# Identified Opportunities in Medicine Development > [!abstract] Thesis > Funds, institutions and incentives limit medicine development more than science does. Each opportunity changes one bottleneck into a company. ## Map of bottlenecks ![[opp-overview.png]] Rust figures show each bottleneck. Each opportunity sits on the step that it attacks. ## Ranking ![[opp-ranking.png]] This is my judgement, not a measurement. Vertical: how large the problem is. Horizontal: how many established players I found in a short check. ## A. Trial start-up network ![[opp-a-start-up-network.png]] **The problem.** Before the first patient starts in a trial, each site reviews the protocol. The site then negotiates contracts, asks for ethics approval and trains its staff. Each trial starts from zero. Twelve different negotiations become seven links to one network that holds the master terms. > [!question] Test in the Gulf > Can HMC, PHCC, Sidra and WCM-Q sign one master agreement? ## B. Verification engine ![[opp-b-verification-engine.png]] **The problem.** A third of trial cost comes from source data verification. A person compares each data point with the paper records. The FDA does not recommend this method, because it finds a small number of errors. A risk model sends only the high-risk data points to a person. Today a person checks each point. ## C. Record-native trials ![[opp-c-record-native-trials.png]] **The problem.** Trials accept only patients with narrow criteria. They then tell the patients to come back to a clinic many times. RECOVERY recruited patients through the UK National Health Service, used simple consent and was fast. A classic trial moves the patient to the trial. A record-native trial moves the trial to the usual treatment of the patient. > [!question] Test in the Gulf > The national health information exchange of Qatar (QHIE) is a single record like the one that RECOVERY used. Non-communicable diseases cause most deaths in Qatar. Can a pilot start in cardiometabolic treatment? ## D. Platform-trial operator ![[opp-d-platform-trial-operator.png]] **The problem.** A platform trial tests many treatments against one shared control group. RECOVERY tested more than a dozen Covid drugs. It found that dexamethasone cut deaths by a third in the sickest patients. Four trials have four control groups. One platform trial shares one control group. New arms start when other arms stop. > [!question] Test in the Gulf > Cardiometabolic disease is the burden that MoPH names first. ## E. Repurposing engine ![[opp-e-repurposing-engine.png]] **The problem.** After a patent ends, generics become available and no one pays for large trials of new uses. More than 90% of new-use approvals come before expiry. GLP-1 and SGLT2 drugs show what is at stake. After patent expiry, the incentive to fund trials falls but the patient benefit continues. The company works in that space. ## F. Pull-funding rails ![[opp-f-pull-funding-rails.png]] **The problem.** Tropical diseases receive about $4B each year in R&D. 95% of rare diseases have no approved treatment. An advance market commitment promises payment if the drug works. Donors promise a price for each dose. The platform pays only after an external check shows that the drug is safe and that it works. > [!question] Test in the Gulf > Hypothesis: Gulf sovereign and philanthropic funders can be pull-funders. Test this with a conversation, not a model. ## G. Translation studio ![[opp-g-translation-studio.png]] **The problem.** Firms make small investments in open basic research, because rivals copy the results. AZT came from the National Cancer Institute and GLP-1 came from academic labs. Only some firms fund the step between a public result and a drug. Public discovery has funding. Firm development has funding. The valley between them is the problem. ## Related [[What Medicine Could Be]] · [[Healthcare]] · [[Drug Discovery]] · [[TechBio MoC]]