1. We should recognize the enormous cost of those conditions for which we do not yet know enough to treat affected patients effectively, let alone prevent the disorders. More of the same is not good enough for our children and grandchildren. 2. We should put more emphasis, especially with public funds, on scientifically interesting, low- cost interventions for which there may be no proprietary incentive for industry. One successful example is the fortification of flour and grains with the B vitamin folic acid since 1997. This action has greatly reduced the incidence of one of the most serious categories of birth defects— neural tube closure defects (spina bifida and anencephaly).* The cost of such fortification of cereal grains is extremely low, and everyone receives the ''treatment." Such public health advances often meet with fierce resistance from an uninformed population or others with different agendas, which must be dealt with by effective communications plans. 3. We should be aware of the very high—and increasing—costs of bringing effective new drugs to the marketplace. We need to refine the regulatory process to make approvals less costly, while simultaneously requiring post-marketing surveillance to more readily recognize adverse effects and take steps to prevent harm. New genomics and proteomics methods may well yield biomarkers useful in identifying subgroups of patients and specific molecular targets or combinations of targets for new drugs. *It was thought very likely that folic acid (and vitamin B12) administration through fortification or through supplementation to reduce circulating homocysteine levels would have the additional benefit of reducing the nation's number-one cause of death—cardiovascular diseases (heart attack, stroke, and peripheral vascular disease.)8In this case, however, no benefit was demonstrated in the research studies of risk-reduction in patients with existing heart disease.
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