Why The Best Biotech Leaders Take It Personally
By Lisa Ricciardi, CEO, Cognition Therapeutics
Emerging biotech companies are tasked with a dual mandate: advance breakthrough science to create new medicines for patients, and in doing so, create value for investors. There is no established playbook for doing both well, only constant recalibration in the face of capital constraints, scientific and clinical uncertainty, and evolving market expectations.
After 30 years in the life sciences field, here’s my advice: effective leaders take their work personally. Not in a way that clouds their judgment, but rather in a way that sharpens accountability. When variables are constantly shifting, the one true constant becomes the leader’s conviction: a strong willingness to fully own both the risk and the responsibility that comes with being a leader in this type of environment.
For companies like Cognition Therapeutics, this sense of responsibility is amplified because patients desperately need what we’re developing. We operate in disease areas with significant unmet need and shifting resources. On the one hand, there have been large investments in science and many clinical trials for Alzheimer’s disease. Very large drug companies operate in this area, and despite their resources, there have been innumerable trial failures. Further, there has been almost no investment for dementia with Lewy bodies, and few companies have deployed resources in that area. For both indications, the risks are clear, and the responsibilities can feel overwhelming. Moving forward requires total commitment, doing many things at once with limited funds, and taking appropriate risks all along and all the time.
Such a high level of commitment must be deliberately cultivated through intentional leadership practices over time, and at different stages of a company’s development.
Go Beyond The Data — Get Close To Patients To Understand Their Needs
While assessing unmet patient needs may ultimately include rigorous clinical and market research, it absolutely begins with genuine, human-centered curiosity. The purview of a biotech leader must reach beyond a disease area to encompass a sincere interest in the lived experiences of the people who have that disease, plus those who care for them. Truly listening to the needs of patients and their caregivers is more than a symbolic exercise: their stories become highly strategic input that can shape better decisions across the organization and ultimately be a fundamental driver of progress.
Firsthand patient feedback informs everything we do, from how we design our trials to where we place our trial sites, so we can reduce the participation burden. Choices like these will directly impact patient enrollment and retention, and ultimately the integrity of our trial data. Making a concentrated effort to assess the needs of these patients and their caregivers strengthens their willingness to participate in our trials. Steps like these also resonate with our investors. In other words, patient-centricity is not a nice-to-have, separated from our operational rigor; it is fundamental to our processes and strength.
The challenge of connecting with patients is that meaningful engagement is not always straightforward. Traditional approaches, like advisory panels or in-person forums, are limited by the number of participants, their ability to access such meetings, and the costs and time required for arranging logistics. As our research and development get more complex, we’ve needed to develop a new playbook for engaging with patients. In our experience, facilitating insightful patient-to-patient interactions, in addition to direct company engagement, has proven to be invaluable. Forums like these will not only generate key insights; they can also reduce isolation, particularly in underrecognized conditions like dementia with Lewy bodies.
A key learning for me is straightforward and simple: there is no substitute for genuine, authentic dialogue. In forging strong connections, patients become more than just datasets; their stories become a meaningful lens through which our scientific innovations and clinical progress can be shared with our investors and other relevant audiences. When leaders remain close to patients, their perspectives move from anecdotal to actionable.
Use Communication As A Core Operating Discipline — Go Beyond Words To Good Practices
In biotech, uncertainty is inevitable; what’s unknown is fundamental to the practice of life sciences innovation. But effective teams don’t practice uncertainty in their business practices and operations. Strong leaders build good habits and resilient systems that can deal with uncertainty effectively; this includes frequent communication and a spirit of transparency.
As a leader, a spirit of transparency starts inside your company, by assessing how you look at your employees and work colleagues. Do you step back to understand your employees as people first? They all come to work from an ecosystem of their own lives, families, and personal ambitions. And frankly, these are deeply connected to your company’s endeavors and ultimate success. By engaging with your employees first as individuals, understanding where they’re coming from and where they are, you’re able to establish greater trust and achieve better performance. When people in an organization feel as though they’re understood and treated respectfully, it shows in their work and in their relationships with their colleagues.
In a small operating environment, the quality of work relationships is critical. We cultivate strong colleague relationships by bringing our team members together each month. During this time, team members can work together directly, create new work, and resolve any roadblocks. We review organizational goals and will frequently course correct. All this effort is enhanced by a conscious decision to spend time, money, and resources on maintaining frequent, in-person work and social time each month.
Transparency with external audiences requires a different skillset and practices. As a public company, we need to communicate clear messages frequently. Consistency across these messages is critical, and avoiding long periods between updates is very important. The expression “nature abhors a vacuum” is particularly true for small cap companies with a limited number of catalysts. That’s why we work diligently to maintain a continuous, open dialogue with investors and partners through required vehicles such as securities filings, along with press releases, podcasts, R&D updates, and attending to investor inputs on our website. No one will assume that you’re using their money well each day; they need to be reminded of your mission and progress along your stated goals.
Embrace Being The Underdog — The Challenge Is Bigger Than All Of Us
An emerging biotech must compete with established organizations that have larger teams, deeper resources, and typically more complex infrastructures. While the disparity is real, it’s not determinative. It’s worth remembering that, ultimately, every company faces the same challenge — one that’s bigger than any of us, because it’s shared by all of us: the biology of the human brain. It’s a vast frontier that remains only partially understood, and it levels the playing field much more than might be immediately apparent.
For smaller companies like ours, constraints like this can be a catalyst. Our focus can be sharper, and our decision-making faster. Smaller teams can be more tightly aligned around a shared mission for success.
Team alignment becomes most essential in moments of great pressure. To this point, some of our most challenging moments for Cognition Therapeutics have also become our most defining. For example, we were working with a collaboration partner on a large clinical trial. At one point, the trajectory for recruitment and trial completion was months behind; given the importance of this trial to our company, this needed to be addressed. Our clinical trial experience thus far was that we have hit every milestone we have publicly communicated for our studies. We couldn’t afford to damage our reputation by not continuing to hit these milestones.
A major effort was undertaken by our internal team, analyzing the data at every step to identify gating factors. We then engaged repeatedly with our partner and their team, reviewing our assumptions and theirs on a detailed, line-by-line basis. This was followed by multiple in-person meetings across the country. The takeaway is that our recruitment is back on track, and our target readout remains on schedule.
For a small biotech company, our credibility is paramount, and with significant focus and partner outreach, the proverbial ship was “righted.” This experience demonstrates our shared commitment to go further than was thought even possible, regardless of difficulty. Because when not just your company — but also the hopes and needs of countless patients — hinges on every new trial result, there’s no latitude for half measures.
Demonstrations of consistent focus like this are a sure sign that when a biotech leader takes it personally, a small-but-passionate team can make a larger-than-life impact. Some may underestimate what a small biotech company like yours can achieve, but as its leader, you simply cannot. Being underestimated can be a great advantage — provided a leader refuses to internalize it.
Much like Franklin Roosevelt’s observation that “the only thing we have to fear is fear itself,” the biggest risk a biotech leader can often face is underestimating what their own team can accomplish. When you and your team are deeply committed, fully aligned, and working with shared ownership of the outcome, you can become truly unstoppable.
About The Author:
Lisa Ricciardi joined Cognition Therapeutics in March 2019 as a member of the Board of Directors. She was appointed CEO in 2020 and led the company through its initial public offering. Her career experience includes drug development and commercialization, healthcare services, and genomics. She has a proven track record launching large-market therapeutics, as well as negotiating financial and business development agreements, from small to multi-billion-dollar deals.