If avian flu does gain a foothold in humans, what can drug companies do about it? (This should give you the latest headlines on the disease.) It's definitely something to worry about. There hasn't been a real rampager of a flu epidemic in a long time, and a pessimist would say that we're overdue.

The answer to my question is "Work on a vaccine!" Because if you rephrase it and ask "What can people like this Derek Lowe guy and his hotshot medicinal chemistry buddies do?", the answer is "Not much." It's not a widely appreciated fact among the public, but we have hardly any drugs that affect viral diseases. The disease with by far the largest number of therapeutic options is HIV infection, and if you find that an unnerving thought, you should.

The problem, as I've mentioned before, is that viruses don't give you much to work with. They have very small genomes, and thus code for a bare-bones set of proteins. Since those are generally what we'd attack, we're often at a loss to find a good drug target. Sometimes you can find a target in the human cells that the virus attacks, but that takes a lot of basic research into the infection process.

And even if we find a target, we're years away from a drug. Getting a chemical lead structure, optimizing it, making sure that it actually does some good (and doesn't do a corresponding amount of harm!) - it's a terribly slow process. And it's remained that way despite hundreds of millions of dollars waiting to be picked up off the ground by the first company that can shorten it. The incentives are there; the technology isn't.

That time scale probably won't be much use if we get into an epidemic one of these years. The virus will outrun us. The best thing we can be doing now is learning everything we can about the whole class of H5N1 influenza viruses and how to make broadly active vaccines against them and their combinations with human agents. Prevention, monitoring, and immunology are going to have to save us if we get into trouble. Because though it pains me to say it, people like me aren't going to be able to help.