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The thinking behind the build.

Field notes on the work that actually happens between RFI and First Patient In, from the team building the infrastructure for it.

CAPABILITY · ON PAPERDELIVERY · IN THE ROOM
Latest essayPre-Award · June 5, 2026

Why Pharma and Biotech Struggle to Choose the Right CRO

Capability is a corporate fact. Delivery is what these specific people do for this specific protocol when the plan breaks.

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SPONSORSCRO · INFRASTRUCTURESITES → PATIENTS
Strategy · October 24, 2025

Why We Decided To Build For CROs First

We bet on the infrastructure that runs clinical trials today and will still run them tomorrow.

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SSO?MANY PLATFORMSTHE REAL PROBLEMFALSCHE FÄHRTE · A FALSE TRAIL
First Principles · October 8, 2025

Is Single Sign-On Really What Sites Need?

We let the complaint dictate what we build. But SSO is a falsche Fährte, a false trail. The real problem is somewhere else.

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CLASSIC · ONE TRIAL, ONE DRUGPLATFORM · SHARED BACKBONE
Trial Design · August 29, 2025

Platform Trials as a Service: A CRO Model for Rare Diseases?

Clinical trials today are still prototypes. Ford’s revolution wasn’t the car. It was the assembly line.

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T H E W H I T E S P A C E≈ $80,000 / DAYSITE SELECTEDSITE ACTIVATED
Operations · August 14, 2025

The Whitespace Tax: Why Biotechs Lose Time, Money, and Patients Before First-Patient-In

The silence between “site selected” and “site activated” costs about $80,000 a day, and sometimes a patient’s last good option.

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10–20 DRUGS / $B<1 / $B19502010E R O O M ' S L A W · EFFICIENCY HALVES EVERY 9 YEARS
History · Part 1 · May 16, 2025

Why Drug Development Slowed Down (And What Can Be Done)

Drugs once reached patients in months. A journey back to the era before regulation tightened its grip.

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SITERECORDENGAGEMENTINTELLIGENCE
Category Design · April 18, 2025

A Theory of Site Engagement

Sites are the atomic unit of clinical development. Yet no company has a structured view of the quality of its relationships with them.

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SALES · CRMR&D · NO SYSTEM
Infrastructure · April 11, 2025

Why Commercial Teams Obsess Over HCP Data, and What ClinOps Must Learn

The most valuable data isn’t in your lab notebooks. It’s in how you select, engage, and contract with your sites.

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