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patients switch multiple times, outcomes suffer.
Tolerization, once invisible, is becoming a cost center that
can no longer be ignored.

The Conclusion:

Everyone in this system is doing their job.
But no one owns the long-term outcome.

That’s the flaw.

The biologics we prescribe today weren’t designed to
remain in the body for five years. They were designed to
prove their worth in six months. And once they cleared
that hurdle, the system moved on—without ever building a
feedback loop to reward staying power.

This is why tolerization wasn’t treated as a crisis. It wasn’t
even treated as a variable. It was left unmeasured,
unmonitored, and eventually, normalized. A known issue
that became an accepted limitation. A side effect of
progress.

But in doing so, we quietly severed the link between
biological performance and biological sustainability. We
created a reality in which a therapy could fail
immunologically—but still succeed financially. Where a
$100,000 drug could lose efficacy in a year—and the
response would be to prescribe another $100,000 drug. Not
because it’s optimal. But because the system has no
alternative plan.

This isn’t just a scientific gap.
It’s a design failure.
We built for launch.
But we forgot to build for longevity.

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