomer. And then from there it gets to your liver and shuts it down. Then it starts working. So it's about an hour and a half before you, from the time you inject to the time it starts bringing down your sugar.

But when I inhale the start device now in seconds, it's already in my blood just like oxygen. It's working already. Cause it's in a monomeric form and it's hitting my liver in seconds. And now my sugars are gonna be in control much 

faster. 

And the only way you can really get insulin in the bloodstream that quickly is through the inhaled route.

Cuz to stabilize it in injectable form and protect as biologic. it just, you can't do it really. And now if you do it, you can't even price it to make your money back. So I doubt anyone's gonna invent insulin. so my prediction is, and look I'm for society purposes. I hope I'm wrong.

But as a company, I think we're the last. Novel mealtime insulin to come out in the next decade, maybe 20 years. So this is it. So either deal we're dealing with which hasn't worked for the last 20 years for people or try something different and to try something different is when you go to a diabetes conference today, how is just the American diabetes association, all the companies were technology and what are they all trying to do to fix the profile of insulin?

You got an alarm to tell you if you're high, an alarm to tell you if you're low, check your sugars, check your eyes. It's all about the problems of insulin. And if we actually just think about that and actually try to change your insulin, maybe you'll take it. Maybe it'll work better. Maybe it'll fit in your lifestyle better.

But when people are missing 20% of their doses of insulin, they intentionally miss because they're at lunch with their colleagues, they don't wanna inject, or they don't wanna check. you're not gonna get the goal. And when you're not the goal, you get a lot of complications that take over 10, 20 years.

So it's a long term complication. It's not just mankind's gonna solve it. It's a societal one. but it's one that's depressing. when you work here every day, trying to change people's lives.

Mike Koelzer, Host: Some of those products had to create problems, like the, not balding, everybody thought balding was a problem, toenail, fungus, and, 

restless legs, those things that kind of had to, those had to create a market.

And so with the insulin, it's sad that we're still creating, in a negative way, but creating a market of saying, more out there than, than this. When you talked about the marketing and you talked about the rebates and PBM and Medicaid and Medicare and that kind of stuff, throwing that to the side. If you had a marketing budget of X. where nowadays should that go? And let's divide that by sales reps and by,billboards and super bowl ads and across the gamut, what percent are you spending?

Where, and I know it depends on what you're trying to do long term versus short term, but in general, what are you gonna spend? Where

Michael Castagna, PharmD, MBA: So I, I think in general, and I won't get specific for mankind cause we don't break stuff like that 

out. 

But

General, when you're launching a drug, depending on the company's mindset, right? smaller companies are gonna take their time and do it. Sequentially, bigger companies will just blow it all at once.

because they have to. but in general you want doctors to be aware of a drug, know how to prescribe a drug and you wanna work on the managed care to make sure it's covered. So when they get prescribed, that's all, that's as easy as it could be. And then you start, once you have a base of prescribers and consistency, then you go in the consumer, your turn on TV.

And whether that's magazine, print, digital, TV, we could debate those things. But, then you go into DTC, usually 18 to 24 months after launch. These days companies are going big, hard because they need revenue sooner and there's generics and everything else happening in biosimilars. And so they have the cash to spend and try to make drugs bigger, faster.

And I've seen that model evolve the last 10 years. Now I see companies saying, okay, I'm gonna go really intense for the first two, three years. And then I'm gonna pull back some and put that on my next drug launch. So in, instead of doing a little bit over time, now they're betting big in the beginning.

Once it's established, like then they go onto the next one. So literally I thought that a good job with that for migraine, they launched Trulicity, they spent a lot of money. They probably took the money from Trulicity from something else. And then they pulled back from that. And then they went after the migraine and they did a great job of migraine and then they kinda moved on to the next one.

And I think for [00:40:00] me, I think you're seeing Twitter and Elon Musk fighting, I predict that a lot of online advertising that companies are spending is actually just wasted money. and there's really, you think you can track and you can track a lead, but you get 1% clicks, half percent clicks.

