It's understandable that a patient with a life-threatening disease might be willing to pay a hefty price for a drug that would provide a cure. But according to a recently published economics paper, completely healthy people might be willing to pay as well, if they believe they might need it someday.
That study indicates that people who aren't actually sick are a largely overlooked market for new medications and treatments -- a finding that could have both positive and troubling implications. The findings are presented in the journal Review of Economic Studies by Johns Hopkins University assistant professor of economics Nicholas W. Papageorge and colleagues Tat Y. Chan and Barton H. Hamilton, from Washington University in St. Louis.
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The researchers focused upon one particular historical example -- HAART, a lifesaving anti-retroviral drug for treating HIV infections that was introduced back in the mid-1990s. They looked at data amassed at health centers in four U.S. cities from more than 2,400 patients, collected over a 13-year-period that began before the drug became available. But it wasn't only HIV-positive men who valued the new drug. Uninfected men wanted it to be available too, in case they ever needed it.
"The idea is that agents who are not infected, but who anticipate some probability of future infection, benefit in expectation from the provision of a new medical technology they are unlikely to ever consume," the researchers wrote.
"It's like an insurance policy," Papageorge explained in an interview. "If something bad happens, this will make it better. They might think, ‘I don't really need any of these drugs right now, but I'm glad they're around. Or, if they're not available yet, I want my tax dollars to be spent on developing them."
The study focused upon HAART and gay men, in part because of the wealth of reliable, detailed information that already had been collected on the subject, Papageorge said. But he believes the conclusions hold true for other groups as well. "You could extend it to other medications," he said. For example, just as a gay man might perceive value in an anti-HIV drug, a 60-year-old woman might want to see money shifted to development of breast cancer treatments.
Besides just wanting to see research money spent on a treatment or valuing an existing drug's availability, though, Papageorge thinks that healthy people might go so far as to purchase a drug that they don't actually need at the moment, and might never use. "If there might be a shortage of the drug, I'd like to get my hands on it today," he said. "People make decisions based upon the future."
One potential upside of the study's findings is that it suggests that the public will support spending on medical research, if they see the results as potentially benefiting them someday. But it also raises the problematic possibility that unscrupulous pharmaceutical marketers might try to convince healthy consumers that they face an illusory risk, in order to get them to buy a drug.
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"There is a downside to this," Papageorge says. "It highlights a problem. If I'm sick, I know I'm sick. But if we're doing something based upon the expectation of getting sick, there's a lot of room to screw around with my expectations. You might want to convince people that they're going to need something that they don't actually need."
An avenue for such marketing already exists. Starting in the late 1990s, the U.S. Food and Drug Administration relaxed regulations and allowed the growth of direct-to-consumer pharmaceutical advertising, which touts the value of medications that people can ask their doctors about.
A 2011 article in the journal Pharmacy and Therapeutics notes that the average American TV viewer sees as many as nine drug commercials each day and spends 16 hours each year watching them, "which far exceeds the amount of time the average individual spends with a primary care physician."
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Charles Ponte, a professor of clinical pharmacology and family medicine at West Virginia University, says he is worried that marketing drugs to people who aren't ill might encourage them to continue to engage in unhealthy behaviors, such as a poor diet or smoking, due to the belief that the availability of a treatment will mitigate the risk.
He's also concerned that allowing that market to influence drug development might divert resources from whether they're needed. "It doesn't make sense to say, ‘If you smoke too much and get lung cancer, we're going to spend $10 billion to develop a drug, just so that you can have it on hand,'" Ponte explains.
Ponte also says that patients stockpiling drugs, out of a belief that they'll need them in the future, would bring risks. "What if the drugs become outdated, or they start taking them on their own, because they start thinking they need it?" he asks. "That could have harmful effects on them."