Gemzar

The same week that scientists announced the complete decoding of the human genome, Al Gore declared war on medical progress. Even though the private sector completed sequencing the genome ahead of the government-and is already developing information that will help produce powerful new drugs-Gore rarely credits the work of private biotech and drug companies in discovering important new medicines. Now Gore has launched a populist attack on "price gouging" by the drug companies.

Pundits view this as just a ploy to solidify Gore's standing among senior citizens and build support for his proposed new Medicare drug entitlement; but Gore's animus runs deeper. He distrusts biotechnology, and stripping the biopharmaceutical industry of its powers by turning it into a public utility is something he has had in mind for years.

His role as an enemy of medical progress should come as no surprise. When biotech Luddite Jeremy Rifkin wrote Algeny-a diatribe against gene-based drug development in which he implied that the human life span should revert to that enjoyed before the Bronze Age so that mankind could be closer to nature-it was Al Gore who wrote the glowing blurb that Rifkin has given us "an insightful critique of the changing way in which mankind views nature." Then-congressman Gore invited Rifkin to advise the Science and Technology Subcommittee about the dangers of biotechnology, and about Gore's proposal to have the federal government regulate genetic engineering.

In Earth in the Balance, Gore wrote longingly of the Dark Ages as a time when religious dogma dominated science. In a 1991 article for the Harvard Journal of Law and Technology, he referred to biotechnology as "a powerful, and threatening tool."

As vice president, he has portrayed himself as a proponent of medical progress-because he promises to expand the government's role in biomedical research. In fact, however, his recent proposals are consistent with his belief that biotechnology is a threat to humanity.

His public-utility vision of drug development is pure fiction, which will only delay real progress in the war against cancer. The (federal) National Institutes of Health has never produced a huge number of drugs; it was set up to fund more basic research. Indeed, the drug-development program of the National Cancer Institute (also federal) has never developed one cancer drug without substantial private-sector support, nor does it have the resources to conduct the clinical tests of safety and efficacy that are required before breakthrough drugs can be brought to market.

The federal cancer project relies largely on discoveries in private labs; private researchers do most of the heavy lifting that results in medical progress. But Gore suggests that drug companies and biotech firms only rip off-and market-what government scientists come up with. And he-joined, sadly, by some Republicans-wants to impose government price controls on any product a private company developed in collaboration with government scientists, or that relied on research that had any federal support, at any time.

Years ago, there were price controls on such partnerships; the result was long delays in the development of many important new drugs for cancer and mental illness. Hundreds of interesting research projects withered on the vine. It was only after NIH director Harold Varmus eliminated price controls, in 1995, that such partnerships, including the genome project, began to flourish.

Since collaboration occurs at one time or another in most projects-government scientists are often invited to coauthor research papers with university and private-sector scientists-Gore could claim that virtually everything is federal research and therefore subject to price controls. The result would be to kill much important gene-based research. Currently, the twelve genomic companies have an aggregate market capitalization of $36 billion-120 times the NIH budget for the human-genome project. If Gore's policies are put in place, their value will collapse.

The main problem with Gore's position is that it's based on a fundamentally mistaken assumption-that drug companies earn their profits not by investing in truly valuable drugs, but through price gouging. Several studies demonstrate that the rise in drug spending is not the result of rising drug prices, or of the launch prices of new drugs, but of the increase in the use of newer medications. In countries with drug plans similar to those proposed by Gore, the rise in drug prices is avoided by the use of older and cheaper drugs: In Canada, France, and the United Kingdom, the entry of new drugs is delayed for up to five years-and even when drugs are approved, they are not paid for by the government. Britain's National Health Service only recently decided to cover the use of Taxol for breast cancer (which is standard in the U.S.). It is estimated that Britain's delay cost about 25,000 lives a year.

Our Department of Veterans Affairs, in a policy embraced by Gore allies as an example of how a Medicare drug benefit could be administered, routinely denies schizophrenics the most effective anti-psychotic medications in favor of the cheapest ones; victims of pancreatic cancer are denied access to Gemzar, the cutting-edge treatment for the disease, and are instead given a drug that is less powerful and has more side effects.

It doesn't take an inventor of the Internet to figure out that Gore's war on medical progress would wound our nation for generations to come. It would lead to a huge loss in what Harvard University's David Cutler and Elizabeth Richardson call "health capital-the dollar value of health a person will have over the course of their remaining life." For a newborn in 1990, Cutler and Richardson estimate health capital at about $3 million, while for the elderly, health capital is nearly $1 million. Health capital has increased greatly over time-by roughly $40,000 to $50,000 per decade. Gore believes that drug companies earn profits by price gouging, not by investing in valuable new drugs; but Cutler has found that just 30 percent of the increase in America's health capital in the past 40 years would have been enough to justify that period's investment in medical progress.

Moreover, it is clear that gains in life expectancy, birth weight, and the reversal of starvation in the developing world are largely due to advances made through medical progress. Columbia University professor Frank Lichtenberg has found that, over the past decade, a one-time pharmaceutical R&D expenditure of about $15 billion subsequently saves 1.6 million life-years per year. Lichtenberg also found that for every dollar spent on new drugs, America saves nearly four dollars on physicians and hospitalizations.

Al Gore's plan will do little to ease the plight of the 20 million people worldwide who are afflicted with Alzheimer's, or the 24 million in Africa with AIDS, or the millions more with cancer. His small, federally regulated and funded biotech business would kill incentives for investment and drain wealth into Medicare entitlements. The result would be a death knell for medical progress, retarding and reversing the recent gains in health and life expectancy. America would pay a huge, and unnecessary, price for a new middle-class entitlement, and for Gore's life-denying vision of biotechnology.

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