Long concentration on dementia and the Biogen alliance that produced lecanemab (2023)

The price of concentration, and where the bet lands

The core of this decision was a refusal to follow the industry’s drift toward competing on scale, and a narrowing of research and development onto dementia — a field in which failure had followed failure. CEO Naito Haruo has consistently described the urgency created by cutting off one’s own escape routes as a strength rather than a burden. Through the setback of aducanumab, lecanemab emerged from the same alliance, demonstrated efficacy in numbers, and reached the clinic; the sequence can be read as long concentration bearing fruit at last. Behind a thirty-year consistency of bet lies the pride of being the world’s first — the pioneer.

Approval, however, was a starting line as much as a destination. The practical walls — diagnostic and testing capacity, a high price, the management of side effects — still stand between a trillion-yen ambition and actual reach to patients. That the leading candidate to succeed as president left the company immediately after full approval raised a separate question about how thin the bench of people able to carry the result really is. Whether a world in which dementia is “nothing to be feared” can be built rests not on the single point of approval but on the accumulated work of diffusion and infrastructure that comes after it.