The Pharmaceutical Journal Vol 267 No 7169 p510-525
13 October 2001

BPC 2001 summary

Patients’ different views of medicines

Patients’ perspective of developments in medicines are strikingly different to the views of scientists and researchers, according to John Waite, in his talk entitled “Science in the service of patients?”

Mr Waite, presenter of the BBC Radio 4 consumer programme You and Yours, which has been running for 40 years, pointed out that items covering medicines and medical ethics on the programme often attracted as many as 3,000 e-mails. And although researchers might believe that advancement was a good thing, for the general public it was a moot point.

The old patient/professional relation ship was gone, Mr Waite said. “Consumers now have a whiff of power and decide when they will or will not take a medicine.” Far more people are concerned about safety and there is a widespread belief that science is scary and can get out of control. Mr Waite said that people were also concerned about the size of the pharmaceutical industry: “As far as listeners to Radio 4 are concerned, Big is Bad.”

Mr Waite went on to explore some of the reasons for these views. “In the past 50 years there have been more medical breakthroughs than the previous 2,000 years.” Ventolin, tamoxifen and Viagra were among the examples he picked.

“About 90 per cent of medicines in the early ’90s were unknown 30 years before; the output from the pharmaceutical industry has doubled over the past 20 years.” Listeners, he explained, think that with size goes power and with power goes secrecy. He outlined listeners’ worries about the launch of new products when their efficacy is based on trials involving small numbers of patients. He also said that they were concerned that too many drugs were being used on children without proper trials.

Mr Waite also berated successive governments about their approach to drug disasters: “There has never been a public inquiry into a drug disaster,” he said, making the point that some medicines have killed more people than the number killed in the Paddington rail disaster.

“You and Yours always receives a huge number of comments following items on addiction to benzodiazepines,” Mr Waite said. He had been surprised to learn that only 27 yellow cards had been received by the Committee on the Safety of Medicines, whereas in his estimation there should have been something in the region of 600,000.

At a later question and answer session, Mr Waite emphasised that his comments should not be seen as a criticism of pharmacists. As far as the Radio 4 audience is concerned, pharmacists are uniquely held in high esteem. “The general public see you as being on their level. Do not undervalue yourselves,” he concluded.

Pharmaceutical research

The lecture given by Professor William Dawson, managing director of Bionet Ltd and a member of the Science Committee at the Royal Pharmaceutical Society, focused on the research end of the spectrum rather than the consumer end.

He pointed out in “Medicine in the service of patients: future prospects” that medicines have seven values: they provide new treatments; they may eliminate or reduce the need for more costly treatments; they may speed up treatment itself and therefore free NHS resources; they have benefits for the quality of life; they reduce cost in other areas of public expenditure; they reduce cost of ill-health to the economy as a whole; and they improve health of the nation.

Professor Dawson acknowledged that patients in the 21st century want to know more about the conditions from which they are suffering as well as the treatment options — both orthodox and complementary. They need to know about lifestyle changes that may help them, about success rates of treatments, about unwanted side-effects and they need to have access to independent sources of advice and support. This is a service that could be provided by pharmacists. Patients need to understand more so that they benefit more and are not given confusing and conflicting information.

Professor Dawson traced the history of modern medicine back to the 1890s with the development of chemotherapeutic agents. Pharmacological treatments started to develop in the 1940s to 1960s followed by molecular treatments in the ’70s and ’80s and then the genomic option in the ’90s.

“New drugs will still take a long time to develop. It takes between eight and 12 years to bring a new entity to market and costs £400m from the chemist’s bench to marketplace. There are huge costs in clinical trials,” he explained.

Better diagnostic systems, as well as genetically targeted treatments, may allow the selective use of medicines with fewer side-effects and greater efficiacy. But this will pose new social questions in terms of insurance and counselling. “Again there is a role here for pharmacists,” Professor Dawson said. He pointed out that 250 new biotechnological products are in global clinical trials, many for cancer but also for CNS and cardiovascular diseases.

New delivery systems will be vital if these are to be successful. Gene therapy is early in its development, but delivery will also present a challenge.

“The future looks rosy,” he remarked. For example, developments in the treatment of osteoporosis and atherosclerosis will come from better understanding of disease. At the moment the treatment of neurodegenerative disease is restricted to symptom control but in time it is hoped that it may stop disease progression.

Professor Dawson touched on the subject of population genetics, which also holds out hopes for the future. There will be a need to understand the risks of developing a disease, for profiling the population and genetic counselling.

And almost in response to the concerns that Mr Waite had previously voiced, Professor Dawson said that all these developments and prospects have changed the way pharmaceutical companies structure themselves. They are now more inclined to work in partnership with smaller research companies and universities.

“Corporate survival will be important for patients. There will also be harmonisation in the regulation process (particularly in Europe), because at the moment there is the potential for pricing policies to inhibit research efforts.”

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