NYT: Is the United States becoming a less healthy society in some respects? Dan: Yes, in some aspects, less healthy. The most important aspects are lack of exercise and being overweight. Public health policies have worked in infant mortality and the reduction of smoking, but, unfortunately, those trends are overtaken by these other developments.
NYT: What should Americans be doing to fix the system? Dan: One aspect is better patient education and better nutrition. People continue to eat as they did during the times when they were working in the fields. That is a dramatic mistake. Secondly, we should look at how to give incentives to people to avoid disease-prone behaviors such as smoking, alcohol consumption and being overweight. If you look into the health care system itself, at data management, information systems and information technology, it is not very progressive. There is no shared database.
The last point I would make is liabilities. In the health care system, for doctors, hospitals and pharmaceutical companies, you have huge liabilities that have lots of indirect costs, from insurance costs to the overtesting of patients. That costs over $100 billion a year.
NYT: Have you seen the Michael Moore movie â€œSickoâ€? Dan: No, unfortunately not. But I know he has great skill in mixing things which are true with things that are skewed or biased. (Pharmalot comment: Unfortunately? If he wants to see it, what's keeping him from making the time?)
NYT: Is the pharmaceutical industry part of the cure or part of the problem? Dan: If you look at the mortality rates from hypertensive heart disease or stroke or gastrointestinal bleeding or cancer, in the past 40 years, these diseases have declined as the cause of mortality by 60 to 70 percent. Medicine has made huge progress and to a large part itâ€™s due to better pharmaceuticals.
Having said that, the prices have increased significantly. People are starting to ask, â€œIs it too expensive?â€ There are, of course, internal costs which one has to take into account. We have invested 17 percent more, year after year, in the past six years for research and development. Externally, clinical studies have become longer and more difficult. And regulatory authorities, especially the F.D.A., have become extremely risk-averse, increasing the risks of research dramatically. That is all contributing to the cost of pharmaceuticals.
NYT: When Americans arenâ€™t complaining about the price of drugs, they worry that the pipeline for new drug discovery has dried up. Is that right? Dan: I donâ€™t think itâ€™s accurate to say we have a drying up of the pipeline. The problem is that productivity has gone down significantly. If you look at the pipelines of companies and add up the number of products in development, it is quite high. The problem is that it takes longer and is much more costly; dollars spent per compound have increased dramatically. But the potential has not declined. With the unraveling of the human genome, within 10 or 15 years, we will see new products thanks to the new insights. There is a gestation period from the time we have science and logic until we have a drug. Unfortunately, the FDA has become extremely risk-averse.