
The future of pharma: a bleak insider's perspective - aaavl2821
https://www.linkedin.com/pulse/pharmas-broken-business-model-industry-brink-terminal-kelvin-stott/?trackingId=pxFWXIOZmLDKgmmLMNJfIw%3D%3D&utm_source=STAT+Newsletters&utm_campaign=83993f507e-EMAIL_CAMPAIGN_2017_11_26&utm_medium=email&utm_term=0_8cab1d7961-83993f507e-150446797
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Nomentatus
The article doesn't explain why the returns are diminishing so steeply when
illnesses, particularly chronic illnesses aren't exactly going away - and our
technological capabilities are increasing rapidly. Why doesn't it all balance
out to keep progress steady?

Part of the reason is that nowadays there are more longitudinal studies that
tend to expose larger death rates overall even when drugs are "effective"
along some one desired dimension.

But a larger reason is this: the vast majority of drugs mimic hormones
(messenger molecules) or block them; or other messengers such as
neurotransmitters. In other words, we are overruling a brain/body decision and
hoping we know better than millions of years of evolution. But there just
aren't that many cases when the body's responses are truly inappropriate.
We've found most of them already.

There are some such cases of course. We've altered our environment a lot,
after all. For example, although beta blockers wouldn't be appropriate for
nomads because doing without adrenaline might mean not spearing vital game, or
even getting outrun and eaten. However in the modern world, with a lot of
environmentally caused heart disease, beta blockers are saving a lot of lives.

Of course, some drugs are still used to target invaders, but chronic illnesses
are by far the bigger part of the medical and economic picture now.

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aaavl2821
The articles point is that we've actually made a lot of progress in treating
chronic illnesses versus where we were decades ago with the discovery of
statins, beta blockers, aces / arbs, metformin, insulin etc. this is "low
hanging fruit". The next generation of drugs for chronic illness face a higher
bar than the previous generation of drugs: they can't just work better than
placebo, they must work better than a drug that works.

And while we've identified many many molecules associated with diseases, only
a very small portion of these are amenable to targeting with current drug
tech. These have been picked over fairly well. A new generation of drugs will
need a breakthrough like "fracking" in oil to create more novel drugs

I'd disagree that there are very few cases where the body's response is
inappropriate. Arguably in every diseases this is the case. We have identified
some instances of this but not as many as we'd like, and in many cases even if
we've identified instances we can't do anthying about them

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Nomentatus
Few not numerically, but as a percentage.

