[mattkrause]

That's a frustrating article.

Figure 1 shows that recent neuro/psychatric drugs don't have dramatic effects. That's true--but it's not for want of trying. People have been bashing their heads against the brain for decades, but it turns out to be a really hard problem. Biogen lost $18B of market cap on its aducanumab trials early this year. Eli Lilly, AstraZeneca, Roche, Pfizer, Merck, and Johnson & Johnson have all also had big Alzheimer's trials go sideways. I'm not sure that throwing more money at the same amyloid hypothesis will help. Maybe share buybacks—which get taxed and thereby fund the NIH--might not be the worst idea.

The paper also complains about expensive drugs and me-too drugs. The initial HepC drugs were crazy expensive (nearly six figures), but produced quick cures in virtually all of the patients. This was still a massive win over slow, ineffective treatments that still ended with liver cirrhosis/ cancer/transplants for half of the patients. The subsequent "me- too" drugs, which mostly target the same pathway, don't work appreciably better (hard to demonstrate improvement vs a 95%+ cure rate) but have driven the price down by tens of thousands of dollars.