- Email: [email protected]
BLEAK PROSPECT FOR DRUG RESEARCH
1335 countries. So far, however, the revolution has been of little benefit to poor agriculturists, since only wealthy large landowners can afford to purchase the seeds and provide the fertilisers and irrigation necessary for their cultivation. Less labour may be needed for the new crops and so the local effect of the green revolution has often been to make the many poor poorer and the few rich richer. Lappe and Collins believe strongly that every country, even Bangladesh, could be self-supporting in food and that local agriculture could meet the needs of increasing populations in the future; they also supply evidence to support their view. The first step to reduce world hunger, they claim, is to restrict U.S. agribusiness. They regard most foreign aid as futile and they would stop all forms of aid that reinforce the priority use of land for export crops and that helps establish a new privileged class of farm entrepreneurs who maintain the hunger status quo. They claim that all local populations have the abilities and skills to grow sufficient foods for themselves, if their initiative and self-reliance is not sapped by outside interference by *
or by large landowners. Self-reliance and local effort should counter despair. Even if one cannot go all the way with Lappe and Collins, their book is a pleasure to read. Throughout it is full of optimism and they have faith in mankind. Since they describe the absurdities in much of contemporary agriculture with humour rather than with bad temper and cynicism, they should get their message over.
foreign agencies,
BLEAK PROSPECT FOR DRUG RESEARCH
No one seems to question that drug research should continue. But will it? For about fifteen years the number of new drugs reaching the market has been falling steadily while costs and other constraints have continued to increase. Hence the few drugs that do appear carry huge development costs. A recent estimate by the Center for the Study of Drug Development, at Rochester, N.Y., put the figure at$55 million without any extra plant requirements. No more than twenty-five laboratories around the world are capable of undertaking work on this scale and, if only by default, the discovery and development of new drugs have become the prerogative of the large pharmaceutical firms. They spend 10 -20% of their annual turnover on research and development, but this pays only for work in progress. It does not allow for inflation or provide a return on investment in fixed assets for research, which probably represent$150-250 for each$100 of current expenditure. Altogether some $2 billion a year are now being spent by the industry worldwide-a large sum, but it is only$0.5per head of the world population. In the advanced countries it is under 1 % of health-care costs. These are some of the figures given at a recent meeting in Geneva.l With remarkable unanimity speakers from the Western world, where most of the drug 1. Trends and Prospects in Drug Research and Development. XIth Round Table Conference. Council for International Organisations of Medical Sciences (CIOMS) in collaboration with W.H.O. Geneva (in the press).
research is conducted, were pessimistic about prospects. At a time when the technical difficulty of making genuine therapeutic progress was greater than ever, numerous other constraints-financial, fiscal, legal (including patents and product liability), bureaucratic, political, and ethical, and above all the mounting requirements of drug control authorities and their failure to reconcile international variations-had combined to create a highly unfavourable climate. Four major drugregulating authorities still required much of the testing to be repeated within their national boundaries. Individually, most of the constraints were understandable and desirable but collectively they added tremendously to operating costs and they diverted resources from more creative activities. Paradoxically society had made it progressively more difficult for the pharmaceutical industry to provide the drugs that society itself increasingly demanded-such as drugs for the rarer diseases or even for common diseases in poor countries. The contracting number of areas in which research seemed to offer worth-while prospects, and the ten years or more before any return on investment could be expected, might soon convince the large and dominant multidivisional enterprises to put their money elsewhere. The profitability of the British pharmaceutical industry is said to have fallen steadily, now being no higher than that of British industry in general.2 No one at the meeting seemed to think that some form of centralised research was the answer. On the contrary, strong arguments were advanced against it. The general feeling was that, if society wanted new drugs, it must provide more incentives to innovation. In particular, the scientific community and the general public should be more conscious of their share of the responsibility, and the industry should try harder to secure public confidence and trust; in the past it had provided much ammunition to detractors. The drug-regulation authorities should accept that their object is to bring forward new drugs, not only safely but also quickly and economically. There was scope here for more international collaboration-all the safeguards and restrictions ultimately had to be paid for in one way or another. We know very little about the economic effects of medical treatments. Thus it is hard to say what drugs a community needs and can afford. Meanwhile, drug prices engender strong emotions. Perhaps we ought to think more in comparative terms. In 1976, for example, the average cost of an N.H.S. prescription was 130 p.33 The average duration of treatment provided is not known, but if, for the sake of argument, it was 13 days, the daily cost of drug treatment would be 10 p. What can you buy for that? A small bar of chocolate or a ticket for two stations on the London underground; maybe seven minutes in hospital, certainly not a cup of tea or coffee in a public place. The N.H.S. pharmaceutical services that year cost C561 million.3 In the same period the nation spent over five times more on tobacco and, in addition to its direct costs, smoking caused 30 000 extra deaths, the loss of over 1000 babies, the loss of 50 million working days, a lot of fires, and an enormous cost to the Health Service.4 2. Lancet, 1977, i, 1016. 3. Association of British Pharmaceutical Industry Annual Report, 4. Atkinson, A. B., Townsend, J. L. Lancet, 1977, ii, 492.
