More Drugs, Less Crime: Health Reformers Should Worry About Setting Back Pharmaceutical Innovation

In 1990, the United States was near the peak of a decades-long crime wave. Time magazine reported that New York City was undergoing "a surge of… violent crime that government officials seem utterly unable to combat."

Less than two decades later, the city's crime-rate has plummeted. Noting yet another year-over-year decline in criminality, The New York Times recently reported that experts are at a loss as to explain why – but many credit the impressive work of the New York Police Department.

To be sure, the NYPD has done impressive work, but it's important to understand that New York's experience mirrors similar drops in crime across the country. Beginning in 1960, U.S. crime rates climbed steadily, and for decades they showed no sign of slowing. By the early 1990s, each year saw nearly 800 violent crimes for every 100,000 residents – up fourfold from fewer than 200 three decades before.

But then, both violent crime and property crime dropped sharply. The trend has continued steadily downward ever since.

Numerous explanations for the shift have been proposed, but none fully explain the simultaneous downturn in crime in the U.S. and in our neighbor to the north, Canada.

So what happened? A new report from the National Bureau of Economic Research suggests that the decline in crime was directly influenced by the increased efficacy and prescription of psycho-pharmaceuticals – drugs used to treat mental illness.

As Congress considers how to reform America's health sector, and with it, make major changes impacting the pharmaceutical industry, it is worth recalling that drugs don't merely make individuals healthier – they can improve society as a whole in subtle and unexpected ways. The authors of the report, Dave Marcotte of University of Maryland and Sara Markowitz of Emory University, examined evidence dating from 1997 through 2004. They found a clear pattern: As prescriptions for psychiatric drugs increased, the incidence of violent crime decreased. In particular, they found that sales of the newest, most cutting-edge drugs meant to treat Attention Deficit Hyperactivity Disorder correlated most strongly with drops in violent offenses.

Their estimates suggest that advances in psychopharmacology technology may have accounted for as much as 12% of the recent drop in crime nationwide. Moreover, that's without even looking at the early '90s, which, the authors note, was "a period of the largest expansion of treatment for mental illness and most rapid decline in criminal violence."

Nor is this the first time psycho-pharmaceuticals revolutionized the way we treat mental illness. After their introduction in the 1950s, doctors for the first time had a way to provide life-altering treatments for their patients. And today, antipsychotic drugs are widely considered the most effective stabilizers for individuals with mental and behavioral disorders.

Take the story of Janet (not her real name), which is relayed on the Bronx district attorney's Web site. Before the age of 30, Janet was a dropout, drug addict, and five-time felon with a long police record, including a term in state prison.

Janet, however, was not merely an offender. She was deep in the throes of severe, life-long mental illness. Once treated, Janet managed to obtain an apartment of her own, and she got certified as a substance abuse counselor. Her pathway to success was through the borough's Mental Health Unit and a drug treatment regime that included antipsychotics.

Janet's story, and the untold number just like it, wouldn't have happened without constant innovation in the pharmaceutical sector. The process of creating a breakthrough drug starts in the lab. Using increasingly sophisticated research techniques, scientists have made some unprecedented discoveries about the biopharmaceutical underpinnings of mental illness. The most promising discoveries eventually become full-fledged drug treatments, but only after years of development and billions in financing.

Unfortunately, some lawmakers are pushing to impose heavy-handed regulations on the pharmaceutical sector that would dry up resources for research and deny patients access to needed medicines.

For instance, many in Congress want to allow the government to dictate prices and rebates for drugs covered by Medicare. In the Medicaid program, companies already are required to rebate back to the government 15.1% on the amount Medicaid spends on brand-name drugs. In the drug program administered by the Department of Veterans Affairs, pharmaceutical firms are required to give discounts of 24%. The Medicare program would likely be restructured along these lines. If forced to provide these sorts of massive and arbitrary discounts, drug companies would have less money to invest in research and development, and we would see many fewer new and better drugs.

Another disastrous reform that has already begun to take effect involves so-called comparative effectiveness research. This is government-funded research used to determine which medicines are worth their cost, and which aren't. Those medicines that don't meet a certain arbitrary cost standard could end up being denied to patients covered by public health programs.

When you consider that anti-psychiatric drugs have played a crucial role in the dramatic drop in violent crimes in this country, any policy that makes it harder for Americans to access these medicines shouldn't even be considered.

If regulators take steps to encourage – not undermine – pharmaceutical innovation, we can witness even greater public health successes in the future.

Grace-Marie Turner is president of the Galen Institute, a nonprofit research organization focusing on patient-centered solutions to health reform.

