The Same Molecule, Two Different Fates Depending On Who You Give It To!
Warning: This article contains a bold recommendation on how to proactively develop drugs that payers, HCPs, and patients want.
A dear friend and muse often makes a deceptively simple but deeply provocative observation:
“If you gave the same early-stage asset to two different companies with equitable resources, one would outperform the other.”
At first glance, that sounds intuitive. Of course, different teams get different outcomes. But the real insight lies in why. Because the difference isn’t the molecule. It’s the thinking.
A Lesson in Assumptions
Years ago, a senior development executive told me at the start of our first meeting—without irony—that he didn’t need to discuss drug development with me because, in his words,
“I already know how to develop a drug for diabetes. I’ve done it several times before.”
I paused, then asked,
“If someone else had your same tenure and track record, would they also know how to develop a diabetes drug?” He thought for a moment, nodded, and said, “Yes.”
Then I asked, “So… which of you is going to think differently?”
He fell silent.
That moment has always stayed with me. Because in a world where experience is abundant, differentiation doesn’t come from doing the same thing again—it comes from seeing it differently.
(And in case you’re wondering, I believe Stefan (not his real name) has now retired—so there’s a good chance he won’t see this article. Let’s call it a safe retrospective 😄)
The Molecule Is Only Half the Story
We like to believe that the molecule carries the promise. But the truth is, its destiny is shaped less by its pharmacology than by the strategy, culture, and decisions made around it.
Here’s what separates the outperformers from the pack:
- Strategic Clarity from Day Zero
Winning teams start by asking: What real-world problem are we solving? Who will benefit? Who needs to be convinced—and why?
Others default to standard development plans and hope it all lines up later. But hope is not a strategy. I love that line, but it feels rude to use it when challenging someone. The best outcomes begin with purpose, not protocol. - Cross-Functional Thinking from the Start
Outperformers build their strategy like a symphony, not a solo. Medical, commercial, access, clinical, regulatory—everyone has a seat at the table from the beginning. They should also have equal opportunity to speak up.
Average teams stay siloed. Great teams co-design the journey. - A Culture That Challenges
Some teams focus on speed to Phase 2. Others focus on relevance to the system. The latter might move just as fast—but with sharper endpoints, clearer populations, and better alignment to future access.
The difference? A culture that rewards questioning over compliance. - Proactive External Engagement
Regulators, payers, and systems aren’t end-stage hurdles. They’re early-stage partners—if you let them be.
The best teams don’t just share data. They co-shape it. That upstream collaboration leads to smarter trials and faster, more confident decisions downstream. - Focused Leadership
Leadership isn’t just about vision—it’s about focus. The outperformers don’t chase every opportunity. They prioritise. They say no. They double down on what matters.
It’s not how many options you have. It’s how well you choose.
So, if two companies start with the same molecule and the same resources… why does one succeed while the other falters?
Because one of them asked better questions. Listened more closely. Challenged assumptions. Brought more voices to the table. Designed with access and adoption in mind. And refused to do “what we’ve always done.”
The molecule doesn’t decide. You do.
A Thought Experiment Worth Trying
If the same molecule can lead to vastly different outcomes depending on the team and thinking behind it… why not test that upfront?
What if pharma companies took their highest-potential early-stage assets and assigned them to two different internal teams, each given space to shape their own vision, strategy, and development plan?
Let them explore. Let them diverge. Let them compete—not in silos, but in ideas. Then let leadership choose the path that represents the future, not just the familiar.
It’s bold. It’s uncomfortable. But betting everything on a single way of thinking may be riskier.
So next time you’re handed a promising molecule, ask yourself:
What would two different teams do with this?
And which one are you building?
Have you seen teams start with the same science and land in very different places? I’d love to hear your perspective.
