Bountiful Bogeymen: The drug companies-so easy to defend.

In his acceptance speech at the Democratic convention, Al Gore branded biotechnology and pharmaceutical firms enemies of the people. He lumped them in with polluters and tobacco companies as a force that stands in the way of better lives for millions of Americans. Thanks in part to such rhetoric, public contempt for pharmaceutical firms is running high.

But Gore's attack is factually wrong. He says that "most of the valuable research" in medicine is being paid for by taxpayers-when in fact, most of the gains in Americans' health are the result of the work of private-sector drug companies. Far from being an evil force, these firms have produced significant health benefits for millions of Americans at a relatively low cost.

The chief beneficiaries of the recent generation of drugs have been the elderly. The proportion of Medicare beneficiaries age 65 and older with a chronic disability was 21 percent in 1994, down from 24 percent in 1982. One reason is that we now have better drug treatments for osteoporosis, stroke, Parkinson's disease, congestive heart failure, and other diseases. Meanwhile, even as treatments improved, the amount that senior citizens spent on health care (including drugs) as a percentage of income remained unchanged.

But the value of pharmaceutical innovation has been totally ignored by both Gore and George W. Bush in the effort to pander to upper- and middle-class voters who want these life-enabling and lifesaving drugs at bargain-basement prices. Neither Gore nor Bush has pointed out that drug companies have helped create a way to mine the human genome to search for genes that cause and control disease; nor do they show any sign of understanding that this breakthrough-and its continued funding through pharmaceutical profits-is the key to future medical progress.

Those who bash the drug companies omit to mention the very specific ways these companies have improved the lives of millions of Americans.

AIDS. When AIDS was first identified in 1981, there were no medicines available to treat it; today there are more than 50 approved medicines to treat AIDS-related diseases. Combination drug therapy reduced AIDS deaths by more than 70 percent from 1994 to 1997. It has also enabled thousands of people with AIDS and HIV to go back to work and get on with their lives. And for all of Gore's bashing of Schering-Plough for the profits it has made on the allergy drug Claritin, it turns out that this relatively small company has created a compound that has already succeeded in blocking HIV viruses in test tubes and offers promise against AIDS.

Stroke. This is the third leading cause of death in the U.S. today, and the most common cause of disability among seniors. The timely use of clot-busting drugs has brought the death rate from stroke down by as much as 50 percent; the next step is to reduce even further the disability associated with stroke. Drug companies, biotech firms, and research institutions are zeroing in on neuroprotective agents, which protect the brain from damage caused by lack of oxygen and by the chemical reactions that occur in the injured brain tissue. The mechanisms and compounds for preventing such trauma are the result of private-sector investment and research.

Cholesterol. Today's anti-cholesterol drugs have been shown to reduce the rate of death even in healthy people, but these drugs have their limits because they cannot control the production of bad cholesterol; the next generation of cholesterol-fighting drugs will do just that. According to Science magazine, researchers have "pinpointed a biological master switch in mice that controls three pathways that work together to both rid the body of excess cholesterol and prevent its absorption from the intestine." The breakthrough basic research is being done by scientists at Howard Hughes Medical Institute, which receives major funding from drug companies.

Wherever you look, the private sector is leading the way. One of Gore's most resounding campaign pledges is to double federal research budgets to find a cure for cancer-but here, too, the real advances are taking place at private companies. Over the last decade, age-adjusted cancer-death rates have declined for the first time. Most future cancer treatments are being funded by pharmaceutical firms in conjunction with biotech companies. Researchers at Millennium Pharmaceuticals have identified the genes that control whether cancerous cells metastasize. Judah Folkman, a Harvard cancer researcher, had received about $5 million to support his research to identify factors that stimulate angiogenesis (the formation of new blood vessels). Folkman wanted to inhibit angiogenesis because cancerous cells help generate new blood vessels in order to grow tumors: Stop angiogenesis and you have a potent anticancer drug. It has taken the combined financial efforts of several drug and biotech companies to replicate Folkman's experiments and produce enough versions of the angiogenesis factors to run clinical trials in animals and humans. (Government scientists, meanwhile, were convinced that Folkman's work was a fluke-because they could not duplicate the angiogenesis effect of his compounds.)

Another important avenue to curing cancer is knowing whether people can tolerate a specific combination of drugs. Pharmacogenetics-the study of the genetic basis for reaction to drugs-will allow companies to develop many medications and their dosages on the basis of each patient's inherited ability to metabolize, eliminate, and respond to specific drugs. Using information about genes involved in processing drugs at the molecular level, drugs and vaccines can be developed to limit side effects, target cancerous cells more precisely, and reduce recovery times.

Chris Sander of Millennium Pharmaceuticals notes that, in general, the new drug science based on genomics will advance drug research and development, cutting pharmaceutical costs in the process. This, in turn, will lead to earlier disease prevention, better health outcomes, and a decline in overall health-care costs. Here too, 99 percent of the research studies are being conducted by private institutions.

On the campaign trail, you won't hear a word about this vast potential; nor that it is being paid for by the 10 percent of health-care spending that is devoted to prescription drugs. In fact, the biggest whiners about drug spending do not seem to be senior citizens (unless they are on the buses to Canada paid for by Big Labor), but HMOs and health plans that are seeing the demand for the fruits of medical progress cutting into their profits.

The rhetoric of the insurance industry's leadership is similar to Gore's: What good are all these drugs if we can't afford them? Why should drug companies charge such high prices if the government does all the research? The reality is that insurance companies and HMOs know that pharmaceuticals are transforming the way medicine is practiced and paid for. Specifically, drugs will be prescribed for people before they are sick, and will be available to people with chronic illnesses who will, as a result, live long and productive lives. Insurance companies and HMOs see a brave new world coming, and they are terrified: They fear that their profit margins will evaporate as their ability to resist consumer demand is overrun by the medical revolution.

Though they are afraid to withhold new drugs directly, Gore is doing their dirty work. He is effectively creating an expectation for breakthrough drugs at unreasonably low prices, and this expectation can only be met through price controls and rationing. Gore's rhetoric has already hurt our ability to sustain medical progress: HMOs and insurance companies are warning consumers they won't have access to medical breakthroughs if the government doesn't do something about drug prices. It's only a matter of time before drug prices, which are a relative bargain compared to the alternatives (expensive hospitalization, chronic illness, or death), are beaten-or regulated-down to the point where our pace of progress slows down to Europe's level. Whether Gore gets elected or not, that will be part of his legacy to the American people; and George W. Bush has yet to expend any political capital to reverse the harm Gore is doing. He should get going.