A 2025 Biotech Reflection

Hello, friends. Welcome to 2026.

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With enough distance from the past year, the shape of 2025 has become clearer. Many end-of-year reports attempt to capture a year while it is still unfolding. I chose to wait, letting urgency dissipate so patterns could surface.

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Shaped by proximity to the work—by conversations with founders, operators, and partners, and by time spent inside systems where execution matters more than narrative—this reflection looks at how biotech functions when capital, science, infrastructure, and human systems intersect, and where those intersections continue to strain. To those of you who provided input, I am grateful.

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Progress Without Resolution

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There is no question that biotech regained a measure of momentum in 2025. Capital became more selective but did not retreat. Scientific progress continued across modalities. Radioligand therapies matured. Platform companies refined their focus or quietly exited. The excesses of earlier cycles gave way to greater operational discipline.

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And yet, listening closely across the year, I heard a persistent mismatch between innovation and execution.

The industry continues to reward novelty more reliably than durability. We invest aggressively in discovery while assuming that existing systems will stretch to absorb new complexity. That assumption surfaced repeatedly, not as an abstract concern, but as a practical constraint encountered by people trying to move therapies forward.

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In that sense, 2025 was less about breakthroughs and more about ceilings. Ceilings imposed not by the incredible science, but by infrastructure, and coordination, and access. These ceilings rarely appear in pitch decks. They show up in delayed trials, uneven enrollment, and bottlenecks that quietly erode value over time. I am very interested in those bottlenecks.

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This matters because biotech creates value differently than most industries. Its true contribution lies in reducing future harm, not simply in producing products. And that’s a very difficult thing to price. When the systems that enable that reduction falter, value is delayed, or distorted, or even lost entirely.

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Radiopharmaceuticals and the Execution Gap

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Radiopharmaceuticals offered one of the clearest illustrations of this dynamic in 2025.

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Investment continues to flow into isotope production, supply chains, and next-generation radioligand platforms. The scientific promise is real, and in some cases already clinically validated. But progress at the bench does not automatically translate into progress at the bedside.

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In conversations with Jason Hurt, founder of Theragnostic Insights, the constraint he returned to was not scientific feasibility or capital availability, but clinical trial execution.

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“Capital continues to pour into isotope production and supply chain innovation. Those are vital components. Yet the real bottleneck remains where patients meet the science: clinical trial execution.”

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What this framing reveals is a shift in where risk actually resides. The industry has spent years focusing on upstream innovation while assuming downstream systems would adapt. That assumption is increasingly fragile.

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Radiopharmaceutical trials still rely heavily on academic medical centers that are already stretched thin. Coordination across nuclear medicine, oncology, radiopharmacy, and clinical operations remains fragmented. Equipment ages. Administrative processes slow. Complexity accumulates faster than capacity.

Jason was direct about the implications of this imbalance.

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“The industry is assuming academia can absorb this growth. That assumption will not hold.”

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What stood out to me was not the warning itself, but what it implies about value creation. When execution infrastructure lags behind innovation, value does not disappear all at once. It leaks. Timelines extend. Costs rise. Promising therapies stall. The market continues to price potential while underestimating the drag created by structural bottlenecks.

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This is where I see a deeper pattern emerging. Biotech is exceptionally good at signaling value upstream and far less consistent at supporting the conditions that allow value to materialize downstream. What gets funded, celebrated, and narrated does not always align with what carries therapies safely and reliably to patients. Over time, that misalignment compounds. Over time, even our best intentions produce neutered benefits.

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If radiopharmaceuticals are to scale responsibly, the next phase of investment will need to focus less on novelty and more on building dedicated, integrated clinical environments designed for complexity rather than convenience. Infrastructure is not ancillary to innovation. I’ll repeat that for my friends in the back:

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infrastructure is not ancillary to innovation. It is the mechanism through which innovation becomes real.

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Clinical Trials as Human Systems

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Infrastructure is only one axis of constraint. The other is human. Very human.

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Across therapeutic areas, clinical trials remain poorly understood by many of the people they are meant to serve. Awareness gaps, trust gaps, and logistical barriers continue to shape who participates and who is excluded. These gaps are not incidental; they are designed, albeit poorly. They directly influence enrollment timelines, trial diversity, and the ethical credibility of the research enterprise.

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Casey Witt, founder of Foxglove Clinical, articulated this clearly through her work at the intersection of clinical operations and patient advocacy.

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“One of the biggest barriers we see is that many individuals simply aren’t aware that clinical trials could be an option for them. They may not know where to start, who to ask, or even that asking their healthcare provider is possible.”

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This problem is often framed as an education issue. In reality, it is a systems issue. Awareness does not exist in isolation. It is shaped by trust, by history, and by whether patients feel seen as participants rather than subjects.

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This became personal for me in an ordinary way. My mother has retinitis pigmentosa. Over the years, her vision has degraded to a fraction of what she had as a child—approximately 3% vision in her left eye and 4% in her right. Daily tasks have become difficult at best. She has expressed interest in clinical trials thoughtfully and repeatedly. Yet she has no clear way of understanding what options exist, where to look, or how to evaluate whether a trial is appropriate for her. There is no obvious entry point. No shared language. No system designed to meet her where she is.

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Regulatory initiatives aimed at improving trial diversity matter. But regulation alone cannot create understanding or confidence. That work happens locally, through sustained engagement and translation. Patient advocacy organizations play a critical role here, not as a compliance mechanism, but as a bridge between clinical research and lived experience.

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As Casey noted:

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“By collaborating with patient advocacy groups, we help ensure that people have the knowledge and support they need to even consider clinical trials as a care option.”

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When viewed honestly, clinical trials are not purely operational systems. They are social systems. They require empathy, clarity, and continuity, not just protocol optimization. When those human dimensions are underinvested, value creation slows in ways that are difficult to quantify and very easy to feel.

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The Economic Pattern Beneath the Friction

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Stepping back from individual conversations, a deeper pattern becomes visible.

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Biotech’s most persistent challenges are no longer primarily scientific. They are structural and economic. They arise from a mismatch between how value is created and how it is supported. Innovation accelerates. Infrastructure lags. Trust remains uneven. Execution absorbs risk that markets often fail to price accurately.

In other words, the industry continues to generate possibility faster than it builds the systems required to carry that possibility forward.

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This is not a failure of intent. It is a failure of alignment. Infrastructure, coordination, and patient inclusion demand long-term investment and sustained accountability. They are slow. They are expensive. They rarely generate headlines. As a result, they are consistently underweighted in decision-making, even as they quietly determine outcomes.

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Jason captured this tension succinctly:

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“Bravery in this field doesn’t mean chasing hype. It means tackling the hard, unglamorous work of infrastructure.”

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I heard versions of this sentiment across very different corners of the industry in 2025. The future of biotech will not be determined solely by new modalities or platforms (or AI). It will be determined by whether the surrounding systems are allowed to evolve with equal seriousness.

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Trust, execution readiness, and infrastructure capacity are not soft assets. They are economic inputs. When they are neglected, value creation becomes fragile and uneven, regardless of how promising the science appears.

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2025 – 2026

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As the patterns of 2025 come into clearer view, they point toward a need for deeper alignment between innovation and execution, between scientific ambition and the human systems that sustain it, and between what the industry rewards and what actually carries therapies forward.

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The work ahead requires a different posture. One where bravery looks like listening carefully, resisting premature conclusions, and allowing those closest to the work to shape what comes next.

With heart,
John

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