New CEO Mark McLaughlin resisted board pressure for a quick IPO, arguing that going public is a starting line, not a finish line. He first focused on hiring key leaders and building scalable systems to ensure the company could operate successfully in the public markets, not just survive the IPO event.

Madrigal defied the typical 12-18 month pre-launch hiring window by bringing in a new CEO just seven months before approval. He leveraged his network to quickly assemble an experienced commercial team he had worked with before, enabling the company to build a sales force and launch in record time.

The commercial success curve of a new drug is locked in within the first six to nine months post-launch. After this point, market perceptions are set, and additional investment yields diminishing returns. A rapid, real-time feedback loop is crucial for course-correction *during* this make-or-break period.

The focus in advanced therapies has shifted dramatically. While earlier years were about proving clinical and technological efficacy, the current risk-averse funding climate has forced the sector to prioritize commercial viability, scalability, and the industrialization of manufacturing processes to ensure long-term sustainability.

The old assumption that small biotechs struggle with commercialization ("short the launch") is fading. Acquirers now target companies like Verona and Intracellular that have already built successful sales operations. This de-risks the acquisition by proving the drug's market viability before the deal, signaling a maturation of the biotech sector.

A biotech transitioning from a small, 'fit-for-purpose' R&D team to a large commercial organization gets a rare chance to create a new culture. Madrigal treated its rapid growth from ~100 to over 500 people as an opportunity to establish fresh core values for the newly-formed enterprise.

Factory's founder views fundraising as a milestone marking a shift in the company's state, triggered by rapid growth and the need to scale the team, rather than an end goal. This mindset keeps the focus on the core business.

In Biotech, risk is removed pre-FDA approval via clinical trials, making a Chief Development Officer (clinical, regulatory, manufacturing) the most critical hire. In many MedTech sectors, risk is removed post-FDA approval via market adoption, making a Chief Commercial Officer paramount.

The transition from a resource-rich environment like Novartis to an early-stage biotech reveals a stark contrast. The unlimited access to a global organization is replaced by a total reliance on a small, nimble team where everyone must be multi-skilled and hands-on, a change even experienced executives find jarring.