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.

When facing a crisis, Fibrogen's CEO decided to shut down discovery research programs. The value inflection opportunity was too far in the future, and capital was better spent on assets with the potential to create more near-term value, ensuring the company's survival.

The transition from a leadership role at a large pharma company like Gilead to a biotech CEO involves a massive shift in scope. Instead of managing one large function with a large team, a biotech CEO is hands-on with every aspect of the company, from science to finance.

Successful biotech leadership requires a clear decision-making hierarchy. Dr. Bahija Jallal advocates for a framework where patient welfare is paramount, followed by scientific rigor. Financial success is treated as a byproduct of excelling in the first two areas, not the primary goal.

Astute biotech leaders leverage the tension between public financing and strategic pharma partnerships. When public markets are down, pursue pharma deals as a better source of capital. Conversely, use the threat of a public offering to negotiate more favorable terms in pharma deals, treating them as interchangeable capital sources.

A biotech investor's role mirrors that of a record producer by identifying brilliant talent (scientists) who may lack commercial experience. The investor provides the capital, structure, and guidance needed to translate raw scientific innovation into a commercially successful product.

Market dynamics, like investor fixation on AI or predatory short-selling, pose a greater risk to biotech firms than clinical trial results. A company can have a breakthrough drug but still fail if its stock—its funding currency—is ignored or attacked by Wall Street.

Luba Greenwood argues that unlike in tech, many biotech CEOs lack P&L experience. In today's cash-constrained market, CEOs need to be able to build financial models and understand finance deeply to be effective, a skill she personally developed after transitioning from law and science.

Investor preference for CEOs has shifted dramatically. While 2019-2021 favored scientific founder-CEOs, today’s tough market demands leaders with prior CEO experience. The ideal candidate has a "matrix organization" background, understanding all business functions, not just the science.