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April 2003
Volume 67 |
Number 4 |
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Between Mergers and Market Forces: Keeping Research
Alive
Joanne M. Conroy, M.D., Vice-Chair
FAER Board of Directors
This article
was excerpted from a speech presented by Joanne M. Conroy,
M.D., at the ASA Annual Meeting FAER luncheon on October
12, 2002, in Orlando, Florida.
This is an interesting time for both anesthesia and
industry research. I now have the distinct pleasure
of living in New Jersey, the Garden State, one of the
most fertile areas in the country for medical research.
When it comes to private spending and research, New
Jersey attracts more than $10 billion per year, the
most for any state on a per-capita basis and among the
top five in total dollars. Of that investment, more
than half flows into medical research. Most of this
comes from giant American and European drug manufacturers
with operations in New Jersey.
The business of medicine is a way of life in northern
New Jersey. The Wall Street Journal is the
local paper. We even have a section in the Newark paper
dedicated to pharmaceutical company news. The consequence
of their investment is that when Merck burps, all of
Wall Street seems to shudder. When Guidant loses its
court appeal or Wyeth answers questions about Prempro,
it makes the front page. Accordingly, the last two to
three years have been turbulent ones for everyone. Merger
after merger, with the inevitable restructuring, has
affected and preoccupied both industry and health care.
Greater restrictions and external scrutiny by government
and consumers have forced us unwillingly into the public
eye.
Like medicine, pharmaceutical companies are now being
regulated as never before. In some ways, the industry’s
position is even worse than it was two years ago, partly
because HMOs have managed to get out of the political
cross hairs.
Consider the following exchange that took place during
last month’s senatorial debate in South Dakota.
Both candidates spit out the words “drug money,”
referring to legitimate and legal political contributions
from pharmaceutical companies, as if they were talking
about money from the Cali cocaine cartel. It is a fascinating
dichotomy. If you talk to the American people about
the importance of medical advances and pharmaceuticals
and the difference it makes in their lives, everyone
can tell you a story. Then you turn around and talk
about the business of medicine and they become negative
and distrustful. It is as though the industry is totally
divorced from its scientific contributions.
The contradiction is that the corporate investment in
scientific research is greater than ever. There are
more than 800 medications currently under development
for geriatric diseases, including Alzheimer’s
and osteoarthritis, and more than 200 for children’s
conditions. These drugs are being developed only because
pharmaceutical companies can acquire patents and then
sell their drugs at a profit. Typically, only one out
of 5,000 to 10,000 compounds ends up as a marketable
drug, and only 30 percent of these make money.
Unfortunately, almost no politician in the United States
is willing to stand up and utter the simple truth: that
the nation’s medical providers, medical technology
and pharmaceutical companies have done more to extend
the lives of ordinary U.S. citizens than any other industry
in history.
Anesthesia and industry are facing increased demands
for clinical anesthesia care and pressure to meet growing
medical needs of the population at a lower cost. Anesthesia
providers and health-related industries are being forced
into roles that meet short-term needs of patients regardless
of long-term impact.
And there is a long-term impact.
My perspective on this paradox was shaped by a book
written by Juan Enriquez, M.D., titled As the Future
Catches You – How Genomics and Other Forces are
Changing Your Life, Work, Health and Wealth. Dr.
Enriquez is Director of the Life Sciences Project at
the Harvard Business School where he is building an
interdisciplinary center focusing on how business will
change as a result of the life sciences revolution.
The book is made up of a number of succinct observations
of the global economy accompanied by data elements and
dialogue discussing the importance of creating a culture
that generates new knowledge. He challenges us to consider
what is about to happen in medicine.
We currently spend nine times as much for doctors and
medical interventions as we spend on medicines and prevention.
In the future, we may end up spending just as much on
pharmaceuticals as we do on doctors.
Medicines do not have to be pills or injections; they
can be part of the food we eat every day or our soap
and cosmetics.
Dr. Enriquez observes that Proctor & Gamble is considering
a merger with a pharmaceutical company, L’Oreal
is hiring molecular biologists, and Campbell’s
is selling soups specially designed for hospital patients.
The lines are already blurring between industries.
Dr. Enriquez believes that the dominant language and
economic driver of this century is going to be genomics.
Those who remain illiterate in this language will not
understand the force making the single biggest difference
in our lives. And yet many countries and companies just
do not get it. They continue to invest primarily in
producing stuff they can see and touch, even though
two-thirds of the global economy is already a knowledge
economy.
Science and technology allow people to multiply their
productivity much faster than those who do not have
the same knowledge or instruments. Some countries and
companies are choosing not to invest in or attract smart
people who are science-literate, and they do not become
particularly concerned as many of their brightest leave.
(This sounds strangely familiar.)
Those who generate knowledge are the ones whose wealth
is increasing. As a product becomes standardized and
is mass-produced, be it a seed, a machine or a computer
program, the knowledge component becomes more and more
important and the manual labor less valuable.
What our world will look like in 50 to 100 years depends
to a significant extent on our ability to adopt and
adapt to the ethical, political and economic challenges
of the digital genomic era.
In his book, Dr. Enriquez drives home the point (in
an entertaining but compelling manner) that it is no
longer sufficient to just produce goods and services
— we must produce knowledge. We can apply his
premise to today’s challenges both in anesthesiology
and industry. Our real value is in the production of
new knowledge and technology, in the generation of new
compounds in the research and development pipeline or
the investigation into the mechanisms of anesthetic
cellular and molecular action.
Yet external forces — the market, government and
consumers — are pushing both of us to become simple
purveyors of “goods and services,” to focus
on expanded clinical service hours or to take dollars
earmarked for research and instead subsidize lower medication
prices. Consequently we are in great danger of neglecting
that aspect of our profession which makes us thought-leaders.
FAER leadership has struggled with this dilemma. We
know that the increasing demands for clinical productivity,
coupled with decreasing reimbursement for clinical anesthesia
services, has limited anesthesia research. This increasing
pressure for clinical service coupled with a reduction
of clinical cross subsidies to encourage scientific
development bodes ill for the continued growth if not
survival of anesthesiology as a specialty of medicine.
However, we cannot ignore our commitment to research,
education and mentoring of hundreds of young scientists.
I see more clearly now the importance of research and
its contribution to both our educational endeavors and,
more importantly, the quality of our clinical care.
I can see the clinical impact of advances in health
care on the health of my communities. I believe that
more and more patients will select their physicians,
hospitals and systems based on quality, and they believe
that they will get the best and most knowledgeable care
available within those quality institutions. This emphasis
on quality is accomplished by the creation of an energetic
environment of intellectual curiosity, whether in a
university or a community setting.
Public investment in research results from an understanding
that ideas pondered in laboratories will grow from ideas
to commercial products that make a difference.
It is easy to believe that drugs and health care technology
cost too much, at least it is if you are not a member
of my community who has just died of colon cancer or
my friend who endured experimental chemotherapy to fight
lymphoma. For them, drugs do not cost nearly enough
since the higher cost would bring forth more and better
means of fighting cancer and other diseases.
It is the challenge for and responsibility of everyone
in this room to make sure we keep this dream alive,
and our goals are more similar than you would think.
“To promote the generation of new knowledge in
anesthesiology and medical research that advances patient
care and to foster career development of those dedicated
to research and education.” That is the FAER mission.
Believe it, live it, support it.
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Joanne M. Conroy, M.D., is Chief Medical Officer
and Vice-President of Academic Affairs, Western
Region Atlantic Health System, Morristown Memorial
Hospital, Morristown, New Jersey. |
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The views expressed herein are those of the authors and
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