Three developments I’m watching today: new ovarian-cancer biology, almost USD 500 million raised through two biotech IPOs, and Big Pharma’s increasingly urgent search for pipeline assets.

1. New ovarian-cancer research points to what happens after chemotherapy

A new study in Nature Aging has identified a potentially important mechanism in the way ovarian cancer spreads following chemotherapy.

Researchers found that chemotherapy-induced senescent ovarian-cancer cells can release metabolic signals (including fructose) that appear to reduce cell adhesion and make neighbouring cancer cells more capable of detaching and spreading.

In preclinical models, a high-fructose diet was also associated with greater tumour dissemination. However, this is early research so it’s too early to conclude that dietary fructose causes ovarian-cancer progression in women.

What I find Interesting

A lot of focus when it comes to cancer therapeutics is whether a cancer treatment kills the tumour. But this research raises another question that I find fascinating: “What biological environment does treatment leave behind?”

If chemotherapy kills cancer cells but also changes the surrounding environment in ways that help surviving cells disseminate, then the effect of treatment doesn’t necessarily end when the chemotherapy does.

Now, this is preclinical research so we are a long way from knowing whether this mechanism matters sufficiently in humans to become a therapeutic target. But conceptually, it changes the question from simply: “Did the treatment kill the cancer?” to: “What did the treatment do to the biology of what survived?” That is a much more interesting question.

2. Two biotech IPOs just raised about $500 million

Latigo Biotherapeutics and BlossomHill Therapeutics completed US IPOs on Friday, raising approximately USD 496 million between them. Latigo raised USD 345.6 million after selling 19.2 million shares at USD 18. BlossomHill raised another USD 150 million. Both offerings were upsized.

Latigo is developing non-opioid pain medicines targeting sodium channels. BlossomHill is developing oncology therapies and expects to allocate around $70 million of its proceeds to its lead EGFR programme. Read More

What I find Interesting

The fact that biotech stocks are rising is interesting but the fact that companies can actually raise hundreds of millions of dollars in the public market much more interesting. Because this is where market sentiment starts becoming financing infrastructure.

But I would be careful with the conclusion. The IPO window is opening but is not open to everyone. In the first half of 2026, 68 venture-backed biotechs raised more than $9 billion. That sounds great until you see that roughly two-thirds of those rounds went to companies that already had drugs in human trials, and 76% of the capital went into rounds of $100 million or more.

So capital is returning, but it isn’t returning equally and I think that’s the more interesting signal. Investors are still willing to take extraordinary risk in biotech. What they appear less willing to do is finance too many layers of uncertainty simultaneously.

3. Big Pharma's patent cliff is becoming biotech's M&A opportunity

Biopharma acquisition activity is running at one of its strongest rates in years. By midyear, 38 biotech acquisitions had already been announced (the fastest start in at least seven years) and almost two-thirds were worth $1 billion or more.

Behind that activity sits a very large problem for the pharmaceutical industry. Drugs generating an estimated $200–300 billion of revenue are expected to lose patent protection by 2030. Big Pharma needs replacement assets and increasingly, it is buying them.

What I find Interesting

Pharma has always bought innovation so the interesting thing isn’t that Big Pharma is acquiring biotech. It is the urgency with which some of those buyers may need to acquire it.

Patent cliffs are unusual because the problem is both enormous and reasonably predictable. Management teams know which products lose exclusivity and when. They know roughly how much revenue is exposed and they know their internal pipelines.

Which makes me wonder whether the most important consequence for venture investors is strategic scarcity for the right asset: If several pharmaceutical companies need to fill similar pipeline gaps at roughly the same time, a genuinely differentiated clinical asset could become worth considerably more to a strategic buyer than its standalone financial value might suggest… just some food for thought!

1. Women’s health raised more than $120 million across 17 disclosed rounds in July

A newly published funding roundup by Everything Startups identified more than $120 million of disclosed financing across 17 women’s-health startups in July, spanning the US, UK, Germany, Estonia, Canada and India. The largest disclosed round was Rejoni’s $25 million financing for its Juveena Hydrogel System, designed to prevent intrauterine adhesions following gynaecological procedures. Read More

What I find Interesting

What I find quite interesting is the mix. Diagnostics and monitoring were particularly active, while the largest disclosed round (Rejoni’s $25 million financing) was for a medical device designed to prevent intrauterine adhesions following gynaecological procedures.

This is what the institutionalisation of women’s health looks like. For years, the category was disproportionately associated with fertility apps and consumer products but that is changing. We are beginning to see an investable ecosystem across therapeutics, diagnostics, medical devices, clinical infrastructure and enabling technologies.

This matters for investors because it changes the portfolio-construction question. You can increasingly diversify a women’s-health portfolio not just across diseases, but across business models, technologies, development stages and types of risk.

2. Grail is about to test one of the biggest assumptions in cancer diagnostics

The FDA will convene an external advisory committee on 23 September to consider Grail’s premarket approval application for Galleri, its multi-cancer early-detection blood test. Grail shares rose about 5% after the meeting was announced. Galleri uses molecular signals and machine learning to screen a single blood sample for signals associated with more than 50 cancers.

What I find Interesting

Multi-cancer early detection could create an entirely new screening category. The potential opportunity could be enormous because if we see widespread adoption, this could change how asymptomatic populations enter the cancer-care system but… (and this is a big but), the evidence is complicated.

In a major UK trial, Galleri failed its primary endpoint of significantly reducing overall late-stage cancer diagnoses, although some secondary results were encouraging (by the third screening round, stage IV diagnoses for 12 particularly deadly cancers were 26% lower).

But here is an uncomfortable question at the heart of the diagnostics boom (and not necessarily related to Galleri): What if finding more disease doesn’t actually improve health? The investment case begins when earlier detection changes what happens next; for example:

• Can we treat the cancer differently?

• Does the patient live longer?

• Do we avoid more harm than we create through false positives, unnecessary investigations and overdiagnosis?

• And ultimately: will the healthcare system pay for it?

In diagnostics, outcomes create the market, and that distinction is going to separate some very impressive technologies from some very valuable companies.

3. The “picks and shovels” healthcare thesis has a blind spot

Oxford Biomedica fell more than 24% on Friday after cutting its 2026 revenue forecast because of operational delays and customers postponing programmes.

This came despite what looked like improving fundamentals: 2025 revenue had increased 31%, the company achieved its first positive operating EBITDA and contracted backlog had reached £204 million.

