Drug Development and Access: Time to Act Like Lives Depend on It

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The Problem and the Incremental Solution

An Op-Ed in the Sunday New York Times in the past few weeks pointed out that important cancer drugs are being rationed by companies that have simply interrupted production. (See Ezekiel Emanuel, “Short Changing Cancer PatientsNYT August 6, 2011). As a result, many cancer patients can’t get the drugs they need.

Ezekiel Emanuel: Doesn't He Look Like a Policy Wonk?

Dr. Emanuel is an oncologist and a health policy wonk who was most recently an adviser in the Obama White House. In his article the good doctor details the current shortage of commonly-used cancer drugs and what he sees as possible solutions to the problem. He clearly understands deeply the issues of cost reimbursement and the cost interaction between generics and patented drugs. He believes that the best way to get the missing drugs back on the market is to make generics of the drugs that are in short supply more profitable.

Capitalism and Health Care: Not a Good Mix

The article got me thinking once more about whether capitalism and health care are concepts that make any sense together, and about how cancer and ALS are different, yet the same.

In his op-ed, Dr. Emanuel says, “You don’t have to be a cynical capitalist to see that the long-term solution is to make the production of generic cancer drugs more profitable.”

I see the situation differently: you don’t have to be a raging socialist to see that the solution to the drug access and cost problem is to nationalize the pharmaceutical industry. We can pass laws until the cows come home to try to get pharmaceutical companies to behave in ways that will not harm patients while keeping their profits intact. But the goal of companies that make drugs is to make money, and that goal will always trump the needs of patients when the two conflict. Sadly, you can bet your life on it.

As long as we insist that health care must provide a profit for the drug companies and that this profit must not be subject to regulation our health will be short-changed.

Meanwhile, the shortage of cancer drugs is dire and getting worse as patients await the arrival of prescribed medicines so they can start or continue the treatment that may extend or improve their lives.

Cancer and ALS: Different Diseases, Similar Issues

That cancer treatment situation is terrible. Equally, but differently, bad is the situation in ALS, where there is only one drug approved to treat the disease. That drug is Rilutek. If it works – and it doesn’t work for everyone – it delays progression of the disease for up to 9 months. It does nothing to make you feel or function better and nothing to extend your life.

The absence of ALS drugs is in part the result of the fact that the market is so small: because, relative to cancer and some many other diseases, so few people have ALS. That means there is not as much profit to be made from ALS drugs. But that doesn’t mean that the research resources are so limited that we can address only the diseases for which drugs can be profitably made. It simply means that there’s not enough potential profit in ALS drugs or drugs to treat other relatively untreatable diseases (like pancreatic or head and neck cancers, to name just a few) to make the research attractive to private companies.

Potential profit will continue to be an incentive to develop drugs for diseases that are relatively wide spread. What we need are incentives to push the research also in the direction of, if you will “less profitable” diseases that need treatments. What would happen if national policy required drug development for diseases that are always or nearly always fatal, and for which there are very few if any good treatment options? I’m sure there are many people who would take issue with this standard, but maybe we should have the conversation and think about whether and how it might work.

In my opinion, it’s time to get away from niggling around the edges of how to make capitalism and drug development (or health care in general) work together. Maybe it’s time to put patients’ needs first. Isn’t that a nifty idea?

© Barbara A. Brenner 2011

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7 Responses to Drug Development and Access: Time to Act Like Lives Depend on It

  1. Amy Pett says:

    It’s more than a nifty idea, it is a moral one. Perhaps the rate of profit that drug companies were allowed should be linked to how many unprofitable drugs they develop. I am all for nationalizing drug companies–and all of health care. No one should profit from our illnesses, our medical treatment, or our medications. All of health care is a human right!
    Bravo Barbara!

  2. Donna Brorby says:

    Like they all are, this post was fun to read, Barb.

    I’m on the middle ground between the not-cynical-capitalists and the not-raging-socialists. I’d favor single payer health care, and then let the government exercise its regulatory and funding power to influence development and price of pharmaceuticals. Even without a single payer system, the government is the biggest health care payer (Medicare and funding for state programs to provide medical care to the indigent), and it should use regulatory and funding power to improve development of and access to necessary pharmaceuticals.

    If we should nationalize the pharmaceutical industry, aren’t there a few other industries we should nationalize for the health and safety and to meet the basic human needs of people. With what we’ve seen so far (demonstrating human imperfection), do we really trust the government to run so many things?

    I’ve never believed we could evolve or transition to socialism, maybe that’s all that is coming out in these thoughts. Are there models of nationalized industries that would help us see that it might work for the pharmaceutical industry in the US?

  3. abby abinanti says:

    Patient needs first…..I am in a cultural black hole….where did these people/companies come from that they could live with themselves/their profits by not putting people first????

  4. Catherine Thomsen says:

    Ah, Barbara, I miss seeing you, so I am so happy to have your blog for these well-reasoned, insightful comments on the diseases of our bodies and our society.

    If we can just nationalize all aspects of health care, it would help! I may not completely trust a government to run the system (per Donna’s comment), but at least we would have the chance of a more integrated system, with fewer perverse incentives.

    I trust health care, pharma and insurance companies far less.

  5. Martin Elsbach says:

    As long as management is motivated, and is in fact mandated, to pursue profits as the primary business driver the system will not change. This is also why the focus is on treatment and not cure. I am certain that if it were up to the research staff they would have a very different focus as to the diseases they would prefer to work on. And as Donna can attest I am not on the middle ground on this.

  6. Chuck Hummer says:

    Unfortunately solutions to problems like this are stymied by a broken political system.A cure for that must preceed any reasonable expectation of solutions such mundane issues like drugs for the terminaly ill.

  7. Nancyspoint says:

    Putting patients’ needs first, that is a nifty idea.

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