Comment by bonsai_spool
2 days ago
Not being rude, and I definitely know about medicine.
I explained in sibling that I understood the Lowe article to be about new research (as a researcher, I don't often think about how hard it is to make a GLP survive the stomach but I do think about how incretin biology works). I guess these VEGF agents you list feel like a very straightforward engineering question (can we make an antibody that targets VEGF, humanize its Fc etc) while Lowe brings up conceptual areas like PCSK9, HMG-CoA reductase.
I still maintain that the 1% better thing is not going to lead to incredible success because rational actors aren't going to change their prescribing patterns each time a new agent gets approved.
Oh fun trivia about those straightforward engineering problems was Novartis beavu. It had a few percent higher Side Effects than standard of care after lunch. This was enough to cause Novartis (a top 5 or 10 Pharma company) to essentially cease all ocular drug research and sell off much of their ocular portfolio.
I dont think you have an accurate model of how US prescribers and patients operate.
They want the best, and are willing to sepnd 10x the price or switch treatment to secure that 1% survival, extra week of dosing interval, or the ability to inject at home via mail instead of some sweaty infusion clinic.
I used to think like you before transitioning from medical devices to pharmaceutical development.
The USA is the only real Market that matters for drug development. Unlike the with marginal benefit pricing and National negotiation, the US market is consumer Centric, with patients and their providers wanting the best, even if it is marginal. That 1% means that you can either take the market share or 10x the price.
> I guess these VEGF agents you list feel like a very straightforward engineering question
Each of those straightforward engineering questions takes about 100,000 labor-years and a billion dollars to get approval.