Please subscribe and tell your friends why it’s worthwhile. Quality journalism costs money. When you subscribe to Timmerman Report at $199 per year, you reward quality independent biotech reporting, and encourage more.
Please subscribe and tell your friends why it’s worthwhile. Quality journalism costs money. When you subscribe to Timmerman Report at $199 per year, you reward quality independent biotech reporting, and encourage more.
Colette Delawalla, founder and CEO, Stand Up for Science
The days of strongly worded letters, statements to the press, white papers, and op-eds are over. The people dismantling science are coming at all we care about with a pliers and a blowtorch.
If I have learned anything in the past year as founder of Stand Up for Science, it is that most of the people who value science and have made money in science-based industries are silent. The silence is harmful.
As Martin Luther King said:
“The greatest tragedy of this period of social transition was not the strident clamor of the bad people, but the appalling silence of the good people.”
A few are speaking out, like Peter Kolchinsky of RA Capital Management, and Noubar Afeyan most recently. Afeyan’s annual letter for 2026 from Flagship Pioneering was spot on; “man-made miracles” of science are all around us.
For the first time in human history about one-third of babies born aren’t dying before they reach adulthood. We have utterly extraordinary treatments and cures for wicked diseases such as HIV, depression, various cancers, and diabetes. We’ve put a man on the moon, reached the bottom of the ocean, and accurately predicted the weather to save thousands of lives a year.
These “man-made miracles” of science did not happen by accident. The ecosystem — everything across the research and development continuum — that has created these “miracles” is in deep danger.
These courageous statements from leaders of the biopharma community are rare and extremely important. It is one prong of the campaign to defend science, but not the only one.
I founded Stand Up for Science in February 2025 because existing organizations who advocate for science were not meeting the moment. My view is that science needs brass knuckles.
We are not your grandmother’s science advocacy nonprofit. In the final three months of 2025, we made over 4.5 billion impressions across all our communications channels. This was from completely earned media coverage, not a cent of paid advertising.
We have mobilized hundreds of thousands of citizens in over 200 peaceful protests across the globe, supported federal scientists at the NIH, NSF, EPA, NASA, and FEMA in whistleblowing, held double the number of Congressional meetings as legacy science organizations, launched viral messaging campaigns, and secured sponsorship of and helped draft the articles of impeachment against Secretary Kennedy filed in the House of Representatives on Dec. 10.
Stand Up for Science is just getting started.
The threats to science, and public health, are clear and present.
I could publish a list of the economic damages that will befall the biopharma and healthcare sectors by having a man who doesn’t believe in germ theory running Health and Human Services. Anti-vaccine policy at HHS isn’t just bad for the vaccine business – it’s bad for kids and families everywhere. The world needs people with wealth and power to provide a voice that extends to the voiceless because it is the right thing to do, not just because it is the fiscally responsible thing to do.
In the US, science and democracy are so thoughtfully linked that science has a place in our Constitution (Article 1, Section 8, Clause 8, which established the foundation in law for patents and copyrights). Indeed, a thriving scientific–and intellectual–ecosystem is critical to a healthy democracy. What is happening in the United States right now, is way bigger than whether the FDA is going to approve your new drug. A government banning the word “woman” from grant applications is not a sign of a society moving toward a freer and brighter future.
Science itself can be twisted from a method of unbiased inquiry into a weapon.
Secretary Kennedy is pulling apart all protections against biotech and pharma companies to allow people with perceived “vaccine injuries” to sue vaccine makers. The Advisory Committee on Immunization Practices (ACIP) is run by fervent anti-vaxxers, making changes to vaccine recommendations without new evidence of harm. Members of the public are left confused.
The CDC has proposed funding appallingly unethical experimentation on babies in the west African nation of Guinea Bissau. The CDC-backed study – currently suspended by local health authorities – would withhold the hepatitis B vaccine from thousands of newborns in a placebo group, making them vulnerable to infection with hepatitis B, a chronic liver damaging disease, in a nation where more than 20% of the population is positive for hepatitis B.
HHS is systematically dismantling the Substance Abuse and Mental Health Services Administration (SAMHSA). Kennedy is railing against selective serotonin reuptake inhibitors (SSRI’s) for depression.
The list goes on. The HHS leadership is tearing down our pandemic monitoring systems, cancelling Sudden Infant Death Prevention programs, defunding addiction treatment centers, threatening doctors who provide gender affirming care, and have disrupted clinical trials impacting over 75,000 people.
But these wrongs are not occurring in a vacuum. Outside of science, America is not okay. In 2026, the same people who are allowing ICE to violate our constitutional rights, calling for the US to invade sovereign nations, and rubber-stamping consolidation of power to the Executive, are in control of American science. Having read a few history books, I can say with confidence, good things do not ever come from oppressive governments interfering in science on ideological grounds.
I’ve spent a lot of time with members of Congress in the last six months. I have two key takeaways: 1) the political tools of old will not work in this moment and 2) making any assumption of good will is a mistake comparable to bringing a white paper to a gun fight.
The civic duty of everyone privileged enough to live in a democracy is to stand up, where we can, if the democracy is in peril. This is what Benjamin Franklin meant when he said, “a republic, if you can keep it.” Right now, we can Stand Up for Science to prevent science from being used as a weapon against the public and to protect democracy in our corner of society.
The first step in fixing a problem is admitting you have one…and then endeavoring to fix it.
It is an uncomfortable moment in history. It is difficult for scientifically minded people who rail against black and white thinking for a living. We have a moral obligation to push back against these damaging policies.
The second step is out of your comfort zone.
We can embrace a new identity: science activist. We can take off the gloves, put on the brass knuckles, and (nonviolently) fight! We look to our predecessors, such as Jacques Monod, Nikolai Vavilov, Albert Einstein, Paul Langevin–leading scientists who leveraged their positions to take a stand against authoritarianism, in many cases, at great cost. I would be remiss not to include Alex Pretti, nurse and researcher at the Minneapolis VA, among this esteemed list of principled science activists. He was murdered by ICE on Jan. 24 while assisting a woman who had fallen after being pepper sprayed.
The third step is putting your money where your mouth is.
The MAHA Action Fund has a war chest of tens of millions of dollars they are using right now, as you read this, to spread misinformation.
I’m eager to enlist scientists to fight against that machine. I’ve talked to leaders in this sector–folks who have made their billions–and I’m tired of hearing “I agree with you, but…”
Talk is cheap. If you see what is happening in the US, right now and you are standing on the sidelines, you are a part of the problem. If you read this and Afeyan’s letter and are ready to really do something: put your money where your mouth is. Stand Up for Science cannot turn hot air into resistance, but we can turn money into people power and cutting-edge communications. We can break through to people and be heard in a flooded media environment.
Here is how you can Stand Up for Science:
Colette Delawalla is the founder and CEO of Stand Up for Science. colette@standupforscience.net
Please subscribe and tell your friends why it’s worthwhile. Quality journalism costs money. When you subscribe to Timmerman Report at $199 per year, you reward quality independent biotech reporting, and encourage more.
Ron Renaud is today’s guest on The Long Run. He is the CEO of Waltham, Mass.-based Kailera Therapeutics.
Ron Renaud, president and CEO, Kailera Therapeutics
Kailera is pursuing what could be the biggest opportunity in pharmaceutical industry history.
