COMMENTARY: What we get wrong about prescriptions, chronic disease

Prescription drugs account for 15 percent of health care costs. Yet, they’re our best defense against the chronic diseases that drive 90 percent of health care spending.

That’s why policymakers ought to be cautious about any “reforms” that deter drug development. If drugmakers’ revenues drop precipitously, all analysts agree they will invest less money in research and development, which will reduce the number of drugs coming to market.

We’ve already seen how the new price negotiations under Medicare have resulted in research cuts. And the president’s recent “most-favored-nation” proposal to import foreign price controls would compound the damage.

While estimates of the number of lost medicines vary widely, all analysts agree there will be fewer drugs developed because of price controls.

That would set back progress in the fight against chronic diseases.

Heart disease and stroke cause nearly 1 million deaths annually. Almost 20 million people have cancer, with 2 million diagnoses and 600,000 deaths annually. About 40 percent of Americans will face a cancer diagnosis at some point. Meanwhile, 38 million Americans have diabetes, and an additional 98 million have pre-diabetes. Obesity affects 40 percent of adults and 20 percent of children, many of whom develop chronic diseases such as type-2 diabetes, heart disease and cancers.

Proper treatment of these chronic diseases and hopes for permanent cures depend on pharmaceuticals.

Consider how the preferred treatment for heart disease, in addition to diet and exercise, involves a combination of medications: statins to lower cholesterol, beta blockers and ACE inhibitors to reduce and manage blood pressure, anti-platelet agents to reduce the risk of clots, diuretics to manage fluid levels and nitrates to relieve chest pain.

Many of these medicines were initially expensive but are now available as generics and are relatively inexpensive. Newer versions that deliver even better outcomes have been developed, some of which will soon go off-patent and become cheaply available, just as previous generations of treatments did.

Or consider how cancer treatment typically involves a combination of surgery, radiation and chemotherapy. New and improved medicines drove 60 percent of the life expectancy gains for breast cancer patients between 1975 and 2012.

Biopharmaceutical companies spend tens of billions yearly on cancer research for treatment and the search for cures. If there is a hope for a cure for cancer, it is almost certain to be found in the research and development of pharmaceutical manufacturers.

Meanwhile, diet and blood sugar control remain the preferred protocol for treating diabetes, especially type-2 diabetes. Older drugs such as metformin are a first-line treatment (for less than $5 a month). Insulin remains a necessity for most type-1 patients and some with type-2. There are newer drugs, such as SGLT2 inhibitors for glucose control. The latest diabetes drugs are in the GLP-1 class, which reduces blood sugar.

Until recently, the primary treatment regimen for obesity was diet and exercise, and, for some, gastric bypass surgery. However, the GLP-1 class of drugs is now helping with weight loss, too. Early reports suggest a weight loss of up to 30 percent, surely enough to improve health. There are many aspects about these drugs that we do not know, but they have the real promise of treating obesity, diabetes and related diseases.

Drug development is a decade-long and costly process replete with failures. If we don’t incentivize continued investments in drug research and development, we’ll lose out on new therapies that don’t merely treat but prevent and cure many chronic diseases. Even one drug foregone could be the medicine that would have cured cancer or Alzheimer’s.

As Sen. Dick Durbin, D-Ill., recently put it at a Senate hearing on proposed NIH budget cuts, “If research is underway, you at least have the hope that maybe there’ll be a cure, maybe in the lifetime of someone. How can you walk away from that?”

It’s worth noting that pharmaceutical manufacturers spent nearly $288 billion on R&D last year, six times the NIH budget and 16 times the proposed NIH reductions.

Health-care costs are high and rising, primarily because of chronic disease. Leveraging drugs that can keep people out of hospitals and nursing homes is one of the few ways to improve health and reduce costs.

The cost of not having new treatments — in dollars and lives — is far, far higher.

Dan Crippen is a former director of the Congressional Budget Office. He wrote this for InsideSources.com.