“Peak Pharma” is now—access to drugs, NOT innovation, increases lifespan.

We’ve already gotten most of the benefit from pharmaceutical discovery that we are ever going to get. It doesn’t matter if the flood of new drugs slows to a trickle. Few of them will have much impact on health and lifespan. Access is a bigger problem than innovation.

We’ve all seen this graph or one like it.

Spending a few hundred dollars per capita to provide clean water, vaccines, antibiotics and maternal care has an enormous impact on health and lifespan. Expenditures above $2000 show no clear trend in improving health and life.

That’s at the population level, of course, and large benefits to small numbers of people are masked. And this graph looks at all health expenditures, of which pharmaceuticals are usually only a small portion (they account for about 10% of health spending in the US).

What’s the evidence that innovative (and pricey) new drugs help us live longer lives? It is surprisingly weak. The Manhattan Institute published a study [1] (sponsored by Aventis, J&J, Novartis, Pfizer and Pharmacia) claiming new drug launches added 0.8 years of life expectancy 1986–2000. The methodology of this study has been slapped down hard [2]. But even if correct, new drugs would account for only a fraction of the roughly 4 years of increased world life expectancy in this period.

The picture is a bit clearer when we look at individual drugs and diseases. Statins - hailed as one of the great drug advances of all time - clearly reduce deaths from heart disease. But the overall increase in lifespan? It’s 3–4 days [3]. That’s right. Years of statin therapy will buy you half a week of existence. Yikes.

At least statins are cheap. How about all those new and obscenely expensive[4] cancer drugs? Cancer drugs introduced in the EU between 2009–2013 added a median of 2.7 months of survival [5]. Half showed no clear benefit at all. Would we, as a society, really suffer if drug companies had decided not to develop them?

If new drugs for heart disease and cancer - the leading killers in developed countries - have so little impact on lifespan, then new drugs for other diseases will have even less impact.

I’ve argued (here and here) that we’ve reached Peak Pharma - that the drug company business model is no longer economically viable. What’s less obvious, but no less true, is that we’re not going to miss them when they go.