14 ms·

With no prospects for profits, big pharma neglects new infectious diseases

154 points by mmoya 7y ago

nostromo 7y ago
Perhaps they’re behaving entirely rationally. Infectious diseases do not kill that many people compared to cancer in America. We may have a bad “flu” year this year, with a spike of elderly deaths, but we have a bad cancer year every year.
- JamesBarney 7y ago
  But we don't really develop "cancer" drugs. We develop a drug that treats certain type of pancreatic cancer that give the individuals another 3-6 months to live. But curing an infectious disease can give someone another 40 years.
  - refurb 7y ago
    There are several cancer (lymphomas) that were literal death sentences a decade or two ago, but how have a very high cure rate. It's not fair to say we don't develop cancer drugs because some, very difficult to treat cancers, haven't seen as much progress as others.
    - dehrmann 7y ago
      Testicular cancer is now very treatable, but before Cisplatin, the prognosis was pretty grim. I guess to grandparent's comment, we absolutely do develop chemotherapy drugs, and many don't just buy you six months, they're life-saving.
      - refurb 7y ago
        I unfortunately can't find it, but there was an interesting chart that showed overall survival in metastatic colorectal cancer. It covered the last 30 years. Each new therapy improved survival by only 6-12 months, but each new drug was more effective than the last. Over those 30 years, the median survival went from 6 months to over 5 years. People shouldn't discount incremental improvements because that's often how medicine progresses.
        DrScump 7y ago
        Cell type is much more relevant to curability than location.
  - est31 7y ago
    Cancer is an extremely complex disease and we are making real progress on it. Only because we don't discover a powerful medication like antibiotics that eliminates multiple types of the same disease doesn't mean that we aren't making progress.
  - drocer88 7y ago
    This recent drug does better than 3-6 months: Nivolumab . One-Third of Patients With Advanced Melanoma Survive at Least 5 Years After Nivolumab Treatment. (https://www.ascopost.com/issues/may-10-2016/one-third-of-patients-with-advanced-melanoma-survive-at-least-5-years-after-nivolumab-treatment/ https://www.ascopost.com/issues/may-10-2016/one-third-of-pat... Here's another recent success : https://hcp.lutathera.com/ https://hcp.lutathera.com/ --- https://www.nejm.org/doi/full/10.1056/NEJMoa1607427 https://www.nejm.org/doi/full/10.1056/NEJMoa1607427 At the data-cutoff date for the primary analysis, the estimated rate of progression-free survival at month 20 was 65.2% (95% confidence interval [CI], 50.0 to 76.8) in the 177Lu-Dotatate group and 10.8% (95% CI, 3.5 to 23.0) in the control group. Lutathera delivers a radioactive molecule to the tumor.
    - m0zg 7y ago
      $150K+/yr. OOF. On the positive side, 20 years from now these drugs will be dollar a bucket as generics. Thank god for capitalism.
      - _jal 7y ago
        No, it won't. Look at inulin prices. Or pharma-bro's Daraprim. That's what capitalism does to generics.
        m0zg 7y ago
        Not really. Regarding insulin, that's what _the lack of capitalism_ does to generics. You can't import insulin into the US, and that's why it's so expensive here. Daraprim wasn't generic until literally 5 days ago: https://www.biospace.com/article/fda-approves-first-generic-for-daraprim-the-drug-martin-shkreli-increased-the-price-of-by-5-000-percent-/ https://www.biospace.com/article/fda-approves-first-generic-...
  - briandear 7y ago
    How much experience do you have in oncology? There are millions of breast cancer survivors that might disagree with you. There is also the false assumption that we haven’t made much progress in infectious diseases when, in fact, we have. Tamiflu was launched in 1999. AIDS drugs are light years ahead of where they were 25 years ago. We have effective vaccines for some of history’s worst killer diseases. Gilead has been working on remdesivir since 2016 for Coronaviruses. Hepatitis C is now curable (also thanks to Gilead.) There is a lot of significant work happening in infectious diseases. However, curing cancer is the holy grail and a pursuit of that is on the same level as pursuing manned space flight. Flying people into space seemed frivolous at the time as well. After all, think of all of the hungry kids would could feed if we redirected Apollo money! However, space flight gave society countless advances that we didn’t foresee at the time. Perhaps we should argue that studying quantum physics is a waste of resources. Or studying astronomy. Or any number of fields where societally-useful breakthroughs are few and far between. It’s ridiculous to imply that developing cancer drugs should be ditched in favor of developing more infectious disease drugs. We can walk and chew gum at the same time: this isn’t guns or butter. If we want to apply pure rationality to drugs: let’s stop cancer drug expenditures so we can save more people from malaria, then we could apply that logic to social programs as well: why bother helping the mentally disabled when instead we could direct those funds towards something that provides more economic value to society? A kid with cerebral palsy isn’t going to contribute as much to society as a healthy kid — so why waste resources on that research? Of course it isn’t a waste when it’s your kid. Following that line of reasoning and we ultimately end up with eugenics and society would become a very nasty place indeed.
  - Broken_Hippo 7y ago
    We do develop "cancer" drugs to a point. That HPV vaccine is preventing an entire group of cancers! But cancer itself is... complicated. There are many different types with many different causes that are complicated by many different things. Breast cancer is not the same as skin cancer, and neither of these are lung cancer. But we do, to an extent, know how to treat things to a point. Sometimes, our best efforts have only resulted in giving folks 3-6 months. And we do cure or prevent some infectious disease. The plague and leprosy, for example, is curable. We have taken leaps and bounds with HIV/Aids - while we can't really cure it, we can give drugs to folks to stop it from being so infectious. But like cancer, "infectious disease" comes in many forms, some being vastly more complicated to "cure" than others. This is why some things, like the common cold and common influenza do not have cures. These are hard problems. And for lack of better words, we've simply not "unlocked" the secret in ways that would be good year after year.
- StanislavPetrov 7y ago
  Perhaps what's "rational" in a purely economic sense isn't whats best for the nation or for society. In an economic sense, you could make an argument that slavery is "rational" as far as profits for slaveholders are concerned, but we don't allow slavery because its wrong and immoral despite the potential economic benefits to certain vested interests. Similarly, perhaps its time that we as a society reevaluated our reliance on health care delivery systems that base their agenda on outcomes that are economically profitable for them, rather than what is desirable for our society as a whole.
  - dodobirdlord 7y ago
    Slavery, really? Besides, totally beside the point. The argument for rationality isn't that if we exclude the people who experience downside, maybe it's a net positive (always true by tautology), but rather that maybe even counting the people who experience the downsides it's still rational. The novel coronavirus is likely to end the lives of a lot of elderly people, but the majority of elderly people are going to have their lives ended by cancer or heart disease. Perhaps, even with the threat of pathogens like the novel coronavirus lurking to strike, it still makes sense to put most of our resources toward researching cancer and heart disease.
    - geofft 7y ago
      Yes, slavery, really. Rational actors today engage in slavery. https://venturebeat.com/2020/03/02/apple-foxconn-and-81-others-are-accused-of-using-uighur-forced-labor/ https://venturebeat.com/2020/03/02/apple-foxconn-and-81-othe... And you can construct a "rational" argument for it: the slaves are living under an oppressive government anyway and apparently nobody is going to intervene, so if they're stuck in internment camps, may as well give them something to do with their time. Sure, they don't have freedom, but they weren't going to have it anyway, so it's still rational. Right? In seriousness - if you don't take into account the economic reliance on slavery that jurisdictions with legal slavery (e.g., the US South in the 1800s) had, and you claim it's solely that irrational slaveholders saw certain people as less than human in the abstract, you've missed a good part of the explanation and risk inaccurately understanding how to prevent it from happening again. People had a strong economic incentive to come up with justifications for their objectively immoral actions.
