[Ip-health] Science: Prizes Eyed to Spur Medical Innovation

[malini.aisola@keionline.org]

http://www.sciencemag.org/cgi/content/full/319/5864/713

Prizes Eyed to Spur Medical Innovation
John Travis
8 February 2008


MAASTRICHT, THE NETHERLANDS--If the World Health Organization offered a
$10 billion award for a malaria vaccine, would that persuade major
pharmaceutical companies to go after the prize? Could a $100 million prize
encourage development of a reliable, cheap, and fast diagnostic assay for
tuberculosis? And would those monetary awards prove to be the cheapest, or
fastest, way to achieve such medical innovations?

Provocative questions such as those were at the core of a 2-day workshop*
here last week addressing whether prize incentives can stimulate the
creation of new drugs and therapies. For some speakers, prizes offer a
chance to spur medical research on neglected diseases, including those
that strike people in developing nations who can afford little health
care. Others took a more radical view: A national or global medical prize
scheme could eliminate drug patents, stimulate drug development, and lower
escalating health care costs. "A prize is a [research] incentive, the same
way a monopoly is an incentive," says James Love, director of the think
tank Knowledge Ecology International (KEI) in Washington, D.C.

        Figure 1 Prize-worthy. Noting the long history of scientific and
technological prize contests, James Love argues that a national
scheme of awards for medical innovations should replace drug
patents.

 NOTABLE     AWARDS     AMOUNT     GOALS     WINNER
 Napoleon's Food
 Preservation Prize (1795);  12,000 francs;   Ease food-supply problems
for invading armies
 Nicolas Fran=E7ois Appert's canning process (1809)
 Ansari X Prize (1995);   $10 million;   Private, crewed reusable spacecraf=
t
 SpaceShipOne (2004)
 Methuselah Mouse Prize (2003); $4.5 million fund; Extend longevity or
slow aging of mice; Multiple winners
 Prize4Life (2006);  $1 million; Biomarker for ALS;   No winners so far

Cosponsored by KEI and UNU-MERIT, a research and training center run
jointly by United Nations University and Maastricht University, the
workshop drew several dozen economists, intellectual-property specialists,
public-health officials, and drug-development experts to discuss a concept
that's attracting more attention. For example, U.S. Senator Bernie Sanders
(I-VT) has introduced a bill, the Medical Innovation Prize Act, written
with Love's help, that would replace medical patents with an estimated $80
billion annual award fund. Although the bill is unlikely to go anywhere
now, Sanders hopes to get a Senate hearing this year to publicize the
concept. "There is growing interest and political feasibility for trying
prizes in a variety of contexts," says Stephen Merrill of the U.S.
National Academies, who recently examined how the U.S. National Science
Foundation could set up a prize system to stimulate innovation (Science,
26 January 2007, p. 446).

Prize contests have long been used to steer efforts toward particular
discoveries or technological accomplishments, and they're becoming popular
again (Science, 30 September 2005, p. 2153). One well-known early success
was the British government's 18th century prize to find a way for
seafarers to gauge longitude. More recently, the $10 million Ansari X
Prize for a private, reusable, crewed spacecraft prompted an estimated
$100 million to $400 million in space-flight research before Burt Rutan's
SpaceShipOne won it in 2004.

Although perhaps not as prevalent as technology competitions, medical
prizes are attracting sponsors. Pierre Chirac of M=E9decins sans Fronti=E8r=
es
said at the meeting that his group was considering an award for the
desperately needed TB diagnostic test. And in 2006, Prize4Life, a
nonprofit group founded by a patient with amyotrophic lateral sclerosis
(ALS), announced a $1 million prize for a biomarker that can track the
fatal disease's progression--a key for any drug development. Prize4Life
hopes to launch two more contests, including a $2.5 million prize for a
treatment that proves effective in a common mouse model of ALS.

Such modest awards pale in comparison to the mammoth prize system Love
advocates through the Sanders bill. Financed annually with 0.6% of the
United States's gross domestic product--about $80 billion at the
moment--the Sanders plan would give annual awards to medical innovations
based on the health impact for the nation--assessed using a measurement
known as quality-adjusted life years that gauges improvements in life
expectancy. Instead of the government granting patents to a company, a
board that would include business and patient representatives, as well as
government health officials, would each year judge any new products and
award their developers a share of the fund.

At the Maastricht meeting, intellectual-property specialist William Fisher
III of Harvard Law School argued that prize schemes have some advantages.
Patents, said Fisher, guide medical research away from vaccines, which may
require at most a few doses per person but arguably have the most health
impact, and toward treatments for the rich and the development of "me-too"
drugs, copies of an already successful drug with just enough differences
to be patentable. "Prizes can offset all three" of those biases, he says.

PhRMA, a trade group in Washington, D.C., that represents pharmaceutical
and biotech firms, has strongly criticized the Sanders bill as a step
toward socialized medicine. And yet it is intrigued by new incentives, if
the patent system stays intact. "It's an interesting idea to add prizes
for neglected diseases to the existing system," says Shelagh Kerr of
PhRMA, who attended the workshop.

Prize incentives are, however, unlikely to sweep the medical research
world. Philanthropic and patient groups may offer new awards, but
governments may be more cautious. "We're no longer in the Longitude Prize
era. We pay scientists many millions to do research," says David King,
former science adviser to the U.K. government. "How do you decide how much
money to award?" adds economist Aidan Hollis of the University of Calgary
in Canada, noting that governments typically don't know in advance what
social value a medical treatment will have.

The workshop itself offered an ironic morsel of evidence that prizes are
not perfect incentives. Organizers offered a =801500 award for the best
paper on using monetary prizes to stimulate private investment in medical
research, but no entries have been submitted thus far. The contest has now
been extended to mid-April.

* "Medical Innovation Prizes as a Mechanism to Promote Innovation and
Access," 28-29 January.


--

Malini Aisola
malini.aisola@keionline.org
www.keionline.org

Knowledge Ecology International
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