Breakthrough drugs aren't always driven by novel biological targets. Major successes like Humira or GLP-1s often succeeded through a superior modality (a humanized antibody) or a contrarian bet on a market (obesity). This shows that business and technical execution can be more critical than being the first to discover a biological mechanism.

Founder Sean Ainsworth intentionally started his pioneering AAV gene therapy in an ocular setting before any Western approvals existed. Because an intravitreal injection uses a very small vector amount, it provided a significant safety advantage and a manageable way to prove the technology before attempting systemic delivery.

CZI's Biohub model hinges on a simple principle: physically seating biologists and engineers from different institutions (Stanford, UCSF, Berkeley) together. This direct proximity fosters collaboration and creates hybrid experts, overcoming the institutional silos often reinforced by traditional grant-based funding.

This structure offers fundraising flexibility by appealing to two distinct investor types. Some investors prefer the diversified, lower-risk profile of the central hub, while others want direct exposure to a specific high-potential asset or disease area within a subsidiary spoke. This broadens the potential capital pool.

Unlike typical tech disruption, healthcare often requires collaboration. Startups effectively "rent" distribution and patient access from incumbents. In return, incumbents "rent" cutting-edge innovation from startups, creating a necessary symbiotic relationship.

Single-product companies struggle to align R&D team size with fluctuating opportunities. Bending Spoons uses a centralized pool of flexible R&D talent that can be rapidly deployed to different portfolio companies, maximizing efficiency and capturing short-lived windows of opportunity that others miss.

FCDI launched multiple clinical-stage companies (Century, Opsis, Kenai) by providing a proven iPSC technology backbone. This "platform and spinout" model allows new ventures to focus on clinical development rather than early platform discovery, increasing their chances of success and attracting partners.

To avoid the pitfalls of scale in R&D, Eli Lilly operates small, focused labs of 300-400 people. These 'internal biotechs' have mission focus and autonomy, while leveraging the parent company's scale for clinical trials and distribution.

The future of biotech moves beyond single drugs. It lies in integrated systems where the 'platform is the product.' This model combines diagnostics, AI, and manufacturing to deliver personalized therapies like cancer vaccines. It breaks the traditional drug development paradigm by creating a generative, pan-indication capability rather than a single molecule.