| Again want to say I really appreciate how thoughtful you are about this. I just want to offer a few of my thoughts because you've been so generous with yours. So you know, I work in the industry. More on the biz side than the scientific. And I am intensely interested in this issue. 100-1000 times cheaper I don't think is achievable in the medium term, if ever. As long as we're running clinical trials I think costs will stay constrained to about a 5x decrease. A 100-1000x reduction, I think, implies a world where we can largely simulate the impact of drugs without resort to in vivo testing. A future I believe in, but one that has a lot big unknown technical obstacles to overcome - like entirely new fields of science and engineering. I'm thinking here on a 50-100 year horizon. This would also entail a huge change for the regulatory environment, but I think we're so far in the future in this scenario that it's hard to predict what that will look like. I think a 2x reduction is possible in the near-medium term. If we can change the probability of technical success for trials through better tox models - not testing - that creates an enormous amount of value. The stuff people are doing to design better molecules pales in comparison to doing this. I think the math and know-how exists to do it now - the challenges are more institutional - Who pays? Who provides data? Lot's of coordination problems between actors who are in economic knife fights with each other, though people are trying. Data problems too. Pharma companies are terrible at databases. It's a mess. Also, it's better to solve tox because it's not disease specific. The effort invested in building the model (or models) will be distributed over many development life-cycles and would remain valuable after a good drug for an indication is invented. This is a huge win for the world because it makes diseases that are important but not economic easier to justify. The phrase 'important but not economic' churns my stomach, but there it is. None of this will fix pricing. Not as long as the patent structure stays the same. If you can legally do it, people will do it. Doesn't matter what it costs. Coke is still charging you two bucks for something that costs them cents to produce, and they don't have a patent. If you want a near term future with lower drug prices (as I do), I fear your route lies through congress. I think it can happen, but I'm an optimist. Thanks again for your thoughts and your work. It's good to see other people pulling in the same direction. |