Interesting back and forth on medical innovation at The Daily Dish

Andrew Sullivan quotes a reader’s response to his assertion that “restraining costs means rationing in the end and expanding the power of the public sector in ways that will reduce patient choice and slow innovation and research.” The reader writes that 

this passage fell flat. Its based on a shibboleth, the ingrained automatic conclusion by market fetishists that the private sector does innovation better than the the public.  In the case of health care this is simply untrue. From the New Republic:

The single biggest source of medical research funding, not just in the United States but in the entire world, is the National Institutes of Health (NIH): Last year, it spent more than $28 billion on research, accounting for about one-third of the total dollars spent on medical research and development in this country (and half the money spent at universities). The majority of that money pays for the kind of basic research that might someday unlock cures for killer diseases like Alzheimer’s, aids, and cancer. No other country has an institution that matches the NIH in scale. And that is probably the primary explanation for why so many of the intellectual breakthroughs in medical science happen here.

… I’m quite sure that some of the retroviral treatments you need were the product of the private sector.  I’m equally sure the majority of the basic research paving the way to those medicines was financed by public funds and conducted in public institutions.

Sullivan counters that “two-thirds of pharmaecutical research is done by the private sector,” but the reader’s point still stands strong. What many research industry outsiders fail to understand, in my opinion, is that while most recipients of NIH funding are indeed located within the public sector, the competition between them is just as fierce as it is in the private sector. I know from personal experience that the NIH doesn’t just give away grants; I’ve seen really good science get sent back to the applicant with nothing but “good luck next time.” Most of us, especially those connected with science in one way or another, have heard the adage, “publish or perish,” and it’s no overstatement. Tenure in many cases depends on how many grants you can get, and how many publications you land in prestigious journals. For many scientists (especially non-clinical biology or chemistry researchers), getting a grant means having a salary – so you know damn well that those men and women are competing as hard as possible for that government money. The drive for a publication or for important figures and data to put in your next grant application never lets up – and this is why the NIH is so effective at fomenting awesome science. Another thing about the NIH is that it loves “translational” science, or projects that are based in basic science but have realizable applications for patient care or public health. Sullivan mentions that 2/3 of drug-discovery comes from the private sector, but that means that a big 1/3 comes from the public sector, in addition to lots and lots of foundational basic science that the private sector certainly engages in and uses, but doesn’t produce like NIH grantees do. 

This is not to say that the private sector doesn’t do a great job, and that the competition for the big money in private sector biotech does not produce amazing results in drug discovery, cancer therapeutics, genetics, and more; the results (lipitor, albuterol, imatinib, viagra, coxII inhibitors etc.) are easily recalled. However, that industry does end up shading more towards “lifestyle drugs” than and NIH researcher would, because the academic’s job is evaluated at the end by scientists at the NIH, whereas big pharma looks to the consumer for success. And while that consumer may be someone stricken by an infectious disease (not too often – especially not where that someone has money), or a cancer patient (often), it’s more likely (statistically) that the consumer who has money to spend is bald or fat, and so more drugs are made to address those issues, less for cancer, and dishearteningly few (in the private sector, at least) for antimicrobial therapy.

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