It’s developing a portfolio of GLP-1-based drugs for obesity. Drugs in this category have been around a long time for treatment of Type 2 diabetes, but over the last few years demand has skyrocketed. That’s because evidence has been mounting that these drugs are effective at helping all kinds of people – not just diabetics — to lose significant weight and lower their risk for a bunch of chronic ailments that stem from obesity, like cardiovascular disease and chronic kidney disease.
More than 1 billion people worldwide are considered obese. Eli Lilly and Novo Nordisk are the category leaders, and their success has inspired an estimated 80 different drugs and drug combinations sprinting ahead in clinical development. Dozens of public and private companies are striving to capture a piece of a market. Some analysts estimate it will be worth more than $150 billion a year in sales by the early 2030s.
Kailera is one of the well-funded and aggressive entrants in the category. It has raised $1 billion in a pair of venture capital rounds. The money is being used to advance a portfolio of injectable and oral drug candidates from China-based Jiagsu Hengrui Pharmaceuticals. Kailera is now running a series of global Phase III clinical trials with a lead candidate that seeks to compete with Eli Lilly’s blockbuster tirzepatide, marketed as Zepbound for obesity.
Ron has a long and diversified track record of success in biotech. He was previously CEO of a hepatitis C drug developer acquired by Merck, a messenger RNA therapeutics developer acquired by Sanofi, and a neuroscience drug developer acquired by AbbVie.
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Please subscribe and tell your friends why it’s worthwhile. Quality journalism costs money. When you subscribe to Timmerman Report at $199 per year, you reward quality independent biotech reporting, and encourage more.
John Cassidy, general partner, Kindred Capital
On the surface, delegates at this year’s JP Morgan Healthcare Conference have reason to be pleased. The Nasdaq Biotech Index was up 30% last year. After years of public market woes, it looks like there is light at the end of the tunnel.
Some structural issues still exist – 10 years to get a molecule to clinic, regulators that need a shot in the arm, and (I’d argue) a negative enterprise value on most new programs. But Big Pharma isn’t stupid. Patent cliffs are looming, pipelines are thinning, and the market is hungry for new assets.
So the industry did the rational thing: it looked East.
The new playbook is simple: license clinical-stage assets from China and run them globally.
Reuters pegged the trend: in just the first half of 2025, U.S. drugmakers signed 14 China-licensing deals worth $18.3 billion, compared with just two deals the year before. Morgan Stanley framed it cleanly: China has gone from “generics factory to innovation engine.” And Western pharma wants in.
Some of these assets will be great. Patients will benefit. There will be headlines about “win-win” globalization.
But this licensing wave is also, in many cases, window dressing. It tells a story about where molecules are sold, not where they’re made. It celebrates downstream commercial rights while ignoring upstream capacity loss.
One nuance matters here. The West still runs the clinical machine. Late-stage trial execution, global site networks, data management, regulatory choreography, pharmacovigilance — this is still a Western strength. This piece is not arguing we forgot how to run Phase III. It’s arguing we made a quieter bet: that preclinical biology is a commodity you can safely rent.
Clinical dominance can hide preclinical dependency. The clinical layer is visible, audited, and legible to boards. The preclinical layer is where the learning curve compounds, and where “process innovation” quietly becomes the innovation.
Western companies, in the name of asset-light models and operational efficiency, spent years transferring preclinical execution into Chinese platforms. Not just isolated tasks, but entire modalities. The result?
We now have Western companies licensing from ecosystems that Western capital helped train.
This wasn’t one grand conspiracy. It was a thousand “reasonable” decisions:
“We’re asset-light.”
“We’ll rent capacity.”
“We don’t need in-house biology.”
“This CRO is faster.”
“This is just execution; the IP stays with us.”
If this feels familiar, that’s because it is. We’ve seen this movie before.
In the 2000s, Apple built the world’s most iconic consumer hardware. But it built it in someone else’s factory. That choice, logical at the time, drove speed, scale, and margins.
It also seeded something harder to unwind: dependency. Operational know-how leaked. Local capability compounded. Today, reversing that reliance takes decades, not quarters.
Tesla walked the same path. In 2019, it became the first Western automaker to build a wholly owned factory in China. In 2025, it lost global EV leadership to BYD, a company born in part from the ecosystem Tesla helped fund.
Now biotech stands at the same crossroads.
The product isn’t phones. It’s the infrastructure that discovers, tests, and manufactures medicine.
Take WuXi AppTec. In 2024, it synthesized over 460,000 new compounds. It booked RMB 25B ($3.6 billion USD) in revenue from U.S.-based customers, more than 60% of its total. It reinvests 23–25% of that revenue into expanding its own capacity. That’s self-funded CapEx at geopolitical scale.
Now layer in AI. Drug discovery is becoming a loop: design → make → test → learn → redesign. The tighter that loop, the stronger the model. The better the wet lab integration, the better the output. Eli Lily has embraced this and become the first $1 trillion market cap pharma (granted this may be partly because of Novo’s missteps…).
When you outsource that loop, two things happen:
This is how virtual pharma becomes vulnerable pharma. And it’s how TechBio turns from a buzzword into a national priority.
In AI x Bio, patents are just one layer. What matters now is what you can build, execute, and ship, over and over again.
Software already ran this experiment. Bill Gurley’s version is blunt: patents rarely decide outcomes. Elon’s move is even blunter: open source what others hoard, then win anyway. In practice, distribution plus iteration plus execution eats legal exclusivity for breakfast.
Pharma feels like the exception, because here IP is oxygen. Without patents, there’s no pricing power, no exclusivity window, and capital stops showing up. True. Also incomplete. Because “IP” is no longer a single thing. It’s a stack.
At the bottom is legal IP: the molecule, the claims, the regulatory scaffolding that turns a chemical into a business.
Above that is system IP (or proprietary know-how): the data, the loop, the meta learning. The machinery that lets you generate, select, and improve candidates faster than anyone else.
Above that is capability IP: the tacit knowledge of how biology breaks in the real world. Assay design. Troubleshooting. Batch drift. The instinct that tells you “this dataset is lying” before the slide deck does. This doesn’t live in a patent. It lives in teams and workflows.
To be fair, pharma has always been a know-how business. What’s changing is that AI and robotics can scale that know-how: faster data creation becomes faster insight generation, which becomes faster iteration, which becomes enduring advantage.
This is where biotech starts to rhyme with software. As distribution shifts, defensibility shifts with it. Molecules don’t live in a vacuum anymore. They live inside an experience: symptoms, testing, triage, prescription, and a box on your doorstep. In that world, molecule IP is necessary but not sufficient. The moat starts to include the channel and the interface.
Add AI and the boundary blurs again. In AI x Bio, value is shared between the asset and the engine that produced it. If your model, data, lab automation, and experimental loop compound faster, you don’t just make one drug. You build a machine that makes many drugs.
The uncomfortable implication is that control may drift away from the molecule holder and toward whoever owns the interface. If a platform can interpret diagnostics, recommend next steps, and steer treatment decisions, it can become the choke point without inventing the drug. None of this is new. Formularies, guidelines, and default pathways have always shaped outcomes. What’s new is that software and AI-mediated triage can encode those defaults and scale them, turning interface control into a tighter choke point.
The uncomfortable truth is that the Western system can select winners without selecting for upstream process excellence. You can win by licensing the molecule, then outcompeting others on reimbursement strategy, access, marketing, and distribution. That is profitable in the short term, but it quietly degrades the one thing that compounds: the industrial capability to discover, test, and make the next generation of drugs.
But systems still run on messy human capability. Biology is not a clean API. The loop only compounds if you own the ugly middle: how experiments actually get done, how failures get debugged, how quality is enforced, how intuition forms.
