DOI
https://doi.org/10.1177/1535370218794365

Summary
For more than 20 years, drug discovery has relied on two assumptions, i.e. (i) a therapeutic response can be triggered by modulating the activity of a single gene product, and (ii) a compound uncovered by its activity on a recombinant protein in vitro can perform its activity in vivo. Drug discovery operates accordingly by using the concepts of targets and pipelines. The target, such as a gene product, is the intended point of therapeutic intervention, and compounds that modulate its activity in vitro follow a series of downstream developments. This reductionist approach has developed due to advances in combinatorial chemistry, robotics, molecular biology, and genomics. The expectation of this approach is that the frequency of drug discovery will dramatically increase, while its associated cost would decrease. However, the frequency of new drug discovery has decreased, while the associated costs have surged. We performed a retrospective study that examined how successful development programs have led to marketed drugs for all indications except anti-infective and anti-neoplastic agents. We concluded that the target and pipeline paradigms are limited and are actually causing the drug development industry to collectively fail to meet the critical medical needs

Relevance for Complex Systems Knowledge
The focus of this investigation is the individuation of a set of human genes that are presumed to be the therapeutic intervention points of drugs approved in USA. Almost all the therapeutics areas were considered with the only exception of oncology and a non-redundant set of API was identified. Considering complex diseases, the author observed that “there is not a single instance in the history of drug discovery, where a compound, initially selected by means of a biochemical assay, achieved a significant therapeutic response.” The conclusion indicates that a reductionist approach in the discovery of new therapeutic agents for complex disease failed and the design of complex biological assays it will be mandatory for the primary selection of candidate therapeutics.

Point of Strength
The results reported in this research suggests that therapeutic molecules needs to interacts not with the acute short-term physiological systems but they have to promote a long-term regulation, proposing a system biological approach as alternative for a change of paradigm in drug discovery. This manuscript demonstrates that is time to pass from the reductionistic interpretation of a single in vitro test to a multivariate assays with multiple endpoints.