The Promise and Price of Cellular Therapies

August 23, 2019

(The New Yorker) – For most of the twentieth century, the definition of a drug was simple, because drugs were simple: they were typically small molecules synthesized in factories or extracted from plants, purified, and packaged into pills. Later, the pharmacopoeia expanded to include large and complex proteins—from insulin to monoclonal antibodies. But could a living substance be a drug? Thomas, who saw bone-marrow transplantation as a procedure or a protocol, akin to other organ transplants, would never have described it as a drug. And yet, in ways that Thomas couldn’t have anticipated, he had laid the foundation for a new kind of therapy—“living drugs,” a sort of chimera of the pharmaceutical and the procedural—which would confound definitions and challenge the boundaries of medicine, raising basic questions about the patenting, the manufacturing, and the pricing of medicines.