Great points here. I don’t have great answers for all these, but here’s where I’m coming from:

I don’t feel confident about the chance that there’s a huge amount of free-energy lying around

I couldn’t agree more. It seems obvious to me that the system operates today in an ugly but stable equilibrium. Perhaps the new U.S. Medicare drug pricing bill and/or the current downturn in biopharma equities might cause a shake-up, but it’s been a stable equilibrium for an awfully long time.

What exactly are the “emergent properties of complex systems” mentioned in the neglectedness section? It sounds like perverse incentives, unexplained lack of translation of technological progress to profitability and maybe backfiring legislation?

You’ve got it. I’ve tried to cite thoroughly, but in this area in particular I’m borrowing very heavily from J. Storrs Hall’s book Where is My Flying Car. In my view the case is even easier to make in this field given how obvious the steady the process of bureaucratization has been in all important institutions touching on drug and vaccine development.

Can you point to any examples of such companies not succeeding for lack of funding?

I cannot. I think it’s the nature of things that—like publication bias—the uninteresting outcomes are not reported in the trade press or anywhere else. Unsuccessful startups die quiet, sad, lonely deaths.

this sounds potentially very time-expensive. If money isn’t the limiting resource, EA community member time/focus might be. What is your sense for the number of people/amount of time it would take to test this hypothesis?

Hmm, I suppose I could have made this clearer. I don’t have a great sense of what it takes to shift a culture. What I understand groups like New Science and Roots of Progress are trying to accomplish seems extraordinarily difficult. From what I gather, a lot of it boils down to talking about it a lot, and in various ways. Perhaps talking is just one of the main ways that culture is propagated, and therefore changed? Perhaps also institution building (i.e., end-running existing institutions that are bottlenecking progress). If I'm understanding that correctly, than participating in that conversation, and amplifying things, seems like a really important contribution that the EA community is making to the Progress Studies cause. It's how I came to these ideas, for one example.

However, in the narrow context of drug/vaccine development, I think the SpaceX example offers an intriguing additional path that's open to deep-pocketed  donors. Biopharma execs may be hopelessly tied up in their own red tape today, but if someone shatters an existing cash-cow drug franchise with a really novel development program, the entire industry would sit up and take note. 

To visualize what could be possible, I think a good example of abrupt, industry-wide remodeling might be what happened in the market for cell phone handsets after Apple launched the first iPhone. It looked like science fiction when it came out, and within a few years the former industry goliaths (Nokia, Motorola) were knocked completely out of the market.

SpaceX was a startup and Apple was obviously not, I'm stretching my analogy. But then again, I don’t think any biopharma companies are run with Steve Jobs charisma today. If it’s possible for this to happen in the biopharma field, it will have to come from a startup. And above all what startups are starved for is funding—in particular funding for the wilder long-shot ideas that could really shake things up.

Without a catalyst like that, I suspect the current unhappy equilibrium is probably too stable to be dislodged with dialogue alone.