A CEO's primary role differs fundamentally based on company type. In an asset-centric biotech, the CEO must act as a hands-on program manager, micromanaging execution. In a platform company, the CEO must be deeply embedded in the science to predict and leverage the technology's long-term trajectory.

Moving from a large corporation to a startup requires blending foundational knowledge of scaling processes with newfound resourcefulness and risk appetite. This transition builds a holistic business muscle, not just a product one, by forcing leaders to operate without endless resources or established brand trust.

Early-stage founders often mistakenly hire senior talent from large corporations. These executives are accustomed to resources that don't exist in a startup. Instead, hire people who have successfully navigated the stage you are about to enter—those who are just "a few clicks ahead."

While startups must be nimble, analytical processes from large corporations are invaluable. The key is applying the same rigorous thinking to decision-making but compressing the timeline. Having prior experience with similar situations allows leaders to make informed choices more quickly.

Unlike software startups that can "fail fast" and pivot cheaply, a single biotech clinical program costs tens of millions. This high cost of failure means the industry values experienced founders who have learned from past mistakes, a direct contrast to Silicon Valley's youth-centric culture.

Responding to Wall Street pressure to de-risk, large pharmaceutical firms cut internal early-stage research. This led to an exodus of talent and the rise of contract research organizations (CROs), creating an infrastructure that, like cloud computing for tech, lowered the barrier for new biotech startups.

The transition from a C-suite operator managing thousands to an investor is jarring. New VCs must adapt from leading large teams to being individual contributors who write their own memos and do their own sourcing. This "scaling down" ability, not just prior success, predicts their success as an investor.

Former Biogen R&D head Al Sandrock defines the agility of a small company not just as speed, but as the ability to make decisions by informally gathering key people in the hallway, bypassing the need to schedule formal meetings. This contrasts with large organizations where many more people and committees are necessarily involved.

The CEO of Peptilogics boils down leadership in the unpredictable, long-haul life sciences industry to three traits. Leaders must adapt to rapid changes, maintain a steady hand for the decade-plus development cycles, and provide a clear, guiding vision throughout.