Down in the comment weeds of a recent Roger Pielke Jr post, I came across a great Megan McArdle piece on, among other things, the difficulty of translational research. It is, quite simply, very hard to take a bioscience discovery and turn it into a useful drug. Here is former NIH director Elias Zerhouni:
When he arrived at Sanofi, “I thought the solution would be simple,” Zerhouni said at a recent R&D press event attended by the Health Blog. He thought the answer to the company’s R&D woes was to make it more creative and more nimble, like a small biotech.
But he realized that small biotechs are no more successful than large drug makers at coming up with new drugs. “At the end of the day, there’s a gap in translation,” he said.
Zerhouni’s observation reminded me of this graph of the productivity slowdown in pharmaceutical R&D. I wonder how much of this trend can be attributed to “all the low-hanging facts having been found.”
Along those lines, here is Atul Gawande commenting on medicine today:
We are at a cusp point in medical generations. The doctors of former generations lament what medicine has become. If they could start over, the surveys tell us, they wouldn’t choose the profession today. They recall a simpler past without insurance-company hassles, government regulations, malpractice litigation, not to mention nurses and doctors bearing tattoos and talking of wanting “balance” in their lives. These are not the cause of their unease, however. They are symptoms of a deeper condition—which is the reality that medicine’s complexity has exceeded our individual capabilities as doctors.
The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.