Dear clients and friends: Given your interest in health and medicine, we would like to share with you our collection of the most interesting perspectives on our industry's trends and developments. We are happy to share them with you — and hope you share your thoughts with us.

1. Why So Few Biotech Startups?

The tech sector is awash with startups, but not healthcare. Why? Noubar Afeyan, co-founder of Moderna and CEO of Flagship Pioneering, offers a simple but foreboding answer – a lack of talent:

It’s usually about people more so than capital and innovation since we’re sourcing a lot of capital, both to start these things but also to scale them. Some roughly $5 billion of capital has gone into our collective activities over the last decade, little more than a decade of it, just as we’ve ramped up.

Then on the innovation side, our methodology by which we actually make inventions — which is quite different than the way scientific innovations are usually made — I don’t think that that is limited in its potential. There’s far more white space out there than there is occupied adjacencies, which is what innovation today is usually focused on. One way of saying, I think it’s about people, and it’s people who, on the one hand, need to be trained in this way of thinking about it and be willing to dedicate themselves to a pretty contrarian way of life.

2. No Safe Haven

Haven – the headline-grabbing healthcare extravaganza from Amazon, Berkshire Hathaway, and JP Morgan – made the modest proposal to fix healthcare. It has since folded. The Wall Street Journal eulogizes:

Despite Amazon, JPMorgan, and Berkshire’s collective size, they lacked scale to garner enough negotiating power with care providers. To achieve their big aims, they would have needed more partner companies to join, or cooperation with government…"They did not have enough bargaining power with the insurance industry or with providers,” said Lyndean Brick, CEO of health-care consulting firm Advis. Sweeping changes “will take massive governmental and business reform, and we have yet to see that cooperation.”

3. Healthcare Data: “Incomplete, Incorrect, Missing, and Biased”

Dr. Rachel Thomas, the Founding Director of the Center for Applied Data Ethics at the University of San Francisco, argues that healthcare “technologies exacerbate imbalances of power.” In the Boston Review, Thomas outlines how data and AI can empower healthcare without disempowering patients:

First, it is crucial to acknowledge that medical data—like all data—can be incomplete, incorrect, missing, and biased. Second, we must recognize how machine learning systems can contribute to the centralization of power at the expense of patients and health care providers alike. Third, machine learning designers and adopters must not take new systems onboard without considering how they will interface with a medical system that is already disempowering and often traumatic for patients. Fourth, machine learning must not dispense with domain expertise—and we must recognize that patients have their own expertise distinct from that of doctors. Finally, we need to move the conversation around bias and fairness to focus on power and participation.

4. The Case for Pessimism

Read and weep: Lawrence Wright examines the early days of the pandemic in The New Yorker. The retrospective, which may rival the Sparknotes for War and Peace for number of characters and plot lines, offers a devastating assessment of the U.S.’s response. Just one example:

Without the test kits, contact tracing was stymied; without contact tracing, there was no obstacle in the contagion’s path. America never once had enough reliable tests distributed across the nation, with results available within two days. By contrast, South Korea, thanks to universal public insurance and lessons learned from a 2015 outbreak of MERS, provided free, rapid testing and invested heavily in contact tracing, which was instrumental in shutting down chains of infection. The country has recorded some fifty thousand cases of COVID. The U.S. now reports more than four times that number per day.

5. The Case for Optimism

Putting aside for a moment the extravagant bungling, the pandemic may have prompted a better way to advance knowledge by opening access to scientific and academic journals. Economist Tyler Cowen makes the case for keeping the new status quo:

Most relevant scientific advances on the Covid-19 front have been put online in open-access form and then debated online. Even if they later came out in refereed journals, their real impact came during their early open-access days…The articles are free, the whole world can read them, and the interplay of ideas they generate is easier to track. As scientific contributions come from a greater number of different countries, including many poorer countries, these factors will be increasingly important. I work at a major U.S. research university, but even so I am frequently unable to gain access to desired academic publications.