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Opinion | What Joe Biden Knows That No One Expected Him To


Democrats should braid policies to make drugs cheaper with policies to make drug innovation easier and, in some cases, more profitable. I spent some time this week talking to Heidi Williams, an economist at Stanford who studies drug development, and the point she made is so obvious it’s a wonder we haven’t done more about it. We spend a lot on the beginning of drug development — basic science and research — and even more on the products that ultimately get developed. But we neglect the middle: All the unglamorous, difficult infrastructure needed to turn a promising molecule into a miraculous treatment.

One example: Much of the difficulty and risk of drug development comes in running clinical trials. One reason clinical trials are hard to run — as we saw during Covid — is that it’s hard to find the patients needed to run trials that will generate good data, fast. Years ago, we created a national registry for cancer patients that made it much easier to run cancer studies in the United States — and now, compared with drugs for other diseases, far more cancer trials are run in the United States. We could, and should, scale that model.

Bernie Sanders used to promote an idea for creating a system of prizes to run parallel to the patents we normally use to make drug development profitable. The government could identify, say, 12 conditions that it wants to see a drug developed for. The first group to develop and prove out such a drug would get a princely sum — $100 million, or $500 million, or a billion dollars, depending on the condition and the efficacy. In return, that drug would be immediately off-patent, available for any generic drug producer to manufacture for a pittance (and available for other countries, particularly poor countries, to produce immediately).

More money might be good — particularly spent in new ways, like for prizes or ARPA-H — but Washington spends tens of billions of dollars now on medical research, and it’s worth asking if that is all well spent. A thoughtful report from New Science backs up a complaint I’ve heard privately for years: The N.I.H. is a remarkable institution beset by a deep internal conservatism. ARPA-H is an admission of this problem, even as it is located within the N.I.H.: If the N.I.H. were making the kinds of bets ARPA-H is designed to make, there’d be no reason for ARPA-H at all. But that raises the obvious question of whether the N.I.H. should be more daring at its core.

There are, to be fair, good reasons for caution, and they are political, not just scientific or economic. The same Republicans who lambaste government for being too conventionally minded and slow-moving weaponize failed grants and odd gambles as wastes of taxpayer money, creating the incentives for the precise bureaucratic caution they then condemn.

But the pandemic should leave no one convinced of the infallibility of our health agencies. The N.I.H. proved unable to shift focus quickly when the pandemic hit — only 2 percent of its 2020 budget went to Covid research, one study found. The F.D.A. was excruciatingly slow to approve the same rapid tests that Europe was using long before us. The C.D.C. was, flatly, a mess. Yet none of the failures we witnessed in real time led to major reforms of these agencies. That can’t be right.



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