Putting Medical Science Under the Microscope, Part 4

by Elizabeth | Break the Status Quo, For Doctors and Physicians

We want to believe that researchers and pharmaceutical companies are primarily concerned about improving our health. After all, it’s our very lives which are at stake. But, just as we need to be aware that medical research has a positive bias, as I discussed in my last post, we also have to recognize that pharmaceutical companies are motivated by profit. This motivation drives pharmaceutical companies to do more than raise the costs of old medications. The profit motivation finds its way into laboratory, driving the science and directing the research behind new medications.

In my last post, I discussed a new medication for atopic dermatitis which was approved by the FDA recently. This ointment works, but not very well, though you have to study the data carefully to determine how effective it is. In the clinical trials, fewer than 1/3 of patients achieved a positive result, which is barely better than the results for placebo.

This medication — which provides a 13% improvement, at best — costs approximately $600 for a 60 gram tube. That’s $10 per gram, a glob of ointment the size of a raisin. In an adult, a gram of ointment covers an area the size of the backs of both hands. Atopic dermatitis can affect large amounts of the skin, so a person can easily need 5 or 10 grams or even more to treat all of their rash. What’s more, the medication needs to be applied twice a day. Even if a person used just one gram per application, he would still spend $20 per day. For very little improvement.

Naturally, the press release for the new ointment doesn’t mention either of these shortcomings, not the lackluster results nor the high cost.

Staying on the subject of dermatology medications, in the past several years there have been a host of new medications developed to treat psoriasis, most of them intended to treat moderate-to-severe psoriasis. From my years of treating patients, I know how miserable psoriasis makes people feel. I know how difficult it is to treat and how frustrated it makes patients.

But the simple fact is that about 0.3% of people in the United States have moderate-to-severe psoriasis, compared with 11% for heart disease, 33% for high blood pressure, and 9% for diabetes. Psoriasis is a drop in the bucket compared to many other serious chronic medical conditions. Yet, since 2014, there has been one new medication approved for psoriasis each year, which represents a huge amount of time and effort by scientists. Why so much effort for an uncommon condition? It’s hard not to draw the conclusion that pharmaceutical companies chose to develop these medications and have priced them with profit in mind.

These new medications cost between $3000 and $9000 per month and have to be taken indefinitely. Psoriasis often starts in early adulthood, so the average “customer” for a psoriasis medication will need treatment for decades. While drug development is very expensive, with each new medication requiring $1.4 billion in development costs, these new medications are priced in a way which allows pharmaceutical companies to recoup their investments even if relatively few people take the medication. For example, a one year supply of the cheapest of these medications costs $36,000. If 38,888 people (which is only 4% of the moderate-to-severe psoriasis patients in the US) take the medication for one year, the pharmaceutical company has recovered its research and development costs. And, because psoriasis is a chronic, recurrent condition, repeat “customers” are the rule, not the exception.

You can argue that pharmaceutical companies are businesses which need to make a profit in order to continue doing life-saving research. The point to a business is to stay in business, after all. I agree, but only to an extent.

Scientists are rare, highly skilled people. Research is slow and painstaking. There’s a natural limit to the amount of scientific discovery and research which can be done in any one year. I believe scientists should spend their precious intellectual resources and their time studying conditions and treatments which have the potential to benefit the greatest number of people.

When profit motivates research, this potential doesn’t materialize. Instead, we may all be shortchanged in ways we don’t realize. There may be medications and treatments which will never be discovered or tested. All because something other than the highest good is driving science.