I feel like I've been reading this exact same article for the last 15 years.. I find it very difficulty to parse what is real and what is vaporware in the medical breakthroughs community.
Just 7% of studies that do a preliminary study on humans actually get through phase 3 and get approved for use. This is before even the preliminary point, its a tooth (or even a tooth analogue) in a petri dish. No idea if the material will be safe in a human mouth yet.
There is a lot of hyping of results in medicine papers in general but its not really their fault. The entire academic world is being forced to publish or die as governments look to measure results from the science they instead get what is measured and everyone has to embellish the importance of what they found and always find positive results.
Despite how obtuse the current administration views are, this has been true for decades. The churn of new papers and hype around medicine/biotech is nothing new.
Says nothing about endemic reproducibility crisis of the social sciences.
Since student loans have been basically guaranteed (bankruptcies can’t erase student loan obligations, in an attempt to push rates lower) and tuition steeply rose, academic institutions’ ratio of administrators to students has skyrocketed to a bureaucratic mess, leading to a flywheel of higher education costs and incentivizing research for money’s sake over impact to the field.
Real impact would be reproducing notoriously iffy studies, but that doesn’t bring in the dollars.
KPIism is the death knell of modern society. In the 90s and 2000s this mantra of "measure and improve" took hold like a virus. It is in all instances I observe a rats race where everybody just starts to look for the cheat-codes instead of "doing-the-right-thing".
Arguably America is the pinnacle of this right now, where (many) politicians and (many) business leaders now feel justified do whatever's legal just to score points. I would argue this type of thinking was birthed in the UK though under Thatcher who as a first step removed the general trust in (civil servants in her case) your fellow human beings. Blair then came up to replace that trust with KPIs.
We need to get back to a world where we trust people to do the right thing - without measuring their success in short-term KPIs.
MBAs are the source of KPIism. We have spent many decades minting them at scale in the USA and now the chickens are roosting. Anything can be ruined by pursuit of KPIs at all costs. The model is to optimize a particular KPI, get your bonus, use this story to get your next job at +$X, leave, repeat. The longer story of the company does not matter, you shipped and got paid, even if the village burned down after you left.
> The entire academic world is being forced to publish or die as governments look to measure results from the science they instead get what is measured and everyone has to embellish the importance of what they found and always find positive results.
It sounds like they're running it like a business.
A lot of this is the direct result of trying to run a government like a business. If we instead left some things that are unprofitable but important to government then we'd probably get better results than having businesses do those things expecting a profit. This was the model in the 30's, 40's and 50's that led to the "golden age" that people are now trying to recapture.
You're describe an age where the government was a wash with surplus dollars. Secondly, most of these research institutions run as non-profits that effectively just cover costs (but run a large hedge fund as a side business)
The escalation in costs have come from:
- Incentives around US News College rankings (and the amenities that drive the rankings)
- Administrative (non-teaching, non-research) bloat
Research is definitely in need of reform though, but not sure these outcomes are actually causal or even corrilated.
From what I can see, taxation as GDP percentage was never really under 10% since 1950, while big cuts to the top tax rate happened in the 60s and 80s (and the federal budget was continuously in the red since mid 70s basically, with one brief exception before 2000).
> Top marginal tax rate was surprisingly not too correlated to government revenue
Yes. Which is interesting, but also makes sense if you assume that a frequent goal is to shift the tax allocation between wealth classes (adjustments to top rate would be somewhat compensated by other changes).
I think it is always too easy to find arguments for almost any position in data like this, because the overall picture changes dramatically over just a few decades; wealth/income percentiles become qualitatively different as GDP grows ("workers class" pre WW2 is quite different from the same income percentile now) and the data is noisy too, so if you squint you can interpret almost anything in there.
In a perfect world, we would have twenty identical Americas with fixed tax policies, and be able to compare their development over decades; what we have is instead a bunch of different nations radically changing their behavior basically every time a different government comes into power, and many conclusions are inevitably just educated guesswork.
Totally in agreement that we always read a lot from the conclusions based on data. Data often obfuscates.
I do think, however, that empiricism is a better framework for grounding outcomes in reality than pure ideology. Pure ideology (either way) is usually just confirms biases by cherry picking data.
Every spending problem is also an income problem. Whether you see it as a spending problem or an income problem is really just showing whether you value the things we spend money on or not.
you're describing this during an age where trillions of dollars are spent for the military industrial complex, which makes it hard to believe that there's not enough money. priorities are just...the way they are.
