I'd agree with a lot of that in terms of both many drugs being 'discovered' in clinical trials as oppose to earlier ( a lot of it it about choosing the right patients and dose ), and the differences in mindsets between researchers and those often involved in the clinical trial side.

One of the things you've missed is the strong restrictions put on pharma in terms of promoting use of existing drugs beyond the existing approval ( which makes sense ), and the almost complete freedom Doctors have to do what they want - they can just decide to prescribe something off-label if they think it might help.

It can take a very long time for new ideas to become new products - and a lot of that is inertia ( nobody else is doing it ).

Many thanks for saying what I suspected when looking at the research publications and clinical trials on neurodegenerative diseases. I was starting to think I was an unproductive perpetual malcontent.

For example, memantine has been tested 5 times in ALS. There even no pre-clinical studies that show any positive effect of memantine in animal models. This seems so bizarre to me.

Is this a market that can be disrupted? It sounds if you know how to save a few billion and introduce more science based drugs, it’s ripe for an overtake.

The current system is like Churchill's description of democracy: the worst system, except for all the others.

Biology is extremely complex. There's no substitute for actually trying things out on subjects in vivo. For many diseases we don't even know the cause (Alzheimer's for example). Drug companies have all the incentive in the world to improve the system to get better odds; it's not like they want drug discovery to be such a crapshoot.

This trial is using an existing drug in a potentially novel way (before surgery as opposed to after surgery). I dont think it really lives up the original article title.

The article literally says "Funded by Bristol Myers Squibb and others".

Supported by Bristol Myers Squibb;

https://www.nejm.org/doi/full/10.1056/NEJMoa2402604

> whose health is not considered worth investing into. If they get auto-diagnosed by app (zero-cost), they could volunteer for a free chemical trial

What a profoundly ineffective and broken system we have that this could be uttered as anything other than satire.

Lovely: so just give tons of people an experimental drug and collect garbage data by doing so!

When hospitals are contracted to do work in a clinical trial setting they take their costs and multiply it by 10 (at least). This was done in house with in house resources. This hospital has its own pharmacy that can synthesize drugs and give it to the patients. The pharmacy probably charged just the material costs internally and not for the time.

PhD candidates are paid salary in the Netherlands. Less of course than the senior trial researchers at pharma. I also would not assume there is no compensation for subjects as thats part of the medical-ethical process and not just ‘it helps the subject so no money’.

> Most other products require a lot of high paid labor to produce, think of a video game studio for example, also without any guarantee it won't flop, and it certainly takes longer to develop than to do a clinical trial.

You have to try really hard to make a video game no-one wants[0]. You might not recoup all your investment, but you won't sell zero copies. A drug can have all that money poured in, and nothing come of it.

[0] https://arstechnica.com/gaming/2024/09/two-weeks-after-launc...

This is the most misinformed unknowing take in all of the comments.

You can’t just recruit “200 homeless” and have it pass research standards. The homeless population is the most difficult of all to track, maintain accurate records, and even recruit for that matter. You think the homeless just line up for novel drug trials and report back for updates on a strict schedule?

You need good candidates for the trial. You need them to follow up. You need admins to properly track them and ensure it’s at least mostly accurate. Even the best trial candidates won’t follow the protocol correctly.

> Neither of the vaccines prevents cancer; rather, they are a kind of immunotherapy that prompts the body’s immune system to battle the disease in patients with non-small cell lung cancer.

Not 100% sure, because I've only heard about vaccines in preventative contexts before, but based on this description my guess would be that "anything that tells your immune system to Do Stuff" counts as a vaccine. Versus something like Herceptin, which also treats cancer, just with ready-made antibodies that were grown in a lab.

My wife (MD) tells me that vaccine refers to anything that induces an immune response against a pathogen or disease. In this case the vaccine causes anti-EGFR antibody production

I am sorry for your loss, you lived through my biggest fear. It must be so frustrating to read this kind of thing over and over.

> Doctors want the best outcomes for themselves. If they’ve found an effective treatment that others are overlooking then they’ll seek to publish

However often the work required to prove something is effective is beyond a capacity of a single Doctor. Also in terms of wanting the best outcome for themselves - sometimes that involves not putting their career at risk by trying unproven treatments on patients ( you are focussing on the outcome when it works, not the more likely outcome and consequence of it not working ).

So sure 'miracle' cures are unlikely to lay undiscovered - but most improvements in medicine are incremental, rather than miraculous.

>> If there is an overlooked treatment then they’ll communicate it to their doctor

Hah sure.

Try this and tell me how the egomanical "gods in white" react.

Go through some stuff the RFK says about vaccines etc... and you'll see that in real life it's the opposite.

This was just published by UI showing a potent effect of high dose vitamin C + chemotherapy: https://medicine.uiowa.edu/content/high-dose-iv-vitamin-c-pl... and https://www.sciencedirect.com/science/article/pii/S221323172...

Thanks for providing a plausible explanation. Do you know of any links (ideally peer- reviewed research) supporting the quick evolution of resistance to vitamin C? If not I'll google around.

Rare diseases fund research through philanthropy. And let's not forget Biden's Cancer Moonshot program!

https://www.whitehouse.gov/cancermoonshot/

I don't see how something like high dose vitamin C IV is very expensive. I would assume a handful of oncologists could do the whole thing themselves. We get X patients a year, we randomly suggest the vitamin C IV to half, the half with vitamin C did better or worse by these metrics. Vitamin C is not expensive and they have to collect the outcome data for everyone involved anyway - so where is the expense coming from?

If it has benefits then more doctors will start to do it and more data will become available. If not, onto the next thing.