Hacker News Reader

Comment by sammalloy | Hacker News Reader

One thing that has always stuck with me in regards to this topic is the lack of medical research in areas that need it but don’t get it because there isn’t any money in it. One area that comes to mind is feline urinary tract disease. Many years ago, I had a cat who kept coming down with this, and the vet(s) were at a total loss as to how this kept happening. So I decided to open up the literature and plough into it as a layman with no knowledge about animal medicine. Within the space of a single hour I quickly learned that many of the most common diseases facing animals have very little research behind them and a lot of unknowns. Which brings me back to one of the main points of the author. If the neoliberal approach to research is only going to focus on what is profitable to treat, then medical science as a whole has backed itself into a dark corner.

View on HN

I'm sorry but veterinary medicine is an entirely different problem domain with little overlap beyond capitalism and mammalian biology.

No it is not. Maybe you have heard about animal testing before. If what you say is true we hadn't been using animal testing.

Animal testing is to test human drugs/treatments/cosmetics on animals to see if they are safe enough to test on humans.

A lot of basic research is also done in animals, it's a pretty important part of the process that led to many drugs being tested in the first place.

But it's true an understanding of the animal is usually treated as an unimportant tangent. Like you might introduce a mutation into a mouse gene that is analogous to a mutation thought to be relevant in humans and then look at how that affects some other biomarker of interest in the mouse. But you're not going to be studying some issue that arises naturally in mice. Hell you're only using the mouse because it's an established lab model, you don't give a shit about mice.

Also, all the mice are hella inbred and grow up in a sterile cage, so they're hardly even reflective of IRL mice. So even if someone did want to fund lots of research on mouse veterinary science, it would still be a long road (technically and culturally) to get that integrated with basic medical research.

I'm not saying this is the way it should be, but it's the way it is.

"animal testing" and "healing animals" are two diametrically opposite things

My autoimmune disease is likely caused by modern technical advances and is almost nonexistent in countries that haven't modernized. There's very limited research done on on fixing it and lots done on treating the symptoms. Each commercial I see advertising a new medication to treat the symptoms is like a slap in the face.

It's played a large part in being vaccine hesitant. My life has been severely impacted by "trusting the science". It's very likely the science that ended up negatively impacting me is not harmful for 99% of the population. We're trying to reverse engineer systems by clicking buttons on the UI instead of reading the code.

> My autoimmune disease is likely caused by modern technical advances

I'm absolutely certain that my autoimmune disease manifested itself later in life due to chronic stress at work (a modern advancement so to speak). While not the cause, it was certainly the catalyst. Now that the proverbial Pandora's box of autoimmune diseases has been opened inside of me, there's no closing it back up and I can only manage it to some degree.

> There's very limited research done on on fixing it and lots done on treating the symptoms. Each commercial I see advertising a new medication to treat the symptoms is like a slap in the face.

Yup, exactly this. You have to take things into your own hands and figure out what works for you in terms of management. Not many doctors are going to take the time to sit down with you to figure out the root cause(s).

What autoimmune disease if you don’t mind me asking?

I would guess Guillain-Barre, since that is triggered by some viral infections and also sometimes vaccination (perhaps the same underlying reason). It affects very few people after vaccination, but that information is not going to be much comfort to the people it does impact. It is one condition that is a known risk factor for certain vaccines (or of various viral infections). That it could have happened anyways, from an infection, is also probably not much comfort to those who end up with it.

Exactly. And this is true to other medicine not only one produced for felines.

> areas that need it

The premise of capitalism is that enterprising individuals and institutions will respond to the monetary incentive created by these needs.

Could it be that what is unprofitable to treat is maybe not that big of an actual need? Can I argue that I'm happy that there has been no research on feline urinary tract disease as long as human cancer isn't solved yet?

Putting aside cats, there are plenty of diseases that impact humans which don’t get researched enough due to very rare, e.g. <1 in 100 million people.

> maybe not that big of an actual need Not that big of a need to who? It’s certainly a very big need to the people who suffer from or are dying from rare problems.

> Putting aside cats, there are plenty of diseases that impact humans which don’t get researched enough due to very rare, e.g. <1 in 100 million people.

Sure, and is that a problem? Should we as a society not apportion medical research spend to the most impactful areas? I'm curious to what extent the misalignment of incentives is due to capitalism as opposed to the actual need being lopsided

> It’s certainly a very big need to the people who suffer from or are dying from rare problems.

I totally agree. At the same time society cannot put all of its resources in support of very rare cases at the expense of common issues of similar seriousness

Sometimes fixing rare, obscure bugs others haven't bothered with can lead to massive discoveries. Everybody could be banging their head into the wall because it looks most profitable, maybe you could be the one to crawl through the window instead.

Your premise doesn't really survive the fact that death by starvation, thirst and exposure are still a thing.

The best counterexample I can think of is the unwillingness of drug companies to produce new, narrow-spectrum antibiotics. We're facing a looming crisis of bacterial antibiotic immunity, we know that producing the aforementioned antibiotics will resolve it, but the low profit margins prevent pharmaceutical companies from doing research.

Capitalism pursues profit growth, not human need. There may be some correlation between these two forces but it's obviously not perfect.

There isn't money in narrow spectrum antibiotics, because there isn't need yet. We don't have infinite resources, so putting effort into a looming, but not yet existing crisis can very easily lead to worse outcomes.

Yes this is a more plausible example of needed regulation to align capitalistic incentives on societally beneficial outcomes (vs cat UTI research)

In my (admitedly idealistic view) research is something that a society should fund without the expectation of it always returning a ROI. I dont know what the minimum level of monetary support should be and am aware that it could lead to bad actors. But I dont think capitalism should be the primary motivator for deciding what path research should take. We can always research things in parallel. One might even help the other. But we wont know unless we try it

It’s tricky for both sides to go for a pure capitalist point of view:

- human cancer might never be solved if strong business entities were to rely on the prevalence of cancer

- death of cats might have secundary, tertiary effects that are not clear enough to push businesses to enter the market. We would be looking at the negative impacts without ever realizing what the cause is.

> Human cancer might never be solved if strong business entities were to rely on the prevalence of cancer

Given the amount of money someone with a patent on a cancer treatment or cure would make, it's hard for me to imagine that

You are referring to a technical solution, but the patented miracle cure could be limited to 1% of the patients and never make it to the rest, if for whatever reason it didn't make economical sense to do so. It's a bit of goal pushing, but I wouldn't call that "solving" cancer.

There is a bottleneck in the number of MD positions. Without the MD title, your typical life science researcher cannot easily carry out medical research. Medical education and training has a scale problem.

It's possible to get closely involved with this kind of research with just a PhD, but there are all kinds of issues with that career path too.

To conduct good clinical research, I think you need to understand the constraints of clinical practice. It's not only a matter of holding the title, but more of practical experience.

You do need someone with the clinical experience to understand the questions that need asking and to confirm the trends and suspicions seen in clinical practice, but clinical academics are expensive, and also terrible at stats and good research practice. I think the right mix of both is important.

Reply on news.ycombinator.com