Navaneetha Rao, ScD 1994

The recent authorization of the 2 different vaccines (and others in development) is a clear victory for science and human ingenuity.  It is a clear testament to what is possible when all stake holders (spanning various geographies) cooperate. On the other hand, the overall botched public health response/management of the pandemic is a testament to what happens when politics holds sway over science.  If the overall messaging and management was left to agencies well equipped to manage such pandemics, namely the CDC, FDA, NIH, and various Schools of Public Health, and not to botched politically charged/motivated messaging, the assault on health, liberty, and economy might have been far more modest and less crippling.

Leaving aside all of the political baggage that comes with public health, if we only had the CDC, the FDA, the NIH, and the Deans of the Public Schools, we would have been in a different place by now. Of course, this is all a non-trivial situation at all, and we’re just learning that the US really does not have the infrastructure regarding vaccination for infectious disease. Most vaccination happening in the US is primarily pediatric infections, but here we’re talking about an infectious disease primarily affecting adults and seniors. Even the flu vaccine is very small in scale. Unfortunately, these things were all well known, and that’s what frustrates me as a scientist.

The burden of communicating science well, of course, falls not just on the media but also on the public and in this particular case, on the scientific community as well. This is a key deficiency in the US and in the world.

We in the scientific realm are used to uncertainties because it’s an issue of probabilities - there’s always caveats to something, and we understand that because that’s the way science works. But the media opts for black or white messaging. Meanwhile, scientists on the sideline say no, no, no, that’s not what I said. But that’s the issue - we still like to be in our ivory towers with our papers and all, and I think that time for that is long past. We need to engage the public in a frank manner.

What I’ve been doing to move us in the right direction is, at any type of gathering with friends, whenever I hear something that is “factually incorrect” outside of opinion, I do make it a point to provide as much of a science-based counter/explanation as is possible. I’ve also been engaging with some media, primarily in India, trying to start a podcast that brings rational scientific thought into the space. Media is responsible, at the end of the day, because it is what is allowing all this information to be disseminated. We need to engage with credible, responsible media people to get the right message out.

I cut my teeth in drug development working on some of the sexiest technologies possible 20 years back - example, gene and cell based therapeutics. My initial focus was in cardiovascular disease and subsequently, it has been in other areas including oncology. However, a challenge is to develop therapeutics  which are actually cost effective, not just clinically effective. We shouldn’t just be talking about therapy-related toxicities, but also financial toxicities.

The current (and growing upward trend) in overall healthcare-related expenditure (touching almost 20% GDP) is not sustainable.  It doesn’t matter how scientifically fascinating it is, maybe if we try something less scientifically advanced but is more effective clinically and financially, that would be better. So an alternative we explored was drug repurposing - when you take a product already approved for one indication and use it for another.

The indication which we initially focused on was cachexia ,i.e., unintended weight loss, a dreaded condition of advanced cancer. Even today, there’s no effective treatment, so we came up with a good treatment idea which showed much promised in clinical studies. The frustration, however, was that it had zero commercial value. Many, many good ideas which are out there are gone because they have no commercial incentive or innovation to make the product concepts a reality. If you can come up for a solution for that, you will have addressed a part of the cost curve.

To put this graphically…

Unlike Moore’s Law that applies to microchip/computer performance, the Eroom Law applies to drug development productivity. 

This, combined with the steady increase in healthcare expenditures:

Requires us to think of truly innovative (not just new/novel technology) ways of addressing this dual whammy of decreasing productivity and increasing costs. One potential way of doing this for addressing a small but important part of the healthcare spend could be “drug repurposing.”

If you want to take a product, the only way you can get there is by doing what I’ve been working on - clinical trials. For the COVID vaccine, hundreds of thousands of people have been enrolled in advanced clinical studies. Most products never see this, and there’s a tremendous cost to development.

We as a society have to stop pointing fingers and blaming the pharmaceutical industry - yes, there are egregious examples and we should give them the worst possible punishment that there is - but you cannot blame the entire industry. For example, right now less than 5% of eligible patients participate in trials. Imagine if we could increase that patient enrollment. Everything would be much easier. You have more time, you cut the cost, and you learn so much. Medicine has been incredibly important in our lives, and we need trials to keep our health preserved and good.

Snow in Houston recently… combined with no power/connectivity for days!!!

Navaneetha Rao

ScD 1994 | Cell biology, Physiology

Drug development scientist

Interviewed and Compiled by Felicia Ho