Is this a market that can be disrupted? It sounds if you know how to save a few billion and introduce more science based drugs, it’s ripe for an overtake.
ie totally ignoring existing regulations, pretending they don't apply to you and just hoping you can push through.
In a lot of the 'problems' are the regulations ( which are double edged and tricky to get right ) - and pharma companies are just following the rules.
I think governments might be less lax in letting there be a new wildwest in drug development.
What makes it difficult is the word “prove”
It turns out it’s obscenely hard to make a drug that’s good, and even harder to prove that it’s good.
So how do you do that ethically? How do you justify taking off something that you know works to some extent and try something completely new or worse placebo? ie don't you have to construct the trial in the context of existing treatments etc?
These are the kind of challenges that makes drug development slow - in the end you don't do one trial, but a series of trials, slowly building confidence and making the case.
Often that's what takes the time during the clinical phase.
Of course it would be much faster to go straight to a big trial that would show how well your treatment works in conditions optimal to it - however that kind of 'move-fast break-things' approach involves potentially breaking things which happen to be people.
Regulation just reflects the cautious 'first do no harm' philosophy.
Now let's be honest - big pharma will simultaneous complain about regulation and the cost of development, and at the same time know it creates barriers to entry - there is always some frustration about the slowest of regulatory authorities to adopt new methods - however you wouldn't want your regulatory to be gungho.
Just to be clear, most drug trials for anything where we have an effective treatment are not “new drug vs placebo”, but instead “new drug vs standard of care”. Thus the goal being to prove it’s better than what already exists.
If the standard of care is already good and you don't need a placebo - then you have another problem - you probably are going to have to do quite a big trial to get the stats to show a significant difference, and you are going to find it harder to persuade people to participate with an experimental treatment if there already is a fairly good treatment.
The whole point about the challenges with clinical trials is that it's not an intellectual exercise in designing the perfect experiment and 'just doing it'.
It's about persuading yourself, the regulators, the doctors and ultimately the patients that it's something you should try - and before you've done your first trial you don't have any human data to show it's safe and effective - all a bit chicken and egg - the solution is often to move slowly in stages.
We can't do any of that for drugs that affect emotions and consciousness because we're barely in the stone age of our understanding of the brain and the technology we have to affect it.
Stop trying to venerate the taxi industry, they’re horrible.
My experience of taxi companies in the UK is that they are generally safe, reliable and operate based on reputation.
My experience of taxi's in the US is that they appear to be often operated by desperate people living on the edge of existence.
The sole reason Uber pulled off what they did, is there's no national authority governing taxi style services for all states and cities, it's a state and local effort. So Uber counted on navigating around zillions of slow local governments long enough to get big, and it worked very well. You can't do that in prescription drugs, the feds have a big hammer and can (and will) use it anytime they like.
Except they did the same mistake anyone who comes up with this disruption plan commits (including Google with Calico, or Zuck with CZI) - they recruit existing academics to do the disruption. Unfortunately this just fails miserably because they’re culturally corrupted to think of standard dogmas (like there can never be a single cure for cancer). I remember a time when other such dogmas existed (remember how it was considered impossible to de-differentiate somatic cells?).
The other mistake tech bros make in biology is they think they can make any cool idea work if they are smart enough. Because this is actually true in tech. But biology is restricted by laws of nature. If a drug doesn’t work, it can’t be made to work. There’s no room for wishful thinking.
Third mistake I see often is individual bias towards fields that they come from. Someone who has an RNA background will only try to use RNA to solve everything, likewise with antibodies, or imaging, etc. The current research funding system incentivizes such thinking and it becomes entrenched in anyone already in this field. There’s never a thought of “which is the exact technology and approach I should use to solve this problem independent of what I’m an expert at?” So a lot of projects are doomed from the start.
As long as you’re cognizant of these three facts, I think it’s very possible to disrupt this field.
Bat "normal" might be. Of course, now we are crossing the threshold from medicine to bio-augmentation.
There won't be any magic for cancer. It's just going to be slow grind to solve one hard problem after another.
Also, you seem to be very pessimistic. Many interventions in the history of medicine, like washing hands or the first vaccine against smallpox, were almost "magical" in their efficiency: they addressed a lot of problems through a relatively trivial intervention.
It is likely that a lot of this low-hanging fruit has been picked up, but you insinuate that there isn't any low-hanging fruit to begin with, only an endless slog of attacking hard problems. That is way too negative.