- empath75 7y ago
  This bad flu is going to kill tens of millions of people and wipe out health systems around the world and wreck the world economy. I wish people would stop downplaying it.
  - Aunche 7y ago
    If it is really going to kill tens of millions of people, you can bet that pharmaceutical companies are already working on cures.
block_dagger 7y ago
With the amount of economic upheaval from the coronavirus scare, I fail to see how there are no prospects for profit.
- alephnan 7y ago
  Creating value is one part, capturing it is another
  - csallen 7y ago
    Not sure why people are downvoting you. It's clearly the case that there are lots of problems you can solve that create value and make/save people money, yet don't result in you capturing any of that money for yourself. For-profit companies mostly ignore those kinds of problems by definition.
- H8crilA 7y ago
  SARS vaccine was abandoned after the epidemic died out because the funding was cut. Pharma is being perfectly rational knowing that in 6 months all of the funding may be cut. What's not rational is cutting funding to supposedly disappeared diseases. They do re-occurr. The Spanish Flu died out at first, only to re-emerge in WW1 trenches and wreck absolute destruction.
  - hobofan 7y ago
    > What's not rational is cutting funding to supposedly disappeared diseases. They do re-occurr. The Spanish Flu died out at first, only to re-emerge in WW1 trenches and wreck absolute destruction. Wouldn't the fact that the disease has disappeared in human populations greatly increase the required funding and limit the effectiveness of the research? The best you could do would be to produce a bandwidth of candidate drugs that can't advance to human trials for ethical reasons.
- aschatten 7y ago
  It's very hard to incorporate events like this into a financial model. With chronic disease like diabetes or cancer they can get a pretty good forecast of demand, so it's translates into a clearer understanding of ROI with higher confidence: more they invest the more they get plus some error, but even the error won't offset the forecast by much. With epidemics, not only you need to predict when, but also what kind of virus it's gonna be. The reward is great, but so is the risk. Would you invest $100 to almost surely get back ($130 +/- $5), or $1000 with a potential outcome of $10000, but very low confidence that it is going to happen at all before you run out of money. Similar to financial crisis, if the next one could be predicted, it wouldn't happen.
refurb 7y ago
What's needed is a new payment model for anti-infectives. This already happens at a small scale with grants from institutions like BARDA. The DOD of also does this for vaccines for biological weapons like anthrax where there is a high likelihood the drug will never be used, but a vaccine is needed because if there is an outbreak, the consequences are severe. Basically, rather than paying for drugs on a per unit basis, you pay a lump sum for access to the drug. This solves the issues of spending $100M to develop a new treatment for some disease where there is never a outbreak and you cover none of the cost of R&D. There have been ideas to have X-Prizes for new antibiotics. Discover a new drug for a anti-biotic resistant infection? Great, here is $500M as long as you agree to produce as much drug as needed for free or some nominal cost.
- JumpCrisscross 7y ago
  > Great, here is $500M as long as you agree to produce as much drug as needed for free or some nominal cost Why not give $5bn (or whatever the NPV of the drug at a reasonable rate of return might be) in exchange for releasing the drug into the public domain? Then any number of generics manufacturers could be contracted to maintain a stockpile.
  - refurb 7y ago
    Sure you could do that, but manufacturing drugs isn't as simple as hitting a switch - the infrastructure needed along with the scientific expertise is sometimes hard to replicate.
    - markdown 7y ago
      The infrastructure and expertise exists in India, and they'll gladly manufacture drugs at a cost that the developing world can afford.
      - refurb 7y ago
        Depends on the drug. Small molecules, sure? Complex biologics? Even other large pharma companies can have challenges making those.
WalterBright 7y ago
In the 1960s big increases in regulations on new drug development led to big cost increases, and hence less interest in non-blockbuster treatments.
- refurb 7y ago
  Sure, but as a result we don't have problems like thalidomide popping up every decade or so. There are benefits (and drawbacks) to having a much more stringent approval process. And probably worth adding that in public health emergencies, the FDA is more than willing to pull back on regulations in the interest of the public good.
  - WalterBright 7y ago
    Thalidomide was never approved for use in the US, and the heavy regulation came afterwards.
    - jokowueu 7y ago
      It's was never approved because of one person that was continually harrased if it wasn't for her it would have been approved . There were only 11 people responsible to review these new drugs . For crying out loud pcp was approved as an analgesic after using it on a few prisoners . FDA's stringent approval process is required
      - WalterBright 7y ago
        > FDA's stringent approval process is required The downside of that is greatly reduced new drug development due to the expense, much more expensive drugs, and years of delay for the ones that are worked on. If you have a less popular disease, or can't wait years, you're out of luck.
        maxerickson 7y ago
        FDA has a special process and contributes funds to developing drugs for rare diseases: https://www.fda.gov/about-fda/office-clinical-policy-and-programs/office-orphan-products-development https://www.fda.gov/about-fda/office-clinical-policy-and-pro...
daenz 7y ago
"Neglects" implies that they're ignoring their responsibilities. How is this the case?
m0zg 7y ago
How can you target "new" infectious diseases if they are really "new" every year other than by guessing the right vaccine (as they do e.g. for the flu)? I mean, what worked for SARS won't necessarily work for COVID19, even though it's also a subvariant of SARS. If this is the case, by the time you come up with a drug and take it through all the (extremely costly) stages of testing approval, it'll be too late already, and herd immunity would have obviated the need for what you've just invested billions and countless person-years into.
- RandomWorker 7y ago
  You can monitor existing viruses in wild animal populations and give them treatment before it mutates and goes to humans. This would be relatively cheap compared to solving the problem afterwards. We now know that bats are prime suspects for carriers of these diseases because they them selves don’t get sick much from them, live is close quarters, fly and are mammals.
  - Broken_Hippo 7y ago
    You'd be wasting money, though, and not necessarily saving money. Most animal diseases do not cross over to humans and IIRC, most of them that have crossed over come from farm animals. More people live in close contact with farm animals than they do things like bats. This effort would honestly be better spent working on things humans already have.
perl4ever 7y ago
I thought the "party line" was that private industry doesn't accomplish much if anything, so isn't "big pharma" irrelevant? It makes more sense to demand higher taxes and more basic research.
- lazyier 7y ago
