Fragmentation as systemic misallocation.

A diagnostic lab builds patient matching logic. A pharma company builds it again for their trials. A cell therapy manufacturer builds it again for chain-of-identity. A CRO builds it again for regulatory submissions.

Same problem, solved independently, four times.

Every organization in precision medicine rebuilds the same execution infrastructure: onboarding, lineage tracking, validation, compliance.

The patient matching logic that a diagnostic lab builds to link specimens to patient records is functionally identical to the patient matching logic that a CRO builds to link trial subjects to enrollment records. Both resolve names, dates of birth, MRNs, and specimen IDs against a canonical identity. Both handle edge cases: name changes, transfers between facilities, multiple specimen types. Both need to be auditable. Neither organization can reuse the other's implementation, because there's no shared layer to build on.

Systemic waste

The work is identical. The implementations are bespoke.

That's not overhead. It's wasted effort on a massive scale.

The science composes beautifully. A variant discovered in one lab can be validated by another and applied in a third. But the execution layer underneath, the part that tracks who did what, proves it happened correctly, and packages it for regulators, gets rebuilt from scratch every time.

Precision medicine pays infrastructure costs without shared infrastructure. The difference shows up as longer timelines, more rework, and slower submissions.