3 ms·

It's almost like the market is extremely poorly suited for developing drugs

by darby_eight 2y ago

nradov 2y ago
Do we have examples of non-market systems that have proven to be consistently more effective for developing drugs?
- sudosysgen 2y ago
  Yes, universities and public research labs. What they aren't effective at, however, is financing trials, so unless we find a way to overhaul that issue we have to deal with pharma companies.
  - pfdietz 2y ago
    Yes, they are very effective at developing drugs, if you ignore all the necessary expensive steps, steps that often show the drug is worthless.
    - sudosysgen 2y ago
      Most drugs are shown to be worthless way before any clinical trial, and while yes they are expensive, so is fundamental research. By only looking at what pharma companies do, you skip just as many very expensive necessary steps that often show the drug is worthless.
      - pfdietz 2y ago
        And most of the drugs that advance to clinical trials wash out there as well.
        sudosysgen 2y ago
        Yes. You are the one that's trying to argue that pushing past clinical trials is riskier than fundamental research, so I don't understand your argument. You have to argue that clinical trials are riskier, not that they are risky at all. I suspect we would agree that fundamental research is actually far riskier. Universities and research labs are really quite good at coming up with drugs that are good candidates for clinical trials, so the issue is not an issue of development, it's an issue of aligning incentive and finance to get them to pay for trials, which is not currently possible. This is a problem that is likely solvable. Showing that this is not true would require you to show that private pharmas are somehow able to come up with drugs that are more likely to survive clinical trials, which is not something I believe to be true. There is some evidence on this subject - in fact, a rising percentage of drugs are invented in academia (more than 30% as of 2020), and then transferred to for-profit pharma companies that then run trials, which indicates that academia can produce new drugs more efficiently (see for example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552459/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552459/), and that academic-invented drugs are as likely to succeed even when early trials are largely ran by academic institutions (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226120/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226120/) Indeed, recent data shows that a growing majority of biotech drugs are acquired from universities, and in turn those are a growing majority of newly approved drugs - a large and very profitable part of the pharma industry nowadays is to get universities to come up and screen drugs for you, and then to run them to trials. This arbitrage opportunity indicates to me that yes, publicly funded research seems to be a very efficient source of drugs. This is even clearer when you realize that only 20% of public research funding goes towards drug development - most of it goes to the fundamental research that makes it possible to come up with drugs in the first place, something that pharma companies will never do.
        pfdietz 2y ago
        Could you argue against what I actually wrote? Thanks. Of course the fraction of drugs that succeed after reaching clinical trials is greater than the fraction of drugs that succeed from the very beginning. What clinical trials are is very expensive. So I would not be at all surprised if most of the cost of failed drugs is from those that fail late rather than early.

It's almost like the market is extremely poorly suited for developing drugs

nradov 2y ago

Do we have examples of non-market systems that have proven to be consistently more effective for developing drugs?

sudosysgen 2y ago
Yes, universities and public research labs. What they aren't effective at, however, is financing trials, so unless we find a way to overhaul that issue we have to deal with pharma companies.
- pfdietz 2y ago
  Yes, they are very effective at developing drugs, if you ignore all the necessary expensive steps, steps that often show the drug is worthless.
  - sudosysgen 2y ago
    Most drugs are shown to be worthless way before any clinical trial, and while yes they are expensive, so is fundamental research. By only looking at what pharma companies do, you skip just as many very expensive necessary steps that often show the drug is worthless.
    - pfdietz 2y ago
      And most of the drugs that advance to clinical trials wash out there as well.
      - sudosysgen 2y ago
        Yes. You are the one that's trying to argue that pushing past clinical trials is riskier than fundamental research, so I don't understand your argument. You have to argue that clinical trials are riskier, not that they are risky at all. I suspect we would agree that fundamental research is actually far riskier. Universities and research labs are really quite good at coming up with drugs that are good candidates for clinical trials, so the issue is not an issue of development, it's an issue of aligning incentive and finance to get them to pay for trials, which is not currently possible. This is a problem that is likely solvable. Showing that this is not true would require you to show that private pharmas are somehow able to come up with drugs that are more likely to survive clinical trials, which is not something I believe to be true. There is some evidence on this subject - in fact, a rising percentage of drugs are invented in academia (more than 30% as of 2020), and then transferred to for-profit pharma companies that then run trials, which indicates that academia can produce new drugs more efficiently (see for example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552459/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552459/), and that academic-invented drugs are as likely to succeed even when early trials are largely ran by academic institutions (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226120/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226120/) Indeed, recent data shows that a growing majority of biotech drugs are acquired from universities, and in turn those are a growing majority of newly approved drugs - a large and very profitable part of the pharma industry nowadays is to get universities to come up and screen drugs for you, and then to run them to trials. This arbitrage opportunity indicates to me that yes, publicly funded research seems to be a very efficient source of drugs. This is even clearer when you realize that only 20% of public research funding goes towards drug development - most of it goes to the fundamental research that makes it possible to come up with drugs in the first place, something that pharma companies will never do.
        pfdietz 2y ago
        Could you argue against what I actually wrote? Thanks. Of course the fraction of drugs that succeed after reaching clinical trials is greater than the fraction of drugs that succeed from the very beginning. What clinical trials are is very expensive. So I would not be at all surprised if most of the cost of failed drugs is from those that fail late rather than early.