Comment by Gareth321
5 hours ago
One might argue that we have calibrated drug safety to such a high degree that the aggregate negative social impacts are far higher than the costs of side effects. Of course we don’t want another thalidomide catastrophe but I think there are large potential test groups to mine who are much less sensitive to the risks. For example, the elderly and those with terminal diagnoses. Right now we only permit drug testing in very limited cases for the latter group, and only when the treatment is related to their terminal diagnosis. I’m seeing older people taking all kinds of experimental anti-aging drugs right now, either off label, or novel. We’re not collecting any of this data empirically because what they’re doing is not legal.
Further, [we are getting much better at simulating drug interactions.](https://pubmed.ncbi.nlm.nih.gov/41155903/) I strongly suspect AI will offer new probabilistic models to funnel novel drugs into more targeted trials which are much more likely to succeed. If we had 90% certainty of success and high certainty of lower adverse reactions I think we could allow much less stringent human trials. That means much lower cost and much faster turn-around.
My wife is a doctorate in pharmacology, I made exactly this argument to her but she dismantled it pretty quickly.
a) We do test on terminally ill people, but after testing in other models. b) Thalidomide was all roses compared to the horrors you can inflict. c) Profit-driven industry makes extremely perverse incentives.
Still I do come down more on your side of the argument, and we have historically made massive leaps doing some horrific things.
I wonder if we can get better models based off of human cell-lines / tissues? Like CRISPR did?
Testing a drug in a terminally ill person for something other than their illness is not going to produce meaningful data.
You misunderstand how hard it is to pull signal from a drug being put into a human body, which is why we need large numbers of people who meet extremely narrow criteria (and don't have things like a terminal cancer).
Your latter idea is a good one, and hopefully something AI will help with. As you imply: we will know empirically when it's ready because trial failure rates will trend toward zero. Today we're closer to 90% failures and not even clearly trending in the correct direction.
You're aware that, as a healthy volunteer, you could go sign up for a Phase 1 study today, right? You can even earn a pretty penny doing so.
Besides moral qualms I think it could be difficult establishing a representative baseline with the elderly and terminally ill
“The elderly” might be much less sensitive to risks but it may still be an issue if the experimental drug you gave Grandma turns her into soup.
Why? Two birds, one stone: reduce care costs, feed poor people.
> For example, the elderly and those with terminal diagnoses.
The amount of disdain you have for human life when it's past an accepted state of freshness is disgusting.