Pubdate: Mon, 28 Apr 2003
Source: Wall Street Journal (US)
Copyright: 2003 Dow Jones & Company, Inc.
Contact:  http://www.wsj.com/
Details: http://www.mapinc.org/media/487
Author: Peter Landers

WHY TREATING ADDICTS IS TOUGH PLAY FOR DRUG FIRMS

Larry Bloch is one of those rare folks with degrees in both medicine and 
business from Harvard. Recently, his biotech company created an enzyme that 
breaks down cocaine molecules and is highly effective in rats given a 
cocaine overdose.

Dr. Bloch (M.D.) is thrilled. Mr. Bloch (M.B.A.) isn't so impressed. 
"There's a very large business risk" to developing cocaine treatments, he 
says. The company where he serves as chief financial officer, Applied 
Molecular Evolution Inc. of San Diego, hopes the government will pay for 
the next stage of research because it isn't sure its investors want to put 
their own money on the line.

Dr. Bloch's experience is all too common. Scientists are discovering more 
medications that seem to help addicts, and given the huge social costs of 
addiction one would expect those medications to be rushed onto the market. 
Instead, they limp through development, hobbled by a shortage of funds and 
lack of interest from big pharmaceuticals companies.

Why? In a word, economics. If a drug company finds a cure for cancer, 
insurers and the government will include it among their covered treatments 
and pay almost whatever price the company wants. The cure's discoverer also 
will reap a bonanza of good publicity. So drug companies spend billions of 
dollars of their own money each year studying cancer.

For addiction, the calculations are different. Few companies want to be 
tarred by association with junkies, and the size of the market is 
uncertain. While some insurers are covering a new medication called 
buprenorphine for heroin and painkiller abusers, coverage of methadone, an 
older treatment, is less common. As a result, even addicts lucky enough to 
have insurance can pay several thousand dollars a year out of pocket for 
methadone, says Chris Kelly, the head of a methadone-users group in 
Washington. Of course, many addicts are uninsured.

Besides, a drug company can't send a bill to the largest group that 
benefits from addiction treatment: nonaddicts. Everyone wants lower crime 
and a more efficient work force, but it is hard to imagine drug-company 
executives going door-to-door collecting fees from homeowners who weren't 
robbed because their neighborhood had fewer addicts. "If General Electric 
absorbed the costs [of addiction] you can be sure there'd be a market," Dr. 
Bloch says.

To economists, such "market failures" are a familiar problem. The classic 
case is pollution: Individually no one has an incentive to pay for a filter 
that cuts car pollution, but collectively society is better off if everyone 
drives low-polluting cars. The solution is laws on auto emissions. It's 
effectively a tax, since antiemission equipment costs money, but cleaner 
air is worth it.

Yet federal and local governments hesitate to use their power of taxation 
to pay for the development of antiaddiction drugs . True, a variety of 
government programs use tax money in drug-abuse research and treatment. The 
National Institute on Drug Abuse, whose main job is funding research, has 
an annual budget of $960 million. Many states cover methadone treatments 
for indigent addicts under Medicaid. But these sums are dwarfed by the 
costs of addiction, which are estimated as high as several hundred billion 
dollars a year.

Skeptics point out that addiction treatment isn't as certain to work as a 
pollution filter. Medications under development typically help only some 
addicts or address only part of the recovery process.

Most scientists, however, see addiction as a brain disease that, in 
principle, can be addressed with drugs just as well as mental illnesses 
like schizophrenia. They accept that subduing addiction will require a 
collection of partially effective weapons rather than a single magic bullet.

One such weapon is lofexidine, which Britannia Pharmaceuticals Ltd. has 
sold in Britain since 1992 for addiction to opiates such as heroin. It 
isn't a cure, but British doctors believe it helps relieve withdrawal 
symptoms and put addicts on the road to recovery. The U.S. government paid 
for a clinical trial of lofexidine, and the results were so good that last 
year the trial was stopped early.

Now, Britannia Managing Director Max Noble is looking for an American 
partner to help foot the bill for a large-scale U.S. clinical trial and, if 
successful, a marketing campaign here. Midlevel executives at one big U.S. 
pharmaceuticals company were intrigued, but higher-ups nixed the deal early 
this year.

Meanwhile, U.S. addicts wait. "You've got to get society to make a 
decision: Is drug addiction something to be scolded or something to be 
faced up to?" says Mr. Noble, who has shifted his search to smaller companies.

Eventually, Mr. Noble's drug will probably make it to the market here, and 
Dr. Bloch's company will scrape up the funds to test whether its cocaine 
antibody works as well in humans as it does in rats. But it will likely 
take longer than it would if Americans were more committed to the idea that 
medicines can help drug abusers.
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MAP posted-by: Larry Stevens