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An Economist Who Gets It

Alex Tabarrok has finished up his short series on me-too drugs, and he’s done a fine job of hitting the nail on the head. It’s gratifying to see people from outside the field who really know what they’re talking about:
“(Marcia) Angell is also skeptical that me-too drugs can have different effects in different people.  Frankly, I was shocked at this argument. Every clinical trial that has ever been run demonstrates that the same drugs have different effects in different people – it’s hardly a surprise that different drugs have different effects.  And me-toos are different – different enough not to violate the patent on the innovator drug almost certainly means different enough to have different effects in some people.  My local supermarket carries at least a dozen different styles of peanut butter, a fact of which I approve, but Angell thinks two angiotensin-converting-enzyme (ACE) inhibitors may be one too many (p.90).  Give me a break. 
Finally, it’s important to recognize that small changes can actually make for important improvements.  What could be more me-too than a once-a-day pill replacing a twice-a-day pill?  Yet, to dismiss this change is to overlook the people factor.  A once-a-day regime that people stick to is much better than a twice-a-day regime that people fail to follow.  Forget the chemical structure the economics says a drug that people actually take is a better drug.”

5 comments on “An Economist Who Gets It”

  1. Joe Decker says:

    The criticisms of so-called “me too” drugs drives me nuts as well, I’m signficantly nauseated to one of the PPIs, but not Nexium, if my memory that they’re fairly chemically related is correct (and my memory may very well be faulty here, I am not a chemist), I’m deeply grateful for the extra option.

  2. Scott S. says:

    Nice to see someone to whom people pay attention is writing on this subject. When I try to talk to people about drug companies and issues such as ‘me-too’ drugs, it is difficult to break through. However, there are many persuasive arguments one can make to expand people’s attitudes.
    Really, though, it is up to the drug companies to improve their image. In my experience, a lot of people seem extremely angry at pharma for some reason, thinking they are taking advantage of people.
    Once they understand that it takes many years and over 800 million dollars to get a drug through clinical trials, and there is no guarantee that the drug will pass muster, they may change their minds.

  3. zp2k says:

    The analysis here neglects a key issue that underlies the outrage, though, which is one of opportunity cost. It’s easy enough to dismiss the idea that no benefit accrues to society from the development of each additional ACE inhibitor. It’s a slightly more difficult question whether there are other, more neglected, conditions that would be getting more attention if the balance of expected profits were different. It’s also hard to argue that the margins associated with different classes of drugs accurately reflect society’s long-term interests.

    Are there really so few targets out there that it makes sense to chase the returns (non-zero, sure, but diminishing) from the umpteenth statin? Will the US really benefit more from another therapy for erectile disfunction than from, say, better antimalarial drugs? I think these sorts of questions underlie many of the more heated criticisms…

  4. The Novice Chemist says:

    Not to pick nits, but the United States will almost certainly not benefit directly from a better anti-malarial drug, seeing as how we have no malaria in the United States.
    I’m guessing that those areas that are neglected are neglected for a reason, profit or science, probably both.

  5. zp2k says:

    Sorry – I guess I was trying to bring two thoughts into the discussion simultaneously. For the more immediate of the two, replace malaria with the orphan indication of your choice.

    The other is the question of whether long-term US interests wouldn’t be better served by an incentive system more tilted toward global health issues, but that’s probably a discussion for another day.

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