While the FDA is often blamed for high trial costs, a major culprit is the consolidated Clinical Research Organization (CRO) market. These entrenched players lack incentives to adopt modern, cost-saving technologies, creating a structural bottleneck that prevents regulatory modernization from translating into cheaper and faster trials.
Related Insights
The decline in R&D productivity (
The conventional wisdom that enterprises are blocked by a lack of clean, accessible data is wrong. The true bottleneck is people and change management. Scrappy teams can derive significant value from existing, imperfect internal and public data; the real challenge is organizational inertia and process redesign.
When introducing a disruptive model, potential partners are hesitant to be the first adopter due to perceived risk. The strategy is to start with small, persistent efforts, normalizing the behavior until the advantages become undeniable. Innovation requires a patient strategy to overcome initial industry inertia.
A significant portion of biotech's high costs stems from its "artisanal" nature, where each company develops bespoke digital workflows and data structures. This inefficiency arises because startups are often structured for acquisition after a single clinical success, not for long-term, scalable operations.
China is no longer just a low-cost manufacturing hub for biotech. It has become an innovation leader, leveraging regulatory advantages like investigator-initiated trials to gain a significant speed advantage in cutting-edge areas like cell and gene therapy. This shifts the competitive landscape from cost to a race for speed and novel science.
Regulating technology based on anticipating *potential* future harms, rather than known ones, is a dangerous path. This 'precautionary principle,' common in Europe, stifles breakthrough innovation. If applied historically, it would have blocked transformative technologies like the automobile or even nuclear power, which has a better safety record than oil.
The Orphan Drug Act successfully incentivized R&D for rare diseases. A similar policy framework is needed for common, age-related diseases. Despite their massive potential markets, these indications suffer from extremely high failure rates and costs. A new incentive structure could de-risk development and align commercial goals with the enormous societal need for longevity.
Faced with China's superior speed and cost in executing known science, the U.S. biotech industry cannot compete by simply iterating faster. Its strategic advantage lies in
A massive disconnect exists where scientific breakthroughs are accelerating, yet the biotech market is in a downturn, with many companies trading below cash. This paradox highlights structural and economic failures within the industry, rather than a lack of scientific progress. The core question is why the business is collapsing while the technology is exploding.
The next decade in biotech will prioritize speed and cost, areas where Chinese companies excel. They rapidly and cheaply advance molecules to early clinical trials, attracting major pharma companies to acquire assets that they historically would have sourced from US biotechs. This is reshaping the global competitive landscape.