A few thoughts on the NIH, institutional inequalities, 8% NCI paylines, and Elizabeth Warren. 
In the 1990’s, Princeton chemist Ed Taylor developed pemetrexed, an antifolate chemotherapy. The drug extended lung cancer survival and quickly became widely used (it’s not the most impressive KM plot, but lung cancers are awful and hard to treat). medicines.org.uk/emc/product/38…
The drug was licensed by Princeton to the pharmaceutical giant Eli Lilly. The US sees about 200,000 new lung cancer patients every year, and a large fraction of them were treated with pemetrexed. In 2011 alone, the drug had over a billion dollars in sales. fiercepharma.com/special-report…
That was good for Eli Lilly’s stock price – and for Princeton too. Thanks to their licensing agreement, Princeton received more than 500 million dollars in royalties from sales of this single drug. dailyprincetonian.com/article/2013/1…
The royalties were used to construct a gorgeous 263,000 square-foot Chemistry building, to support other Princeton research, and to give some of the faculty a (sizable) raise. nj.com/news/2010/09/p…
At the same time, do you know who else supported Ed Taylor’s research? The NIH! Pemetrexed was developed thanks to an NCI R01 entitled, “DEAZA DERIVATIVES OF TETRAHYDROFOLIC ACID”. projectreporter.nih.gov/project_info_d….
Despite being developed with over a million dollars in NIH funding, the NIH didn’t get a dollar from Eli Lilly for pemetrexed.
Taking a step back: about a quarter of all new drugs are discovered in academia (and then developed in partnership with biotech/pharma). Nearly all of this academic biomedical research is supported by the NIH nature.com/articles/nrd32…. pnas.org/content/115/10….
Putting aside for a second the question of Eli Lilly’s right to make billions of dollars from a drug – when considering the academic, preclinical development process, why should Princeton get $500 million and the NIH $0?
Let’s imagine, for a second, a world with an Elizabeth Warren-style tax – not on wealth, but on blockbuster drugs. If a drug has >$100 million in sales, and if it comes directly from NIH-funded research, then let’s say the NIH gets two pennies for every dollar in sales.
By the time pemetrexed’s patent expires in 2022, it looks like it will generate over $25 billion in sales. Throw in a 2 cents per dollar “NIH-supported research payment" – and that’s $500 million, or enough to fund more than 250 new R01 grants.
In 2018, the NCI gave out 647 R01’s. If these extra grants were awarded over 5 years, they would be enough to get the NCI’s R01 success rate up to 12%! Just from a single NIH-funded blockbuster drug. report.nih.gov/success_rates/…
Pemetrexed is a particularly striking example, but many other drugs developed in academia would qualify for this too. Thalomid – from Rockefeller/HMS – made billions for Celgene and could also fund hundreds of new R01’s. blogs.sciencemag.org/pipeline/archi…
There’s an additional point that I want to make: we are living during a period of immense structural and institutional inequalities. Princeton (my alma mater) got to benefit from pemetrexed’s sales, but the NIH (which ostensibly has a national purview) gets nothing.
State universities have been starved of funding, and there has been an immense consolidation of research into a few select cities/institutions. 10% of institutions get 80% of research funding. theatlantic.com/education/arch… tandfonline.com/doi/full/10.10…
Institutions like Princeton get their millions, and can pay for the newest/best buildings, equipment, students, etc. Despite the fact that American taxpayers paid for the R01 that led to pemetrexed’s development, all other institutions get nothing.
I don't think that that is healthy for the biomedical research ecosystem.
And of course the NIH is far from blameless here, and has contributed to these structural funding imbalances. But I think that greater NIH funding is an absolute boon, and, if divided wisely, it would have the potential to counteract some of this research consolidation.
So – I’m absolutely not contesting Princeton’s right to collect royalties on its drug. The new Chem building is beautiful! But I don’t think Princeton should reap all the benefit. How about a 2% fee on blockbuster drugs developed with NIH funding go back to the NIH?
