Paying for Zero Is a Line Item, Not a Surprise
A predictable fraction of every portfolio returns nothing. Price it in instead of discovering it at closeout.
Confidence: hypothesis. The failures below are drawn from published industry data and widely reported patterns, not firsthand deployment. The pattern at the end is an argument, not a shipped system. Argue with it.
When you place a lot of similar bets and pay roughly the same for each, it is tempting to expect roughly the same return from each. That expectation is almost always wrong, and it is wrong in a specific, predictable way. A few bets carry most of the return, a long tail returns almost nothing, and a stubborn slice returns exactly zero while costing exactly as much as the winners. The zero is not a surprise. It is a line item, and pretending otherwise is how the budget gets built on a fantasy.
Clinical trial sites make this concrete and measurable.
The clinical why
A trial activates its chosen sites, and activation costs about the same for each one: contracts, budgets, ethics submissions, training, drug shipments. Then enrollment comes in, and it is brutally uneven. A handful of sites deliver most of the patients. A long tail delivers one or two. And a reliable fraction delivers none.
This pattern is one piece of a longer treatment. The full essay is issue 6 of Stage × AI, a series walking the entire clinical-trial lifecycle stage by stage — what each stage really does, where AI helps, where it must not go, and one buildable pattern per stage:
full essayEvidence in, evidence out. Corrections welcome.