Interesting article by Sharon Begley and Mary Carmichael. They discuss how there is tons of federal support for basic research but that there’s a big gap between research findings and medical applications–a gap that, according to them, arises not just from the inevitable problem that not all research hypotheses pan out, but because actual promising potential cures don’t get researched because of the cost.
I have two thoughts on this. First, in my experience, research at any level requires a continuing forward momentum, a push from somebody to keep it going. I’ve worked on some great projects (some of which had Federal research funding) that ground to a halt because the original motivation died. I expect this is true with medical research also. One of the projects that I’m thinking of, which I’ve made almost no progress on for several years, I’m sure would make a useful contribution. I pretty much know it would work–it just takes work to make it work, and it’s hard to do this without the motivation of it being connected to other projects.
My second thought is about economics. Begley and Carmichael discuss how various potential cures are not being developed because of the expense of animal and then human testing. I guess this is part of the expensive U.S. medical system, that simple experiments cost millions of dollars. But I’m also confused: if these drugs are really “worth it” and would save lots of lives, wouldn’t it be worth it for the drug and medical device companies to expend the dollars to test them? There’s some big-picture thing I’m not understanding here.
I think part of the problem is when, for a given indication, a competitor has beaten you to the market. That means that your new drug must defeat the competitor in head-to-head trials rather than just beating a placebo. That makes it more difficult. And, being the first to market has some other advantages like longer patent protection, better visibility, etc. In all of the clinical trials that I worked on (about 10 big trials and lots of smaller ones), only one was a head-to-head comparison.
To get a drug into the market can cost, from start to finish, a few hundred million dollars. It is "worth it" to the pharmaceutical company if it makes money on it- nothing to do with saving lives alas. And there is a huge amount of uncertainty associated with these investments. You don't know that you are going to get FDA approval. Say someone in the trials dies, it may or may not be related to the drug but you will often see the company's stock price fall like a stone. And you have the nasty problem, alluded to above, of competitors.
Basically, its an expensive uncertain business.
Antibiotics are a good example of a family of drugs where research is drying up. Even faced with the growth of multi-resistant staph infections, there is a huge lack of new antibiotics. One piece of the puzzle is economic. Even after development of a "cure" most patients only need an anitbiotic treatment once in their lives (if that) for only a couple weeks. Compare that revenue to any of the Lipitor's etc. that chronic sufferers need to take daily for the rest of their lives. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC20950… for more info.
"There's some big-picture thing I'm not understanding here."
Whatever the specific reasons, I'm sure it's related to the pusillanimous greed and severe dearth of conscience on the part of pharmaceuticals
I just pray that the Chinese and Indian pharmaceutical companies put their western counterparts out of business.
A good read is <a>Marcia Angell's "The Truth About the Drug Companies"
Following up on Kevin's point, there is actually less money in drugs that cure a condition than in drugs that treat them indefinitely. See antibiotics for an example.
(Just to be clear, antibiotics fall into the cure category)
There is also a question of Type I errors in basic research and the translatability of that research into humans.
A discovery is made in MRSA, for example, in rats. There is a high probability that it may be a Type I error (the literature is full of Type I errors). Then even if it truly works in rats, will it work in humans?
Plus we all know about the file drawer problem. Do we really know how much 'successful' basic science is getting tested by industry, shown to be not worthwhile internally, and never heard from again?
But cost and uncertainty, as mentioned by others, remains a huge concern.