What I find Interesting

I like the “picks and shovels” thesis in healthcare, you know, the CDMOs, CROs, diagnostic infrastructure and specialist manufacturers because they diversify individual drug-development risk.

But there is a blind spot in it. We often say infrastructure is attractive because you don’t have to pick the winning drug. True…but risk doesn’t disappear. It moves.

• From clinical risk to utilisation risk.

• From molecule risk to customer concentration.

• From trial failure to programme delays.

Oxford Biomedica can have a £204 million backlog on paper. But if the biotech company behind that order delays its programme because its financing hasn’t closed, the manufacturer’s revenue moves with it. So I increasingly ask a different question when looking at healthcare infrastructure: “What has to go right for that backlog to become revenue?” The answer tells you where the risk really sits.

4. Healthcare AI has an 8,500-trial reality check

A large analysis examined 8,532 AI-related clinical trials across 32 medical specialties.

• Only around 30% used randomised controlled designs.

• Approximately 38% remained retrospective validation studies,

• while another 21% were prospective but did not allow the AI to influence clinical decisions.

Only 184 trials involved semi-autonomous or closed-loop systems.

What I find Interesting

8,532 AI clinical trials sounds impressive until you look under the hood of that number;

• A large proportion are still retrospective (meaning the AI is being tested on data that already existed, rather than being used with real patients as care is happening)

• Many prospective studies don’t allow the AI to influence the clinical decision.

• Only a tiny fraction involve semi-autonomous or closed-loop systems.

And that tells us something important about healthcare AI. The hard part isn’t getting an algorithm to predict something. The hard part is getting a clinician to trust it enough to act differently, and then proving that acting differently makes the patient better. So this is increasingly how I think about healthcare AI:

Algorithm → validation → workflow → decision → outcome → reimbursement.

Every step removes another layer of risk and, in my view, every step should earn another layer of valuation.

There are thousands of healthcare AI companies but far fewer have crossed the distance between prediction and clinical consequence. That distance is where the investment opportunity sits.

5. Biotech is starting to behave as though the capital cycle is turning

Biotechnology outperformed again on Friday. IBB gained roughly 2.45%, XBI approximately 1.83%, versus about 0.59% for the S&P 500.

The move followed surprisingly weak US employment data, which reduced expectations of another Federal Reserve rate increase. The next major test is US inflation data.

What I find Interesting

I wouldn’t say biotech is back (or at least not yet) but something more interesting may be happening. The transmission mechanism that finances biotech is beginning to reconnect.

• Public valuations are recovering.

• The IPO window is opening selectively.

• Pharma has a very real pipeline problem, with patent cliffs forcing strategic buyers back into M&A.

• And weaker employment data may finally be taking some pressure off the cost of capital.

But these are not the same signal. A biotech ETF rally doesn’t mean an early-stage company can raise its next round and a handful of successful IPOs doesn’t mean the IPO market is open to everyone. And (seriously), pharma buying assets because it needs to replace lost revenue tells us more about pharma’s balance sheet than it does about venture fundraising. The question is whether these separate developments begin to feed into one another.

M&A creates exits. Exits create distributions. Distributions improve venture fund DPI. Better DPI gives LPs a reason (and the all-very-important liquidity) to recommit. And eventually, that capital finds its way back to the companies at the beginning of the cycle.

That is the part I’m watching. Because a good week for biotech stocks is interesting but a functioning transmission mechanism from public markets back into venture capital is something much bigger (and more interesting).

But this week, I am making an exception. The minute I read the Novo Nordisk announcement, I knew I was going to be clearing my calendar to unpack it. So here we go! I’ll give you the facts first and then get to my opinion later.

On July 31, Novo Nordisk announced that Ziltivekimab (I know its a mouthful but please bear with me), a drug it paid up to USD 2.8 billion to acquire, had failed a major clinical trial.

The trial was called ZEUS and it included 6,376 people with heart disease, kidney disease and high levels of inflammation. Half of the people received Ziltivekimab. The other half received a placebo. Researchers followed them for up to four years.

But lets talk about Ziltivekimab for a minute.

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Ziltivekimab was designed to block IL-6, a protein that helps to drive inflammation in the body. This matters because inflammation can make the fatty plaques inside the arteries unstable and if one of those plaques breaks open, it can create a blood clot that causes a heart attack or stroke.

IL-6 is one of the proteins that drives this inflammatory process and when IL-6 activates the liver, the liver produces CRP (C-reactive protein). People with high hsCRP (high sensitivity C-reactive protein) levels tend to have a greater risk of heart attack and stroke, even when their cholesterol is normal.

Novo’s theory was straightforward: blocking the IL-6 inflammatory pathway would make dangerous cardiovascular events less likely.

There were good reasons to test the theory. Genetic studies had linked IL-6 signalling to coronary heart disease. An earlier trial of a different anti-inflammatory drug had reduced cardiovascular events, and in a smaller study called RESCUE, Ziltivekimab had lowered hsCRP and several other inflammatory markers by remarkable amounts.

The ZEUS trial was designed to answer the next (and much more important) question: would those biological changes actually prevent heart attacks and strokes?

The drug succeeded at the first part re - biological changes. It reduced hsCRP by as much as 92%. But regarding the second and more important part of the question re - prevent heart attacks and strokes, the results were clear. That dramatic reduction in hsCRP did not lead to fewer heart attacks, strokes or cardiovascular deaths. The results were almost identical in the drug and placebo groups.

Why the failure hit Novo so hard

For Novo Nordisk, the financial consequences were immediate. The company said it would record an impairment charge in the third quarter (basically write down the value of the asset), and its shares fell by close to 10%.

But the market reaction was about more than one failed drug. This was an important opportunity for Novo outside of its obesity and diabetes business. So investors were doing two things:

First, they were repricing their expectations for potential future revenues from Ziltivekimab and Novo’s growth trajectory. And second, they were also treating the results from ZEUS as evidence against the broader biological approach. This explains why companies like BioAge Labs who is pursuing a related inflammatory mechanism, lost 65% of its value in one day.

That broader conclusion (about the biological approach of this class of drugs) may eventually prove correct. But one detail deserves closer attention.

Only 27.5% of the people in ZEUS were women. Heart disease is the leading cause of death among women worldwide. Yet a trial now influencing how investors value a multibillion-dollar area of drug development was conducted in a population that was almost three-quarters male.

That figure is striking, but please allow me to add some context.

