Slashdot Mirror
Former Intel CEO Rips Medical Research
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.'"
The only reason Intel has had any motivation to come up with any real breakthroughs in the last 20 years is AMD eating their lunch with the Opetron. All they had in 2003 was the Itanium and we all know how big of a turd that was.
I feel a car analogy coming on...
I don't think that the IT industry has the regulatory pressures that the medical industry has, so he isn't comparing like with like.
You break all the laws of physics and you seriously think there wouldn't be a price?
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.
From the article
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.
Test your net with Netalyzr
Former Intel CEO rips automotive industry for not doubling fuel efficiency and halving cost every 18 months.
I can hardly imagine what the medical profession would be like had it been subjected to the so-called progress and innovation we've been cursed with in the tech industry in the past couple of decades, but the possibilities are horrifying. Microsoft Doctor? Intel Inside? Intestinal Exploder? "rights management" for your medications? Nursing outsourced to call centers? No thanks, Andy.
Unlike chip makers, pharmaceutical companies need a national government's approval to market their product. How quickly would Intel and AMD have been able to step up the capabilities of their processors if some Digital Restrictions Ministry or some other government agency had to approve every stepping?
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.
Well Andy, Maybe the human body is just many many times more complex than a calculator.
And it's news that the Pharms would prefer to treat the symptoms rather than cure a disease? There's no money in cures. But keeping people buying pills to treat symptoms - or better yet - reclassifying symptoms as new diseases. Now you're talkin' the shareholder's language baby!
Otherwise it's all just an order for another box of a half-dozen duh's. To go.
We don't understand the human body. We don't know how some drugs even work. It isn't like a computer that we built from scratch ourselves. Two people of exactly the same body mass and type will react differently to the same drug, and we usually don't know why. We haven't mapped the genome, and when we finish mapping it, we won't understand it. We don't know why aging happens. We don't know what causes many diseases. We don't know where viruses came from or how to stop them.
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.
Learn to love Alaska
Hey there! I'm in an unrelated field and I don't know how to do your job, but here's a few changes I'd like to see anyway....
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....
~
His argument is not without merit though. There is no financial interest in developing new drugs when old drugs are still protected under obscenely long lasting patents. And researchers are, as researchers are. I highly doubt many of the silicon engineers are eagerly awaiting news of how Timmy used their latest creation to do his high school term paper on. Like whys, most researchers are likely more interested in continuing their research than the 5-20 year battle what ever their last findings will go through before becoming a commercial grade product.
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
"Most people in the U.S. wouldn't know they live in a tyrannical state if it walked up and grabbed their junk." - MyFirs
If someone actually cured the diseases, they wouldn't be making billions selling drugs for them.
God spoke to me.
OK, so Grove compares apples and oranges, and the liabilities involved with testing medical "studd" are way higher than with microprocessors and other tech stuff... all that and more... but I, in my hart of hearts, feel he has a point. I often wonder what, really, does modern medicine manage to really solve? Diabetes? Nope. Cancer? Nope. Arthrytis? Nope. Ostheoporosis? No. MS? No. etc. (keep that flamethrower down, damn!) I volunteer helping blind people, and just happen to know many eye diseases that are uncurable.
It's a bit depressing, considering it's one of the oldest sciences.
"The agriculture ministry is not in charge of Gundam" - Japanese ministry official.
"...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."
What absolute horseshit. Has he _been_ to a meeting on, say, cancer research recently? I have. And I'll tell you that the vast majority of Big Pharma and academic researchers with NIH grants are working their asses off to develop the Next Big Drug. Not only are there public health reasons involved, but also big financial reasons as well. I've seen amazing things thrown at problems: room-sized robots screening chemical libraries, natural product extractions from flora and fauna harvested by divers from the sea floor, massive computer time and effort thrown into drug design, data mining of the literature of known compounds and their interaction partners, ultra-precise radiation delivery systems involving whole-body imaging...in other words, _huge_ technological efforts costing millions--nay, billions of dollars to develop treatments for cancer.
And you know what the net result is? We're still using drugs and techniques mostly discovered in the '60's to the '70's. Why? Because despite all of these efforts, we haven't found anything that works better. And that's the important thing. It has to work better. Not as good as. Better. Nothing much does.
