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Zero to One

Peter Thiel’s thoughts about startups, which I presume every founder past, present, and future has read and internalized.

But I jest. Browse Twitter and you’ll see his seven fairly simple principles of running a successful startup abused, ignored, and misinterpreted, particularly in biotech.

Instead of building a technology that will be useful 20 years from now — the durability factor — technologies are made to solve problems of 20 years ago. Layering optical character recognition, artificial intelligence and machine learning over the cruft of hand-written notes faxed back and forth between doctors' offices comes to mind. Compare and contrast to mRNA vaccines, a technology created more than a decade ago to treat today’s pandemic.

Instead of developing drugs and other treatments with at least 10 times the effect size of current standards of care — principle of technology — the regulatory agencies and markets are overwhelmed by me-too drugs whose marginal benefit requires mammoth trials for any chance of detection.

Instead of vertical integration and ownership of drug discovery, manufacturing, clinical operations and biomarker development within the same organization, with positive feedback loops between all the factors leading to a faster pace — the team prinicple — we get ghost companies made of slide decks and good wishes whose only tangible impact on the world is achieved via Contract Research Organizations.

I could go on: the principles of timing, monopoly, and distribution are also violated early and often in a biotech startup’s lifetime. But then I’d be breaking a principle myself, that of the secret.

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