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> If you could do research that will save 10 lives, vs research that will save 1 life, which would you choose? Both. We're not even close to our limits on rese

> If you could do research that will save 10 lives, vs research that will save 1 life, which would you choose? Both. We're not even close to our limits on research capacity. If we actually were at the limits of research capacity, and we were actually forced to make decisions between livesaving treatments to research where we couldn't do both without sacrificing something else that saves lives, then yes, of course, choose the thing with the highest number of predicted lives saved. But we're not even close to needing to make such decisions yet. We just don't have a good system for funding cures you can't sell to millions. That's not anywhere close to "heartbreaking decisions" territory; that's "societal coordination problem" territory.

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blfr 5y ago
> Both. We're not even close to our limits on research capacity. Really? From the outside it seems to me like we are beyond our limits on research capacity. The progress seems to be slowing down everywhere while the price per discovery of a new drug skyrockets with many having rather disappointing efficacy (high NNTs).
- JoshTriplett 5y ago
  None of those limitations seem inherent, nor are we close to the societal limits for what we can do when we actually care about accomplishing something. We may be somewhat close to the limits of what we can do with current R&D structures and incentives, but that's quite different.
kettleballroll 5y ago
> We're not even close to our limits on research capacity. Maybe not at your stage of research, but it's my understanding that further down the pipeline (eg clinical trials) you're mich closer to the limits, simply due to financial constraints: given that a trial for something you can sell to millions isn't that mich more expensive than one you can sell to dozens,and given that you need to get payed for your job, i don't see how it doesn't make sense to prioritize the lower hanging fruit. Am i missing something?
logifail 5y ago
> We just don't have a good system for funding cures you can't sell to millions (Full disclosure: close family member works at $bigPharma) I don't think it's about finding treatments you can "sell to millions", it's that in pharma, like in pretty much every other business, it's about ROI. You definitely don't need millions of patients, but you do need to cover the R&D costs _and_ have enough left over to keep the shareholders happy.
- newswasboring 5y ago
  This is such a fucked up incentive structure. Literally having the capacity to save lives but not doing it because otherwise people will pull out their money because Roblox is has a better ROI.
  - logifail 5y ago
    > This is such a fucked up incentive structure [..] It may well be(!), so let's assume you're right, what better incentive structure should we put in place instead? Increase general taxation and use that to fund more pharamaceutical R&D?
    - mschuster91 5y ago
      Break up the pharma companies and let them only be at-cost (!) manufacturers, move all R&D off to universities, and cooperate with other countries in said R&D efforts.
      - logifail 5y ago
        > Break up the pharma companies For many politicians that would be seen as a "courageous decision" (hat-tip: Sir Humphrey Appleby) > and let them only be at-cost (!) manufacturers Won't it be hard to find investors if you do that? > move all R&D off to universities I think the "D" in "R&D" might be the problem in this approach. Universities are great at many things, including research, but based on my experiences (science PhD two decades ago in a research group which worked on anti-infectives) the scientists there aren't necessarily very good - or even actually interested - in development as such. We partnered fairly closely with $bigPharma at the time, and they funded a fair chunk of our work.
dsign 5y ago
Thanks for your answer. Yes, this is not a case of lacking science, research, or even treatment capabilities. It is a case of too many hoops to jump. Maybe twenty years from now some people with a high degree of knowledge, skills, and some resources will be able to get around these hoops illegally (by the laws of certain jurisdictions) and fix these conditions (or kill themselves or somebody else trying, but so does god/nature and doctors, with different[citation needed] probability distributions).

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blfr 5y ago

> Both. We're not even close to our limits on research capacity. Really? From the outside it seems to me like we are beyond our limits on research capacity. The progress seems to be slowing down everywhere while the price per discovery of a new drug skyrockets with many having rather disappointing efficacy (high NNTs).

JoshTriplett 5y ago
None of those limitations seem inherent, nor are we close to the societal limits for what we can do when we actually care about accomplishing something. We may be somewhat close to the limits of what we can do with current R&D structures and incentives, but that's quite different.

kettleballroll 5y ago

> We're not even close to our limits on research capacity. Maybe not at your stage of research, but it's my understanding that further down the pipeline (eg clinical trials) you're mich closer to the limits, simply due to financial constraints: given that a trial for something you can sell to millions isn't that mich more expensive than one you can sell to dozens,and given that you need to get payed for your job, i don't see how it doesn't make sense to prioritize the lower hanging fruit. Am i missing something?

logifail 5y ago

> We just don't have a good system for funding cures you can't sell to millions (Full disclosure: close family member works at $bigPharma) I don't think it's about finding treatments you can "sell to millions", it's that in pharma, like in pretty much every other business, it's about ROI. You definitely don't need millions of patients, but you do need to cover the R&D costs _and_ have enough left over to keep the shareholders happy.

newswasboring 5y ago
This is such a fucked up incentive structure. Literally having the capacity to save lives but not doing it because otherwise people will pull out their money because Roblox is has a better ROI.
- logifail 5y ago
  > This is such a fucked up incentive structure [..] It may well be(!), so let's assume you're right, what better incentive structure should we put in place instead? Increase general taxation and use that to fund more pharamaceutical R&D?
  - mschuster91 5y ago
    Break up the pharma companies and let them only be at-cost (!) manufacturers, move all R&D off to universities, and cooperate with other countries in said R&D efforts.
    - logifail 5y ago
      > Break up the pharma companies For many politicians that would be seen as a "courageous decision" (hat-tip: Sir Humphrey Appleby) > and let them only be at-cost (!) manufacturers Won't it be hard to find investors if you do that? > move all R&D off to universities I think the "D" in "R&D" might be the problem in this approach. Universities are great at many things, including research, but based on my experiences (science PhD two decades ago in a research group which worked on anti-infectives) the scientists there aren't necessarily very good - or even actually interested - in development as such. We partnered fairly closely with $bigPharma at the time, and they funded a fair chunk of our work.

dsign 5y ago

Thanks for your answer. Yes, this is not a case of lacking science, research, or even treatment capabilities. It is a case of too many hoops to jump. Maybe twenty years from now some people with a high degree of knowledge, skills, and some resources will be able to get around these hoops illegally (by the laws of certain jurisdictions) and fix these conditions (or kill themselves or somebody else trying, but so does god/nature and doctors, with different[citation needed] probability distributions).