Effective clinical innovation: an ethical imperative

• Published in: The Lancet (British edition) Vol. 359; no. 9320; pp. 1857 - 1858
• Main Author: Horrobin, David F
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 25.05.2002; Elsevier Limited
• Subjects: Bioethics; Committees; Costs; Disease prevention; Drug Therapy - trends; Ethical standards; Ethics; Ethics, Medical; Humans; Innovations; Life expectancy; Medical ethics; Medical research; Patients; Pharmaceutical industry; Research - trends; Risk analysis; Risk factors; Skin diseases; Africa; Biomedical and Behavioral Research
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(02)08707-X

We are making depressingly slow progress with specific medical interventions. With the increase in western affluence and the reduction in major risk factors such as smoking there has been a steady rise in general health and life expectancy but one that has little to do with specific medical actions. A person who develops nearly any type of cancer, common skin disease, asthma, or psychiatric or neurological illness is unlikely to be much better off than if they were receiving the best available treatment 30-40 years ago. Even in the cardiovascular area, in which there seems to have been a great deal of innovation, improvements are small and are shown only by very largescale trials. We have a clearer idea about just how effective or ineffective specific interventions are, and effective interventions may be more available than they were, but for many common diseases we are simply not doing very well. Much of the escalating cost of medicine relates not to new and effective cures but to the expense of implementing inadequate treatments, which, because of their poor effectiveness, ensure that patients repeatedly return to their doctors. Innovation in the development of effective specific drugs and preventive measures had a golden age between about 1930 and 1965. Much less of significance has happened since then. A large part of the explanation is that we have lost our enthusiasm for clinical innovation and our sense that such innovation is an ethical imperative.