R

R&D
A good reason we pay so much for perscription drugs

Oct 13, 2001

What were the odds that someone in the United States would contract anthrax? Certainly not very high; until this month, the last human case had been in 1992, and it had been the more common and treatable cutaneous form. Only 25 cases of inhalation anthrax have been identified in the United States in the past 100 years, and no cases of the third type, a gastrointestinal form, have ever been reported here.

So if you developed anthrax symptoms, and if your health-care provider was alert enough to correctly diagnose the disease, you could bet that drug companies in the United States hadn’t spent much money developing products to help you survive. You could hope to benefit from the fact that the bacillus responds to common antibiotics stocked for other illnesses; beyond that, you’d probably be glad that the military and other government agencies have carried out anthrax research because of the prevalence of the disease in other parts of the world.

Did you know, though, that only one factory in the United States manufactures anthrax vaccine, and that manufacturer has not succeeded in obtaining FDA approval for its product? Furthermore, did you realize that vaccination against anthrax is an 18-month process? Or that the vaccine may cause sterility and other side effects, and is not always effective against the disease? Those details seemed inconsequential when no one in the civilian population ever expected to catch anthrax; suddenly, they’re not so irrelevant any more.

The odds of contracting anthrax are still extremely small. Unfortunately, it’s not the only disease for which vaccine is in extremely short supply. Tetanus, pertussis, this year’s expected varieties of influenza — those are more immediate risks, and then there’s smallpox, against which hardly anyone has been vaccinated for years. Privileged Americans believe that restored health is just an pill away, but the truth is that an outbreak of a communicable disease could be devastating even here.

The world is filled with microbes that we’ve largely managed to avoid here in the United States. Because we haven’t suffered from them, we haven’t been a lucrative market for their prevention or treatment. That can change literally instantly, but the research and development necessary to cope with such illnesses can lag years or even decades behind. For many, we have no treatment.

Pharmaceutical companies, like other corporations, use their resources in ways that promise the most profit. In the United States, a treatment for erectile dysfunction is almost infinitely more profitable than a treatment for anthrax. What, then, are such firms likely to concentrate on?

Research and development is always a gamble. For every Viagra there are thousands of products that never made it to market, as well as more that were developed for rare applications. The work done on each of those adds costs to those few that are financially lucrative. Those who have to pay that price complain loudly about it. The alternative is that the government could use tax dollars to support research even more than it already does, but that transfers costs rather than shrinking them.

Now we’ve received a sharp reminder that research and development is important, sometimes in ways that cannot be identified by traditional cost-benefit analysis. Science is not all about earning dividends for stockholders and holding down costs for consumers. Sometimes, it has to be about developing information and products that will be essential in situations we cannot yet imagine. Research results archived years ago are still available to us, and we may yet be very glad that the costs for that research were tacked onto our bills.