On Thursday, as I was leaving the UCLA dental clinic after having a crown re-cemented, I paused to read a research poster (whether student or faculty I couldn’t tell) about the prospects for developing a vaccine against dental caries (cavities). The poster claimed that vaccine development was technically feasible, though not likely to happen quickly, and that immunity was likely to be passed down from mother to child in breast milk, so that vaccinating one generation would protect future generations.
According to an NIH panel report, this is not work likely to be funded by the pharmaceutical industry; the best time to do the immunization is before teething, which means that the clinical trials to determine whether the vaccine prevented caries in adults might last longer than the patents.
The benefits for prosperous people in rich countries would be considerable; the benefits for those who can’t afford dentistry, including many poor people in rich countries and most of the population of developing countries, would be enormous.
The panel reports that vaccine development would cost “a lot of money,” which isn’t very precise. But the present value of the future stream of savings from such a vaccine, on a willlingness-to-pay basis, would obviously be in the hundreds of billions, if not the trillions.
[Introspect: what proportion of your lifetime income would you, personally, pay to never again have a filling, a crown, or a root canal, including the cost of the procedures themselves? A tenth of 1%? That is, if you expect your lifetime income-stream to average $50,000 a year, would you be willing to pay $50 a year of that to avoid all caries-related dental work? Surely not less, even if your teeth are much better than mine. I’d pay a couple of percent without thinking twice. Gross World Product is running about $50 trillion a year; a tenth of one percent of that is $50 billion. (Yes, I know the relevant number is personal income rather than gross product, but for back-of-the-envelope purposes we can ignore the difference.) What’s the value of a stream of benefits of $50 billion per year? Assuming a discount rate 10 points higher than the rate of growth of income, and a useful life of 20 years starting 10 years from now gives a present value of about $180 billion. Compared to numbers in that range, whatever we’d actually have to spend is rounding error.]
If you’re ever tempted, as I have been, just for a moment, to imagine that the public-health left — which, Lord knows, can be astonishingly wrong-headed — is anywhere near as nutty as the religious right, just ask yourself: will anybody, even Sidney Wolfe, oppose the development of a caries vaccine out of fear it will encourage people to eat candy?
And the heartwarming fact is that the organized dental community, having pushed hard for fluoridation, will likely get behind this new initiative to reduce the demand for dental services. But that doesn’t mean it’s going to happen on its own in anything like the right time-frame.
I wonder how this would work as a political issue? Maybe worrying about cavities is infra dig. for a Presidential candidate. Or maybe this is exactly the sort of issue that could, in skilful hands. be used to remind voters that there are more painful aspects of life than taxation, and that tax dollars can be used to eliminate some of them.