Dr Feelgood, Dr Lookgood - The world's top pharmaceutical companies feel they are close to curing killer diseases, but also expect to enhance our lives by beating many scourges of ageing, says Stella Shamoon.
The accommodating pill pusher Dr Robert, according to the eponymous song by The Beatles, had something for every need:
'If you're down, he'll pick you up, Take a drink from his special cup.'
Dr Robert was a fiction, but drugs companies today claim they have indeed found the answers to most of what we want in the way of dealing with life's problems. Take your pick: baldness, obesity, impotence, memory loss, depression. The world's pharmaceutical giants are said to be developing little packets of pills to deal with them all. But, whatever you do, don't call them 'lifestyle' drugs. Hard science lies behind the development of these new products, which are designed to tackle genuine health problems.
We are in the 'golden age of science', says William Steere, chairman and chief executive of Pfizer, in an interview with Management Today.
He is not talking about the fabulous profits Pfizer makes, or the recent rocket-like growth of its market capitalisation to $135 billion to put it among America's corporate heavyweights with the likes of IBM and Coca-Cola.
Steere says the pharmaceutical industry is poised to deliver exciting new drugs that will improve the quality of our lives, prescription drugs that you might not put in a survival kit but which are potent aids for a healthier and more productive life. In addition, serious problems such as cancer, asthma and infectious diseases will fall to breakthrough research thanks to genomic mapping and better understanding of how enzymes and proteins work.
Globally, the biggest companies (Novartis, SmithKline Beecham, Pfizer, Merck, Glaxo Wellcome and the rest), battle for a market worth a massive £180 billion a year. But success does not come cheap.
Even in the UK market, which represents 3% of the global figure (about £5 billion), just over £2 billion a year is spent on research, and nearly £400 million more on marketing. This is dwarfed by the US market (more than 30% of the global figure, including Canada) where an estimated $17 billion will be spent on research this year and another $11 billion on marketing.
Risks are high in this costly and unpredictable research, but the rewards, both financial and scientific, are great. The excitement of the big players is palpable. According to Steere: 'We are beginning to understand the process of disease itself.'
Glaxo Wellcome's scientist chairman, Sir Richard Sykes, agrees. 'We have wonderful science, and there is huge demand for therapeutic remedies which we can and must discover and develop. Scientific discovery has been revolutionised by the study and understanding of genes.'
The range of illnesses and ailments under attack is vast. For example, Pfizer has three anti-obesity drugs in pre-clinical or early clinical development. Obesity is no joke. Very fat people run a higher risk of hypertension, lipid disorders, type II diabetes, coronary artery disease, stroke, osteoarthritis and certain cancers.
Some diseases, of course, have only been recognised and considered treatable in modern times and these are among the most lucrative areas for research and development. SmithKline Beecham's chief executive, Jan Leschly, says: 'Depression is a very serious disease. We estimate that 30 million people (in the US) suffer from depression and another 17 million from social phobia, while 10 million more are inclined to panic.'
Paxil, an anti-depressant, is one of SmithKline's star performers, accounting for over £1 billion of sales last year. Some 80% of such sales can be wiped out when patents expire and generic copies come onto the market.
(The patent on Paxil will not expire until 2005.)
Leschly argues: 'Paxil can demonstrate a cost-benefit in terms of helping people work. These are real problems we are addressing, as well as finding cures for chronic diseases linked to old age which most of us shall experience. We are talking about senility, cancer, Alzheimer's, incontinence.'
Scientists are impatient with the suggestion they are developing frivolous, 'designer drugs'. At Pfizer's research centre in Sandwich, Kent, where four out of 10 of Pfizer's top drugs were developed, Dr David McGibney, head of R&D for Europe, is keeping quiet about what lies in the labs beyond the serial security gates. But he argues that the so-called lifestyle drugs are not for trivial conditions. 'Depression, for example, causes 5% annual mortality. Optimism makes you more resilient when fighting disease, so you cannot trivialise depression, anxiety - or even chronic shyness - by calling the drugs that treat such conditions lifestyle drugs.'
McGibney argues that only drugs to treat, say, hair loss or skin wrinkles, where the medical components are unimportant, can correctly be classified as lifestyle drugs. He stresses, however, that remedies for such cosmetic problems raise self-esteem, and that this, too, can be a potent positive force in human health.
This view is echoed by others in the market. At SmithKline, Dr George Post, chief science and technology officer, says: 'So-called lifestyle diseases can make people's lives wretched. Our contribution is to relieve their suffering. The term lifestyle drug trivialises the ailments which they treat. The only real lifestyle illnesses are self-inflicted, such as sexually transmitted diseases and those induced by alcohol and smoking.'
Whereas prescription drugs in the past had to demonstrate safety, effectiveness and efficiency, today they must also pass a cost-benefit analysis in order to become freely accessible and refundable by state health authorities and providers of managed care. The cost of life-enhancing drugs is quantifiable, but the benefit is often qualitative and difficult to justify in purely financial terms.
Glaxo Wellcome's Imigran, a migraine headache treatment, costs about £7 a pill; GPs don't readily prescribe it because it is expensive. But £7 is cheap if you get a life for a day - a day that is otherwise lost in the misery of a migraine. The cost of drugs such as Clozapine, the schizophrenia treatment made by Novartis and Zeneca, is £3 to £4 a day.
The NHS refuses to fund this - but Clozapine has been shown to have been successful in reducing suicide rates, and one night in intensive care costs £500.
