From the field
Dispatches from the field — before I've had time to be diplomatic about it.
I joined The Principal Podcast to talk about building a category-leading firm. The host wanted the consulting version; the deeper principle is the same one that decides winners in tools and diagnostics — in complex, technical markets, deep domain expertise is the most durable moat there is. And AI makes it more valuable, not less.
Read note →Three days at TD Cowen's Tools/Dx "Revolution," where AI was the whole conversation. The contrarian read: AI is a demand multiplier for the wet lab, not its executioner — and the defensible value is migrating off the assay into the workflow, the data, and the reimbursement access around it.
Read note →We built a tool that reads how NGS diffused through 98,000 papers, then checked it against our bottom-up model of the $7.3B market. The two agree — and the publications got there first.
Read note →We placed eight precision medicine technologies on the Rogers adoption curve using two signals from the published literature. The hard part was not the math — it was teaching the formula what we already knew. The result is a leading indicator of where the science is heading — usually a few years ahead of the market.
Read note →Only about 175 NGS papers ever reached Nature, Science, or Cell. We read every one. They explain what the diffusion curve measures, why 2008 was the whole story in a single year, and why a collapsing top-journal score says nothing about clinical value.
Read note →We read every Nature, Science, and Cell paper for three sequencing platforms — 859 in all. NGS earned its premium for new methods; single-cell and spatial earned theirs for atlases. The prize migrated from the technique to the map, and the window keeps getting shorter.
Read note →We built a diffusion index across seven precision medicine technologies — NGS, single-cell RNA-seq, spatial transcriptomics, spatial proteomics, long-read sequencing, cfDNA, and multi-omics. The benchmarks reveal a clean taxonomy: two classes of technology, four phases, and one underappreciated signal about where markets are actually heading.
Read note →France isn't arguing about whether precision diagnostics matter anymore. The argument now is how to make them reimbursed, routine, and equitable — and that turns out to be a business-model question as much as a clinical one.
Read note →I left Roche Diagnostics Day with one overriding impression: this was not really a product launch event as much as a full diagnostics platform buildout. Roche is assembling the operating system for precision medicine.
Read note →Alamar's IPO is a signal that proteomics is becoming investable again — and that precision medicine is expanding beyond DNA. Genomics told us what could happen. Proteomics may tell us what is happening.
Read note →AI is becoming unavoidable, and diagnostics is having a moment — not in the frothy, hand-wavy sense, but the industry is beginning to recognize that diagnostics are not just a support function for therapeutics. They are increasingly becoming the operating layer for precision medicine.
Read note →AGBT 2026 may not be remembered as the year of one giant announcement. It may be remembered as the year the field looked less like a collection of competing technologies and more like an emerging operating system for biology.
Read note →The UK has the NHS, Genomics England, UK Biobank, strong academic centers, and a policy narrative built around prevention and earlier detection. In other words, it has the raw materials for a precision medicine operating system. The question is whether it can turn those assets into a scalable model for adoption, reimbursement, and patient impact.
Read note →Precision diagnostics had a killer year in 2025. Tools companies are responding, and doing it with strategy, not just enthusiasm. If you're navigating this pivot, we'd be happy to compare notes!
Read note →The downside is increasingly bounded, the upside has multiple paths, and the market has quietly shifted from interesting research technology to embedded infrastructure. Our latest NGS manufacturer market scenarios — and why the risk is now asymmetric.
Read note →Precision medicine has always sounded beautifully simple: the right treatment, for the right patient, at the right time. The next bottleneck is turning complex biology into repeatable infrastructure. The science is hard. The plumbing may be harder.
Read note →For three years, specialty diagnostics was in market purgatory — paying for its COVID-era sugar high with reimbursement skepticism, compressed valuations, and investor fatigue. The Caris IPO is a signal that the market may finally be distinguishing between diagnostics as science projects and diagnostics as scaled clinical infrastructure.
Read note →That may be the real lesson from the trip. Healthcare transformation will not happen through technology alone. It will require vision, infrastructure, coordination, trust, and the willingness to build for decades. The UAE appears serious about that challenge.
Read note →For years, the running joke in diagnostics was that specialty Dx companies could do almost everything except make money. GeneDx is showing what happens when the answer gets bigger, the clinical value gets clearer, and reimbursement starts to catch up.
Read note →I did a Prenuvo scan, because apparently I’ll try every futuristic test available before remembering to schedule the very-much-not-futuristic colonoscopy!
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