Published in the New York Daily News, October 26, 2009

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In 1990, the United States was near the peak of a decades-long crime wave. Time magazine reported that New York City was undergoing "a surge of… violent crime that government officials seem utterly unable to combat."

Less than two decades later, the city's crime-rate has plummeted. Noting yet another year-over-year decline in criminality, The New York Times recently reported that experts are at a loss as to explain why – but many credit the impressive work of the New York Police Department.

To be sure, the NYPD has done impressive work, but it's important to understand that New York's experience mirrors similar drops in crime across the country. Beginning in 1960, U.S. crime rates climbed steadily, and for decades they showed no sign of slowing. By the early 1990s, each year saw nearly 800 violent crimes for every 100,000 residents – up fourfold from fewer than 200 three decades before.

But then, both violent crime and property crime dropped sharply. The trend has continued steadily downward ever since.

Numerous explanations for the shift have been proposed, but none fully explain the simultaneous downturn in crime in the U.S. and in our neighbor to the north, Canada.

So what happened? A new report from the National Bureau of Economic Research suggests that the decline in crime was directly influenced by the increased efficacy and prescription of psycho-pharmaceuticals – drugs used to treat mental illness.

As Congress considers how to reform America's health sector, and with it, make major changes impacting the pharmaceutical industry, it is worth recalling that drugs don't merely make individuals healthier – they can improve society as a whole in subtle and unexpected ways. The authors of the report, Dave Marcotte of University of Maryland and Sara Markowitz of Emory University, examined evidence dating from 1997 through 2004. They found a clear pattern: As prescriptions for psychiatric drugs increased, the incidence of violent crime decreased. In particular, they found that sales of the newest, most cutting-edge drugs meant to treat Attention Deficit Hyperactivity Disorder correlated most strongly with drops in violent offenses.

Their estimates suggest that advances in psychopharmacology technology may have accounted for as much as 12% of the recent drop in crime nationwide. Moreover, that's without even looking at the early '90s, which, the authors note, was "a period of the largest expansion of treatment for mental illness and most rapid decline in criminal violence."

Nor is this the first time psycho-pharmaceuticals revolutionized the way we treat mental illness. After their introduction in the 1950s, doctors for the first time had a way to provide life-altering treatments for their patients. And today, antipsychotic drugs are widely considered the most effective stabilizers for individuals with mental and behavioral disorders.

Take the story of Janet (not her real name), which is relayed on the Bronx district attorney's Web site. Before the age of 30, Janet was a dropout, drug addict, and five-time felon with a long police record, including a term in state prison.

Janet, however, was not merely an offender. She was deep in the throes of severe, life-long mental illness. Once treated, Janet managed to obtain an apartment of her own, and she got certified as a substance abuse counselor. Her pathway to success was through the borough's Mental Health Unit and a drug treatment regime that included antipsychotics.

Janet's story, and the untold number just like it, wouldn't have happened without constant innovation in the pharmaceutical sector. The process of creating a breakthrough drug starts in the lab. Using increasingly sophisticated research techniques, scientists have made some unprecedented discoveries about the biopharmaceutical underpinnings of mental illness. The most promising discoveries eventually become full-fledged drug treatments, but only after years of development and billions in financing.

Unfortunately, some lawmakers are pushing to impose heavy-handed regulations on the pharmaceutical sector that would dry up resources for research and deny patients access to needed medicines.

For instance, many in Congress want to allow the government to dictate prices and rebates for drugs covered by Medicare. In the Medicaid program, companies already are required to rebate back to the government 15.1% on the amount Medicaid spends on brand-name drugs. In the drug program administered by the Department of Veterans Affairs, pharmaceutical firms are required to give discounts of 24%. The Medicare program would likely be restructured along these lines. If forced to provide these sorts of massive and arbitrary discounts, drug companies would have less money to invest in research and development, and we would see many fewer new and better drugs.

Another disastrous reform that has already begun to take effect involves so-called comparative effectiveness research. This is government-funded research used to determine which medicines are worth their cost, and which aren't. Those medicines that don't meet a certain arbitrary cost standard could end up being denied to patients covered by public health programs.

When you consider that anti-psychiatric drugs have played a crucial role in the dramatic drop in violent crimes in this country, any policy that makes it harder for Americans to access these medicines shouldn't even be considered.

If regulators take steps to encourage – not undermine – pharmaceutical innovation, we can witness even greater public health successes in the future.

Grace-Marie Turner is president of the Galen Institute, a nonprofit research organization focusing on patient-centered solutions to health reform.

Published in the New York Daily News, October 26, 2009

SHARE THIS ARTICLE

About the author