The sales of Viagra and mood-altering drugs such as Prozac, Valium and Paxil (called Seroxat in the UK) have demonstrated there is huge, underserved, demand for scientifically-based therapeutic remedies that can sometimes enhance the quality of our lives. The commercial opportunities are huge: such drugs are not so price sensitive. People pay almost anything to get them - regardless of whether they are reimbursed by the National Health or private medical insurance. Viagra has famously been retailing at up to £50 a tablet in private clinics and on the black market.
This fact excites Pfizer's Steere and his peers. Their companies make a fortune in the US market which, unfettered by price controls, grows at 20% per annum and generates 80% of their earnings. But it is a different picture in Europe, where the big drugs companies struggle to extract even a 5% return, as cash-strapped state-controlled health services such as the NHS cannot and will not pay for certain drugs. Marketing expenditure in the UK is strictly limited. Frank Dobson, secretary of state for health, and his Continental counterparts, must dread the avalanche of these new pricey pills, launched amid billion-dollar marketing campaigns in the US which make their 'brands' household names.
Who should pay for these drugs? If we are to live longer and demand an ever rising supply of expensive new life-enhancing drugs on the NHS, something has got to give.
The demand for these drugs will increase as the world population ages.
Some 80% of our health-care costs are incurred in the first six years and the last three years of our lives. And in the developed world we are ageing fast.
According to Steere: 'As the first-world population ages and has more discretionary income, these quality-of-life drugs are going to become more and more important. I don't just mean Viagra; it's drugs for obesity, ageing skin and hair loss.
'It's even drugs like Celebra, for osteoporosis. Almost all people over 60 suffer from it, but this drug gives them more mobility, so they can do more things and lead active lives. Where do you draw the line? In some cases, we are giving people back their lives, even if they are not suffering from life threatening diseases.
'When Viagra came on the market in the US there was 1,000 years of pent-up demand and it took off. But there is just so much sex that goes on: you can't create more sex with a pill.' All the same, this drug has generated over $500 million in sales from five million prescriptions for three million patients since its April 1998 launch, thus virtually covering its $600 million development costs.
The Viagra story is the most telling example of the future of such drugs as what retailers call Fast Moving Consumer Goods. Demand and expectation bubbled up to produce its enormous volume of sales. Initially, people bought Viagra in the hope it would increase libido - it doesn't. Nor does it boost sexual desire. What it does is enhance a normal physiological response in a healthy relationship.
In extensive clinical trials, men who were offered unlimited free Viagra chose to use it on average six or eight times a month. This sort of usage might have cost the NHS about £35 for each patient - hardly enough to wreck the £4 billion annual NHS drugs budget, as Dobson apparently fears.
Overnight, Viagra has become a global brand. It underlines the revolution in our aspirations. Never mind long life: it is almost a given today that most of us, thanks to science, expect to survive at least to our late seventies or eighties.
What ageing people who are affluent now aspire to is a better quality of life. We want to look great (ie, younger) and we want to feel younger - for longer.
We don't want to put up with flu, irritable bowel syndrome, memory lapses, menopause, panic attacks, depression, anxiety - even blushing.
So the drugs market sits poised at a fascinating moment in its history.
Almost inexhaustible demand is stirring the pharmaceutical companies into an extraordinary bout of activity. And the drugs giants are being led from the front by committed evangelists for the new products.
At SmithKline, Leschly argues that all drugs are cost-effective because often they save on the cost of surgery or other more expensive medical treatment. It is the drugs which reduce the overall cost of care by their effectiveness that tend to be the blockbusters in terms of $1 billion plus annual sales. Doctors love their effectiveness, and so keep prescribing them.
Sykes at Glaxo says: 'My greatest fear is not of the commercial risks in this industry - as great as they are, given the acute competition and enormous cost of R&D and sales. What I fear most is that we shall fail to meet our full potential.'
Questions arise about how these new drugs should be used. What of men who are depressed because of their impotence? Do they take Viagra or Paxil?
A cocktail of both?
The question has its serious side. Impotence can cause depression, not just in men but also among wives and partners. Depression, in turn, leads to dysfunction in marriage, in parenting and in the workplace.
Will the future really see a never-ending supply of miracle cures?
Among the newer chemical entities that are in the Pfizer locker are those to treat anxiety, sleep disorders, migraine, obesity, gastrointestinal disorders, depression and nicotine addiction. Not all of them will work out.
Some are now available in America. Others may be cancelled, even at a late stage of development and testing, if government regulatory approval looks unlikely or if the benefits of the drug remain unclear.
The bottom line is that the leading drug combines such as Pfizer, Glaxo and SmithKline can effectively enhance your health and quality of life. Healthy employees have a better chance of healthy careers and earnings. Little wonder so many millions are being poured into the search. It looks to be the right prescription for the pharmaceutical industry.
It could even be the magic pill for the lifestyle that we all desire.
LIFE-ENHANCING DRUGS NOW AVAILABLE
Problem Drug Manufacturer
Obesity Xenical Roche
Baldness Propecia Merck
Regaine Pharmacia & Upjohn
Depression Paxil SmithKline Beecham
Prozac Eli Lilly
Panic Paxil SmithKline Beecham
Anxiety Valium Roche
Impotence Viagra Pfizer
Ageing (women) Premarin AHP
Allergy Claritin Schering-Plough
Nicotine addiction Zyban Glaxo Wellcome
Anti-migraine Imigran/Imitrex Glaxo Wellcome
Fungal disorder Diflucan Pfizer.