paid for by an insurance company following best practices.” Schadt was even bolder, predicting that our smartphones would constantly beam information to us about the genetic makeup of whomever we’re talking to at the time, as well as the biological makeup of the pathogens in the air around us.
Sam Isaly predicted inflammatory diseases “will be addressed and even cured 20 years from now,” though he was quick to add that his enthusiasm over the probability of the genomic revolution resulting in hundreds of new cures for other diseases is “somewhat muted.” Dalton was similarly cautious, pointing out that despite huge advances in information technology, the speed of drug discovery has not changed much—and that she didn’t see it changing over the next 20 years.
Everyone on the panel agreed that personalized medicine—targeting new drugs to patients based on their genetic makeup—would be the wave of the future. But the question of where such discoveries would come from sparked a raucous debate. “I would venture to say it’s just as likely a scientist [at an academic institution] in Ohio will make a major discovery that will alter the field far more frequently than 100,000 scientists” in a Big Pharma laboratory, Waksal said. “You don’t have 10,000 geniuses in Groton [CT],” he said, referring to Pfizer’s large research facility in that city. “It’s mostly people doing grunt work.” (Dalton seemed to take the dig in stride.)
Schadt, not surprisingly, suggested that computers might be far more effective than all those scientists at discovering the next breakthrough. Mathematicians and techies will change drug discovery, he predicted, just as they revolutionized Wall Street. “The illustration was Watson beating those Jeopardy champions,” he said. “Machines will make decisions. And they’re going to be so incredibly accurate.”
So who’s going to pay for all these advances? Waksal predicted that the days of insurance companies agreeing to pay $100,000 for a cancer treatment that only adds six weeks to a patient’s life would eventually come to an end. He added that some of those same drugs extend survival in some patients by years—and that scientists are still figuring out why that is. All in all, he said, drug companies will have to be accountable for the effectiveness of their products. “We are going to be saying if it works, pay us, if it doesn’t work, don’t pay us. That is an important change we will see,” he said. Isaly, referring to fund managers and other financial types, quipped, “we work with performance fees, and so should you.”
When asked how government regulators need to change to accommodate the new world of personalized medicine, Dalton griped about a general dearth of education about how drug discovery works. “There’s a total lack of science and technology knowledge in general, and more specifically with our government officials,” she said. “They really don’t understand.” Everyone on the panel agreed. “The FDA needs to modernize. I hope we get some politicians with some wisdom,” Isaly said.
Towards the end of the panel, Waksal drew a laugh from the crowd by referring back to his debate with Schadt over the role of technology in drug development. “I would endorse replacing politicians,” he said, “with Watson-like computers.”
