Suppose for one second that all these people are profit motivated. Whatever research money there is, there is far far far more to be had for the patent royalties from treatments.
Not even close. So much more money to be made from treatment than from research. And there is so much money to be had from beating a competitor with a better treatment than there is to have an equivalent treatment
Taking a cynical profit-only driven view of the world would optimize for better cancer care.
But nobody goes into it "aha I want to make a lot of money." They might go into it wanting to get famous for coming up with a cancer cure. But take the cures that are most closely associated with individuals, whether it's a drug targeting BCR-ABL1 fusions or HER2, and almost nobody knows their name. So even then the fame motive is pretty weak.
> Taking a cynical profit-only driven view of the world would optimize for better cancer care.
There are many promising research directions, which are however grossly underexplored, either because there is a low chance it might lead to a positive result, or because it cannot be patented even if it's successful. Examples in the latter category include off-label use of established procedures, or of already known drugs. Conversely, the majority of money and energy is being spent on highly predictable research and which can result in a patent; almost always the downside is low impact. So as you can see, profit optimisation is not correlated with impact optimisation.
Calling off-label repurposing of established drugs "under explored" is a bit insulting to all those people that attempt it all the time, without a higher success rate than any other method. Folks like Razelle Kuzrock make great progress, and the "under exploration" is more about not spending enough time exploring RNA or protein diagnostics rather than DNA diagnostics, if anything. Which isn't due to lack of impact or profit optimization, just due to intuition biases of the field.
Calling profit and impact optimization "uncorrelated" is not justified by your comment. The biggest impact in the past decade of cancer has undoubtedly been immunotherapies, which are also by far hugely profitable. And immunotherapies themselves were often a backwater, far more so than drug repurposing, until the impact came through with a patented drug.
To be fair, dead and dying people are pretty bad at paying bills. Even assuming staggering, unrealistic levels of corruption in all parts of healthcare, someone in the chain ought to be financially motivated to see the patient recover.
Or it looks like someone suffering from the effects of healthcare treatment of loved relatives, looking for connections and a narrative that fits what happened to a tragic event. Within that cynical diatribe lies a narrative that resonates with some.
That narrative can be boiled down to: Profit in patient treatments produces perverse effects.
It's an alignment problem, where profit aligns to treatment over cures (a metaphor is the overreach of SaaS solutions when more static software could do).
supply chains logistics, capitalistic urges to throw out food instead of giving it away, zoning and HOA's preventing home gardens, coordinated rental hikes, none of those things are aligned with feeding people but instead aligned to bilk money from peoples' hunger (or shelter in the case of renting).
The farmer is relatively aligned financially with feeding people by comparison: they are paid money to grow food...
Some people are convinced that healthcare initiatives are so corrupt as to be theater, in regard to finding new treatments, somehow forgetting that the competition is measured on a race to the highest survival rating (both in large populations and small populations looking to grow - ie Israel). Billions of dollars is nothing if you have billions of people paying even 20$ a month for the duration of their extended lives, going forward through history (since cancer wont stop). It's a purile fantasy that their is a cabal of mustache twirlers, sabotaging medical discovery.
Do you know what motivates hedges to fund new startups effectively? Success in previous investments. Drug cures have nothing but upsides for every economic strata.
Except there is an overabundance of historical evidence of hedge funds giving almost exclusive preference to research which is highly predictable and has negligible impact, as long as it can result in a patent.
See for example below. Aging research is one of the most eclectic areas, because it touches on virtually all biological systems. There are countless promising directions which are grossly underexplored. Yet this massive hedge fund chose to invest in discovering new analogs to older drugs. Why? Because the older drugs are effective, discovering new analogs is easy and the patented products can then be marketed.
So, yes. There is a provable cabal of mustache twirling investors who optimise for profit, at the cost of impact. Why you would defend them, in spite of your self-professed rational interest in the positive externalities of revolutionary healthcare, is beyond me.
Funding in addition to not too the exclusion of. People still fund new restaurants and strip malls not just startups.
Closely related drugs may not cure new diseases but they do help. There’s a lot of drugs like Morphine but the thing is that give doctors options for better treatment. Fast acting and fast metabolizing is beneficial when an EMT is helping someone deal is massive trauma, post surgery recovery and you want a different drug.
Cialis and Viagra may both make your dick hard, but millions of people benefit from the options from having both.
Funding is the essence of scarcity. Funding one thing means those money will not be funding anything else. But you're free to be content with countless minor variations on existing treatments [0]. Curing cancers will require an actual breakthrough.
Total funding for all human activities is scarce, but can go to anything. Money spent on video games could instead be used to fund cancer research.
Thus the percentage of that funding going to medicine isn’t fixed. We essentially spend extra money on this kind of research rather than diverting cancer funding to look for new pain medications. Further, people with sage IV cancer really have benefitted from better pain meds it’s not as useful as a cure but it’s still useful.
Capitalism has freed 90% of humanity to do something other than farm food. We’re in the 3rd stage of human history first almost everyone was hunter gatherer, then nearly everyone was farmers, now people do all kinds of things. How we spend that seemingly boundless surplus of labor may not seem efficient, but it doesn’t need to be to be dramatically better.
Progress is exponential. So looking in the past and saying we should be content with a 90% improvement is misleading, because it is dwarfed by how much more potential there is.
That exponential is based on the increase in number of people not farming. Graph the number of writers/scientists/engineers/etc over time and it’s an exponential, but population isn’t expanded exponentially any more.
I don't defend "them". There is no "them". Conflating price gouging with lack of agency is, a different issue, outside of research. Patents count as output. Regulation hinders progress in the interest of safety and accountability. There are tradeoffs, granted. The idea that funds want to fund partial cures, rather than more comprehensive ones, is partially true. Comprehensive would be better for everyone, if it wasn't so damned difficult in western nations.
PHDs are predicated on thesis papers to prove something novel, which largely have no impact on society. This is a consequence of knowledge availability (and consequently utility), not maliciousness. Medicine is not special, in this regard.
The survival bias applies here. It's hard to know the diseases that are cured or have new treatments, because those cease to be issues at the forefront. Onchocerciasis? Nobody in the 1st world cares that was cured. Peptic ulcer disease? That was handled. What about medical procedures? Even incremental improvements to drugs, allow for more effective treatments or old treatments to have significant efficacy increases.
The field would benefit greatly from even a fraction of the investment in the AI and crypto bubbles