8 - Medical Technologies: Aligning Private Rewards with Health Impacts

项目摘要/摘要 项目8-医疗技术：使私人奖励与健康影响保持一致 在过去的几十年里，新的医疗技术在健康方面产生了戏剧性的改善 多组患者的结果。虽然这是任何新医学发展的关键因素 技术是科学的突破，市场激励往往是其中的关键决定因素 可行的医疗技术成功地从科学家的实验室过渡到病人的床边。 因此，影响市场激励的公共政策的设计--例如专利制度和法规 例如美国食品和药物管理局(FDA)的 医疗创新的方向。 -可以对比率和 这个项目的目标是调查我们目前的专利制度和FDA的政策是否未能提供 鼓励开发一些科学上可行的医疗技术，以产生健康 给病人带来的好处。我们的重点是所谓的“新用途”扭曲，这可能会发生在一个关闭- 专利药物有了新的发现用途，例如发现一种非专利的糖尿病药物可能是一种 有效的癌症治疗。几乎没有激励措施鼓励私人研究投资对旧技术的这种新用途进行研究 药物和公共研究补贴并不明确地旨在鼓励对这种新用途的研究。 我们将开发一个政策分析的概念框架(目标1)，并将开发新构建的数据 (目标2)经验性检验(目标3)这种“新用途”扭曲是否会导致一些科学上可行的药物 从来没有接触过病人。然后，我们将尝试量化这些“失踪”的医疗服务对患者的健康价值 技术(目标4)，以估计在替代方案下可实现的潜在健康收益 政策。 该项目的成果旨在为正在进行的关于如何最好地交付的辩论做出更广泛的贡献 循证医学向患者，特别是在个性化医疗这一新兴领域。具体来说， 在“新用途”问题存在的程度上，“失踪”的无形成本的大小 随着个性化医疗变得越来越重要，它可能引发的创新正在增长。个性化 医学是基于将患者分成不同亚组的想法，假设药物 对一个子组的患者有效，对另一个子组可能效果不佳。随着科学和医学的进步 关于如何最好地将患者分类为这样的亚组，将出现新的具有医学价值的机会 药物和更多目标群体之间的匹配-许多或大多数这些新的匹配很可能 来自现有药物的库存。因此，使老龄化人口的健康最大化将越来越 依赖于促进在不同患者和情况下最有效地使用药物的政策。

PROJECT SUMMARY/ABSTRACT Project 8 – Medical Technologies: Aligning Private Rewards with Health Impacts Over the past several decades, new medical technologies have generated dramatic improvements in health outcomes for many groups of patients. While a key ingredient in the development of any new medical technology is a scientific breakthrough, market incentives are often a critical determinant of which scientifically feasible medical technologies successfully make the transition from a scientist's lab to a patient's bedside. Hence, the design of public policies that affect market incentives —such as the patent system and regulations such as those of the US Food and Drug Administration (FDA) direction of medical innovation. —can have important effects on the rate and The goal of this project is to investigate whether our current system of patent and FDA policies fails to provide incentives for the development of some scientifically feasible medical technologies that would generate health benefits to patients. Our focus is the so-called “new uses” distortion, which may arise in cases where an off- patent drug has a new use discovered, such as the discovery that an off-patent diabetes drug may be an effective cancer treatment. There are few incentives for private research investments into such new uses of old drugs, and public research subsidies are not explicitly designed to encourage research into such new uses. We will develop a conceptual framework for policy analysis (Aim 1) and will develop newly-constructed data (Aim 2) to empirically test (Aim 3) whether this “new uses” distortion results in some scientifically feasible drugs never reaching patients. We will then attempt to quantify the health value to patients of these “missing” medical technologies (Aim 4), in order to estimate the potential health gains that could be realized under alternative policies. The results of this project aim to contribute more broadly to the ongoing debate about how best to deliver evidence-based medicine to patients, particularly in the emerging field of personalized medicine. Specifically, to the extent that the “new uses” problem exists, the magnitude of the invisible costs of the “missing” innovations it may cause are growing as personalized medicine becomes increasingly important. Personalized medicine is based on the idea of separating patients into subgroups, under the assumption that drugs that work for one subgroup of patients may not work well for another. As progress is made in science and medicine about how best to classify patients into such subgroups, opportunities will arise for new medically valuable matches between drugs and more targeted groups—and many or most of these new matches would likely come from the stock of existing drugs. Maximizing the health of an aging population will thus increasingly depend on policies that promote the most effective use of medications across patients and conditions.