You choose the science. The disease chooses the bill.

Most biotech founders never choose their first disease. It comes with the tissue their lab could get, and when asked, founders point to an early signal and a big market. Neither tells them what it costs to prove the drug works.

Pivotal trials on an accepted surrogate averaged $24 million, and trials that had to show a clinical outcome averaged $65 million. The gap opens at the Series A, where few firms lead rounds big enough to close it.

The firms that build companies pick the disease on purpose, and Flagship is now hiring a scientist to turn that judgment into software.