An article in the Wall Street Jounal this past week, as cited by the ACC News Digest, reports that Pfizer will be cutting R&D spending by as much as $3 billion by 2012. The Journal added that the move suggests the company’s executives think its research has not been worth the high levels of investment. 

Now, I’ve anxiously awaited the “genericalization” of the important medications I prescribe every day, and as the years pass, more and more of the expensive brand names have given way to cheap generics. Less often do I hear complaints from patients of inability to afford their drugs, or do I have to say, “Sorry, there is no generic alternative.” 

At the same time, I’ve worried that, as each blockbuster drug falls to the scythe of the patent Grim Reaper, where will the funding come for the R&D necessary to bring new, innovative drugs to market? This issue probably flies under the radar for most of the public that sees the pharmaceutical industry only as greedy entrepreneurs. And while I’m not naïve enough to think the drug companies are inherently more moral in their business practices than any other publicly held company that is beholden to profit-seeking shareholders, at least they provide an essential, and laudable service (unlike the tobacco industry). 

In cardiovascular medicine I think the problem is especially acute. Disease is widespread, so the impetus for developing new therapies is strong, and remarkable strides in drug treatment (and other areas) have been made in the last couple of decades. In a sense, the drug companies are victims of their own success. It now takes expensive clinical studies involving thousands of patients to demonstrate small, statistically significant improvements in hard endpoints, such as heart attack rates and death. Then we have to ask, is it worth the three or four dollars a pill to reduce your risk, even with an admittedly serious endpoint, from say, 2.5 to 1.8 percent? I suppose no one objects when someone else is paying, but the system is going broke and besides, people are increasingly unwilling to shell out the higher co-pay for non-generics when they can get almost the same protection from the cheaper drug. 

So here we are: barring a drug that provides a cure for a chronic ailment, which I don’t see on the near horizon, the pharmaceutical industry is in for some hard times, and this could slow the march toward new, innovative treatments. Of course, breakthroughs in genetic research and highly targeted therapies could suddenly change the landscape, but this area of study, while progressing rapidly, is still in its infancy and may not be viable commercially for five to ten years, or longer. And it takes a long time and a lot of money to bring a drug to market, especially when we are subsidizing a good portion of the rest of the world. 

I don’t have the answers here, only a prayer that the economy recovers as fast as possible, because, as the saying goes, “a rising tide lifts all boats.”


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