Cheap pills today or new pills tomorrow?

-- (historic), Commentary, Healthcare, Uncategorized

In the battle against disease, human ingenuity has proven itself a formidable combatant. Often using drugs as our chief weapon, we have made in the last century progress against illnesses that were simply assumed to be an unalterable fact of human existence. Now, however, human ingenuity in its destructive form threatens the flow of pharmaceutical innovation just at the moment when it is poised to lay its greatest triumphs at mankind’s feet.

In 1920, 15 people out of every 100,000 in North America were condemned to die from flu and pneumonia. Another 15 each would be lost to syphilis and diphtheria, while tuberculosis would carry off a staggering 118. Today for each of these diseases the death rate is less than one out of every 100,000 annually.

Look at childhood leukemia. According to a 1930 medical textbook, the disease was a death sentence: “Death in acute leukemia is a matter of days or weeks…no form of treatment is of the slightest use.”

Contrast that with the 2000 edition of Nelson’s Textbook of Paediatrics which describes one of the great scientific victories of our age: “The overall cure rate for childhood ALL [leukemia] is estimated at about 80%. Thus, parents can generally be assured at the time of diagnosis that the possibility of cure is very good.”

These victories of the human mind over our human frailties are repeated over and over again. In the United States, death rates from atherosclerosis have declined 74%, from ischemic heart disease, 64%, from emphysema, 57%. Deaths from HIV/AIDS declined from a high of 15 per 100,000 population to about 3 or 4 after the introduction of the first effective drugs in 1995.

That’s not all. We are opening the door on a whole new world of drug innovations because of the recently completed mapping of the human genome. The number of known “receptors” (the parts of the human organism that drugs can potentially target and use to defeat disease) has risen from around 450 to over 4000. And because we mapped the human genome, we don’t have to fool around with the haphazard identification of receptors in rats and hamsters and other lab animals. We can zero in on what works for people, and even ultimately make “designer drugs” tailored for each individual.

But this huge increase in the scope for scientific research and disease-defeating and life-prolonging drugs will be hugely expensive to explore. For every drug that is successfully brought to market, dozens of experimental agents fail. With the huge increase in receptors to research, the potential for great discoveries is increased, but so too is the number of failures we will have to pay for as we grope our way to new wonder drugs. That is one of the chief reasons why the pharmaceutical industry estimates that it costs around $1-billion for each major new drug; the failures must be paid for by the successes. It’s also why drug patents are so important to innovation — even huge drug companies may find that a handful of products generate the lion’s share of their revenue, supporting a vast research effort that reaches beyond the successful drugs and the diseases they treat.

But once a drug has been discovered, the actual cost of producing an individual pill or dose of the medicine may be literally pennies. This difference between relatively low costs of production and the much higher prices actually charged by drug companies makes it easy to portray them as unscrupulous profiteers, exploiting human misery to make a buck. And politicians in search of passing popularity will often play this card, attacking the “greedy” drug companies for electoral advantage. Yet no politician ever cured a child of leukemia, or prolonged the life of a beloved grandparent.

Around the world, politicians are forcing drug companies to lower their prices much closer to their cost for just stamping out each pill. They deny the companies’ products access to hospital dispensaries, or they create buying cartels, or they reduce patent protection or any one of a host of other manoeuvres, as we have frequently done in Canada. The result has been that drug prices have been lowered for medical marvels already discovered, but at the cost of needlessly prolonging the suffering caused by diseases that we have not yet conquered.

It’s not the end of new drug discoveries but, compared to what we could be doing, they will come more slowly and with less regularity than at any time in the postwar era. Sure drug companies need to be watched to make sure they don’t abuse their power, and we need to find ways to make sure that the most vulnerable among us aren’t deprived of access to the drugs they need. But doing so by slowing everyone’s access to the next generations of drugs is the wrong tradeoff to make.