Archive - Drug Development Executive

The Mandelbrot Boundary: The Non-Linear Geometry of Clinical Trial Failure

Why your trial is an iterative dynamical system, not a spreadsheet

Mar 30 • Eswar Krishnan, MD

Your Trial Is Not Behind Schedule. It Is in the Wrong Place.

The geometrical principles of operational failure in clinical development

Mar 19 • Eswar Krishnan, MD

Your Drug Is Fighting the Biology. The Dog Would Not

What a sheepdog paper in Science Advances reveals about how discovery scientists misread cytokine biology — and why that misreading is costing billions…

Mar 16 • Eswar Krishnan, MD

Medical Journal Club: Efferoptosis and efferocytosis:

Imagine your body's cleanup crew.

Mar 6 • Eswar Krishnan, MD

Sleep Loss: The Hidden Metabolic Disease Rivaling Diabetes

Think diabetes is the only metabolic disorder you need to worry about?

Mar 6 • Eswar Krishnan, MD

Your Target Is Perfect. Your Drug Is Potent. Here's Why It Will Still Fail: The 'Target Fallacy'.

A quantitative framework for understanding why target-based drug discovery fails in translation

Mar 6 • Eswar Krishnan, MD

Block One Road. Biology Takes Another

We Killed the Target. The Disease Didn't Care

Mar 6 • Eswar Krishnan, MD

February 2026

Taltz+Zepbound : When Obesity Becomes a PK Problem

We Got the Synergy Story Backwards? Everyone: "GLP-1 + ixekizumab = immune synergy." Data: "Actually, ~70% of the benefit looks like weight loss fixing…

Feb 24

Would You Market a Drug You Can’t Explain?

(I probably will)

Feb 23 • Eswar Krishnan, MD

CAR-T for Autoimmune Disease: A Safety Reckoning Is Coming – and the Field Is Not Ready

Graph showing adverse event rates in CAR-T therapy for lupus

Feb 9 • Eswar Krishnan, MD

The unbearable lightness of AI written posts

There’s a little theatre that plays out on Substack, LinkedIn and other social media.

Feb 7 • Eswar Krishnan, MD

January 2026

Atherosclerotic Plaque as a Lymphoid Organ

An introduction

Jan 15 • Eswar Krishnan, MD

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