Friday, May 21, 2010

The Fancy Toy Focus

Max Mendel makes a very compelling point re: Craig Venter synthesizing life:
As I have written, life sciences research has been the big bet of the U.S. economy, absorbing a rising share of government and academic research dollars If it had produced a stream of commercially powerful innovations over the past ten years, the economics of healthcare would have been different. Indeed, I would argue that the current state of the U.S. economy would be much better.

And he links to this Newsweek article about the clumsiness of the NIH-led structure in shepherding basic research to applied research to an actual production. In fact, here’s a couple of nice grafs from that piece:
From 1998 to 2003, the budget of the NIH—which supports such research at universities and medical centers as well as within its own labs in Bethesda, Md.—doubled, to $27 billion, and is now $31 billion. There is very little downside, for a president or Congress, in appeasing patient-advocacy groups as well as voters by supporting biomedical research. But judging by the only criterion that matters to patients and taxpayers—not how many interesting discoveries about cells or genes or synapses have been made, but how many treatments for diseases the money has bought—the return on investment to the American taxpayer has been approximately as satisfying as the AIG bailout. "Basic research is healthy in America," says John Adler, a Stanford University professor who invented the CyberKnife, a robotic device that treats cancer with precise, high doses of radiation. "But patients aren't benefiting. Our understanding of diseases is greater than ever. But academics think, 'We had three papers in Science or Nature, so that must have been [NIH] money well spent.'?"

The barriers to exploiting fundamental discoveries begin with science labs themselves. In academia and the NIH, the system of honors, grants, and tenure rewards basic discoveries (a gene for Parkinson's! a molecule that halts metastasis!), not the grunt work that turns such breakthroughs into drugs. "Colleagues tell me they're very successful getting NIH grants because their experiments are elegant and likely to yield fundamental discoveries, even if they have no prospect of producing something that helps human diseases," says cancer biologist Raymond Hohl of the University of Iowa. In 2000, for instance, scientists at four separate labs discovered a gene called ABCC6, which, when mutated, causes PXE (pseudoxanthoma elasticum), a rare genetic disease in which the skin, eyes, heart, and other soft tissue become calcified—rock hard. By 2005, scientists had genetically engineered lab mice to develop the disease. The next step would be what's called screening, in which scientists would laboriously test one molecule after another to see which had any effect on ABCC6. But "academic scientists aren't capable of creating assays [test systems] to do that," says Sharon Terry, CEO of the Genetic Alliance, which supports research on rare genetic diseases (her children have PXE). "It's time-consuming drudgery and takes an expertise that hasn't trickled down to the typical academic scientist." Ten years later, there is still no cure for PXE.

I think the points that the Newsweek authors and Max Mendel are fair in that we haven’t seen either the blockbuster drugs or wonder surgical devices over the past decade that we thought we might have. But I think this is the wrong emphasis for our economy.

I think the focus on innovation shouldn’t be inventing the cure to the killer disease, but how to deliver the same care at a lower price. The distinction is very important, because we’re increasingly focusing on the former, with little results to show for it…obviously the cure to cancer, or a vaccine to HIV, or any of these things would be profoundly wonderful for human welfare. But I ask myself this question: how would you feel if current trends in longevity continued in roughly the same way? You’d feel disappointed, I bet—the old 2001 conundrum of: where are my jetpacks?—but I doubt you’d feel outraged or overly angry. After all, an average life span of 76 or so for men and 82 for women sounds pretty good.

But how would you feel if current trends in price continued? Well, you’d be very angry, because you’d be broke.

The fancy toy focus has given us many drugs and machines of very dubious value, because the incentives in the medical sector of our economy are such as to encourage the purchasing of the most expensive drug, the most expensive MRI imager, etc. etc., whether or not they deliver better results. And until you figure that—and until you figure out how to disrupt the current cost structure—thinking about these kinds of diseases is misplaced. Otherwise, we’ll just fall for the fancy toy trap, rather than the actual gamechanger.

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