Lessons from senior leaders across biotech and pharma on how portfolio decisions are made when effective clinical trial strategy is the goal.

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Introduction: The Art and Science of Pipeline Decision-Making

The challenge of determining which clinical programs move forward sits at the heart of pharmaceutical and biotech R&D. It’s a decision that can define a company’s future—especially as organizations balance cutting-edge science, commercial realities, risk, and operational feasibility. In a standout episode of The COG Review: Building Better Clinical Studies, Emily Roberts-Thomson moderates a candid discussion with Raj Patel, Nikhil Dube, and Mukhtar Ahmed, uncovering practical insights from leaders navigating these complex decisions across both startup and large company environments.

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Frameworks for Portfolio Strategy: Three Pillars of Decision

When asked how pipeline advancement is approached, each panellist underscored the need for multidimensional thinking:

• Raj Patel identifies the balancing act between time to market, return on investment (ROI), and risk. “How fast you can get your product approved, and what is going to be the return on investment... Each product has its own risks,” he notes, highlighting tough calls when multiple candidates are similar in profile.

• Nikhil Dube, with experience in large pharma, breaks down decision-making into three core pillars: science, development feasibility, and commercial opportunity. The interplay of these dimensions forms the backbone of most organizational frameworks. “All of us know that trials are getting more and more challenging to recruit,” Nikhil adds, pointing to recruitment realities as a major feasibility filter.

• Mukhtar Ahmed shares how small, agile companies like Greenstone Biosciences leverage both integration with academic research and rigorous early assessment. Their “three filters”—scientific conviction, translational feasibility, and value inflection potential—keep the focus on robust, human-relevant data and clear go/no-go criteria, particularly when capital is limited.

  
  

Key takeaway: Whatever the scale, effective pipeline governance demands robust multi-factor analysis, adaptability, and cross-functional alignment.

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Balancing Science and Business: A Practical Trade-Off

Breakthrough science may captivate teams and drive early excitement, but as each panelist confirmed, business fundamentals ultimately shape what advances. “The tension between strong biology and commercial viability is always real, especially in a small or early-stage biotech,” Mukhtar reflects. Their approach: anchor in science, but pressure-test for commercial boundaries, such as clinical differentiation, scalability, and translational path.

Raj describes his personal evolution: “When I first started, science was very important... But as I moved up, then it became: What is the ROI? How soon am I going to get this product approved? That became more important than the science itself.” This hard lesson is echoed by stories of promising science unable to cross the finish line due to lack of funding.

Key consideration: Effective leaders use business discipline not to stifle innovation, but to channel it towards sustainable outcomes—ensuring only those scientific opportunities with real-world traction receive the necessary investment.

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Cross-Functional Alignment and the Reality of “Too Many Cooks”

For organizations of all sizes, getting alignment on pipeline choices is often the toughest hurdle. Emily Roberts-Thomson and Raj Patel describe the push and pull between scientists advocating for innovation and business leaders focused on ROI. In smaller companies, Mukhtar Ahmed says, “Silo has no place. There has to be transparency from the very beginning, with constant dialogue between scientific and business teams.

In larger companies, Nikhil Dube highlights the need for “right-sized collaboration”, where functional subgroups (research, development, and commercial) crystallize their perspectives before integrating them for consensus-building. This structure prevents endless debate and accelerates clear decisions.

Practical insight: Pipeline strategy is a team sport. Transparent, early, and cross-functional discussions help organizations avoid costly misalignment down the road.

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Market Dynamics and the Role of Investors

Market realities and investor sentiment wield tremendous influence, especially in startups. Raj Patel candidly recounts how shifting public health priorities and external grants helped his company persevere: what once seemed low-priority (‘drug abuse was not a big issue in this country’) became a focus as societal needs evolved and board buy-in followed.

Emily Roberts-Thomson and others emphasize that adaptability—whether to shifting investor requirements or emerging clinical needs—should be embedded into decision-making processes.

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Conclusion: Actionable Questions for Portfolio Governance

This session closes with a practical challenge for the audience: How can you, in your next governance review, better integrate feasibility, commercial value, and team alignment into your decision-making? The lessons from these leaders are clear—balancing vision with pragmatism and fostering informed, collaborative judgement are foundational to building better clinical studies and, ultimately, better patient outcomes.

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