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I've heard many times the claim that drug companies purposely make treatments and avoid selling/researching cures instead. Are there any documented cases of this behavior happening or any concrete reason to believe this is the case?

GBa
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  • The running joke I hear from the doctors I work with is that the best customer for a drug company is one that spends a lot of money maintaining the conditions that they have. Statins have been a huge profit center for drug companies because the customer must be on statins for the rest of their lives, and many people have high enough cholesterol to warrant their use. But is that 'avoiding a cure' or 'striking gold because everyone has to buy your product forever and ever'? – mmr May 13 '11 at 22:27
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    Excellent question. Very keen to see how this one plays out. I have my suspicions. [Healthy Skepticism](http://www.healthyskepticism.org/global) is an Australian group that do great work in this area and their site my be useful for those answering this question. The 'Adwatch' section of the site is particularly good. Esomeprazole vs Omeprazole is a great example of the a drug company maintaining patent control, by essentially, doing nothing. –  May 14 '11 at 02:24
  • *sigh* yet another case where even basic understanding of economics would help (obviously beyond the abilities of Big Pharma haters). If someone has an idea of how to cure disease X, that knowledge is worth a lot of money. If their company is currently invested in treating symptoms of that same disease and this thus not interested in funding the cure itself, you (the guy with the knowledge) can always go work for another company that doesn't have such considerations (doesn't have conflicting drug), or government research where you still get paid $$$ from the patent. – user5341 May 16 '11 at 14:12
  • @DVK-- what about a patent thicket, where the first drug company invests in patents to block other companies or individuals from doing exactly what you're describing? What this question needs is at least one empirical example of a drug company releasing a product that's against their 'best interests' (ie, the profit motive), or a company blocking a drug because it would interfere with one of their existing products. Of course, different companies are different, but these examples would help explain a complex situation. Everything else is just speculation. – mmr May 16 '11 at 15:03

1 Answers1

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I apologize if this sounds a little rude, but the question does not really make much sense.

There is no possibility to "avoid cures", for many reasons. One being that the drug development pipeline takes too long and is too inefficient to let it go when finally a good product is obtained (see graph).

Most of the research funding comes from Government agencies, not pharmaceutical companies. The basic research to find the mechanisms of disease and thus allowing the developing of new drugs are done in Universities/Research Institutes. Big pharma companies may run (usually in cooperation with universities) large-scale chemical compounds testing and fund some pre-clinical studies and the clinical trials (again, usually in collaboration with universities/hospitals).

It is plausible that a company may delay the release of a new drug to maximize the revenue of an older generation drug, but it is impossible for them to block the research in other places. So, if they have a magic cure, they will try to sell it as fast as they can. If not, the drug may be found by some other company or even may be published by an academic institution, preventing the use of any patent.

Budget data:

US Pharma Industry R&D spending anual budget:

  • Estimated by the companies: ~38 B
  • Estimated by the NSF (National Science Foundation): ~15 B.

The difference stems mostly on research performed outside the US and post-market follow up of drugs. Source: Congressional Budget Office 2006.

Of this budget, Canadian data suggest that approximately 15-20% is spent on basic research (i.e., drug discovery), 50-60% in preclinical and clinical trials and 20% in bioavailability and post-market (phase IV) studies. Source: Canadian Patented Medicine Prices Review Board Annual Report 2009. US-based pharma companies may spend close to 80% in clinical research. Source: Applied Clinical Trials.

Most importantly, many of the drugs that have appeared in the market derive from Government-funded research. In the last two decades, universities and research institutes have been patenting its own research and have reached licensig agreements with the pharma industry. There is a very good article about this issue: Stevens et al, N Engl J Med 2011; 364:535-541

US Government annual budget:*

.* It does not include State budgets, Senator's discretional budgets or smaller program budgets scattered in diverse departments.
.** Only a portion is dedicated to research.
.* From that, a portion is dedicated to bionanotechnology. The rest may not be relevant.