That’s why outsourcing is more than a margin decision. When you outsource enough of the wet work, you export capability IP. And it’s almost invisible because it shows up as OpEx, not CapEx. It doesn’t trigger alarms. It just compounds, until the industrial base you rented becomes the one that out-iterates you.
Over the last two decades we built a miracle: rapid hypothesis generation, global testing pipelines, molecules into patients faster than ever. But under the miracle was a trade. We outsourced the compounding parts of biology, the work that makes IP real. The result is we didn’t just globalize execution. We underwrote rival bio industrial capacity. Now the bill is coming due.
So the argument isn’t “IP doesn’t matter.” It’s that IP expanded. Patents still anchor value, but defensible advantage increasingly lives in the loop (system IP), in the craft (capability IP), and in the interface (distribution). If you don’t own those layers, you end up with strong claims and weak control. And in an era of AI-mediated care, control is the thing that cashes the check.
The BIOSECURE Act was an early signal that the policy world is waking up. The U.S. is moving to limit federal work with firms like WuXi, BGI, and MGI. The subtext is the real story. Biology is not just a supply chain anymore. It is infrastructure. And infrastructure has borders.
We saw this in semiconductors. When the supply chain became a strategic liability, the response was not a better procurement spreadsheet, it was to rebuild domestic fabs.
In biology, we are walking into the same trap: fabless biology, assuming the factory can live offshore while the innovation stays at home. Workforces take longer to train. If you have not been paying for your own factory floor, you do not have one sitting idle just in case.
To be clear, late-stage clinical execution and regulatory work is still largely run by Western global CROs, as semiconductor design sits in the West and is only manufactured in the East. The vulnerability sits upstream, and it rhymes on the CDMO side too: China has scale in standardized, high-volume work, but the differentiated edge is fragmented and hard to rebuild once you stop paying for it.
There is a reason Chinese providers dominate large parts of preclinical and early manufacturing throughput today. It is people. Highly skilled, deeply trained labor, scaled to industrial levels, at cost structures the West has not matched in decades. It is not primarily about cutting corners. It is about throughput.
But the ground may be shifting again. Robotics, automation and agentic AI workflows are advancing faster than most biotech boards are planning for. Work that used to be manual, linear, and low margin is becoming programmable, parallel, and scalable.
Lab automation is no longer a few pipetting arms. We are heading toward closed loop systems that can design experiments, optimize conditions, execute assays, interpret results, and propose the next hypothesis, over and over, without losing momentum.
If that trajectory holds, we will get a new kind of cloud lab. Not just shared infrastructure, but intelligent infrastructure. Agentic, increasingly autonomous, and easier to localize. The cost of spinning up a Western CRO could fall sharply. The value of doing AI augmented experimentation under your own roof could rise. And the moat moves again, toward the ability to iterate fast, reliably, and sovereignly, because in biology, the loop is the factory.
Here’s what I hope the JPM talking points become. Not another round of macro agreement where everyone nods about sovereignty and geopolitics and then goes back to optimizing cost.
The real question for founders and investors is much sharper.
Where is your actual IP?
Is it in the molecule, or in the factory that can reliably make and improve it?
Is it in the deck, or in the loop that designed the hypothesis, tested it, debugged reality, and iterated until it worked?
Startups love the phrase asset light. Too often it is code for capability light. If you outsource the work that teaches you, you are not building a company. You are running a spreadsheet with a lab receipt attached.
For investors, this forces a reset in what counts as defensible. The molecule is only part of the story. The loop, the lab, the process intuition, those are strategic assets. If they live in China, you do not own them. If they live inside a system you control, you do.
The best companies in this cycle will not just own patents. They will own the learning curve. As we approach an AI-centric world, the “10 years to clinic” metric collapses. The cycle of Design → Make → Test → Learn shrinks from months to days.
The “process IP” we talked about is no longer human know-how; it is model weights.
First, treat CRO strategy like cloud strategy. Design for portability. Dual source where it matters. Own your truth set. Keep local capacity for anything that teaches you. Outsource the repeatable work. Keep the compounding work close.
Second, invest in the bio industrial commons. No startup should build a full stack lab from scratch. But we can build shared platforms that many startups can plug into. Biofoundries. Medchem cores. Assay centers. It is the physical infrastructure equivalent of what cloud did for software.
Third, reward resilience in fundraising. Asset light does not have to mean sovereignty light. Investors should ask a simple question.
If China cut you off tomorrow, could you still run the company?
Fourth, be explicit about the trade. Speed matters. Price matters. But so do concentration risk, leakage, and geopolitical friction. Good strategy names the cost and pays it intentionally, instead of discovering it later as a crisis.
Because this was never just about cost.
Outsourcing helped finance a Chinese bio industrial base with the scale, capability, and learning velocity to become a competitor. WuXi alone targeting 100,000 litres of solid phase peptide reactor volume in 2025 was not just contract research. That’s sovereign capability.
The Apple and Tesla lesson was not ‘never build abroad’. It was simpler. If you build your business on top of someone else’s factory, do not be surprised when the factory becomes the business.
Biotech is there now.
It is time to own enough of the factory again.
Not everywhere. Not always. But enough to keep the loop tight, the learning local, and the innovation portable. Outsourcing should be a choice, not a dependency.
And then there is the final conclusion, which is not linear. It is orthogonal.
This is not only about plugging holes in the current system or rebuilding lost capacity. It is about asking the bigger question. What if the right answer is not ‘fix pharma’? What if the right answer is ‘build the first $3 trillion dollar biology company’?
The analogy is real. Google did not just crawl websites. It built infrastructure that made the internet usable. It sat between the user and the data. It turned distributed information into a loop. It monetized not the asset, but the search.
So what is the biological equivalent?
A system that closes the loop between data, models, wet lab execution, and patient outcomes. A sovereign engine. A full stack, AI native platform that does not just license molecules, but learns the entire process of making them better.
Not a CRO. Not a pharma company. Something new. Something foundational.
That is the orthogonal bet. Do not just fix the outsourcing mistake. Leapfrog it.
And that’s what I hope is talked about at the parties and dinners of JPM.
Editor’s Note: John Cassidy is a general partner with Kindred Capital in London. He is a member of the Timmerman Traverse for Damon Runyon Cancer Research Foundation team preparing to climb Kilimanjaro in February. A version of this article was first published on John’s SubStack.
Kate Haviland is today’s guest on The Long Run.
Kate is the former CEO of Cambridge, Mass.-based Blueprint Medicines.
Kate Haviland, fomer CEO, Blueprint Medicines
Blueprint was one of the big biotech success stories of 2025. The company was acquired by Sanofi for $9.1 billion in cash at closing, and potentially $9.5 billion if certain milestones are met.
The company started out with a vision for treating rare genetic forms of cancer. It found some success there, but that wasn’t the main reason Sanofi bought the company. Blueprint learned along the way that its drug for a rare type of gastrointestinal stromal tumors could also be used for a couple of related immune disorders – advanced systemic mastocytosis and indolent systemic mastocytosis.
The drug made a big difference for these patients. Once Blueprint realized it had the category to itself, it was off to the races.
You could say this is a story of following the science where it leads, strong execution in both R&D and sales and marketing functions, and a culture of teamwork that glued it all together for more than a decade.
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Patrick Malone, partner, KdT Ventures
One question from 2025 has consistently frustrated me:
Why did AI and crypto become top strategic priorities in the first year of the Trump Administration while biotech was largely ignored?
