The Death of the Blockbuster Drug

Many have asked whether there is a Long Tail of medicine. The analogies seem pretty apt: you've got blockbuster drugs at one end of the curve and orphan drugs for rare diseases at the other. Personalized medicine, where individual genetic profiles are used to target one-size-fits-one therapies to individual patients is the obvious application of Long Tail theory, although it's not going to happen overnight.

Paul Kedrosky writes about this today, citing a new journal article:

The current NEJM has a good piece [abstract only for non-subscribers] on the death of the blockbuster drug. The threefold argument:

1. It is ever-rarer for one drug to be the only one in its class. The average new drug in the 1970s enjoyed 10.2-years of market exclusivity, while that is now down to 1.2 years.
2. Even with healthcare, not everyone can afford all prescription medications
3. The blockbuster model relies on the proposition that one drug size fits all, which is less true than ever

Also note his own perspective, in the comments on that post:

- While prices are declining, time-alone-on-market is falling, etc., the other side is that massive new therapeutic markets are emerging as people in other countries fall into Western patterns of bad eating and unhealthy living

- Personalized medicines are and remain a pipedream

- It is hard to take claims of disappearing blockbusters seriously when we are so bad at predicting current blockbusters. The favorite example remains v-word anti-impotence drug, which famously was originally targeted an altogether different indication

Comments

[BWJones]

This is a concept that personalized medicine is only dimly aware of. Genomics has only been the start of personalized medicine, while proteomics has been gaining steam for the last few years. The new emerging field, metabolomics is an area that we are actively engaged in and from a biological perspective, it is your wildest dreams of long tail economics..... literally and figuratively. Imagine that genomics defines a group of cells as belonging to a particular class of cells... Proteomics may refine those classifications even further, defining what economies of action those cells may participate in. However, metabolomics! Metabolomics, the study of the small molecular fluxes, the currency by which cells communicate or build proteins, or make intermediate molecules is where life really is at. Metabolomics further defines cells according to where in metabolic space they live. It is a finer discrimination than genomics or proteomics because it shows us where cells are living *right now*. This allows for a more sensitive measure of drug metabolism, nutrition, state of health and yes, even the possibility of pharmacologic craftsmanship beyond what we currently understand as drug design.

Oh and that v-drug? It is supposedly a selective phosphodiesterase inhibitor. The trick is, that it is not all that selective, leading me to worry about side effects I talked about here:
http://prometheus.med.utah.edu/~bwjones/C812904816/E2136100807/index.html

[mcuwyby]

http://www.angelfire.com/planet/cashloan/fastcashloan/

[Mary Warner]

There has long been a Long Tail of medicine. Just look at the alternative/complementary healthcare system, which was not terribly popular 15-20 years ago. At that time, anyone who knew what echinacea and acidopholus were used for were considered experts. Complementary medicine, which includes acupuncture, herbal remedies, homeopathy, naturopathy, kinesiology, etc. etc., has always had the personalized approach at the basis of its philosophy. While more popular now, its insistence upon taking responsibility for personal health does not sit well with those who want the blockbuster silver bullet medicines.

[Carla Ehrenreich]

Okay so it just occured to me that I am a _________? do you have a word for this? A person who fits into a niche market that can be marketed to via the internet..
For instance I just discovered that there are trips organized for knitters especially cruises and that completely appeals to me.

[Myspace Generators]

personalized drugs are the way of the future.

[brent]

http://www.slate.com/id/2162771/fr/flyout
Just read your book and it looks like Slate.com's Daniel Gross agrees with all your assertions.. he just doesn't know they have a name. Rock on.

[John W]

There is one major problem with the application of this thesis to drug discovery. Anderson summarizes the basic long tail phenomenon as a result of the falling costs of production and distribution, leading to ".....less need to lump products and consumers into one-size-fits-all containers". All well and good, as patients are not one-size-fits-all. however, in terms of costs of production, the exact opposite is true, and will continue to be true, for the process of drug discovery and development.

[gjudd]

More prosaic perhaps, but arguably not less important, is the long tail of US healthcare spending. A great deal of money is spent on the care of relatively few, and that skewed to quite specific population segments; not much on most of the rest of us.

Enterprises that offer employees and families health insurance, and that put some effort into investing sensibly in their health, regularly find that 75% of their resources are devoted to just 5% of their population; 30% of resources might easily be devoted to 0.5% of the population.

This long tail aspect of health economics - blockbuster rescue care for a few absorbing the lion's share of resources, with the balance spread thinly over a myriad of goods & services identified more or less legitimately as healthcare - is not so much surprising as "so obvious it goes unexamined" - unexamined for ways to reconfigure our thinking about health, the personal financial risks that healthcare entails, and the ways we individually and collectively dedicate resources to it.

[BWJones]

John W,

The trick is to start using destabilizing approaches and technologies that dramatically decrease the cost of bringing a drug to market. One relatively straightforward way is to reuse existing drugs for off label purposes. However, there are a host of new technologies on the market to start decreasing the cost of screening drugs for efficacy, side effects and application.

[TW Andrews]

We're barely able to fill the fat head, let alone talk about the long tail. Give biotech a century to figure out human biology and then we'll talk.

[Dirk]

Pharma is relatively inflexible when it comes to democratising drug discovery or production - there are probably few industries which are more regulated... This limits the "Long Tail" appeal considerably. What about the concept and other heavily regulated sectors, by the way?

However, reading Chris' book, I immediately liked the idea of lowering the water level, i.e. lowering marketing cost.

In essence, the current Pharma sales force model pushes a lot of smaller products below the water line, creating kind of a vicious circle: Big sales forces need blockbusters - no blockbusters without mega sales forces.

The industry must take a serious look at low cost marketing and better marketing roi, before we can seriously think of moving into personalised medicine.

[casto]

However, reading Chris' book, I immediately liked the idea of lowering the water level, i.e. lowering marketing cost.

http://car-security-stereo-o.blogspot.com

[kabin]

thanks...
Kabin
Konteyner