I had the opportunity to host Meri Beckwith on my podcast Life Sciences Today. The inspiration for the company came from Beckwith’s experience in life sciences/medtech VC where portfolio companies struggled with clinical trials. Later his experience as COVID vaccine trial participant in 2020 revealed broken processes.
Most founders think their biggest risk is running out of cash. It’s not. It’s building your company without a strategic position.
Timelines are slipping and CRO revenue is up!
CROs have a pure service business model, and bill by the hour.
They love it when timelines slip! More project management hours billed and more revenue per project.
In other words CROs are directly incentivised to delay projects, and make them more complicated than they need to be... For example many big CRO project managers are KPI'd on the volume of change orders they send.
We are trying something different at Lindus Health.
– Meri Beckwith founder and co-CEO of the anti-CRO Lindus Health
So what does Lindus do differently than traditional CROs?
Lindus has a refreshing business model for running clinical trials and customers are loving it:
Fixed-cost agreements vs traditional hourly billing
Payment tied to pre-agreed milestones
Model incentivizes efficiency and quality
Eliminates traditional CRO incentive to bill more hours
Team mindset shift: focus on efficient setup and patient progression
Careful selection of trials and commercial arrangements to maintain model integrity
They resist pressure from pharma sponsors to revert to traditional models and they balance their business expansion with focused expertise
Listen to my conversation with Meri Beckwith - the Anti-CRO Lindus Health
Intro
After looking at my notes from the show with Meri, I stepped back and asked myself what techbio startups can learn from Lindus.
I reread Michael Porter’s 1996 classic paper “What is strategy” after I got back from my Friday morning Gaga dance session and a much needed shower and calorie restock.
Let’s get it on.
Don’t play a professional services game
If you’re a techbio startup, learn, but don’t copy from clinical trials outsourcing.
If you copy their strategy, you’ll scale billable hours, not intellectual property.
When almost every other activity in our personal and business lives has moved to real-time, digital, online and now AI bots - clinical trial operations have remained firmly stuck in track changes in MS Office documents and hourly billing.
The CRO model is collapsing for 2 reasons:
Agentic AI + cloud workflows are closing the operational efficiency gap between sponsors and CROs.
Clinical data is core IP and life science companies are waking up to that.
When IP is your moat, outsourcing is a liability.
The value of your customers’ core IP far outweighs the value of your outsourcing services.
This is an unstoppable force for life science companies.
To leverage an unstoppable force, you have to learn what is strategy.
There are only 3 strategic positions for techbio today.
Michael Porter wrote the playbook for this 30 years ago.
Variety-based. A variety-based position is based on providing a subset of services. For example, Tilda does regulatory/site workflows. Yendou does site engagement and PicnicHealth does data collection for observational studies.
Needs-based positioning. Lindus creates a meaningful position by delivering the best set of activities for specific therapy areas (e.g. psychiatry and trial types (medical devices, diagnostics, digital health, drug trials and consumer health).
Access-based positioning. Access-based positioning is a function of geographic location. Bioaccess Latin America is an example. Access-based positioning is less common (as the big CROs will go anywhere) and its mechanics are less understood. You’ll have to wait for the podcast and my companion essay on Aug 8 to see how they achieve first-in-human trials in Latin America, Eastern Europe & Australia 40% Faster Than US/EU.
A sustainable strategic position requires tradeoffs
To choose a strategic position you must make tradeoffs.
Without tradeoffs, there would be no need to choose and no need for a strategy.
Whatever the position you choose - variety, needs or access; positioning requires a selecting tailored set of activities (as Lindus and Tilda do) because being competitive is always a function of the difference of activities on the supply side.
Tradeoffs make you choose and protect you against me-too positions.
There are 3 reasons to make tradeoffs.
The first reason is to sustain consistency in your image and reputation. A techbio company known for creating value for oncology biotechs may lack credibility and confuse customers - or even undermine its reputation if it attempts to provide a digital health app for respiratory disorders. Medable raised $800M during the height of COVID in the position of decentralized trials software. 5 years after COVID, Medable leadership still believes in DCT. This is their image, the activities they developed, the values they designed for their company. To do anything different would confuse customers.
The second reason is the activities your company does. Different positions require different product designs, different teams, and different go-to-market systems. Quanthealth’s position of predicting the results of clinical trials requires a completely different set of design, engineering and delivery activities than Tilda Bio has for its AI clinops companions. Quanthealth and Tilda consciously made a tradeoff between clinical operations and clinical development.
The third reason is to sustain internal coordination and control. By clearly choosing to compete on designing and operating better clinical trials for cancer, Flatiron Health leadership makes organizational priorities clear. Companies that try to please everyone, confuse the hell out of their engineering and ops teams.
