
Dustin Moskovitz pours funds into high-risk research - bcaulfield
https://www.nature.com/articles/d41586-017-08795-0
======
maxander
If a philanthropist wants to aim a lot of money at biomedical research,
there's many good ways to do it, but I think the most high-impact, lowest-risk
would be to fund clinical trials for non-patentable interventions. There are
plenty of drugs and therapies that are well-known to work, but which can't be
used (or can only be used through much-more-expensive variants) in clinical
settings, due to the lack of anyone willing to fund the studies to formally
prove their effectiveness to the FDA.

A notable example is recent efforts to fund a study on the use of
corticosteroids and vitamin C to stabilize patients with sepsis [1]- this
would be a _huge_ impact on mortality for patients with all sorts of diseases,
since sepsis is a common consequence of lowered immune system functioning or
post-surgical infections, but since neither corticosteroids or vitamin C are
patentable, there's no commercial incentive to fund trials. Another example is
the use of MDMA as a psychiatric drug- any highschool dropout can tell you
that it _works_ as a powerful mood-elevating chemical with relatively rare and
benign side effects (at least by the standards of psychopharmaceuticals,) but
clinical trials were only recently begun after decades of agitating from
psychiatrists.

The most potent benefits from philanthropic funding tend to be in areas that
can't be reached by conventional for-profit commercial work. There's still
much more low-hanging fruit out there.

~~~
abtinf
Why fight one-by-one. The highest impact use of money would be lobbying to
disolve the FDA or, failing that, eliminating the requirement to show efficacy
(leaving only the requirement to show safety, which is relatively cheap).

Of course, I anticipate a number of replies telling me how wrong I am and that
regulations are needed for safety; none of them will mention the trade offs
involved.

~~~
jashephe
For lack of a rebuttal to the FDA dissolution comment, which I'm sure others
are more qualified to respond to, I wanted to address the efficacy/safety
remark:

A growing number of people have voiced objections to the burdens of the FDA's
efficacy testing requirements, but it's worth at least thinking about why
they're in place. The main issue is that "safety" in the context of
pharmaceuticals doesn't mean "perfectly safe" or even "non-lethal" — it really
means, "safe enough, given the benefits". Side effects of a chemotherapy drug
that can completely eliminate a tumor, for instance, could be acceptably
substantial, because it cures an otherwise terminal illness. Side effects of a
drug mildly lowering cholesterol levels, by contrast, must be strictly
limited, because many Americans may take such a drug for much of their adult
lives, sometimes in combination if the effects of a single drug are too weak.

It's hard to know if the benefits outweigh the risks if you don't know what
the benefits are. Obviously, this efficacy testing carries a huge time and
monetary burden, but without it, contextualizing acceptable risk would be
difficult, if not impossible.

------
nonbel
"Moskovitz, whose estimated net worth is more than $14 billion, and Tuna have
said that they plan to give away most of their fortune during their
lifetimes."

To get an idea of the money involved here, his life's fortune is about what is
currently spent every 6 months on medical research that no one will ever
double check (since it is impossible to do):

"Overall, the team found that poor materials made the largest contribution to
reproducibility problems, at 36%, followed by study design at 28% and data
analysis at 26%. The team estimates the overall rate of irreproducibility at
53%, but cautions that the true rate could be anywhere between 18% and 89%.
That puts the potential economic cost of irreproducibility anywhere from $10
billion to $50 billion per year."

[http://www.nature.com/news/irreproducible-biology-
research-c...](http://www.nature.com/news/irreproducible-biology-research-
costs-put-at-28-billion-per-year-1.17711)

And irreproducible _in principle_ studies are just the tip of the iceberg.
Beyond that there are many problems that can render research useless or
misleading (p-hacking, bias due to unblinding, misinterpreting results,
incorrect analysis, etc). Just pumping more money into this system rather than
trying to change the incentives and practices seems wrong.

------
benkuhn
For anyone else who was confused by the headline: it's "high-risk" research in
the sense of "speculative" or likely to have null results, not in the sense of
e.g. the lethal virus research that was on here a few days ago.

~~~
ClassyJacket
I read it as 'likely to produce nothing useful'; maybe I'm just not
imaginative.

------
notadoc
I'm surprised the "identified 11 priority areas in science" did not include
antibiotic research, given that we are rapidly running out of antibiotics as
resistance develops, all while virtually nobody is researching or developing
new antibiotics.

