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Welcome back to innovation hub. I'm Tara Miller. We're talking about the astronomical prices of new innovative drugs like a $300000 pill called cone light eco which comes from the company vertex and helps treat cystic fibrosis and very worth you have spent years writing about the pharmaceutical industry. And you were saying that apart from some of these massively expensive breakthrough drugs there's also a huge productivity crisis in the industry. I wonder if that money that should be spent to develop drugs is instead being spent on advertisements. I mean I don't know if you ever watch the commercials during the night Lee news when morning comes in the middle of the night. It affects your entire day. Whatever you do you feel lonely and don't enjoy the things you once loved anyone with high cholesterol maybe an increased risk of heart attack. Diet and exercise were enough for me. Side effects may include dry mouth insomnia sexual side effects diarrhea nausea and sleepiness where he would increase gambling

going tend to just as well as abnormal behaviors such as being more outgoing or aggressive than normal confusion agitation and hallucinations. Talk to your doctor about. Talk to your doctor about your risk. Contact your doctor immediately. These ads lead me to a simple question Do drug companies just spend way too much on advertising. Well the answer there is of course they do. I think the worst thing that's happened probably in pharmaceuticals in the last 20 years was the decision in the late 90s to allow direct to consumer advertising if you're older than 30 you may remember a time when the nightly news wasn't saturated with drug ads. But the drug company anticipating these patent cliffs and this loss of revenue pushed very hard through the 90s to get the government to allow them to put TV ads on if you study these ads closely of course what you see is some people who seem to be getting some. Great thrill out of life in some tremendous benefit but it's completely detached from the audio portion which is

simply a lengthy description of all of the things that can go wrong if you take absolutely if you close your eyes seeing what there is yet as if the side effects are for a drug that very often doesn't do anything particularly amazing for you. That's exactly right and it gets back to my original point which is here you have these companies marketing to consumers. You know the great experience here was with a drug for heartburn. The purple pill and this was one of the first triumphs of marketing of advertising when when pharma was finally allowed to do this. And they just said ask your doctor for the purple pill. Now as it turns out this is a pill that actually works very well against heart burn. But the point is you going to people who have no way of valuing whether something works or not or whether it's better than the competition or not. You're saying to them Go ask your doctor for this so you walk into your doctor's office and he or she says What's the matter and you say well I've got some heartburn and I want to take the purple pill. It really got reduced down to that level this became the most

successful market expansion in history of any drug. And so what we've got now is this parade of the ads on the evening news every night for drugs that are marginally better than existing drugs that are generic probably by now a desperate attempt by big pharma to wring the last profits out of these expiring products before they go generic. You know if you go back to those ads that we're talking about one of the things that is also striking and one of the questions I have is have we entered an era in which there's just not great innovations in drugs anymore because a lot of those drugs are what you were kind of calling the meat to drugs better sleeping pills testosterone gels erectile disfunction antidepressants. They're not curing cancer they're not dealing with all Simers they're not dealing with some of the really really big problems that are left unsolved. Well I think you've identified the big problem with big pharma. That is the drug companies became tremendously successful and profitable in the 80s and

90s and a kind of very conservative corporate strategy took hold across the industry which was incremental as I'm trying to bring out a quick to market improvement over something that already exists that you can then go sell the hell out of so that Lipitor for instance was the fifth Staton drug against cholesterol. There were four others that were out there that were doing just fine. And Lipitor had a slightly better profile and Pfizer bought a company Warner-Lambert that had developed it and then applied this huge marketing effort to make it a great commercial success. Was it necessary Did it really make a difference. What were the opportunity cost lost by investing so much in this when as you say there are so many untreated diseases that still need attention. On the other side there has been a huge upsurge of very promising science across the board and has been applied most effectively by small companies.

So there's actually a tremendous amount of innovation within the drug sector but it's not coming from the big players anymore it's coming from smaller companies like vertex. Okay so it sounds like you've got sort of big companies but you're not worried that innovation is going away because it's happening in small companies is that well there's reason to worry. You know a lot of the basic science discoveries are funded by the NIH which is suffered under the sequester. The road to profitability the road to commercializing pharmaceutical product hasn't gotten any shorter and hasn't gotten any less expensive so it's going to take you somewhere between a decade in two decades. The odds against your success are 30 to one. The cost is well in excess of a billion dollars but then if you factor in all of the costs of the ones that crashed and burned it's probably closer to five billion dollars. And the question is Where is all that money going to come from to subsidize to sustain this work until we actually see the drugs that we hope to see out of it.

Is America where the best drugs are coming from. Or is there somewhere else we should be looking to. No and you know that's the catch. OK when you talk to people in the drug industry and you say listen we need some more kind of rational value based outcome based system for deciding how to bring these medicines forward and get them to patients. They say well look at the other countries where they have that. And all you need to do is to go to Cambridge Massachusetts and look at the tremendous building boom in the tech Square area and see who is building there Novartis which is a large Swiss company. The foreign drug makers are building labs now here to be closer to the most innovative discoveries which tend to be coming out of the universities that run on the money. So there's the hook. We do have this out of control payment system in the United States. We also have the most innovative science and the most anticipated discoveries.

