Books: Big pharma in big trouble

This urgent exposure reveals a pharmaceutical industry suffering a catastrophic collapse in its reputation. Can it heal itself? Richard Horton salutes a must-read.

by Dr Richard Horton, editor of The Lancet
Last Updated: 31 Aug 2010

The pharmaceutical industry displays the best and worst traits of modern western democratic societies. There is no other entity today that takes the arcane products of scientific research and translates their remote prospects into the magic of medicine. The astonishing alchemy of this process is the apotheosis of capitalism.

The ambition and achievement that market states encourage in the service of human illness are some of the most remarkable attributes of our species ever recorded. And yet the mendacious excesses that drug companies indulge in at moments of weakness and crisis also point to some of the most venal and debauched aspects of human life.

The industry manufactures diseases as well as drugs. It loads the dice of research before that research has even begun. It creates incentives to cheat. It manipulates science to serve marketing, not medicine. It conceals bad news. It is willing to tolerate epidemics of harm caused by its products in order to protect profits. It brutalises compassion, turning disease into simply one more commodity to be traded and exploited.

In Big Pharma, Jacky Law, a specialist journalist, ably traces the origins and recent history of these extreme boundaries. She recognises and pays tribute to the real successes that industry has delivered. The industry's 10 leading companies, for example, earned more than $200 billion in 2004 - a staggering achievement. It is a reward that has brought 'colossal power in a single human lifespan'.

Pharma executives have almost ceaselessly identified commercial opportunities in our escalating obsession for health and wellbeing. The industry is therefore a reflection only of ourselves. We should not direct our most critical questions at its leaders. Our targets ought to be within our own lives.

Indeed, Law's book is subtitled How modern medicine is damaging your health and what you can do about it. She wants to help the ordinary citizen regain some control over an industry that dominates our lives in subtle, diverse, and sometimes malign ways. But the odds are stacked against her, and indeed the general public.

The industry is suffering a catastrophic collapse in its reputation. Merck's troubles with its anti-inflammatory drug Vioxx have forced it to downsize its workforce by 11% - some 7,000 staff; litigation is even threatening its viability. Last year, the House of Commons Select Committee gave a stinging rebuke to the industry's marketing practices, in a report alleging failures of transparency, honesty, and accountability. The Serious Fraud Office is investigating alleged price-fixing by Novartis, and critics charge the industry with inadequate investment to ensure the safety of its drugs.

Law emphasises the massive 'innovation drought' that has hit big pharma. The R&D spend in the UK is flat, and the number of new drugs coming to market has fallen steadily. Research capacity to test new medicines has also declined. And new drugs that once offered high hopes of quick and substantial returns - eg, AstraZeneca's Exanta, Iressa and Crestor - have been huge disappointments.

Meanwhile, several high-profile regulatory failings (Vioxx being the most serious) have prompted government agencies to get tough on sharp industry practices. When the US Food and Drug Administration flexed its muscles over one of Glaxo's anti-asthma drugs in November, the company's share value fell by 4%.

The UK Government has appointed a health minister specifically to oversee big pharma, and wide consultation is now taking place over how to strengthen pharmaceutical regulation. Companies in breach of the UK code of practice will be named and shamed.

These forces have hit industry hard. Pfizer suffered big slumps in its quarterly earnings throughout 2005. Glaxo has had to cut its US sales and marketing force. Market growth in America is at its lowest levels for a decade. In Britain, the NHS's spend on branded medicines fell by 4% in 2004.

Big pharma seems at last to be responding. The sequencing of the human genome is revealing new targets for drug manufacturers. Glaxo sees an astonishing £16 billion a year market for its expanding vaccines business. Companies are fighting to restore their reputation as ethical businesses. The Association of the British Pharmaceutical Industry has launched a campaign claiming that the fruits of big pharma were being wasted. It accuses the NHS of failing to keep on the cutting edge of modern medicine.

This book is a must-read. Law has drawn on a remarkable range of sources to produce an urgent analysis of one of the most powerful but little-understood industries. Her arguments are compelling and her conclusions disturbing.

BIG PHARMA Jacky Law Constable £12.99; MT price £10.99 To order, visit www.mtmagazine.co.uk

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