Who Certifies the Twin? Institutional Contenders for Trust in the Digital-Twin Economy of Drug Discovery

Digital twins in medicine are acquiring standards vocabulary before they have survived contact with a regulator, an insurer, or a plaintiff's attorney, an ordering that inverts how standards normally form. This perspective examines four institutional contenders for the role of certifying trustworthy digital twins in drug discovery: standards bodies building on ISO 23247, regulators operating through the FDA's AI credibility framework and the joint NSF–NIH–FDA FDT-BioTech initiative, industry practice consolidating around ISPE's Validation 4.0, and the data owners, genomic sequencers, modeling platforms, device makers, EHR vendors, who control what a twin can be built from in the first place. None is positioned to win outright. Drawing a parallel to the unresolved question of website trust in the mid-1990s, this piece argues that the current framing mistakes trust for a certificate a single body can issue, when it is more likely to be settled the way the analogous question was settled then: by whoever controls the infrastructure, not by whoever writes the standard. Terminology will likely be resolved first, by consortia; liability, the harder question, will be resolved second, by courts, one bad outcome at a time. What looks like a standards race is, at present, a liability vacuum wearing the vocabulary of standardization.