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Clinical failure rates over the decades: yikes

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Re: Clinical failure rates over the decades: yikes

#31

Post by arjie »

Can’t agree with the premise. It seems that through changing regulatory regimes and technology a 1 in 10 chance is the economic optimum for this. Interesting stability, certainly, but I’d expect that as technology improves success rate, funding increases until the marginal project is unprofitable.

The better we get at doing things, the more ambitious we get. As an example, we can keep babies alive much earlier in gestation, so we try harder if they’re earlier than we would before. We should expect a homeostatic equilibrium between our skill and our ambition.

Re: Clinical failure rates over the decades: yikes

#33

Post by adolph »

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…

Failures also have lots of valuable information. There was a recent Complex Systems podcast about efforts to glean pharma trials.

https://www.complexsystemspodcast.com/episodes/ruxandra-tesl...

Re: Clinical failure rates over the decades: yikes

#34

Post by s1artibartfast »

arjie wrote: post #31

Can’t agree with the premise. It seems that through changing regulatory regimes and technology a 1 in 10 chance is the economic optimum for this. Interesting stability, certainly, but I’d expect that as technology improves success rate, funding increases until the marginal project is unprofitable. The better we get at doing things, the more ambitious we get. As an example, we can keep babies alive much earlier in ges…

I 100% agree. the criteria for sucess is something that is missed by simplyifying things to a number.

Those failures can include drugs that would be considerer miraculous 10 or 20 years ago. You might have a drug that functionally cures HIV, but failed to outperform the standard of care in a RCT.

You have drugs like Lorbrena for non-small cell lung cancer where the median life extension is unknown because >50% of patients are alive 7 years out. Or Keytruda where 50% of advanced melenoma patients appear functionally cured 10 years post treatment.

Re: Clinical failure rates over the decades: yikes

#35

Post by mianos »

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…

Also, highly related, in the previous paragraph, they say: "We know a lot more about the biology of disease - although God knows, not nearly enough".

Anyone smarter than a 10 year old would not we actually know almost everything about car design. How it works is not at all hidden. We have iterated on pretty much the same thing for 100 years. The current state is about efficiency, materials and manufacturing.

When you have deep knowledge and experience in a field you will get near 100%.

Re: Clinical failure rates over the decades: yikes

#36

Post by dlcarrier »

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…

For a great example of an extreme success rate being a bad thing, look at Japan's legal system. Prosecutors only take cases that they think they will win, and that assumption is now baked into the system, to the point that they are no longer very good at prosecuting, and anyone that is prosecuted is effectively presumed guilty.

Re: Clinical failure rates over the decades: yikes

#37

Post by calf »

mlyle wrote: post #8
calf wrote: post #6

Why does he conclude there is no alternative? He already argued this would be strange in other disciplines. So reform it.

If you can think of a way that you can have a much higher chance than 9% of success in getting a useful treatment to market, you can make a boatload of money. Go ahead, reform it.

Not knowing of a way is inequivalent to inexistence of any way. This is basic and apparently some bloggers are bad writers and or political conservatives of the type "there is no alternative".

Re: Clinical failure rates over the decades: yikes

#39

Post by calf »

EA-3167 wrote: post #9
calf wrote: post #6

Why does he conclude there is no alternative? He already argued this would be strange in other disciplines. So reform it.

How? He’s saying that he can’t think of any good ones, and in my experience that’s true of most informed people. This is one of those hard problems that needs solutions, and so far the present system is the best anyone has managed.

I don't care what he's "saying that" which is just your biased interpretation. His essay does not warrant the final concluding sentence which would require a different essay thesis. It's just basic high school reading and writing skills.

Re: Clinical failure rates over the decades: yikes

#40

Post by calf »

analog31 wrote: post #16
calf wrote: post #6

Why does he conclude there is no alternative? He already argued this would be strange in other disciplines. So reform it.

It's not for lack of trying. People are definitely trying to find better ways of finding stronger candidates earlier. People are trying to gain a more precise understanding of disease mechanisms. There are breakthroughs that I could have never imagined such as mRNA vaccines.

I would have to reread the piece carefully but I don't think "lack of trying by Biopharma" is consistent with the author's main argument. Because he is still being somewhat critical of the way it is currently done (why he cites the other industries). I simply disagree with his final sentence since it requires a different set of essay arguments, and also is subjective in the way say a political centrist might say "there is no alternative to fossil fuels" etc.
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