7 ms·

My comment was extremely flippant. Let me provide an example to explain my point of view. Cancer research can appear very stagnant. Pharma companies and resear

My comment was extremely flippant. Let me provide an example to explain my point of view. Cancer research can appear very stagnant. Pharma companies and researchers funnel money into existing solutions and combinations of existing solutions which increase life expectancy by a few months, and quality of life by a few degrees. Not much foundational research on cures, and why should there be when every new drug which leads to slightly better outcome will be purchased by patients who will do anything to live a bit longer? Now, how in the hell would VC be expected to improve that landscape? The ideal solution is a cheap therapy which cures cancer. Maybe a cancer vaccine. Where's the money in a 50 (or even 1k) tailored vaccine to cure a cancer when a slightly new combination of cancer drugs can cost $50,000 a month for the rest of the life of a patient? I'd argue VC don't think long term for the benefit of anyone except themselves. They'll invest in a moonshot if it disrupts an industry for their benefit (e.g puts all taxi drivers out of work) but not if it eliminates an industry (e.g cancer research). There's way more money in funding a slightly different cancer drug.

whatshisface 4y ago
>Where's the money in a 50 (or even 1k) tailored vaccine to cure a cancer when a slightly new combination of cancer drugs can cost $50,000 a month for the rest of the life of a patient? Profit isn't revenue, for one thing. Does that hypothetical $50k/month treatment cost $49,999/month to manufacture? That's the story for a lot of drugs.
- vkou 4y ago
  Hypothetically, yes. Practically, that almost never happens. The reason the treatment costs $50k/month is because there is no alternative, and that's how much insurance will pay for it. Whether or not the unit economics are $49,999/month or $49/month has no bearing on this. Treatments aren't commodities, they aren't apples at the grocer, where if the prices are too high, you just go to a competitor across the street.
  - killjoywashere 4y ago
    Ok, so here's a thought: who makes money if people don't die of cancer? Let's assume they're all retirees. Agriculture, housing, the local taxation authority, and possibly their immediate kin (assuming, on average, people love their parents and want to spend time with them). Maybe Monsanto, Toll Brothers, and local governments should be funding cancer research?
  - dekhn 4y ago
    I work in pharma. Pricing in pharma for drugs like that is complicated. Usually these drugs do actually require rather expensive manufacturing processes, that have to run in extremely large facilities with extensive QA, but in fairly small batches. More importantly, every major pharma has a compassionate use program that helps people who can't afford the drugs get them, through offsets and credits. I understand the desire to make pharma look like pure-evil profit mongers, but the reality is that this is not an easy business to be in.
    - cmeacham98 4y ago
      Many drugs invented by US companies are available cheaper in countries that don't respect US IP law (with no differences in quality/QA process/etc). The reason for this is obvious: in the US the government gives the inventor a temporary monopoly. It's pretty widely accepted the presence of this government-enforced monopoly significantly increases the price of many drugs. The standard argument in favor of this is that it incentivizes R&D and we wouldn't have these drugs otherwise. I think it's debatable either way, but claiming these companies don't take advantage of this arrangement to increase prices is not true.
      - _0w8t 4y ago
        The price of drugs in US also reflects expensive R&D and sometimes even more expensive approval process. Plus the companies has to account for the possibility of third parties manufacturing without the license which in turn requires higher unit price.
      - rswail 4y ago
onphonenow 4y ago
As you pointed out in your original comment, VC's will def fund moonshots and big growth ideas with 1 in 10 or 1 in 100 chances for payoff. These don't make short term profits, but they have the potential to do something dominating. SpaceX against a huge established industrial base. That's going to be VC type funding, not traditional funding streams. We had govt initially doing everything they could to shut spacex out, doing block buys, trying to crush them on paperwork etc. My complaint is simple. We know the current billions spent under current approaches have not cured a wide variety of illnesses. So what harm is there in spending some, relatively small amounts of money, on other ideas. What's interesting is the reaction from folks like you, NIH, academics and others. It's vehement rejection. But why not instead demonstrate your approach results in a cure. The rejection is because you know you are sitting on nothing. We see this with spaceX. Established astronomers are crying bloody murder. But this is in part because they are afraid. Their huge thirty meter telescope gravy train (decades of funding into their labs) is at risk of being totally trumped by cheaper access to space, where telescopes work great. Established businesses tend to be risk averse. So in short, a role to play here for new ideas. Note: Be careful about snarky comments, those are best avoided on HN, and can be a bit embarrassing in hindsight if you try to be snarky but inadvertently are correct and then have to try and walk back a point that you didn't mean to make.
bglazer 4y ago
What would “more foundational research on cures” look like? I do cancer research and, frankly, the work feels pretty foundational. I’m curious what you would change. Also please note that cancer vaccines have been tried but have failed for a few reasons. First, cancer cells are quite similar to normal cells, so cross reactivity is a problem. So, a typical approach is to to target “neoantigens” which are mutated cell surface proteins that are only on cancer cells. Not all cancers have neoantigens and they can mutate to stop expressing the neoantigen. Also tumors can express proteins that suppress or evade the immune system. PD-L1 blockers target one of the ways tumors do this. All that to say, it’s not like people aren’t trying this stuff. It’s just really, really hard.

