This is completely unsurprising, and this:

But let’s think about that 91% failure rate for a moment. When I bring this up in presentations, I invite the audience to consider what the auto industry would look like of 91% of new car designs proved unable to roll out of the factory, or if 91% of new airliner models were unable to leave the ground

Is an utterly irrelevant comparison. For physical thing we have engineering, and the practical application of the trades and craft, trial and error.

For modern medicine, we're only just starting to come out of the wild west era. Or perhaps slightly further along than that.

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mianos 3 hours ago | parent | next [-]

Also, highly related, in the previous paragraph, they say: "We know a lot more about the biology of disease - although God knows, not nearly enough".

Anyone smarter than a 10 year old would not we actually know almost everything about car design. How it works is not at all hidden. We have iterated on pretty much the same thing for 100 years. The current state is about efficiency, materials and manufacturing.

When you have deep knowledge and experience in a field you will get near 100%.

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levocardia 6 hours ago | parent | prev | next [-]

Indeed, I suspect the failure rate of, say, new jet engine designs is rather high as well -- those failures just never get reported in a federal repository, unlike RCTs, since they never make it out of the simulator or the prototyping lab. And we have, comparatively, much better computational models of how airplanes fly than how cancer cells mutate. FWIW this clinical stat is far better than Edison's supposed lightbulb-idea failure rate!

	▲	TheOtherHobbes 6 hours ago \| parent [-]
		Jet engine design is iterative, and the basic principles are well-understood. Drug design seems a lot more binary. You can find a new pathway, but drugs themselves are fairly simply molecules, and you can't iteratively 'fix bugs' the way you can in an engine or a piece of software. The engine is a given, it's almost astronomically complicated, you know a lot less about how it works than you'd like to, and you're trying to change how it works while it's running without breaking anything, using tiny rigid parts that have to snap into place correctly and can't be bent to fit. High failure rates aren't surprising.

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estearum 5 hours ago | parent | prev | next [-]

> For modern medicine, we're only just starting to come out of the wild west era. Or perhaps slightly further along than that.

Why do you say that? What's the evidence? We continue to have virtually no clue how to make drugs, per TFA.

	▲	perpetuallunch 5 hours ago \| parent [-]
		Targeted gene therapy, cancer survival rates, trauma care, the advancements in hip and knee replacement, all sorts of surgery, HIV is now a non-issue with the right care. The list goes on. Drug development is a hard problem because the solution space is poorly constrained: biochemistry is complex and messy, expecting one chemical substance to have narrow positive effects is probably hopeless.

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bsder 3 hours ago | parent | prev [-]

> Is an utterly irrelevant comparison. For physical thing we have engineering, and the practical application of the trades and craft, trial and error. > > For modern medicine, we're only just starting to come out of the wild west era. Or perhaps slightly further along than that.

I don't think its irrelevant, but a better comparison would be to what vacuum tube development looked like before we understood electrons. There were some very whacky designs and most of them didn't work for crap.

And, yeah, I would argue that PCR shifted us from the alchemy phase of biology to the science phase and now mRNA has shifted us from the science phase of biology to t he engineering phase of biology. We're just getting started.