22 January 2007

Real research vs. PR

Paul, Missy and Curtis

The health stories on the local news tonight were a Belgian heart study on endurance athletes at risk for ventricular arrhythmia and a British study on dogs being a better choice for keeping people healthy. Maybe because you have to walk ‘em.

Notice that those two studies weren’t in the U.S.

Fearmongers against healthcare reform spreads the lie that the free market alone can bring health advances. Not true: governments, including our government, are the major research funders for basic science. Big Pharma’s part in new meds is mostly confined to copying their competitors’ top sellers. So we now have lots of “purple pill” options, lots of erectile dysfunction cures of the pharmaceutical variety.

This 2003 Health Affairs page says that pharmaceutical companies now spend more than government: $30 billion to $20 billion.

A problem with that number is that Pharma counts “opportunity cost” as part of their research total. That means they add in what their $10 million or $100 million for research could have made in a bull market and then add that to the total.
John Mack has a good explanation of how this works on the Pharma Marketing Blog:

Assuming it takes my son only 4 years to complete his undergraduate study at Penn State, I will have spent over $100,000 on tuition, room, board, books, wine-in-a-box, transportation, etc. …
But wait! I forgot my lost opportunity to invest that $100,000 in the next best thing (whatever that is). I could have made another $100,000 with a better investment. So, I will really be spending $200,000 on my investment in my son's degree. I'll have to factor that in on my next IRS return!
But wait! Suppose my son, God forbid!, quit college in his junior year and never earned his BS degree? Did I actually spend $200,000 on his failed attempt? I mean, could I go around to my friends and relatives and say, it was a $200,000 failure?

That’s what Pharma does.

By that bookkeeping, the government still spends more money on research: $40 billion to $30 billion in 2003.

And what does Pharma spend their $30 billion on?

Merrill Goozner in The $800 Million Pill writes that after reviewing the 127 new drugs approved between 1989 and 1993, Dr. David Kessler, head of the FDA from 1990 to 1997 said,

“only a minority offered a clear clinical advantage over existing therapies. Many of the others are considered me-too drugs because they are so similar to brand-name drugs already on the market...”
"In 2002, just seven of seventeen new drugs were rated a priority by the FDA, which indicated they represented a legitimate medical advance..."

Some of the new drugs are dangerous.

“The diabetes drug Rezulin gained fast-track approval status in 1997 even though an FDA examiner warned that it might cause heart and liver damage. A Pulitzer Prize winning series in the Los Angeles Times later revealed that Rezulin caused at least thirty-three deaths and was kept on the market by Warner-Lambert despite there being at least nine other drugs for the condition. (The Rezulin case highlighted on the of the enduring truths about me-too drugs: Users of the new molecule were exposed to greater safety risks than consumers using tried-and-true drugs already on the market. Every one of the thirteen drugs withdrawn from the market for safety reasons during the 1990s failed to meet a medical need that wasn’t already served by a number of drugs already on the market…”

Pharma is offering fewer real advances as they concentrate on profits, but governments continue to fund research on real science, vaccines and preventatives — even dogs — even though there’s no profit in it. Just public health.

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