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May 24, 2021 no comments

Why Small Beats Big: the Hidden Cost of Too Many Voices

The coronavirus pandemic has taught us a lot of lessons.  But some, such as exactly why small biotech companies are increasingly making all the running in early-stage drug discovery and development, are slightly less obvious than others.

Just this week, we have seen the UK Scientific Advisory Group for Emergencies (SAGE) urge the Government to slow the lifting of restrictions out of concern that the so-called Indian variant of covid might be spreading more quickly and could cause a further wave of infections and possibly therefore hospitalizations and deaths.

What does that have to do with the power of small teams in drug discovery?

The common thread is incentives.  Consider the position of the SAGE group: they are charged with forecasting what might happen to coronarvirus cases in the future, armed with mathematical models whose power largely depends on the assumptions upon which they are based.   Armed with such models, there are certainly scenarios that could see significant challenges for healthcare providers in the future particularly if new variants emerge that current vaccines protect against only weakly.  And all these scenarios are mitigated by caution now.  Keep everyone at home for longer, and the risk of future surge is, undoubtedly, reduced.

Hence the advice offered by the SAGE group to the Government, who are charged with making the decisions as to which restrictions stay in place and which are lifted.

Now consider the same scenario from the perspective of the Government ministers.  Keeping restrictions in place has substantial costs in many different ways: economic costs, impact on mental health, slower and poorer treatment of non-covid illnesses not to mention the strong ethical imperative to avoid restricting liberty except in extremis.  In short, as it has been throughout, the decision what to do has been a fine balancing act between the costs and benefits of restrictions.

Next, look at the impact of the advice from SAGE.  Because of their remit, to look at the best way of reducing the impact of the virus, they have set out the best way, in their view, to achieve that narrow goal.  In many ways, the advice is not all that surprising – at every stage throughout the pandemic more restrictions would have reduced viral spread.  And if there were no other considerations, it would have been the right choice to make.  Arguably, if everyone in the country stayed in complete isolation for a month, the virus would disappear altogether with every transmission chain hitting a brick wall simultaneously.

However, the advice has a more insidious effect.  The bad outcomes they forecast are far from certain.  Indeed it …


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