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Dispelling myths about drug research
Editorial
Organ donation in China
Reuters
The printed journal includes an image merely for illustration This online publication has been corrected. The corrected version first appeared at thelancet.com on June 10, 2011
For Comment on organ transplantation in China see Comment Lancet 2008; 372: 1937–38
The announcement on Aug 26 that China has launched a national organ-donation programme and will decrease its reliance on organs from executed prisoners marks a profound shift in policy and deserves praise. The courageous vision and tireless work of one man in particular has made this milestone possible—Huang Jiefu. As Vice Minister of Health and a respected academic hepatobiliary surgeon, Prof Huang has developed the necessary social, legal, and clinical framework to enable large-scale organ donation in China, a process he foretold last year in The Lancet’s Series on health-care reform in China. 1 million Chinese people are in need of dialysis and 300 000 die every year from liver failure. Although 10 000 transplantations are done annually in China, a volume that is second only to the USA, the supply is inadequate to meet the demand of the 1·5 million patients in need of new organs. Recent welcome reductions in executions of prisoners have exacerbated the shortage of organs. Although donor registration began in 2003, only 130 cadaver donations have been made. Reasons
for the low popularity of donation include cultural attitudes and concerns about trafficking in the absence of a transparent system for organ allocation. Under new proposals, the Red Cross Society of China, with assistance from the Ministry of Health, will launch an education campaign, register donors, and provide guidelines for allocation. A key principle is that the system will be based on fairness and transparency. Registration will be piloted in ten cities and provinces, and will begin with allografts after cardiac death. Attitudes to organ donation are changing, particularly among university students, though challenges remain. For example, the concept of brain death is not recognised legally or culturally in China. Countries around the world are struggling to recruit enough organs to match demand, especially in Asia, where donation rates tend to be lower (less than five per million people) than in Europe or North America. Therefore, in addition to health benefits at home, China’s solutions to improve ethical organ donation have the opportunity to lead transplant surgery in the region. ■ The Lancet
Dispelling myths about drug research
iStockPhoto
The printed journal includes an image merely for illustration
For the Health Affairs paper see Health Affairs 2009; published online August 25. DOI:10.1377/ hlthaff.28.5.w969
758
The widely held belief that US firms dominate drug research discovery compared with their European counterparts is challenged in a paper published online on Aug 25 by Health Affairs. Donald Light analysed data from a 2006 study by Henry Grabowski and Richard Wang, which examined the discovery of new drugs between 1982 and 1992 and between 1993 and 2003. Grabowski and Wang concluded that US firms had outshone European companies in terms of productivity. But when Light measured research productivity by comparing the percentage of research and development funding for the USA, Europe, and Japan with the proportion of new drugs discovered by each, he found that the USA discovered far fewer drugs than its proportional share of funding. So, on a dollar-for-dollar basis, European research teams proved more productive than US ones. Furthermore, when it came to global or first-in-class new chemical entities, European research productivity was about the same as US output between 1982 and 1992 and increased by 30% between 1993
and 2003, while US research productivity dropped 26%. Light also asserts that Grabowski and Wang’s study has several biases that favour US productivity. For example, if the study had not ruled out first-in-class new drugs launched in Europe or Japan but not yet available in the USA, Europe’s productivity would be even higher. Light concludes that contrary to industry and official reports, the USA never overtook European drug research productivity. With the current debate over US health-care reform reaching boiling point, this analysis is timely. The US drug industry has long claimed that the high prices they place on new products are necessary to support research. But Light’s results indicate that European drug prices, which are heavily negotiated and subsequently lower than US prices, are more than sufficient to cover companies’ research and development costs and produce profits. The Obama administration should seriously consider price controls for new drugs to bring down the country’s exorbitant health-care costs. It can do so without harming national research and innovation. ■ The Lancet www.thelancet.com Vol 374 September 5, 2009
Organ donation in China
Reuters
The printed journal includes an image merely for illustration This online publication has been corrected. The corrected version first appeared at thelancet.com on June 10, 2011
For Comment on organ transplantation in China see Comment Lancet 2008; 372: 1937–38
The announcement on Aug 26 that China has launched a national organ-donation programme and will decrease its reliance on organs from executed prisoners marks a profound shift in policy and deserves praise. The courageous vision and tireless work of one man in particular has made this milestone possible—Huang Jiefu. As Vice Minister of Health and a respected academic hepatobiliary surgeon, Prof Huang has developed the necessary social, legal, and clinical framework to enable large-scale organ donation in China, a process he foretold last year in The Lancet’s Series on health-care reform in China. 1 million Chinese people are in need of dialysis and 300 000 die every year from liver failure. Although 10 000 transplantations are done annually in China, a volume that is second only to the USA, the supply is inadequate to meet the demand of the 1·5 million patients in need of new organs. Recent welcome reductions in executions of prisoners have exacerbated the shortage of organs. Although donor registration began in 2003, only 130 cadaver donations have been made. Reasons
for the low popularity of donation include cultural attitudes and concerns about trafficking in the absence of a transparent system for organ allocation. Under new proposals, the Red Cross Society of China, with assistance from the Ministry of Health, will launch an education campaign, register donors, and provide guidelines for allocation. A key principle is that the system will be based on fairness and transparency. Registration will be piloted in ten cities and provinces, and will begin with allografts after cardiac death. Attitudes to organ donation are changing, particularly among university students, though challenges remain. For example, the concept of brain death is not recognised legally or culturally in China. Countries around the world are struggling to recruit enough organs to match demand, especially in Asia, where donation rates tend to be lower (less than five per million people) than in Europe or North America. Therefore, in addition to health benefits at home, China’s solutions to improve ethical organ donation have the opportunity to lead transplant surgery in the region. ■ The Lancet
Dispelling myths about drug research
iStockPhoto
The printed journal includes an image merely for illustration
For the Health Affairs paper see Health Affairs 2009; published online August 25. DOI:10.1377/ hlthaff.28.5.w969
758
The widely held belief that US firms dominate drug research discovery compared with their European counterparts is challenged in a paper published online on Aug 25 by Health Affairs. Donald Light analysed data from a 2006 study by Henry Grabowski and Richard Wang, which examined the discovery of new drugs between 1982 and 1992 and between 1993 and 2003. Grabowski and Wang concluded that US firms had outshone European companies in terms of productivity. But when Light measured research productivity by comparing the percentage of research and development funding for the USA, Europe, and Japan with the proportion of new drugs discovered by each, he found that the USA discovered far fewer drugs than its proportional share of funding. So, on a dollar-for-dollar basis, European research teams proved more productive than US ones. Furthermore, when it came to global or first-in-class new chemical entities, European research productivity was about the same as US output between 1982 and 1992 and increased by 30% between 1993
and 2003, while US research productivity dropped 26%. Light also asserts that Grabowski and Wang’s study has several biases that favour US productivity. For example, if the study had not ruled out first-in-class new drugs launched in Europe or Japan but not yet available in the USA, Europe’s productivity would be even higher. Light concludes that contrary to industry and official reports, the USA never overtook European drug research productivity. With the current debate over US health-care reform reaching boiling point, this analysis is timely. The US drug industry has long claimed that the high prices they place on new products are necessary to support research. But Light’s results indicate that European drug prices, which are heavily negotiated and subsequently lower than US prices, are more than sufficient to cover companies’ research and development costs and produce profits. The Obama administration should seriously consider price controls for new drugs to bring down the country’s exorbitant health-care costs. It can do so without harming national research and innovation. ■ The Lancet www.thelancet.com Vol 374 September 5, 2009