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Tuesday, October 18, 2005

The Baker Plan to Eliminate Private Drug Development

Personally, I'm very sympathetic to the Baker plan to have the government get more involved the later stages of drug development. Progressive economist Dean Baker wants the government to start funding clinical trials and develop drugs that would then be released into the public domain. Although the government spends a lot on pharmaceutical research now, they mainly fund basic research and leave the private sector to take the drugs to market. I'd be happy to throw in a billion dollars of taxpayer money to fund Baker's plan.

I think that eventually, it would probably succeed well enough to justify spending 10 or 20 billion a year. But Baker seems keen to go whole hog, and eliminate private drug research and patents as soon as possible. And that scares me.

Patents have worked tremendously well for hundreds of years. The track record of Baker's system is what exactly? That it would probably succeed just isn't good enough to justify anything more than evolutionary change. The stakes are, after all, life and death. And keep in mind that the promised payoff from the Baker plan is a few hundred bucks a year per person.

And it's easy to think of reasons to be cautious about the Baker plan for eliminating all private drug research. The Christian right is currently fighting the "morning after" pill and even a vaccine that prevents cervical cancer, because they believe both will encourage sexual activity among women. If government were the only institution funding drug development, religious fundamentalists would have a much easier time killing drugs they don't like.

Similarly, if Baker or Marcia Angell were in charge, I'd imagine they'd stop research into the "me too" drugs they're constantly criticizing. Which might leave us with drugs like Vioxx (which causes heart attacks) and not the "me too" alternative Celebrex, which doesn't seem to have the same problems.

So, in the end, I think Baker has a good idea, but he tries to make it sound as radical as possible. Consequently his plan sounds a whole lot worse than it would if he were actually trying to pitch his idea and convince people. I really don't understand what Baker's game is here.

Monday, October 17, 2005

Reforming Drug Research: First Do No Harm

Presswatching economist Dean Baker has an interesting post over at MaxSpeak, proposing that the government take over financing all drug research. Baker points out that the government already provides most funds for basic research. He thinks the feds could also do at least as good a job as the private pharmaceutical companies that currently fund drug development with the support of profit-raising patents:
Why shouldn't we believe that if we doubled [federal drug research spending], to replace the $25 billion that the drug industry claims to spend on drug research (two-thirds of which goes to research copycat drugs) that we would end up with at least as good progress in developing drugs as what we have at present?
It seems to me the current system works awfully well at producing lots of amazing new drugs. I think we ought to place a high priority on not messing up a good thing. "First, do no harm," as doctors like to say.

So why not start "small" at, say, a billion dollars a year? That would be enough to start developing at least a dozen new drugs, a few of which would eventually prove beneficial. If it looks like we're getting somewhere, we can up the funding in a few years. But it's crazy to start by eliminating patents, which I think is what Baker has in mind. Certainly that's his long-term goal, and he places great emphasis on the evils of patents in his writing.

Really, there's no choice but to start small. To put Baker's idea into action, we'd have to set up a nonprofit or a new government agency, and let them try their hand at picking drugs and running drug trials to test for safety and efficacy. I don't know of any existing institution (other than the drug companies) that can do this.

Baker and lefty Congressman Dennis Kucinich suggest that the NIH and universities could replace the pharmaceutical companies. But drug development is mostly a hard, unglamorous slog. It's not the kind of thing academic researchers want to do. And it involves a large administrativeapparatuss to recruit thousands of patients into drug trials and collect data. Again, the NIH and Universities just aren't set up to do this kind of thing.

So there's no way to start spending $25 billion a year tomorrow, or even in the next decade. We'd have to build entirely new institutions.

So instead of trying to score rhetorical points by proposing to turn the existing system upside down, why try something modest? There will be plenty of political points to be scored when something so obviously reasonable is killed by the right and the drug companies.

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