  The problem is that regulation is so expensive there isn't any financial motivation in researching does that are unlikely to generate massive revenue. The reason for this is FDA is fundamentally extremely conservative. The people that run the regulatory system are just faceless bureaucrats and are risk adverse. Their pay is based on seniority and there isn't any financial motivation for them to take risks or stand out. FDA is nothing more then a collection of individuals so the motivation of the agency is a mirror image of the motivations of the people running it. To put it bluntly: When diseases like cancer or influenza or <insert name of any disease> kill people the diseases get blamed. But if a drug makes to it market and ends up maiming people or killing them then the FDA gets blamed. So from the FDA's perspective it's much more important that we have ultra-safe drugs then it is to have new drugs to cure and treat diseases. The regulators are going to take the default position that more testing and screening and expenses are good. While allowing consumers and doctors to take risks to treat diseases is bad. And over the decades it has just gotten more and more and more and more expensive to get the drugs out to the public. And since it's too expensive to make new drug companies because of the regulators then you will never see any smaller nimble companies come in and compete with them and force the big companies to behave themselves. This is why you see all the generic drugs being bought up in the past couple decades. During the Obama administration they signed regulatory changes that rose the cost of validating generic drugs considerably. It wasn't so expensive that it would drive generics from the market, but it's expensive enough that you can't make new generic drug companies. So the big name brand drug companies just buys them all up. And because of that they no longer face competition from generics. They own both the name brands and the generics. If it was cheaper to make generic drug companies this approach wouldn't work. People would make new companies for the sole purpose of getting bought. It would make buying companies up to kill competition unsustainable. I've worked in heavily regulated industries before and it's a pretty obvious pattern. Regulators regulate. Costs go up. Competition goes down. And then the big companies become isolated from competition because it's just too expensive to compete with them. Then the government has to bend over backwards to ensure the profitability of these dominate corporations because if they were to go out of business there would never be any replacements. It's a form of market lock-in. Over regulation effectively becomes a license for these big pharma companies to do pretty much whatever the fuck they want. They love it.
pkaye 7y ago
I think governments should take charge in this. Look at how much the development of the ebola vaccine bounced around for years. https://www.statnews.com/2020/01/07/inside-story-scientists-produced-world-first-ebola-vaccine/ https://www.statnews.com/2020/01/07/inside-story-scientists-...
dfsegoat 7y ago
...as they develop a vaccine for Ebola. https://en.m.wikipedia.org/wiki/Ebola_vaccine https://en.m.wikipedia.org/wiki/Ebola_vaccine
blackrock 7y ago
So there you have it. Late Stage Capitalism Failure. No ability to make a bajillion dollars in rent-seeking profit. So F it! Let the people die.
- Mirioron 7y ago
  Well, if capitalism is the problem, then why don't the socialist/communist countries develop the drug instead? Or alternatively, the community could come together and they could work on coming up with the treatment as a group. But we all know that neither of these are likely to happen. Researchers need money to live, labs need money to run.
  - VvR-Ox 7y ago
    Because there is no such countries until someone can prove otherwise (which will not happen because they don't exist). Big capital put this idea inside the heads of many people living in the West and until today they really believe there is countries who are socialist/communist. Neither the GDR nor the UDSSR or China are examples for countries like that and people who know about politics, economy and society know this as a fact. It is easy for you to criticize all alternatives at once because you have never seen any and chose to believe what the ruling party (=capitalism) makes you believe.
    - ros65536 7y ago
      The classic no true communist country fallacy. Have you considered that no such country exists because it is impossible, vecause it so quickly devolves into socialist hell like in USSR, north korea?
    - ben509 7y ago
      > Because there is no such countries until someone can prove otherwise (which will not happen because they don't exist). It won't happen because you'll shift the goal posts. A common dodge is that they're state socialism. The problem with this dodge: it's definitely true that state socialism is impure. But, it's 90% of what you want, and it fails catastrophically. Then the answer is, "well, it can only work if it's 99%!" The regulated markets we have in Western nations, however, are 90% of an ideal "truly free market" and they work quite well. And we find that incremental reforms that deliver to people a little bit more of their economic liberties also improve people's lives bit by bit. Markets have the property that the freer they are, the more benefits they provide. The other dodge is that "it wasn't socialism's fault," especially with Venezuela. Yes, they had an economy centered around oil and that was a problem. The issue was that socialist-inspired reforms made it worse, especially nationalizing the oil companies and price controls. Markets thus have an additional property that they are robust, they allow people to route around problems and mitigate them. Planning is brittle because it necessarily centralizes power, and it tends to fail because planners can't respond to crises in a decentralized manner the way a market naturally does. The third dodge, common now thanks to Sen Sanders, is the Scandanvian nations show that socialism works. But their economies work because they took the opposite approach of 10% socialism. That's not great for apologia since it follows that socialism only works when you hardly do it. > Big capital put this idea inside the heads of many people living in the West and until today they really believe there is countries who are socialist/communist. No one who read the dictionary[2] is claiming that there were any communist nations, since a defining aspect of communism is the absence of the state. You can have lots of communists (persons whose end goal is communism) in a socialist nation, of course, since, as Lenin noted, the purpose of socialism is communism. And Lenin introduced state socialism, not some mad capitalist, and he believed it was, if not proper socialism, a clear stepping stone to socialism. The nations definitely called themselves socialist, and socialists all over the world agreed and while things appeared to be going well, they were bragging about how this proved socialism worked. But it wasn't working because the planners were lying. Socialists here lied and covered up tremendous deaths[1]. And it's only when the problems couldn't be hidden that they became not socialist anymore. [1]: https://en.wikipedia.org/wiki/Walter_Duranty#The_Holodomor_(1932-1933)_and_the_1938_Moscow_Show_Trials https://en.wikipedia.org/wiki/Walter_Duranty#The_Holodomor_(... [2]: That does leave a lot of people claiming it, of course.
foogazi 7y ago
Are there national laboratories with the capabilities to find a cure? Is there a NASA equivalent for infectious diseases to launch a covid-19 moonshot?
- cactus2093 7y ago
  The WHO is saying a vaccine is 18 months out, and I’m very curious what that means. I haven’t seen any detail as to why it takes that long. It’s short enough that clearly they expect it won’t be very hard, like no one would say a general cure for cancer is 18 months out. So what is preventing us from speeding it up more? Why can’t it be made in 6 months, or 3 months? Is the majority of that 18 months a basic r&d phase of figuring out what will work? If so, why can’t it be parallelized and sped up with more resources? Is it time for clinical trials? To ramp up manufacturing? I can’t help thinking that for a disease that prevents such a big risk to society, there must be clever ways to speed up the normal process for this kind of thing, perhaps with some government involvement in funding or coordinating efforts.
  - Infinitesimus 7y ago
    > People have been saying a vaccine is 12-18 months out, and I’m very curious what that means. I haven’t seen any detail as to why it takes that long. All the things you said are factors. Clinical trials are one of the biggest because you have multiple phases to observe to guarantee safety. It's no use shipping a vaccine in 3 months after a small test and have everyone die in a year because of a side effect no one waited long enough to see. Drug development and safety is a very complex space from what I've learned
    - vikramkr 7y ago
      Guaranteeing safety is absolutely a crucial part of it. And if you pull something out that doesn't work, giving people a false sense of immunity would also make things worse. And safety shouldn't be underestimated. The story of dengue vaccine development is a cautionary tale. The first time you get dengue is usually not too bad, but it can be deadly if you get it again. Part of that is hypothesized to be driven by your own immune system, which, once immunized against one strain, produces antibodies against it in the next infection. However, if it's a slightly different strain of dengue the second time around, the antibodies meant to neutralize the disease are believed to make the disease more virulent instead (antibody-dependent enhancement). The immune system makes it worse. So when a dengue vaccine that didn't fully immunize against all strains was developed (not deliberately, people tried to immunize against all strains but this is a case where less efficacy than expected made things worse), it didn't make things better. It ended up priming people to get dengue. Biology is super weird - even something as "simple" as vaccine development has a lot of unknown unknowns. And as dengue showed us, it's not just a case of "it might not work," because it could make things worse. That's why we have to run these clinical trials and take time to do things right, especially for something that would be as widely deployed as a coronavirus vaccine.
