My post from September 18th ("As Others See Us") on Alan Murray's Wall St. Journal column drew some interesting mail. I quoted a line of his:

"Almost no politician in America is willing to stand up and utter this simple truth: The nation's pharmaceutical makers have done more to extend and improve the lives of ordinary Americans than any industry in history."

A friend of mine in the medical profession wrote to differ:

"I just could not let this one pass. One of our Med School teachers would say, "Farmers and Plumbers have saved more lives than any doctor." I think he is right. . . Clean water and uncontaminated food are essential elements of public health. Without these two things, most of us would not live long enough to need a pill for ulcers, type II diabetes, high cholesterol or hypertension. By the way, I believe that providing a supply of vaccines is The Industry's biggest contribution to increase in longevity experienced in the US. "

It's hard to argue with that, actually. It's been pointed out that money spent on clean water supplies in Third World countries is probably the most efficient way to save lives there is. Vaccination has to rank pretty high up there, too. I don't think many drug projects can compete with a good public-health cleanup.

And it's true that many drugs are targeted toward diseases of weathier countries, where the basic measures are already in place and life expectancy takes you into the years where things like arthritis, adult-onset diabetes, and hypertension become problems. A major challenge is figuring out incentives for work on tropical diseases like malaria. There's actually been some recent progress in that area (the incentives, as well as the malaria,) which I'll write about soon.

My friend goes on to say:

"If the writer had said, "The nation's pharmaceutical makers have done more to try to extend and improve the lives of ordinary Americans than any industry in history, " then perhaps he would have been more on target." (Emphasis in the original!)

Ouch! Point taken. The past few years, we've spent a lot more money trying than we have succeeding. And that worries me on several levels - one of the higher ones is that it will only exacerbate the problem of making drugs targeted at wealthy populations, A lot of capital has gone down the tubes, and the natural tendency will be try to make that money up somewhere.