There’s another “Troubles of Drug Discovery” piece in Nature Reviews Drug Discovery, but it’s a good one. It introduces the concept of “Eroom’s Law”, and if you haven’t had your coffee yet (don’t drink it, myself, actually), that’s “Moore’s Law” spelled backwards. It refers, as you’d fear, to processes that are getting steadily slower and more difficult with time. You know, like getting drugs to market seems to be.
Eroom’s Law indicates that powerful forces have outweighed scientific, technical and managerial improvements over the past 60 years, and/or that some of the improvements have been less ‘improving’ than commonly thought. The more positive anyone is about the past several decades of progress, the more negative they should be about the strength of countervailing forces. If someone is optimistic about the prospects for R&D today, they presumably believe the countervailing forces — whatever they are — are starting to abate, or that there has been a sudden and unprecedented acceleration in scientific, technological or managerial progress that will soon become visible in new drug approvals.
However, readers of much of what has been written about R&D productivity in the drug industry might be left with the impression that Eroom’s Law can simply be reversed by strategies such as greater management attention to factors such as project costs and speed of implementation, by reorganizing R&D structures into smaller focused units in some cases or larger units with superior economies of scale in others, by outsourcing to lower-cost countries, by adjusting management metrics and introducing R&D ‘performance scorecards’, or by somehow making scientists more ‘entrepreneurial’. In our view, these changes might help at the margins but it feels as though most are not addressing the core of the productivity problem.
In the original paper, each of those comma-separated phrases is referenced to the papers that have proposed them, which is being rather scrupulously cruel. But I don’t blame the authors, and I don’t really disagree with their analysis, either. As they go on to say, investors don’t seem to disagree, either. The cost-cutting that we’re seeing everywhere, particularly cutbacks in research (see all that Sanofi stuff the other day!) are the clearest indicator. People are acting as if the return on pharmaceutical R&D is insufficient compared to the cost of capital, and if you think differently, well, now’s a heck of a time to clean up as a contrarian.
Now, the companies (and CEOS) involved in this generally talk about how they’re going to turn things around, how cutting their own research will put things on a better footing, how doing external deals will more than make up for it, and so on. But it’s getting increasingly hard to believe that. We are heading, at speed, for a world in which fewer and fewer useful medicines are discovered, while more and more people want them.
The authors have four factors that they highlight which have gotten us into this fix, and all four of them are worth discussing (although not all in one post!) The first is what they call the “Better Than the Beatles” effect. That’s what we face as we continue to compete against our greatest hits of the past. Take generic Lipitor, as a recent example. It’s cheap, and it certainly seems to do the job it’s prescribed for (lowering LDL). Between it and the other generic statins, you’re going to have a rocky uphill climb if you want to bring a new LDL-lowering therapy to market (which is why not many people are trying to do that).
I think that this is insufficiently appreciated outside of the drug business. Nothing goes away unless it’s well and truly superseded. Aspirin is still with is. Ibuprofen still sells like crazy. Blood pressure medicines are, in many cases, cheap as dirt, and the later types are inexorably headed that way. Every single drug that we discover is headed that way; patents are wasting assets, even patents on biologics, although those have been wasting more slowly (with the pace set to pick up). As this paper points out, very few other industries have this problem, or to this degree. (Even the entertainment industry, whose past productions do form a back catalog, has the desire for novelty on its side). But we’re in the position of someone trying to come up with a better comb.
More on their other reasons in the next posts – there are some particularly good topics in there, and I don’t want to mix everything together. . .