How many new drugs do we need, exactly?

Here are two fairly uncontroversial theories: If drugs were cheaper, more people would have access to them; and if drug companies made less money, they’d invent fewer drugs. The controversy comes in when you start involving actual numbers, and, conveniently, the Congressional Budget Office has done just that.

In a preliminary analysis of Rep. Nancy Pelosi’s drug pricing bill, the CBO concluded that, over 10 years, the drug industry would lose out on between $500 billion and $1 trillion in revenue. And as a result, the world would lose out on eight to 15 new drugs over a decade, according to the CBO.

How you feel about that prospect depends entirely on which eight to 15 drugs you’re imagining. Each year, the FDA approves an average of 30 new products. Some of them are never-before-seen treatments that change the course of medicine; some of them are a 19th drug for arthritic pain.

Society would by and large prefer more of the former rather than more of the latter, but just which drugs pharma would prioritize is a matter of debate. What do you think? If the CBO’s estimated future came true, pharma would _____________.

invest less in things like CAR-T and gene therapy because they’re too risky
stop developing me-too drugs because there’s too much competition