The Pharmaceutical Journal
Vol 270 No 7250 p716
24 May 2003

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Villains or heroes? Why pharmacists must support the pharmaceutical industry

By Stephen Goundrey-Smith

Once again, the pharmaceutical industry has come under attack from the media, following the recent Channel 4 documentary "Dying for drugs" with claims that many people in the developing world are being denied access to medicines due either to the pricing or commercial strategies of the multinational pharmaceutical companies (PJ, 3 May, p602). Although it is undoubtedly true that some marketing ploys by pharmaceutical companies are indeed short-sighted and ethically questionable, the PJ leading article is surely correct in saying that medical problems faced by people in developing countries have far deeper roots than simply the economics of medicine supply, and that bad debts, corruption — and indeed, poverty and public health issues — are the real villains of the piece. Moreover, it could be argued that the pharmaceutical manufacturers — investing millions of pounds in the research process and devoting considerable resources to licensing new drugs in an increasingly complex regulatory environment — are, in fact, heroes, not villains.

This is especially so considering the history of the pharmaceutical industry in the United Kingdom. It should not be forgotten that the earliest pharmaceutical companies grew out of the endeavours of some pharmacists to produce "ethical" drug treatments, at a time when any fairground charlatan could quite legally sell dubious nostrums of questionable efficacy and quality. Furthermore, at the end of the 19th century, while Germany had done well in integrating science into the commercial endeavour, Britain had not. In Britain, at the time, industry did not wish to embrace scientific method, seeing it as unnecessary and a barrier to profit. Likewise, the scientific community regarded commerce as rather infra dig.

However, the activities of pioneers such as Henry Dale and Henry Wellcome (of Burroughs Wellcome fame) in the early years of the 20th century ensured that it became culturally acceptable to conduct pharmacological testing on animals in a non-academic environment and that it was a reasonable career move for academically well-qualified scientists to be employed in the pharmaceutical industry. During the inter-war years, it became common for pharmaceutical manufacturers to establish their own research facilities — for example, May & Baker Ltd and British Drug Houses (BDH) Ltd. These developments established the importance of rigorous scientific testing in the production of a reliable and efficacious medicinal product. They also paved the way for the great achievements of pharmaceutical medicine, for example, the development of insulin and of penicillin for therapeutic use) and the design of new therapeutic classes that have revolutionised medical treatment. These inc-lude the development of phenothiazines for treatment of schizophrenia by May & Baker Ltd (subsequently Rhône-Poulenc Rorer Ltd) and of neuromuscular blocking agents by Wellcome Ltd. They are all developments that we now take for granted and that have, in turn, paved the way for further developments.

Furthermore, the development of medicinal products by the international pharmaceutical industry has led to the emergence of a huge corpus of research information, both submitted for licensing purposes and published in peer-reviewed journals — a corpus of information which has been systematised in bulletin publications and in various manual and electronic databases. This information dissemination process has, in itself, assisted in the development of new drugs and treatment modalities.

The Channel 4 documentary led to a number of responses from pharmacists (PJ, 10 May, p648, and 17 May, p680) that were highly critical of the pharmaceutical industry. Such responses are inappropriate given the close association of pharmacists with the pharmaceutical industry in its early years, the motives that those early pharmacists had and the subsequent achievements of the industry. These responses are especially inappropriate given the fact that the pharmaceutical industry has, over the years, been single-handedly responsible for providing pharmacists with products to sell to keep them in business. After all, it is thanks to the pharmaceutical industry that UK pharmacists have various safe and effective over-the-counter medicines available to sell — often recently developed as POM to P switches — at a considerable mark-up. For pharmacists to decry the commercial activities of the international pharmaceutical industry and yet be prepared to sell expensive OTC brands developed by pharmaceutical companies with a considerable on-cost contributing to their profits is, at best, disingenuous and, at worst, hypocritical.

The pharmaceutical industry is not perfect. Having worked in the pharmaceutical industry for some five years, I am as aware of this as anyone. But it is the method, albeit provisional in this imperfect world, by which drugs are made available to people in any country, never mind the developing world. The industry is prepared to sink large quantities of capital into drugs that may not necessarily make it through the research process. Quite rightly, governments around the world ask for stringent efficacy and safety data before licensing a medicine for therapeutic use and, with some notable exceptions, only the large pharmaceutical corporations have the financial resources and commercial clout to obtain and, more importantly, maintain these product licences, thus keeping valuable medicines on the market for general use.

It is important that pharmacists support the pharmaceutical industry. They do not have to believe that it is perfect — after all, what industry can make that claim? But pharmacists must accept that the industry is sufficient for the task of developing safe and efficacious medicines, given the current regulatory and political framework. If nothing more, pharmacists should accept the sufficiency of the pharmaceutical industry as the means by which drugs are developed, because of their integrity as scientists. Over the past 50 years or so, many scientists have accepted that, while science describes a real world, there is no such thing as "pure science" and the world that science describes is inevitably interpreted by human beings, either on an individual or corporate level. This philosophical position is referred to as "critical realism" and represents the philosophy to which many practising scientists at present subscribe, either explicitly or implicitly.

When we understand this, we recognise the difficulties faced by any scientific industry in the fulfilment of its objectives and its ethical imperatives, let alone the pharmaceutical industry, operating as it does in a highly regulated environment and scrutinised by a media intent on finding a highly emotive story with a simplistic message. On this basis, it may be argued that, in terms of making medicines available, pharmaceutical manufacturers are the heroes, not the villains, of the piece.

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