Understanding Biotech in the Present Tense
On listening to the people building the future of biotech today
Much of the conversation about biotech is focused on the future and the outcomes it promises. Less attention is paid to the people building it today. Over more than fifteen years working in design and strategy, I’ve come to treat lived experience as a primary form of knowledge. Hypotheses matter. Data matters. But understanding how something actually works requires proximity: drafting, testing, revising, and learning through years of practice. Without listening deeply to the people doing the work, without validating ideas against their day-to-day reality, explanations risk remaining surface-level. They describe outcomes without capturing understanding.
When I think about what is missing from much of how biotech is discussed, and where I might contribute, it is here. By listening closely and elevating the perspectives of those brave enough to build under real constraints, I hope to make visible a layer of knowledge that too often disappears once outcomes arrive.
Next week, I’ll share my first interview. In the meantime, it’s worth considering what is missing from the story of biotech, and what might become possible if we shared more of how—and perhaps more importantly, why—we choose to build.
What shapes how biotech is understood?
Most public writing about biotech follows a familiar set of frames. There is writing focused on the science itself: the mechanisms, the modalities, the breakthroughs, and the steady accumulation of technical progress. There is writing focused on outcomes: the pipelines, the approvals, the failures, the acquisitions, and the valuations. There is writing oriented toward the future: what biotech could become, where the industry should go, and what might be possible next.
There is also a significant body of institutional analysis: capital flows, policy shifts, regulatory dynamics, and the macro forces shaping the field. None of this is misguided. Biotech is complex and consequential. It requires many modes of analysis. These dominant explanations exist for good reasons, and they do much-needed good work.
But taken together, they produce a particular way of understanding biotech, one that privileges abstraction over experience, outcomes over process, and hindsight over presence. Our collective understanding of the field is set by the parameters with which we choose to publish.
In these explanations, biotech appears legible only once something has resolved. Decisions become visible through results. Meaning arrives after the fact. The work itself is understood retrospectively, once uncertainty has been replaced by a constructed story. Coming from the world of brand, I’m all too familiar with the reasons we choose to tell stories. Some good, and many deleterious to the outcomes we seek.
What gets lost in that framing is not complexity, but honesty.
What do those explanations miss about decision-making?
What those explanations leave out is not intelligence or effort or rigor. What they leave out is proximity to decision-making before clarity arrives. From the outside, choices appear linear. From the inside, they rarely (never) are.
Builders operate within constraints that are unevenly visible: incomplete and asymmetrical information, regulatory uncertainty, misaligned incentives, organizational complexity, shifting timelines. It’s messy, and that’s okay. We’re all human after all. Regardless of how much data we accumulate, we make tradeoffs without truly knowing which risks will materialize and which will dissipate. We decide under pressure, often without precedent, and almost always without a clean feedback loop. And that’s okay too.
Most explanations of biotech are written after those decisions have hardened into outcomes. Hindsight is 20/20, and at that point, meaning is retrofitted. As a strategist and designer, I’ve witnessed this more times than I care to admit. Success becomes foresight. Failure becomes error. Ambiguity is smoothed out, and the texture of the moment is lost. It is something that has kept me up at night lately. The biotech industry is one of the most important and consequential fields of human endeavor. The choices we make today have outcomes that last for generations.
This creates a distorted understanding of how this work actually happens.
It suggests that the most important knowledge lives at the level of results, when in reality it often lives earlier—embedded in judgment calls, in how we prioritize, and the constraints that never make it into formal narratives, annual reports, or pitch decks. How much widom can you put into 10 slides? If you’ve ever witnessed a public critique of a popular new brand, you’ve seen the armchair commenters preach from their pulpits without ever setting foot in the gutter of bringing a company to life.
When that present-moment layer is missing, we misunderstand not just what happened, but how similar decisions are likely to be made again. And history repeats itself. So it goes.
“History is merely a list of surprises. It can only prepare us to be surprised yet again.”
3. What does building biotech look like from the inside out?
Building while the future is still undecided produces a different kind of knowledge. It’s anthropological and ethnographic.
It is knowledge formed without resolution, under conditions where outcomes are unknown and often unknowable. It is shaped by constraint rather than certainty, and by responsibility rather than prediction. It resists simplification because its consequences have not yet revealed themselves.
This is the phase of work where decisions matter most and are understood least. And I am fascinated by those decisions and the people who are committed to making them.
“I can live with doubt and uncertainty and not knowing. I think it’s much more interesting to live not knowing than to have answers which might be wrong.”
When the future is undecided, builders cannot rely on narrative coherence to guide them. They rely instead on experience, on intuition, on ethical judgment, and an evolving sense of acceptable risk. They balance competing demands—scientific, financial, regulatory, and human—without knowing which will ultimately dominate.
