The medical-industrial-governmental complex spends more and more but has less and less to show for it.
Over the last 30 years, spending on medical research and development soared more than five fold, but it didn’t produce five times as many research geniuses whose insights brought us five times the life-saving discoveries, not by a long shot. Instead of the extra billions finding their way to a new generation of ever better funded, ever more empowered intellects, the money went mostly to medical mediocrities spawned by the expanding government bureaucracies that sucked up the monies, and that, too often, helped squelch rather than advance knowledge.
Before the rise of major health bureaucracies such as the Centres for Disease Control and the National Institutes of Health, science gave us the breathtaking breakthroughs that medicine still relies on today — penicillin and antibiotics, vitamins and insulin, vaccines for typhus and polio, devices like x-rays, electrocardiographs, contact lenses, kidney dialysis machines, CT scanners, MRIs and pacemakers and procedures like blood transfusions, laser treatments, open-heart surgery and organ transplants.
Medical breakthroughs haven’t stopped under the bureaucratic weight but they’ve slowed to a crawl. CNN’s “10 medical advances of the last 10 years,” published last year, mostly listed improvements on earlier discoveries such as refinements for laparoscopic surgery, invented a century ago. CNN’s list includes items to make bureaucrats proud, such as expansions in smoke free laws.
Before the rise of major health bureaucracies such as the Centres for Disease Control, science gave us the breathtaking breakthroughs.
While the amount spent developing new drugs has soared — U.S. companies spent $49-billion in 2010 compared to $15-billion in 1995 — the number of new drugs entering the market has plunged. Worse, most of them are deemed “me-too” drugs because they aren’t much different from existing drugs. According to the World Health Organization, a dollar invested in R&D between 2005 and 2010 was 70% less productive in terms of producing a profitable drug than a dollar spent in the previous decade.
What hasn’t declined in the medical field is dogma, as best illustrated by the 2005 Nobel Prize for Medicine, awarded to Barry Marshall for an outside-the-box discovery more than two decades earlier. Marshall, a trainee in internal medicine in Australia, realized that ulcers — then a very serious ailment — were caused by an easily treated bacterial infection rather than by stress, as commonly believed. Marshall was ridiculed, called a quack, dismissed when he presented his findings to an annual meeting of the Royal Australasian College of Physicians, dismissed by the pharmaceutical companies, dismissed by funding bodies that held the purse strings to research grants, dismissed by important medical journals. Although he soon successfully cured his own patients without subjecting them to conventional treatments — like antidepressants to allay the patients’ presumed stress-induced gastric acids or surgical removal of their ulcerated stomachs — the medical world treated him as a fraud, asserting his results couldn’t be replicated and in any case couldn’t be true. Even after Marshall, in desperation, decided to prove that infections caused ulcers by infecting himself, and then curing the resulting ulcer with an antibiotic, he remained a charlatan to most for another decade.
A breakthrough came when Marshall’s story was published — not in an august scientific journal but in Star, a supermarket tabloid that ran stories about Nancy Reagan adopting alien babies, and then in Reader’s Digest and National Enquirer. To the establishment’s chagrin, these periodicals’ readers increasingly demanded his cure for their ulcers, and physicians, after seeing the results, slowly were won over. Eventually, the scientific research establishment was forced by popular opinion to investigate the science and Marshall’s nightmare — and that of millions of needless sufferers — was over.
Today, not only have ulcers disappeared as a major debilitating disease, stomach cancers have too — the same bacterium had been responsible for them both. Why the dogma and the personal attacks on Marshall? How could so many for so long ignore the evidence that was so obvious and so easy to verify? An answer lies in the willful blindness of the vested interests that dominate the medical field.
Money provides one vested interest. Anti-ulcer medicines represented the largest therapeutic drug market worldwide, with sales in the 1990s growing to almost $20-billion. Big pharma had no interest in gutting this moneymaker and neither did individual practitioners. “Every gastroenterologist was doing 20 or 30 patients a week who might have ulcers, and 25% of them would,” Marshall later explained. “Because it was a recurring disease that you could never cure, the patients kept coming back.” Surgeons whose bread and butter was removing stomachs also weren’t interested in hearing their particular specialty wasn’t needed; neither were the numerous scientists grinding out me-too papers by the hundreds on topics such as how to better manage ulcers by tweaking the dose of this or that antidepressant.
Money aside, personal egos and professional reputations were at stake. And cementing these powerful incentives together to form a near-impenetrable groupthink were government agencies that amplified the conventional wisdom and increasingly influenced what research should and shouldn’t be done, what papers should and shouldn’t be published, what drugs should and shouldn’t be licensed. In this medical-industrial-governmental complex, there was and is little appetite for out-of-the-box thinkers who challenge the status quo; there was and is an insatiable need to squelch dissent.
Does more government money in the hands of this already bloated complex save lives, or destroy them? That will be the subject of a future column in this series.
This column is the second in a series. For the first column, see: We’re more vulnerable to diseases.
Lawrence Solomon is a columnist with Canada’s National Post and is research director of Consumer Policy Institute.
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For previous columns by Lawrence Solomon on vaccines, see here.