>> 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.

I don't doubt some of them were just variants on something existing. 
(That's surely a much cheaper way to design a new drug.) From what 
little I saw, some of them were also brand new. (And yes, I don't doubt 
some of them never saw the light of day in the end. That's why we /test/ 
these things, after all...)

>>> 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.

How so?

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

I don't actually have access to the Discovery Channel, annoyingly 
enough. (Still, I bet it's not as good as everybody says it is...)

> The rate of truly new drugs has been declining over the last decades,
> despite all the research.

Do you have an actual citation for that?

> 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.

Or, to put it another way, sometimes you can't just inject somebody with 
a chemical and make everything better again.

> 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.

Oh, the original designer of the drug might stop selling it. But once 
the patent expires, anybody who wants to can make the stuff. I'm telling 
you, we regularly got contracts relating to this very activity.

> Probably quite a lot of drugs never enter the
> market because they are too cheap to produce.

That doesn't even make /sense/. The price a drug sells for is usually 
unrelated to the cost of producing it. (Until the patent expires, anyway...)

>>> 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.

I didn't think that malaria was rare, or that nobody has developed drugs 
to treat it...

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