Unprofitable Treatments
While the government underwrites a substantial portion of the cost of research in medical therapies, the system still depends heavily on private industry to develop, test, and market them. But for a variety of reasons, the market sometimes provides inadequate incentives to develop useful therapies.
The classic examples are "orphan drugs" used to treat rare disorders. In 1983, Congress granted special financial incentives to developers of such drugs. And research by Frank Lichtenberg of Columbia University suggests that the program, which has yielded some 200 commercialized therapies, is successful. "One additional orphan drug approval is estimated to save an average of 211 lives in the subsequent year," he concludes.
But compounds that cannot be patented because of their age and general availability may not see the light of day because it doesn't pay for the industry to test and market them. The federal government has filled the gap in part—for example, by funding long-term studies on the anti-carcinogenic properties of common antioxidants like vitamin E. However, there is considerable disagreement about whether this approach has been pursued with sufficient vigor. And, in a few cases, there is genuine conflict between those who would introduce potential therapies with no commercial value and the holders of patents to competing drugs. In this context, Judith Rodin points to the protracted battle over the approval of lithium—a common compound that costs almost nothing to manufacture—for manic-depressive disorder.
Paradoxically, one may observe the opposite phenomenon—resistance to rigorous testing of new therapeutics on the part of a suspicious public. Dr. Stuart Holden, a Los Angeles-based urologist who is medical director of The Prostate Cancer Foundation, points to the irony: "The same people who will casually use anything sold in a health food store," he laments, "are deeply reluctant to be part of clinical trials for promising experimental drugs."
Read further on economic issues in Safety & Efficacy.