Trump’s core issues over the last decade have been immigration, trade, energy dominance, border security, China, and re-shoring of US manufacturing. It was not obvious that “Artificial Intelligence” and “digital assets” would rise to the top of his domestic policy agenda. Crypto, in particular, is surprising: Trump publicly dismissed Bitcoin and crypto as volatile and “not money” in 2019.
And yet, by 2024–2025, AI and crypto had moved beyond being interesting technologies to become explicit strategic national priorities. During the post-election transition period in December 2024, Trump announced David Sacks as the White House “AI & Crypto Czar.”
This served to elevate the importance of AI and crypto inside the administration, and delegated significant responsibility to a capable and experienced Silicon Valley entrepreneur.
Within weeks, the administration issued executive orders that created real initiatives and deadlines: a new AI executive order directing an AI Action Plan, and a crypto executive order establishing the President’s Working Group on Digital Asset Markets to coordinate agencies and deliver a formal policy blueprint.
The White House signaled its commitment through senior-level meetings, including a crypto summit, and followed through with landmark legislation. For example, Trump signed the GENIUS Act into law, creating a federal framework for payment stablecoins.
Whatever you think of the substance of these policies, the lesson for biotech is that it needs to do a better job of competing for attention at the highest levels of the federal government, and it needs a strategy to better stand up for its interests. AI and crypto earned that attention because they built a political interface.
The AI and crypto business communities had people who could navigate the administration and speak its language, as well generate real political capital. In 2024, Trump was courted directly by tech and crypto operators who raised serious money and built political alliances and infrastructure.
David Sacks and Chamath Palihapitiya hosted a San Francisco fundraiser that raised millions of dollars in one night, with senior figures from crypto and tech in the room. Trump used the setting to pitch himself as the “crypto president.”
At the same time, facing a hostile regulatory posture from the previous administration, the crypto industry moved aggressively into electoral politics. The Fairshake network of super PACs and its affiliates raised and deployed substantial resources in 2024 to support crypto-aligned candidates, making crypto policy consequential at the ballot box.
By 2025, AI began following the same model, with Silicon Valley backing a $100+ million pro-AI political spending effort designed to influence who gets elected—and, in turn, what policy gets made.
The AI and crypto industries didn’t just advocate from the outside. They embedded themselves in the electoral and policy-making process. They invested in operators, institutions, and political machinery capable of translating industry priorities into executive orders, interagency coordination, and legislation.
David Sacks is the clearest example. By naming him AI & Crypto Czar, Trump gave the AI and crypto agenda a single point of execution inside the administration, someone who could turn ideas into policy.
This is the part biotech misses. Policy is not persuasion alone. It isn’t memos, panels, or moral arguments. Policy is execution. Biotech has nobody in a position of influence in the Trump Administration with the know-how, the networks, and the capability to wield power.
What’s missing is the ability to turn ideas into influence and power: securing executive mandate, motivating agencies to act with urgency, and converting that work into law and funding. AI and crypto had operators who could run that playbook, and the legislative results speak for themselves. That’s why Sacks matters.
After his appointment, the administration stood up an internal machine by executive order, produced a formal policy blueprint, and translated it into concrete outcomes, including stablecoin legislation and an AI action plan.
Which brings us to the real gap in biotech. The industry doesn’t just need better arguments or louder advocates. It needs someone who can operate inside the government and actually execute—someone who can translate scientific progress into policy, align a fragmented ecosystem, and make the case for biotech as a strategic national priority rather than a niche technical field.
What has made the lack of progress in biotech policy in the new administration especially frustrating is that the rationale driving urgency in AI policy applies almost word-for-word to biotech: Competition with China. National security. Domestic manufacturing capacity. Strategic dependence on foreign supply chains.
You could literally replace “AI” or “rare earths” with “biotech” in many of the recent EOs, and the logic would still hold. These should be obvious, bipartisan reasons to invest in and accelerate the biotech ecosystem. The opportunity is there.
Biotech hasn’t built a capable political interface for two structural reasons. First, Washington still often conflates “biotech” with “big pharma,” which renders biotech politically invisible. It’s hard to make progress on innovation-driven policy when startups are treated as incumbents, and therefore dragged into debates on pricing, reimbursement, and market power rather than scientific advancement.
Another issue is fragmentation. AI and crypto accelerated because the community acted like a movement. There was a center of gravity pulling together founders, operators, investors, and policymakers.
Biotech, by contrast, is spread across academic labs, NIH, the FDA, startups, pharma, state governments, and a long tail of investors. Large pharma and small biotech sometimes have conflicting priorities and incentives. There is no unifying node that turns these pieces into a coherent whole.
Biotech needs more coordination, not innovation. We need someone who can align founders, investors, scientists, and patient communities around a coherent agenda, translate it into policy and legislative language, and make biotech a clear strategic priority in Washington.
So who could fill the role?
Maybe it’s one person. More likely, it’s a pairing: scientific legitimacy paired with political execution. Biotech has credibility in abundance. What it lacks is a unifying operator who can sit with regulators, legislators, and founders in the same week, and align them around a single agenda.
Here are some suggested candidates to get the conversation started:
Biotech will keep producing world-class science. The question is whether it will also build the political and institutional capacity to match its strategic importance, or whether it will continue to let other sectors define the national agenda.
Priorities in Washington are rarely set by abstractions or white papers. They are set by people, often one or two individuals inside the government who have the credibility and mandate to mobilize institutions.
AI and crypto found those people, but biotech has not. Until it does, biotech will remain insular, failing to make its importance known beyond its own ecosystem.
Luke Timmerman, founder & editor, Timmerman Report
The Timmerman Traverse for Damon Runyon Cancer Research Foundation has done it again.
We have exceeded our team goal of raising $1 million for brilliant young cancer researchers around the US. We currently stand at $1,094,672.
This team isn’t done. The latest group of 22 biotech executives and investors have one month left before traveling to Tanzania, banding together in common cause, and climbing Kilimanjaro, the highest peak in Africa at 19,341 feet / 5,895 meters.
This Timmerman Traverse campaign, like all others, has required sweat and sacrifice. The biotech industry has experienced several lean years. It took creativity and relentless drive to overcome obstacles.
Antonio LaPorte, postdoctoral researcher, Harvard University; Timmerman Traverse-Damon Runyon Fellow
We persisted because it’s important to uplift the next generation of outstanding cancer researchers.
Timmerman Traverse has now raised $3.1 million over four campaigns for the Damon Runyon Cancer Research Foundation since fall 2023. Every dollar raised – 100 percent – goes directly into multi-year grants for the young scientists fortunate and talented enough to win a Damon Runyon award. There are currently five young scientists at institutions around the US supported by the Timmerman Traverse, with three more to be named in 2026.
One of these scientists will join the Kilimanjaro team in February. Antonio LaPorte, a postdoctoral researcher at Harvard University, grew up in the Chicago area and got his PhD in chemistry at the University of Illinois. He’s a Timmerman Traverse-Damon Runyon Fellow who now has secure resources to pursue his dreams because of the biotech community’s support.
Not every young scientist has been so fortunate during a tumultuous year. Damon Runyon has heard from many scientists this year about how appreciative they are for philanthropic support.