If you're lucky you send an email, you. 2% open rate, it's so dismal that marketing is very inefficient and mass marketing, even more inefficient, but people say, oh, you can really target specifically. And sometimes you can, Google and, apple are making it harder cuz they're starting to close their networks a little bit, 

and Facebooks.

And we tried different things. We've tried lots of different things. And, to your point earlier, like we still don't have a lot of awareness, which is our biggest frustration because doctors don't offer inhaled insulin as a choice to their patients. And then we do TV or we do the internet . People go in and ask for it.

And a doctor says, sorry, I don't know much about it. I've never prescribed that. I don't know how to do it. So we get all these excuses and then a poor pharmacist receives a prescription. They go, I never heard of it. I don't have it in stock and I don't know how to count it. And how do I dispense it?

And which cart strength am I pulling and how do I enter into the system? So that becomes a headache. And so we've tried to solve these steps along the journey. We create a reimbursement process to catch a lot of those mistakes. but it's been one of those things we haven't had. , for those who say, why do you need sales reps?

Which I probably would've been in that camp 25 years ago. Do you really need sales reps until I was a sales rep myself? And it's not just because you bring in lunch or coffee. I know that's our perception out there, I was a great sales rep because I knew the science. I could have a debate with a doctor and I could present 'em information to her and then they could take that information and challenge me or go challenge the other company and make the right clinical decision.

but I always viewed our Infor our job as an industry is to provide information and the doctor's job is to synthesize that information and decide the right clinical choice for that patient. and so many times we're afraid to provide information as an industry because is it in the labels? It is not in the label to me, if it's scientifically valid, we should be happy with it.

And if you have shitty science, then that's probably not good, but if you run good science, it's our job to get that to doctors and patients and help people understand the guidelines and all those things. So it's important, but,for us, we've tried a little bit of everything, but we, you can see.

We are subscale. So we don't have enough reps. If we have more reps, we could cover more doctors and help more patients.

Mike Koelzer, Host: you said that was part of the reason you got with the, the patch because 

Michael Castagna, PharmD, MBA: 

Mike Koelzer, Host: they had sales reps already in areas. but that

Michael Castagna, PharmD, MBA: They had 60 reps selling it and then they backed away and then they didn't promote it for a year, because they couldn't afford two products that weren't doing well either. you need. 

Mike Koelzer, Host: of the reason though, to 

Michael Castagna, PharmD, MBA: 

Mike Koelzer, Host: gang up the forces.

Michael Castagna, PharmD, MBA: Yeah. so right now we're just trying, we hired about 15 people dedicated to it. Right now we have 60 people inhaling insulin. And then, eventually we'll be able to get to 75 or a hundred or more 

selling both products. And so that's really the goal at some point. So we didn't commit to a timeline, we think we wanna stabilize cause this other product was declining for 12 months.

So we really went to put a stop, the decline, get it back out there. And a lot of docs were very happy to hear we, we bought it because they said, oh, now I know it's gonna have a home. You've been dedicated to anal insulin. You've taken good care of it. You have good reimbursement programs. so our big customers are really happy.

And so I think the Vigo customers will be very happy to know 

that's here. 

Mike Koelzer, Host: being a independent pharmacy owner, I was with my dad, from my dad then passed on and then I never really had any, what do we want to call 'em cohorts or,industry friends, because I couldn't really talk to my team because I was their boss, you know? And so I really enjoyed them over the years, I was involved with the county pharmacy association because these guys in general, a lot of 'em were owners.

And that was kind of your, you know, your bitch group and so on. Who was that for you as the CEO of your company, when you want to let off steam and maybe with some better thoughts, you say, you know, I probably shouldn't let off steam to this person because , it might not be a good thing. Who is the best person for you to let off steam with?

Is it fellow CEOs? Is it outside of the company? Who is that for you?

