Building a boutique advisory firm is exhilarating. It is also deeply uncomfortable.
Both things can be true.
I am writing this not as a milestone update but as an honest account. Because the version of firm-building that circulates publicly tends to emphasise either the triumph or the struggle, and rarely the strange texture of both running simultaneously.
What momentum looks like
LSA has secured its first substantive client engagement. The weighted pipeline is increasingly diversified across pharma, biotech, private equity, and strategic partnerships. A senior global expert panel is taking shape: people whose credibility I respect, who engage on substance, and whose association with the firm means something. New propositions are emerging around PE diligence and access sustainability, verticals I had mapped in the architecture but did not expect to develop this quickly.
We filmed something rather special yesterday that I am looking forward to sharing. And the strategic partnerships that I spent the early months building quietly are beginning to compound in ways I did not fully anticipate. The deposits, as I wrote about recently, are starting to pay out.
There are days when the momentum feels extraordinary.
Then there are the other days
Late-stage opportunities don't always move at the velocity you expect. Advisory revenue is inherently lumpy: a dynamic you understand intellectually before you start, and experience rather differently once you are inside it. Working across the US, Europe, and India makes the working day elastic in ways that are productive and occasionally exhausting.
And I have learned faster than expected how easily founder mode becomes always-on mode: not in a way I would present as a badge of honour, but as a pattern worth recognising and managing. The operating discipline I wrote about recently applies here too. The substrate is still the same person.
None of this is surprising in the abstract. The literature on building a firm covers all of it. Living inside it is different.
The psychological contract
After two decades of salaried work, senior roles at BMS and IQVIA, mandates spanning oncology, rare disease, and advanced therapies across Europe and Asia, the absence of a salary is only the most visible part of what changes.
The deeper shift is in the psychological contract.
There is no longer a structure that tells you what good looks like. No annual review cycle. No clear external signal for whether this week was successful. No team absorbing the ambient uncertainty of an early commercial pipeline. The uncertainty is entirely yours.
Which is, of course, precisely the point.
What that absence creates in exchange is something I have rarely experienced at this intensity: agency.
The freedom to choose the problems I work on. To have direct conversations with biotech CEOs and investors about decisions that genuinely matter. To build propositions around gaps I believe exist and have the evidence to justify. To choose collaborators on the basis of their quality and alignment rather than their availability. To obsess over the positioning, the website, even individual words in the firm's mission.
To build something increasingly aligned with what I think, how I work, and what I value.
More specifically: to play a meaningful part in getting breakthrough science from discovery to patients. The intersection I find most energising is the space between clinical-stage biotechs navigating complex evidence and access environments, and the investment capital backing them. That is where strategy becomes genuinely consequential. Where the decisions made now, about what evidence to generate, how to sequence indications, how to position value, determine whether a therapy reaches the patients who need it or stalls in the gap between scientific promise and commercial reality.
"Scientific breakthroughs don't change communities. Access to them does."
That is immensely energising. On the good days, it is unlike anything I experienced inside a corporate structure.
The next question
The next challenge is different in character from the first.
The first was proving that someone would buy what LSA is building. That question has an answer, and the answer is encouraging.
The next question is repeatability.
Converting the next wave of opportunities. Productising more of what works. Building commercial foundations beneath what is currently a brand. Establishing the systems and relationships that transform a successful early engagement into a practice rather than a project.
One win validates demand. The next phase is proving you can create it consistently. That is harder to talk about, and more interesting, than the first.
The longer view
There is a dimension to this that I have not spoken about publicly before.
My father was a doctor who emigrated from Bangladesh to the United Kingdom decades ago. My mother built the practice around him, managing everything that allowed the clinical work to happen. Together their mission was direct and specific: serving communities where the gap between medical need and access was visible every day, in clinics and consulting rooms and the lives of the people they treated. That mission, to close a gap between what medicine could offer and who actually received it, was not something I inherited as a conscious project. It is something I have come to understand was always operating in me.
What I am building with LSA is, in part, a continuation of their work. At a different scale, through different means, and in a different part of the value chain. But the ambition is the same: to help close the distance between what medicine can do and who benefits from it.
Improving access to medicines in low- and middle-income countries, reducing health inequity at a global scale, is where I intend to take this work eventually. Not as a detour from the commercial strategy, but as its natural expression. The same access and evidence expertise that matters in a European HTA submission matters, in a different register, in a tiered-access negotiation in South Asia or sub-Saharan Africa.
I want to continue their work. To serve communities. In this chapter, the community is global.
I did not expect building something to be quite this clarifying. The decisions that feel trivial from the outside, which clients to pursue, which partnerships to invest in, how to position the firm at the intersection of evidence, access, and policy, feel extraordinarily consequential from the inside. Every one is a statement about what the firm is, and what it is not.
The highs are real. So are the difficult days.
I am discovering that is probably what building something genuinely looks and feels like.