Why can’t medical drugs be free?

Sunday 14 October, 12:0013:00, ConservatoryBiomedical dilemmas

In the mere 200 years or so that pharmacologists have been discovering medicinal drugs and vaccines, life expectancy has doubled in many countries around the world. These medicines have helped bring some diseases under control and raised hopes of cures for others, enabling us, as a global society, to live healthier, richer lives.

But we still can’t treat or prevent every disease. While some of this is down to the continuing limitations of our knowledge, there are commercial reasons why some kinds of illness have not attracted the concerted efforts of the pharmaceutical industry. The pressure to make a profit forces publicly traded pharmaceutical companies into tough choices about which drugs they can afford to research and develop. Put simply, the profit to be made from treating some diseases is too small compared to the research and development effort that would be required to understand the causes, find substances that could potentially deal with those causes, and then pursue stage after stage of tests and trials to confirm the safety and efficacy of the proposed treatment.

For example, there is only one viable Malaria vaccine, RTS,S – and its efficacy is dramatically low. There was no Ebola vaccine when the West Africa outbreak started in 2014, although a concerted effort quickly produced a number of candidates. Antibiotic resistance is on the rise, yet there are barely any new classes of drugs in the pipeline as a backstop when current antibiotics fail. At the start of 2018, Pfizer said it was withdrawing from research into neurodegenerative diseases to focus on ‘more promising’ areas, despite the fact that an increasing number of deaths are the result of such conditions.

These are urgent, global health challenges, but the industry’s economic realities are understandable – albeit worrying. And now with the tech industry ‘disrupting’ the landscape, there are new hopes and fears. Tech wants to use artificial intelligence and machine learning systems to speed up research – and possibly lower the cost. Yet the price for applying such techniques might be making more and more personal medical data available to big tech firms. Is the loss of privacy the price we have to pay for making progress?

But why should drugs cost anything at all? What would happen if the pharmaceutical industry were freed from the profit-drive, and health priorities were set by what we need rather than what makes money? Could it ever work? Some have championed the idea of research through philanthropy. Perhaps the industry could develop a ​pro bono​ culture to fight those really tough diseases. Should governments, perhaps collectively, take on the task of developing new drugs? How can we remove the barriers to finding new treatments for the many health threats that face us?