There are often false tradeoffs between costs and quality.
False tradeoffs occur when there is redundant or wasted effort (CRA’s physically visiting sites to compare pieces of paper with electronic records was a non-value-added activity 15 years ago that updated less than 3% of data points), poor control (30% of CRAs turnover annually), or weak coordination (sites running after payment for invoices is rampant in the industry).
When headcount drops in the CRO and quality drops in the project, the trial takes more time and billable revenue increases.
These are false tradeoffs.
Fit drives both competitive advantage and sustainability
Your positioning determines your activities and how the activities relate to one another. A good example is Quanthealth. They’ve chosen a variety-based position to predict results of clinical trials. There is a lot of non-scalable work to build a ML model to predict how a particular protocol will do in Phase 1, especially when there is little previous data. But the more projects that Quanthealth do, the better their internal tools and processes become and the faster and more efficient they become and they can ramp-up capacity to do more trials.
Types of fit
The importance of fit among a company’s functional policies is one of the oldest ideas in strategy.
Fit is important because design, product, engineering and sales activities often affect one another.
One of the saddest cases I saw was after a phone call I received from a VC who had invested $10M in a digital health startup and had decided to shut it down. The partner wanted to know how much the IP was worth and asked me to talk to the co-founder and CTO. They had a patch-work quilt of 7 different technologies and languages in their stack (they had more moving parts in the stack than employees). I responded to the VC that it would be close to impossible to do anything useful with the code.
There are 3 types of fit, although they are not mutually exclusive.
First-order fit is simple consistency between each activity and the overall strategy. Tilda’s strategy is to replace manual clinops labor with AI companions. It deliberately does not provide functional CRO services like data management or biostatistics. Consistency ensures that the competitive advantage of Tilda AI companions accumulate as they do more and more projects.
Second-order fit is when activities are reinforcing. Lindus Health works hard to maintain quality and culture during rapid growth and avoid “big bloated CRO” syndrome. Culturally, they manage staff from traditional CRO backgrounds and resist pressure from pharma sponsors to revert to traditional models. They have their own proprietary integrated data management system called Citrus which combines EDC, CTMS and native CDISC SDTM data storage. Using their own software and culturally building their own team for sustained operation in their “Anti-CRO” model is a great example of second-order fit.
Third-order fit goes beyond activity reinforcement to optimization of effort. Lindus optimizes their monitoring for customers with a system that monitors the data (not monitoring data entry discrepancies). Their system captures metadata about ePRO completion and detects “Christmas treeing” (random answer patterns) and enables quick intervention for data quality issues.
This last activity is of particular importance for GCP (Good Clinical Practice) compliance - the industry gold standard for clinops. Real-time alerts from the Lindus database enables their team to respond and resolve in minutes as compared to standard CRO monitoring which lags 5-30 days behind the data capture event.
Fit and sustainability
Strategic fit between the activities creates competitive advantage and sustainability of the advantage.
Here’s why this matters: it’s easy to copy one feature. It’s almost impossible to copy a system.
Let’s say that the probability of a conventional CRO matching any of the individual Lindus activities is 0.8.
For a system of 6 activities - the probability of matching the Lindus system is 0.26.
A competitor that tries to imitate an anti-CRO will be forced to configure (or reconfigure if it’s an incumbent) many activities.
The more second and third-order fit you have, the more sustainable your system is.
Even if their competitors can figure out the Lindus system, they will have trouble replicating them because their system integrates decisions, software, team culture, business model, data model and GCP monitoring.
The Lindus position is most viable because it's incompatible with the existing systems.
We’ve baked these strategic tradeoffs into our workflow tooling. You can’t just bolt on AI. You need to rewire the activity system.
If you want to learn more DM me
Here’s how techbio founders win in 2025:
Pick a strategic position. Make the painful tradeoffs.
Align every decision, every hire, every line of code with that position.
Say no to anything that doesn’t reinforce it.
Design a system so that your activities reinforce each other and compound
And never confuse operational activity for strategic clarity.
About Me
I’m a former pharma-tech founder who bootstrapped to exit.
Now I run a private community with 900+ life science leaders helping them maximize their revenue with the right partners.
📈Every Friday: sharp no-BS insights on how real techbio companies grow revenue—plus candid interviews with the builders.
Join the private network for techbio entrepreneurs.
About Lindus Health
Lindus Health is The Anti-CRO for Life Science Pioneers - Radically faster, more reliable clinical trials, delivered end to end.
🔗 Visit Lindus Health