NCPA - National Center for Policy Analysis

Therapeutic Success Stifles Medical Progress

June 3, 2011

A surprising economic analysis suggests that each new medical innovation may make the next more difficult to achieve, because patients prefer to stick with proven -- though potentially inferior -- treatments rather than trying something new.  Good effectively becomes the enemy of great.  The finding confirms the experience of many medical researchers struggling to recruit patients for their next clinical trial, says Nature.

The analysis, published this month by the National Bureau of Economic Research (NBER), shows that the percentage of HIV-infected men who enrolled in clinical trials plummeted immediately after a regimen of antiretroviral drugs known as HAART hit the market in 1996. 

  • The precipitous decline occurred even as federal funding for HIV research nearly doubled.
  • HAART simply worked so well, says Anup Malani, a law professor at the University of Chicago, Illinois, and an author of the new study, that patients were no longer motivated to sign up for clinical trials as a way to gain access to better treatments.
  • Malani and his co-author Tomas Philipson, also of the University of Chicago, believe similar problems arise whenever a new drug significantly improves the treatment of a particular disease, leading to a decline in pharmaceutical productivity.
  • "Innovations of today increase the cost of innovations tomorrow," Malani says. "And that means the cost of the next-generation drug is going to rise."

HAART represented a therapeutic revolution for a group of patients with few options, but Malani's economic models predict that incremental therapeutic advances would also affect clinical-trial enrollment for other diseases, although the size of the effect may not be as large, says Nature.

Source: Heidi Ledford, "Therapeutic success stifles medical progress," Nature, May 24, 2011.


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