As a business model, why would you want to? The Ebola startup project didn't get enough funding, so maintain the status quote. I say this with a sarcastic tone (not being a troll here) I know, but effectively in a high-brow way the article is saying the same thing IMH(umble)O.
Well we have had lots of cures for past debilitating diseases. That train of thought didn't stop their cures and I am hoping it doesn't stop a cure for HIV either. In fact I hopeful in our lifetime we actually see a cure.
1. I know it's HN and all - but not everything has a business model. Ie I'd say most important things in life are not cash-flow positive.
That's why developed (ie they're actually more developed - not just called that) countries have a massive income redistribution in place to pay for things that society needs (which lack a business model-y)
2. the H in IMHO already means humble, there's no need to explain it :)
If Pat Robertson is correct, and I think we all can agree he is, AIDS will not be cured because it is an instrument of God's wrath against homosexuals.
The article is interesting in terms of the fairly clever science but doesn't point out the really amazing success of the PrEP trials. A variety of PrEP trials have been taking place including the use of oral emtricitabine/tenofovir (Truvada) tablets in a Western context (the PROUD and iPrEx trials) and the CAPRISA 004 pericotal tenofovir gel trial in South Africa.
The basic idea is this: using antiretrovirals as a preventative strategy. Take one of the current combination HIV antiretrovirals (emtricitabine/tenofovir, for instance) and administer it to patients who are at risk of getting HIV (drug users, men who frequently have sex with men without condoms, people with HIV positive partners).
The trials have been really successful. Adherence has been high. Side effects have been low and controllable. Those on PrEP combined with a frequent testing regime don't show signs of increased risk behaviour.
Because of the success of the trials, the WHO and the CDC are now recommending that people in high-risk groups start taking a daily PrEP - and in the US, plenty of doctors are now prescribing it for some of their high-risk patients.
Here's where it gets more interesting: the patents on Truvada, the emtricitabine/tenofovir combo tablet, expire in 2016. Currently Truvada as PrEP is an expensive proposition: in the US costing between $8,000 and $14,000 according to government figures. Low-income users of PrEP can get financial subsidy from Gilead Sciences, the manufacturer of Truvada—Gilead don't consider Truvada as PrEP to be a major financial gain for them so they are providing subsidies in the US for PR reasons.
Countries with national healthcare systems are probably going to try and hold off for long enough for Truvada as PrEP to go out of patent and then wait for generics to come on the market.
That's when things get interesting. Currently, $8-$14k for a preventative is too much even for rich countries to consider. It wouldn't pass the United Kingdom's NICE process on cost-benefit grounds. But imagine if it cost a few hundred dollars a year rather than a few thousand. Then the cost-benefit analysis becomes a lot easier. In the UK, we currently pay around £300,000 to treat an HIV positive patient over the course of their lifetime. A few hundred dollars a year for those most at risk as a preventative cuts a lot of healthcare costs.
Imagine the scenario: in the West, anyone who wants to get on PrEP would be able to do so with minimal fuss—it'd be cheap enough that reasonably well-off people could pay out of pocket, and it'd be covered by insurance and national health coverage. It becomes as routine for the younger gay male population as the contraceptive pill became with women. This provides the sexually responsible a second line of defence, and the less sexually responsible a pretty effective (90%+, if the iPrEx study is to be believed) first line of defence. It's backed up by a routine testing and education regimen that catches infections early to prevent spread. The challenge is how to roll it out cheaply in Africa: finding a way to do bulk production of the drugs and ensure they are being taken responsibly. The hard bit there isn't making the pills but building the public health infrastructure. Still cheaper than the economic costs of mass HIV infection though.
PrEP isn't a vaccine but it might end up functioning like one: reducing the transmission rate in affected communities over the long run means less people needing treatment and decreasing the overall risk of infection. And come 2016, once the patents are gone, it'll be cheap. There's lots of people wringing their hands about PrEP mostly for dumb moralistic reasons but it looks like the first major innovation in HIV that might actually have a shot at working.
I wish I could have posted this question earlier, but, if anyone in the know is reading this, is there a newsgroup for AIDS or a site like stackoverflow.com for medicine?
