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For the past year, I’ve been listening to a podcast called Empires—a brilliant exploration of the rise and fall of the world’s great powers. Their beginnings, their glorious overreaches, and their inevitable collapses.
(Empires Podcast – Wikipedia)
A huge thank you to William Dalrymple and Anita Anand for teaching me lessons we really should have covered in school.

Empires. They rise. They conquer. They overextend. Then they collapse—usually after a badly planned banquet, a few questionable alliances, or someone deciding a horse should be in charge (looking at you, Caligula).

And honestly, if that doesn't sound like the average tech startup, I don’t know what does.

Britain once ruled a quarter of the globe with little more than a flag, a telegraph, and an aggressively starched uniform. Now we struggle to get a lateral flow test delivered before the weekend.

But don’t worry—history has a message for your clinical diagnostics startup, especially if you’re burning through your Series A, juggling CE marking, and wondering why your LIMS still refuses to integrate with your analytics dashboard.

The truth is, empires and startups rise and fall for eerily similar reasons: bold beginnings, glorious overreach, strategic misfires, and one too many middle managers.

Founding Legends

Empires, like startups, begin with mythologies. Rome had Romulus and Remus raised by wolves. The British Empire had Drake, tea, and an unwavering love of maps.

Your diagnostics startup? Two talented postdocs, one ageing thermocycler, and a pitch deck made in a coffee shop after a third espresso.

You probably said something about “revolutionising primary care” or “democratising diagnostic access.” If you mentioned “AI-powered,” congratulations—you’ve already conquered LinkedIn.

Much like the earliest empire builders, founders survive on sheer belief and a blissful ignorance of how much things will actually cost.

Expansion

Empires and companies both adore infrastructure. The Romans built roads. The British built railways and bureaucracy. Your diagnostics startup? You’re building assay panels, chasing funding, and pitching to the NIHR with a poster printed at 2am.

You win a MedTech Innovator award. Your founder is photographed beside a Health Secretary who’s already forgotten your name. An NHS pilot looms. Your lab gets ISO-accredited. You’re scaling. The empire grows.

And then someone suggests entering the US market. Historically, this is known as overreach.

Bureaucracy

By the peak of the British Empire, it took a Venn diagram to figure out how to post a letter. Sound familiar?

You’ve got product steering committees, governance boards, QMS audits, and three project managers fighting over a shared Gantt chart. There are now more acronyms than people.

You’ve hired a Head of Strategic Diagnostics Operations Enablement. Nobody’s entirely sure what they do, but they’re excellent at creating Notion pages and introducing yet another software tool every Monday morning.

The startup that once made decisions in the pub now takes six weeks to approve a LinkedIn post.

Disruption and Decline

No empire expects to fall. But every empire meets its Visigoths. For Blockbuster, it was Netflix. For Yahoo, it was Google. For Nokia, it was… touchscreens.

Sooner or later, someone arrives with better tech, fewer dependencies, and a more intuitive UI.

Maybe it’s a new startup with a faster multiplex platform and a slicker brand. Maybe it’s a diagnostics giant that launches a competing product while you’re still formatting your MHRA submission. Or maybe it’s that ex-cofounder who left to do something “less academic”—and is now headlining at Medica.

Worse still, the NHS changes procurement frameworks (again), and your beautifully designed point-of-care kit is now point-of-not-compatible.

You scramble for “strategic partnerships.” Which, in startup terms, is code for we’re open to acquisition.

Post-Empire

Rome became Byzantium. The British Empire became the Commonwealth and a surprisingly influential soft-power podcast industry.

Your startup? Perhaps your IP gets acquired—empire-speak for “absorbed by a larger empire.” Maybe your tech lives on in a new application.

Either way, someone’s still listing “Founder – Exited” on LinkedIn, which is today’s equivalent of declaring yourself Emperor of Gaul.

The Arc of Empire Is the Arc of Enterprise

Both begin with vision, rise on belief, and fall through complexity, competition, or simply failing to integrate with legacy NHS systems.

So as you navigate ISO standards, NHS procurement, and investor expectations, remember:

It’s not the size of your assay menu that matters.
It’s how long your empire lasts after the MHRA changes the rules (again).

References (Harvard Style)

Beard, M. (2015) SPQR: A History of Ancient Rome. London: Profile Books.
Ferguson, N. (2004) Empire: How Britain Made the Modern World. London: Penguin.
Christensen, C. M., Grossman, J. H. and Hwang, J. (2009) The Innovator’s Prescription: A Disruptive Solution for Health Care. New York: McGraw-Hill.
MHRA (2024) Guidance on the UKCA Marking and Diagnostic Devices. Medicines and Healthcare products Regulatory Agency. Available at: https://www.gov.uk/government/publications (Accessed: 30 May 2025).
NHS England (2023) Innovation and Diagnostics Strategy. Available at: https://www.england.nhs.uk/diagnostics/(Accessed: 30 May 2025).