Der_Einzige 7y ago
Sounds like a good time for capital N nationalization! :)
zachguo 7y ago
Since COVID-19 is targeting elders, I can imagine there are evil capitalists or bureaucrats who view this pandemic as a gigantic economic stimulus for the next decade. Sorry for my evil thought.
- bocklund 7y ago
  The price of the Wirecutter’s #1 recommended forehead/ear thermometer on Amazon has changed from $30 between 2016 and February 2020 to $100 since February. https://camelcamelcamel.com/iProven-Thermometer-Temporal-Forehead-Function/product/B01H3MTVE8 https://camelcamelcamel.com/iProven-Thermometer-Temporal-For...
- vikramkr 7y ago
  The performance and volatility of the markets over the past few days do not agree with the idea that capitalists and bureaucrats view this as an economic stimulus - having your workforce quarantined and your imports restricted are not good for business
aschatten 7y ago
The article mentions the difficulties with clinical trials. It makes sense, now China running hundreds of studies on coronovirus with thousands of people: http://www.chictr.org.cn/searchprojen.aspx?title=&officialname=&subjectid=&secondaryid=&applier=&studyleader=&ethicalcommitteesanction=&sponsor=&studyailment=coronavirus&studyailmentcode=&studytype=0&studystage=0&studydesign=0&minstudyexecutetime=&maxstudyexecutetime=&recruitmentstatus=0&gender=0&agreetosign=&secsponsor=&regno=&regstatus=0&country=&province=&city=&institution=&institutionlevel=&measure=&intercode=&sourceofspends=&createyear=0&isuploadrf=&whetherpublic=&btngo=btn&verifycode=&page=1 http://www.chictr.org.cn/searchprojen.aspx?title=&officialna... testing few drugs and their combination at a time, it's hard to do outside of epidemic.
beardedman 7y ago
What a pile of sensationalist rubbish. In 2018 we had an estimated 400k people dying of Malaria [1] & around 600k (est.) people dying of cancer in the US alone. [2] Compare that to the 3110 deaths that have happened in the last 3 or so months for COVID-19. [3] I think a little perspective would go a long way here. [1] https://www.who.int/news-room/feature-stories/detail/world-malaria-report-2019 https://www.who.int/news-room/feature-stories/detail/world-m... [2] https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html https://www.cancer.org/research/cancer-facts-statistics/all-... [3] https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---3-march-2020 https://www.who.int/dg/speeches/detail/who-director-general-...
- jokowueu 7y ago
  Covid if not put under control will effect every one everywhere (unlike malaria) . Imagine a 1% fatality on the human population but at a repetitive rate .
  - beardedman 7y ago
    That 1% is still to be confirmed. We don't know the mortality rate yet.
- empath75 7y ago
  > Compare that to the 3110 deaths that have happened in the last 3 or so months for COVID-19. [3] There were 300 deaths 30 days ago. There will be 30,000 this month. And the month after that?
  - beardedman 7y ago
    There will be 30k deaths in March? So it's going to go from 1.3k to 30k in the next 20 days?
VvR-Ox 7y ago
1:0 for Capitalism vs. Humanity. Exactly this is why the motivation to do at least some things should not be bound to earning profit. There is common goods that we need to share, global issues that need to be addressed together and we need to find ways to achieve this if we want to develop further as a civilization. Money must not be the sole reason why we do things or we will fail with this "strategy" and we need to come up with good ideas for an alternative and try it. I know this will probably not make me very popular especially with people living in the US as their minds are constantly being flooded with the idea that everything straying from capitalism is socialism and therefor evil. I will post it nevertheless, down-votes don't hurt and I will write my opinion until it is censored completely.
- tim333 7y ago
  Not sure 1:0 is accurate scoring. Most of the drugs and medical advances we have came out of capitalist systems. Not saying that capitalism is perfect or there shouldn't be government funded labs also.
- deleted 7y ago
  [deleted]
LifeLiverTransp 7y ago
This needs a very diffrent financial construct to encourage research. A sort of lifelong dividend, offered by anyone cured of a potential fatal or permanent disease. If out of financial range of a individual, bolstered by a insurance or state funds.
bionhoward 7y ago
one way around this is to develop platforms which apply to a range of diseases. why reinvent some fancy shape of atoms for each disease? it's entirely possible to develop something which works on cancer and coronavirus. just look at CRISPR, or RNAi ... master delivery and you can simply re-target the therapy toward different sequences. Here (https://github.com/bionicles/coronavirus https://github.com/bionicles/coronavirus) is code to design CRISPR-Cas13 CARVER (https://www.sciencedirect.com/science/article/pii/S1097276519306987?via%3Dihub https://www.sciencedirect.com/science/article/pii/S109727651...) 30mer guides against regions of Coronavirus conserved between SARS, MERS, HKU1, and SARS-nCoV-2 (Covid-19 Virus) and not found in highly expressed Lung protein-coding RNA. Uses BioPython, Redis SADD/SISMEMBER, and tools from EMBL (Emboss Consensus and Clustal Omega Alignment) and data from NCBI. The good news is, it's probably possible to delete Coronavirus genome directly inside the lungs, without vaccines; just deliver nanoparticles or adenovirus (doesn't replicate) with an inhaler and express CRISPR-Cas13 and the gRNA using the Surfactant promoter sequence for lung-only expression of the therapy disclaimer: I need to work on the readme and write a blog post, but the data is there and the general core works. There's ~30k guides possible and 226 target 13 longest conserved regions across 4 different outbreaks spanning 17 years of virus evolution (provides reasonable confidence these regions are necessary for the virus to function) If anyone knows some folks in the Pharma / Biotech industry I could use help to run the tests on this, tell em to email bion at bitpharma.com edit: readme improved. currently looking for promoter consensus sequences for lung (surfactant protein TFs like TTF-1)
jmartrican 7y ago
I would imagine living customers and a workforce that is not quarantined would be reason enough, but hindsight is 20/20. It would be silly if the offices of a big pharma company are closed due to an infectious disease that the big pharma company would have been best suited to tackle but cant due to neglect in fighting infectious diseases.
crimsonalucard 7y ago
If commercial incentive isn't viable then the incentive needs to change. Think of it like the military but as a medical industrial complex.
StreamBright 7y ago
Why are we surprised? If the incentives are not for curing infectious diseases than they won't do it. For big pharma, the incentives are: keep humans sick as long as it is physically possible and charge along the way.
- vikramkr 7y ago
  The incentives are to make money, not to keep people sick. You can charge a lot more for a cure than a treatment, and the empirical evidence of new cures for genetic diseases and subtypes of cancers in the past couple years is showing a lot more activity there. Gilead made bank on curing hep C, even with all the political backlash to the price. It's a competitive environment - if your drug treats and your competitor cures, you don't have the luxury of charging money since your competitor will be getting all the patients. The incentives for antibiotics are different though. Because of antibiotic resistance, society would rather not use the best antibiotic unless absolutely needed so we have a backup. So the better the antibiotic, the less people want to use it. In that case yes the incentives are completely broken.
  - StreamBright 7y ago
    I agree with the make money part. Other than making money there is no other incentive.
chapium 7y ago
This is the part where public corporations come in.
magwa101 7y ago
The market does not solve everything, but it does create everything. Therefore we are evolving into pure consumerism.
marricks 7y ago
Maybe there’s just some things that are common good and should be publicly funded rather then gambling on capitalism to solve it
ThomPete 7y ago
The opportunity is a generalized approach to solving these diseases which i think we are getting to finally. Thats the true promise of digital technology. Thats how incentives gets aligned.
Proven 7y ago
And who destroyed the prospect of profits for medicine and vaccine for infectious disease if not statists who won't let capitalists get a good profit on investments in such products?

