Making Sure Disease-Fighting Drugs Work - Now and in the Future

Mar 22, 2007, 1:04 AM, Posted by Paul Tarini

There's a bit of a story behind our support for the "Extending the Cure" effort, which released its Phase I report today. The original proposal came to Pioneer through the mail from someone who had never approached the Foundation before. Ramanan Laxminarayan, an economist with Resources for the Future, was requesting support for a paper that would present a way to tackle antibiotic resistance by re-framing the problem.

He suggested that if the nation thought about antibiotics as a valuable but scarce natural resource, then we could develop new policies and incentives that would help turn the tide on the growing problem of antibiotic resistance. You could come up with new ideas, he suggested, because you'd approach the problem not from the more traditional framing that seeks to control antibiotic prescribing and use, but from a natural resources economist's framework, which seeks to optimize the effectiveness of a scarce common societal good. Taking such a perspective would lead you to look upstream from the point of use and consider issues related to the development, production, regulation and management of antibiotics.

We were intrigued. It's no secret that many of the best solutions to problems come from non-traditional approaches. On the Pioneer Portfolio, we've supported several innovative projects that seek to apply knowledge and disciplines from non-health fields to problems in health and health care. However, we thought the original proposal from Dr. Laxminarayan was, umm, a bit too modest.

The concept was clear and compelling enough, so we worked with him to use the paper concept as a platform to build a bigger project, one that engaged expert advisors and stakeholders to develop and assess various incentive-based approaches to the issue, and begin to share these ideas with a broader group of stakeholders and policy-makers. One result is the report released today. Another is a core group of stakeholders and advisors, including Nobel Prize-winning economist Kenneth Arrow, who can help refine and promote this new approach.

It's a big idea to solve a big challenge, and one that would change incentives and approaches for regulators, pharma companies, hospitals, physicians, payers and others. Incentive-driven policies help to manage forests, fisheries, the airwaves and other resources that are key to our daily lives and well-being; there is promise for similar policy options to ensure sufficient and effective stockpiles of lifesaving drugs now and in to the future.

For what Pioneer is charged with, supporting innovations that can leapfrog us to solutions, we consider this project a near-term success. I say near-term because what Dr. Laxminarayan and his colleagues have produced is well-realized but untested and unimplemented. That, we hope, comes next. The ultimate success will be a dependably effective arsenal of disease-fighting drugs that work.

This commentary originally appeared on the RWJF Pioneering Ideas blog.