You get sick, you take a pill, you get better. It’s a fundamental part of modern healthcare, but how do you know that the pill you’re about to take is safe and does what it claims to do?
It takes significant testing to verify that a pill meets the standards for pharmaceutical quality—that it’s free of contamination or defects that might affect its safety or effectiveness. In the United States, ensuring pharmaceutical quality is an essential part of the Food and Drug Administration’s work.
That work, however, becomes much harder for drugs produced overseas, where it’s more difficult to regulate manufacturers and assess quality. For the past year, Duke M.D./Ph.D. student Christopher Behrer has been exploring this challenge through the lens of policy and economics.
"Pharmaceutical markets everywhere have this issue,” said Behrer, who is pursuing a Ph.D. in public policy and economics. “The question is: How do we provide and regulate the pharmaceutical quality standards while still being able to meet affordability when it comes to producing medications?"
Behrer’s research examines questions such as how prescribing physicians, pharmacies, or consumers react when a particular company fails to meet quality standards, and what happens to the demand for the product.
When pharmaceutical products don’t meet quality standards, they can harm patients and cause drug shortages. The concern is real, and it’s global. For instance, last December the deaths of 18 children in Uzbekistan were linked to a toxic cough syrup that contained a toxic solution.
Behrer is investigating the quality control of the Indian pharmaceutical industry, an overarching global health problem given India’s status as the world’s largest provider of generic drugs.
“The pharmaceutical world has really low-cost production of generic drugs that are often sent over to the developing world and to the United States,” Behrer said.
With funding from a Graduate School dissertation research travel award, he traveled to India to acquire price and quantity data on pharmaceutical products sold in the domestic Indian market. He plans to use that information to study price regulation, tax policy, pharmaceutical distributors’ behavior, the effects of quality regulation, and the tradeoffs inherent in a market for pharmaceutical products.
Behrer, who earned his B.A. in government from Harvard University, is part of the Duke Medical Scientist Training Program, which trains students as physician-scientists, equipping them to solve problems in human disease.
Prior to Duke, he worked at the National Bureau of Economic Research as a research assistant to economist Jonathan Gruber, a key architect of Massachusetts’ 2006 healthcare reform and a technical consultant in the development of the Affordable Care Act.
Behrer decided to pursue his M.D. and Ph.D. at Duke to help people. During his time at Duke, his interests have included health policy, economics, and global health, specifically public, labor, and development economics application to healthcare markets.
“I wanted more practical skills and to work directly with people,” he said. “Working in global health and medicine seemed like a very attractive way to have concrete impacts in international development.”