Follow the Science? It Would Rather Follow a Leader… (2025 Update)

Eight years on from the first version of this article, “follow the science” is still the industry’s favourite comfort blanket.

It sounds noble, unassailable, the kind of thing you put on a lab-wall poster next to a photo of Rosalind Franklin. (Following the X go-around recently, not by Rosalind Franklin…)

But it remains as hollow as ever - reassuring for the people saying it, useless for anyone actually trying to get a medicine to the patients who need it and can pay for it.

The PCSK9 class is still the perfect cautionary tale - and now, finally, a redemption story.

Scientifically? An unqualified triumph. Genetic validation, surrogate endpoints hit, LDL reductions that make statins look like placebos.

Commercially? After a decade of approvals, the class finally crossed $3.7 billion in global sales in 2024 (Repatha ~$2.2 bn, Praluent ~$739 m, Leqvio past $750 m with triple-digit growth in some markets). Real-sounding money at last, but still miles short of the $10–15 bn peak-sales forecasts of 2015–2018.

And remember - when I talk about “product”, I mean far more than the molecule: indication sequence, trial design, endpoints chosen (or avoided), outcomes data generated, dosing regimen, price, access strategy, formulation, positioning… a hundred decisions made or not made between discovery and launch.

The original antibodies (Repatha and Praluent) were launched into the narrow, payer-hostile box of “statin-intolerant” or “maximally tolerated statin” patients.
Brilliant science. Terrible business plan. No price anchor, endless paperwork, patients who often didn’t think they were sick. Result: years stuck under $1 bn.

Then came inclisiran (Leqvio) - same target, twice-yearly dosing, broader label (now first-line in many places), deliberate cardiology-led, health-system-first, market-first strategy. Same biology, radically better product decisions, radically better trajectory.

And in 2025, we have oral PCSK9 inhibitors in late-stage development (Merck’s enlicitide decanoate just read out its Phase 3 with 56–60 % LDL lowering in a once-daily pill). If those succeed with better Commercial, the class could triple again - same mechanism, transformed by modality and convenience decisions. Plus, of course, Verve’s gene editing market experiment is to come…

The molecule doesn’t change from discovery to launch.
What you actually launch is a product of decisions.

Great science discovers molecules.
Great products are designed.

We still see pipelines packed with fantastic molecules pointed at yesterday’s business models. We still see companies waiting until Phase 3 readouts before seriously asking, “Who is actually going to pay for this - and why would they pick ours over the five things already there?”

Science is a brilliant follower.
It’s a terrible leader.

The opposite of “follow the science” isn’t “ignore the science.”
It’s “lead the science.”

That’s what asymmetric learning is: deliberately choosing to learn the things your competitors have decided aren’t worth knowing. Asking the questions everyone else has quietly filed under “too hard” or “not our heritage indication.” Generating the data that rewrites the value story instead of copying yesterday’s.

Unmet medical need is not the same as unmet commercial need.
Confusing the two remains the most expensive mistake in pharma.

No medicine is more expensive than one that never reaches patients.
And most never reach patients because nobody asked - who will pay, and why them? - until it was far too late.

Eight years later, the PCSK9 story is finally proving the point in real time.

Let’s stop pretending the path to market is obvious and that we just need to wait for more signals from the science.

Science would rather follow a leader.

Time to lead.

(As a wise man once wrote… A few sentences ago…) The opposite of “follow the science” isn’t “ignore the science.” It’s “lead the science.”

Edison didn’t follow the filament; he dragged it kicking and screaming into the light bulb. The Manhattan Project didn’t follow physics; it gave physics a deadline and a budget.

And the best drug launches of the last decade didn’t follow the molecule - they decided where it should go, then pointed the entire scientific apparatus in that direction.

Science would rather follow a leader. Time to lead.

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• “Vision without execution is hallucination.”
  – Thomas Edison
  (Edison didn’t wait for the filament to “find its own way” into the light bulb; he led the science through 6,000 failed attempts.)

• “The real problem is not whether machines think, but whether men do.”
  – B.F. Skinner
  Replace “machines” with “science” and you have the modern pharma dilemma: we’ve built the most extraordinary discovery machine in history, yet we keep letting the machine decide where to drive.