The golden age people are trying to recapture is the aftermath of a world war that decimated almost every major power except the US and then the US happily rebuilt everyone’s economies in exchange for riches and power. The 21st century looks very different and only really MAGA folks are looking to rewind the clock as a way to move forward.
The economic theory of MAGA, is that the united states yes rebuilt the world but also exported the US consumer economy through asymmetric nonreciprocal tariffs. Rebuilding countries made money by selling to the US consumer, not the other way around.
You can argue that it's overall bad for the economy, but I think you're missing the arguement.
The 1940s you get for free, what with the war and all nothing was ever going to be very tolerable. But what about the 1930s is a "golden age" in your opinion? What exactly is it from that era that you wish we had more of?
Look, I'm just trying to represent as best I can the sentiment that drives a lot of this regression to how things were in the early part of the 20th century. I agree completely the depression sucked. My grandparents on both sides lived through it and you could see how much it sucked in the habits they cultivated. You'll get no argument from me.
> This eventually leads to competitors taking over and those business failing
If only that fairytale were true. In the real world bloated inefficient companies bribe government, install themselves into government agencies directly (regulatory capture), and hire lobbyists to write laws which protect them from pesky upstarts through unchecked anti-competitive practices and anti-consumer regulation allowing them to stay wealthy and in power forever while killing off innovation and progress.
...which I suppose is why IBM is still the industry leader in computing, while Ford, GM, and Chrysler can't be competed with. Photographers always use Kodak film, and we all talk on our Nokia cell phones. We all shop at Sears, and fly on Pan Am.
IBM's stock price is 10 times what it was in 1991. What the hell have they even done in that time?
They don't have to be whatever you think is "industry leading in computing", because apparently just once being worth something was enough to enrich an entire generation of management while the rest of us struggle.
>Ford
Despite decades of failure that led to their struggles in 2008 and an increase in energy costs, they didn't die, and despite then selling several lines of cars that had serious defects that should no longer happen, they abandoned selling anything other than overpriced trucks and are STILL doing just fine.
>Sears
Sears was murdered to enrich a few already wealthy people. At no point did it do worse business.
Do you know which companies you didn't even mention that do not support your claim? All the gigantic conglomerates that own you.
From Disney owning a giant chunk of all media and setting national IP policy, to Sysco being one of the only food service companies because they ate all the other ones so now every restaurant is stuck selling the same food as most prisons, to Nestle owning most of the grocery store so they can sell you water that they pumped out of your aquifer for crazy rates while complaining they couldn't be profitable without slave labor, to Dupont poisoning the entire earth, to fossil fuel companies that set national energy policy, to most farming in the US being beholden to a single legal entity, to the vast majority of "Brands" in the US just being a label change of a product they did not design.
You seem to be under this absurd notion that as long as the brand name on a couple consumer items changes occasionally (due to the kinds of technological innovations that we will never see again and cannot be predicted or relied upon), everything is fine?
I never claimed that companies can't fail or change, only that bloat and inefficiencies aren't a death sentence. Even several of your examples are still alive and well and it's telling that their major declines took place in the 1980s and 1990s. Companies have gotten a lot better at abusing government and law to protect their profits over the last 40 years.
Companies have gotten a lot better at abusing government and law
Comments like this always seem to lead to calls to give the government greater power to rein in those companies.
I'm not claiming these abuses don't exist. But there's no reason not to also look at them as the government getting a lot better at taking advantage of companies, to protect their offices. If you look at it in this context, it should be clear that increasing regulatory authority is far from a solution: it's actually counter-productive, creating tools to facilitate ever-greater abuses.
You could follow the NIH news feed that contains some of what gets funded but its actually quite difficult given the various institutions all over the world that all fund studies including charities and the universities themselves. On an individual topic with time you could learn who most of the major players are and follow their news but its unique to every topic.
The potentially easier way at least to get a lay of the land is to follow pubmed (https://pubmed.ncbi.nlm.nih.gov/) for the topic you are interested in, if you then look into those papers you will find funding statements as well as the place the research was conducted and use both to build up a picture of the origins of research in a field.
Afraid I don't know of an easier way not a generic one anyway. Sometimes you just have to follow the right person on twitter who announces trials or studies or be at the right conference. Start with pubmed and the output papers and that will get you started. Then also have a search on the NIH and that might lead you to some links to groups and institutions they fund.
