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The central two problems seem to be: (1) Slow feedback loops -- days (cells in culture) to years (clinical trials). You can't speed these up (unless you figure out how to simulate them). (2) Our (relatively) poor/nascent understanding of human biology.
On #2, as is well known, presumed mechanisms of action mostly don't predict correct clinical outcomes, because of the complexity of human biology. On this front, this FDA report looking at a bunch of drugs that failed in Phase II is illuminating: https://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Reports/UCM535780.pdf …pic.twitter.com/7FYV0qbckg
All of this is to say: I’m seeing a *ton* of VC funding of “AI to cure cancer / discover drugs” type companies. But if they’re not solving the two problems I identify above, it’s not clear what fundamental advance would make somebody bullish on them.
The goal is to make drugs that will be effective *in live humans*. If you don’t have a way of speeding up the feedback loop, or if you don’t have some fundamental advance in biology/knowledge, then how are you going to be 10x better than big pharma at this?
Moreover — getting results with AI requires both fast feedback loops (gaming!) and proprietary data. How (if at all) are these startups getting/generating data that is proprietary and that gives them some kind of competitive advantage?
I’m curious to hear from people who are more bullish on this than I am. Until we fix the above problems, it seems to me that drug discovery will not accelerate in the way that more internet-ish fields are, and I would be bearish on the average biotech startup.
I also glossed over explaining the 2 fundamental problems above properly, because this is Twitter, but would be happy to write an essay on this if there’s interest 
It wouldn’t surprise me if R&D productivity were still in stagnation in 20 years. One implication of this for people who want quicker results (which is most tech people) is that “prevention” is a more promising vector for health than “curing”.
Hi Nabeel, thanks for this. It seems that the cost benefits of innovation often show themselves when new organizations are created. Established companies are slow to move off the high cost structures. Is there hope here from new entrants? Getting up to speed on this great topic.
R&D is super capital intensive — you need robots, labs etc — and then you need to get the drug FDA approved which is a whole cost center. Startups/academics just stop at the discovery part and sell the IP to a big pharma for the approval/manufacturing part.
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