Thursday, July 31, 2008

Challenges to medicine and science – medication invention hits a brick wall

Pharma has a problem – they’re not coming up with any great ideas…

Health Blog : Hey, Drug Researchers, Lotsa Luck!

Name a drugmaker that isn’t struggling to come up with breakthrough medicines. Research costs have ballooned while output at many companies has slowed to a trickle. Technology that was supposed to make drug research more predictable seems to have instead made it easier to come up with more drug failures faster.

“The molecular revolution was supposed to enable drug discovery to evolve from chance observation into rational design, yet dwindling pipelines threaten the survival of the pharmaceutical industry,” say consultant David Shaywitz and Nassim Nicholas Taleb, author of “The Black Swan: The Impact of the Highly Improbable.”

“What went wrong?” they ask in the opinion pages of the Financial Times. “The answer, we suggest, is the mismeasure of uncertainty, as academic researchers underestimated the fragility of their scientific knowledge while pharmaceuticals executives overestimated their ability to domesticate scientific research.”

When you get right down to it, Shaywitz and Taleb say, we still don’t understand the causes of most disease. Even when we think we do, because someone found a relevant gene, we’re not very good at turning the knowledge into a treatment. “Spreadsheets are easy; science is hard,” they tell Big Pharma…

I can vouch for the lack of progress. I’m wrapping up a review of roughly the last 7 years of changes in medical practice.

To put it delicately, progress has sucked. If you put a good physician to sleep 7 years ago, and woke her up today, she’d be reasonable competent on day one. A week later she’d be fully up to speed.

My med review conclusions are:

  1. Lots of new combinations of old drugs, maybe due to co-pay schemes
  2. Many new drugs have suicidal ideation as a side-effect.
  3. Lots of failed immune related drugs re-purposed with limited focal impact on a few disorders.
  4. Probably some improvements in seizure meds. Lots of new Parkinson’s and diabetes meds, but they’ve had limited value. (metformin was a home run, but that was more than 7 years ago).
  5. Really lousy progress in antibiotics; there are fewer useful therapies now than 7 years ago. Actually, fewer every year.

Every so often I read stories about how physicians are demoralized by financial pressures or lack of social support. I can see that, but maybe we should start asking real physicians (not industry types like me) if they’re feeling discouraged by the lack of medical progress.

It’s a lot more fun to practice medicine when you’re able to do new things to help people, not so much fun when there’s no more magic in the hat …

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