3 ms·

The future of pharma: a bleak insider's perspective

2 points by aaavl2821 9y ago

Nomentatus 9y ago
The article doesn't explain why the returns are diminishing so steeply when illnesses, particularly chronic illnesses aren't exactly going away - and our technological capabilities are increasing rapidly. Why doesn't it all balance out to keep progress steady? Part of the reason is that nowadays there are more longitudinal studies that tend to expose larger death rates overall even when drugs are "effective" along some one desired dimension. But a larger reason is this: the vast majority of drugs mimic hormones (messenger molecules) or block them; or other messengers such as neurotransmitters. In other words, we are overruling a brain/body decision and hoping we know better than millions of years of evolution. But there just aren't that many cases when the body's responses are truly inappropriate. We've found most of them already. There are some such cases of course. We've altered our environment a lot, after all. For example, although beta blockers wouldn't be appropriate for nomads because doing without adrenaline might mean not spearing vital game, or even getting outrun and eaten. However in the modern world, with a lot of environmentally caused heart disease, beta blockers are saving a lot of lives. Of course, some drugs are still used to target invaders, but chronic illnesses are by far the bigger part of the medical and economic picture now.
- aaavl2821 9y ago
  The articles point is that we've actually made a lot of progress in treating chronic illnesses versus where we were decades ago with the discovery of statins, beta blockers, aces / arbs, metformin, insulin etc. this is "low hanging fruit". The next generation of drugs for chronic illness face a higher bar than the previous generation of drugs: they can't just work better than placebo, they must work better than a drug that works. And while we've identified many many molecules associated with diseases, only a very small portion of these are amenable to targeting with current drug tech. These have been picked over fairly well. A new generation of drugs will need a breakthrough like "fracking" in oil to create more novel drugs I'd disagree that there are very few cases where the body's response is inappropriate. Arguably in every diseases this is the case. We have identified some instances of this but not as many as we'd like, and in many cases even if we've identified instances we can't do anthying about them
  - Nomentatus 9y ago
    Few not numerically, but as a percentage.

2 points by aaavl2821 9y ago

The article doesn't explain why the returns are diminishing so steeply when illnesses, particularly chronic illnesses aren't exactly going away - and our technological capabilities are increasing rapidly. Why doesn't it all balance out to keep progress steady? Part of the reason is that nowadays there are more longitudinal studies that tend to expose larger death rates overall even when drugs are "effective" along some one desired dimension. But a larger reason is this: the vast majority of drugs mimic hormones (messenger molecules) or block them; or other messengers such as neurotransmitters. In other words, we are overruling a brain/body decision and hoping we know better than millions of years of evolution. But there just aren't that many cases when the body's responses are truly inappropriate. We've found most of them already. There are some such cases of course. We've altered our environment a lot, after all. For example, although beta blockers wouldn't be appropriate for nomads because doing without adrenaline might mean not spearing vital game, or even getting outrun and eaten. However in the modern world, with a lot of environmentally caused heart disease, beta blockers are saving a lot of lives. Of course, some drugs are still used to target invaders, but chronic illnesses are by far the bigger part of the medical and economic picture now.

aaavl2821 9y ago
The articles point is that we've actually made a lot of progress in treating chronic illnesses versus where we were decades ago with the discovery of statins, beta blockers, aces / arbs, metformin, insulin etc. this is "low hanging fruit". The next generation of drugs for chronic illness face a higher bar than the previous generation of drugs: they can't just work better than placebo, they must work better than a drug that works. And while we've identified many many molecules associated with diseases, only a very small portion of these are amenable to targeting with current drug tech. These have been picked over fairly well. A new generation of drugs will need a breakthrough like "fracking" in oil to create more novel drugs I'd disagree that there are very few cases where the body's response is inappropriate. Arguably in every diseases this is the case. We have identified some instances of this but not as many as we'd like, and in many cases even if we've identified instances we can't do anthying about them
- Nomentatus 9y ago
  Few not numerically, but as a percentage.