Comment by cc439 | Hacker News Reader

Comment by cc439 | Hacker News Reader

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There is one bright spot on the pharma horizon and that is the industry's discovery and pipeline crisis. There has been a marked slowdown in the discovery of novel drugs over the past decade, a trend that has remained resilient even in the face of enormous R&D spending. Whether you think big pharma spends too much on marketing in comparison to R&D doesn't dampen the importance of the sheer volume of dollars being spent. The pipeline for many pharma giants is practically dry and only getting drier with each passing year. Many have tried to offload the risks involved in massive R&D efforts by letting small companies develop the drug and then obtaining their IP through mergers and acquisitions but even then, the pace of discovery for novel drugs has still slowed meaning the number of M&A opportunities are also shrinking.

Maybe the pharma giants simply played themselves, greedily focusing on exorbitant short term profits and naively assuming R&D would always deliver something at their existing levels of funding while ignoring the long term effects this would have on their business model. Maybe we've simply reached "peak pharma", running out of easy discoveries that are best treated by applying a chemical and entering a world where biotech and immunotherapy will drive the future of healthcare. Either way, the patent cliff looms and we are rapidly approaching the threshold where enough profitable drugs go generic that the industry can no longer afford to buy out, bribe, and cheat their way to maintain their position.

they have a plan for this: reformulating old drugs for new indications. if drug X was originally made for condition Y but there is some inkling which suggests it could work for condition Z, they can commission a new round of trials and eventually remarket X for Z. thus the crusty and middlingly profitable X gets a new lease on life, treating Z with modest efficacy. they do this at a very high rate at present.

they can also rehabilitate their older drugs by making facile new combinations in which drugs A and B which treat condition Z are combined into the same pill which is now rebranded as drug C. this technique is beneficial because if A and B were first-line treatments before, C is guaranteed to be a first-line treatment with a minimal amount of time in the wild.

then there's the old side effect shuffle in which older drugs with acceptable but unpleasant side effects are reformulated or otherwise tweaked to offer marginally better patient experiences, most frequently in a single small patient demographic. marginal improvements win the market if the drug's target demographic is already suffering a lot from their condition or their treatments.

in conclusion, the pharmas can create the appearance of innovation and modest new revenues nearly indefinitely even when their pipelines are in actuality quite sparse and breakthrough innovation is absent. this ability to churn old stuff buys them time to create new stuff to put into the pipeline using more complex therapeutics like immunotherapies, etc.

>the pharmas can create the appearance of innovation and modest new revenues nearly indefinitely even when their pipelines are in actuality quite sparse and breakthrough innovation is absent. this ability to churn old stuff buys them time to create new stuff to put into the pipeline using more complex therapeutics like immunotherapies, etc.

I agree with everything you said in that post but I think we disagree on the inevitability of the pipelines running dry. The mere fact that such strategies have become common industry practice points toward a structural decline in novel drug discovery. While such strategies buy time for new blockbuster drugs to be discovered, they simply are not being uncovered at a rate commiserate with the expectations of the existing pharma business model. What you are describing are what I consider to be patches on the hull of a sinking ship. When today's big pharma business model relies on $X profits and all the profitable drugs are going off patent and being replaced by tweaks and new indications, eventually $X becomes $X-25%+. Once that happens, all these enormously expensive shenanigans are no longer affordable.

Of course, this all comes at the cost of some potential drugs discoveries that could have been made if the business model was kept honest but that's the future we're left dealing with.

How much money is wasted in duplicated efforts of two or more companies working on the same thing? There's merit, of course, to having different teams of people trying different approaches, but I assume even the learnings of failed attempts aren't shared between competitors.

How many medical breakthroughs are on the verge of discovery, of only someone had complete access to data that's currently spread in silos across multiple companies?

I get he gist of what you are saying is “if only we had cross company collaborations” but reality is that you’ll find people even inside the same company not collaborating. Heck you’ll find professors sitting in the same hallway for decades who are working on the same thing and not collaborating.

As for opening up data, as soon as the data becomes valuable to share companies do share it, but quite naturally they charge for it to recoup the costs of creating that same data. And when one company abandons a druf, they don’t just dump it in the ocean, they sell it of to other companies again to recoup some of the costs.

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