whatshisface 4y ago

>Where's the money in a 50 (or even 1k) tailored vaccine to cure a cancer when a slightly new combination of cancer drugs can cost $50,000 a month for the rest of the life of a patient? Profit isn't revenue, for one thing. Does that hypothetical $50k/month treatment cost $49,999/month to manufacture? That's the story for a lot of drugs.

vkou 4y ago
Hypothetically, yes. Practically, that almost never happens. The reason the treatment costs $50k/month is because there is no alternative, and that's how much insurance will pay for it. Whether or not the unit economics are $49,999/month or $49/month has no bearing on this. Treatments aren't commodities, they aren't apples at the grocer, where if the prices are too high, you just go to a competitor across the street.
- killjoywashere 4y ago
  Ok, so here's a thought: who makes money if people don't die of cancer? Let's assume they're all retirees. Agriculture, housing, the local taxation authority, and possibly their immediate kin (assuming, on average, people love their parents and want to spend time with them). Maybe Monsanto, Toll Brothers, and local governments should be funding cancer research?
- dekhn 4y ago
  I work in pharma. Pricing in pharma for drugs like that is complicated. Usually these drugs do actually require rather expensive manufacturing processes, that have to run in extremely large facilities with extensive QA, but in fairly small batches. More importantly, every major pharma has a compassionate use program that helps people who can't afford the drugs get them, through offsets and credits. I understand the desire to make pharma look like pure-evil profit mongers, but the reality is that this is not an easy business to be in.
  - cmeacham98 4y ago
    Many drugs invented by US companies are available cheaper in countries that don't respect US IP law (with no differences in quality/QA process/etc). The reason for this is obvious: in the US the government gives the inventor a temporary monopoly. It's pretty widely accepted the presence of this government-enforced monopoly significantly increases the price of many drugs. The standard argument in favor of this is that it incentivizes R&D and we wouldn't have these drugs otherwise. I think it's debatable either way, but claiming these companies don't take advantage of this arrangement to increase prices is not true.
    - _0w8t 4y ago
      The price of drugs in US also reflects expensive R&D and sometimes even more expensive approval process. Plus the companies has to account for the possibility of third parties manufacturing without the license which in turn requires higher unit price.
    - rswail 4y ago

onphonenow 4y ago

As you pointed out in your original comment, VC's will def fund moonshots and big growth ideas with 1 in 10 or 1 in 100 chances for payoff. These don't make short term profits, but they have the potential to do something dominating. SpaceX against a huge established industrial base. That's going to be VC type funding, not traditional funding streams. We had govt initially doing everything they could to shut spacex out, doing block buys, trying to crush them on paperwork etc. My complaint is simple. We know the current billions spent under current approaches have not cured a wide variety of illnesses. So what harm is there in spending some, relatively small amounts of money, on other ideas. What's interesting is the reaction from folks like you, NIH, academics and others. It's vehement rejection. But why not instead demonstrate your approach results in a cure. The rejection is because you know you are sitting on nothing. We see this with spaceX. Established astronomers are crying bloody murder. But this is in part because they are afraid. Their huge thirty meter telescope gravy train (decades of funding into their labs) is at risk of being totally trumped by cheaper access to space, where telescopes work great. Established businesses tend to be risk averse. So in short, a role to play here for new ideas. Note: Be careful about snarky comments, those are best avoided on HN, and can be a bit embarrassing in hindsight if you try to be snarky but inadvertently are correct and then have to try and walk back a point that you didn't mean to make.

bglazer 4y ago

What would “more foundational research on cures” look like? I do cancer research and, frankly, the work feels pretty foundational. I’m curious what you would change. Also please note that cancer vaccines have been tried but have failed for a few reasons. First, cancer cells are quite similar to normal cells, so cross reactivity is a problem. So, a typical approach is to to target “neoantigens” which are mutated cell surface proteins that are only on cancer cells. Not all cancers have neoantigens and they can mutate to stop expressing the neoantigen. Also tumors can express proteins that suppress or evade the immune system. PD-L1 blockers target one of the ways tumors do this. All that to say, it’s not like people aren’t trying this stuff. It’s just really, really hard.