Michael Castagna, PharmD, MBA: Yeah. I mean, you know, for me, it's a couple people or systems, I'll say, being a publicly traded company puts a different burden on you because you're always worried about somebody trying to get an edge for insider trading and I never wanna go to jail. So therefore your your external friends that are really your truest friends, you can't share anything with because you don't want them to do something stupid or tell someone something stupid.

 Like my drug was getting delayed last October. I was out that weekend with my friend. He had no idea. 

I had no idea you were dealing with all that. And I was like, that's good. that's how it should 

be.

it sucks that I gotta live my life that way, but that's what 

I have to 

Mike Koelzer, Host: That's like My wife's saying, did you know,Sally was pregnant, I'm like I did, but that was like six months ago. you just get used to not talking about stuff from the store, 

Michael Castagna, PharmD, MBA: yeah. So I was like, that's good. So I think like my CFO and I are very close, we talk a lot about what's going on with the company, each other, our families, things like that. So I think, having that confidant in the executive ranks, because you can share what's going on with the company.

You can share what's going on with employees and have that personal touch. HR is a critical one, but then even as a CEO, no one really knows what it's like till you're in the job. You run an independent it's a tough job

and it's tough to stay alive and talk to other people, dealing with it.

How do you deal with different things that come up? 

and so I, I think you've gotta find peer groups and they're good outlets. And how do you do that? In my case, I just signed up. About, I guess it's been two and a half years now with YP O. It's called the young president's organization. So that's for people under 50, that are CEOs of other companies, [00:45:00] public or private family owned doesn't matter.

And so I found that to be a very good peer group. It's very intense. You meet twice a month so it's a big commitment, but that's the value you gotta be there in person. If you're not there, then you're not getting the value. So they really are restricted about that. so I found that to be helpful and there's a couple other ones that have come up.

My wife just signed up for, wanna say cheetahs, but I know that's not it, but,chiefs, that's what it's called. I think people are tribal by nature. Like you like hanging out with groups that assimilate with you and understand what you're going through and, and I think that.

being able to, if I was a pharmacist, I always did all the local pharmacy things. When I was in business school, I did all the local business school things. I was in marketing, I did all marketing clubs. And I think that's how you build your network. It's how you learn more.

It's how you learn from others. I asked somebody once to head like 10,000 sales reps. And I said after 20 years of running a major sales force, one of the top five pharma, what was your conclusion of what made a good rep versus a bad rep? And he said three things. First generation college grad, continued improvement in education.

And I can't be third one, maybe with a track record of awards or something. And I thought about that and I was a first generation college grad and part of it is you wanna get through, you wanna prove yourself, you wanna work hard. I thought about education. Like I went back up my MBA twice.

I went back up my pharm D like, I didn't need to do that. I did that for myself. My mom wasn't pushing me. Nobody pushed me. . And I think about that when people get their education, the reality is it does take a lot of work to go back and get another degree or to get your doctorate.

And, you realize that those people that are self-driven and self-motivated, you don't come across 'em as often as you think people always want it, but they don't wanna work for it.

And I think that's something in society we gotta deal with. and I'm sure you saw up and came to the pharmacist, who's got it together. Like, Hey, you're gonna do very well. And others who just show up and do their job, and can't wait to get the lunch break and go home. you want the guys who wanna do well ahead, but then they're gonna start their own pharmacy anyway.

 But you can keep those employees as long as possible, and help them make a difference. And that's

Mike Koelzer, Host: great. So Mike, I'm gonna take some things off the table for this next question. I'm gonna take off that you're helping people's health and that you're making a difference in the world and those type of things, 

when you look at your. Life as a CEO, what are some things? And I want you to go as selfish as you can here.

What are some things that you would like out of this and I'm thinking things like, um,maybe satisfaction, those kinds of feelings, what are some of those things? Not related to just, you know, helping out mankind kind of thing.