Aleadam
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  • @Monkey I am answering the last part of the question: "or any concrete reason to believe this is the case?", and my answer is clearly NO. – Aleadam May 13 '11 at 21:58
  • That claim in bold needs a citation. For instance, here is the dollar amount that big pharma spends on R&D: http://blogs.wsj.com/health/2009/12/22/rd-spending-numbers-for-pfizer-jj-merck-lilly-and-bristol/ Where are the comparable numbers for government expenditures? Do they crest $17 billion in drug R&D alone? Some of the NIH and NCI budgets go to drugs research, but they also go to education (grad students and post docs, etc). – mmr May 13 '11 at 22:25
  • @mmr 30.7 billion is the 2011 budget for NIH alone. That's only **one** of the many US agencies: http://news.sciencemag.org/scienceinsider/2011/04/2011-spending-deal-spares-nih.html . On top of that, you need to include the DOH, DOD, State agencies, and even some NASA projects, to name a few. And that's just the US. Europe and Japan have big investments also. – Aleadam May 13 '11 at 22:49
  • @Aleadam-- but as I said, what percentage of that is dedicated to drug research alone? Not basic science or the like? Are you going to claim that the DOD pays for drug research for curing, as opposed to buying guns and training soldiers? – mmr May 13 '11 at 22:51
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    @mmr That's pharma industries *spending*. It does not only includes the actual reagents for research. Furthermore, much of that money is invested, as I said above, in the clinical trials. For example, plese refer to the Canadian Patented Medicine Prices Review Board Annual Report 2009: http://www.pmprb-cepmb.gc.ca/english/view.asp?x=1340&mid=1196 – Aleadam May 13 '11 at 22:55
  • @mmr I do not believe there is such thing as "drug research alone". How do you "research cures"? – Aleadam May 13 '11 at 22:57
  • Yes, DOD funds both research to kill and to avoid being killed. That includes counter-bio terrorism research, which can be used also to treat common infections. – Aleadam May 13 '11 at 22:59
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    DOD even has a breast cancer research program: http://cdmrp.army.mil/bcrp/default.shtml – Aleadam May 13 '11 at 22:59
  • @Aleadam-- so now we switch to include the Canadian markets as well? All I'm asking for is a validation of the claim you have in bold. There is a difference between 'drug research alone' and basic science research. Basic science attempts to uncover the mechanisms of action (cellular, organ level, etc), while drug research attempts to uncover compounds that can remove or ameliorate the condition. Knowing about the fifteen families of myosin does not necessarily lead to a cure for MS. – mmr May 13 '11 at 23:10
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    @mmr I gave you the Canadian link because it is what I found right now. Please, take it as an **example** of pharma spending. I do not think there is *any* number to show how much is spent in drug development, just because the grants may include different aims and it will be impossible to sum partial uses. Besides that, target validation is also part of drug R&D – Aleadam May 13 '11 at 23:17
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    We [expect answers to provide references for all significant claims they make](http://meta.skeptics.stackexchange.com/questions/5/must-answers-be-referenced). Please add appropriate references to your answer. – Mad Scientist May 14 '11 at 00:33
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    @Fabian I am learning the methodology as I go. I'm new here and I'm mostly used to stackoverflow, where you're answer is right or wrong depending if your code works or not. No need for citations there. Most of what I know is from talking to higher NIH officials and pharma executives in different meetings. Thus, I do not have all the sources at hand (is mostly "personal communication"). I understand the need for the sources here, so I tried to gather some information together to substantiate my answer. I hope this is now up to skeptics.SE standards. – Aleadam May 14 '11 at 03:46
  • @Aleadam: Some great info here. Cheers. –  May 14 '11 at 04:06
  • I have heard some people claim, let's say Big Drug Company sells a treatment for A Really Bad Disease (ARBD) which requires twice daily dosages. Now if the company were to discover a cure or hear about an emerging patent to permanently cure ARBD they would bury it to continue lifetime profits due to their own ongoing treatment's profitability. Are there any known examples of this? – GBa May 14 '11 at 04:28
  • @Greg: I suppose an *inverse* to this is the invention of disease. Just keep inventing more diseases. It's like creating a solution to find a problem. Some of the proposed DSM-5 'diseases' are quite laughable and would only get some play in Western cultures. Even commonly accepted diseases like hypertension are human constructs. –  May 14 '11 at 04:33
  • @Aleadam-- thanks for the updates there. My point was not to attack you or suggest that you were wrong, but that you had made a pretty bold claim and didn't substantiate it. What you have just pointed out as that government expenditures does not vastly outpace spending of pharma companies in bringing a drug to market. It's like Brooks said in The Mythical Man Month, and I paraphrase: the easy part about writing code is the algorithm, 9/10 of the work is debugging it and getting it ready for customers. It looks like government funding does that first 1/10 of the work, from your description. – mmr May 14 '11 at 04:43
