Diagnostic testing is expensive, so doctors order it sparingly and disease gets caught late. The founder behind Wallace Biotechnologies argues that is a cost problem rather than a science problem, and that fixing it changes what medicine can see.
Ask most people why their doctor did not catch something earlier and they will talk about symptoms, or luck, or an appointment they never booked. Ask James Sackl and he will talk about the price of a test.
His argument is narrow and, once stated, hard to unsee. Medicine is not short of things it could measure. It is short of permission to measure them. Every test carries a cost, so every test has to be justified, so tests get ordered once somebody already suspects something is wrong. The result is a system that is very good at confirming illness and very poor at seeing it coming. Not because the science is missing, but because the accounting says no.
Sackl, 36, founded Wallace Biotechnologies to go after the accounting.
The number that is not the number
The way into his thinking is to separate what a test costs from what a test is billed at.
The chemistry inside a routine blood panel is worth cents. The price a health system pays is orders of magnitude higher. Almost the entire difference sits in what surrounds the chemistry: the collection appointment, the courier run, the accessioning, the technician, the instrument time, the reporting, the billing.
That gap is the opportunity. If most of the cost of a test is not the test, then most of the cost is an engineering problem rather than a biological one. Engineering problems get solved by building something different.
Wallace's answer is what the company calls Robolabs: autonomous wet laboratories that run on robotics rather than technicians, designed to operate continuously instead of in batches around a working day. Sackl puts the reduction at roughly 90 per cent per test.
The claim is not that the chemistry improves. It is that nearly everything wrapped around the chemistry disappears.
Why cheap changes the question
Cost reduction in diagnostics is normally pitched as a saving. Sackl pitches it as a change of category, and this is the part of the argument that is distinctly his.
At current prices, testing is rationed, so it happens once, late, when a patient presents with something. A single measurement taken at a single moment tells you where a person is. It cannot tell you where they are heading.
Blood markers move. A value sitting inside the reference range means very little on its own if it has been climbing steadily for two years. A value outside the range can mean nothing at all in somebody for whom it has always sat there. Medicine reads these numbers as thresholds because thresholds are all a single measurement can support.
Make testing cheap enough to repeat and the data changes shape. Snapshots become a trajectory, and a trajectory supports a different kind of medicine: catching a direction of travel rather than an arrival.
Sackl's longer ambition follows from that. Enough longitudinal biological data, across enough people, becomes something you can model. He describes the target as a living model of a person's biology, showing where it is now and where it is going, so that trouble is identified before it becomes illness.
From measurement to prediction
The furthest version of the plan moves from monitoring individuals to running trials.
Sackl describes a clinical trials platform in which software forecasts how a molecule will behave across thousands of different bodies, and a network of continuously monitored people confirms whether the forecast held. Drug development currently takes years and hundreds of millions of dollars, much of it spent discovering late that a compound behaves differently in real populations than it did in a cohort. He thinks both the time and the cost could fall by an order of magnitude.
He is straightforward that this does not exist yet at the scale described. The cost argument is arithmetic and is already being built. The predictive layer is a hypothesis, and a reasonable one, but it rests on data nobody currently has, which is the point of building the cheap testing first.
The reason underneath
Wallace sits inside a larger argument Sackl makes about where the economy is heading, and it explains why the founder of Terraform Technologies, a company that builds solar-powered industrial plant, ended up pointing at biology.
His view is that artificial intelligence and robotics are about to make work and goods abundant, and that two things stay scarce. Somebody has to want things, and somebody has to decide what gets made. Both require people. Across the developed world, populations are already tipping into decline.
Keeping people healthy and alive for longer is, in that framing, an economic objective as much as a medical one. Fewer people leaving is arithmetically the same as more people arriving.
"We are heading into a period where you ration neither," Sackl says of cheap energy and cheap intelligence arriving at once, "and almost nothing in the economy is priced for it yet."
The version of Wallace he describes is a long way from a cheaper blood panel. The claim underneath it is harder to argue with. Testing is priced far above what it costs to perform, that price is the reason medicine sees so little of what it could, and until now nobody has been paid to fix it.
James Sackl is an Australian founder building Wallace Biotechnologies, an autonomous diagnostics company, and Terraform Technologies, a solar-powered industrial materials company. He writes at jamessackl.com.au.