a16z Bio

Our ability to engineer biology will fundamentally transform how we diagnose, treat, and manage disease. The first great leap forward took place in the early 1980s with recombinant DNA technology and the first biotech drug, thanks to our newfound ability to insert human genes into bacteria to produce human insulin. Today, modern tools like CRISPR and gene circuitry enable us to to program biology with greater and greater precision and sophistication, from bacteria that is engineered to produce new chemicals and proteins, to cells that are engineered to attack cancer. The explosion of “programmable medicines” (in the form of genes, cells, microbes, even mobile apps and software that can improve our health itself) are today leading us closer than ever before to that holy grail of medicine, the cure. 

Because these new medicines are engineered systems and programmable in nature, drug discovery and development will move from a bespoke to an iterative process. We can now move from designing a molecule for one specific target to designing a platform on which many future medicines can be built. Like software upgrades, programmable medicines make it increasingly possible to improve a given medicine in subsequent generations. Each new version of engineered CAR T-cells, for example, will be more sophisticated than the last. And the modular aspect of these medicines mean that new applications will be easier to build, reusing and repurposing common components like Lego blocks: once we learn how to deliver a gene to a specific cell in a given disease, it’s significantly more likely we will be able to deliver a different gene to a different cell for another disease.

Increasingly, not all therapies will be molecules. Already, today you can download a therapeutic to manage complex chronic conditions like diabetes or behavioral disorders—potentially better than any existing medicines can. For these complex conditions, software may be our best way to impact biology. These digital health therapeutics have the potential to not only make you better, but themselves get better and better over time as they treat you. Now biology doesn't just evolve, our therapeutics do, too.  

All of this is powered by the ability to generate data that we’ve never had before, plus sophisticated computational tools to make sense of them. Biology is incredibly complex —maybe even beyond the ability of the human mind to fully comprehend. AI-powered platforms have the potential to connect dots that have before looked like noise; to generate new discoveries; even to change the nature of discovery itself. This will drive both new therapies and next-generation diagnostics that give us the ability to detect diseases like cancer earlier and earlier, perhaps even stopping disease before it begins. 

But when we do get sick, we rely on the healthcare system. We are at a unique moment in time where our entire healthcare system—how we access, pay for, and deliver healthcare—is being re-engineered through technology. Dynamics that have traditionally been barriers to change in the healthcare system, such as misaligned incentives and lack of transparency, are finally shifting. The patient is finally becoming a powerful stakeholder in the system. And healthcare is being pushed outside the four walls of the hospital, with new models emerging every day for delivering care at community-based locations; or at home; or virtually, wherever you are. 

In all these areas, technology is reducing friction, introducing automation, and enabling new methods for delivering cost-effective clinical services. Building successful products and services in this market will always require a deep understanding of the complex healthcare value chain as it exists today—and how to integrate into it. But payment model innovation and an expanding definition of what constitutes healthcare itself are exposing gaps in the system that can be uniquely filled by new startups. Going forward, the dominant players in the healthcare market will be technology companies at their core. Software, finally, is eating healthcare. 

Biology, of course, doesn’t just impact human health and disease. With its unparalleled ability to evolve, replicate, and create, biology is one of the most advanced manufacturing technologies on earth. We’ve already seen it transform food, agriculture, textiles, manufacturing, and—with DNA-based computers—even software itself. Bio today is where information technology was 50 years ago: on the precipice of touching all of our lives. Just like software—and because of it—biology will one day become part of every industry. 

This next generation of companies will be built by a new generation of founders who are multidisciplinary, with deep expertise in their domains. The bio companies of the future will take learnings from predecessors in other spaces: consumer, enterprise, fintech, and beyond. So, just like our founders, we believe investors in this space also need to have deep expertise and experience, and be multidisciplinary—to have the vision to support founders as these traditional sectors and industry lines are shifting. We are living in the century of biology, and biology is eating the world.