154 points by mmoya 7y ago

Perhaps they’re behaving entirely rationally. Infectious diseases do not kill that many people compared to cancer in America. We may have a bad “flu” year this year, with a spike of elderly deaths, but we have a bad cancer year every year.

JamesBarney 7y ago
But we don't really develop "cancer" drugs. We develop a drug that treats certain type of pancreatic cancer that give the individuals another 3-6 months to live. But curing an infectious disease can give someone another 40 years.
- refurb 7y ago
  There are several cancer (lymphomas) that were literal death sentences a decade or two ago, but how have a very high cure rate. It's not fair to say we don't develop cancer drugs because some, very difficult to treat cancers, haven't seen as much progress as others.
  - dehrmann 7y ago
    Testicular cancer is now very treatable, but before Cisplatin, the prognosis was pretty grim. I guess to grandparent's comment, we absolutely do develop chemotherapy drugs, and many don't just buy you six months, they're life-saving.
    - refurb 7y ago
      I unfortunately can't find it, but there was an interesting chart that showed overall survival in metastatic colorectal cancer. It covered the last 30 years. Each new therapy improved survival by only 6-12 months, but each new drug was more effective than the last. Over those 30 years, the median survival went from 6 months to over 5 years. People shouldn't discount incremental improvements because that's often how medicine progresses.
      - DrScump 7y ago
        Cell type is much more relevant to curability than location.
- est31 7y ago
  Cancer is an extremely complex disease and we are making real progress on it. Only because we don't discover a powerful medication like antibiotics that eliminates multiple types of the same disease doesn't mean that we aren't making progress.
- drocer88 7y ago
  This recent drug does better than 3-6 months: Nivolumab . One-Third of Patients With Advanced Melanoma Survive at Least 5 Years After Nivolumab Treatment. (https://www.ascopost.com/issues/may-10-2016/one-third-of-patients-with-advanced-melanoma-survive-at-least-5-years-after-nivolumab-treatment/ https://www.ascopost.com/issues/may-10-2016/one-third-of-pat... Here's another recent success : https://hcp.lutathera.com/ https://hcp.lutathera.com/ --- https://www.nejm.org/doi/full/10.1056/NEJMoa1607427 https://www.nejm.org/doi/full/10.1056/NEJMoa1607427 At the data-cutoff date for the primary analysis, the estimated rate of progression-free survival at month 20 was 65.2% (95% confidence interval [CI], 50.0 to 76.8) in the 177Lu-Dotatate group and 10.8% (95% CI, 3.5 to 23.0) in the control group. Lutathera delivers a radioactive molecule to the tumor.
  - m0zg 7y ago
    $150K+/yr. OOF. On the positive side, 20 years from now these drugs will be dollar a bucket as generics. Thank god for capitalism.
    - _jal 7y ago
      No, it won't. Look at inulin prices. Or pharma-bro's Daraprim. That's what capitalism does to generics.
      - m0zg 7y ago
        Not really. Regarding insulin, that's what _the lack of capitalism_ does to generics. You can't import insulin into the US, and that's why it's so expensive here. Daraprim wasn't generic until literally 5 days ago: https://www.biospace.com/article/fda-approves-first-generic-for-daraprim-the-drug-martin-shkreli-increased-the-price-of-by-5-000-percent-/ https://www.biospace.com/article/fda-approves-first-generic-...
- briandear 7y ago
  How much experience do you have in oncology? There are millions of breast cancer survivors that might disagree with you. There is also the false assumption that we haven’t made much progress in infectious diseases when, in fact, we have. Tamiflu was launched in 1999. AIDS drugs are light years ahead of where they were 25 years ago. We have effective vaccines for some of history’s worst killer diseases. Gilead has been working on remdesivir since 2016 for Coronaviruses. Hepatitis C is now curable (also thanks to Gilead.) There is a lot of significant work happening in infectious diseases. However, curing cancer is the holy grail and a pursuit of that is on the same level as pursuing manned space flight. Flying people into space seemed frivolous at the time as well. After all, think of all of the hungry kids would could feed if we redirected Apollo money! However, space flight gave society countless advances that we didn’t foresee at the time. Perhaps we should argue that studying quantum physics is a waste of resources. Or studying astronomy. Or any number of fields where societally-useful breakthroughs are few and far between. It’s ridiculous to imply that developing cancer drugs should be ditched in favor of developing more infectious disease drugs. We can walk and chew gum at the same time: this isn’t guns or butter. If we want to apply pure rationality to drugs: let’s stop cancer drug expenditures so we can save more people from malaria, then we could apply that logic to social programs as well: why bother helping the mentally disabled when instead we could direct those funds towards something that provides more economic value to society? A kid with cerebral palsy isn’t going to contribute as much to society as a healthy kid — so why waste resources on that research? Of course it isn’t a waste when it’s your kid. Following that line of reasoning and we ultimately end up with eugenics and society would become a very nasty place indeed.
- Broken_Hippo 7y ago
  We do develop "cancer" drugs to a point. That HPV vaccine is preventing an entire group of cancers! But cancer itself is... complicated. There are many different types with many different causes that are complicated by many different things. Breast cancer is not the same as skin cancer, and neither of these are lung cancer. But we do, to an extent, know how to treat things to a point. Sometimes, our best efforts have only resulted in giving folks 3-6 months. And we do cure or prevent some infectious disease. The plague and leprosy, for example, is curable. We have taken leaps and bounds with HIV/Aids - while we can't really cure it, we can give drugs to folks to stop it from being so infectious. But like cancer, "infectious disease" comes in many forms, some being vastly more complicated to "cure" than others. This is why some things, like the common cold and common influenza do not have cures. These are hard problems. And for lack of better words, we've simply not "unlocked" the secret in ways that would be good year after year.
StanislavPetrov 7y ago
Perhaps what's "rational" in a purely economic sense isn't whats best for the nation or for society. In an economic sense, you could make an argument that slavery is "rational" as far as profits for slaveholders are concerned, but we don't allow slavery because its wrong and immoral despite the potential economic benefits to certain vested interests. Similarly, perhaps its time that we as a society reevaluated our reliance on health care delivery systems that base their agenda on outcomes that are economically profitable for them, rather than what is desirable for our society as a whole.
- dodobirdlord 7y ago
  Slavery, really? Besides, totally beside the point. The argument for rationality isn't that if we exclude the people who experience downside, maybe it's a net positive (always true by tautology), but rather that maybe even counting the people who experience the downsides it's still rational. The novel coronavirus is likely to end the lives of a lot of elderly people, but the majority of elderly people are going to have their lives ended by cancer or heart disease. Perhaps, even with the threat of pathogens like the novel coronavirus lurking to strike, it still makes sense to put most of our resources toward researching cancer and heart disease.
  - geofft 7y ago
    Yes, slavery, really. Rational actors today engage in slavery. https://venturebeat.com/2020/03/02/apple-foxconn-and-81-others-are-accused-of-using-uighur-forced-labor/ https://venturebeat.com/2020/03/02/apple-foxconn-and-81-othe... And you can construct a "rational" argument for it: the slaves are living under an oppressive government anyway and apparently nobody is going to intervene, so if they're stuck in internment camps, may as well give them something to do with their time. Sure, they don't have freedom, but they weren't going to have it anyway, so it's still rational. Right? In seriousness - if you don't take into account the economic reliance on slavery that jurisdictions with legal slavery (e.g., the US South in the 1800s) had, and you claim it's solely that irrational slaveholders saw certain people as less than human in the abstract, you've missed a good part of the explanation and risk inaccurately understanding how to prevent it from happening again. People had a strong economic incentive to come up with justifications for their objectively immoral actions.
empath75 7y ago
This bad flu is going to kill tens of millions of people and wipe out health systems around the world and wreck the world economy. I wish people would stop downplaying it.
- Aunche 7y ago
  If it is really going to kill tens of millions of people, you can bet that pharmaceutical companies are already working on cures.