So if I may said to you Hey Barry were you studied this how do you design an industry that promotes innovation. What would you say. I'd say what you need to do is look at each drug in terms of the value that it will add to patients lives and to society and that it's probably well worth paying a lot of money for drugs that have a high value to patients and a high value to the country. And it's not worth paying for expensive drugs that don't do that and really make a delineation there. Let me just add one factor here which I think is something that also hasn't been addressed much. This whole period that I was describing with big pharma in charge is generally referred to as the blockbuster era where the blockbuster era is over and what we're seeing more and more is companies focusing on high value drugs that really make a difference for small numbers of patients like collided CO and that cost a tremendous amount of money and that really is the model towards which the whole industry is

evolving. And as a consequence we're really going to have to hit a reckoning point pretty fast because as I said earlier on we can afford to pay very high prices for very good drugs for small numbers of patients now but when there are more of them the costs are quickly going to become unsustainable. So I said the key here is value. Is this really important. Life changing transformational medicine for very sick patients if it is I think we'll all agree it's worth the cost if it's something that's not any better than another drug it only adds a month and a half of life to an already very sick probably quite old patient. We can't afford that anymore it's not you know I know this raises the whole specter of death panels but it's simply not sustainable. As I see it. Well it's tricky we already have a situation in which 5 percent of patients use about 50 percent of the health care spending. And as these drugs pop up for more common problems the breast cancers in the lung cancers as you say we may hit a reckoning

point. Right and the other key here is better diagnostics and this is coming you know 10 years ago if you had lung cancer they would try this and then they would try that and they would try the other thing and it would be effectively a hit or miss trial and error medicine. It's now understood that 10 percent of patients have a certain genetic mutation that will make them much more likely to improve on one drug or another if we can begin to do less hit or miss medicine and more targeted directed medicine that will treat the people who need to be treated and we won't use for treating the people who don't need to be treated that will be again another more rational more refined way of dealing with the problem. Barry worth is the author of the antidote inside the world of new pharma. He is also the author of a tale of two drugs in the MIT Tech Review very Worth thank you very much for coming in and joining us. You're very welcome.

And finally today health through a very different lens. And there is Nutella in this story. So get ready. New research has begun to show that your taste preferences may have been determined by what your mother ate during her pregnancy. Kristen Wartman has written about these studies for the New York Times. We had to ask her about them. So Kristin how do researchers know whether what we like to eat is really due to our mothers and their diets. The studies I focused on were the ones that showed babies born to mothers who ate you know highly processed foods foods high in sugar and salt in particular then had a preference for those foods later in life. But that studies actually the second study in my article from the University of Adelaide. The Chemical Senses Center studies show that

for example babies who are formula fed don't get that exposure to a wide variety of foods so that when they're weaned off of formula they then don't have that kind of diverse palate that's accepting of a broad range of flavors. And it's the same for women who breastfeed but don't eat a wide variety of foods. So those babies also will prefer the same kind of monotonous flavors. So let's get to formula in a minute but let me ask about how you figure out whether kids like Cheetos at four or five years old because of what they were exposed to when they were in utero. Well so the science from the Mon-El center isn't quite that direct. It's more looking at bland flavors vs. very pungent or sour flavors. And what they found was that since babies and human beings are hard wired to like sweet sugary food since breast milk is naturally sweet and it was part of our evolutionary safeguards so that we didn't

eat anything poisonous. Babies don't need to learn to like sweet. But what they do need to learn to like things like broccoli or other kind of pungent foods. And so if they're not exposed to that early on they're less likely to want to eat those foods in. And what they found was that if you don't eat them before you're about two or three years of age it's very difficult to change that later in life. If you want a more direct correlation for example for something like Cheetos you can look at the study from the University of Adelaide which is in South Australia and researchers there found that mothers who eat a diet high in junk food and they actually used Cheetos as one of the foods they used tele they used tiny teddies and Fruit Loops. It was a rodent model and those offspring the mothers who ate those kinds of foods then had a de-sensitized reward pathway in the brain meaning they had more of those same foods in order to get the same feel good response much like you see

in drug addicts. So just a little bit of Nutella is not going to do it for you after a while. Right. So you'd have to eat more Nutella or more of the fruit of the Cheetos or the fruit loops to get the same feel good response it's an opioid pathway in the brain. It's actually the same pathway that responds to drug use. So if you eat a regular serving of Cheetos for example but your mother ate them while you were pregnant while she was breastfeeding you you don't get that same hit of that pleasure response and so you have to eat more of it to get the same response as someone who wasn't exposed to that in utero or in breast milk. Now I can hear a lot of people saying and I'm saying it myself. I know when I was very young at least my parents told me so that I pretty much just bread and cheese and butter and pasta and that kind of thing. But now i almost every vegetable. So how do you I mean and a lot of kids I know are sort of fussy eaters. So how do you explain that kind of evolution of

