Lower numbers don’t mean we’re doing better, it means we’re trying less.
Their goal often seems not to be toward a successful, sustainable product. They just market their vision in the hopes of being acquired.
A few fewer failures might not be entirely a bad thing.
ugh, I don't know
Yes, the science advances, previously high-hanging fruits become low-hanging become high-hanging again [1], but the tooling also advances: we now have databases like OpenTargets which let us more easily evaluate potential drug targets. Failure is so much more than that, though: a program can fail after you've shown efficacy in animals, sometimes it just doesn't happen in the human subjects. Or you fail to find the right measurement (endpoint). A million ways to die.
[1] Gene editing is an example: impossible, then very possible, but now the blocker is public perception which in turn blocks investment.
He starts off on the wrong note, there is nothing at all wrong with a high rate of clinical failures. If anything, the reasonable argument standard might be that this rate is too low. It implies researchers are trying things that they expect to have a 10% chance of working out. That means we're missing out on all the cures and techniques that have a 1% chance of working out but but nonetheless do work.
Failed attempts cost society nearly nothing and successes will have compounding benifits for, y'know, lets optimistically say the human race survives for centuries. 1% or 0.1% success rates sound completely reasonable with that sort of lopsided risk profile. There isn't much of a reason not to try anything and everything that has the faintest chance of helping and see what happens.
If this try or die mentality does work, why don't we try every possible amino acid chain in every configuration possible? It's an infinitesimally small chance but try or die "outweighs". This is evidently absurd.
> If this try or die mentality does work, why don't we try every possible amino acid chain in every configuration possible?
You tell me. If someone wants to start working through the amino acids one by one I'm not going to say they should be stopped; sincerest good luck to them. I'm just not going to be the one funding it.
> You could solve all forms of cancer tomorrow, which would be a great thing, but you aren't "saving humanity".
This is a straw man. "Saving humanity", whatever that means, is outside the scope of medicine and I never argued for it. Nobody did. It isn't relevant.
But let’s think about that 91% failure rate for a moment. When I bring this up in presentations, I invite the audience to consider what the auto industry would look like of 91% of new car designs proved unable to roll out of the factory, or if 91% of new airliner models were unable to leave the ground
Is an utterly irrelevant comparison. For physical thing we have engineering, and the practical application of the trades and craft, trial and error.
For modern medicine, we're only just starting to come out of the wild west era. Or perhaps slightly further along than that.
Drug design seems a lot more binary. You can find a new pathway, but drugs themselves are fairly simply molecules, and you can't iteratively 'fix bugs' the way you can in an engine or a piece of software.
The engine is a given, it's almost astronomically complicated, you know a lot less about how it works than you'd like to, and you're trying to change how it works while it's running without breaking anything, using tiny rigid parts that have to snap into place correctly and can't be bent to fit.
High failure rates aren't surprising.
Why do you say that? What's the evidence? We continue to have virtually no clue how to make drugs, per TFA.
Drug development is a hard problem because the solution space is poorly constrained: biochemistry is complex and messy, expecting one chemical substance to have narrow positive effects is probably hopeless.
I don't think its irrelevant, but a better comparison would be to what vacuum tube development looked like before we understood electrons. There were some very whacky designs and most of them didn't work for crap.
And, yeah, I would argue that PCR shifted us from the alchemy phase of biology to the science phase and now mRNA has shifted us from the science phase of biology to t he engineering phase of biology. We're just getting started.
If they could do that today, they would. Trial criteria are already incredibly narrow specifically to try to encode as much of this knowledge as the company has prior to starting the trial. But it empirically turns out they don't have nearly enough to matter.
It's really not a problem that pre-filtering to that responders group produces too small a market. There are plenty of drug programs going after way-too-small markets because of all these wacky perverse incentives created by insurers and regulators to incentivize the creation of billion-dollar++ drugs for diseases virtually no one has.
There are breakthroughs that I could have never imagined such as mRNA vaccines.