There's luck involved. Things like Viagra come along not because we _designed_ it to be an ED drug (in fact, it was originally a treatment for high blood pressure), but because it was _discovered_ to be an ED treatment. You can say "I'm going to have a drug to treat prostate cancer by the next Apple Developers Conference" all you want, but it ain't gonna happen unless you get amazingly lucky.
Pharma is not the semiconductor industry because people are not machines.
Considering the fat that the average pharmaceutical company invests 20% of their earnings into R&D (and mot of them don't even research new things) compared to the 50% that go into advertising campaigns/bribing doctors one should really wonder if there might be some misunderstanding here.
Besides, pharmaceuticals are the biggest patent trolls known to man. Just change two functional groups of an already known (and cheap) drug that already proved to be anti-cancerous and starting to market it as a new cancer drug nets Roche a hundred times more money per pill than the old generic one.
He's a rich man who is getting sick and old, and he's mad because it has turned out to be hard to find out how to stop people from getting sick and old. He's upset, and I understand that, but he also missed most of the points that might be out there to get.
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.
(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."
Welcome to the Panopticon. Used to be a prison, now it's your home.
which makes it much easier to grab the low hanging fruit. The history of medicine goes back thousands of years and is much more "mature". Any industry accomplishes a lot when it is young, that seems to be the nature of the game. Look at airplanes. There was less than 50 years between the flight at Kitty hawk and testing the first jets. But how much have planes improved in the past 50 years? Not nearly as much because it gets harder and harder to find places to improve. Boeing's all composite design is pretty revolutionary, but it only achieves about a 20% increase in efficiency at best. Same with medicine.
Medicine is also chasing a moving target much more than say microchips are. There are always going to be new challenges in tech, but once a problem is "solved" in the computer world, it tends to stay that way. Compare that to what medical researchers have to deal with. As seen in the news, bacteria and viruses evolve. Malaria is a constantly moving target. Much harder to chase a moving target than a still one.
Monstar L
A while ago Grove was ranting about the bar-code system for blood banks and going on about how they should be replaced with RFIDs. One Intel employee who actually had run a hospital blood bank pointed out that those bar-codes are readable by candlelight. When lives are at stake, you do not introduce unnecessary complications into the system.
Lacking <sarcasm> tags,
You know what is ironic? Computer hardware is a major limiter of research; imagine that. Calculating the most stable structure and interactions between proteins is very computationally intensive. Excluding super-efficient mathematical methods [unlikely] we are stuck with *his* hardware to do the job. If he wants to attack something for his perceived lack of medical progress, he better start cracking on the better hardware so that we can do our work.
Sigs are too short to say anything truly profound so read the above post instead.
There's a big difference between applying tools to solve a problem (engineering) and developing those tools from observation of existing systems (science). Someone should remind Andy that the entire information technology industry is still based on understandings of electromagnetism and optics that date back more than 100 years. In contrast, we only learned about DNA about 50 years ago.
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.
Build a man a fire, he's warm for one night. Set him on fire, and he's warm for the rest of his life.
You make some good points. However, to some extent I agree with Andy Grove's original statement. If you read the medical literature, most of the journals are full of poorly controlled articles, case reports and sometimes wild guesses. There is very little in medicine which is proven, especially in my field. I am a pediatric neurosurgeon and when I am reading the neurosurgical literature it is absolutely amazing what gets published. It almost seems as if articles are accepted into peer reviewed journals just so the the journal can fill its pages for the month. As also mentioned, the placebo effect greatly obfuscates the process. The ability to get a good case controlled trial which can prove or disprove that a medicine or procedure works requires a huge number of patients. In order to get a good study which may even include a sham surgery requires a huge amount of funding which no one is willing to provide, including the NIH, which is continually having its budget cut. Even if the money is acquired, getting the study past the institutional review board discourages almost all research. After all of this, the Health Insurance and Portability Act passed by the congress has imposed onerous standards for using even anonymous patient data. Overall, the legislative and legal environment in the United States is firmly in place against groundbreaking medical research which can prove or disprove whether treatments actually work.
Please mod parent up. This is precisely why this medical model does not work. It is not geared to rid people of illnesses - it is just a legal drug bandits' model! Now you see why considering regulating the medical industry is not that crazy...