block_dagger 7y ago

With the amount of economic upheaval from the coronavirus scare, I fail to see how there are no prospects for profit.

alephnan 7y ago
Creating value is one part, capturing it is another
- csallen 7y ago
  Not sure why people are downvoting you. It's clearly the case that there are lots of problems you can solve that create value and make/save people money, yet don't result in you capturing any of that money for yourself. For-profit companies mostly ignore those kinds of problems by definition.
H8crilA 7y ago
SARS vaccine was abandoned after the epidemic died out because the funding was cut. Pharma is being perfectly rational knowing that in 6 months all of the funding may be cut. What's not rational is cutting funding to supposedly disappeared diseases. They do re-occurr. The Spanish Flu died out at first, only to re-emerge in WW1 trenches and wreck absolute destruction.
- hobofan 7y ago
  > What's not rational is cutting funding to supposedly disappeared diseases. They do re-occurr. The Spanish Flu died out at first, only to re-emerge in WW1 trenches and wreck absolute destruction. Wouldn't the fact that the disease has disappeared in human populations greatly increase the required funding and limit the effectiveness of the research? The best you could do would be to produce a bandwidth of candidate drugs that can't advance to human trials for ethical reasons.
aschatten 7y ago
It's very hard to incorporate events like this into a financial model. With chronic disease like diabetes or cancer they can get a pretty good forecast of demand, so it's translates into a clearer understanding of ROI with higher confidence: more they invest the more they get plus some error, but even the error won't offset the forecast by much. With epidemics, not only you need to predict when, but also what kind of virus it's gonna be. The reward is great, but so is the risk. Would you invest $100 to almost surely get back ($130 +/- $5), or $1000 with a potential outcome of $10000, but very low confidence that it is going to happen at all before you run out of money. Similar to financial crisis, if the next one could be predicted, it wouldn't happen.

refurb 7y ago

What's needed is a new payment model for anti-infectives. This already happens at a small scale with grants from institutions like BARDA. The DOD of also does this for vaccines for biological weapons like anthrax where there is a high likelihood the drug will never be used, but a vaccine is needed because if there is an outbreak, the consequences are severe. Basically, rather than paying for drugs on a per unit basis, you pay a lump sum for access to the drug. This solves the issues of spending $100M to develop a new treatment for some disease where there is never a outbreak and you cover none of the cost of R&D. There have been ideas to have X-Prizes for new antibiotics. Discover a new drug for a anti-biotic resistant infection? Great, here is $500M as long as you agree to produce as much drug as needed for free or some nominal cost.

JumpCrisscross 7y ago
> Great, here is $500M as long as you agree to produce as much drug as needed for free or some nominal cost Why not give $5bn (or whatever the NPV of the drug at a reasonable rate of return might be) in exchange for releasing the drug into the public domain? Then any number of generics manufacturers could be contracted to maintain a stockpile.
- refurb 7y ago
  Sure you could do that, but manufacturing drugs isn't as simple as hitting a switch - the infrastructure needed along with the scientific expertise is sometimes hard to replicate.
  - markdown 7y ago
    The infrastructure and expertise exists in India, and they'll gladly manufacture drugs at a cost that the developing world can afford.
    - refurb 7y ago
      Depends on the drug. Small molecules, sure? Complex biologics? Even other large pharma companies can have challenges making those.

WalterBright 7y ago

In the 1960s big increases in regulations on new drug development led to big cost increases, and hence less interest in non-blockbuster treatments.

refurb 7y ago
Sure, but as a result we don't have problems like thalidomide popping up every decade or so. There are benefits (and drawbacks) to having a much more stringent approval process. And probably worth adding that in public health emergencies, the FDA is more than willing to pull back on regulations in the interest of the public good.
- WalterBright 7y ago
  Thalidomide was never approved for use in the US, and the heavy regulation came afterwards.
  - jokowueu 7y ago
    It's was never approved because of one person that was continually harrased if it wasn't for her it would have been approved . There were only 11 people responsible to review these new drugs . For crying out loud pcp was approved as an analgesic after using it on a few prisoners . FDA's stringent approval process is required
    - WalterBright 7y ago
      > FDA's stringent approval process is required The downside of that is greatly reduced new drug development due to the expense, much more expensive drugs, and years of delay for the ones that are worked on. If you have a less popular disease, or can't wait years, you're out of luck.
      - maxerickson 7y ago
        FDA has a special process and contributes funds to developing drugs for rare diseases: https://www.fda.gov/about-fda/office-clinical-policy-and-programs/office-orphan-products-development https://www.fda.gov/about-fda/office-clinical-policy-and-pro...

daenz 7y ago

"Neglects" implies that they're ignoring their responsibilities. How is this the case?

m0zg 7y ago

How can you target "new" infectious diseases if they are really "new" every year other than by guessing the right vaccine (as they do e.g. for the flu)? I mean, what worked for SARS won't necessarily work for COVID19, even though it's also a subvariant of SARS. If this is the case, by the time you come up with a drug and take it through all the (extremely costly) stages of testing approval, it'll be too late already, and herd immunity would have obviated the need for what you've just invested billions and countless person-years into.

RandomWorker 7y ago
You can monitor existing viruses in wild animal populations and give them treatment before it mutates and goes to humans. This would be relatively cheap compared to solving the problem afterwards. We now know that bats are prime suspects for carriers of these diseases because they them selves don’t get sick much from them, live is close quarters, fly and are mammals.
- Broken_Hippo 7y ago
  You'd be wasting money, though, and not necessarily saving money. Most animal diseases do not cross over to humans and IIRC, most of them that have crossed over come from farm animals. More people live in close contact with farm animals than they do things like bats. This effort would honestly be better spent working on things humans already have.

perl4ever 7y ago

I thought the "party line" was that private industry doesn't accomplish much if anything, so isn't "big pharma" irrelevant? It makes more sense to demand higher taxes and more basic research.

