Two venture capitalists dissect why biotech burns billions while China runs trials in weeks, and why the next Genentech won't look anything like the last one. Elliot Hershberg reveals the "three horsemen" strangling drug development as costs explode to $2.5 billion per approval, while Lada Nuzhna exposes how investigator-initiated trials in Shanghai are rewriting the competitive playbook faster than American founders can file INDs. When the infrastructure that built monoclonal antibodies becomes the commodity threatening to hollow out an entire industry, the only path forward demands inventing medicines that are literally impossible to make without tools that don't exist yet, and they're betting everything on which approach survives. Timestamps: 00:00 - The State of Biotech: Record Lows and Structural Challenges 03:00 - The Biggest Disconnect: Technology Progress vs Market Reality 06:00 - Eroom's Law: Why Drugs Cost $2 Billion and Take Longer Than Ever 10:36 - How the Biotech Industry Actually Works: From Dye Manufacturers to Drug Discovery 13:33 - China's Speed and Cost Advantage: The Geographic Arbitrage Problem 17:00 - "We Have to Invent Stuff": America's Path to Competing with China 22:24 - AI in Drug Development: Can It Make a $2.5B Drug Cost $500M? 33:00 - GLP-1s: The Drug That Gave Biotech Its Mojo Back 38:14 - What Is Aging? We'll Treat It Before We Understand It 58:00 - Where Are The Next Iconic Biotechs? Rebundling the Stack Follow Jorge on X: https://x.com/JorgeCondeBio Follow Lada on X: https://x.com/ladanuzhna Follow Elliot on X: https://x.com/ElliotHershberg Follow Erik on X: https://x.com/eriktorenberg Stay Updated: If you enjoyed this episode, be sure to like, subscribe, and share with your friends! Find a16z on X: https://x.com/a16z Find a16z on LinkedIn: https://www.linkedin.com/company/a16z Listen to the a16z Podcast on Spotify: https://open.spotify.com/show/5bC65RDvs3oxnLyqqvkUYX Listen to the a16z Podcast on Apple Podcasts: https://podcasts.apple.com/us/podcast/a16z-podcast/id842818711 Follow our host: https://x.com/eriktorenberg Please note that the content here is for informational purposes only; should NOT be taken as legal, business, tax, or investment advice or be used to evaluate any investment or security; and is not directed at any investors or potential investors in any a16z fund. a16z and its affiliates may maintain investments in the companies discussed. For more details please see a16z.com/disclosures.