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Former Intel CEO Rips Medical Research
Posted by
ScuttleMonkey
on Mon Nov 05, 2007 06:00 PM
from the git-r-done dept.
from the git-r-done dept.
Himuanam writes "Former Intel CEO Grove rips on the medical research community, contrasting their lack of progress with the tech industry's juggernaut of breakthroughs over the past half-century or so. 'On Sunday afternoon, Grove is unleashing a scathing critique of the nation's biomedical establishment. In a speech at the annual meeting of the Society for Neuroscience, he challenges big pharma companies, many of which haven't had an important new compound approved in ages, and academic researchers who are content with getting NIH grants and publishing research papers with little regard to whether their work leads to something that can alleviate disease, to change their ways.'"
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Basic Research (Score:5, Insightful)
And that's the way it ought to be. Not all things need immediate applications. Many of the most impressive inventions of our time have been a fusion of research that seemingly have few worthwhile applications. Expanding the sum of human knowledge is never a waste of time.
Re:Basic Research (Score:5, Insightful)
Bzzt. Wrong. Endoscopic surgery. Cardiac stents. Infinitely better drugs. Colonoscopy. Go back to 1977 and have a stroke, a heart attack, a major car wreck, testicular cancer - hell, go back then and have chronic stomach ulcers. The treatment for those used to be a partial resection of the stomach through an open incision. Now, it's a course of antibiotics. Those were just the examples that occurred to me over the course of five minutes. There are a lot more.
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Agree: Big Pharma, not "research", is the problem (Score:5, Insightful)
We have had steady advances in medicine. Just during the time I was in medical school (a decade ago), I was astounded by how much medical science had advanced. By the time I was finishing up on my medical training and getting ready for independent practice, we were being taught: "Remember that treatment for arthritis you learned in second year? Well, we don't do that any more --here's what we do instead
However, from the standpoint of the ordinary patient, there has been a problem in one specific area of medical research: Big Pharma. (That's what they call the largest pharmaceutical industries: Pfizer, Merck, Novartis, GSK, Astra-Zeneca, Wyeth, etc.) This is because they are not bringing new drugs to market.
Don't misunderstand me, now. I didn't say that basic research wasn't taking place, or that it didn't have potential to be developed into useful products. I said that Big Pharma was not bringing new drugs to market. I blame this on the profit-centred, corporate-minded groupthink that has been running Big Pharma. In a nutshell, Big Pharma has been mismanaged.
In the pharmaceutical industry, you can see a new drug coming from a long way off. First there has to be basic research; one in ten research studies will show a promising molecule (ie. possible drug candidate). One in ten molecules will be developed into a stable usable form that doesn't have to be sealed in gaseous form or injected directly into the kidney or other impractical things. One in ten usable molecules will show promise when tested on animals. One in ten animal-tested drugs will go on to clinical trials in humans. One in ten human trials will show something that's worthwhile marketing. (Okay, don't take the one-in-ten ratio too literally; a better estimate is that every drug brought to market came from somewhere around 500 to 1000 possible molecules.)
It takes time to go through all these discovery phases, and to go through clinical trials, get approval from the FDA (or equivalent regional drug authority), etc. There's a very long pipeline to go through before a drug gets to market, so you can see right now what sorts of drugs will be coming out five years down the road.
And Big Pharma has, basically, nothing coming out.
This is because there has been a huge merging frenzy in the past decade, almost like an orgy of nested expressions that would do any LisP programmer proud. Toss in SmithKline and Beecham, blend with Burroughs and Wellcome, sprinkle in some Glaxo, bake at high temperature, and out comes a steaming hot GlaxoSmithKline. Then there's Pfizer, gobbling up Warner and Pharmacia / Upjohn, and then spitting out the bones, a process so repetitious that the people eaten up and summarily laid off produced a T-shirt with the oval blue logo in the style of the Pfizer logo that says, "Pfired!"
It's been great for people juggling stocks. Valuations went up, people made money, CEO's made speeches
Any of you heard of "patent lawsuits"?
Yup, they went through patents! Hey, little company there, you can't sell our drugs, cuz WE have the patents! We have to make our money! My favourite example: a few years ago, a little company called Andrax sees that the patent for omeprazole (brand name Losec, or Prilosec in the USA) will be expiring soon, so they start developing a generic equivalent, preparing studies for the FDA to show that their generic equivalent is safe and equal to the brand name version. The plan is that, a year later, all the manufacturing equipment and research will be in place and they can start mass producing omeprazole the instant it comes off patent.
