E-DRUG: Scores of unessential drugs - the main game (4)
I am not at all surprised by the information supplied by Don Light in his
post to this list, and I think it is important to take note of the
situation being reported.
The US medical establishment has some amazing strengths and some very
worrisome weaknesses. In my view these are not monitored in any meaningful
way, so there is more reporting based on ideology than reporting based on
meaningful quantified data. I am happy to see the information supplied by
The US financial establishment has a singular focus on profit performance,
and so called Big Pharma and research are driven by profit performance and
stock price behavior. The distortions that arise because of this in the
allocation of resources to solving important health problems is
preposterous ... but this is bound to be as long as the primary driver of
the performance of these drug companies is based on the financial metrics.
I have argued for a long time that the purpose of the medical establishment
is to improve the state of health ... and I believe it is fair to say that
the vast majority of health researchers embrace that idea. Medical
researchers might advise on decisions about allocation of R&D resources,
but the actual decisions get made with a heavy weighting from the financial
community where profit trumps health impact. The 'orphan drug' problem
needs to be talked about a lot more.
As regards the regulatory bodies such as the FDA, their performance can be
understood in the context of the career path of the staff, and potential
for profit associated with regulatory decisions and the influence that can
be brought to bear through all sorts of 'interesting' channels. Science and
data is somewhere in the mix ... but whether or not good science gets to
dominate the decisions is less than obvious.
While I believe that the US business model of 'profit above all else' is
broken and unsuited to the 21st century I think it is still fair to say
that medical science is at an amazing place, and even more amazing progress
is possible. I argue that the framework for decision making about
allocation of resources should be based on something bigger than profit ...
specifically the impact of people, place and planet. So what is the value
of saving the life of a child growing up in poverty in a poor place
relative to selling a drug at high profit to a rich person in a rich place?
So ... how should fund flows into activities that save lives in poor places
be incentivized and rewarded? How do we move from where we are to where we
want to be? How do we make the best use of the human resources that we have
... including the unemployed and underemployed educated youth? How do we
make brain-power the limiting factor in progress rather than a shortage of
All sorts of things are possible ... the challenge is to make them happen.
A singular focus on money profit for an organization is a huge constraint.
Somehow we need to quantify the value of doing the right thing so that
people's health improves.
Peter Burgess <email@example.com>