The Alto Advantage: Rethink Everything

Interview with Amit Etkin, MD, PhD, CEO
August 31, 2022
Alto Advantage

The Alto Advantage is a five-part series that covers the company’s guiding principles for pioneering precision psychiatry and, ultimately, establishing a new treatment paradigm in mental health.

Alto was founded on the premise that we have to think differently to do differently. To do this, the company approaches age-old problems with unconventional wisdom, always starting with “why?” 

For Amit Etkin, MD, PhD, decades of practice as a psychiatrist and neuroscientist at Stanford led him to the conclusion that innovative work not only involves questioning, but upending the status quo

“As we work to redefine the treatment paradigm in psychiatry, we start with the assumption that we're not on the right track,” said Dr. Etkin.

“Constructive criticism and scientific questioning have become a healthy part of our culture at Alto. Team members at all levels within our company actively seek feedback as we constantly push one another to learn more and do better.”

Rethink Everything by Questioning Everything

Alto rethinks everything in relation to how their data are captured and analyzed, how studies are conducted, and how clinical programs are prioritized. Throughout every phase of drug development, the company relies on a strong feedback cycle for assessing, adapting, and iterating.

“We’re coming up with new solutions to big problems that have had relatively little innovation put into them in a long time,” commented Dr. Etkin. 

“To do this, we’re open to questioning established facts and asking guiding questions such as, ‘Is this really established? Do we actually believe in this as an immutable scientific fact? Is there a possibility here to draw different conclusions? Everything we do is led and fed by the data,” he said.

Alto’s greatest advantage is that the team, composed of some of the brightest minds in biotech, actively embraces not knowing the right answer for everything right away. This constant questioning allows for an evolution of understanding, which they believe is how true innovation is born.

Pioneering Precision Psychiatry

Alto’s mission to redefine psychiatry innately requires an immense amount of rethinking around the status quo. For decades, psychiatry has been defined by a trial-and-error approach as drugs have been created and prescribed without an understanding of patients’ brain biology.

Understanding that different people respond to the same drug in different ways, a medication can be lifesaving or useless depending on whose brain it’s working in. 

“Psychiatry has seen no meaningful progress in decades because it has not heeded this basic understanding. This is also why most neuroscience companies and drugs have failed,” Dr. Etkin stated.

Alto is different because their platform can predict likely responders to their drugs – all already clinical-stage assets with first- or best-in-class potential – via their validated machine learning biomarker platform. 

“We are defining a nimble, technology-oriented approach to understanding and characterizing patients. If successful, this will define a completely new landscape for patients and providers,” he noted.

This nimble approach serves as the backbone of Alto’s pursuit to pioneer precision psychiatry.

“Everything” Encompasses Everything

The “Everything” in “Rethink Everything” encompasses all aspects of the company’s approach, ranging from patient recruitment to clinical trial operations, data capture and analysis, and the overall organizational structure of Alto.

Alto has rethought how clinical trials should be conducted, reflected by their in-house patient recruitment efforts and internal database of potential study participants, establishing their own network of trial sites, and successfully developing a fit-for-purpose framework for decentralized clinical trials.

On the data collection and analysis front, Alto also leverages custom-built brain biomarker tests, as well as their proprietary AI platform based on over a decade of human data.

“Efficiency is always a large consideration throughout our drug development process. We’re focused on doing things faster for lower cost, all while maintaining quality and improving processes and stratification as we go.” 

Rethink Everything has become part of the collective mandate at Alto, and the team understands that everyone’s voices are equally important. “We maintain a culture where people are empowered to share their perspectives as they gather unique insights into different segments of our work, and how we interact with the outside world, whether with our sites or with our data,” Dr. Etkin shared. 

“It's incumbent upon each of us to constantly question, not in a doubtful way, but in a constructive way, what we’re doing and the feedback we’re receiving from ongoing efforts. We take pride in maintaining a flat organizational structure where everyone is encouraged to take part in this discussion to openly share opinions and ideas,” he concluded.

With “Rethink Everything” as a fundamental value, the Alto team is committed to remaining curious in their approach, creative in their thinking and relentless in their execution.


If you are a doctor or clinic interested in learning more about participation in our drug trials, please send us an email at

Interview with Amit Etkin, MD, PhD, CEO
August 31, 2022
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