Among the many redeeming features of market capitalism is a certain kind of predictability. Not a predictability of details and individual transactions, of course, otherwise stock picking would always be as easy as NASDAQ in the late 1990√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs. No, the predictability of markets lies in the big picture and the general direction. One can be pretty certain that markets will follow the money. Profitable enterprises and industries attract effort and investment, while unprofitable ones are shunned and left to wither.
With such a simple rubric as our guide then, let√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs examine where the market is directing pharmaceutical research for the future. Where is the money going to go, and therefore, where will the (surviving) industry follow? Some people, of course, like to think of the health care industry, including drug discovery efforts, as a sort of public trust. But it√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs not. It√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs a business, and it will stand or fall as a business. Good intentions cannot be distributed to shareholders.
Two things that drug companies must therefore avoid in the future are children and sick people. Although these two groups may seem like great markets for drugs, they are increasingly undependable as potential sources of revenue. Children make great plaintiffs. When a trial lawyer wheels a crippled child into a courtroom, people gasp — then they start adding zeroes to a random number in their head. It does not matter if the drug or vaccine that harmed that child saved the lives of 10,000 others. There is no moral calculus of net good that can be made to apply in such situations, which are inherently personal and emotional. It does not even matter if the child was, in fact, harmed at all by the product in question. All that matters is that a child is suffering and that the deep pockets of a corporation can be opened in an attempt to alleviate that suffering.
The fact that corporations are considered evil in the popular mythology of David, Goliath, and Erin Brokovitch doesn√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęt help too much either. √?¬Ę√Ę‚??¬¨√?‚??Make √?¬Ę√Ę‚??¬¨√?Ň?em pay!√?¬Ę√Ę‚??¬¨ ¬Ě seems to be a legal philosophy at least as coherent as, and considerably more popular than, anything that has come out of the Supreme Court lately. Make √?¬Ę√Ę‚??¬¨√?Ň?em pay for what they did wrong, or didn√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęt do right, or didn√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęt do at all. Make √?¬Ę√Ę‚??¬¨√?Ň?em pay for the weather or missed lottery numbers as well, they have money — and they gave Meryl Streep cancer in that movie, remember. Get a pitiful child before a jury, point at a plausible villain and Presto! You√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęre rich enough to buy a Senate seat and run for Vice President. Facts may change later, but the money is yours forever.
The solution to such a trap, of course, is caution, then extreme caution, then pathological caution regarding any health care endeavor affecting children. In the end, it√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs just best to wish them well and avoid them altogether. No one can sue √?¬Ę√Ę‚??¬¨√?‚??Natural Causes√?¬Ę√Ę‚??¬¨ ¬Ě when he comes for the uncured; he may cause a lot of harm, but he has no money.
Sick people are also pitiful and, worse yet, they vote. They are, therefore, dual threats, and to be avoided in the future. These folks sue your pants off for the totally unforeseeable (after all, if a side effect is so rare or subtle that it was not caught by the Food and Drug Administration review process during $100,000,000 worth of clinical trials under the most intense expert monitoring imaginable, then how can the manufacturer be held liable afterwards under a standard for negligence that is supposed to be absence √?¬Ę√Ę‚??¬¨√?‚??reasonable√?¬Ę√Ę‚??¬¨ ¬Ě care?). Worse yet, they will attempt to simply vote themselves drugs at reduced prices every chance they get. Society may not want to spare any expense for a sick child, but a sick voter is something else altogether. Sick people also tend to organize themselves into groups, first to demand to know why drug companies aren√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęt investing more money in research for their disease, then to demand to know why the drug companies that did invest money in their disease aren√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęt giving away drugs for free. Who needs bad press and price-controls? It√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs time to admit that sick people cannot be treated profitably any longer.
So what does this leave? Succinctly put, the answer is people afflicted with embarrassing personal annoyances. This is the ideal market and is clearly being exploited even as we speak. Impotent men are never going to publicly organize themselves to demand lower cost Viagra, Cialis, or Levitra. It√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs just too embarrassing. Likewise they are not as sue-happy as other patients, since even if they do have a heart attack while using the product, they are generally happy at the time. And best of all, they are never going to convince the taxpayers that the price of their drug is a severe national crisis. It√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs pretty much something you don√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęt expect your neighbors to have to help pay for. Ergo, no price controls!