It hit me after reading this article that perhaps researchers could take a step back and try to look at AIDS as a really hard math problem. That way they could take a higher level view and be able to apply mathematical transformations without getting lost in all the low-level biology and chemistry.
So for example, here are some rules off the top of my head, if we use A for AIDS, C for cells, I for immune system cells, T for time, P for protein, D for drug, R for the rate of mutation, etc:
1. Once A1 is within C1, it can’t be removed
2. C1 expires after some duration T1
3. A1 is invisible to I1 until P1 binds to A1
4. P1 can be delivered to the body by D1
5. P1 can be produced by the body in response to D2
6. A1 mutates into A2 at rate R1
...
After applying a solver: Dn triggers immune system response that create P1, P2..Pn which bind to A1, A2…An and keep An from leaving Cn for T years.
I don’t know what the form of these rules would be or how many there would be. But if they were rearranged into a big matrix in a language like Prolog, then computer simulations could be run that might reveal how to administer some drug that triggers a response that creates something that interacts with the AIDS virus and weakens it or makes it visible to the immune system. Maybe that drug could be a lot cheaper than the current antiviral drugs. Or maybe it could even be a one-time dose that causes the body to make that certain something from then on, working at least until the virus mutates.
I did a quick google search of “protein that binds to AIDS virus” and found these:
They look like mumbo jumbo to me but some things jumped out, like this quote from the second link:
“Native dodecameric SP-D bound to HIV gp120 more strongly than native trimeric SP-D. Since one common polymorphic form of SP-D is predominantly expressed as trimers and associated with lower blood levels, these individuals may have less effective innate defence [sic] against HIV.”
This is probably old news to experts but it was certainly news to me that things like this are already present in the body and come in different forms in different people and have a lot to do with an individual’s susceptibility. I think the web could be used to bring non-medical folks “up to speed” on certain key insights like this. Big data APIs like IBM’s Watson could find the hidden relationships by looking not just at links but at the semantics of the pages.
I’m just saying that everyone could use a little help from outside their chosen field, and building these rulesets and crunching them in big distributed computer networks is really easy for computer scientists (and hackers, honestly). We are used to hammering on a problem until the solution is found, and we are compelled to keep after it, especially if the solution is elusive. If we had a standard notation to go between biology and mathematics, then it would open up a lot of possibilities for kind of “open sourcing” medical research.
I realize this is probably already a work in progress somewhere, but if this isn’t a mainstream thing like SETI@home, then it doesn’t quite exist yet, you know?
6 comments
[ 2.2 ms ] story [ 35.2 ms ] threadThat's why developed (ie they're actually more developed - not just called that) countries have a massive income redistribution in place to pay for things that society needs (which lack a business model-y)
2. the H in IMHO already means humble, there's no need to explain it :)
The basic idea is this: using antiretrovirals as a preventative strategy. Take one of the current combination HIV antiretrovirals (emtricitabine/tenofovir, for instance) and administer it to patients who are at risk of getting HIV (drug users, men who frequently have sex with men without condoms, people with HIV positive partners).
The trials have been really successful. Adherence has been high. Side effects have been low and controllable. Those on PrEP combined with a frequent testing regime don't show signs of increased risk behaviour.
Because of the success of the trials, the WHO and the CDC are now recommending that people in high-risk groups start taking a daily PrEP - and in the US, plenty of doctors are now prescribing it for some of their high-risk patients.
Here's where it gets more interesting: the patents on Truvada, the emtricitabine/tenofovir combo tablet, expire in 2016. Currently Truvada as PrEP is an expensive proposition: in the US costing between $8,000 and $14,000 according to government figures. Low-income users of PrEP can get financial subsidy from Gilead Sciences, the manufacturer of Truvada—Gilead don't consider Truvada as PrEP to be a major financial gain for them so they are providing subsidies in the US for PR reasons.
Countries with national healthcare systems are probably going to try and hold off for long enough for Truvada as PrEP to go out of patent and then wait for generics to come on the market.
