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not just the short-term metrics that look good on a Phase III
slide.

The Old Contract: Fragility, Churn, and Repeat
Revenue

Let’s be honest about the structure we built:

• Drugs were designed for maximum biochemical
impact, not immunological compatibility.
• Regulatory frameworks prioritized short-term
endpoints—6-week, 12-week data.
• Payers reimbursed therapies based on response
rates, not durability curves.
• And pharma companies built their models on
churn. If a biologic failed in 18 months, that was
okay—there was another one waiting to be infused.

This model didn’t reward persistence. It rewarded
escalation.

The result? Billions spent on therapies that get abandoned.
Patients left cycling through immune rejection. And an
entire class of medicines whose failure was baked into their
very structure.

The New Contract: Trust, Tolerance, and Time

The biologics of tomorrow must not simply treat disease.
They must earn the immune system’s trust. That means
rethinking every layer of the value chain—from molecular
design to delivery route, from reimbursement to regulation.

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