of taste as you get older. Well that's absolutely true but why not set your kids up to not have to go through that rough period of really being picky eaters and only wanting the bland foods until they're in their 20s because you know your brain develops your heart develop your eyes develop all these important parts of your body are developing and they require highly nutrient dense diet in order to function properly so if you can set your kids up to like these really nutrient rich foods as early as possible why not. Also why not in your spare yourself the trouble of dealing with fussy and picky eaters. I'm Karen Miller. This is innovation hub from WGBH We're speaking with Kristen workman a journalist who has contributed to the Atlantic the Huffington Post The New York Times. She's the author of bad eating habits start in the womb in the New York Times and we'll link to that on our website. You make this case that in some ways industrial food is very very innovative and this even extends to baby

formula. In what ways are the makers of industrial food. What ways do they try to make inroads with formula over breast milk. Well we know there's been terrible history of formula makers going to developing countries and marketing formula in the place of breast milk in this country. Formula makers go into hospitals and they provide these kind of goodie bags to hand out to new mothers which include samples of formula mothers interpret this as a sign of approval from the medical community that formula is is good. Labels on formulas say things like similar to breast milk or you know same nutrition as breast milk but that's really not true. It's impossible to mimic the actual nutrition you get from breast milk because it's constantly changing. It changes from woman to woman it changes from day to day or minute to minute even based on what the mother is eating and the researchers at the moon else unter find breastfeeding so important and such an elegant system for

teaching babies what foods they can then expect later in life because they're going to be getting the flavors that the mother is eating through the breast milk. And it allows them to have this wide open palette to those same foods. But an interesting thing about the formula business which I did not realize is it's an incredible growth business. Who would expect that. Well it's booming overseas just in 2013 alone it was the largest growing functional food segment in the world and China is a big market for it and functional foods are the foods that the industry creates and tells you are better than natural real Whole Foods. And this is largely a marketing scheme because they obviously make a ton of money on something like formula where they're not making any money if you're breastfeeding one of the solutions that you've proposed to the common diet processed foods including things like we talked about like Cheetos and Nutella and even Formula One of the solutions that you offer is have people do more cooking at home. And you've

even said you know we should do we should pay people to cook at home. Explain that proposal which seems quite amazing. Yes. It would be amazing. Quite unusual yeah and unusual yes. Well this you know that article you're referring to which was also a New York Times op ed piece actually links very well into this piece because the reason so many women don't breastfeed is because we don't have paid maternity leave in this country. So many women are working full time or they're single mothers and they don't have the ability to be home with their child and exclusively breast feed them you know for up to two years. That's the World Health Organization recommendation. So if we could somehow make it that raising healthy kids cooking in the home breast feeding our babies these are Purdy's they're important for the society to run well. So I propose that perhaps if we could have some kind of program or incentives to pay women or men if men just so choose to stay home cook

for their kids there could be healthy we have to take certain courses on how to shop for food how to prepare food and you know perhaps qualify for something. But I think that this gets to the root of the problem in America where people don't have the time to cook food cooking shopping preparing foods takes an enormous amount of time if you have children you know how hard this is when you're working. So that was my kind of radical solution to this problem we always were always harping on you know eat healthy cook healthy. But if you don't have the time to do it it just becomes you know insurmountable. Obviously there's a lot of discussion about government budgets and cutbacks. Would paying people to cook at home be worth it. I think so. You know the whole kind of germ of an idea for the piece came from Selma James who was a labor activist and feminist scholar writer. She had this idea of wages for housework. And it really you know strongly connects to paying people to cook at home wages for housework care for children

cooking cleaning all these things that women generally women do but more and more men are doing as well but they're not compensated for yet they're the foundation for our economic system to even run in this country it's so much you know we pay people to take care of our kids to clean to cook we pay them to do it. But then what about their children. So I just saw the recent report that one third of all women living in poverty. So you know why not think of some radical new idea of way to get lift women up out of poverty create healthy homes create healthy children and prioritize health in this country. Is there any country state area that has ever paid for this kind of thing where you can say OK well this is the laboratory they actually paid people to do cooking or some other domestic work. Well there are some northern European countries that have these time off or part time off programs so people can children when you have so small children up to eight years old you can be paid but work you know a quarter of the

time. So you're getting the same amount of money but they recognize that the work of raising small children and what you need to do to make them healthy adults and productive citizens is to take care of them properly cook for them and care for them. So there are some models of that not quite exactly what I'm suggesting but something that's along those lines. Kristen workman is a journalist. She's the author of bad eating habits start in the womb. She has contributed to the Atlantic the Huffington Post and The New York Times in which this piece appears and we will link to it on our website. Kristen workman thank you so much for joining us. Do you think so. And thank you for joining us. Remember that you can learn more about our conversations on how money bins are my on the astronomical cost of new drugs and on how our taste preferences might be formed in the womb. On our website innovation hub dot org and you can also share our segments on iTunes or SoundCloud

From NPR and WGBH radio. I'm Karen Miller and this is innovation.