The last mile of medicine, and why it's the hardest.

In logistics, the last mile is the most expensive and complex part of any journey. Medicine has a last mile too, and it is where good science most often disappears.

Move a package across an ocean and the cost is trivial per item. Move it the final few streets to someone's door, and the economics invert. That final stretch (unpredictable, individual, human) is the hardest and most expensive part of the whole journey. It has a name: the last mile.

Medicine has a last mile too. It is not measured in streets but in the distance between a proven molecule and a person actually, reliably taking it.¹ And like every last mile, it resists the efficiencies that got us that far.

Why the last mile resists

Discovery scales. A single insight can help millions. But the last mile is stubbornly particular: this body, this routine, this fear of swallowing, this forgotten dose on a hard morning. What works in the aggregate breaks down in the specific.

The last mile is where good science most often disappears.

Because it is unglamorous and hard to measure, the last mile is chronically under-invested. The prize goes to the discovery; the disappearance happens quietly downstream, where few are watching.

Closing the gap

Closing it means treating delivery as a discipline, not an afterthought, designing the format, the experience, and the routine of a medicine with the same rigor we bring to the molecule itself. It is slower, less celebrated work. It is also where a great deal of unrealised benefit is still waiting.