Dr. Anu Rebbapragada has spent over two decades translating diagnostic innovation into clinically trusted, commercially viable services — as a clinical microbiologist and high-complexity lab director, a national leader across Canadian diagnostic lab networks, a MedTech executive at a Fortune 500 global diagnostics company, and a strategic advisor to entrepreneurial ventures. She holds a PhD in microbiology and molecular genetics, has published over 40 peer-reviewed papers, sits on Canada's first national AI-in-clinical-decision-support standards committee (CAN/DGSI 138), and completed Harvard Medical School's executive program on AI implementation in healthcare.

In this conversation, Anu walks through what she calls "pilot purgatory" — the graveyard where excellent Canadian diagnostic research dies before it ever reaches routine practice. She unpacks why the problem isn't the science: it's a fragmented, thirteen-jurisdiction reimbursement patchwork where the identical test on the identical platform pays out differently province to province, a regulatory pathway with no equivalent to the U.S. lab-developed-test route, and what she terms "institutional inertia" — staff so stretched sustaining outdated, paper-based workflows that they have neither the bandwidth nor the incentive to adopt something new. She traces one case in detail: a McMaster-spun-out molecular test for endometriosis, clinically promising, structurally boxed in by the very system meant to bring it to patients.

The conversation turns to what Anu calls a kind of collective amnesia: Canada proved during COVID that rapid, responsible diagnostic innovation at scale is possible — home collection, point-of-care testing, virtual portals, all stood up fast and safely — only to revert to sluggish, pre-pandemic defaults once the pressure lifted. She and Natalie dig into the binary nature of Canadian healthcare (public system or private workaround, with little in between), the "postal code lottery" of provincial fragmentation, and why she believes the missing ingredient isn't more pilots or more publications but public awareness and grassroots advocacy — health consumers demanding better tests exist, rather than assuming the status quo is the ceiling.

This is Breaking Innovation Paralysis: research for a book on why Canada keeps losing the cures, capital, and companies it builds. Not a promotional platform, an honest look at the structural gaps: inertia, risk aversion, and diffusion of responsibility.

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