Once outcomes arrive, this knowledge is often overwritten. The present tense collapses into a past-tense story that no longer reflects what it felt like to decide in real time.
Yet it is precisely this moment—the unresolved, uncertain present—that shapes everything that follows. The stories we tell ourselves about the work we do today create the container for how the future will critique our actions.
If we want to understand biotech as it is actually being built, we need access to this layer before it disappears.
4. How do scientists and builders form judgment within uncertainty?
“Nothing in life is to be feared; it is only to be understood.”
Before outcomes are known, perspective does more than color interpretation. It shapes action.
In the absence of clear results, perspective becomes the primary organizing force. It influences what risks are considered acceptable, which constraints are treated as binding, and how responsibility is distributed across a system. It affects what gets prioritized, what gets deferred, and what gets framed as non-negotiable.
This is not a matter of temperament. It is structural. The stories we tell ourselves today create the infrastructure for understanding what must come next.
Two teams can face the same technical problem and arrive at different paths forward based on how they understand their role, their obligations, and the system they are operating within. Perspective determines which signals are noticed and which are ignored.
Once outcomes are known, perspective is often rewritten to align with the result. Decisions that led to success are framed as insight. Decisions that led to failure are framed as miscalculation. What disappears is the fact that, at the time, many of these choices were made under genuine ambiguity. From everything I’ve gathered in the course of my life and career, we are all just making it up as we go, as best we can.
Ignoring perspective in this phase leads to repeated misunderstandings. It encourages explanations that feel complete but fail to account for how decisions are actually formed when certainty is unavailable. It ignores why we choose to build in the first place.
How do the stories we tell shape the organizations we run?
Human stories are often treated as secondary to the “real” work of biotech: the science, the data, the infrastructure. But in practice, they are deeply entangled with how systems function.
Stories carry context. They transmit judgment. They encode lessons about what has worked, what has failed, and what is worth protecting. In complex environments, they often serve as informal operating systems, shaping behavior where formal structures fall short.
This is not about narrative polish or personal branding or thought leadership. It is about how meaning moves through an organization.
When builders explain why they made a particular decision, what they were optimizing for, or what they were trying to avoid, they reveal the human logic beneath technical choices. That logic affects alignment, trust, and execution. It influences how teams respond under pressure and how they interpret uncertainty.
When this layer is ignored, explanations become technically accurate but operationally incomplete. Similar technologies, teams, or strategies can produce very different outcomes depending on the human context in which they are applied. Most companies skip this layer altogether.
Human judgment does not simplify biotech. It makes it more legible—and, in doing so, more understandable.
What would it mean to document biotech before outcomes exist?
Most records of biotech are retrospective by design. They organize information around milestones, results, and conclusions. By the time a story is told, the future it once described has already resolved.
A living record of the present tense would look different.
It would capture how decisions are made before they are validated. It would preserve uncertainty rather than smoothing it out. It would allow builders to speak in their own voice about what they are navigating, what they are unsure about, and what tradeoffs they are holding.
Such a record would not aim for consensus or completeness. It would value proximity over polish and clarity over certainty. It would treat lived experience as a form of knowledge rather than as anecdote or color, or as a form of “content marketing”.
Importantly, it would exist alongside traditional forms of analysis, not in opposition to them. Its role would be additive, filling a gap rather than replacing existing explanations.
By doing so, it would make it easier to understand not just what happened, but how and why it happened in the first place.
What changes when decision-making context is visible?
When the human layer of biotech is visible, understanding deepens.
Decisions become easier to contextualize. Tradeoffs become easier to evaluate. Patterns emerge that are otherwise obscured—not patterns of success or failure, but of judgment, and responsibility, and constraint.
This does not guarantee better outcomes. But it does reduce the likelihood of repeating the same misunderstandings under the guise of novelty.
In a field as consequential as biotech, misunderstanding how decisions are made is not a neutral error. It shapes incentives, expectations, and future choices. Over time, those misunderstandings compound. Over time, they affect billions of people.
Understanding biotech while it is still being built means staying close to the people doing the building. It means listening before conclusions are available, and taking seriously the human context in which the future is being shaped. It asks for the discipline to remain present with uncertainty, rather than rushing to resolution.
Without that proximity, we are left with explanations that feel complete, but are missing the very layer that determines how the work unfolds.
Love the emphasis on capturing decision-making before hindsight smooths everything out. The Feynman quote nails it - living with uncertainty is where the real insight lives, not in retrofitted narratives. I've seen this pattern in tech where sucess stories erase all the messy tradeoffs that actually drove the outcome. The idea of biotech needing an anthropolgical layer feels right because those human judgment calls under constraint shape everything downstream.