ZEUS did not study everyone with heart disease. It studied a narrower population with atherosclerotic cardiovascular disease, chronic kidney disease and elevated inflammation. In a recent real-world study of a similar population, women represented 25.9% of participants.

So the 27.5% figure does not prove, by itself, that ZEUS enrolled too few women relative to the population eligible for the drug but it does fit a much broader pattern in cardiovascular research.

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This is the pattern not the exception

A 2025 review examined 1,079 cardiovascular trials conducted between 2017 and 2023. Together, those trials included almost 1.4 million patients and women represented 41% of participants.

But even that figure hides the scale of the problem. Some types of trials, including those involving obesity and pulmonary hypertension, enrolled more women than men. But trials for some of the deadliest forms of heart disease included far fewer women:

• Women represented only about 30.8% of participants in coronary heart disease trials.

• They represented roughly 22.1% in trials for acute coronary syndrome

• and heart failure trials were not much better with 37.4% female representation.

So, this is the pattern and clearly not a new problem. One study examined 60 trials of cholesterol-lowering drugs conducted between 1990 and 2018. The results are stark: in the early 1990s, women represented 19.5% of participants. By 2018, that percentage had risen to 33.6%.

Even government-funded trials show how headline numbers can hide the problem. One study examined cardiovascular trials funded by the US National Heart, Lung, and Blood Institute between 1965 and 1998. At first sight, women represented 54% of participants in trials. But that figure was pushed up by two enormous studies that enrolled only women: the Women’s Health Study and the Women’s Health Initiative. When researchers removed those two all-female studies, female participation in clinical trials actually fell to 38%.

ZEUS did not break the pattern. But whether women were underrepresented relative to its specific eligible population is a separate question.

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Why ZEUS does (and does not) tell us

ZEUS was designed to test whether Ziltivekimab reduced cardiovascular events across all 6,376 participants. Meaning the trial was large enough to detect a 20% reduction in risk if it showed up. The result was clear: the drug did not reduce cardiovascular events across the overall trial population.

That conclusion includes the women enrolled in ZEUS. It would therefore be wrong to say that the drug was not tested in women. But the topline result does not answer a different question: did women and men respond differently?

Approximately 1,750 women participated. Whether that produces a meaningful result depends on the number of events among women, the hazard ratio, the confidence interval and whether there was a credible interaction between sex and treatment. Novo has not yet published those details.

This means we do not yet know whether the negative result was entirely consistent across women and men. And even if a more favourable result appeared in one subgroup, it would need to be treated cautiously because ZEUS failed its primary endpoint (but that’s another point).

What this means for investors

or investors, three lessons stand out.

First, ZEUS provides strong negative evidence against ziltivekimab in the population studied. It is reasonable to reduce the value assigned to the drug and weaken confidence in the mechanism.

But deciding that the same conclusion applies to every patient group, clinical setting and related drug is a broader investment judgement. That should be informed by the full results and not only the headline.

Second, trial demographics are investment information, but percentages cannot be interpreted in isolation. Investors need to compare trial participants with the population that would actually be eligible for the treatment. They also need to understand whether the trial was designed to examine differences between women and men.

The drug failed overall and that is clear. Perhaps the real investment question is how much further that conclusion should travel.

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References

1. Swerdlow DI, Holmes MV, Kuchenbaecker KB, et al. “The interleukin-6 receptor as a target for prevention of coronary heart disease: a Mendelian randomisation analysis.” The Lancet. 2012;379(9822):1214–1224. Full text | DOI

2. Ridker PM, Everett BM, Thuren T, et al. “Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease.” New England Journal of Medicine. 2017;377:1119–1131. PubMed | DOI

3. Ridker PM, Devalaraja M, Baeres FMM, et al. “IL-6 inhibition with ziltivekimab in patients at high atherosclerotic risk (RESCUE): a double-blind, randomised, placebo-controlled, phase 2 trial.” The Lancet. 2021;397(10289):2060–2069. PubMed | DOI

4. Rivera FB, Magalong JV, Bantayan NRB, et al. “Participation of Women in Cardiovascular Trials From 2017 to 2023: A Systematic Review.” JAMA Network Open. 2025;8(8):e2529104. Full article | Open-access version | DOI

5. Khan SU, Khan MZ, Raghu Subramanian C, et al. “Participation of Women and Older Participants in Randomized Clinical Trials of Lipid-Lowering Therapies: A Systematic Review.” JAMA Network Open. 2020;3(5):e205202.
   Full article | Open-access version | DOI

6. Kim ESH, Carrigan TP, Menon V. “Enrollment of Women in National Heart, Lung, and Blood Institute-Funded Cardiovascular Randomized Controlled Trials Fails to Meet Current Federal Mandates for Inclusion.” Journal of the American College of Cardiology. 2008;52(8):672–673. PubMed | DOI

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“Why do we wait until adulthood to fix what could have been prevented by the first 1,000 days of nutrition?

Yes, it was a question about infant nutrition that sent her down the rabbit hole but it was also a question about maternal health, biotechnology, and an industry that had prematurely settled for “good enough”. Your messages to me in response to that story told me that you loved that story.

Then I asked Bonnie Marcus to talk about ambition, age and what it means to continue navigating the workplace as a woman over 50….and you responded again

And then, two weeks ago, Professor Sandra Kooij shared her work on ADHD in women and how hard it is to get funding and attention to something that affects so many lives, you wanted more of that too.

On the face of it, these three articles don’t have much in common: infant nutrition, workplace ambition after 50, an under-funded slice of women’s health. But look closer and there is a pattern.

Each one takes you behind the headline and introduces you to the person and the work: what they’ve seen, what they’re trying to change, and the challenges and obstacles in their way. None of them treats the subject like a market opportunity first.

That tells me something about what you actually want from this newsletter. Not just to know what’s happening in women’s health, but to hear from the people building it, researching it, funding it, changing it. I’ve heard you.

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There’s over 20,000 of you here - investors, founders, healthcare operators, and people who just want to understand what is changing in the world of women’s health from a capital perspective.

You’ve read, shared, questioned and paid for this newsletter. Somewhere along that journey, this stopped being about one person writing about an overlooked corner of healthcare and became an actual community. And I think that community deserves the best stories and ideas across women’s health that’s out there.

There is an incredible amount of knowledge and stories across the women’s-health ecosystem.

• … from founders who are learning what it really takes to build companies in categories that markets and healthcare systems do not yet fully understand.