What happens? AstraZeneca ("AZ"), owner of the original brand name, sues Andrax for violating the patent. They say that the patent actually
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Re:Basic Research (Score:5, Informative)
Instead, with modern advancements I was able to have the VATS procedure. This involves three tiny incisions and the insertion of a small camera to help the surgeon work. It's still a painful recovery, but there's a lot less interior trauma.
So it's BS to say there have been no advancements made over the last 20-30 years. Look at our life expectancy over that time - it's only gone up. That's not because we're net healthier (true, we smoke less, but then we're also much more obese), it's because we're eradicating or controlling more and more diseases, we're performing fewer and safer surgeries, and we're using more effective medications (yes, even for so far incurable diseases like HIV).
In fact, one of the things most people don't realize is that almost all of our life expectancy gains over the last 100 years have been due to disease control, not better overall health. In 1900, lots of people made it to 70 or 80 years old before death, but lots of people died when they were 20 from things like polio, smallpox and TB. Infant mortality was also much higher than it is now. In other words, we're living longer lives because of the health care industry, not because we're all eating better food.
That's to say nothing of modern pain management. Say what you want about oxycontin, I don't know how I would have gotten through the first six months after my surgery without it. A lot of modern medicine is focused on quality-of-life issues, which are important issues. 20 years ago, a doctor would have said to just live with it; the pain is good, means your nerves are coming back. The current thinking is it's not enough to just save a person's life, it's also about giving them a life worth living. After my pain meds ran out the first two weeks after my lung surgery, I was in absolute hell until I made it back to the doctor and got my prescription for oxycontin. People who have never gone through major surgery have no idea what real pain is like. Oxycontin made life bearable until I healed well enough to get off it (and seriously, it was about a year).
The pharmaceutical industry has its share of problems. But it's just way off base to say there have been no advancements over the past however many decades.
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Liability... (Score:5, Insightful)
The fundamental tenet that drives us all in the semiconductor industry is a deeply felt conviction that what matters is time to market, or time to money. But you never hear an executive from a pharmaceutical company say, "Before the end of the year I'm going to have xyz drug," the way Steve Jobs said the iPhone would be out on schedule. The heart of every high-tech executive has been, get the product into customers' hands and ramp up production. That drive is just not present in pharma; the drive to get sufficient understanding and go for it is missing.
Let me tell you, if Intel had to pay $5,000,000 to the widow of everyone killed by an FDIV bug who would have died 3 weeks later (eg, like a drug company has to do), they would be a lot more conservative about getting chips to market.
Next up... Car industry. (Score:5, Funny)
Re:Next up... Car industry. (Score:5, Insightful)
As for Harley's: it's a taste. Like buying the biggest pickup truck you can find and jacking it up to 12 feet in the air. Or owning a hummer. Or a Ferrari for that matter. Now you might say, "a Ferrari? That's cool though!" Sez you. Still gets less than 10 mpg, you can't ever really use its speed without risk of getting caught, so you have an expensive, fuel quaffing car that looks pretty.
Personally, I hate Harleys. People make them loud as a cannon, drive down your road at 6 in the morning to go to work. "Loud pipes save lives," they say, which is utter crap because I can't even hear the tractor trailer next to me with my windows up, how the heck am I going to hear you coming up behind me? Whatever, it's a feeling of power thing, I gather, sitting on a big rumbling beast of metal.
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tech innovation? (Score:5, Insightful)
No so easy (Score:4, Insightful)
First, given the current regulation scheme (the FDA in the US, for example) the distance between a fundamental discovery and an actual drug on the market is much greater in medicine than it is in technology -- Intel does not require approval from anyone to market their next-gen processor. Second, the current patent system makes making trivial improvements on existing drugs (hence extending monopoly protection) much more profitable than researching new drugs (high risk of failing to produce anything).
But even ignoring all these things, on a fundamental level biology is orders of magnitude more difficult than physics. We understand the physics of seminconductors and the mathematics of computation fairly well. We can simulate future processors ahead of time to see if a new cache design will improve performance or not. We have no idea how to simulate a biological system, and barely have quantitative models for event the simplest ones. Let's give it 100 years and try again.
