Jonathan D. Grinstein, PhD, North American Editor of Inside Precision Medicine, hosts a new series called Behind the Breakthroughs that features the people shaping the future of medicine. With each episode, Jonathan gives listeners access to his guests’ motivational tales and visions for this emerging, game-changing field.
Rahul Gupta, MD, MPH, stepped down in January 2025 as the director of the White House Office of National Drug Control Policy—the nation’s “drug czar”—he closed a historic chapter in American drug policy. As the first physician and the first immigrant to lead the office, Gupta pushed the U.S. toward a public-health–centered approach to the overdose crisis. During his tenure, he championed harm reduction, expanded naloxone access—including the first nationwide move toward over-the-counter availability—and pushed for treatment over punishment. His years in the role coincided with some of the deadliest years of the fentanyl epidemic, and his policies reshaped how federal agencies, state governments, and even law enforcement think about addiction, treatment, and recovery.
In his next chapter, Gupta has taken his expertise in a new direction as President of GATC Health, a biotechnology and AI company focused on accelerating drug discovery and predictive health analytics. After years navigating policy, politics, and crisis response at the highest levels of government, he is shifting to the private sector to explore how technology can move faster than bureaucracy ever could. Speaking with Gupta offers a rare window into what he learned inside the West Wing during the fentanyl crisis—and how he now hopes to leverage data and innovation to change outcomes from a different vantage point.
This interview has been edited for length and clarity.
IPM: What were some of the most prominent healthcare issues you encountered as a clinician?
Gupta: Following 9/11, I had seniors come into my office who had to choose between medications and food. I ended up calling the local pharmacy many time to ask to waive their $1 Medicaid co-pay so that they can actually get the medication. I’ve seen relative poverty and everyday Americans’ decisions about their healthcare.
When I diagnosed someone with a rare or ultra-rare disease, such as amyotrophic lateral sclerosis (ALS), I would watch them die. Policymakers do not understand what is needed on the ground in terms of how we help people with their healthcare, particularly the cost of care, which becomes an important issue overall.
IPM: Have these issues in U.S. healthcare improved over the course of your career?
Gupta: No, unfortunately it has not. We haven’t changed a whole lot. When you look at the $5 trillion federal budget for healthcare, the majority of it goes to three sectors: hospital bills, doctor bills, and pharmaceutical expenses, which are one of the most rapidly rising costs we’ve seen in recent years. You can argue that it’s gotten worse. Today, the average person over the age of 60 takes about 23 medications per day. We have become a pill nation dependent on these medications for almost everything. Opioids are a classic example. These medications were developed to treat pain, but they ended up treating suffering. As a result of that, look where we are.
As a nation, how do we close the gap between those who can afford it and those who cannot? It is critical to continue addressing the challenges of education and prevention, particularly among young people, but we also require newer treatments. They use different mechanisms and are designed to take advantage of the most recent technology available.
For example, since 1938, we have almost always required animal testing as part of the drug approval process. But the data shows that 90–95% of medications that pass animal testing fail human testing…yet we continue to use animal testing. There are so many technological advances like artificial intelligence (AI)-driven platforms, organoids, and organs on a chip. All of these methods are available now. We’re moving forward…but the pace is so slow, and at the same time we’re sacrificing these tens of millions of animals a year, spending so much time and money with it.
IPM: After serving as the Biden administration’s drug czar, why did you transition to biotechnology?
Gupta: One of the things I thought about when I finished my work at the White House earlier this year was how I could continue to have an impact on the larger public health aspect of this and globally. I found this company [GATC Health] doing cutting-edge work. When I looked at it, I thought to myself, “Wow, this is science fiction coming to life.” And their first drug going into human trials was for opioid addiction, so I was sold.
GATC Health primarily uses Multiomics Advanced Technology, which uses artificial intelligence platforms and machine learning (ML) technology to create a human digital twin from human data, allowing you to do two things in general. One, if you really wanted to move forward, you could discover new medications and drugs faster and for less money than ever before, to the tune of nearly a molecule per month. That includes discovering drugs for rare and ultra-rare diseases, which was not possible before. Second, it can predict the success or failure of any molecule in the world with 90% accuracy. Any molecule out there has a 90% chance of failing in human trials and never reaching the market. We have very few drugs approved by the FDA because the process is so stringent and rigorous that it takes time, effort, and money. We now have the technology to predict, almost like looking into a crystal ball for that molecule, what’s wrong with it with 90% certainty, and then work with the molecule to fix that wrong on the one hand. The product is de-risked, and by doing that, you’re doing a few things.
You’re reducing the risk that investors are taking into the molecule. You’re maximizing capital efficiency, focusing resources on high-potential assets and avoiding unnecessary spending and strategically allowing yourself to manage the [financial] burn that happens. You’re improving strategic planning. You can have a pipeline that you want to go bankrupt because you now know which molecules work and which do not, and you can move that more likely forward. This de-risking is unique.