That's when things get interesting. Currently, $8-$14k for a preventative is too much even for rich countries to consider. It wouldn't pass the United Kingdom's NICE process on cost-benefit grounds. But imagine if it cost a few hundred dollars a year rather than a few thousand. Then the cost-benefit analysis becomes a lot easier. In the UK, we currently pay around £300,000 to treat an HIV positive patient over the course of their lifetime. A few hundred dollars a year for those most at risk as a preventative cuts a lot of healthcare costs.
Imagine the scenario: in the West, anyone who wants to get on PrEP would be able to do so with minimal fuss—it'd be cheap enough that reasonably well-off people could pay out of pocket, and it'd be covered by insurance and national health coverage. It becomes as routine for the younger gay male population as the contraceptive pill became with women. This provides the sexually responsible a second line of defence, and the less sexually responsible a pretty effective (90%+, if the iPrEx study is to be believed) first line of defence. It's backed up by a routine testing and education regimen that catches infections early to prevent spread. The challenge is how to roll it out cheaply in Africa: finding a way to do bulk production of the drugs and ensure they are being taken responsibly. The hard bit there isn't making the pills but building the public health infrastructure. Still cheaper than the economic costs of mass HIV infection though.
PrEP isn't a vaccine but it might end up functioning like one: reducing the transmission rate in affected communities over the long run means less people needing treatment and decreasing the overall risk of infection. And come 2016, once the patents are gone, it'll be cheap. There's lots of people wringing their hands about PrEP mostly for dumb moralistic reasons but it looks like the first major innovation in HIV that might actually have a shot at working.
It hit me after reading this article that perhaps researchers could take a step back and try to look at AIDS as a really hard math problem. That way they could take a higher level view and be able to apply mathematical transformations without getting lost in all the low-level biology and chemistry.
So for example, here are some rules off the top of my head, if we use A for AIDS, C for cells, I for immune system cells, T for time, P for protein, D for drug, R for the rate of mutation, etc:
1. Once A1 is within C1, it can’t be removed
2. C1 expires after some duration T1
3. A1 is invisible to I1 until P1 binds to A1
4. P1 can be delivered to the body by D1
5. P1 can be produced by the body in response to D2
6. A1 mutates into A2 at rate R1
...
After applying a solver: Dn triggers immune system response that create P1, P2..Pn which bind to A1, A2…An and keep An from leaving Cn for T years.
I don’t know what the form of these rules would be or how many there would be. But if they were rearranged into a big matrix in a language like Prolog, then computer simulations could be run that might reveal how to administer some drug that triggers a response that creates something that interacts with the AIDS virus and weakens it or makes it visible to the immune system. Maybe that drug could be a lot cheaper than the current antiviral drugs. Or maybe it could even be a one-time dose that causes the body to make that certain something from then on, working at least until the virus mutates.
I did a quick google search of “protein that binds to AIDS virus” and found these:
http://en.wikipedia.org/wiki/Envelope_glycoprotein_GP120
http://vir.sgmjournals.org/content/86/11/3097.full
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC191382/
http://www.pnas.org/content/111/26/E2676.abstract
They look like mumbo jumbo to me but some things jumped out, like this quote from the second link:
“Native dodecameric SP-D bound to HIV gp120 more strongly than native trimeric SP-D. Since one common polymorphic form of SP-D is predominantly expressed as trimers and associated with lower blood levels, these individuals may have less effective innate defence [sic] against HIV.”
This is probably old news to experts but it was certainly news to me that things like this are already present in the body and come in different forms in different people and have a lot to do with an individual’s susceptibility. I think the web could be used to bring non-medical folks “up to speed” on certain key insights like this. Big data APIs like IBM’s Watson could find the hidden relationships by looking not just at links but at the semantics of the pages.
I’m just saying that everyone could use a little help from outside their chosen field, and building these rulesets and crunching them in big distributed computer networks is really easy for computer scientists (and hackers, honestly). We are used to hammering on a problem until the solution is found, and we are compelled to keep after it, especially if the solution is elusive. If we had a standard notation to go between biology and mathematics, then it would open up a lot of possibilities for kind of “open sourcing” medical research.
I realize this is probably already a work in progress somewhere, but if this isn’t a mainstream thing like SETI@home, then it doesn’t quite exist yet, you know?