New federal research – subsidizing pharma

A more fruitful mission for the Federal Government, and NIH, is focusing on the therapeutic care process. What should doctors do better, and what help do they need to improve their practices?  The huge wave of baby boomers with chronic diseases potentially burdens our healthcare system with the greatest costs ever. Living with serious chronic diseases, and worrying about the end of life, impacts the society across the board.  Americans should rethink their healthcare models, not just look for more and better drugs.

Healthcare reform has fallen short – it has just aimed to reform financing, and only obliquely influences changes in treatments. The mandates of the proposed NIH Center only reinforce this wrong-minded approach.

The Center is a barely veiled subsidy to the pharmaceutical industry. It supports drug development  – to identify candidate drugs, and conduct animal studies traditionally done by the drug makers. Considering the vast efforts to control increasing drug costs, a government subsidy to produce more drugs with even higher prices cannot help. Moreover, it sets up an equally expensive industry of cost containment to control the use of the drugs as they come to market. The vicious cycle of sophisticated basic research, expensive new drugs, and growing cost controls hurts patients, especially poor ones.

The field of mental health illustrates the problem with this approach. Too many patients are over-medicated with the “latest and greatest” drug, and come to treatment suffering with their illness and the side effects of the medications.  And, too many less expensive promising treatments and diagnostics don’t get fair testing.  Desperate patients try out complementary and alternative treatments hoping for a cure.

Ironically, according to The New York Times, there have “…only (been) two major drug discoveries in the field in the past century; lithium … and Thorazine …” That’s a bit of an exaggeration, considering Valium and Prozac, but illustrates the flawed thinking that having the right drug is all you need for better mental health. Good mental health knits biological, social, environmental, and physical factors together. The military is relearning that lesson and recognizing that talking to soldiers does more than having the “right prescription.” Certainly, the recent tragedy in Arizona didn’t happen only because the shooter didn’t get the best drug available. The challenges in therapeutics go beyond finding better medicines.

Investing in drug development propagates the myth of searching for magic bullets – and ignores the realities of patients’ lives.

It’s time for a new paradigm and focus on patients, practitioners, and therapeutics.  If the NIH does not have a track record to do that, then the money and resources should be allocated elsewhere. But, innovation is overdue.

Michael Porter proposed “prioritizing value improvement” in a recent article. Where’s the value – a more comfortable life, or one that is more productive, or just simply living longer? Such questions vex baby boomers and the poor alike, and the overly burdened healthcare system they encounter.  The challenge shouldn’t be how to fund the pharmaceutical industry. It is far greater, beyond the prescription.  The challenge in the 21st century is fashioning the care process for a new era. No matter the potential in exploiting fascinating discoveries of the genome, the odds of finding useful medicines are low.  Better investments can be made in improving healthcare delivery and being cost efficient.

Stephen N. Xenakis is a child and adolescent psychiatrist and a retired Army brigadier general. He is in clinical practice and the founder of a nonprofit conducting research on brain-related diseases.