In Episode 4 of Precision Signals, Dr. Sean Khozin sits down with Daniel Arbess—investor, social entrepreneur, and healthcare innovator—to explore why the limiting factor in solving cancer and neurodegenerative diseases isn't breakthrough science, but institutional innovation.

Daniel Arbess has built a career on questioning foundational assumptions across multiple domains: from analyzing Cold War nuclear policy to restructuring post-Soviet industries as the youngest-ever partner at White & Case, to founding Xerion Capital, a hedge fund that delivered over 25% annualized returns through the 2008 financial crisis. Now, he's applying that same lens to healthcare transformation.

In this episode of Precision Signals, Dr. Sean Khozin speaks with Dr. James Gulley, Chief of the Medical Oncology Service and Co-Director of the Center for Immuno-Oncology at the National Cancer Institute.

Dr. Gulley is one of the world’s leading figures in immuno-oncology. He helped bring immune-based cancer therapies from an era of skepticism into a clinical mainstay, shaping both the science and the clinical frameworks that define the field today.

Their conversation explores the critical frontiers of immunotherapy: the limits of predictive biomarkers, the biological opacity of treatment resistance, and the shortcomings of current trial designs. They discuss adaptive clinical trials, new endpoints, and the integration of AI into clinical research. Emerging tools such as digital pathology, wearable monitoring, and continuous physiologic data capture are highlighted, including recent work detecting CAR-T toxicity before it becomes clinically evident.

Dr. Michelle Longmire, physician-scientist, technologist, and CEO, cofounder of Medable; shares how early lessons in science and systems design shaped her mission to fix one of medicine’s most persistent bottlenecks: slow, fragmented, and inaccessible clinical trials.

We discuss her path from autoimmune skin disease research at Stanford to building Medable into a global clinical trial infrastructure platform operating across 14 therapeutic areas, and what it takes to align technology, AI, and scientific rigor with the needs of patients, regulators, and researchers.