  • @mmr I never considered this an attack. I do enjoy a good discussion. I really do not see where do you get the 1/10 of the work. The fact that the clinical trials take so long does not mean that is it so labour intensive. Basic research is. An my point was not comparing the costs to **bring a drug to the market**. It was about the cost of **finding new drugs**. There is a huge difference in that. It is irrelevant how much is spent in phase III trials for this question. (contd) – Aleadam May 14 '11 at 05:27
  • All clinical trials are public and usually multicentric, so there is little to no chance to hide anything. In fact, hiding data from a trial may be considered a criminal act in most countries. The only moment in which a pharma company may hide a development is in its very early phases, previously to filing any use patent (patents are also public domain). And there is no doubt from the data posted that most of the pre-patenting spending is done through Gvt-sponsored research. Basic and preclinical research is long, tedious, and definitely not easy. – Aleadam May 14 '11 at 05:33
  • @Greg as I said in the answer and the comments, pharma companies are not alone in the discovery process. In fact, public domain research is much more important in that instance. In addition, the discovery process is usually the sum of effort of several groups in different locations. I do not know any example of a discovery solely attributable to one single group. That will increase the chance for any other pharma company to develop a similar strategy, patent it, and profit from it. To finish up, I can't say it never happened. But I do not know of any example and I find it quite improbable. – Aleadam May 14 '11 at 05:43
  • @Aleadam-- good, I'm not trying to be aggressive. The 1/10th thing was a rule of thumb from Brooks' Mythical Man-Month, a programming text that says that most programmers think that just writing the program is the hard part, when really it's the debugging and sanitizing for the customer is the hard part. I don't know what the relevant proportions would be here. As for the clinical trial thing, some big pharma companies have been accused of hiding data: http://www.vanityfair.com/politics/features/2011/01/deadly-medicine-201101 – mmr May 14 '11 at 05:59
  • (cont'd) But in the end, does having public funding disprove the original question of Big Pharma dragging their feet to prevent a cure for a condition being released, especially if they're making money on that condition? Taking a drug from the public research phase through the clinical trial phase takes a long time and has a large failure rate (http://seekingalpha.com/article/256697-why-phase-3-trials-fail-what-investors-need-to-know), so is it inconceivable that a company would sit on a cure for a condition if they already have a successful drug for that condition? – mmr May 14 '11 at 06:04
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    @Aleadam: [LSD](http://en.wikipedia.org/wiki/History_of_LSD) was a notable sole group thing. Actually it was a single individual. It's the exception, not the rule though. –  May 14 '11 at 07:52
  • @boehj nice one! although I would not consider it a cure really... – Aleadam May 16 '11 at 02:46
  • @mmr from the beginning (see the second paragraph of my answer) I said that it is plausible that companies may **delay the release of a product**, which is not the same as **avoiding the research**. I'm not trying to make a phd thesis on pharma companies behaviour, just refute the notion that companies hide cures because they want to sell aspirin. What maybe I failed to emphasise before is the fact that public research is, well, *public*, so researchers in any field have a notion of the new alternative treatments for the conditions in their fields (contd) – Aleadam May 16 '11 at 02:51
  • @Aleadam - That's somewhat debatable. Bill W (founder of AA) was a bit of an [acid aficionado](http://en.wikipedia.org/wiki/Bill_W.#Alternative_cures_and_spiritualism). Terence McKenna noted in at least one of his lectures that Bill W simply replaced alcohol with LSD. But I think I can agree with you here nonetheless. –  May 16 '11 at 02:55
  • and if any company started a phase I trial with good results, sitting on it would make researchers and physicians voice against the delay, and the public opinion of the company would sink. That, of course, assuming that the research was conducted at least in part in a regulated country. Lastly, being the previous research public domain, a lack of a patent for a treatment is an invitation to the competing companies to develop such treatment. And that's too high a risk. – Aleadam May 16 '11 at 02:55
  • @boehj see also http://en.wikipedia.org/wiki/Kary_Mullis :) – Aleadam May 16 '11 at 02:57
  • @Aleadam - Yeh I know. Very strange chap and I can't agree with most of what he says. But he does make it pretty clear that LSD was the key to him inventing PCR. And we all know how important PCR is. I think the big winner here is LSD. :) –  May 16 '11 at 03:02
  • @Aleadam-- I think where we differ is just how ruthless we think these drug companies are. Just because there's the potential for pressure from doctors to go to phase II, III, or beyond does not mean that a drug company is under any compulsion to continue. These companies get rewarded for having long-term customers whose conditions don't get fixed, just get temporarily alleviated. The question is whether the pressure from doctors to go the next step with a drug would override the profit motive, and I'm too cynical to think that it would. I'd love for an empirical example to prove me wrong. – mmr May 16 '11 at 14:01