Translation: "I'm elderly and scared of death" (Score:5, Insightful)
This just in - WATER IS WET (Score:5, Insightful)
Otherwise it's all just an order for another box of a half-dozen duh's. To go.
It's not like computers (Score:5, Insightful)
Medical science is mostly things we don't know, so we stick to the few we do and research the heck out of them. Also, Big Pharma aren't interested in cures. Cures hurt profits. They research treatments, not cures. That's what I'd hope is the main point of a rant against Big Pharma. They are paid to keep people sick, but mask the symptoms, not to actually make them well.
Rich and wise aren't always the same. (Score:5, Interesting)
No question that medicine is a different culture than engineering. I've spent a lot of time in both, and I know. I also know that medicine is NOT particularly creative, and you don't really want it to be. You want your illness to be routine and fixable, and being routine means that nobody has to sweat particularly hard to figure it out. The sweat, and there's plenty, has to be done in research and development, and the difference in development effort between a new therapy for a disease and a new electronic entertainment device is remarkable.
He talks about how the two cultures deal with failure. In engineering, particularly in microelectronics, failure means that you spend money, time, and energy fixing something you broke. In medicine, failure means that you kill somebody. This used to happen a lot, and the modern biomedical research culture is highly biased against failure. It's not OK to die in a study any more, even if the condition we're studying is in and of itself fatal. Changing this would speed up the process of research, but who's volunteering to die for the cause? (And no, offshoring it is NOT the answer - foreign governments are wising up to this quickly, as are domestic ethics consultants.)
He derides modern statistical techniques, misunderstanding the difference between statistical failure and subgroup averaging, and he flatters himself a prophet when he recommends something that pharmaceutical researchers have been doing for thirty years: analyzing failure to see if you can find partial success somewhere.
He writes off in a sentence or two the hardest problem of all, which is figuring out what in the heck is really going on (preparatory to changing it). In engineering, the complexity is finite and human-directed, and the systems are designed with severable components to make the process of debugging and analysis easier. In medicine, the complexity is engineered by a billion years of evolution, not all of it productive or even useful, and very poorly understood. In an organism such as people, where 50,000 poorly-understood genes interact with factorial complexity, just figuring out which end to push on can be maddening. It's the reason that peer review was invented: if you're up a creek with a paddle-less enzyme, there are probably only a few hundred people in the world who can tell whether you're a genius or just confused. Peer review at its best is just like open source. At it's worst it's a lot like open source at it's worst, but the less said of that the better.
I would love to see more acceptance of modern information techniques and more flexibility in medical research. I would love to see better use of rapid prototyping and model systems, and we're heading that way. We've actually come a huge way in medicine just in the last decades, and the pace is accelerating. TFA is just a measure of the fact that, just like software, sometimes the better the system gets, the more you can see how imperfect it is.
Dilbert still has the answer (Score:5, Funny)
(misquoting shamelessly from memory)
PHB: I figure that anything I don't understand can't be that hard. "Reengineer our world-wide network topology: 30 minutes."
Toys for the sake of toys (Score:5, Interesting)
Science vs. Engineering (Score:5, Insightful)
Imagine trying to learn about computers by starting from scratch with a Core 2 Duo chip. Now multiply that by 1,000 and you have the human genome. And that doesn't even get into the more complex firmware, software, viruses, etc. of biological systems.
That's A Big "No Shit" (Score:4, Insightful)
So Mr. Grove, let's consider all the faulty products you shipped in just one year of your career at Intel--and now let's imagine every single customer that bought one of those products suing your company for a half-million dollars each, and winning....
~
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Not without merit (Score:5, Insightful)
All of that could be put aside though, save for one major factor. There is a HUGE amount of money in the pharmaceutical world. And the sad fact is, more of that money goes to crap like Viagra commercials during the Super Bowl than to the research and development of new drugs and treatments.
I'm not saying everyone in the industry is a greedy whore, heck, I've met and worked with some really great people who are in it for the cures. But the privatization of research, the excessive burden of patents, and the big-business/lobbyist friendly approach of our government over the last 2+ decades have lead to a slowing of development and a maximization of profits.
-Rick
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He's got a point. Here's an example: (Score:5, Interesting)
That's fucked up. This is politics essentially censoring science.
