It's the momentum that gets you
This is the first in a series of posts I introduced last week where I’ll walk through the different stages and workflows of a typical drug development startup, working backwards from the first major milestone for many such companies - writing and filing an IND to bring a potential treatment into clinical trials. And I’ll start just before the writing starts, at the point of collecting all the evidence and making the final go/no go decision.
To set the stage for this, note that at this point your startup has invested a huge amount of (other people’s) money in this decision. You’ve evolved a story about why this particular treatment has a good shot of making it through clinical trials and onto the market. And this story is closely intertwined with the story and the finances of the overall organization. So there’s going to be a lot of pressure to end up with a “go” decision that fits this story. This is momentum, and it’s been increasing with each decision you’ve made.
It’s momentum in the sense that if at any point there had been a reason to shift direction, it wouldn’t be enough for that to be the right decision - it would have to be compelling enough to overcome the existing narrative, the sunk cost fallacy, etc. And the more decisions you make, the more momentum there is to overcome.
So there’s a lot to be said about making sure you can find the right evidence at the right time as you make these decisions. But I’ll cover that in a later post. Today, I want to explore the problem of presenting this evidence in a way that minimizes the impact of momentum and maximizes the ability to make an objective decision.
Usually, biotechs collect the evidence for these decisions in slide decks. The slide decks frame each decision within the existing narrative, present snippets and summaries of the data/evidence (sometime with links to references) and present details targeted at an audience that’s already deeply familiar with the context. This makes sense given that they’re often one-off decisions (or feel that way) and depend as much on company strategy as science. The decision makers need to already have a deep understanding of the broader strategic context, and that limits the number of potential decision makers.
But there are two implications of this that magnify the momentum: 1) Anyone who has enough context to interpret and understand this presentation is already bought in on the narrative, so less likely to question it, and 2) even if someone did want to dig deeper, it’s very hard to get to the underlying evidence.
In other words, the way to push back on the momentum is to make the evidence accessible to a broader audience (within the organization) in a way that they can interrogate the details and question the narrative. Usually, the handful of strategic decision makers are already seeking critical feedback from this broader audience. But they may not be giving them the tools to provide it. Better software, along with processes that support it, should try to fix this.
I don’t know what the ideal solution to this problem looks like. (As with many of my posts, this series is more about nails than hammers.) But we have tools for presenting and interacting with data. It’s just a matter of fitting them to the problem.