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Life After Eroom’s Law

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Re: Life After Eroom’s Law

#21

Post by contravariant »

The current Covid-19 vaccine seems a crucial example of how important model validity can be. The mod-mRNA vaccines can apparently be created in a matter of hours and validated on animal subjects within days/weeks, yet it has taken us almost a year with extensive testing to be sure it will work and be safe. And even that is considered a record breaking time.

It cannot be overstated how big an advancement in medical science it would be if we could show that all such vaccines are safe and (probably) effective.

Re: Life After Eroom’s Law

#22

Post by refoundable »

tehjoker wrote: post #19
refoundable wrote: post #16

Earlier quoted context omitted.

The FDA does not allow Pharma companies to create safe and slightly less effective drugs than the best-in-class, even if such drugs were 10-100x cheaper and would thus alleviate most people's complaints about outrageous drug prices. Scannell's observations are focused on the problem of finding drugs that are more effective than the current best-in-class, the so-called Better than the Beatles problem. This turns out t…

The costs of drugs is usually profit seeking. Many drugs can already be produced and delivered cheaply if the economic system would allow it. Trying to patch the drug instead of the economics just gives people worse drugs.

I see no reason why we can't do both. We obviously need better drugs for the diseases we haven't yet cured, and we need cheaper drugs for the diseases we've already cured. The two are related yet distinct problems.

Incidentally, Scannell wrote one of the best teardowns of how drug pricing actually works: https://www.forbes.com/sites/matthewherper/2015/10/13/four-r...

Re: Life After Eroom’s Law

#23

Post by Dysseus »

refoundable wrote: post #16
Dysseus wrote: post #13

Earlier quoted context omitted.

Could you expand a bit on that? I'm having a hard time making the connection between declining efficiency and there necessarily being something broken about the science. To expand just a bit: Scannell seems to be primarily focused on the disease model as the root issue here. This is curious to me. My understanding is that drugs fail primarily in two ways: 1) It's ineffective - fails to treat the disease. Which is par…

The FDA does not allow Pharma companies to create safe and slightly less effective drugs than the best-in-class, even if such drugs were 10-100x cheaper and would thus alleviate most people's complaints about outrageous drug prices. Scannell's observations are focused on the problem of finding drugs that are more effective than the current best-in-class, the so-called Better than the Beatles problem. This turns out t…

First, really appreciate the engagement here. This is a hugely important problem and this interview and your presentation of it is a great contribution.

I think one of the things that gets lost when we talk about Eroom's law is that the original data points were established before congress passed the Kefauver-Harris amendments in 1962 which set standards for clinical trials, iNDA process, and basically required that drugs show efficacy before they could be marketed.

An important part of those amendments is they made the drug companies go back and review the 4,000 drugs already on the market and provide evidence on their efficacy. It took FDA a long time to work through that backlog, but when they did:

"In January 1968, the Drug Efficacy Study panels finally reported their conclusions to the FDA. They had reviewed over 16,500 therapeutic claims for 4,000 pre-1962 drugs. Only 434, about 12 percent of those examined, delivered on all their promised claims. Seven hundred and sixty-nine were marked as 'ineffective'" [0].

I bring that up to say two things:

1) Our baseline in examining Eroom's law is a bit skewed because standards have been going up since the graph begins.

2) We should be careful in how we change those standards. Many of them were bought with patients lives.

I need to go now, but I do want to address your comment on pricing later.

Thank you again. Really great work.

[0] Pharma - Gerald Posner - Pg 224. https://www.amazon.com/Pharma-Greed-Lies-Poisoning-America-e...

Re: Life After Eroom’s Law

#24

Post by bfieidhbrjr »

refoundable wrote: post #12
rossdavidh wrote: post #11

Elephant in the room: what was it you thought would stop it? If I have a great new idea for a high-performance computer chip, which would also cause them to be twice the cost, it won't get funded, because people will just settle for a higher performance chip in a few years at a lower cost. In the case of medicine, as society gets wealthier, it is willing/able to spend more on medicine. The only time you say "no thank…

Most people tend to focus on the cost side of Eroom's law, but I find its most disturbing implication to be the other side: That between 1950 and 2010, we got ~100x worse at finding drugs that actually work. That suggests that there's something deeply broken about the science, and not just about the regulation or the cost structure.

Well, are you aware that the common model of cancer (genetic) is almost certainly wrong? And that we've wasted 50+ years, and something like an infinite amount of money on it?

https://www.amazon.com/Cancer-Metabolic-Disease-Management-P...

https://www.amazon.com/Tripping-over-Truth-Overturning-Entre...

