New Federal Research – Subsidizing Pharma

New Federal Research – Subsidizing Pharma

by Stephen N. Xenakis, M.D., Brigadier General (Ret), U.S. Army


The National Institutes of Medicine is proposing to launch a new federal research Center to help develop medicines (The New York Times, January 23, 2011). Dr. Francis S. Collins, the Director of the NIH, remarks that the “drug industry’s research productivity has been declining for 15 years, ‘and it certainly doesn’t show any signs of turning upward.’” Dr. Collins had directed the Human Genome Project for years at the core of new drug development.


Launching the Center misses the mark on what’s needed to shape and reform healthcare. The Center is a barely veiled subsidy to the pharmaceutical industry, and that’s not what this country needs. Considering the vast efforts to control increasing drug costs, the economics of a government subsidy to produce more drugs with even higher prices cannot help. Moreover, there is an almost equally expensive industry of cost containment that will go into high gear to control the use of the drugs as they come to market. The “do loop” of sophisticated basic research, expensive new drugs, and growing managed care and insurance cost controls hurts patients, especially poor ones.


It may sound trivial – but, what is needed are better ways to care for patients – to help patients have better lives and live with the illnesses and infirmities that afflict them. Sadly, we don’t have a federal agency that does that. In the same article in The New York Times, Dr. Thomas R. Insel, Director of the National Institutes of Mental Health, is quoted as saying that the NIH is “…an agency that doesn’t know how to do therapeutics that well…” If there ever has been a time for developing better therapeutics, it is now–when health care costs are soaring and good healthcare is out of reach for millions of Americans. Unfortunately, healthcare reform is realistically synonymous with reform in financing, and only obliquely influences the fundamental changes in delivery that could make a difference.


The Times’ commentary on mental health is instructive – “…only two major drug discoveries in the field in the past century; lithium for the treatment of bipolar disorder in 1949 and Thorazine for the treatment of psychosis in 1950.” That’s a bit of an exaggeration, considering the introduction of Valium and Prozac, but illustrates the flawed thinking that just having the right psychiatric drug is all you need for better mental health. Good mental health knits biological, social, environmental, and physical factors together. The military is relearning that lesson again and recognizing that having more counselors to talk to soldiers does as much or more than having the “right prescription.” Certainly, the recent tragedy in Arizona didn’t happen because the shooter didn’t get the best drug available. The challenges in therapeutics go far beyond finding better medicines, and certainly not the most important variable.


An axiom of clinical medicine is that drugs don’t cure patients, but doctors – good practitioners providing good medical care do. A better mission for the Federal Government, and the NIH, would be to focus on the therapeutic care process. What should doctors do better, and what help do they need to improve their practices? The huge wave of baby boomers with chronic diseases potentially imposes the greatest burdens and costs on our healthcare system that we have ever seen. Living with serious chronic diseases, and worrying about the end of life, impacts the society across the board. The realities of millions of chronically ill Americans should inspire us to rethink our healthcare models.


In effect, the current model boils down to searching for improved treatments – better drugs and other magic bullets – and then imposing cost controls by restricting access to those same medications and limiting compensation to practitioners prescribing them. The realities of patients’ lives – the concerns, outcomes, and expectations that they bring to their doctors – get obscured in the fog of managed care.


It’s time to shift the paradigm and focus on patients, doctors, and therapeutics. If the NIH does not have a track record institutionally to do that, then the money and resources that would be allocated to its proposed Center should go elsewhere. But, innovation is overdue.


Michael Porter proposed “prioritizing value improvement” in his recent article in The New England Journal of Medicine (December 23, 2010). Where’s the value – a more comfortable life, or one that is more productive, or just simply living longer? Such questions vex baby boomers and the poor alike, and the overly burdened healthcare system they encounter. The challenge shouldn’t be just finding more drugs – and funding the pharmaceutical industry. The challenge is far greater. Ironically, it almost seems like this proposed Center is a legacy of Timothy Leary – “…better living through chemistry…”