lazyier 7y ago
The problem is that regulation is so expensive there isn't any financial motivation in researching does that are unlikely to generate massive revenue. The reason for this is FDA is fundamentally extremely conservative. The people that run the regulatory system are just faceless bureaucrats and are risk adverse. Their pay is based on seniority and there isn't any financial motivation for them to take risks or stand out. FDA is nothing more then a collection of individuals so the motivation of the agency is a mirror image of the motivations of the people running it. To put it bluntly: When diseases like cancer or influenza or <insert name of any disease> kill people the diseases get blamed. But if a drug makes to it market and ends up maiming people or killing them then the FDA gets blamed. So from the FDA's perspective it's much more important that we have ultra-safe drugs then it is to have new drugs to cure and treat diseases. The regulators are going to take the default position that more testing and screening and expenses are good. While allowing consumers and doctors to take risks to treat diseases is bad. And over the decades it has just gotten more and more and more and more expensive to get the drugs out to the public. And since it's too expensive to make new drug companies because of the regulators then you will never see any smaller nimble companies come in and compete with them and force the big companies to behave themselves. This is why you see all the generic drugs being bought up in the past couple decades. During the Obama administration they signed regulatory changes that rose the cost of validating generic drugs considerably. It wasn't so expensive that it would drive generics from the market, but it's expensive enough that you can't make new generic drug companies. So the big name brand drug companies just buys them all up. And because of that they no longer face competition from generics. They own both the name brands and the generics. If it was cheaper to make generic drug companies this approach wouldn't work. People would make new companies for the sole purpose of getting bought. It would make buying companies up to kill competition unsustainable. I've worked in heavily regulated industries before and it's a pretty obvious pattern. Regulators regulate. Costs go up. Competition goes down. And then the big companies become isolated from competition because it's just too expensive to compete with them. Then the government has to bend over backwards to ensure the profitability of these dominate corporations because if they were to go out of business there would never be any replacements. It's a form of market lock-in. Over regulation effectively becomes a license for these big pharma companies to do pretty much whatever the fuck they want. They love it.

pkaye 7y ago

I think governments should take charge in this. Look at how much the development of the ebola vaccine bounced around for years. https://www.statnews.com/2020/01/07/inside-story-scientists-produced-world-first-ebola-vaccine/ https://www.statnews.com/2020/01/07/inside-story-scientists-...

dfsegoat 7y ago

...as they develop a vaccine for Ebola. https://en.m.wikipedia.org/wiki/Ebola_vaccine https://en.m.wikipedia.org/wiki/Ebola_vaccine

blackrock 7y ago

So there you have it. Late Stage Capitalism Failure. No ability to make a bajillion dollars in rent-seeking profit. So F it! Let the people die.

Mirioron 7y ago
Well, if capitalism is the problem, then why don't the socialist/communist countries develop the drug instead? Or alternatively, the community could come together and they could work on coming up with the treatment as a group. But we all know that neither of these are likely to happen. Researchers need money to live, labs need money to run.
- VvR-Ox 7y ago
  Because there is no such countries until someone can prove otherwise (which will not happen because they don't exist). Big capital put this idea inside the heads of many people living in the West and until today they really believe there is countries who are socialist/communist. Neither the GDR nor the UDSSR or China are examples for countries like that and people who know about politics, economy and society know this as a fact. It is easy for you to criticize all alternatives at once because you have never seen any and chose to believe what the ruling party (=capitalism) makes you believe.
  - ros65536 7y ago
    The classic no true communist country fallacy. Have you considered that no such country exists because it is impossible, vecause it so quickly devolves into socialist hell like in USSR, north korea?
  - ben509 7y ago
    > Because there is no such countries until someone can prove otherwise (which will not happen because they don't exist). It won't happen because you'll shift the goal posts. A common dodge is that they're state socialism. The problem with this dodge: it's definitely true that state socialism is impure. But, it's 90% of what you want, and it fails catastrophically. Then the answer is, "well, it can only work if it's 99%!" The regulated markets we have in Western nations, however, are 90% of an ideal "truly free market" and they work quite well. And we find that incremental reforms that deliver to people a little bit more of their economic liberties also improve people's lives bit by bit. Markets have the property that the freer they are, the more benefits they provide. The other dodge is that "it wasn't socialism's fault," especially with Venezuela. Yes, they had an economy centered around oil and that was a problem. The issue was that socialist-inspired reforms made it worse, especially nationalizing the oil companies and price controls. Markets thus have an additional property that they are robust, they allow people to route around problems and mitigate them. Planning is brittle because it necessarily centralizes power, and it tends to fail because planners can't respond to crises in a decentralized manner the way a market naturally does. The third dodge, common now thanks to Sen Sanders, is the Scandanvian nations show that socialism works. But their economies work because they took the opposite approach of 10% socialism. That's not great for apologia since it follows that socialism only works when you hardly do it. > Big capital put this idea inside the heads of many people living in the West and until today they really believe there is countries who are socialist/communist. No one who read the dictionary[2] is claiming that there were any communist nations, since a defining aspect of communism is the absence of the state. You can have lots of communists (persons whose end goal is communism) in a socialist nation, of course, since, as Lenin noted, the purpose of socialism is communism. And Lenin introduced state socialism, not some mad capitalist, and he believed it was, if not proper socialism, a clear stepping stone to socialism. The nations definitely called themselves socialist, and socialists all over the world agreed and while things appeared to be going well, they were bragging about how this proved socialism worked. But it wasn't working because the planners were lying. Socialists here lied and covered up tremendous deaths[1]. And it's only when the problems couldn't be hidden that they became not socialist anymore. [1]: https://en.wikipedia.org/wiki/Walter_Duranty#The_Holodomor_(1932-1933)_and_the_1938_Moscow_Show_Trials https://en.wikipedia.org/wiki/Walter_Duranty#The_Holodomor_(... [2]: That does leave a lot of people claiming it, of course.

foogazi 7y ago

Are there national laboratories with the capabilities to find a cure? Is there a NASA equivalent for infectious diseases to launch a covid-19 moonshot?

cactus2093 7y ago
The WHO is saying a vaccine is 18 months out, and I’m very curious what that means. I haven’t seen any detail as to why it takes that long. It’s short enough that clearly they expect it won’t be very hard, like no one would say a general cure for cancer is 18 months out. So what is preventing us from speeding it up more? Why can’t it be made in 6 months, or 3 months? Is the majority of that 18 months a basic r&d phase of figuring out what will work? If so, why can’t it be parallelized and sped up with more resources? Is it time for clinical trials? To ramp up manufacturing? I can’t help thinking that for a disease that prevents such a big risk to society, there must be clever ways to speed up the normal process for this kind of thing, perhaps with some government involvement in funding or coordinating efforts.
- Infinitesimus 7y ago
  > People have been saying a vaccine is 12-18 months out, and I’m very curious what that means. I haven’t seen any detail as to why it takes that long. All the things you said are factors. Clinical trials are one of the biggest because you have multiple phases to observe to guarantee safety. It's no use shipping a vaccine in 3 months after a small test and have everyone die in a year because of a side effect no one waited long enough to see. Drug development and safety is a very complex space from what I've learned
  - vikramkr 7y ago
    Guaranteeing safety is absolutely a crucial part of it. And if you pull something out that doesn't work, giving people a false sense of immunity would also make things worse. And safety shouldn't be underestimated. The story of dengue vaccine development is a cautionary tale. The first time you get dengue is usually not too bad, but it can be deadly if you get it again. Part of that is hypothesized to be driven by your own immune system, which, once immunized against one strain, produces antibodies against it in the next infection. However, if it's a slightly different strain of dengue the second time around, the antibodies meant to neutralize the disease are believed to make the disease more virulent instead (antibody-dependent enhancement). The immune system makes it worse. So when a dengue vaccine that didn't fully immunize against all strains was developed (not deliberately, people tried to immunize against all strains but this is a case where less efficacy than expected made things worse), it didn't make things better. It ended up priming people to get dengue. Biology is super weird - even something as "simple" as vaccine development has a lot of unknown unknowns. And as dengue showed us, it's not just a case of "it might not work," because it could make things worse. That's why we have to run these clinical trials and take time to do things right, especially for something that would be as widely deployed as a coronavirus vaccine.

