The Orphan Drug Act successfully incentivized R&D for rare diseases. A similar policy framework is needed for common, age-related diseases. Despite their massive potential markets, these indications suffer from extremely high failure rates and costs. A new incentive structure could de-risk development and align commercial goals with the enormous societal need for longevity.
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Breakthrough drugs aren't always driven by novel biological targets. Major successes like Humira or GLP-1s often succeeded through a superior modality (a humanized antibody) or a contrarian bet on a market (obesity). This shows that business and technical execution can be more critical than being the first to discover a biological mechanism.
The decline in R&D productivity (
While the FDA is often blamed for high trial costs, a major culprit is the consolidated Clinical Research Organization (CRO) market. These entrenched players lack incentives to adopt modern, cost-saving technologies, creating a structural bottleneck that prevents regulatory modernization from translating into cheaper and faster trials.
A significant portion of biotech's high costs stems from its "artisanal" nature, where each company develops bespoke digital workflows and data structures. This inefficiency arises because startups are often structured for acquisition after a single clinical success, not for long-term, scalable operations.
A centrist solution to high drug prices involves combining ideas from both political aisles. Oliver Libby suggests allowing Medicare to negotiate prices (a left-leaning idea) while also extending patent life for drug companies (a right-leaning idea), thus lowering costs without killing the incentive for innovation.
The conversation frames GLP-1 weight-loss drugs not merely as a healthcare breakthrough but as a potential moonshot for the national economy. A mass government rollout could drastically reduce healthcare costs, improve mental health, and boost productivity, representing a powerful tool for social and economic policy with far-reaching ramifications.
Chronic illnesses like cancer, heart disease, and Alzheimer's typically develop over two decades before symptoms appear. This long "runway" is a massive, underutilized opportunity to identify high-risk individuals and intervene, yet medicine typically focuses on treatment only after a disease is established.
Diseases like Ebola and malaria, which primarily affect poor countries, lack market incentives for vaccine R&D. The Ebola vaccine only progressed because it was briefly on a U.S. bioterrorism list created after 9/11, highlighting how market failures require creative, sometimes accidental, incentives to overcome.
The future of biotech moves beyond single drugs. It lies in integrated systems where the 'platform is the product.' This model combines diagnostics, AI, and manufacturing to deliver personalized therapies like cancer vaccines. It breaks the traditional drug development paradigm by creating a generative, pan-indication capability rather than a single molecule.
Unlike labor-dependent services that get more expensive, prescription drugs offer a unique societal ROI because they eventually go generic and become cheaper. This deflationary aspect is a powerful, underappreciated argument for investing in drug development, as successful medicines provide compounding value to society over time.