Publicy Funded Research and Clinical Relevance
Thinking about today’s tweets-the overlap between 2 concepts I tweeted about became apparent.
There is precious little evidence to support much of what we do clinically. The NIH funds few studies that directly inform clinical practice.
They do invest heavily in basic science. I do not know the number, but I suspect 100’s of millions of dollars was spent on GLP-1 research. Yet, when the results of that work were translated into a useful drug such as the GLP-1 agonist tirezapide, it is sold by private industry at a huge cost such that most patients – ie, those who paid for the research via their taxes – cannot afford the medication.
How is this fair?
Furthermore, all the excitement about the most recent tirzepatide article in NEJM results from a drug company pouring large amounts of money into a clinical trial. Despite the hype in the press, the trial’s results were not that impressive-the observation that the development of diabetes in obese patients can be prevented by weight loss is not new. Any, even small amount of diet-induced weight loss, will have the same effect. This has been known for decades.
There are many treatments that would have the same effect on diabetes that do not have the same level of evidence to support their use because the NIH puts very little money into clinical trials that would show this sort of thing.
So—There is precious little public funding interventions that will not yield private sector profit – Public funding mostly does into basic research that eventually hugely benefits private industry.
The loser in all this is tax-paying patients. They invest in medical research through their taxes but to yield the benefits of that investment they have to pay a second time via the exorbitant prices for the new drugs developed from the knowledge gained from publicly funded basic medical research.
Solutions to this mess are
1) The NIH should fund research that will have direct clinical relevance for the medical care of patients in the US. Any funded project should have a rationale justifying how the research’s findings will directly (and not indirectly) affect clinical practice.
2) Drugs developed based on publicly funded research should be affordably priced, recognizing the public’s investment in the research that led to the development of the drugs. This is aligned with drug company’s arguments that they need to charge high prices for new drugs to recoup the costs of bringing the drugs to market. Tax paying consumers who paid for the research underlying the drug’s development deserve the same return on investment.