Yung Lie, president and CEO, Damon Runyon Cancer Research Foundation
“I’m absolutely thrilled and, at the same time, not at all surprised that this group of outstanding leaders reached this fundraising benchmark so soon. The Timmerman Traverse for Damon Runyon has been an incredible force multiplier in cancer research,” said Yung Lie, president and CEO of Damon Runyon. “We’re so grateful to everyone who has participated in or donated to one of our expeditions, past and present. We are excited to include a current Damon Runyon-Timmerman Traverse Fellow on the Kilimanjaro 2026 team to share with the group just how critical this funding is right now in this uncertain scientific climate.”
Thanks to the following sponsors for their generous support:
$25,000
$10,000
Browne Consulting
Cooley
Ryan Turner Specialty
Wolf Greenfield
Thanks to the peripatetic participants in this 2026 Timmerman Traverse of Kilimanjaro for Damon Runyon.
If you or your company would like to sponsor this team, there’s still time to get recognized on the banner we will carry to the top of Kilimanjaro and on team gear we will wear with pride. Contact Elyse Hoffmann, elyse.hoffmann@damonrunyon.org.
For me, this was the 14th consecutive successful season as team leader of the Timmerman Traverse. All of the campaigns for cancer research, fighting poverty and sickle cell disease (14 of 14, 100 percent) have exceeded the fundraising goals since my personal 2018 summit of Mt. Everest for Fred Hutch. These teams of biotech executives and investors – in up years and down years — have raised a combined $15.3 million to alleviate suffering from cancer, poverty, and sickle cell disease.
I look forward to seeing many readers in San Francisco next week at the JP Morgan Healthcare Conference. Planning is underway for the next Timmerman Traverse for Damon Runyon in summer 2026. It will be a pair of hikes in the Evolution Range of California’s High Sierras. It’s a spectacular section of one of the great mountain ranges in North America.
Interested in how you or your company can get involved? Let’s talk. luke@timmermanreport.com.
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Niels Plath, chief scientific officer, Muna Therapeutics
The Alzheimer’s research community has tried for decades to get rid of amyloid plaques in the brain, in hopes of slowing down or preventing the memory-robbing disease. But amyloid might not be an insurmountable enemy after all.
A remarkable group of people whose ability to resist the cognitive decline of Alzheimer’s was, until recently, completely invisible. These were individuals who lived long, cognitively healthy lives despite their brains harboring the very amyloid plaques we have long considered to be a death sentence.
Advances in our scientific toolkit made it possible to study postmortem brain tissue directly. And this wasn’t a rare fluke; the finding of plaques in healthy people appeared again and again. It was the first real evidence of a bona fide, innate mechanism of resilience in the brain–an ability to thrive despite what looks like a devastating tangled web of amyloid plaques.
This concept was powerfully reinforced by the astonishing finding that a rare genetic variant (the “Christchurch mutation”) can protect individuals from dementia, even when they carry a mutation in a different gene PSEN1 (presenilin 1) that would otherwise spell certain doom.
That discovery was made in a single individual back in 1987, but the significance wasn’t fully appreciated by the scientific community until more evidence buttressed the finding in 2019 and 2024. The question began to shift from ‘How do we clear the plaques?’ to the far more profound ‘How do these brains successfully fight back?’
The idea of being resilient to disease is common in immunology, where we credit a ‘stronger immune system’ for protecting our bodies from the invasion and spread of bugs. This concept is more nuanced in areas like oncology and neurodegeneration. What does resilience mean in an Alzheimer’s context?
A recent landmark study published in Nature provides a credible blueprint for what this resilience looks like at a molecular level. It was a signpost, providing concrete, human-derived data that proves that we can, in fact, identify biological pathways that protect the brain.
Researchers at Harvard Medical School analyzed human brains with single-cell RNA-seq resolution, and discovered that, of 27 different metals measured in brain cells, the brain’s innate level of lithium was the one most relevant to Alzheimer’s. Lithium levels were significantly reduced in individuals with mild cognitive impairment, a precursor to Alzheimer’s. The study revealed that amyloid plaques act like sponges, sequestering the brain’s natural lithium and reducing its bioavailability.
Further experiments in mouse models confirmed this link: reducing lithium levels by about half markedly accelerated the deposit of amyloid and tau, activated inflammation and sped up cognitive decline. Aging-related decline in learning and memory was largely reversed by treatment with lithium. In normally aging humans, the study showed that higher natural lithium levels were positively correlated with better scores on cognitive tests, offering a direct molecular link to cognitive resilience.
This is not a lifestyle fad; it is rigorous molecular biology revealing key pathways that offer actionable therapeutic targets. Lithium orotate, a salt with reduced amyloid binding, could be given as a replacement therapy. This insight – that we can perturb brains to overcome what looks like a disease pathology — stems directly from our new technological tools that have made it possible to ask and answer questions at an unprecedented speed and volume.
The tools that enable us to study these mechanisms are only just becoming widely available to neuroscientists. Single-cell RNA-seq, and spatial transcriptomics are a couple examples.
This is the most auspicious time to be studying the basic pathophysiology of Alzheimer’s disease and other neurodegenerative disorders. Progress in Alzheimer’s has been stymied by the lack of critical tools to interrogate cells and molecular mechanisms in the human brain itself. We have been forced to translate our findings across from mouse models, where these animals do not even experience Alzheimer’s disease.
To build on this newfound momentum, we must wage a collective campaign to amass, harmonize, and share our data.
The alternative is to let it sit idle and unconnected to today’s fervent research efforts. Brilliant research, including the discovery of the Christchurch mutation, the recent lithium study, and the continued characterization of key brain cells in neurodegeneration, has opened a door.
But to walk through it, we must confront the critical bottleneck: the scarcity and siloing of brain tissue samples and the rich clinical metadata from the individuals who donated them. Without large-scale data sharing and analysis, we will be stuck looking at samples that might represent a few anecdotes. We might miss the larger patterns that could point to promising therapeutic targets.
For decades, our goal was to wage a defensive war against damage. Now, we have a more profound and promising path forward: harnessing the body’s innate, protective mechanisms leading to resilience. The future of Alzheimer’s therapy may not be a drug that simply fights the disease, but one that empowers the brain to protect itself.
Please subscribe and tell your friends why it’s worthwhile. Quality journalism costs money. When you subscribe to Timmerman Report at $199 per year, you reward quality independent biotech reporting, and encourage more.
Emily Conley is today’s guest on The Long Run.
She is the CEO of Berkeley, Calif.-based Renasant Bio.
Emily Conley, CEO, Renasant Bio
The big idea at Renasant is to develop oral small molecule drugs to treat patients with autosomal dominant polycystic kidney disease, known as ADPKD. Patients with this disease develop cysts on their kidneys that sometimes cause the kidney to balloon in size and grow into 30-pound dysfunctional, painful and swollen organs.
Scientists think there’s a way to stop it. Renasant is developing small molecule correctors and potentiators that target the polycystin protein abnormalities that drive the disease. If the drugs work as conceived, they would enable people to avoid the grim fate of kidney dialysis or transplant. An estimated 300,000 patients in the US and Europe have the disease, which technically makes it rare, but not that rare.
Emily came to this startup a couple of years ago when it was in stealth mode, and just started talking about it a few months ago. She’s a neuroscientist by training and had a formative early biotech career experience at 23andMe, the consumer genetics pioneer. The opportunity to make a convenient small molecule drug, or a complementary combination of small molecules, that act on the underlying disease biology were a big part of what compelled her to join this startup.
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Now, please enjoy this conversation with Emily Conley on The Long Run.
John Flavin, founder and CEO, Portal Innovations
When we started our first biotech company, MediChem Life Sciences in the early 1990s in Chicago, there was nothing resembling a “biotech ecosystem” nearby.