Der_Einzige 7y ago

Sounds like a good time for capital N nationalization! :)

zachguo 7y ago

Since COVID-19 is targeting elders, I can imagine there are evil capitalists or bureaucrats who view this pandemic as a gigantic economic stimulus for the next decade. Sorry for my evil thought.

bocklund 7y ago
The price of the Wirecutter’s #1 recommended forehead/ear thermometer on Amazon has changed from $30 between 2016 and February 2020 to $100 since February. https://camelcamelcamel.com/iProven-Thermometer-Temporal-Forehead-Function/product/B01H3MTVE8 https://camelcamelcamel.com/iProven-Thermometer-Temporal-For...
vikramkr 7y ago
The performance and volatility of the markets over the past few days do not agree with the idea that capitalists and bureaucrats view this as an economic stimulus - having your workforce quarantined and your imports restricted are not good for business

aschatten 7y ago

The article mentions the difficulties with clinical trials. It makes sense, now China running hundreds of studies on coronovirus with thousands of people: http://www.chictr.org.cn/searchprojen.aspx?title=&officialname=&subjectid=&secondaryid=&applier=&studyleader=&ethicalcommitteesanction=&sponsor=&studyailment=coronavirus&studyailmentcode=&studytype=0&studystage=0&studydesign=0&minstudyexecutetime=&maxstudyexecutetime=&recruitmentstatus=0&gender=0&agreetosign=&secsponsor=&regno=&regstatus=0&country=&province=&city=&institution=&institutionlevel=&measure=&intercode=&sourceofspends=&createyear=0&isuploadrf=&whetherpublic=&btngo=btn&verifycode=&page=1 http://www.chictr.org.cn/searchprojen.aspx?title=&officialna... testing few drugs and their combination at a time, it's hard to do outside of epidemic.

beardedman 7y ago

What a pile of sensationalist rubbish. In 2018 we had an estimated 400k people dying of Malaria [1] & around 600k (est.) people dying of cancer in the US alone. [2] Compare that to the 3110 deaths that have happened in the last 3 or so months for COVID-19. [3] I think a little perspective would go a long way here. [1] https://www.who.int/news-room/feature-stories/detail/world-malaria-report-2019 https://www.who.int/news-room/feature-stories/detail/world-m... [2] https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html https://www.cancer.org/research/cancer-facts-statistics/all-... [3] https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---3-march-2020 https://www.who.int/dg/speeches/detail/who-director-general-...

jokowueu 7y ago
Covid if not put under control will effect every one everywhere (unlike malaria) . Imagine a 1% fatality on the human population but at a repetitive rate .
- beardedman 7y ago
  That 1% is still to be confirmed. We don't know the mortality rate yet.
empath75 7y ago
> Compare that to the 3110 deaths that have happened in the last 3 or so months for COVID-19. [3] There were 300 deaths 30 days ago. There will be 30,000 this month. And the month after that?
- beardedman 7y ago
  There will be 30k deaths in March? So it's going to go from 1.3k to 30k in the next 20 days?

VvR-Ox 7y ago

1:0 for Capitalism vs. Humanity. Exactly this is why the motivation to do at least some things should not be bound to earning profit. There is common goods that we need to share, global issues that need to be addressed together and we need to find ways to achieve this if we want to develop further as a civilization. Money must not be the sole reason why we do things or we will fail with this "strategy" and we need to come up with good ideas for an alternative and try it. I know this will probably not make me very popular especially with people living in the US as their minds are constantly being flooded with the idea that everything straying from capitalism is socialism and therefor evil. I will post it nevertheless, down-votes don't hurt and I will write my opinion until it is censored completely.

tim333 7y ago
Not sure 1:0 is accurate scoring. Most of the drugs and medical advances we have came out of capitalist systems. Not saying that capitalism is perfect or there shouldn't be government funded labs also.
deleted 7y ago
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LifeLiverTransp 7y ago

This needs a very diffrent financial construct to encourage research. A sort of lifelong dividend, offered by anyone cured of a potential fatal or permanent disease. If out of financial range of a individual, bolstered by a insurance or state funds.

bionhoward 7y ago

one way around this is to develop platforms which apply to a range of diseases. why reinvent some fancy shape of atoms for each disease? it's entirely possible to develop something which works on cancer and coronavirus. just look at CRISPR, or RNAi ... master delivery and you can simply re-target the therapy toward different sequences. Here (https://github.com/bionicles/coronavirus https://github.com/bionicles/coronavirus) is code to design CRISPR-Cas13 CARVER (https://www.sciencedirect.com/science/article/pii/S1097276519306987?via%3Dihub https://www.sciencedirect.com/science/article/pii/S109727651...) 30mer guides against regions of Coronavirus conserved between SARS, MERS, HKU1, and SARS-nCoV-2 (Covid-19 Virus) and not found in highly expressed Lung protein-coding RNA. Uses BioPython, Redis SADD/SISMEMBER, and tools from EMBL (Emboss Consensus and Clustal Omega Alignment) and data from NCBI. The good news is, it's probably possible to delete Coronavirus genome directly inside the lungs, without vaccines; just deliver nanoparticles or adenovirus (doesn't replicate) with an inhaler and express CRISPR-Cas13 and the gRNA using the Surfactant promoter sequence for lung-only expression of the therapy disclaimer: I need to work on the readme and write a blog post, but the data is there and the general core works. There's ~30k guides possible and 226 target 13 longest conserved regions across 4 different outbreaks spanning 17 years of virus evolution (provides reasonable confidence these regions are necessary for the virus to function) If anyone knows some folks in the Pharma / Biotech industry I could use help to run the tests on this, tell em to email bion at bitpharma.com edit: readme improved. currently looking for promoter consensus sequences for lung (surfactant protein TFs like TTF-1)

jmartrican 7y ago

I would imagine living customers and a workforce that is not quarantined would be reason enough, but hindsight is 20/20. It would be silly if the offices of a big pharma company are closed due to an infectious disease that the big pharma company would have been best suited to tackle but cant due to neglect in fighting infectious diseases.

crimsonalucard 7y ago

If commercial incentive isn't viable then the incentive needs to change. Think of it like the military but as a medical industrial complex.

StreamBright 7y ago

Why are we surprised? If the incentives are not for curing infectious diseases than they won't do it. For big pharma, the incentives are: keep humans sick as long as it is physically possible and charge along the way.

vikramkr 7y ago
The incentives are to make money, not to keep people sick. You can charge a lot more for a cure than a treatment, and the empirical evidence of new cures for genetic diseases and subtypes of cancers in the past couple years is showing a lot more activity there. Gilead made bank on curing hep C, even with all the political backlash to the price. It's a competitive environment - if your drug treats and your competitor cures, you don't have the luxury of charging money since your competitor will be getting all the patients. The incentives for antibiotics are different though. Because of antibiotic resistance, society would rather not use the best antibiotic unless absolutely needed so we have a backup. So the better the antibiotic, the less people want to use it. In that case yes the incentives are completely broken.
- StreamBright 7y ago
  I agree with the make money part. Other than making money there is no other incentive.

chapium 7y ago

This is the part where public corporations come in.

magwa101 7y ago

The market does not solve everything, but it does create everything. Therefore we are evolving into pure consumerism.

marricks 7y ago

Maybe there’s just some things that are common good and should be publicly funded rather then gambling on capitalism to solve it

ThomPete 7y ago

The opportunity is a generalized approach to solving these diseases which i think we are getting to finally. Thats the true promise of digital technology. Thats how incentives gets aligned.

Proven 7y ago

And who destroyed the prospect of profits for medicine and vaccine for infectious disease if not statists who won't let capitalists get a good profit on investments in such products?