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Clinical failure rates over the decades: yikes

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Re: Clinical failure rates over the decades: yikes

#21

Post by DivingForGold »

roenxi wrote: post #18

> I’m fond of saying that the most important single statistic about the drug industry is the clinical failure rate, which is (by any reasonable standard) appallingly high. 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 hav…

Except that governing bodies approve many of these drugs which, further down the line, consumers may experience high failure rates or even toxicity, which in other industries such results would be considered outright fraud subject to legal action. if sold to consumers.

Re: Clinical failure rates over the decades: yikes

#22

Post by m463 »

jcims wrote: post #15

Roughly equivalent to the percentage of startups that fail. Lower numbers don’t mean we’re doing better, it means we’re trying less.

lower numbers might be play to not lose, instead of play to win. On the other hand, do no harm.

ugh, I don't know

Re: Clinical failure rates over the decades: yikes

#23

Post by halperter »

roenxi wrote: post #18

> I’m fond of saying that the most important single statistic about the drug industry is the clinical failure rate, which is (by any reasonable standard) appallingly high. 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 hav…

Rather notably, companies are profit-driven, not good-for-society driven. If 99% of your attempts which cost millions to do fail, the company either has to raise the prices of the drug insanely high or not work as a company. In addition, most drugs aren't humanity saving or crucial for humans to live. You could solve all forms of cancer tomorrow, which would be a great thing, but you aren't "saving humanity". You add less than a decade or so, maximum, to the average human lifespan. This isn't critical to humanity's existence, so this "try or die" mentality doesn't work.

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.

Re: Clinical failure rates over the decades: yikes

#25

Post by Fomite »

tchalla wrote: post #20

I’ve been hearing for 10 years now on how “AI” will change this clinical rate. It’s now like the “This is the year of Linux” prediction meme. And like Derek has mentioned multiple times you can’t statiscialise biology. I don’t think many people get it so we have tech bros like us throw AI at data.

I've been hearing some form of it since I was an undergrad. I just submitted by packet for full professor. There have been some spectacular strides, but we've been through multiple rounds of "Stand aside, the computers will take it from here."

Re: Clinical failure rates over the decades: yikes

#26

Post by a_bonobo »

levocardia wrote: post #3

I'm actually surprised it isn't going up over time. That is naively what you would expect as the low-hanging fruit is plucked. So the fact that it's been stable is probably a sign that scientific advances are roughly keeping pace with the (presumably) increasing challenge of finding ever more targets for drugs.

I actually do this for a living within pharma now! There's a TON of work that goes into drug discovery before we even call it a program. The odds of success are low, so we put in months of work evaluating a candidate before even have a hunch of a program.

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.

Re: Clinical failure rates over the decades: yikes

#27

Post by BobbyTables2 »

jcims wrote: post #15

Roughly equivalent to the percentage of startups that fail. Lower numbers don’t mean we’re doing better, it means we’re trying less.

I’m not entirely sure other startups necessarily want to succeed…

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.

Re: Clinical failure rates over the decades: yikes

#28

Post by roenxi »

halperter wrote: post #23
roenxi wrote: post #18

> I’m fond of saying that the most important single statistic about the drug industry is the clinical failure rate, which is (by any reasonable standard) appallingly high. 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 hav…

Rather notably, companies are profit-driven, not good-for-society driven. If 99% of your attempts which cost millions to do fail, the company either has to raise the prices of the drug insanely high or not work as a company. In addition, most drugs aren't humanity saving or crucial for humans to live. You could solve all forms of cancer tomorrow, which would be a great thing, but you aren't "saving humanity". You add…

Lowe mentions costs 0 times though, he isn't making an economic argument. If you want to make an economic argument then 90% is probably the consensus on what is optimal given that is what people are doing.

> 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.

Re: Clinical failure rates over the decades: yikes

#29

Post by bsder »

perpetuallunch wrote: post #2

This is completely unsurprising, and this: 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 engineerin…

> 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.

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.

Re: Clinical failure rates over the decades: yikes

#30

Post by throwaway27448 »

BobbyTables2 wrote: post #27
jcims wrote: post #15

Roughly equivalent to the percentage of startups that fail. Lower numbers don’t mean we’re doing better, it means we’re trying less.

I’m not entirely sure other startups necessarily want to succeed… 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.

Isn't this the entire point of vc culture? Builders are rubes; investors are the smart kids who can cash out before their investment collapses.

The missing ingredient of course is the people. We cannot let this country pretend it's functional when it invests so poorly. Any sane version of the us will expect years if nit decades of economic pain before these investments pay off

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