Effective leadership in an innovation-driven company isn't about being 'tough' but 'demanding' of high standards. The Novonesis CEO couples this with an explicit acceptance of failure as an inherent part of R&D, stressing the need to 'fail fast' and learn from it.

Clinical trial protocols become overly complex because teams copy and paste from previous studies, accumulating unnecessary data points and criteria. Merck advocates for "protocol lean design," which starts from the core research question and rigorously challenges every data collection point to reduce site and patient burden.

In high-stakes fields like pharma, AI's ability to generate more ideas (e.g., drug targets) is less valuable than its ability to aid in decision-making. Physical constraints on experimentation mean you can't test everything. The real need is for tools that help humans evaluate, prioritize, and gain conviction on a few key bets.

Success in drug discovery hinges on a rare, intuitive 'nose for value.' Lengauer likens this to a star athlete who consistently makes the game-winning shot after many attempts. It's an unteachable gift for getting the big decisions right more often than others, especially in a context of repeated failure.

A significant number of Eli Lilly's compelling inventions came from unsanctioned projects. The company intentionally provides budget flexibility and avoids micromanagement at its R&D sites, allowing scientists to pursue their curiosity.

Effective, fast research isn't about skipping steps but about rightsizing the effort. Instead of defaulting to a previous method like "10 interviews," teams should determine the minimum insight needed to mitigate the specific risk at hand, using that to define the research scope and approach.

In high-stakes fields like medtech, the "fail fast" startup mantra is irresponsible. The goal should be to "learn fast" instead—maximizing learning cycles internally through research and simulation to de-risk products before they have real-world consequences for patient safety.

Frame process management like a portfolio. Processes exist solely to lower 'beta' (volatility and unpredictability). The tradeoff is they also suppress 'alpha' (creativity and outperformance). The key is applying rigid processes where you need low beta (e.g., payroll) while allowing freedom where you need high alpha (e.g., new product discovery).

The difference between successful and unsuccessful drug hunters isn't intelligence or education, but cultural attributes that exist 'in the margin.' These include radical transparency, honesty, humility, and being part of a supportive, truth-seeking team. These soft skills determine the outcome of high-stakes R&D.