Michael Castagna, PharmD, MBA: it's funny. My wife and I just had this debate the other day. As I get older and I get physical, I'm like one day I'm gonna die sooner than later. Last March when we did, we raised $230 million in convertible debt. And I went home that night and I said, we finally saved the company. Now that was for long years, but the fact that I can now breathe and know that we'll be here and now if I lose this much money, it's because I'm an idiot. and hope I'll do it long in this job.

everything I laid out has come true, right? The pipeline, the growth, the everything that's happening. And so now the company needs to execute like hell and help as many people as we can. That's our mission and our job. But for me personally, that mission was accomplished.

There's nothing more I want or need in life. I want my kids to do well. I want them to be happy. So many kids struggle with social anxiety and illness these days and mental illness, I want them to do great. But like my mom doesn't really know what I do. She has no clue. None of my family does for that matter. they just probably see a public CEO, they all Google my salary and see what I make. And I go, yeah, it says, I make this much money, but actually when you take away my stock that I can't sell for five years, you look at my base and then I'm divorced.

So I got alimony support, like any divorced dad, I provide for my kids and my California taxes. I go, I feel like I make a good living, but then, you know, it's not that good in the end. 

I provide two, two families these days. The money is a nice byproduct, but it's not what gets me up every day.

So many people I know are rich and miserable and depressed, and that's one thing, for those listeners. , you think if you get outta debt or you think if you're on your own business or you think if you had a different spouse, you're gonna be happier. The answer is probably not you get to that point and you may feel happy for a moment, but just like when you buy a new pair of sneakers, you're like 'em for a day or two, then they get dirty a month later and that's life.

I used to think, oh, if you bought a nice car, they must get treated differently. 

Now the service is a little better. You pay $500 for, it will change instead of a hundred.

Mike Koelzer, Host: It's the hedonic treadmill of, you're happy for a bit. It certainly sounds like a climb. It's the satisfaction of the climb.

It seems.

Michael Castagna, PharmD, MBA: Satisfaction. Yeah. I enjoyed the journey. I enjoyed the job. I've enjoyed all the people I've met and the careers I've helped. And lots of people have helped me. for me, it's I just had this dilemma, my wife, as like, when you die, like my purpose in this world 

is to get back to society.

That's my purpose. It's not to leave my kids a bunch of money. It's not to say I'm worth a hundred million like that. That doesn't matter. I'd be much happier. When I hear the stories of my wife's Mexican and I see what her mom does, volunteering for the farm workers in the community these people don't have.

And, we have food under the table. We have no idea how it got there, but believe me, there's people busting their ass, trying to find childcare. 

Mike Koelzer, Host: yeah.

Michael Castagna, PharmD, MBA: we take for granted the strawberries that show up at the grocery

 Um, but if you knew what, how these people live, they have no mattresses.

Their kids barely have care during a day, whether they're out picking in the fields and 

they're somewhat constrained because they [00:50:00] can't always become legal citizens. And then they're fighting for that. so I'm just very thankful to be in this country. I'm very thankful that I've got to college and I hope I have kids that do something productive in life.

And there's just a balance of trying to be a good dad and a good husband and a good CEO and a good boss. These are all the things that. I'm just a human being like anybody else. That's why I tell people and you know, and, and, uh, you know, you just try to do good for society and give back. And I think that's what I try to spend my energy doing.

I just started volunteering to help this organization in, um, Louisiana called Son of a Saint. And it's really for inner city Louisianas who don't have fathers. And these kids, they don't have mentors.

They don't know how to get to college. I didn't have any of that. And I relate it with that organization. During all the black lives matter stuff, we looked for a nonprofit to donate to. And this was one that I picked and, I got to meet the kids a few months ago when I was there. And it's just great seeing these kids.

And they got about 140 kids in the center. and the basic questions they have and the things that they're dealing with are much different than what I gotta deal with every day. And how do you just get some humility about life and what people go through? And that's why I try to volunteer as much as they can to help and understand others and what they're dealing with, because that's how you stay grounded.

I think as you go up in society, you forget where you came from sometimes, or you don't realize the struggles that people still go through and five and 10 grand makes a difference to

people. And,

I think that's important. I like what you do with your kids when you describe college.

