Francesco De Rubertis, co-founder and partner at Medicxi, has been at the forefront of reshaping biotech investment and governance. He is a key architect of the asset-centric investment model, which focuses on building biotech ventures around singular, high-value drug programs rather than traditional platform companies. This model led to the formation of Centessa Pharmaceuticals, where he consolidated 10 biotech startups into a single, publicly traded company - an experiment in overcoming fragmentation and inefficiency in biotech R&D.
Centessa’s board is balanced between the investor directors and a group of outsiders with diverse backgrounds and experience. Some of the other, private, biotech boards Francesco currently chairs are investor-dominated.
Francesco’s direct experience with many investor-led boards gives him a unique perspective on both their strengths and their limitations. He understands how capital providers think, how investment committees operate, and how these dynamics influence boardroom decisions. At the same time, his deep involvement in company-building gives him firsthand insight into where investor-heavy boards fall short - particularly in product development, operational strategy, and long-term value creation.
Strong boards help drive company success - not just by securing financing but by shaping strategy, mitigating risks, and ensuring a life science venture builds a product that can reach patients. Yet too often, early-stage life science boards are entirely dominated by investor directors. This can (but does not have to) lead to a narrow focus on capital efficiency and milestone-driven decision-making. While financial discipline is essential, a lack of diversity on the board can result in missed opportunities, short-term thinking, and strategic blind spots.
How can biotech CEOs push beyond this sameness, ensuring their boards are equipped to make the best strategic decisions - not just for the next financing round but for the longer term success of the company?
Why This is Relevant for You
As a CEO, your board is one of your most important assets—or liabilities. An investor-heavy board can mean:
Short-term decision-making over long-term value creation – The emphasis on hitting financing milestones can sometimes overshadow the strategic patience required to develop a viable product.
Limited operational expertise – Investors bring financial acumen but often lack the direct experience of running a biotech company, guiding a drug through development, or navigating regulatory hurdles.
Missed opportunities due to groupthink – Without cognitive diversity, boards may reinforce existing assumptions rather than challenge them, leading to suboptimal strategic choices.
A lack of gender and experiential diversity – Biotech boards remain predominantly male and often composed of the same network of investors, limiting perspectives that could strengthen decision-making.
Research has shown that companies with diverse boards outperform their peers in financial performance and strategic resilience (McKinsey, "Diversity Wins"). Yet in venture-backed biotech, the barriers to achieving this diversity remain high. Understanding how to (within the limitations that you face as a venture financed company) build the right board—one that balances investor oversight with operational and product-development expertise—is a critical leadership challenge.