Comment by s1artibartfast
2 days ago
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.
This comment makes no sense.
Why would anyone make a drug if the current prevalent treatment was as good as a functional cure?
What do lorbrena and keytruda have to do with the rate of failures being constant?
"Why would anyone make a drug if the current prevalent treatment was as good as a functional cure?"
I am not sure whether you ask for economic why, or an overall why.
The overall why seems easier to explain:
a. The new drug may be cheaper.
b. The new drug may be safer. (e.g. no risk of anaphylaxis etc.)
c. The new drug may not need cold storage (huge problem outside the First World).
d. The new drug may have other properties that the original does not have (e.g. being taken once a day instead of four times a day, not requiring people to stay off specific food etc.)
e. The side effects (such as vomiting) may be lower.
In general, it is always better to have alternatives in medicine.
This is very facile thinking - are there any examples of a-e in the real world (namely, a brand new drug program was spun up to exploit a-e) ? I think not, which is why I asked the question.
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Lots of reasons.
The new drug could be cheaper to manufacture, fewer side effects, a full cure in stead of a functional cure.
Cost of manufacture is not a meaningful driver of pricing outside the biological
How will your clinical trial of the ostensible full cure work if standard of care is curing people?
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These are examples of ambitious drugs that wouldn’t have been attempted even a few decades earlier. But technology improved and the money was there so they tried anyway, and found success. But for any 3 successes there are still 27 failures because those 27 were equally ambitious.
Feels like a just-so story. How to quantify “ambitious”? If the goal were flight, would jumping off cliffs with wings like birds be “ambitious”?
The most parsimonious explanation is either our models or methods (or both) are garbage. Something’s missing. The failure rate is insane, and writing it off as ambition or “biology is hard” rather than digging in does us no favors.
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Keytruda revenue is 30+ billion per year. If your new drug performs 1% better than Keytruda, that revenue becomes yours. If your drug perfroms 1% worse, you become a failure in the statistics.
That isn’t how a rational person would pursue this - it costs $1B to make a drug start to finish, and there’s no reason to believe your new mechanism will work.
If you’re talking about copycat mechanisms, that is fine but we’re still left discussing successes when OP is about failures
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