[Ip-health] Science: Medical Innovation Prizes as a Mechanism to Promote Innovation and Access

[James Love]

"Medical Innovation Prizes as a Mechanism to Promote Innovation and
Access," 28=E2=80=9329 January.

www.sciencemag.org SCIENCE VOL 319 8 FEBRUARY 2008 713, Published by
AAAS
Downloaded from www.sciencemag.org on February 8, 2008


NEWS OF THE WEEK, RESEARCH FUNDING

Prizes Eyed to Spur Medical Innovation

MAASTRICHT, THE NETHERLANDS=E2=80=94If the World Health Organization offere=
d 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.

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=E2=80=93VT) 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=C3=A9decins sans
Fronti=C3=A8res 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=E2=80=94a key for any drug developmen=
t.
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=E2=80=94about $80 billion at the mom=
ent=E2=80=94
the Sanders plan would give annual awards to medical innovations based
on the health impact for the nation=E2=80=94assessed using a measurement kn=
own
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 =E2=82=AC1500 award for the be=
st
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. =E2=80=93JOHN TRAVIS

--
_____________________________
James Love, Knowledge Ecology International (KEI)
http://www.keionline.org, mailto:james.love@keionline.org
voice +1.202.332.2670, fax +1.202.332.2673, US mobile +1.202.361.3040,
Geneva mobile +41.76.413.6584