• … from investors who are seeing patterns in what gets funded, what struggles to attract funding and how todays’ investment frameworks are being adapted to fit an emerging category.

• …from researchers are uncovering sex-specific evidence gaps and emerging risks that the wider market may not yet know to look for.

• …from operators and industry leaders are navigating the less or (in)visible barriers that determine whether a promising innovation ever reaches patients.

• and from people around the world (who rarely get press coverage) building and developing women’s-health markets under very different clinical, cultural and economic conditions.

These stories need to be heard, not just because they can show us what's actually changing, but also because they can potentially help us understand the women’s-health market better than any glossy report or funding report could.

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I'm opening the newsletter up to other voices

Starting today I an opening up this newsletter to the people building, funding, researching, and pushing forward the women's-health economy directly and not just filtered through my interviews.

• Maybe you're a founder or operator who learned something important that never made it into the pitch deck.

• Maybe you're an investor who's noticed where capital keeps flowing, or where it keeps getting stuck.

• Maybe you're a clinician or researcher who can explain what a piece of new evidence actually means for patients or product development.

• Or maybe you work somewhere that barely registers in international women's-health coverage,

• Or you've watched a regulatory or reimbursement mess up close, or something in your own life exposed a failure (or an opportunity) that the people deciding what gets funded need to understand.

You don't have to be a polished writer. You just need something worth saying.

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What I'm actually looking for

You can write about what you’re building, but the piece has to hold up on its own. The pieces that work are built on something you actually earned, an argument you can back up, or a part of the market that only comes into focus because of where you’re standing.

It shouldnt be a press release dressed up as thought leadership. If in doubt, here’s a test: “would this still teach the reader something if we cut the company name and the ask to buy, invest, or participate?”

Every contributor gets a byline and bio. Plus I’ll work with you to edit and fact-check before anything goes out, and contributed pieces stay clearly marked apart from my own reporting.

How to pitch us

Just reply to this email with your name, role, and organisation; your idea in one sentence; a few sentences on the argument; why you’re the right person to write it; any research or data behind it; and any commercial interest I should know about. That’s genuinely it, no full draft, no formal proposal.

I can’t run every pitch. But if there’s something you know that this community needs to hear, reply and tell me.

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These ideas are at the heart of my new book, The Billion Dollar Blindspot. You can find The Billion Dollar Blindspot on Amazon.

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Disclaimer & Disclosure

This content is for informational and educational purposes only.

She didn’t hesitate. Researchers already knew the study they wanted to do. The proposal was simple. The study would compare three approaches for women with ADHD entering perimenopause: stimulant medication, hormone replacement therapy (HRT), and the combination of both to answer the questions:

• Which treatment works best?

• Which symptoms improve?

• When should one be preferred over another?

Then she told me something I wasn’t expecting. They had already applied for the funding but the proposal had been rejected. When I asked why, she paused before giving the answer she had been given.

“It was considered not relevant for society.”

I kept coming back to those five words, not because I doubted that research funding is competitive; every year, excellent ideas fail to receive support. What I couldn’t understand was something much simpler. How does a scientific question become important enough to deserve an answer? That was the question I found myself trying to wrap my head around.

Not whether the study was right or whether the study would succeed, but something more fundamental: who decides which research questions matter?

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Over the past few weeks, this series has followed a simple question.

Why are women with ADHD still entering a healthcare system that struggles to meet their needs?

In Part One, we traced that story back to diagnosis itself. ADHD became defined around the behaviour of hyperactive boys, leaving generations of girls to grow up without recognising themselves in the condition.

In Part Two, we followed the story beyond diagnosis. Women were finally being recognised, but they were entering a treatment system that had been developed largely without considering the biological questions unique to women.

That led me to a conversation with Professor Sandra Kooij, one of the world's leading experts on ADHD in women and lead author of a landmark 2025 international review on hormonal transitions and ADHD across the female lifespan. I wanted to understand why these gaps still existed. Instead, I left our conversation thinking about something else entirely: the reason she had been given when the study was rejected:

“Not relevant for society.”

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One possibility for the rejection was that the funding committee was right. Perhaps studying treatment options for women with ADHD simply is not an important scientific question, although the evidence suggests otherwise.

ADHD affects an estimated 2–5% of adults, and increasing numbers of women are receiving ADHD diagnoses in adulthood, many only in their thirties, forties or fifties after years of going unrecognised. Increasingly, clinicians have also begun to notice another pattern: many of these women report that their symptoms fluctuate during periods of hormonal change.

That observation is no longer confined to individual consulting rooms.

Research has shown that women with ADHD are substantially more likely to experience premenstrual dysphoric disorder (PMDD), postpartum depression and more severe menopausal symptoms than women without ADHD. These are not isolated conditions. They represent recurring stages of a woman’s life where changing hormone levels appear to interact with attention, mood and executive functioning.

The scientific community has already recognised this.

Earlier last year, an international collaboration led by Professor Sandra Kooij reviewed the state of knowledge on ADHD in girls and women across the lifespan. The authors concluded that hormonal transitions—including puberty, the menstrual cycle, pregnancy and perimenopause—appear to exacerbate ADHD symptoms and mood disturbances.

At the same time, they found that pharmacological research addressing these hormonal changes remains limited and called for longitudinal, sex-specific studies to develop more individualised care.

That is an important distinction. Researchers are no longer asking whether hormones matter in women with ADHD. They are asking how that knowledge should change diagnosis, treatment and care.

Professor Kooij’s proposed study was not attempting to answer a speculative question. It was attempting to answer a recognised one.

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The assumption most of us make is that once medicine recognises an important question, the search for an answer simply begins. In reality, there is another step in between. Questions do not become evidence on their own.

Before a single patient is recruited, before the first blood sample is taken and before the first result is published, a question must first survive a very different process. Someone has to write the grant application. Experts have to review it. Funding bodies have to decide whether it deserves support and only then can the science begin.

This is easy to overlook because we tend to think of scientific knowledge as something that accumulates naturally over time. In reality, every clinical trial exists because, at some point, a group of people decided that one question was more important than the hundreds of others competing for the same resources.

Evidence, in other words, is not produced by science alone. It is also shaped by the decisions that determine which science gets done.

That was what made Professor Kooij’s story so striking. The scientific question already existed. The study had already been designed. The researchers were ready to begin. What stood between the question and the answer was not another scientific breakthrough. It was a funding decision.

