Introduction

For $250 million and ten years of your life, you may purchase a lottery ticket. The ticket has a 5% chance of paying out. When it does pay out, it pays roughly $5 billion. A quick calculation will show you that the expected value of the ticket is $250 million. This is essentially what drug development is. Or rather, it's what drug development was, twenty years ago. The upfront payments have been climbing, the hit rates falling, and expected values have, at best, held flat. Should you buy a ticket?

Perhaps not. In fact, any reasonable player should have long since stopped playing this stupid game. Unfortunately, we still need drugs. People have cancer, and heart failure, and Alzheimer's, and a thousand genetic diseases that nobody has ever heard of, and the only industry on Earth currently set up to do anything about any of this is the same industry running the lottery-ticket business described above. The game is dumb and we need it played anyway.

So the real question is not whether to play, but how to make playing less awful for this involved. And the answer, increasingly, is ‘financial engineering’: a set of structural tricks that [...]