A recent survey of 225 leading general internists ranked the top ten medical innovations of the past twenty-five years, and four out of the top eight innovations were medications used to treat chronic and life-threatening diseases (per Fuchs in Health Affairs, Sept./Oct. 2001). While much of the current health care dialogue revolves around the high cost of prescription drugs, this report underscores the benefits of an innovative, research-oriented pharmaceutical industry and how their products have improved the lives of all Americans.
The American Heart Association estimates that 140 million Americans have either borderline or high cholesterol and over 500,000 die of coronary artery disease each year. It comes as no surprise that ACE inhibitors and statins were highly ranked by medical professionals as important innovations (ACE inhibitors were #2 on the chart, coming in right after MRI/Catscans, while statins were #4, just below balloon angioplasty). Heart disease is the number one killer in America, and these preventive measures have greatly improved the public's health. Also listed among the top innovations were proton pump inhibitors and H2 blockers, which are used to reduce acid reflux and flaring peptic ulcers (they ranked #7, just below mammography and coronary bypass artery grafts). Today, those suffering from digestive upsets can find comfort in a simple prescription. And, finally for the nearly 20 million Americans with depressive disorders, SSRI and non-SSRI antidepressants give hope for happier times (and come in at #8, above cataract/lens surgery and hip/knee replacement). We may complain about the price of these and other commonly prescribed drugs, but as we run through the long list of benefits, can we afford to live without them?
Americans spent nearly $150 billion dollars last year on prescriptions, but this still accounts for only ten percent of health care costs in the United States and helps reduce other health care costs. These drugs help to reduce or eliminate hospital stays and surgical procedures, making health care cheaper than it would be if patients were confined to sick beds.
Canada and France are sometimes held up as models for the U.S. because of their socialized medical systems and drug price controls, but there are costs to their policies. Price negotiations between these governments and drug companies take years. For example, during the four years of negotiations in France for ACE inhibitors, 16,000 lives and $528 million were lost. The U.S., for all its flaws, largely avoids such delays.
Drug price controls reduce the profits which drug makers would subsequently invest partly in research and development. Price controls leave consumers worse off because there are fewer breakthroughs, fewer options, and fewer improvements. Countries with price controls often ride the coattails of the U.S.'s innovations. The lack of price controls in the United States helped make it a leader in pharmaceutical innovation, developing 45% of the top 152 leading global drugs, while France, for example, contributes a mere 3%. Though these are impressive statistics, it would be better if the U.S. did not have to fund the majority of pharmaceutical research in the world. Instead of talking about imposing price controls of our own on prescription drugs, the United States might do more good by encouraging other countries to forego their price-control policies for a more free-market system.
We are an obese country with an aging population, and the longer we live, the more we will need a wide array of drugs to counter the effects of old age and unhealthy living. Drug companies will only invest in us if we invest in them. Without a profit incentive, there will be no drive to develop the newest, most innovative drugs items for the Top Ten Medical Innovations list of the next quarter century.
Karen Strazik is a Research Intern at the American Council on Science and Health.