Drug development getting left behind

I constantly marvel at technological development and the free market capitalism that makes such progress possible. In a recent excellent podcast, Perry de Havilland at Samizdata mentions the cheap availability of 80GB hard drives as a symbol of such development. It got me thinking back to the first PC I built, a 386SX with a 170MB hard drive and a 256Kb (Yes I do mean Kb for any geeks out there) graphics card.

These days, my current PC has maybe 500 times the performance of my first, the progress in about 12 years in this area has been utterly phenomenal. I started to wonder, if only pharmaceuticals had progressed quite as quickly, we would all be reaping the benefits. Now many will say they are vastly different technologies and can't be compared, I'm actually not so sure, I can't help thinking of another reason for the difference. Markets. There is simply no absolutely free market in pharmaceuticals anywhere in the world, you pretty much get what your doctor chooses and your government or health insurer thinks is best value, indeed in the UK prescription drugs can't even be advertised to the general public.

So what effect does this have? Well, back to computers. Every year or so I upgrade my PC, partly because I like the latest games, partly because of bragging rights, never because I actually have to, it is a luxury. But because millions of others around the world think like me, small incremental increases in product performance give computer companies a substantial competetive edge, there is a massive incentive to do just a little bit better. Which over 10 or 15 years adds up to a huge amount better, including the cheapest, most basic PCs.

For pharmaceuticals, it is precisely this incentive I feel is lacking. As an example, a while back on a medical blog (I can't remember the link I'm afraid), NHS doctors were falling over themselves to state how they would never prescribe a new skin patch (for incontinence I think) at £1500 a year as opposed to the same drug in a pill for about £200, think of the budgets!

Now drugs, when taken orally, go from the intestines straight to the liver, which is actually pretty good at destroying foreign chemicals, then to the bloodstream. Patches avoid this process. As such, you have to take more of the drug orally than with the patch, exposing your intestines and your liver to a higher dose, with potentially more side effects. The NHS would probably say a few less side effects is really not worth the money, so the patches are out. Most people given the choice with their own cash would probably agree, take the cheaper pill and make do. A few however would pay extra for the patch in the same way a few geeks like me pay extra for the latest computer technology. Those few would drive the market forward, reward innovation, and soon enough as with computers, everyone would be getting those patches for £200.

Competition and the rewards of a marginal increase in product performance are great mechanisms, but they can't work when individuals neither control their choice of medication or the money which pays for it. Like in many areas, we all suffer when markets are constrained and choice is restricted.