What Really Moves Drug Design Forward?

Written By Lynetta Wang

We’ve got CRISPR gene editors, AI that predicts protein structures in minutes, and gene therapies sprouting across pipelines—but bringing a new drug to market still takes 10 - 15 years and costs about $2 - 3 billion. It’s a phenomenon known as Eroom’s Law, shorthand for slow innovation despite tech progress. Why this disconnect? This post pulls back the curtain on the whole innovation machine: science, incentives, regulation, manufacturing, pricing, and trust. I’ll frame it with two starkly different cases:

  • Casgevy, the first CRISPR-based therapy that succeeded when everything aligned.

  • Aduhelm, an Alzheimer’s drug that flamed out despite early enthusiasm.

Then I’ll widen the lens to show how discovery science is actually speeding up, and whether other gears are keeping pace.

The Eroom’s Law Paradox

When Jack Scannell’s team coined Eroom’s Law, they meant it: drug R&D is slowing and becoming more expensive. Today, it typically costs $2.5 billion and takes 12–15 years per drug—and these figures double roughly every nine years  . That’s science swinging forward against regulatory, financial, and systemic friction.

The Five Gears That Drive Innovation

Successful drug design happens only when all these gears engage:

  1. Science: breakthroughs like CRISPR, AI-assisted biological models, programmable mRNA sensors, etc.

  2. Incentives & Funding: public grants, patents, market exclusivity.

  3. Regulation: pathways like fast-track, orphan, and RMAT designations.

  4. Manufacturing & Delivery: capacity to produce and administer therapies.

  5. Economics & Access: pricing models, payer coverage, and infrastructure.

Let’s see what happens when one or more gears misfire.

Casgevy: All Systems Go

Approved in December 2023, Casgevy (exa‑cel) treats sickle-cell and β‑thalassemia - 11 years after CRISPR’s discovery.

  • Science & Speed: Lab to patient in just 11 years.

  • Incentives: Received fast-track, orphan, and RMAT status from the FDA.

  • Manufacturing & Delivery: 45 centers in the US, with plans for ~75 globally.

  • Cost & Economics: Priced at $2.2 million per patient.

Casgevy shows the magic that happens when gears synchronize: platform tech, incentives, infrastructure, and pricing all in lockstep.

Aduhelm: A Gear in Crisis

Aduhelm (aducanumab) was approved in June 2021 under accelerated FDA guidelines, despite evidence of only modest amyloid plaque reduction and inconclusive clinical benefit .

  • Regulatory discord: Approved despite unanimous FDA advisory committee rejection, with allegations of unconventional FDA-Biogen dealings.

Lynetta Wang