Everything is Changing Everywhere
A conversation with investor, social entrepreneur, and patient advocate Daniel Arbess on why medicine needs institutional innovation, not just more science
It was a great pleasure to sit down with renowned investor and social entrepreneur Daniel Arbess for a deep conversation about the future of healthcare and biomedical research. Dan’s career trajectory—from foreign policy analyst to the youngest partner at White & Case, to founding Xerion (a $3.5 billion hedge fund that delivered 25%+ annualized returns through the financial crisis), to his current work in patient advocacy—offers a unique lens on system-level transformation.
Our conversation centered on a fundamental thesis: healthcare doesn’t just need more science; it needs a moonshot of institutional innovation. Dan argues that our current system was architected 100 years ago to treat visible symptoms with available therapeutics. We now have the scientific capacity to detect disease at its molecular origins and treat patients as true N-of-1s, but our institutions haven’t evolved to match.
Several key points emerged from our conversation:
On regulatory reform: Dan argues that if we accept every patient is biologically unique, proving interventions work uniformly across populations becomes less relevant than allowing physicians to apply treatments based on mechanistic understanding, pointing to the need for FDA flexibility in making approval decisions.
On data infrastructure: The path forward begins with standardized electronic health records that capture longitudinal patient data from the start—not after disease manifests. This creates the foundation for understanding individual phenotypes and their evolution over time.
On economic alignment: The current fee-for-service model and diagnostic billing codes perpetuate symptom-focused care. Dan sees the current level of federal budget spent on healthcare as recoverable through early intervention and prevention, rather than managing expensive end-stage disease.
On the opportunity: With an administration open to disrupting calcified systems, there’s a unique window to redesign how we generate evidence, reimburse care, and ultimately practice medicine.
Dan’s work in neuroimmunology—looking across Alzheimer’s, Parkinson’s, ALS, and brain tumors to identify common dysregulatory mechanisms—exemplifies this systems-thinking approach. His first academic presentation at the Society for Neuro-Oncology (which we collaborated on) attempted to extract learnings from failed trials to inform better trial design. The limited feedback he received underscores the challenge: the field continues designing studies without fully integrating what we’ve learned about heterogeneity and mechanism.
The conversation reinforced something I’ve been thinking about: the gap between our technical capabilities and our institutional capacity to deploy them may be the defining constraint in modern medicine. We have the tools. We lack the operating system.