During our conversation, Professor Kooij said something that stayed with me.

“A real taboo is something you don’t even realise is there.”

At first, I thought she was talking about ADHD.

She wasn’t.

She was talking about something much larger: what it means to be a woman living with hormonal fluctuations that influence almost every organ system throughout life, and how little of that reality is still reflected in medical knowledge, diagnosis and treatment.

ADHD is one place where that gap becomes visible. Research tells us that women with ADHD are substantially more likely to experience worsening mood, anxiety and emotional symptoms during the menstrual cycle and in the days leading up to it. Yet many women assume these experiences are simply part of being a woman. They often do not realise that what they are experiencing is part of a pattern increasingly recognised in the scientific literature.

As Professor Kooij explained, many women cope with these symptoms quietly. They continue working. They reorganise their lives around them. They also rarely compare experiences with other women and therefore don’t recognise that millions of others are describing remarkably similar patterns.

The result is that what is, in reality, a widespread clinical phenomenon is often experienced as millions of separate personal and individual struggles. The problem exists at population scale, but it is lived in isolation.

That matters because problems that remain largely invisible can also appear less urgent. When the true burden is dispersed across individual experiences rather than recognised collectively, the need to investigate it can be underestimated.

Professor Kooij believes this is one reason that research into the interaction between ADHD and women’s hormonal transitions has progressed so slowly. Not because the symptoms are uncommon, but because much of the burden has remained hidden in plain sight.

Professor Kooij challenged another assumption. Many people think of ADHD as a psychiatric condition. She doesn’t.

Increasingly, she sees it as a condition that affects—and is affected by—many different biological systems. Hormones, the immune system, connective tissue, cardiovascular health and reproductive health all appear to interact with ADHD throughout a woman’s life.

That has an important consequence. Women do not experience these systems separately. A woman going through perimenopause is not experiencing hormones one day, ADHD the next and cardiovascular changes the day after. They are happening at the same time, in the same person, and influencing one another.

Medicine, however, is organised differently. Psychiatrists specialise in ADHD. Gynaecologists specialise in reproductive health. Cardiologists specialise in the heart. Immunologists specialise in the immune system. Each specialty is essential. But some of the most important questions in women’s health sit at the intersection of several of them.

Take Professor Kooij’s proposed study. On the surface, it was about ADHD medication. But it was equally about hormonal changes during perimenopause and how those hormonal changes influence treatment response. It wasn’t purely a psychiatry question or purely a gynaecology question. It belonged to both.

And that is where the difficulty begins.

Research funding is organised in much the same way as medicine itself. Most grants are reviewed within specialist fields, and questions that fit neatly within a single discipline have a natural place to be evaluated. Questions that span several disciplines often do not.

Perhaps that is one reason important questions in women’s health can remain unanswered for so long—not because they lack scientific merit, but because they do not fit neatly into the way scientific research is organised.

I spend much of my time thinking about capital allocation. Most people assume that capital allocation in healthcare begins when investors decide which companies receive funding.

In reality, it begins much earlier. Long before venture capital backs a new therapy or a pharmaceutical company develops a new treatment:

• Someone has to decide which scientific questions are worth answering.

• Someone has to fund the laboratory, and the (pre-) clinical trial.

• Someone has to generate the evidence

and only then can new knowledge emerge for entrepreneurs to build new products and for investors to finance them.

Seen through that lens, research funding is not simply an administrative exercise. It is the first capital allocation decision in healthcare. Every grant awarded is an investment in one possible future. Every grant declined is a decision that another question will have to wait.

Over the past few weeks, this series has followed the same story from three different perspectives. First, we saw how generations of women with ADHD were overlooked because the condition was defined around the behaviour of boys. Then we saw that, even after women began receiving diagnoses, many entered a treatment system that still lacked evidence for the questions their biology raised.

Now we arrive at a deeper conclusion.

Sometimes the missing evidence is not the result of scientific disagreement. Sometimes researchers know exactly which questions need answering. The harder question is whether we choose to invest in answering them.

Perhaps the greatest blind spots in medicine are not created by what science fails to discover. Perhaps they are created by the questions society never chooses to fund.

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These ideas sit at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

References

• Faraone SV, et al. The World Federation of ADHD International Consensus Statement. Neuroscience & Biobehavioral Reviews. 2021. DOI: 10.1016/j.neubiorev.2021.01.022.

• Young S, et al. Females with ADHD: An Expert Consensus Statement. BMC Psychiatry. 2020. DOI: 10.1186/s12888-020-02707-9.

• Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research. 2021.

• Kooij JJS, de Jong M, Agnew-Blais J, et al. Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women’s Health. 2025. DOI: 10.3389/fgwh.2025.1613628.

• Ter Beek, L. S., Böhmer, M. N., Wittekoek, M. E., & Kooij, J. J. S. (2023). Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study. Archives of women's mental health, 26(6), 851–855. https://doi.org/10.1007/s00737-023-01356-7

• H3 Network: Head, Heart & Hormones

• Personal interview with Professor J.J. Sandra Kooij, July 2026.

• Valedictory Speech - Professor Sandra Kooij

Disclaimer & Disclosure

This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.

Over time, you stop re…

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For years, I thought my aunt died from diabetes. That was the story our family told ourselves. She had developed gestational diabetes during pregnancy, then life moved on. She had her baby. The pregnancy ended. The diagnosis disappeared into her medical history like a chapter that had served its purpose.

No one suggested that pregnancy had revealed something important about the decades still to come. No one spoke about long-term cardiometabolic risk. No one explained that the pregnancy itself might have been the first signal of a biological trajectory that deserved to be watched carefully for the rest of her life.

Years later she would develop diabetes. Then came the complications which eventually took her life. Looking back now, I no longer think the defining medical event in her story was the diagnosis that appeared years later. I think it was the one that came first.

Her body had already told the healthcare system something important. The system simply didn’t yet know what to do with the information.

That, increasingly, is what precision healthcare is supposed to change.

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Precision health is often described through the language of technology. Genomics. Artificial intelligence. Biomarkers. Wearable sensors. Personalised therapies.

Those technologies matter, but they are not the essence of precision medicine. Its deeper promise is much simpler. It is the idea that medicine should become better at recognising meaningful biological differences before those differences become avoidable harm.

If that is true, then precision healthcare faces an important test. Can it recognise biology that changes over time? Because that is exactly what women’s health asks it to do.

