Escaping Commercial Gravity

Cell and Gene Therapy is the most extraordinary scientific achievement of my lifetime.

More than two decades across diagnostics and cell and gene therapy have given me a front row seat to what brilliant people can build — diagnostic advances that find disease earlier than we ever thought possible, therapies that cure conditions that were death sentences a decade ago, science that rewrites the genetic code of a living human being, programs built on belief, sacrifice, and an almost unreasonable commitment to patients who had nowhere else to turn.

I am more optimistic about this industry than I have ever been.

And that is exactly why this conversation matters.

Because the science is proven. The commercialization systems are not. And the gap between those two things is costing this industry something it cannot afford to lose — patients who needed a therapy that existed but never reached them.

I call that gap Commercial Gravity.

It is not a critique of the science. It is not a criticism of the founders, the operators, or the investors who built something real and remarkable. It is the name for a structural force that acts on every CGT company regardless of how good the science is, how experienced the team is, or how much capital is behind them.

And it is solvable. If you see it early enough.

Commercial Gravity builds from the moment a company decides — consciously or not — that commercialization systems can wait until the science is further along.

It builds when the BD hire is made too late and without infrastructure behind them. When reimbursement strategy is treated as a post-approval problem. When treatment center relationships are assumed rather than built. When patient identification infrastructure is never built at all, meaning eligible patients never enter the treatment pathway. When the investor deck has a commercial slide that nobody in the room has actually pressure-tested.

None of these are catastrophic decisions individually. Each one is completely reasonable given the pressures of building a CGT company. Collectively they create a company that has done everything right scientifically and has not built the commercialization systems to convert that science into outcomes.

The cost of that gap is not abstract. Developing a single cell or gene therapy costs an estimated $1.94 billion when you account for the programs that do not make it. I have personally watched far too many disappear — not because the science failed, but because the commercialization systems were never built. That number is not an outlier. In this industry it is closer to a Tuesday.

Nearly 3,500 gene, cell, and RNA therapies are in preclinical and clinical development worldwide. Fewer than 50 have reached patients through regulatory approval.

That gap is not a science problem. The science is extraordinary and accelerating. It is a commercialization systems problem. And as the pipeline matures, as more programs move from clinical promise toward commercial reality, the companies that have built those systems will move faster, convert more partnerships, and reach patients sooner than the ones that have not.

The window to build ahead of the need is open right now. It will not stay open indefinitely.

Commercial Gravity does not just stall drug developers. It stalls everyone whose business depends on them.

Over the next several weeks I am going to break down exactly where Commercial Gravity operates and what escaping it actually looks like — the approval trap, the BD illusion, what actually drives purchasing decisions, the phase most companies skip, and what the companies that reach patients do differently.

Not in the abstract. In the specific situations I have watched play out repeatedly across CGT companies, diagnostic platforms, tools and technology businesses, and service providers at every stage of development.

The science in this industry deserves to reach patients. Building the commercialization systems to get it there is not a compromise of that mission — it is the fulfillment of it.

Susan Nichols is Managing Director and CEO of Propel Biosciences. With more than two decades spanning diagnostics and cell and gene therapy — as a drug developer, as a CEO, as a Chief Commercial Officer, and as a Chief Business Officer in the CGT industry — she has sat on every side of this table. She works across both industries because the commercialization challenges in each inform the other.