Erectile dysfunction is not the only √?¬Ę√Ę‚??¬¨√?‚??Baby Bear√?¬Ę√Ę‚??¬¨ ¬Ě disease either — perfectly balanced between being severe enough to motivate the afflicted to seek treatment, but not so severe that treatment seems an entitlement. Consider the horror of discolored and thickened toenails. You√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęve seen the commercials. You need to get to the source of the infection, which is a cartoon character that gleefully scratches raw the defenseless flesh underlying your perfectly annoying, yet un-pitiable, discolored and thickened toenails.
Still don√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęt see a trend? Perhaps it√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs because you were distracted by acid reflux. Once dismissed as √?¬Ę√Ę‚??¬¨√?‚??heartburn,√?¬Ę√Ę‚??¬¨ ¬Ě acid reflux is a huge problem, a multibillion dollar problem, and one I myself suffer from on a daily basis (control your emotion, dear reader; I bravely struggle on). However, it is hard to imagine a group of gastroesophageal reflux disease (GERD) victims testifying before Congress on the human cost and emotional toll of heartburn. Acid reflux is thus a great disease, the only caveat is that it is associated with an increased risk of esophageal cancer and could therefore morph into a serious disease √?¬Ę√Ę‚??¬¨√?‚??cause√?¬Ę√Ę‚??¬¨ ¬Ě at any moment. Should this happen, research efforts will need to be halted immediately.
The research efforts formerly aimed at GERD can then be directed against Rosacea, an annoying — yet not disfiguring — reddening of the skin of the face. Again, you√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęve probably seen the commercials informing the victims of their victimization — √?¬Ę√Ę‚??¬¨√?‚??that annoying reddening of the face could actually be Rosacea!√?¬Ę√Ę‚??¬¨ ¬Ě √?¬Ę√Ę‚??¬¨√?‚??Fourteen million Americans have Rosacea and most of them don√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęt even know it!√?¬Ę√Ę‚??¬¨ ¬Ě That√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs a disease you can treat without interference.
Baldness? Don√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęt even get me started! Curing impotence and leaving baldness untouched is just cruel, yet not so cruel as to warrant a lawsuit or a lobbying group. Baldness is a potential profit center for all the companies that have been driven away from vaccine manufacture by litigation and price controls. No lawyer is going to be able to look a jury in the eyes and say √?¬Ę√Ę‚??¬¨√?‚??LOOK! Just look at my client√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs bald, shiny head! CORPORATE MONSTERS!√?¬Ę√Ę‚??¬¨ ¬Ě And if the anti-baldness drug causes adult acne, well, that√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs a great market too. It√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs a win-win, really.
Being mildly overweight seemed to be the ultimate Baby Bear condition at one point, but weight-loss drugs appeal disproportionately to women, who make great plaintiffs (though not as good as children, mind you). So in the future, perhaps obesity research should be aimed at sour middle-aged white guys only. Bad plaintiffs. Good insurance.
The road to Hell is actually paved with unintended consequences. When people squeeze the profit out of an enterprise, it ends. It doesn√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęt matter if the profit was squeezed out in the name of humanity, economy, or just plain greed. People seek profitable futures. Due to a self-righteous and cost-motivated war on medical innovation, the profitable future for medical research will be, more and more, in what might be called √?¬Ę√Ę‚??¬¨√?‚??Luxury Drugs.√?¬Ę√Ę‚??¬¨ ¬Ě This will occur not because drug companies are evil, or because price controllers weren√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęt very well intentioned. It will occur because capital markets are somewhat predictable. They follow the money.
The trend toward Luxury Drugs is still young, and most drug research still focuses on Cancer, Arthritis, Schizophrenia, Alzheimer√?¬Ę√Ę‚??¬¨√Ę‚??¬Ęs Disease and other debilitating or lethal illnesses, but that could change. We have to consider what the long-term effects of our short-term cost saving measures will actually be.
We can reward work on life-saving cures, or we can reward work on adult-diaper rash. Demographically alone, the latter is getting pretty appealing.
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