We had to build our own labs, figure out how to raise money and how to recruit a team of scientists and professionals. The universities in the Chicago area were more focused on basic science. The culture frowned on connections between faculty and industry.
The scene has changed dramatically.
Pat Flavin, president, Portal Innovations
Although still early in development, the Chicago biotech ecosystem is thriving. A similar story is playing out around the U.S. and internationally.
Academic research has undergone a shift over the past decade, driven by the need for practical application in the life sciences. Federal funding for research has flattened, and universities have sought new ways to attract and retain talent. One way to attract bright young scientists is by fostering an environment conducive to translational research and embracing the sort of relationships with industry that were once frowned upon.
The result is that life science entrepreneurship and new product development is flourishing outside traditional coastal epicenters, creating a dynamic and distributed map of regional hubs across the United States. This article explores the impact of the emergence of these life sciences innovation hubs around the world, examining how these ecosystems are reshaping the future of biomedical innovation.
Historically, research universities relied on federal grants to fund cutting-edge research aimed at discovering new drugs, devices, and diagnostics. The National Institutes of Health (NIH) budget, for instance, peaked in real purchasing terms at approximately $41.7 billion in 2022, but projections show a stagnation or slight decline because of federal budget cuts and inflation eating away at the purchasing power of NIH-funded scientists.
This reduction in basic science activity, exacerbated by the current U.S. administration’s threats to slash more dramatically, has prompted research institutions to rethink their business models.
Today, there is a growing emphasis on translational research—research that aims to transform scientific discoveries into practical applications that benefit society. The market is huge and growing. The global biotechnology market is expected to reach $2.4 trillion by 2028, according to a report by the Milken Institute.
The Covid-19 pandemic acted as a global shock to the life sciences innovation system, accelerating pre-existing trends and forcing a rapid re-evaluation of how and where innovation happens.
Before the pandemic, innovation was firmly concentrated in established hubs like Boston/Cambridge and the San Francisco Bay Area. The pandemic didn’t kill these centers of innovation; it further established their importance as hubs with spokes that are delivering new energy to the nodes in the network.
Figure 1. Capital growth shift in venture ecosystems. Percentage change in total invested capital comparing the post-COVID era (2022–2025) to the COVID-era baseline (2018–2021) for companies receiving a 1st Round deal between $2–15M. Emerging Hubs (150%) experienced higher relative capital growth than Established Hubs (46%) during this period transition.
Figure 2. Deal volume shift in venture ecosystems. Percentage change in the total number of deals comparing the post-COVID era (2022–2025) to the COVID-era baseline (2018–2021) for companies receiving a 1st Round deal between $2–15M. Deal volume contracted by 20.5% in Established Hubs but grew by 6% in Emerging Hubs, highlighting a structural shift in deal flow.
The post-COVID era (2022–2025) was compared to the COVID-era baseline (2018–2021) for companies on Pitchbook raising a 1st Round deal between $2–15M. Established hubs are defined as companies in MA and CA. Emerging hubs encompass companies in GA, IL, NJ, RI, and TX.
Regional biotech hubs must attract and retain innovative faculty and researchers to be competitive. Younger academics are prioritizing the impact of their work beyond traditional publishing in peer-reviewed journals. A survey by the American Association of Universities found more than 70% of new faculty members now consider industry partnerships and translational research opportunities when choosing an institution.
Regions that effectively create and promote an environment conducive to innovation are reaping the benefits. Cities like Boston, San Francisco, and San Diego have become magnets for scientific and entrepreneurial talent because of their established biotech ecosystems. For example, the Massachusetts Biotechnology Council reported that Massachusetts is home to over 1,000 biotech companies, employing more than 60,000 people and generating over $5 billion in annual revenue.
Until recently, talented researchers who got their training outside of the leading biotech clusters were exported along with adjacent intellectual property to the established biotech hubs. The top hubs are like suns – they have a strong gravitational pull. This made sense because these researchers and their ideas needed to be plugged into a rich environment full of local investors, CEOs, CMOs, pharma companies, and other partners.
This export phenomenon is changing. Most top-tier research institutions and the regions they anchor are actively investing in the environment to retain the talent they have attracted. This investible talent migration is making it possible to start and scale companies in new geographies.
For example:
Nathan Gianneschi, professor, Northwestern University; co-founder, Grove Biopharma
Sarah Hein, co-founder and CEO, March Biosciences
The pandemic was a significant contributing factor. It accelerated the remote work revolution. The experience proved that not every part of R&D needs to be in a physical hub. The geographic location of life sciences innovation has become more fluid and [we believe] the future of life sciences innovation will be less about a single best location and more about the strength of the network connecting diverse and specialized geographic nodes.
Different regions have different advantages. For example, Kendall Square in Cambridge, Massachusetts, is renowned for its concentration of biotech firms and research institutions. The proximity of prestigious universities, such as Harvard and MIT, creates a vibrant ecosystem that attracts talent and investment. According to a report by CB Insights, over $8.1 billion was invested in Boston-area biotech companies in 2020 alone.
Similarly, states like Texas, New Jersey, Rhode Island, Washington, and North Carolina are investing heavily in infrastructure and workforce development programs. For example, North Carolina’s Research Triangle Park, home to more than 300 biotech companies, has generated more than $4.9 billion in revenue and supports over 60,000 jobs. Texas taxpayers approved and renewed the Cancer Research and Prevention Institute (CPRIT) $6 billion that invests directly in biotech companies in the Lone Star State.
Texas built on the CPRIT success by investing in a new $3 billion fund this year focused on neurodegenerative diseases. It’s called the Dementia Research and Prevention Institute of Texas (DPRIT).
David Baker, professor of biochemistry, University of Washington; director, Institute for Protein Design
Washington state hasn’t directed state resources on the same level, but its community is playing to its own strengths. Nobel laureate David Baker, a Seattle native, has attracted brilliant colleagues at the Institute for Protein Design at the University of Washington. This core group of scientists, in turn, is supported by a network of local investors and entrepreneurs, including the Gates Foundation.
Great science attracts investors, corporate partners, graduate students and young faculty. All of this activity builds momentum and critical mass for the local biotech ecosystem.
The University of Chicago’s Polsky Center for Entrepreneurship and Innovation, in our home region, exemplifies how academic institutions are adapting to the changing landscape. After years of building the center, it has become a pivotal player in fostering entrepreneurship within the university. The center has facilitated the launch of more than 160 startups since its inception, attracting more than $1.3 billion in funding.
The center’s transparent approach to innovation has led to successful partnerships with industry, allowing researchers to access funding and resources necessary to bring their ideas to market. Hyde Park Labs, Harper Court Ventures, GS Innovation Fund and the Polsky Center focus on providing faculty with tools to start ventures with market-worthy platforms. This model serves as a blueprint for other universities aiming to establish their own biotech hubs.
These activities have spawned biomedical spinoffs including:
Tom Gajewski, professor, University of Chicago
Providing an option for innovators to start their ventures locally increases talent and company retention. It’s not enough for a university to support translational research and entrepreneurial support to spin out a company. These early-stage ventures need access to a broader market of investors and partners. Without a local market, these companies migrate to established hubs.
By facilitating collaborations between researchers and entrepreneurs, our platform at Portal provides a local market in young biotech ecosystems by providing seed capital, lab space and talent to build and scale locally.