We’ve reached an agreement with Lloyds of London, the Medical and Commercial International (MCI) conglomerate, to be able to—they’ve created an insurance product in which they will provide debt insurance to companies conducting clinical trials because we can underwrite that product for them. AI and ML are completely changing the drug discovery and development process, which has been in place for over a century.
Innovation moves faster than access. What we don’t want is to have a few miracles for the few We want innovation that can be de-risked responsibly, followed by distribution, which means we need scalable products. It goes back to why, in opioid use disorder, tens of thousands of Americans are still alive today: because we were able to scale up our solutions. It’s really important, almost morally and ethically responsible of us, to ensure that science makes it possible to address the economics and ethics so that these miracles, so to speak, are reachable to the average person. Oftentimes, we are limited by some great things, but they don’t end up going anywhere. This is the part that we are very conscious of, and we want to figure it out, and we’re working to democratize drug discovery. So that people, institutions, and others can own a piece of the molecule, we’re doing great innovation research and all of that work while also taking it to the next level so that it’s affordable to the masses.
IPM: Which current U.S. healthcare issues stand out to you?
Gupta: Every U.S. president in my adult life has mentioned the high cost of drugs, and we have the Inflation Reduction Act. We are now working with the Most Favored Nation, and things are being done on a level that is only the tip of the iceberg. They’re transient and small, but they’re impactful from a politics standpoint. I became more interested in fundamentally changing how drug pricing works, which is related to their discovery and development, if we can have molecules that are 90% likely to succeed, discovered with relatively few dollars, and can be quickly brought to market at reasonable prices through a safe but externally driven process. I believe we will transform the global healthcare system, at least in terms of medication pricing and affordability.
When I was at the White House, I realized that everywhere I went, people would frequently talk about economics related to healthcare. Economic prosperity is inextricably linked to human health. We know this from epidemiological studies, and we know from other sources that people who are financially successful are generally healthy. I’ve been very interested in determining whether it’s housing, income inequality, childhood poverty, or childhood trauma. Those things become healthcare issues because ultimately those are the folks that deal with poor health when they grow up or do not have education or employment. All of these things, what I’m coming to realize, I guess maybe a little late, they’re all connected, and so we have to work together.
IPM: What are your thoughts on single-payer versus universal healthcare?
Gupta: We have decided that healthcare is a privilege, not a right. We made that conscious decision as a society and turned it into a capitalistic good. We also have the VA, Indian Health Services, the military, and the TRICARE system. We have Social Medicare at the end of the day. Medicaid is one of these socialized systems. We just choose not to acknowledge it.
Before we can find a solution, we need to have some honest conversations in which we will have to say, “You can’t be a little pregnant.” You are or are not.
The problem is that we currently have two, three, or four track systems in healthcare, and none of them are for the better. We spend the most of any country in the world, and we have one of the worst efficiency outcomes; we’re really bad. It’s because we do have in some levels, socialized medicine, or you could say single-payer systems. On the other hand, many people have to go to the marketplace or through their employer to purchase the same similar type of insurance. At the end of the day, these insurances depend on these. You have to have an enrollment in November, and then if you’re in Medicaid, it changes month to month.
We’re a complex system, probably the most complex in the world. At some point, we’ve got to figure this puzzle out because our disability rates are going up, and our consumption rates of healthcare are as high as they’re ever going to be, and they’re actually increasing. None of the things that we thought were going to reduce the cost will have reduced costs.
Think about it this way. Put the entire U.S. budget, GDP, and everything we spent, from military to education, on a page of paper. Then consider Social Security and Medicare to be your Pac-Man, and that Pac-Man will eat up the entire budget, the entire country’s budget, if the rate of growth continues and we do not address these issues. There is a sense of urgency for all politicians and sides to come together and figure this out. Otherwise, we will not only pay with poor health, but we will also behave in ways that have an impact on our economic prosperity, which is already happening.
IPM: Where will the U.S. healthcare system be in the next decade?
Gupta: With the advent of AI and ML platforms, we have this amazing opportunity to do physician medicine. It’ll make you have some light swelling or constipation. It takes a year just to get the right medication—not to lower your blood pressure, which is still high, but to get the right medication side effects. This is a 19th- and 18th-century state. Yet, we can now take a swab from your mouth and tell you exactly what medication you’ll likely do well with, as well as write it down so you can keep track of it and manage it automatically.
We’ve come so far as a world and as a nation. We must first understand the appropriate financing mechanisms, as our reimbursement systems, public-private partnerships, and patient outcomes, followed by the use of tracing models, consistently lag behind technology and innovation by decades, if not more. This is why I became interested in public health in the first place. Doctors often had to lie on the forums in order to get the patient’s access to basic tests. We’re in the same phase even today.
If we get our models right, we can get people to the point where they can quickly have good health and prevention, and then maintaining good health becomes the norm, allowing you to go about your business and enjoy life rather than going bankrupt. The number one cause for [bankruptcy] is still medical debt. That’s the mindset we have to change, and I see a future with the advent of AI getting us there. We have to allow our systems, politicians, and policies to get there.
