This is an interesting project! I hope youâre able to show it to people who are in a good position to evaluate whether itâs really such a promising idea (Open Phil has certainly made some grants for research on health issues not specific to the developing world), and that youâll post about further updates on the Forum.
I think that this post gets off slightly on the wrong foot with this analysis:
There are ~2 million Crohnâs disease sufferers worldwide, and many use immunomodulatory injections (such as adalimumab which costs ~50K$ USD/âyear) to reduce inflammation and symptoms. A back of the envelope calculation suggests this would have a direct economic impact of 50K$ x 2M = ~100B$ USD/âyear.
The back-of-the-envelope calculation assumes that the drugs reach every person with the disease, that all of those people were already using the expensive injections (I assume the drug wouldnât be as useful to people whoâve already had stomach surgery, but maybe it would be?), and that the drugs will replace the expensive injections entirely. The analysis also ignores the cost of getting the drug to patients worldwide (including getting past each countryâs equivalent of the FDA) and the chance that it might not be approved in some countries.
Of course, if a cure can really be developed and marketed for a cost in, say, the tens-of-millions-of-dollars range, this would still be a very good opportunity for impact. But the oversimplified impact calculation looks a bit like âgilding the lilyâ (trying to exaggerate the benefits of something that, even with a more realistic calculation, still looks good).
On the other hand, a true âcureâ would also bring benefits to all future sufferers of Crohnâs, so in another sense, the impact calculation may be somewhat understated. Iâd love to see a more comprehensive analysis at some point, as Zeke suggested.
Thanks for your feedback. You raise many valid points. I would have liked to replace the impact by a more detailed analysis, but I donât know how to go about doing this (measuring utility and adjusting for PPP is hard!). The impact math in the summary can be improved in many ways.
One important point which I seemed to have not explained well is that itraconazole is one of the most used antifungal drugs right now. It has been on the market for 30 years. It is already approved in most jurisdictions to treat various fungal infections. It is inexpensive, in part because there are now many generic manufacturers.
Thanks Aaron! I suppose OpenPhil and other people interested in funding projects monitor this forum? If you think we should do something else to get it to people in a position to provide funding, Iâm all ears!
I donât know whether any employees of grant-making organizations monitor the Forum. Open Phil rarely funds unsolicited proposals and has no formal process for accepting them. You can sign up here to be notified when the next round of the Effective Altruism Grants program begins, though I donât know whether your project would be a good candidate for funding.
Have you spoken to any nonprofits that specialize in funding Crohnâs research? The Crohnâs and Colitis Foundation seems to be a prominent example of that category.
Hi Aaron, Thank you very much for looking into possible funding sources. I met with the Canadian foundation six months ago (Iâm Canadian). They told me they were tapped out (funding-wise) for the foreseeable future, and did not have time to look into this in detail. I did not reach out to the American foundation. In a continued attempt to fund the replication of Samuel et al 2010, I then looked for wealthy donors in the Montreal area. I did not manage to get the full sum by mid-October, after three months of trying very hard to put this sum together, and the private funding effort stalled.
This is an interesting project! I hope youâre able to show it to people who are in a good position to evaluate whether itâs really such a promising idea (Open Phil has certainly made some grants for research on health issues not specific to the developing world), and that youâll post about further updates on the Forum.
I think that this post gets off slightly on the wrong foot with this analysis:
The back-of-the-envelope calculation assumes that the drugs reach every person with the disease, that all of those people were already using the expensive injections (I assume the drug wouldnât be as useful to people whoâve already had stomach surgery, but maybe it would be?), and that the drugs will replace the expensive injections entirely. The analysis also ignores the cost of getting the drug to patients worldwide (including getting past each countryâs equivalent of the FDA) and the chance that it might not be approved in some countries.
Of course, if a cure can really be developed and marketed for a cost in, say, the tens-of-millions-of-dollars range, this would still be a very good opportunity for impact. But the oversimplified impact calculation looks a bit like âgilding the lilyâ (trying to exaggerate the benefits of something that, even with a more realistic calculation, still looks good).
On the other hand, a true âcureâ would also bring benefits to all future sufferers of Crohnâs, so in another sense, the impact calculation may be somewhat understated. Iâd love to see a more comprehensive analysis at some point, as Zeke suggested.
Hi Aaron,
Thanks for your feedback. You raise many valid points. I would have liked to replace the impact by a more detailed analysis, but I donât know how to go about doing this (measuring utility and adjusting for PPP is hard!). The impact math in the summary can be improved in many ways.
One important point which I seemed to have not explained well is that itraconazole is one of the most used antifungal drugs right now. It has been on the market for 30 years. It is already approved in most jurisdictions to treat various fungal infections. It is inexpensive, in part because there are now many generic manufacturers.
Thanks Aaron! I suppose OpenPhil and other people interested in funding projects monitor this forum? If you think we should do something else to get it to people in a position to provide funding, Iâm all ears!
I donât know whether any employees of grant-making organizations monitor the Forum. Open Phil rarely funds unsolicited proposals and has no formal process for accepting them. You can sign up here to be notified when the next round of the Effective Altruism Grants program begins, though I donât know whether your project would be a good candidate for funding.
Have you spoken to any nonprofits that specialize in funding Crohnâs research? The Crohnâs and Colitis Foundation seems to be a prominent example of that category.
Hi Aaron, Thank you very much for looking into possible funding sources. I met with the Canadian foundation six months ago (Iâm Canadian). They told me they were tapped out (funding-wise) for the foreseeable future, and did not have time to look into this in detail. I did not reach out to the American foundation. In a continued attempt to fund the replication of Samuel et al 2010, I then looked for wealthy donors in the Montreal area. I did not manage to get the full sum by mid-October, after three months of trying very hard to put this sum together, and the private funding effort stalled.