Can You Benefit from a Drug You Never Use?

It is no secret that those with an illness will welcome new, groundbreaking and effective medication. Most people, however, are not sick. But many of us are able to at least anticipate the possibility that one day we might become ill, and will likely feel more positive about our future if we know that new medicines will be there if we need them.

In newly published research, my co-authors and I aimed to use a real-world example to illustrate the idea that healthy people value medications for diseases that they don’t have – but might one day get (1). I’d like to explain our research here to encourage more discussion on this point.

In our work, we went back to a pivotal moment in pharmaceutical history; the invention of life-saving treatments for HIV – known collectively as highly active antiretroviral therapies (HAART) – which are credited with transforming HIV infection from a virtual death sentence into a chronic, but manageable condition.

Who benefitted from HAART? HIV-positive people are the natural beneficiaries; their survival rates soared, as did their quality of life. But in our research, we were more interested in HIV-negative individuals. We turned to a data set from the Multi-Center AIDS Cohort Study, following thousands of men who have sex with men, starting in 1984 – about half of whom were HIV-negative (2). The study asks questions about sexual behavior and conducts blood tests to see if anyone has become infected, and if so, whether or not their immune health is declining (a condition well known as AIDS).

We found that HIV-negative men started having riskier sex (for example, multiple partners and inconsistent use of condoms) after HAART came onto the market and we argue that this shift in behavior reflects changes to their views about the future. For HIV-negative men, the invention of HAART functioned somewhat like an insurance policy. By making HIV infection less terrible, HAART allowed HIV-negative men to go about their life (including riskier sex) with less fear of infection.

Our study does not condone risky sex (nor does it condemn it). It simply builds on the idea that individuals want to live long lives but also enjoy themselves. Therefore, when it comes to making decisions about risky behavior – the types of things that are enjoyable today (for example, alcohol, drugs, junk food), but may have negative consequences down the line – individuals tend to weigh the risks against the benefits, and then land somewhere in the middle.

Some people see this example of HIV and risky sex as extreme, but even the most careful among us take risks every day – for example, when we drive a car or even leave the house. We could certainly avoid most car accidents if we never drove, but then we would also sacrifice other things we enjoy, such as going out to restaurants or visiting friends, or even miss out on career opportunities.

I believe our findings have strong implications for how research dollars should be spent. Most people are not HIV-positive, but our study suggests that the “market” for HAART can be extended to include virtually anyone who is sexually active and at risk of infection. This is an important consideration; the appropriate allocation of research dollars should account for all potential beneficiaries of a new drug – and not just those who are already sick.

In terms of the perhaps not-so-obvious beneficiaries of pharmaceutical innovation, we also considered the value of a hypothetical, fully functional HIV vaccine. Clearly, HIV-negative men would be beneficiaries, as they would no longer have to worry about infection at all. However, HIV-positive men may also benefit from a vaccine because HIV-negative men would likely react to a vaccine with increased sexual risk-taking. As a result, HIV-positive men may have an easier time finding sexual partners.

The vaccine scenario is similar to the HAART example. In both cases, there is a group of obvious beneficiaries of a medical innovation, and less obvious groups who will also benefit. The big question is: how can we better promote the wider benefits of medical development? With every medicine, I encourage developers to think more about the true market for their innovation.