From the outside, founding a company can look glamorous. From the inside, it’s sleepless nights, funding that’s never guaranteed (and never quite enough), regulatory timelines you can’t control, and the constant awareness that real patients are waiting on the other end of your decisions.
I’ve built biotech companies from an idea through late-stage development, and it’s never easy. What makes it worthwhile is that it isn’t just a business venture — it’s a way to make a difference in people’s lives. That’s also what makes the job heavier than a spreadsheet suggests: the cost of getting it wrong isn’t only capital, it’s time a patient doesn’t have.
Here are a few things I’ve learned about leadership over the years:
Leadership means making difficult decisions that don’t always have a clear answer. When things are black and white, it’s easy to know what to do. But most of the decisions that matter arrive grey — an ambiguous data set, a trial design with no perfect arm, a partnership that solves this year and constrains the next. Leaders make the best call they can with the information available at the time, and own it later without pretending the picture was clearer than it was.
Things don’t always go as planned. A readout misses. A timeline slips by two quarters you didn’t have. Keeping your cool when everyone else is losing theirs is what differentiates leaders from the rest of the group — not because composure fixes the problem, but because a steady room can still think, and a panicked one can’t.
Tell people the truth early. Bad news doesn’t improve with age, and teams and boards can absorb far more reality than most founders give them credit for. What erodes trust isn’t the setback; it’s learning about it late.
Lead by example. Hold yourself accountable for whatever is expected of the rest of the team. No one appreciates a “do as I say, not as I do” approach — and in a small company, everyone is watching what you actually do, not what you say at the all-hands.
Building is difficult, but important work. Leaders usually decide to create something because they recognize a need and want to make a difference. Creating positive change requires you to open your ideas and your capabilities to the world, and to be judged on both. Stepping out of the woodwork takes courage.
It’s a lot easier to destroy things — to find fault with what others built, to criticize from a distance where nothing is at stake. That’s the real line between builders and destroyers: builders accept the risk of being wrong in public, because the alternative is that the thing never gets made and the people waiting keep waiting.