Now, I've seen a lot of arguments in this thread about how medicine is so regulated and semiconductors aren't, but I think that's slightly disengenuous. In fact, Intel has broken the law many times in their chip making efforts. This is not a secret. They've been sued probably hundreds of times since the seventies for contaminating groundwater supplies with heavy metals and doing all kinds of mean nasty things that release toxic chemicals into the air, water and dumped across the land. That's just a fact and it shouldn't be surprsing to anyone here at Slashdot. I'm all into recycling and doing my part to save the planet and what not, but being fully aware of Intel's past I'm still using their products right now. I'm culpable as well. What's done is done. They bent the rules and went for it and they certainly had the nuts to go ahead and say fuck it to the rules sometimes even if it meant lawsuits. Intel has been sued for taking chances with peoples health on hundreds of occasions. It's not such a different situation. Let's not pretend they never took any risks and everything was just hunky dory and above board all the way down the line and somehow it's a whole different game for people in medicine.
Admittedly, there is a big time difference in the business models which helps explain the differences. Semiconductors are essentially a glorified form of printing that uses lots of nasty chemicals. So printing and money go hand in hand. Money is printed too, after all. Medicine is a whole other ball of tits. It is supposedly privatized and profit oriented in the US, but it doesn't really work that way on the research level as we see with this story about Ian Wilmut and the questions that weren't asked. Personally, I belive medicine should not and essentially can not be profit oriented in an effective way, certainly not a moral way. It should be government subsidized just like education and the government should be forward thinking and willing to take chances and innovate. The heart of the problem with that plan is that the American electorate seems to be so incredibly dysfunctional and hooked on this psychotic free market rhetoric that real advanced medical techniques based on stem cells, gene therapy and tailored therapies will probably emerge and become popular in the massive state subsidized medical systems of Asia and Europe first.
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Re:Breakthroughs? (Score:5, Insightful)
- G
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Re:Breakthroughs? (Score:5, Funny)
I agree with you 100.000000000137468%
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Re:Breakthroughs? (Score:5, Interesting)
For example, my wife has Crohn's disease. http://en.wikipedia.org/wiki/Crohns/ [wikipedia.org]
It's a pretty nasty disease of the small intenstine which affects something like half a million people in North America. The treatments start off typically with steroids (an old drug with lots of well-known nasty side effects), moving onto Imurin (a kidney anti-rejection drug that's been out for awhile, also with lost of nasty side effects) and Remicaid (the only really "new" treatment for it...still with nasty side effects though). Once those has been exhausted, they perform surgery to remove the infected parts, and then start all over again.
Here's the problem, it was discovered in 1932! In 75 years the best they can do is pump you full of nasty drugs that are toxic to the liver and kidneys until your body won't take it anymore, and then cut the infected sections out. They haven't figured out a proper cause for it yet! Some think it's an auto-immune disease, some think it's actually a persistant infection of the intestinal lining, some think it's genetic, some think there's a genetic predisposition and that diet or taking too many anti-biotics as a child will essentially "activate" it.
When you think about it, that's rather sad... We can't figure out what causes a disease we've knows about for 75 years and that affects half of million people. Of course, we have how many different drugs to help old men get it up? (And yet, strangely, they still haven't come up with one to help women want sex more. =) )
Yes, I realize that's a legit medical concern, but maybe we could work on other things besides another depression pill, or another drug for impotence, or another of whatever cash crop drug is currently popular with the medical industry. In the tech industry they don't leave things behind like that... We don't have 25GHz PC's with 32MB of RAM and 512KB graphics cards.
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Re:Breakthroughs? (Score:5, Insightful)
Science needs to stay spread out and constantly looking at different things, not rehashing the same stuff over and over because it's easy. I mean, you never know, the cure something like Crohn's might lead by accident to the cure for cancer! That's why you need to blaze new trails and constantly strive for incrimental improvements across all disciplines of medicine.
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You're still talking out of your @$$ (Score:5, Insightful)
Here's a computer problem comparison since that is probably your specialty. There are a MILLION programs out there that can act as calculators, they're very easy programs to write - but there are only a handful of good BLAS libraries out there, those are difficult problems. You'd be called a fool if you suggested that we could make BLAS progress faster by taking the people off developing calculators and put them on BLAS - it's the same as your uneducated assumptions about the medical community.
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Re:Put down the flamethrowers for just a femtoseco (Score:5, Interesting)
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