Publish or perish is more about status & careerism within academia than any sort of govt forcing function. If you don't publish, you are invisible to your peers and your career stagnates, regardless of the govt funding environment.
It is entirely their fault. If no one agrees to do performative research, the problem will be solved.
The problem is some people prefer an academic lifestyle in exchange for doing performative research.
Yes there are other actors eg politicians demanding performative productivity, but mostly it’s the inmates running the asylum.
Academia is one failed western institution amongst many, and those failures are ultimately directed by the actions of the individuals that comprise those institutions.
> It is entirely their fault. If no one agrees to do performative research, the problem will be solved.
Right, and the prisoner's "dilemma" isn't a real thing; everyone knows it's their own fault for not just all picking the decision that gives them all the best outcome. Every individual within a network effect is obviously responsible for the outcomes the entire system produces.
They're not responsible for the situations that end up encouraging certain actions though, and they shouldn't be blamed for not being able to solve the collective action problem[1]. I'd argue that the only blame that's fair to place on them in situations like this is from direct results of their individual actions, not the propagation of incentives that are beyond their power to change regardless of their own individual decisions.
If you're willing to blame someone for not acting against their own individual interest, doesn't it make more sense for it to be the people who are going out of their way to reward others for acting in that way?
Evolution creates a situation that encourages all sorts of terrible actions, and the vast majority of people choose to control their animal instincts.
Additionally: the people who encourage the performative research are the people who control grant review. And those people are the same people as the performative researchers.
A bunch of people figured they could make a career doing bs performative research and corrupted the whole system to serve them.
Same feeling here. Dental seems particularly fraught (though maybe I just pay more attention to it out of interest). I know the cycle time between press releases/hype and actual application can be the better part of a decade, so I assume that's coloring my perception too.
re: dental in particular - It seems like enamel regeneration and stem-cell-based tooth replacement have both been in the news year-after-year without applications actually coming to market.
Does anyone know why casein phosphopeptide (Recaldent) hasn't had more success?
https://pubmed.ncbi.nlm.nih.gov/9294493/
You can buy the Japanese gum with Recaldent online, but I expected it to be in the gum display in retail shops by now.
Everyone knows that teeth are luxury bones in the US. The market just isn't there for fancy treatments. The ultra-wealthy just get their teeth replaced with perfect veneers anyway.
Really? This sounds more like someone's plan to get grants to research stem cells than someone's plan to repair (or replace) teeth.
We already have a natural ability to grow new teeth that replace existing ones. Everybody does it... once. Where's the research into getting it to happen again?
Theet formation is a very early procces, even before the baby is born.
> Primary (baby) teeth start to form between the sixth and eighth week of prenatal development, and permanent teeth begin to form in the twentieth week.
There has been a ton of research in the area of re-growing teeth from stem cells. A cursory search-engining will turn up a ton of articles, some going back decades, and many giving the impression that it's close to happening. I've been following it for awhile because I knew I'd be in the market for a new tooth eventually.
There have been a lot of research around USAG-1, too [1]:
> Uterine sensitization-associated gene-1 (USAG-1) deficiency leads to enhanced bone morphogenetic protein (BMP) signaling, leading to supernumerary teeth formation.
If that could be targeted at a given tooth site (i.e. I don't want to go thru another round of deciduous teeth across my entire mouth) that would be pretty cool. We're each carrying a perfect growth matrix for new teeth, after all.
If it just repeated the process everyone is already familiar with, in which each of your teeth falls out and grows back in one at a time over a period of several years, it would already be a perfect solution to tooth decay and demand would be massive.
A similar approach was reported in 2019,[1] but that produced thinner coatings, and the recovery of the architecture of inner layers of enamel was only partial.
While I 100% agree with what you wrote, I'd just add that it does seem in my own dental visits over my lifetime that there have been real advancements, too. But yes, I agree, hard for non-expert to parse.
Seeing SLA 3D printers at my dentist's office was pretty cool. Apparently they use them for a variety of fixturing and jigs, and have a workflow that includes a handheld scanning unit that SLAMs to generate a solid model of the patient's teeth.
I have 4 crowns, 2 done using moulds, 2 using the 3d scanner. Same doc, same office. The moulded ones were ok with some adjustments, but the 3d scanned ones were perfect since day 1. I'm happy with the progress in dentistry.
I'm surprised how many low-hanging fruit issues are still not solved. So many dentists use cold or tap water for their rinse sprayer despite the fact that many people have temperature sensitivity issues with their teeth. Having lukewarm water would be trivial but I've yet to go to an American dentist that does it.
