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Bubbles that need some popping
There is not a day that goes by that I do not receive an email that either invites me to join an editorial board, submit a paper to a journal in the next six weeks or give a plenary talk at a scientific conference. Many of us with .edu email suffixes receive these things. As readers know, I am a big fan of free market capitalism, but not with rampant excesses. Part of the problem here is preying on the perverse incentive of bibliometrics, whereby numbers of publications are judged more important than their quality. While widely considered of little value, it is done because it easily can be done. The attempt at derived value is purportedly augmented by the “impact factor” of journals, a metric that likewise has little to do with the quality of any individual’s published science. Quality is subjective and impact takes time to assess. We love numbers and we are impatient for objective conclusions. It’s not working. It’s a bubble needing to be popped.
The traditional science press refers to predatory journals. These often are named in ways that confuse them with longstanding traditional journals. They promise rapid publication and a wide readership. These journals regularly demonstrate weak peer review, publishing articles with no evidence that methods or reagents were validated. A lot has been said about irreproducible science. Today we read of fake science and more recently, counterfeit science as well. There are counterfeit reagents, counterfeit software, counterfeit and manipulated images in journal articles. Valid science takes longer. It can be difficult to sort out the legitimate from the less so. The traditional publishers are slicing and dicing channels for science in finer and finer ways, perhaps to fight off the predators. Several of my favorite societies are further inundating me with daily newsletters, webinars and career advice.
In parallel, we have a proliferation of conferences. Given electronic communications and the cost and inconvenience of travel, it’s surprising there are so many of these. Yet net attendance at traditional conferences drops. Few of us can afford to spend more than a day or two anywhere without taking a hit on productivity. Could the STEM education bubble be rationalized by an increase in the workforce to fill these conferences? Meanwhile, we are seriously behind in filling skilled positions in manufacturing, technology, nursing, welding and construction.
We March for Science too, advocating that facts be clear in public policy decisions. Facts are fine, but very few of them are unambiguous. Everything important has an error bar, a randomness around a mean. Many of these data related to public policy are very broad and are selected to support a narrative. Some have been manufactured or used without error bars. Big data is rarely good. Were there inclusion/exclusion criteria reported? Debate contrary to some narratives is discouraged, particularly on college campuses.
Here at DDNews, we don’t pretend. We are about the business news of getting to therapeutic benefits. Who does what and what do they say about it? Nowhere is this more important than with cancer, the focus of this issue. When a therapy cost a few kilo bucks, we’d take a chance that it might not provide a satisfactory result. What should we do when a course of therapy cost $150,000 and provides a satisfactory result in one-third of the patients? Should the cost be fully applied only for a satisfactory result and discounted for no observed positive outcome? Some cases might then justify a $50,000 spend for a good try and others $400,000 for complete remission. In innovative pharma, the reliable cash cows that once supported innovation have been taken away by a generics industry. If most drugs for cancer become orphan drugs and only successful outcomes get reimbursed, the pricing bubble will burst. Paying for drugs that don’t work well partly covers the cost for those that do.
It’s a perverse insurance, spreading risk, but is insurance nevertheless. Imagine the cost of an SSRI if only the happy patients paid. That’s depressing. FDA Commissioner Dr. Scott Gottlieb suggests easing the path to generic approvals will help drug pricing. That may be helpful on average, but will not help pricing for modern oncology drugs anytime soon.
The irrational exuberance in everything we do is creating bubbles all around us. Wearable devices, biomarkers, big data, omics, opiates, student loans, journals, conferences and tweets. It’s summer—go for a swim and eat mostly salad. Investing in prevention will bring a good return.