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Picture two patients. Both are fifty years old. Both have identical cholesterol, identical blood pressure and identical weight. Run them through a conventional cardiovascular risk calculator and they receive exactly the same score.

What the calculator cannot see is that one woman entered menopause two years ago while the other has not yet begun the transition. From the model’s perspective, they are identical but biologically, they are no longer the same. The model has nowhere to put that.

That single sentence reveals something important.

Much of medicine has become remarkably good at measuring biological differences between people. It is still learning how to measure biological change within the same person.

That distinction may define the next generation of precision healthcare.

To understand why, it helps to look at one of medicine’s greatest success stories. Modern oncology rarely treats cancer as a single disease anymore. HER2-targeted therapies are prescribed only when a tumour expresses a specific protein. BRCA-directed therapies follow a genetic signature rather than a diagnosis code.

This is precision medicine working exactly as intended. A measurable biological variable determines who receives which treatment. Outcomes improve because the match becomes more precise. But there is something important about these variables. They are largely static. Once measured, they remain informative for years.

Female biology is different because it unfolds through biological time. Across a lifetime, the same woman moves through adolescence, reproductive years, pregnancy, postpartum recovery, perimenopause, menopause and older age. These are not separate medical stories. They are chapters in the same biological narrative. Each chapter alters physiology, changes risk and provides new biological information.

Precision medicine’s first generation became exceptionally good at recognising fixed biology. Its second generation must learn to recognise biology that changes over time. That is a much harder problem.

This is not simply an observation from outside the medical profession. Cardiology itself has acknowledged it.

The American Heart Association’s dedicated guidelines for cardiovascular disease prevention in women, published in 2011, did not incorporate menopause as an independent cardiovascular risk factor. Menopause appeared largely as a period of possible vulnerability rather than as a transition requiring changes in risk assessment or management.

Yet the evidence already showed that the menopause transition is associated with measurable changes in lipid metabolism, vascular function and cardiometabolic risk that cannot be explained by chronological ageing alone.

Age has always been part of cardiovascular risk models. Biological transition was not. That difference matters because age moves in one predictable direction whereas biology does not.

It took until 2023 for major cardiology guidance to begin explicitly addressing pregnancy, lactation and menopause as transitions requiring specific clinical consideration. This is genuine progress. But it also reveals something larger.

One of medicine’s most data-rich and scientifically sophisticated specialties needed more than a decade to begin integrating one of the most common biological transitions experienced by half the population.

This was not because women were invisible. Cardiovascular disease in women has been studied for decades. The blind spot was more subtle. Medicine had evidence What it lacked was a way of modelling biological time. It knew biology changed. It simply didn’t yet know how to organise care around that change.

That distinction matters far beyond cardiology. Women’s health is often treated as though it were another clinical specialty alongside cardiology, oncology or endocrinology. It is not. Women’s health is one of the clearest demonstrations that biology unfolds across a life course.

Pregnancy is not merely an obstetric event. It can become an early warning for future cardiovascular disease. Menopause is not simply the end of reproductive life. It reshapes metabolic health, bone health, brain health and vascular risk.

The point is not that women experience different diseases. It is that biology itself changes in ways medicine increasingly needs to recognise, measure and respond to. That is why women’s health should not be understood as a niche within precision healthcare. It is one of the clearest tests of whether precision healthcare is becoming genuinely precise.

The implications extend beyond medicine. Every time science learns to measure something it previously overlooked, new opportunities emerge to build diagnostics, biomarkers, therapeutics, care pathways and entirely new companies around that knowledge.

Markets follow measurement and capital follows markets. Wherever biology becomes more visible, innovation follows. Women’s health therefore represents more than an overdue correction to historical blind spots. It offers one of the clearest windows into where precision healthcare is heading next.

The question is no longer whether medicine will become more biologically precise. It already is. The more interesting question is who recognises the implications early enough to build around them. That is where this series goes next.

These ideas sit at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

The Women’s Health Capital Thesis Map

1. Part I: The Women’s Health Capital Thesis

2. Part II: Why Women’s Health Is the First Test of Precision Health — You are here

References

1. American Heart Association — 2011 guidelines never incorporated menopause as a CVD risk factor

   Mosca L, Benjamin EJ, Berra K, et al. “Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update.” Circulation. 2011;123:1243–1262.
   https://www.ahajournals.org/doi/10.1161/CIR.0b013e31820faaf8

2. The 2020 AHA scientific statement confirming the gap and discussing menopause transition’s cardiometabolic effects

   El Khoudary SR, Aggarwal B, Beckie TM, et al. “Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association.” Circulation. 2020;142:e506–e532.
   https://www.ahajournals.org/doi/10.1161/CIR.0000000000000912

3. Independent confirmation in 2020 that no AHA/ACC women’s CVD prevention guideline has been issued since 2011

   JACC State-of-the-Art Review, “Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women.”
   https://www.jacc.org/doi/10.1016/j.jacc.2020.03.060

4. The 2023 Chronic Coronary Disease guideline finally addressing menopause, pregnancy, and lactation as risk-relevant transitions

   Blazoski C, Kim YJ, Spitz J, Blumenthal RS, Sharma G. “Sex and Gendered Approach in Chronic Coronary Disease Guidelines: One Size Does Not Fit All.” JACC: Advances. 2024;3(6):100859.
   https://pmc.ncbi.nlm.nih.gov/articles/PMC11286996/

5. HER2-targeted therapy as the static-biomarker precision medicine example

   “Deep Learning-Based Prediction of Molecular Tumor Biomarkers from H&E: A Practical Review.”
   https://arxiv.org/pdf/2211.14847

   ---

Disclaimer & Disclosure

This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.

What happens when an entire healthcare market has been built on evidence, systems, and investment assumptions that were never designed to see women properly?

That question has taken us from menopause and ADHD to diagnost…

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It aimed to treat the human body. But for much of its history, the body it studied first and treated as the reference point was male.

That did not always mean women were absent from research. The deeper problem was that female biology was often treated as a variable to be excluded or controlled for, rather than a source of information to be understood.

As a result, treatments were developed with an incomplete picture of how sex and life stage might alter response. Symptoms that presented differently in women were missed and conditions that evolved differently across a woman’s life were diagnosed late.

The consequences run through the full arc of a woman’s life: from hormonal health to cardiovascular disease, autoimmune disease, brain health, bone health, mental health, cancer, chronic pain, and ageing.