ART with HVGIC has basically solved dental caries since the 80s. But you aren't likely to get it in the US or most western nations because there is a massive industry around drilling and filling with resins and then solving the multitude of problems that such a destructive process creates. Crowns, root canal, periodontal disease etc.
A better approach is to monitor FDA updates. When an FDA trial shows positive results for a new treatment and approval for public use appears imminent, that would qualify as news in that regard.
As it turns out, this is really hard to do. There are a lot required of teeth: they have to be extremely durable to resist repeated strain of chewing ,stay in the gums, not be rejected by body, etc. It's little surprise progress has been so slow.
It is probably tough getting investment because this is ultimately cosmetic and not something covered by most dental insurance. Existing repair is probably good enough and I’d expect cheaper too.
Cancers have had extremely effective new treatments developed for in the last ten years.
Depending on the type of cancer, we now have cures or treatments that stave off death for years.
My wife has a rare type of cancer with not much research thrown at it, and even her type of cancer went from a median time of survival measured in months to several years.
Tooth regrowth is something I was really hoping for. I abused one of my molars. After years of efforts (repeated fillings, a crown) to stave off losing the tooth it finally had to come out last month. Now I'm waiting for the bone graft to "take" before getting an implant. I was hoping I'd waited long enough for tooth regrowth to become "a thing" but I have not.
(Should have taken better care of it when I was younger and not ignored the massive hole that was growing in it. Chalk it up to a bad dental experience as a child and 25+ years of avoiding dentists as a result...)
After a few years of bad mental health, I do have several dental problems, including two badly chipped front teeth. Sadly, my local dentist isn't taking any new patients at the moment so I can't get them looked at even though I now want to. It would be good if I could regrow the teeth but I think it's going to end up being an expensive procedure :/
It would be wonderful if it were someday a routine treatment, but it feels like the technology is perpetually out of reach. If the tech ever does pan out I assume it will be decades until it reaches the masses. It's difficult to be optimistic.
The anxiety about having actual problems with my tooth eventually overrode the anxiety about going to the dentist and I started going regularly (after a pause of 26 years).
I'm pleased that I found a good dentist and I've been able to overcome my anxiety. I recognize that I'm lucky in this regard.
I was also lucky in that, aside from this one problem tooth, my oral care regimen in my 26 years of not having regular dental care were sufficient to prevent any further issues. I expected to come out of that first checkup with massive problems (even though I'd never had any pain or issues) and I was pleasantly surprised.
All in all I think I'm very lucky. I tried to take care of my teeth on my own, and largely succeeded, but I do wish I'd taken care of this one problem tooth before it was too late.
I was reading your comment just as I was sat in the dentist office paying for my partner’s kid long due treatment. She was afraid of dentists and neglected treatment for too long but I took her to the same superb (and expensive) dentist I use for my own kids and she was happy and had everything done. Your comment reminded me why I do it. Thank you.
I am confused by this comment about HIV/AIDS. Is it cynical? Are you confused why we have not "cured" HIV? I grew up during the AIDS Crisis. It was awful. People were dropping like flies. Today, you can be "technically" HIV positive, but test negative, give birth to HIV-negative children, and have unprotected sex (and not infect your partner). As far as I am concerned, the battle has been won. It is a miracle in my eyes.
HIV meds have a slew unpleasant but tolerable (certainly far superior to HIV itself) side effects, imo the battle isn't "won" until the treatment is entirely inconsequential.
That said, the progress has indeed been miraculous. A great example of the capabilities modern medicine.
One-and-done HIV protection in infants - https://news.ycombinator.com/item?id=44736988 - July 2025 (First author of the paper even commented here at the time: "labanimalster - First author here. We solved a 30-year problem in gene therapy by leveraging neonatal immune tolerance. A single AAV vector injection encoding HIV antibodies achieved 89% success in newborns vs 33% in 2-year-olds, with protection lasting through adolescence. This could transform HIV prevention in regions where maintaining regular medical care is challenging. Happy to answer questions about the science or implications.")
it might be slow exponential thing, 60 years of low to medium improvements in cancer, and hopefully suddenly a few big cracks to turn it into a chronic liveable condition (or maybe cure it).
there are more articles about advanced tumors being shrunk to nothing than before (based on my personal monitoring)
I find it interesting that we are closer to regrowing teeth than hair. At least there was human clinical test for TRG-035. Is it just cause hair transplant is "good enough" stopgap solution?
