Clinical Development Moves. Medical Affairs Debates. Can Pharma’s Future Wait?

AI is transforming the pharmaceutical industry—but the transformation isn’t evenly distributed. While Clinical Development appears increasingly ready to harness AI in meaningful, scalable ways, Medical Affairs remains stuck between aspiration and execution. And the more I work with different pharma company Medical Affairs teams, Clinical Development team, vendors, and tech startups, the clearer it becomes: this is less a matter of desire and more a matter of design.

Let me be clear—there have been bright spots. Pockets of innovation. Forward-thinking leaders. Some truly promising pilots. I’ve met countless individuals in Medical who are hungry for change and deeply committed to reimagining their function. But as someone who sits across the table from multiple pharma companies and AI innovators, I have the privilege—and challenge—of viewing Medical Affairs from a broader, more comparative lens. And one truth consistently surfaces: Medical Affairs is not yet wired for the kind of AI transformation the industry is so excited about.

The DNA Problem

Unlike Clinical Development, which thrives on structure, scale, and data integrity, Medical Affairs operates in a space shaped by nuance, ambiguity, and deep compliance constraints. Its workflows are often unstructured, its systems fragmented, and its value harder to quantify. While this complexity makes Medical an incredibly human and strategic function, it also makes it harder to automate, scale, or optimize with AI.

Many Medical teams are still negotiating basic digital fluency, let alone readiness for advanced AI integration. There's rarely a clear owner of AI initiatives. Technical talent is often borrowed, not embedded. And while curiosity is abundant, real agility—the ability to test, fail, learn, and iterate quickly—is in short supply. The culture rewards control more than experimentation, precision more than pace. It never ceases to amaze me. I’ll reconnect with a company I advised a year ago—only to discover their AI capabilities haven’t advanced much at all. Yet their “AI strategy” PowerPoint? On version 9.2. Updated fonts, new buzzwords, sleeker animations… but little meaningful progress. It is somewhat embarrassing, no? Think about the world around us with AI uptake? I know it's more complicated in Pharma, but the point remains the same--and its historical precedence with 'digital' confirms this.

Real AI adoption isn’t about polishing decks—it’s about doing the hard work: aligning teams, changing processes, rethinking incentives, and embedding experimentation into the culture.

This isn’t a failure, but rather a reflection of how the function evolved: risk-averse by necessity, consensus-driven by design, and often stretched thin by its cross-functional remit.

Meanwhile, Clinical Development Moves

Clinical Development, by contrast, is operationally primed for AI. The function has long walked the line between success and failure---and innovating is a mandate. Status quo is not. AI aligns with its evidence-based, process-oriented approach. Teams are already familiar with the data science mindset: structured inputs, defined outputs, continuous refinement. Their legacy systems may be imperfect, but their working model is fundamentally compatible with the demands of AI.

Put differently: Clinical has a head start—not because it’s more innovative, but because it’s more structured for innovation. This is a really important point.

So Where Does That Leave Medical Affairs?

This isn’t a eulogy for Medical innovation--and should not be viewed that way. If anything, this is a challenge, a call for action, a call for decision-making. Put basically--it’s a challenge. AI isn't a luxury Medical Affairs can afford to ignore. Sitting on the sidelines while the technology matures isn’t a viable option—not when the entire enterprise is moving forward. But here's the critical question: Where does Medical Affairs want to sit on the AI train? Front? Middle? Back? Or, does it not even want to board?

There is no wrong answer. Not every function needs to be the tip of the spear. But there is risk in not deciding. A function that doesn’t know its position risks mismatching expectations with reality--and that will overwhelm and frustrate employees. It gets stuck in endless pilots with no path to scale. It gets excited by what AI could do, but paralyzed by the gap between vision and readiness.

Final Thought: Leading Is a Choice, Not a Trait

If you find yourself disagreeing with these perspectives—or even feeling the urge to defend the current state of affairs—that’s a good thing. Debate signals engagement, and engagement is how progress begins.

Medical Affairs may not have been built to lead the AI revolution, but that doesn’t mean it’s unfit to. The issue isn’t a lack of pilots or tools; it’s the absence of a shared strategic intent.

What’s needed now isn’t more technology—it’s clarity. Clarity on where Medical wants to go, how quickly it’s willing to move, and what principles will guide the journey. In this moment, leadership isn’t about algorithms. It’s about ambition.

And once Medical Affairs chooses where it wants to sit on the AI train, everything else—talent, structure, investment—can begin to align accordingly.

#ClinicalDevelopment #MedicalAffairs #PharmaInnovation #ValueBasedHealthcare #RWD #PharmaLeadership #DigitalTransformation #PharmaCareers #AIinPharma #ClinicalStrategy #MedicalStrategy #FutureOfPharma RS CONSULTATIVE, LLC

 *Narrative by me; editing by GenAI