David Shaywitz

As economic historian Carlota Perez has described, there is typically a significant time lag between when the promise of novel technology begins to emerge and the productive deployment of this technology at scale; TR readers will recall the discussion here from June 2023. Today, we are seeing this with generative AI, an emerging technology that everyone is still trying to... Read More

Most of my columns tend to focus on the importance and difficulty of applying emerging technologies to biopharma R&D, aiming to accelerate the delivery of impactful medicines to patients.  Yet, as long-time readers know, I have an enduring interest in how to sustain health and ward off illness, a discipline that’s sometimes called Preventive Medicine, Preemptive Health, or, the term... Read More

Part II of this series is here “Agency,” Harvard’s Zak Kohane and I agree, is the word of 2025.    Kohane’s reasoning: “Patients understand how to increase their agency in their disease journey with often correct and thoughtful instant second opinions from AI.”    This perspective aligns with the opportunities described by A16z VCs Vijay Pande and Marc Andreessen, as... Read More

Part I of this series is here. Over its 15 years of existence, the Andreessen Horowitz (“A16z”) venture capital firm has evolved from a media-savvy disruptive upstart to an exceedingly well-heeled incumbent and powerful force in Silicon Valley and the country.  In April 2024, the firm announced a gargantuan $7.2B (with a “B”) fund.  For a typical VC firm with... Read More

The likely impact of AI on health and medicine is … highly dependent on who you ask. Consider the spectacularly wide range of opinions offered in just the last several weeks. A $500 billion AI project, dubbed “Stargate,” was announced with great fanfare on January 21 in the Roosevelt room of the White House by President Trump. He was flanked... Read More

As we head into Thanksgiving, I wanted to share a story that highlights the promise and possibility that can emerge from a devastating diagnosis, and emphasizes what can happen when industry, academia, and — especially — impassioned parents and advocates join forces. Consider the devasting rare genetic disease, spinal muscular atrophy, or SMA. According to Cure SMA, SMA is “a... Read More

“Does the crowd understand? Is it East versus West Or man against man? Can any nation stand alone?” Burning Heart, by Survivor – Rocky IV In national politics, the culture wars may pit the coasts against the rest of the country.  In biotech, however, the AI culture war seems to pit the coasts against each other. Consider this recent LinkedIn... Read More

In 2011, we were experiencing the ascension of technologies like the cloud and the smartphone.  Apps had become a thing: social network apps like Instagram (the iPhone “App of the Year” in 2011) and Twitter, utility apps like Evernote and Dropbox, navigation apps like Google Maps and Waze, and game apps like Angry Birds. Yet in medicine, as I wrote... Read More

Two weeks ago, I wrote about how difficult it is for R&D leaders to “pick winners,” despite the enormous incentives to do so.  I explained how we tend to underestimate the role of chance, and overestimate our ability to “domesticate uncertainty,” as Nassim Taleb and I wrote in the Financial Times in 2008.  Mostly, efforts to systematically improve success rates... Read More

Everybody reading this column knows that biopharma is a difficult business.  Biology is unfathomably complicated and figuring out how to introduce something into the human body that does more good than harm is a fiendishly difficult challenge. That’s why it’s important to recognize the occasional success. It reminds us what’s possible, and inspires us to think about how to achieve... Read More

Peter Thiel, the contrarian investor, had a favorite question for interviewees: “What important truth do few people agree with you on?” My answer: No one can pick winners in pharma R&D.  When I think of the most significant blockbusters in the industry involving novel mechanisms of action (follow-ons are a different story), I see a huge amount of luck on... Read More

A central challenge of R&D, like many disciplines characterized by rare, outsized success, is how to think about risk, as well as the contributions of luck and skill.  Two new books – How To Become Famous, by Cass Sunstein, and On the Edge, by Nate Silver, offer valuable perspectives. I’ll also highlight several articles that provide additional relevant insight, including... Read More

The phrase “assent without belief” has been used to describe the concept of going along with the outward manifestations of an ideology without true conviction. Most commonly, this is used to describe a familiar contemporary approach to religious observance.   It also seems to describe how the vast majority of biopharma colleagues view AI and other emerging digital and data technologies. ... Read More

Peter Attia is a prominent physician-turned-California longevity guru, and (to paraphrase Woody Allen) as California longevity gurus go, he’s one of the best, striving to remain grounded in science and data. Known for his popular book Outlive, and his affection for “rucking” (look it up), Attia is also the host of a long-form podcast called The Drive, and an engaging... Read More

“It was all mixed into one, enormous, overflowing stew of very real technological advances, unfounded hype, wild predictions, and concerns for the future.  ‘Artificial intelligence’ was the term that described it all.” – Cade Metz, Genius Makers   The buzzy excitement around artificial intelligence (AI), and most recently generative artificial intelligence (genAI), has inspired some biopharma leaders, exasperated many others,... Read More

While visiting my parents on Memorial Day weekend, I reflected on the wonder and joy of a life in medicine and science — theirs as well as mine.  Incredible Progress in Medicine My parents are academic physician-scientists at Yale Medical School, where they founded and continue to lead the Yale Center for Dyslexia and Creativity. Now in their early 80s,... Read More

The two broad categories of medical discovery that command the most attention are insights resulting from rare, informative genetic conditions (see here) and advances resulting from fortuitous observations.   A canonical example of the value of extreme genetic phenotypes is the patient with familial hypercholesterolemia who inspired Brown and Goldstein’s scientific pursuit of cholesterol metabolism and led to the statins. Similarly,... Read More

GLP-1 medicines are obviously having a real moment – medically and culturally.  These once-weekly injectables, which reduce appetite and result in significant, long-lasting (so long as you’re taking them…) weight loss, have been demonstrated to have a number of important health benefits beyond simply shedding pounds.  In March, Novo Nordisk’s semaglutide (Wegovy) was approved by the FDA for its ability... Read More

A main theme of this column – perhaps even the dominant theme – is how to operate in a power-law domain like drug development where there are few, outsized successes, where most efforts end in failure, and where it’s incredibly difficult to predict in advance how you are likely to fare. Earlier this week, I discussed the parallels between film... Read More