Response to Michael Wonder’s comments on the article ‘Assessment of the therapeutic value of new medicines marketed in Australia’

We thank Michael Wonder for his comments on our article ‘Assessment of the therapeutic value of new medicines marketed in Australia’ which give us the opportunity to clarify some points further. We agree with him that the definition of pharmaceutical products which are ‘considered innovative as long as they are new and the success of innovation is defined in terms of sales, with the assumption that higher sales is a measure of the intrinsic worth of the innovation’ is more befitting of a pharmaceutical industry perspective than a standard definition used in economics. However, the confusion between ‘new’ and ‘innovative’ is often fostered in economic reports where ‘the conventional benchmark for measuring the pace of pharmaceutical innovation has been the total number of new molecular entities’ approved each year’ [1]. Therefore, the main aim of our study was to demonstrate that ‘new’ was not equivalent to ‘innovative’ with regards to therapeutic value in the context of pervasive beliefs that all new medicines bring ‘therapeutic innovation and better health outcomes’. Wonder states that we did not present solid evidence that such beliefs are widespread in Australia. Although we have not been able to identify a recent survey on this topic in Australia, there is evidence of these beliefs in other countries. In a recent US study, 39% of participants mistakenly believed that the US FDA approves only "extremely effective" drugs; 25% mistakenly believed that the FDA approves only drugs without serious side effects [2]. There is no evidence that the Australian public is more aware than the American public that only a minority of the new medicines marketed every year provides added therapeutic value compared to existing treatments. These beliefs are strongly encouraged by the pharmaceutical