~~~
coltonv
I know that antibiotic resistance is a problem but can you elaborate on how
were rapidly running out right now? I got strep last week and they prescribed
me amoxicillin (or penicillin if i was allergic) which are both quite old and
established, and still prescribed today.

~~~
notadoc
In short, it's evolution. Bacteria develop resistance when exposed to
antibiotics. They lose their effectiveness.

This will give you a decent overview of antibiotic resistance:

[http://www.who.int/mediacentre/factsheets/antibiotic-
resista...](http://www.who.int/mediacentre/factsheets/antibiotic-
resistance/en/)

If you like to watch documentaries, Frontline has a few on the topic, though
each show is several years old now which is an eon to pathogens

[https://www.pbs.org/wgbh/frontline/film/hunting-the-
nightmar...](https://www.pbs.org/wgbh/frontline/film/hunting-the-nightmare-
bacteria/)

(on youtube
[https://www.youtube.com/watch?v=gE4VzFz9PPo](https://www.youtube.com/watch?v=gE4VzFz9PPo)
)

[https://www.pbs.org/wgbh/frontline/film/trouble-with-
antibio...](https://www.pbs.org/wgbh/frontline/film/trouble-with-antibiotics/)

~~~
coltonv
No i know how antibiotic resistance works, i just haven't seen it have any
effect on me or anyone I know, which makes the statement "we're rapidly
running out" seem distant

------
jph
Congratulations and thank you.

If you want to see concrete progress thanks to Dustin and Open Phil, read
about Target Malaria, one of the research organizations.

I am seeing firsthand the need in Southeast Asia: an emerging drug-resistant
"super-malaria" is spreading along the Mekong and is impossible to treat with
standard medicine.

Big U.S. pharma has no answer for this, and the problem is accelerating. I
believe Open Phil and similar independent science funding orgs can give us all
a major avenue of research to help save many lives.

[http://time.com/4960649/super-malaria-southeast-
asia/](http://time.com/4960649/super-malaria-southeast-asia/)

[https://targetmalaria.org/](https://targetmalaria.org/)

------
kayhi
Exciting to see more funds going to research, but cringe knowing the
efficiency in how it is spent.

Due to procurement not having a research background, they often due poorly
negotiating prices for basic scientific chemicals and supplies. The result
makes it very difficult for researchers to buy from the open market such as
Amazon, etc.

Here are 12 tweezers for nearly $700 list price:
[https://us.vwr.com/store/catalog/product.jsp?catalog_number=...](https://us.vwr.com/store/catalog/product.jsp?catalog_number=89259-984)

Procurement feels good getting 45% off of list price across all products, but
they do not compare the actual price.

~~~
goialoq
I don't have a research background, and I know not to feel good paying $60 for
a pair of tweezers. What prevents procurement from buying from Amazon?

[https://www.amazon.com/Tweezees-Precision-Stainless-Steel-
Tw...](https://www.amazon.com/Tweezees-Precision-Stainless-Steel-
Tweezers/dp/B00LYLJJO2)

~~~
Q6T46nT668w6i3m
I’m curious about this too. I can’t imagine a procurement office not
permitting Amazon! It’s a crazy world.

~~~
kayhi
The problem is creating many hurdles to purchase.

For example, a contract gives the scientific distributor the right to match a
price [1]. Scientists need to make this request through their procurement
office or to a sales rep. which takes a couple of days and additional
paperwork to complete. These extra steps create enough friction that
researchers will often by through contracted providers despite them being more
expensive.

[1] examples:
[https://procurement.fsu.edu/vendors/VWR](https://procurement.fsu.edu/vendors/VWR)
[https://www.dfa.cornell.edu/procurement/news/improved-
prefer...](https://www.dfa.cornell.edu/procurement/news/improved-preferred-
supplier-agreements-laboratory-supplies-and-equipment)

------
hkmurakami
Animal Welfare reminds me of David Duffield and Maddie's Fund.
[http://www.maddiesfund.org/dave-
duffield.htm](http://www.maddiesfund.org/dave-duffield.htm)

If you know anyone working in this field, it never hurts to contact this org.