Re: Life After Eroom’s Law

#25

Post by refoundable »

contravariant wrote: post #21

The current Covid-19 vaccine seems a crucial example of how important model validity can be. The mod-mRNA vaccines can apparently be created in a matter of hours and validated on animal subjects within days/weeks, yet it has taken us almost a year with extensive testing to be sure it will work and be safe. And even that is considered a record breaking time. It cannot be overstated how big an advancement in medical sc…

You're right on the money.

Any breakthrough that could either dramatically shorten the feedback cycle (from years to weeks), or reduce the cost of drug development by 100-1000x would unlock so much value as to completely reshape the structure of the Pharma industry.

The consolidation of the industry in recent decades could be justified by the high fixed costs of drug development that made it necessary to seek greater economies of scale, but in a world where the cost of drug development drops precipitously, the pendulum could swing in the other direction, unleashing a wave of decentralization in the industry.

Absent this kind of breakthrough, I expect only more intense regulatory and pricing pressures for the Pharma industry in coming years.

Re: Life After Eroom’s Law

#26

Post by nn3 »

refoundable wrote: post #16
Dysseus wrote: post #13

Earlier quoted context omitted.

Could you expand a bit on that? I'm having a hard time making the connection between declining efficiency and there necessarily being something broken about the science. To expand just a bit: Scannell seems to be primarily focused on the disease model as the root issue here. This is curious to me. My understanding is that drugs fail primarily in two ways: 1) It's ineffective - fails to treat the disease. Which is par…

The FDA does not allow Pharma companies to create safe and slightly less effective drugs than the best-in-class, even if such drugs were 10-100x cheaper and would thus alleviate most people's complaints about outrageous drug prices. Scannell's observations are focused on the problem of finding drugs that are more effective than the current best-in-class, the so-called Better than the Beatles problem. This turns out t…

As I understand most of the cost of a new drug is the testing and certification. It's unlikely that a new drug with the same testing/certification requirements is significantly cheaper than an old one.

Re: Life After Eroom’s Law

#28

Post by refoundable »

bfieidhbrjr wrote: post #24
refoundable wrote: post #12

Earlier quoted context omitted.

Most people tend to focus on the cost side of Eroom's law, but I find its most disturbing implication to be the other side: That between 1950 and 2010, we got ~100x worse at finding drugs that actually work. That suggests that there's something deeply broken about the science, and not just about the regulation or the cost structure.

Well, are you aware that the common model of cancer (genetic) is almost certainly wrong? And that we've wasted 50+ years, and something like an infinite amount of money on it? https://www.amazon.com/Cancer-Metabolic-Disease-Management-P... https://www.amazon.com/Tripping-over-Truth-Overturning-Entre...

It's worth noting that the most effectives breakthroughs against cancer in recent decades (Immunotherapy, angiogenesis-suppressing drugs) have largely been based on ideas that were first dismissed and widely ridiculed by senior scientists working on cancer research.

I suspect that in another 50 years, when the war against cancer is (finally) over, we will end up with a completely different perspective on the history of cancer research than the often self-serving and propagandized perspective we have today.

Re: Life After Eroom’s Law

#29

Post by beloch »

refoundable wrote: post #8

Author here. I interviewed Jack Scannell on the hypothesis that the man who wrote the now famous paper on Eroom's law would likely have many more insights to offer that didn't necessarily make it into print. One of the oddest things about biotech and pharma is that cures trail improvement in technology by at least a couple of decades. That's terrible news if you're a patient/consumer though maybe great news if you're…

The way your website handles font-size and zoom is really weird.

Re: Life After Eroom’s Law

#30

Post by titanomachy »

beloch wrote: post #29
refoundable wrote: post #8

Author here. I interviewed Jack Scannell on the hypothesis that the man who wrote the now famous paper on Eroom's law would likely have many more insights to offer that didn't necessarily make it into print. One of the oddest things about biotech and pharma is that cures trail improvement in technology by at least a couple of decades. That's terrible news if you're a patient/consumer though maybe great news if you're…

The way your website handles font-size and zoom is really weird.

I feel like there should be a named law of hacker news for this. There's sometimes more discussion about how the page doesn't work without javascript, font colors are bad, page is slow, whatever, than about the content of the article. Although in this case most people are talking about the article.

Agreed though, there's some weird responsive CSS going on here that makes it impossible to resize fonts on a desktop.

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