On 21-9-2012 22:39, Orchid Win7 v1 wrote:
> On 21/09/2012 07:27 PM, andrel wrote:
>> I think you're case for the pharmaceuticals is a bit biased towards the
>> official propaganda of those companies.
>> Reality is much more complex.
>
> I see...
>
>> There is the problem that very few new medicines come on the market.
>
> Cool. So all those "first time in man" drugs I've helped my ex-employers
> work on... apparently those didn't actually exist, right?

Did you follow them up afterwards? And did you check that claims?
Many of those would have been (hopefully) irrelevant variants of 
something existing.

>> The rules are probably just too strict.
>
> This is somewhat outside my area of expertise, but IMHO the rules are
> reasonably OK ATM.

Reasonable, but not the best in the interest of patients.

>
>> And the main improvements are mostly
>> done, most things nowadays are statistical improvements.
>
> While it's true that there are plenty of cases of designing a new drug
> which is like an existing one but slightly different in some way, it's
> also true that there are plenty of people scouring the tropical
> rainforests, the great coral reefs, and the bottom of the oceans to find
> unusual molecules that do something interesting. Most drugs are "found"
> rather than "designed". Oh, sure, the molecule you find might not be
> perfect; you might need to do some design work to improve it. But the
> basic design is from mother nature's kitchen, mostly.

Did you do research on that or just watch Discovery Channel now and then?

>> What the
>> companies are doing is finding ways to extend an existing patent, not
>> creating new ones. (A bit like Walt Disney finding ways to extend the IP
>> on mickey mouse indefinitely.)
>
> Again, while I'm sure they /do/ try to find inventive ways to keep
> milking their stuff for every last penny, that doesn't mean that there's
> nothing new coming out.

The rate of truly new drugs has been declining over the last decades, 
despite all the research. One of the problems is that most diseases are 
too complex. If you have a broadly defined disease, 'heart failure' for 
instance you have the number of patients for a new drug. Only, some 
subgroups will benefit and some others will get worse. On average there 
is only a small effect, possibly even negative. Which means that the 
drug never goes to market. (Unless it is a small effect but the target 
patient group is (after marketing) extremely numerous, as in the case of 
statins) You might figure out which subgroups do benefit and which are 
harmed, but then the group becomes too small to make a reasonable 
profit. Or the identification is too complicated to make sense for the 
general hospitals and GPs.

>> The money they earn with that only for a
>> small fraction goes into research, most of it goes to marketing.
>
> Now /that/ I can believe...
>
>> In the mean time proven effective medicine is withdrawn from the market,
>> because they make more money on another medicine.
>
> I doubt that. Usually once a drug comes off patent, a whole raft of
> other companies step in to start copying it. (My ex-employers got quite
> a lot of contracts from companies wanting to investigate the properties
> of drugs that have just recently come off patent.)

So no new drugs actually...
But I meant that they are taken off market before the patent expires to 
be replaced by an almost identical one that has a more recent patent or 
they can charge more for. Or simply taken off market because it is too 
cheap.
 From my limited experience with drugs in the clinic I know at least one 
example of the latter. Probably quite a lot of drugs never enter the 
market because they are too cheap to produce. You would hope and expect 
that governments would step in to fill that gap, but 'somehow' that does 
not happen.


>> And we need Bill Gates to fund the medicines that are needed but not
>> profitable.
>
> Sadly, that is probably true. It costs a fortune to develop a drug;
> you're probably not going to bother for something extremely rare. (Who
> would you test it on anyway?) Meaning that if you contract a very rare
> disease... you're kind of screwed.

Indeed. We are talking about rare diseases like malaria and other 
tropical diseases.

>> It is clear that the current way of funding medicines has a lot of
>> problems, but we don't have a better alternative yet.
>
> I agree with this sentence.


-- 
Women are the canaries of science. When they are underrepresented
it is a strong indication that non-scientific factors play a role
and the concentration of incorruptible scientists is also too low

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