I think it's more that fixing teeth is largely about replicating a specific material with one-off procedures, whereas fixing hair is all about controlling a complex never-ending process that is linked to all sorts of factors.
Also, everyone has teeth issues, whereas hair issues are mostly limited to a subsection of the population (older males, and not even all of them).
> subsection of the population (older males, and not even all of them)
Those men will pay lot of money to get back their hair though.
If I not mistaken it was Bill Gates who said more money is spent in hair regrowth research compared to vaccine to prevent diseases like malaria which kills thousand of people.
I would say, maybe look at medical studies from the opposite end, epidemiological studies look at factors that reduce mortality/morbidity. Granted, it's less flashy, basically vaccines, alcohol/tobacco reduction, increase in active lifestyle, statins/ace inhibitors, monoclonals/oncology fanciness. although someone who actually is an MPH can probably correct me.
on the neuroscience side, off the top of my head, the most impactful things have been better anticoagulants and preventive care for stroke, monoclonal abs for autoimmune diseases like MS/myasthenia, , certain stereotactic brain surgeries, and such. But considering what ails most people, the overall population effect probably is minuscule compared to say better crash safety in automobiles.
Fortunately there doesn't seem to be any harm from flossing. At least from my anecdotal experience there are positive bad breath ramifications. (I've also been conditioned, by flossing regularly, to feel like my mouth is "cleaner" after flossing, to the point that it feels bad if I don't.)
Many people are not honest about how much they floss, and those who do often don't floss correctly. We have a well understood mechanism for how tooth decay and gingivitis happen, and it's clear clinically that flossing can address these more effectively than brushing alone can. Furthermore, the subjective reduction in bad breath means harmful oral bacteria are reduced, which could have benefits beyond oral health.
This is the key issue. There is zero doubt whatsoever that flossing is essential, and the fact that the empirical evidence is equivocal shows the limitations of science to prove even the most obvious things.
I do floss, but I genuinely don't see that this is obvious. You can do a lot of damage with mechanical force, to both teeth and gums! Starting a flossing regimen after not having one tends to cause pain--isn't that a signal to stop? etc.
Furthermore, correlation is not causation and it could well be the case that flossing is associated with better outcomes without causing it. For example, people who can afford to go to the dentist regularly are therefore regularly told to floss. People who care about dental health in general probably floss more, but also may be doing other things, consciously or unconsciously, to improve outcomes. Gut (and perhaps mouth) bacteria have behavioral effects; perhaps flossing is caused by having healthy mouth bacteria!
(at least one study says mouthwash is better than floss. That seems obvious to me! liquids are smaller than floss.)
Actually, recent research suggests daily mouthwash use, especially alcohol-based and antimicrobial formulas, carries underappreciated risks (e.g., Microbiome disruption kills beneficial oral bacteria that help regulate blood pressure while promoting harmful strains linked to gum disease and certain cancers [oral, esophageal, colorectal]; Long-term alcohol-based mouthwash use is associated a with 40-60% increased risk of oral/pharyngeal cancers, with risk scaling by frequency and duration; Chlorhexidine reduces nitrate-reducing bacteria, potentially raising blood pressure and increasing prediabetes/diabetes risk even in healthy users; Some formulas actually increase acidic bacteria that lower salivary pH, promoting tooth demineralization and staining).
In other words, mouthwash offers short-term hygiene benefits but should probably not be used daily unless medically indicated. The oral microbiome matters more than we thought, and indiscriminately nuking it has downstream effects.
Do you have consistent gaps between all your teeth, and/or other conditions like strong enamel, or a good diet? If so, congratulations - flossing might not do much for you. But it's ridiculous to suggest that - if you don't floss and get food stuck between your teeth for days on end - that doesn't have a negative effect. Arguments about correlation/causation be damned.
> Starting a flossing regimen after not having one tends to cause pain--isn't that a signal to stop?
Moderate exercise after not exercising for a while causes pain - is that a signal to stop?
Any chance you would be willing to summarize the research or provide information on some relevant studies? I've always been skeptical about flossing and would like to learn more.
The wikipedia article [1] suggests that there is no strong evidence for flossing being a good thing. However, that might just be because experts have not updated the article.
I hear so many counter-logical ideas proposed with "scientific evidence". Poorly designed studies and P-Hacking has ruined the publics trust in science. I highly doubt flossing is a net negative for almost anyone.