Prior to Portal’s launch in 2020, local seed capital and commercial lab space did not exist. Scientific cofounder Ryan Clark returned home from working at Sana in Boston along with University of Illinois Professor Brad Merrill. They wanted to build their company in Chicago to access strong synthetic biology talent. Syntax Bio, a CRISPR-based cell therapy startup spun out of UIC launched in 2021 at Portal, received funding from Portal and DCVC Bio, and recently partnered with Astellas, Illumina and Draper for their Series A round.
Young ecosystems can’t survive sustainably over time in isolation. Connected innovation hubs are crucial for the success of the local markets. Kendall Square thrives with transparency and momentum since all the dots are connected. Simulating this environment across a wider geography is possible by connecting all the nodes. These hubs facilitate talent flow, collaboration, knowledge sharing, and resource exchange among various stakeholders, including researchers, entrepreneurs, investors, and policymakers. The concept of “three currencies”—economic, intellectual, and social capital—underscores the importance of building robust networks within these ecosystems.
As biotech hubs continue to grow, they pave the way for new opportunities. The ability to connect researchers with industry leaders and provide access to resources is vital for driving innovation and addressing global health challenges.
Chicago has a cluster of talent and infrastructure around high performance computing and quantum fueled by Argonne National Laboratory. Ecosystems with research groups and start-ups around the world working on data intensive biology efforts such as RNA applications access these resources through collaborations.
The rise of biotech hubs is not confined to the United States. There are several interconnected factors have powered the rise of hubs outside the US.
Seeing the success of the US life sciences industry, foreign governments have highlighted biotech as a strategic priority for economic growth. Forward-looking governments are applying successful incentive programs including grants and R&D tax credits. In addition, a growing spirit of collaboration between regulatory agencies has improved the streamlining of regulatory pathways to accelerate drug approvals.
Instead of trying to replicate the broad model of Boston, new hubs have achieved success by applying a specific niche strategy of focusing on the regional strengths. Some key examples of this niche strategy: Switzerland excels in biologics and large molecule therapeutics. Ireland and Israel are leaders in medical devices and the UK is a world leader in genomics and AI-driven drug discovery.
Around the globe, countries such as China, Japan, the United Kingdom, Israel, and Australia are emerging as leaders in biotech innovation. Saudi Arabia, UAE and Greece are picking up the pace. For instance, China’s biotech market is projected to reach $173 billion by 2025, driven by substantial government investments and a rapidly growing demand for healthcare.
Similarly, the UK’s focus on collaboration between universities and industry has resulted in a thriving biotech sector, with the UK biotech industry contributing £84 billion to the economy in 2021 and supporting over 280,000 jobs.
The rise of biotech hubs represents a significant shift in the landscape of academic research and innovation. As universities adapt to changing funding dynamics and prioritize translational research, the potential for impactful discoveries is greater than ever. By fostering interdisciplinary collaboration, attracting innovative talent, and investing in infrastructure, regions around the world are seeking to capture some of the benefits of the biotech revolution. New ecosystems open possibilities for new types of innovation and novel business models leveraging the endogenous strengths of the local market. Fusing tech platforms such as quantum, AI, and advanced batteries in to life sciences may be more likely in new places with different people than the established centers.
Some of the biggest ideas of the future may come from places off the beaten path. New ecosystems tend to attract more risk takers since the price of failure is higher. But the rewards to innovators, investors and patients can be substantial. Over time, as these ecosystems scale, the risk factor decreases.
Federal Funding Trends:
National Institutes of Health (NIH) Budget:
National Institutes of Health. (2022). NIH Budget Fact Sheet. Retrieved from NIH https://report.nih.gov/nihdatabook/category/1
Global Biotechnology Market Growth:
Milken Institute. (2021). The Global Biotechnology Market: A $2.4 Trillion Opportunity. Retrieved from Milken Institute
University Faculty Trends:
American Association of Universities. (2021). New Faculty Survey: Trends in Research and Industry Partnerships. Retrieved from AAU
Massachusetts Biotech Employment:
Massachusetts Biotechnology Council. (2020). 2020 Massachusetts Life Sciences Industry Report. Retrieved from MassBio
Interdisciplinary Research Collaboration:
Nature Biotechnology. (2018). The Importance of Interdisciplinary Research. Retrieved from Nature
University of California San Diego Infrastructure Investment:
University of California San Diego. (2021). UC San Diego Invests $1 Billion in Research Facilities. Retrieved from UCSD News Center
Boston Biotech Investment:
CB Insights. (2021). 2020 Boston Biotech Report: Funding Trends and Insights. Retrieved from CB Insights
North Carolina Research Triangle Park:
North Carolina Biotechnology Center. (2021). The Economic Impact of the North Carolina Biotechnology Industry. Retrieved from NC Biotech Center
University of Chicago Polsky Center:
University of Chicago Polsky Center for Entrepreneurship and Innovation. (2022). Impact Report. Retrieved from Polsky Center
Global Biotech Startup Funding:
PitchBook. (2021). 2021 Global State of Venture Capital Report. Retrieved from PitchBook
China’s Biotech Market Growth Projection:
China National Pharmaceutical Industry Information Center. (2021). China’s Biotech Market Report (in Chinese). Retrieved from CNPIC
UK Biotech Industry Economic Contribution:
BioIndustry Association. (2021). The UK Bioeconomy: A £84 billion Opportunity. Retrieved from BIA
Please subscribe and tell your friends why it’s worthwhile. Quality journalism costs money. When you subscribe to Timmerman Report at $199 per year, you reward quality independent biotech reporting, and encourage more.
David Shaywitz
Agency — the conviction I can shape my future — is a vital driver of human health and human potential.
It is also the factor overlooked by most digital health platforms.
University of Pennsylvania psychologist Martin Seligman, who has spent decades studying this, says agency boils down to the belief “I can make a positive difference in the world.” People with high agency believe there is something they can do next that might help – and then they actually try.
As Seligman emphasizes, the moments when we “try hard…persist against the odds…[and] make new, creative departures” are precisely when agency is at work. That extra effort and sustained determination — not just the mindset — shows up as improved performance, greater achievement, and enhanced health. It also manifests as resilience, enabling us not only to recover from adversity but (ideally) to bounce back as an even better version of ourselves.
GLP-1s highlight the power and promise of newfound agency. For many living with obesity, past attempts at weight loss reinforced a “cycle of despair” – trying harder mostly meant failing again. With the advent of GLP-1 medicines, many found that their weight would come down — and stay down. Oprah Winfrey called the feeling “a relief, like redemption, like a gift.”
The deeper change is psychological: for the first time in years, effort feels rewarded. GLP-1s unlock an agentic dividend: the motivational boost that comes from finally being able to take control of your health. That surplus sense of possibility can be channeled into the familiar health basics — moving more and sleeping better — but also, often more importantly, into how we show up in our relationships and communities, in the enthusiasm we bring to our hobbies and pursuits, into the totality of experiences that make life so meaningful.
Agency is the motivational currency of health, the ATP of behavior change – it lets success in one domain drive progress in others.
Connected fitness platforms have a similar opportunity. Each discrete achievement — finishing a class, riding three times in a week, noticing that the stairs feel easier or the back hurts less — is a small proof of “I can do this.”
In fixating narrowly on performance metrics, platforms like WHOOP, Oura, Peloton, and Tonal are leaving agency on the table. The opportunity here is to help people recognize, name, and bank their achievements, compounding the agentic boost that comes from each small win and making it easier to translate that confidence into the rest of life.
