An industry insider's take on the success of Karuna Therapeutics, a biotech company acquired for $14B on the strength of their schizophrenia drug KarXT. What struck me was the combination of how simple and almost obvious the fundamental scientific idea was (combine a drug that is known to be effective against schizophrenia but had unpleasant side effects, with a drug that decreases those side effects), and the enormous 16-year slog required to get it over the line. Some insights on (biotech) VCs too.