A Research Crisis in Diseases of the Brain
Professors David Nutt (Imperial College London) and Guy Goodwin (Oxford University) have recently authored a report for the European College of Neuropsychopharmacology which sounds the alarm on the elimination of research by pharmaceutical companies in areas such as depression and schizophrenia. They are greatly concerned that companies like GSK, AstraZeneca and Pfizer “see research into better neuropsychiatric drug targets as economically non-viable.” Their fear is that if such research is stopped “we will have a dead space of 20 to 30 years before we can begin to do it again.”
First of all, it is encouraging to hear prominent academics extol the importance of research that occurs in the pharmaceutical industry. Usually, industrial drug R&D is minimized by people like Dr. Marcia Angell, former editor of the New England Journal of Medicine, who promote the view that pharmaceutical companies do little original R&D and instead license all of their drugs from universities and small start-up companies. Others, like Dr. John Abramson, author of Overdosed America, feel that the anti-depression drugs that have been produced by the industry add little value. It is a pleasant change to hear these professors recognize the value of the contributions of the R&D of pharmaceutical companies.
Nutt and Goodwin are justified in their concerns. While drugs already exist to treat these central nervous system (CNS) disorders, they are far from ideal. However, their rationale as to why pharmaceutical companies are abandoning this research may be not be entirely correct. Because the biology of the brain is so complex, it is not unusual for an agent in the CNS to have side-effects such as changes in mood, anxiety, insomnia or even create suicidal tendencies. Nutt and Goodwin say the industry is spooked by potential litigation over these types of side-effects, but every drug causes side-effects. If a pharmaceutical company worried exclusively about adverse reactions, it would never develop any new medicine for any condition. As was said here before, the key in navigating side effects is that everyone involved–the industry, the FDA, the doctors and, most importantly, the patient–understands the risk-benefit profile of a new drug.
Nutt and Goodwin should be applauded for calling attention to the beneficial research done by the pharmaceutical industry; however, the real issue here isn’t fear of litigation. It’s that there are not many compelling targets for industrial scientists to study. Traditionally, academic researchers have helped to fuel the generation of new ideas by doing basic research into how the brain works. This preliminary research yields areas for industrial scientists to probe. But funding of this type of academic research by institutions like the NIH have decreased over the years. Furthermore, the NIH is now diverting hundreds of millions of dollars to doing drug discovery, which is clearly better done by industry.
To avert the “dead space” feared by Nutt and Goodwin, a greater emphasis on basic CNS research needs to occur. While some companies have gotten out of this area, many are still doing research in seeking new pathways to treating CNS diseases. The FDA needs to express an openness that new medicines that result from this work will be given a high priority in their review process. In addition, the public sector needs to increase funding for academic researchers in the CNS field to plant new seeds that can be developed by industrial scientists.
Ironically, Congress christened the 1990s as the “Decade of the Brain.” Unfortunately, much more than a decade will be needed to make the breakthroughs necessary to relieve the burden of disease caused annually by the neurological disorders.