There are techniques that seem to support agency – cognitive reframing, elements of motivational interviewing, healthy conversation skills that help people generate their own plans, positive-psychology exercises that increase a sense of control and possibility.
But there isn’t a well-validated playbook. The 2021 Duckworth–Milkman exercise megastudy and a 2022 review by Feig and colleagues both point in the same direction: many thoughtfully crafted interventions, when rigorously evaluated, have disappointingly yielded only modest, generally short-lived changes in behavior; in the case of the megastudy, the effects observed were on average nearly ten times smaller than expert forecasts. Cracking this nut remains one of the biggest opportunities in health and technology.
Moreover, as public-health thinkers like Michael Kelly and Mary Barker, and Angela Duckworth in her emphasis on “situational agency” remind us, behavior is always embedded in social practices and daily routines, not floating in individual headspace. Kevin Hall’s work on obesity underscores the same point from a metabolic angle: in environments saturated with ultra-processed, hyper-palatable, calorie-dense foods, many people will overeat and gain weight. Our environmental defaults can make it much harder for individual agency to gain traction.
Powerful emerging technologies — from AI to connected devices and “health OS” platforms — now give us a new lever on this problem, but only if we use them thoughtfully. So far, most effort has focused on treating people as objects to be managed, with platforms competing to instrument every moment and compress our lives into ever more granular scores and rankings.
The real white space, I’d argue, is a platform that can reliably cultivate agency at scale. Building something like that would mean putting our most sophisticated AI and connected-health tools in the service of scaffolding human agency — helping people see real options, notch early wins, recover from lapses, and let small successes accumulate into a lived identity of capability.
None of this — from GLP-1s to digital health platforms — makes behavior change easy, but it does make sustained, structured support more possible than before, for patients, for consumers, and for employees trying to stay well while they work.
While we don’t have all the answers, designing for agency will likely emphasize:
By focusing technology on enhancing our intrinsic potential rather than just crunching our extruded numbers, we can strengthen our agency and with it, our capacity to live healthier, more fully realized lives.
In a year when tech-forward health platforms are vying to incorporate the most agentic AI, our greatest challenge, and most important opportunity, may be figuring out how to leverage these ever-more powerful emerging technologies — with wisdom, humility, and humanity — to nourish the development of the most agentic people.
For more on health and agency see KindWellHealth.
Please subscribe and tell your friends why it’s worthwhile. Quality journalism costs money. When you subscribe to Timmerman Report at $199 per year, you reward quality independent biotech reporting, and encourage more.
Please subscribe and tell your friends why it’s worthwhile. Quality journalism costs money. When you subscribe to Timmerman Report at $199 per year, you reward quality independent biotech reporting, and encourage more.
David Shaywitz
In this weekend’s Wall Street Journal, I review Off the Scales, a fascinating new book by Reuters journalist Aimee Donnellan about the discovery and development of GLP-1 agonists and their impact on medicine, culture, and society.
The review, aimed at a generalist audience, focuses mostly on the societal and cultural implications, but TR readers may be especially interested in the book’s extensive discussion of the science that led to semaglutide. This agent is now marketed by Novo Nordisk as Ozempic (injection for type two diabetes), Wegovy (injection for obesity), and Rybelsus (pill for type 2 diabetes).
Donnellan describes the early work at the Massachusetts General Hospital (MGH), subsequent product development at Novo Nordisk, and even some of the commercial decisions and leaders. One example: the brash American marketing executive, Jeremy Shepler, who came up with the earworm Oh-Oh-Oh Ozempic jingle, based on Pilot’s “Magic,” that contributed to the category’s success.
Pioneering GLP-1 chemist Svetlana Mojsov
In relating the discovery of GLP-1, Donnellan is particularly attuned to contribution of peptide chemist Svetlana Mojsov, who played a critical role in identifying and purifying the active form of GLP-1 while she was at MGH, serving as an Instructor of Medicine in the Endocrine Unit at Massachusetts General Hospital and director of the Howard Hughes peptide-synthesis core facility.
Mosjsov was initially not included on key GLP-1 patents; these initially were awarded to MGH physician-scientist Joel Habener alone. She subsequently spent more than a decade in an exhausting, ultimately successful legal battle to be added as an inventor. Today, Mojsov is Lulu Chow Wang and Robin Chemers Neustein Research Associate Professor at New York’s Rockefeller University, the institution where she originally trained.
Donnellan writes that Mojsov’s story “reveals the ruthless nature of science,” and “is yet another example of how women are often sidelined.” From her disheartening account it is hard to discern how much of the patent snub involved gender, and how much was the result of factors such as seniority, training (Ph.D. rather than M.D.), and function (tool-builder vs. orchestrator).
Massachusetts General Hospital — characterized as “all hierarchy” in Aimee Donnellan’s new book that recounts the contested history of GLP-1’s scientific discovery.
Also not included on the patent: Dr. Daniel Drucker, at the time an early-career physician-scientist at MGH working on the biology of GLP-1 as a member of the Habener lab. Drucker collaborated with Mojsov on critical early GLP-1 research, but did not join her in contesting the patents, as Donnellan discusses. Drucker is now at the University of Toronto, where he is University Professor in the Department of Medicine’s Division of Endocrinology, Chair in Incretin Biology, and a Senior Investigator at Sinai Health’s Lunenfeld-Tanenbaum Research Institute.
Readers can get a sense of how recognition for Mojsov has evolved by starting with the 2021 historical review in Cell of GLP-1’s development penned by distinguished endocrinologist Stephen O’Rahilly. The article was written on the occasion of the 2021 Canada Gairdner International Award bestowed upon Habener, Drucker, and University of Copenhagen physician-scientist Jens Juul Holst for the trio’s early work on the chemistry and biology of GLP-1. O’Rahilly subsequently wrote a correction once he was more fully apprised of Mojsov’s substantial role.
Those interested in learning more may also want to look at Jennifer Couzin-Frankel’s 2023 Science feature on Mojsov, entitled “Sidelined,” as well as Couzin-Frankel’s 2024 piece on Mojsov’s “yearlong journey out of obscurity.”
Also notable: Mojsov’s selection in 2024 as a co-recipient (along with Habener and Novo Nordisk drug developer Lotte Bjerre Knudsen) of the Lasker–DeBakey Clinical Medical Research Award, which honored the development of GLP-1–based therapies for obesity and type 2 diabetes. Inevitably, perhaps, this award omitted other key researchers who might reasonably have been included (Holst, Drucker, and Novo’s Mads Krogsgaard Thomsen come to mind).
It remains entirely unclear who (if anyone) will ultimately receive a Nobel for GLP-1, given the Prize’s cap of three awardees. My guess: Habener, Holst, Mojsov, and Drucker will all be in contention for their work on the foundational science, and recipients may be determined by survival as much as by merit (since the Nobel cannot be awarded posthumously).
I’ve been captivated by the endocrinology of metabolism since I was a medical resident at MGH. I discussed the biology of ghrelin, known as the “hunger hormone,” in my second year talk. Later, as an endocrinology trainee at MGH (where I recall almost no personal interaction with Habener) I provocatively gave a Fellow talk on the question, “Is type 2 diabetes a surgical disease?” I emphasized the remarkable efficacy of bariatric surgery for this condition, and the unexpectedly rapid endocrine effects associated with the procedure.
As TR readers appreciate, I’ve remained fascinated by the topic, and written quite a bit about GLP-1, weight, weight management, and type 2 diabetes management over the ensuing years. Those who’d like to explore more may find the following selected pieces useful; they are grouped thematically.
