Posted tagged ‘Geriatrics’

Guest Post: Michelle Sipics on the limits to private sector R and D

August 10, 2008

Guest blogger and my former student Michelle Sipics is back with another post centered on her major area of interest — mental health, and especially the intersection of mental health inquiry and treatment and the care and well-being of the elderly.

It’s a crucial topic, IMHO, and it is one that does not get the attention it needs, as part of the larger neglect, at least in writing for the public, of the experience of aging in the United States (and presumably elsewhere, though my knowledge of science/medical journalism stops at the water, and certainly at the English language barrier).

So — see what Michelle has to say, and think about the question she leaves us with.


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Back in June, my good host posted about the media coverage of the psychological tolls of
the wars in Iraq and Afghanistan. He discussed the steps that the military is beginning
to take to address brain injury and mental illness, and I left a comment detailing my
feeling that we have a long way to go before these problems are anywhere near solved.

A fellow commenter–Tom Tyler, by name–suggested that waiting for politicians to fix or
even begin to address such problems is a loser’s bet, and that private R&D is the way to
go to get good research done. He may have a point. I’ve been thinking about that off
and on for the last month or so, and quite recently came across a news article that
highlighted the issue once again.

Those who have read my first guest post on this blog may recall that I have a particular
interest in mental health research, and especially in geriatric mental health. Well,
this article didn’t discuss mental health, but it did focus on an issue that primarily affects the
elderly. It seems that GM is working on a tech- heavy windshield that’s designed to aid
drivers with vision problems: a camera, lasers, and various sensors combine to “enhance”
what’s happening in the driver’s field of vision, so that the edge of the road is
highlighted more clearly, for example.

I think this is a potentially great example of what Tom Tyler discussed in his
aforementioned comment–private R&D leading to a product or service that addresses a
major problem facing ordinary people. Granted, it’s not as if this is pure medical
research; GM stands to make a bundle from it, and it’s clear that their primary
incentive is profit, not altruism. But is motivation, in and of itself, a problem? If,
in the end, people are helped by this system, and less accidents result from its use,
will we mind that it also helps GM’s bottom line–that it wasn’t developed by someone
with no major personal or financial interest in its use?

Personally, I don’t. I see this as an example of the private sector seeing a market
opportunity and jumping on it, to the potential benefit of millions of people. The AP
article about it specifically mentions the fact that the elderly population of the US is
on the verge of exploding, so that by 2030, one-fifth of the US population will be over
65. That, of course, is the group of folks with the most vision problems, and many of
them still drive, so this could be a big boon for both them and GM. Who loses?

Now, the big question for me: how does this concept–private-sector development that can
benefit ordinary people–apply to geriatric mental health?

One obvious issue that comes to mind is drug development. Pharmaceutical companies could
have a huge impact against a disease like Alzheimer’s with the development of an
effective drug. Yes, some are already on the market, but none that can help treat the
illness for more than a year or two at most. I’m sure many others are also in
development or trial stages, but the average time to market beyond discovery for a drug
is around 15 years. With the first of the baby boomers turning 65 in 2011, just three
years from now, things don’t look great at the moment.

A similar possibility is an anti-depressant targeted specifically for the elderly. Why
not? Narrow-focus drugs can be extremely effective. But to my knowledge, no such drug is
in existence or even being researched. (Please, anyone who knows of one, feel free to
correct me.) If one were discovered, brought to market, and widely adopted, it could
potentially prevent scores of suicides and increase the quality of life for elderly
patients suffering from depression. But one key word in that sentence is “adopted.” Many
elderly patients who are in fact suffering from depression are ashamed to admit it and
don’t seek treatment; and, compounding the problem, many don’t recognize aches, pains,
trouble sleeping, etc, as potential symptoms of depression. If they do go to a doctor,
it’s typically a general practitioner–and as I discovered while researching this topic
some years ago, the symptoms of depression are often overlooked by GPs when treating
elderly patients, so the underlying problem can be left undiscovered and the symptoms
cracked up to “old age.”

So with all of these problems, is it really to the benefit of pharmaceutical companies
to spend millions of dollars and so many years developing a drug that targets a problem
patients won’t admit to having? Is private R&D really the best answer here? No
pharmaceutical company is going to put itself in the red to develop a drug that won’t
result in a bottom line profit, even if it could help millions of people. So what’s the
best answer?

Personally, I do think private R&D can still have a huge impact in geriatric mental
health, but first we have to address the problem of stigma–and that problem is largely
left up to society as a whole. Before elderly patients, or any mental health patient,
can benefit from treatment, we have to convince them that it won’t come along with
rolled eyes from friends or condescending speeches about picking oneself up by one’s
bootstraps instead of accepting that treatment. Unfortunately, change like that also
takes time–and we’re running out of it.

My main reason for writing this post was to find out what others think. Can private R&D
help address the coming crisis in geriatric mental health? What issues stand in the way,
and what has to be done to get things rolling? Throw in your two cents, and let’s see
what we can do as a society to improve the situation.