I went through this debate, with my ex-wife at the time, I said, make 'em borrow the money, make 'em work for it. Make 'em think about the ROI of the degree because these kids go to get like a health, a history major, an art. I don't know what you do with that.

You got 250 grand in debt and you're complaining you can't pay for it. I agree. You can't pay for it. but you chose to be an art historian and I don't know, there's no jobs for that that pay over 35 grand. So you might as well just go work at McDonald's and make $20 an hour.

Mike Koelzer, Host: It's a choice in a business that you can't have stuff like that. That logic goes out the window. you 

Michael Castagna, PharmD, MBA: yeah, yeah. So I, 

Mike Koelzer, Host: that. everything has to make sense, 

Michael Castagna, PharmD, MBA: I like what you did and my daughter, she's a big runner, my other one's a big mountain bike and soccer player, and they're doing great and winning awards. And I said, that's your ticket? That's your differentiator now? What do you wanna do for your career? Do you wanna go into science? Do you wanna go into business?

Do you wanna go into accounting and just teach kids like, Hey, advanced degrees that require licensure, generally get higher salaries. You generally have more 

jobs,

if for a reason. Not everybody can do it.

Mike Koelzer, Host: That's 

Michael Castagna, PharmD, MBA: That's so true. 

that's, to me when you see athletes, like I, I've got to meet a lot of famous people the last couple years of my job and very successful people, whether hedge funds or actors or race, car drivers, and the thing you learn about all these people is they've been working as long as you can imagine, 80 hours a week to get to the top of what their game and whether it's football, indie car go car racing since they're eight years old or, hedge fund managing money since he was 16 in his own money.

These guys work long hours and they make a lot of sacrifices. Whether it's going to the beach with their friends, going to parties, there's just a lot of sacrifice that comes to get to the top peak of whatever you wanna do. And, I just see more and more society in the US saying, we're not willing to do that.

 and that's good and bad. We gotta compete with China and India in the long run. and they're still developing countries at the end of the day. They have a billion people who don't wanna be poor. You know that's who we're competing with. And I don't think Americans realize, eventually we gotta keep ahead.

Mike Koelzer, Host: 

If you're happy, good. If you're not happy, a lot of stuff has befallen you, but you can also probably work a little bit harder to get where you want to be to make yourself 

happy. 

Michael Castagna, PharmD, MBA: can go back and get an advanced degree. You can switch careers and take a little bit of a pay cut to go ahead again. Don't just show up every day, unhappy

 all companies have brown grass to me. It's what you make of that lawn. That's in front of you. And, and that's what I've found in my career. I've been the luxury director for Novartis, Brita, Myers, Amgen.

I, I, these are great fortune 500 companies, and they taught me a lot. They invested a lot in me. I've done a lot for them, but,it's been a good equation and I'm only 45, I've done a lot the last 25 

years. I can't imagine the next 25. and, and so 

Mike Koelzer, Host: You got about, let's see, 45. You 

got another 45. 

Michael Castagna, PharmD, MBA: my grandfather died at 91 and

my grandmother's 94. So 

Mike Koelzer, Host: age. You're not middle aged yet. You're not middle aged.

Michael Castagna, PharmD, MBA: yeah. so it depends. I found out who my dad was and he passed away at 75. somewhere in between 75 and, 95, I'll be 

Mike Koelzer, Host: 

Michael Castagna, PharmD, MBA: if I don't kill myself in a car

accident or

something who 

Mike Koelzer, Host: That's right. Mike, thanks for joining us. You're a good leader and, uh, you're making a big difference. 

what you're doing for the profession.

Michael Castagna, PharmD, MBA: Thank you. And, anything I could do to help and connect me on LinkedIn and any of your listeners, but we have PharmDs coming from USC and tech school medicine. We have two fellows here next year. I do kinda get back to the pharmacy community. I'm a big proponent of pharmacists and I love what we do for a profession.

 Thanks.

you. 

Thank you.

Thanks for 

your time today. All right.