The Ultimate Cure

Deep in Big Tobacco country, I’m talking to a former chief scientist for R.J. Reynolds about new wonder drugs for the brain that are inspired by, of all things, nicotine. We’re huddled in a futuristic steel-and-glass building in Winston-Salem, North Carolina, that looks like an alien starship next to the abandoned storefronts and empty brick cigarette factories of this faded town. I’m skeptical. Now C.E.O. of a company called Targacept, the ex-Reynolds man, Don deBethizy, is describing a class of drugs called nicotinics, which he says can restore the memory of Alzheimer’s patients, control pain, and improve attention spans. What’s more, they may boost cognition and memory in healthy people.

It seems far out even for the neurotechnology industry, a rapidly growing cluster of companies—small upstarts as well as pharmaceutical giants—that want to alter your gray matter and make billions of dollars in the process. These firms are trying to adapt groundbreaking research into the basic workings of the brain to new drugs for ailments ranging from insomnia to multiple sclerosis. Some companies are trying to regrow portions of the brain using stem cells. Others have developed implants to insert into a person’s head to control seizures and restore hearing. Cyber­kinetics Neurotechnology Systems, a Foxborough, Massachusetts, company, implanted electrodes into the brain of a quadriplegic that allowed him to operate machines with his thoughts. (View an interactive feature showing brain researchers’ latest efforts.)

DeBethizy’s jump-out-of-his-seat gusto makes me want to believe him.Yet I can’t shake the image of the Nick Naylor character in Thank You for Smoking, the film based on Christopher Buckley’s satirical novel about a spinmeister and apologist for the tobacco industry. Targacept’s birth was a by-product of deBeth­izy’s attempts at Reynolds to create a “safe” cigarette and find positive uses for nicotine. Neuroscientists and investors I spoke to vouch for deBeth­izy and insist that Targacept is among the hottest companies in the brain business and a leader among several outfits developing nicotinics. So here I am in this dog-eared burg to learn more about an industry that may not only hold the key to treating some of the most serious maladies of our time but also challenge society’s—and regulators’—opinions of whether drugs should be used to enhance healthy brains as well as treat illness.

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Targacept is one of about 500 brain­tech companies going after the estimated $2 trillion that it costs globally when brains atrophy, degenerate, experience depression, cause convulsions, register pain, trigger anxiety, or simply fail to work as well as we would like. The size of the market is huge, according to data from the World Health Organization and others, which report that more than 1 billion people suffer from brain-related ailments each year. That number has grown rapidly during the past generation, as neurodisorders like depression have gone from being underdiagnosed to perhaps over­diagnosed, and Western populations, along with their brains, have aged. It’s hard to believe, but even in our Prozac nation, possibly tens of millions of people who might need brain meds aren’t getting them. In some parts of the developing world, the figure could be as high as 90 percent. (View a pop-up graphic that shows the revenue breakdown of drug treatments and disease.)

Neurotech’s returns are already enormous. In 2006, the industry brought in more than $120 billion—about $101 billion from drugs and the rest from neurodevices ($4.5 billion) and neurodiagnostics ($15 billion)—up 10 percent from the previous year, reports NeuroInsights, a market research and investment advisory firm. But industry analysts insist that this figure hardly begins to suggest the potential. For Alz­heimer’s, a disease currently without an effective treatment for about 4.5 million sufferers in the U.S., 40 companies—including behemoths like Eli Lilly, GlaxoSmithKline, and Wyeth, as well as Targacept and a gaggle of similar upstarts—are testing 48 new drugs in human trials in a quest for the Prozac of dementia. The push has brought many small to midsize biotech firms together in partnerships with larger pharmaceutical companies to pursue everything from pain-control compounds derived from chili peppers to an antistroke medicine developed from vampire-bat saliva. There is so much activity in neurotech that last fall it got its own index, NERV, on the Nasdaq, tracking the performance of 30 leading brain companies based in the United States. Analysts estimate that the sector should continue to grow by about 10 percent a year, which would produce a brain-industrial complex worth more than $300 billion in the next 10 years.

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