But a new paradigm is emerging. It is being driven by the convergence of scientific progress, new diagnostic and data capabilities, ageing populations, and the rising cost of treating disease too late.

Its consequences will reach far beyond medicine. They will reshape how healthcare is designed, how risk is understood, and where capital looks for the next generation of growth.

Share The Billion Dollar Blindspot

The old model of healthcare was built for a world of scarcity. Scarcity of data, diagnostic tools, computing power and longitudinal information about what happened to a person between one appointment and the next.

The practical response was to build systems around averages: standard pathways, broad populations, late intervention, and treatment after disease had already declared itself.

But that model is beginning to change. Genomics, biomarkers, more sensitive diagnostics, AI-enabled pattern recognition, wearables, remote monitoring, and new care-delivery models are making it possible to see disease earlier and with greater specificity. The ambition is no longer simply to treat a condition once it becomes obvious. It is to understand risk, monitor change, detect deviation, and intervene before a health problem becomes expensive, disabling, or irreversible.

This is what we mean by precision health—healthcare designed around the biological differences that determine who gets sick, how disease presents, what prevention looks like, and which treatment is most likely to work. Women’s health is one of the clearest tests of whether that transition is real.

Female biology affects disease risk, symptom presentation, progression, and treatment response across the life course.

Hormonal transitions can alter cardiovascular risk, bone density, cognition, metabolism, immune function, sleep, and mental health.

Pregnancy can reveal future cardiometabolic risk. Autoimmune disease disproportionately affects women. Chronic pain is more prevalent in women, yet has often been poorly understood and inadequately treated.

The National Institutes of Health now explicitly treats sex as a biological variable that should be considered in study design, analysis, and reporting. But policy recognition is not the same thing as full scientific integration. A recent National Academies review concluded that sex differences remain inconsistently implemented across research design and practice.

That gap is where the opportunity begins. When biology becomes more legible, markets once treated as peripheral become visible as infrastructure problems waiting to be solved.

A New Class of LPs is Forming

The capital signal is already visible. Over the past several years, private capital has begun to look at women’s health differently. The conversation has moved beyond whether the category is “investable” at all.

Increasingly, the questions are about access: which managers have real specialist expertise, where the strongest science is emerging, how to assess clinical and commercial maturity, and how to build exposure without reducing a global healthcare transition to one narrow theme. That shift is producing a new class of healthcare LPs.

It includes family offices looking for differentiated long-duration healthcare exposure; wealth managers responding to client interest in prevention, longevity, and healthcare innovation; entrepreneurial families with operating experience; healthcare executives; foundations; catalytic-capital providers; and next-generation capital stewards who see health not simply as a social issue, but as a structural economic one.

The Great Wealth Transfer which is currently ongoing through to the year 2048 matters here too. While the transfer of wealth to women does not mean that women who inherit or create wealth will automatically allocate to women’s health as capital decisions still remain shaped by mandate, risk appetite, family context, governance, and access.

But it does increase the number of people who hold, influence, or advise capital while also having direct experience of fertility care, pregnancy, chronic pain, menopause, caregiving, diagnostic delay, or the fragmented reality of healthcare systems.

This changes what they notice. It changes what they ask. It changes which questions reach private banks, family offices, investment committees, and advisers.

Investable before Institutionalisation

By now, the commercial case for women’s health is becoming harder to ignore.

There is growing scientific understanding. New companies are being built across diagnostics, therapeutics, care delivery, devices, data, and longevity. Private capital has begun to move into the category. And the underlying demand is not speculative: women are living longer, managing more chronic disease, and spending more years navigating healthcare systems that were not designed around their biology.

But recognition is not the same as access. A family office may see the opportunity and still struggle to answer a practical question: where, exactly, should we put capital to work?

That is because the category has developed faster than the infrastructure through which large pools of capital typically invest.

Institutional allocators typically invest through structures they can assess and govern: managers with long track records; vehicles that can absorb meaningfully sized tickets; benchmarks; portfolio-construction logic; and comparable data so that the opportunity can be evaluated alongside other healthcare allocations.

In women’s health, those structures are still emerging. This is not a reason to dismiss the category. It is a description of where the category sits in its development.

Climate investing offers a useful, limited parallel. The climate thesis was recognised before specialist managers, reporting standards, benchmarks, policy frameworks, and institutional familiarity had matured sufficiently for broad allocation. The thesis came first. The infrastructure followed. Capital scaled once it had credible routes through which to participate.

Women’s health is on a similar journey of capital formation, though not an identical one.

What the Biology Actually Does

The opportunity in women’s health is global, fragmented, and cross-disciplinary. It does not sit neatly inside one clinical category, one geography, one company type, or one investment stage. It stretches from diagnostics and therapeutics to care delivery, medical devices, data, ageing, and adjacent health technologies.

The expertise required to understand it is similarly dispersed. It often sits with specialist managers who have built relationships with founders, clinicians, researchers, hospitals, regulators, and local healthcare systems. These managers have developed the pattern recognition to identify a meaningful platform; the clinical networks to understand whether a therapy is genuinely differentiated; or the local knowledge to see where a care model can move from a promising service into durable infrastructure.

The strongest expertise is often held by these specialist managers that are relatively young in terms of track record, geographically dispersed, capacity constrained or too small for large institutional tickets. For larger allocators, that creates an access problem.

In this case, the answer is not simply to put more money into women’s health. The answer is to organise capital around specialist expertise: through disciplined manager selection, diversification across geography, clinical category, stage, and business model, governance, and institutional-quality portfolio construction.

The Question Capital Now Faces

Healthcare is becoming more precise. Private capital is beginning to seek exposure. The ownership and influence of wealth are changing. Yet the institutional architecture remains unfinished.

Women’s health is not a niche investment theme. It is where the transition to precision healthcare, the emergence of new healthcare LP demand, and the unfinished architecture of institutional capital meet.

The question is not whether this market will become more visible. It already is. The question is how we build credible routes for capital into the women’s health market.

The Women’s Health Capital Thesis Map

1. Part I: The Women’s Health Capital Thesis — You are here

2. Part II: Why Women’s Health Is the First Test of Precision Health — Read Next

These questions sit at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.

I’m grateful that the book recently reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.

It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.

Order Your Copy

References

1. National Academies of Sciences, Engineering, and Medicine, Review of NIH Structure, Policies, and Programs for Women’s Health Research (2025); NIH Office of Research on Women’s Health, NIH-Wide Strategic Plan for Research on the Health of Women 2024–2028.

