Originally published on Substack

Precision medicine companies have raised over $50 billion but struggle with adoption. The problem isn't regulatory hurdles or physician education—it's that they're trying to deliver individualized care within systems that are mathematically designed to prevent individualized care.

The Mathematical Impossibility

Centralized medical systems, by virtue of being centralized, must optimize for populations rather than individuals. This creates an irreconcilable conflict with precision medicine's core value proposition: optimizing care for each individual patient. The mathematical functions are incompatible.
Population optimization seeks to maximize aggregate benefit across large groups, accepting suboptimal outcomes for many individuals to achieve the best average result. Individual optimization requires approaches tailored to individual biological complexity rather than population patterns—something centralized systems structurally cannot accommodate.

When Expertise Became Obsolete

The expert-based medical system emerged in the 19th century to solve legitimate problems: information asymmetries between experts and patients, and the need for standardization. When medical knowledge was simpler, centralization provided genuine benefits.
But modern medical technology has created an information explosion that has fundamentally broken these assumptions. We can now measure thousands of biomarkers simultaneously, sequence entire genomes, and analyze multi-omic datasets. The volume and complexity of medically relevant information has grown exponentially beyond what any human mind can process or integrate.

The Regulatory Catch-22

This creates the fundamental bottleneck: precision medicine companies must prove their approaches work for populations to receive approval, even though their entire value proposition depends on optimizing for individuals rather than populations. The FDA cannot approve treatments that might be optimal for some individuals but create population-level risks.

The Technological Circle

The same technologies that have made precision medicine possible have also made the original justifications for centralization obsolete. AI systems can now process complex medical information more effectively than any human expert. Patient spending on alternatives ($180B annually) proves the transformation is already happening—with or without proper infrastructure...
[Continue reading to discover how we can complete the circle from centralized expertise back to patient empowerment, but with sophisticated tools that can handle the complexity that originally made centralization necessary.]