Missing the Boat

Christoph Westphal is undoubtedly a smart guy, an MD and a successful Boston-based biotech entrepreneur, executive, and investor (see his Wikipedia entry, Westphal).  Recently in his spare time, he is writing commentaries for the Boston Globe editorial page and his most recent was “Innovation suffers with ill economy,” August 15, 2011 (Westphal editorial).  While it is great that he is explaining an important local industry to a wider (at least, newspaper-reading) audience, I think there is a boat (or two) he is missing.

In his commentary, he points out that Massachusetts’s great academic/medical/industrial complex is supported in large part by pubic dollars, which is mostly true since the US federal government supports most of the basic life science research but more importantly, buys $100 billion in prescription drugs annually (US Senate Committee on Aging).  But then he repeats the standard line that “innovation,” that is, drugs that are better than existing ones or for currently untreatable diseases, need to be expensive (high-priced) because drug discovery and development is expensive.  The pharmaceutical industry knows it has multiple productivity, cost, and pricing problems and is scrambling to improve the efficiency of drug discovery and development (of course, while its lobbyists beat the high-cost-of-innovation drum).  Even I have noted how development for drugs in general and drugs for neglected diseases can be less costly (e.g., my posts of 3/11/10, 11/4/11, 11/11/10, and 12/16/10).  I’d prefer that he took another line, that our state’s academic/medical/industrial complex needs to demonstrate, like other industries (except maybe the military), that technological innovation results in lower prices.

Next, Dr. Westphal notes several fixes.  Academic researchers need to focus on more applied research “that can measurably improve human health in a reasonable time frame- not just at some distant point in the future.”  I agree we need less information and more understanding and academics are best positioned to provide it.  He also says government needs to improve the transfer of intellectual property, although I think the government’s role is just to define what the property is through the patent system (which is needs improvement despite the recent reforms) and let the market do the transferring as fast as possible.  He also thinks that the USFDA is over-regulating by raising the safety bar on drugs for treating chronic disease (which taken for a patient’s lifetime).  This is an important and scientifically challenging question, but really boils down to how society wants to compensate the relatively small number of patients who are harmed by a drug that benefits many more.  There is an analogy; the government and the vaccine industry addressed this problem with the 1986 National Childhood Vaccine Injury Act, but it’s value is being reconsidered through a Supreme Court case (WSJ Health Blog).

But the big boat I think Dr. Westphal misses is where the Bay State academic/biotech/pharma industry should be looking for its next customers.  While I agree with him that “they must look for solutions to diseases and medical issues that may be more prevalent outside the United States,” I disagree that next customers are those “able to pay for innovation (what are the medical needs in China or Brazil?).”  I have advocated and provided examples, as have many others including organizations like BIO Ventures for Global Health, that there are attractive markets for affordable treatments for diseases that afflict millions throughout the world, not just in countries with high-growth economies.  Yes, developing affordable drugs in a cost-effective way is challenging scientifically and operationally, but this country’s potent combination of government, academia, and industry is up to it, and frankly, to be competitive in a world marketplace, I don’t see any other choice.  So my request is that Dr. Westphal and his many smart colleagues noodle on this problem and editorialize on some solutions.



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