The Force actually is with me.
Some drugs alter a chemical balance.
Other drugs kill things.
Comparatively, it is much easier to alter a balance than it is to kill things, WITHOUT killing the patient.
For example, if you have a hormone deficiency, it's pretty 'easy' to replace the hormone you're missing.
But if your body is being killed by a living organism (bacteria/virus/cancer/etc), it is much harder to kill the bad thing WITHOUT killing the good thing.
That's why it's easy to create anti-depressants and things that make it easier to have an erection, but hard to create drugs that kill cancer but NOT the rest of you.
paintball
As a scientist I can state categorically that it is not currently feasible to do the types of failure analysis that is common in electrical engineering. The most complicated machinery or circuitry ever constructed by humans is trivially simple when compared to the human body. We're slowing developing techniques that will allow for such failure analysis but this is a slow process.
And his idea of needing more non-conformists is fine provided he favors snake-oil salesmen. While the scientific community is a little slow to change, this is overall a good thing. Even the biggest changes, the most recent of which being the acceptance of prions, eventually occur and only take a 5-10 years (largely because only a few people were working on it and they needed to do a LOT of experiments).
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.
From It's The Prices, Stupid: Why The United States Is So Different From Other Countries:
Monopoly power allows sellers to raise prices above those they would obtain in perfectly competitive markets. In the jargon of economics, they are thus able to earn "rents," defined as the excess of the prices actually received by sellers above the minimum prices the sellers would have to be paid to sell into the market. Countries differ in the degree to which they try to whittle away at the rent earned on the supply side through the creation of market power on the buy (monopsony) side of the market. A single-payer system would be called a "pure monopsony."
In the U.S. health system, for example, money flows from households to the providers of health care through a vast network of relatively uncoordinated pipes and capillaries of various sizes. Although the huge federal Medicare program and the federal-state Medicaid programs do possess some monopsonistic purchasing power, and large private insurers may enjoy some degree of monopsony power as well in some localities, the highly fragmented buy side of the U.S. health system is relatively weak by international standards. It is one factor, among others, that could explain the relatively high prices paid for health care and for health professionals in the United States.
In comparison, the government-controlled health systems of Canada, Europe, and Japan allocate considerably more market power to the buy side. In each of the Canadian provinces, for example, the health insurance plans operated by the provincial governments constitute pure monopsonies: They purchase (pay for) all of the health services that are covered by the provincial health plan and used by the province's residents.
Of course, Medicare is also forbidden from using its buying power to lower costs, anyway.
After cloning Dolly the sheep, Ian Wilmut was invited to Boston to give a lecture on his work. After his presentation, there was a call for questions and the room was silent. There was zero interest in this research and you'd have to quite naive to not know why. Everybody there was making their living on grants. The last thing in the world you want to put on a federal grant is that you're going to do human therapeutic cloning. So why would you even bother asking a question in the direction. The subject has nothing to do with you if you're an American biomedical researcher who plans to stay employed. And yet at the same time it's some of the most exciting science in decades.
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.
They make money, thats why. At minimal risk of litigation.
Not that I agree with that, I myself would LOVE better neuro/psychiatric/physiological medications for myself and my family. The sad truth of the matter is given the industry environment it is more profitable for said pharmaceutical company to manufacture drugs with lower risk:net profit ratios than those with a
1)smaller user base;
2)more difficult research;
3)increased chance of litigation.
Given the current business/political environment, this is the reality of Big Pharma.
sig sig sig siggy sig
Minoxidil was a heart medication. Growing hair on bald spots was a side effect that the pharmas did the trials on so they could sell it as a baldness cure.
Viagra... blood pressure medication. Boners were a side effect.
A number of the medications you rail against as fluff were actually discovered while trying to fight something more important. They turned out to be better at the fluff than the intended purpose, but fluff makes money too, and gears were switched so they got marketed for the side effect instead of the intended effect..
Start a happiness pandemic
I echo the sentiments of the sibling/parent posters. To sum up:
..."
... and they sort of forgot about making any drugs. Instead, they made money through tactics with which any Slashdotter will be disgustingly familiar.
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
404555974007725459910684486621289147856453481154 in hex is "You sank my Battleship?"
[GPG key in journal]