Disclaimer & Disclosure

This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.

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She was 56 years old when she was finally diagnosed with ADHD.

The diagnosis arrived the way late diagnoses often do. Not as a revelation but as a reckoning. Decades of compensating. Decades of systems: the lists, the alarms, the overpreparation, the private terror of forgetting something important. Decades of believing, in the way women who have never been told otherwise tend to believe, that the effort required to function was a character flaw rather than a neurological one.

The diagnosis changed that. It gave the thing a name and then came the prescription. The drug was Vyvanse—lisdexamfetamine, sold in the UK and Europe as Elvanse, the same molecule under a different name. Her doctor was attentive. The dose was standard. She filled the prescription and took the first tablet the way you take anything you have been waiting for without knowing you were waiting for it.

What happened next, she did not expect. The medication made her sleepy. Not mildly tired, but deeply, dangerously sleepy. Then one afternoon, driving home from a weekend away with friends, she fell asleep at the wheel. It was noon. She woke as she crossed the double yellow line on a two-lane highway, her car moving directly towards a truck. The truck swerved. She swerved. They were both, as she later described it, very lucky.

When she told her doctor what had happened, he said something that has stayed with her ever since:

“That side effect is an indicator you have classic ADHD.”

She had not thought to ask (and no one had told her to ask) whether the medication had been specifically studied for how it behaves in women. whether the evidence behind her prescription had asked what happens when this drug meets a hormonal environment that changes every month or whether anyone, at any point in the drug’s development, had designed a study around that question.

A few weeks ago, another reader left a comment that stopped me mid-scroll:

“Please look into Elvanse and how different sexes respond.”

That comment received eleven likes because beneath it sits a much larger question:

The story of women and ADHD is usually told as a story of recognition. Women were missed. Women masked. Women compensated. Women were finally diagnosed.

That story is true but it stops one chapter too early.

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Lisdexamfetamine did not arrive yesterday.

Vyvanse was introduced in the United States in July 2007 for children aged six to twelve and approved by the FDA for adults in April 2008. In the UK, NICE guidance offers lisdexamfetamine alongside methylphenidate as a first-line pharmacological option for adults with ADHD. When adult women now arrive at diagnosis — in their thirties, forties, fifties — the treatment pathway is already there. The drug, the dosing range, the prescribing guidance, and the clinical habits all exist.

This is the strange asymmetry of the moment. Women spent decades outside the diagnostic frame, and when the frame finally widened, they entered a treatment system that had already been built, already calibrated, and already closed.

The assumption, often unspoken, is that once the diagnosis is correct, the treatment question is mostly technical. Start low. Titrate. Monitor response. Adjust. But this assumes that the evidence base has already asked the questions that matter for the patient now sitting across from the clinician. In the case of women with ADHD, that assumption deserves scrutiny.

The Questions The Trials Did Not Ask

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A few years ago, a health diagnosis sent me into the healthcare system in a way I had never experienced before. The…

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The acquisition is being covered as a story about the race to own “immune system reset” technology. That read is correct. But the most important commercial logic embedded in this deal has not appeared in any coverage published so far.

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What happened

On May 3, 2026, UCB, the Belgian biopharmaceutical company, announced an agreement to acquire Candid Therapeutics for $2 billion upfront, with up to $200 million in additional milestone payments. Total deal consideration: up to $2.2 billion. The transaction is expected to close by end of Q2 to early Q3 2026.

Candid Therapeutics is a US-based clinical-stage company developing a new class of autoimmune drugs. Its lead asset, cizutamig, works by directing the body’s own immune cells to identify and destroy the specific cells responsible for producing the antibodies that drive autoimmune disease and effectively clearing the source of the problem rather than suppressing the immune system broadly.

As of the acquisition announcement, more than 100 patients had received cizutamig, including 68 with autoimmune diseases. Global Phase 2 studies are planned in myasthenia gravis and interstitial lung disease. Earlier-stage evaluation is also underway across additional autoimmune indications including lupus, rheumatoid arthritis, systemic sclerosis-associated disease, and IgA nephropathy.

UCB describes the acquisition as part of a platform-driven strategy in next-generation immunology — a deliberate move to own multiple targeting approaches before the field matures.

Why it matters

The coverage this week is framing this as a story about platform immunology. Two billion dollars for a clinical-stage company with a novel mechanism, before pivotal proof. A high-conviction bet on the thesis that if you can eliminate the cells producing the antibodies that drive autoimmune disease, you may produce durable remission rather than managing symptoms indefinitely. That read is accurate. It is also incomplete.

The most important commercial logic embedded in this deal has not appeared in any coverage published this week. In this edition I will name it, explain why it changes how capital allocators should read the acquirer landscape in this space, and deliver six observations on where to be positioned before the next announcement; three on what the deal signals now, and three on what to track as the thesis develops.

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Veozah launched in 2023 as the first non-hormonal oral treatment for menopause symptoms. Two and a half years later, the commercial revolution the category promised has not arrived. Bayer launched its competitor anyway. Here is what that tells capital allocators.

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What happened

In May 2023, Astellas’ Veozah became the first FDA-approved non-hormonal oral treatment for the hot flashes and night sweats affecting approximately 75% of women during the menopause transition. Astellas projected US revenues of $375 million in the drug’s first year of commercialisation.

In FY2024, its second full year on market, Veozah generated approximately $220 million globally. In December 2024, the FDA added a black box warning for rare but serious liver injury; the most prominent safety flag the agency can attach to a prescription drug.

Fast forward to October 2025 and Bayer’s Lynkuet received FDA approval for the same indication. It targets both the NK1 and NK3 receptors, a dual mechanism that Veozah does not carry. Importantly, it has no black box warning. Bayer made it commercially available in November 2025 and estimates annual peak sales of approximately €1 billion.

In April 2026, BioPharma Dive published a survey of persistent structural barriers in women's health drug development, noting that despite two approved non-hormonal drugs and a large unaddressed patient population, Veozah has faced slower-than-expected sales and reimbursement complications.

Why it matters

The coverage this week is framing this as a competitive story. Two drugs, same indication, different mechanisms. One with a cleaner safety profile. The question most coverage is asking is which company wins the menopause hot flash market.

That is the wrong question for capital allocators and in this piece, I will cover the one development most coverage has missed entirely, and share three observations on what this category dynamic tells capital allocators in women’s health about where to be positioned before the next announcement.

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