1976-7.
or by large landowners. Self-reliance and local effort should counter despair. Even if one cannot go all the way with Lappe and Collins, their book is a pleasure to read. Throughout it is full of optimism and they have faith in mankind. Since they describe the absurdities in much of contemporary agriculture with humour rather than with bad temper and cynicism, they should get their message over.
foreign agencies,
BLEAK PROSPECT FOR DRUG RESEARCH
No one seems to question that drug research should continue. But will it? For about fifteen years the number of new drugs reaching the market has been falling steadily while costs and other constraints have continued to increase. Hence the few drugs that do appear carry huge development costs. A recent estimate by the Center for the Study of Drug Development, at Rochester, N.Y., put the figure at$55 million without any extra plant requirements. No more than twenty-five laboratories around the world are capable of undertaking work on this scale and, if only by default, the discovery and development of new drugs have become the prerogative of the large pharmaceutical firms. They spend 10 -20% of their annual turnover on research and development, but this pays only for work in progress. It does not allow for inflation or provide a return on investment in fixed assets for research, which probably represent$150-250 for each$100 of current expenditure. Altogether some $2 billion a year are now being spent by the industry worldwide-a large sum, but it is only$0.5per head of the world population. In the advanced countries it is under 1 % of health-care costs. These are some of the figures given at a recent meeting in Geneva.l With remarkable unanimity speakers from the Western world, where most of the drug 1. Trends and Prospects in Drug Research and Development. XIth Round Table Conference. Council for International Organisations of Medical Sciences (CIOMS) in collaboration with W.H.O. Geneva (in the press).
research is conducted, were pessimistic about prospects. At a time when the technical difficulty of making genuine therapeutic progress was greater than ever, numerous other constraints-financial, fiscal, legal (including patents and product liability), bureaucratic, political, and ethical, and above all the mounting requirements of drug control authorities and their failure to reconcile international variations-had combined to create a highly unfavourable climate. Four major drugregulating authorities still required much of the testing to be repeated within their national boundaries. Individually, most of the constraints were understandable and desirable but collectively they added tremendously to operating costs and they diverted resources from more creative activities. Paradoxically society had made it progressively more difficult for the pharmaceutical industry to provide the drugs that society itself increasingly demanded-such as drugs for the rarer diseases or even for common diseases in poor countries. The contracting number of areas in which research seemed to offer worth-while prospects, and the ten years or more before any return on investment could be expected, might soon convince the large and dominant multidivisional enterprises to put their money elsewhere. The profitability of the British pharmaceutical industry is said to have fallen steadily, now being no higher than that of British industry in general.2 No one at the meeting seemed to think that some form of centralised research was the answer. On the contrary, strong arguments were advanced against it. The general feeling was that, if society wanted new drugs, it must provide more incentives to innovation. In particular, the scientific community and the general public should be more conscious of their share of the responsibility, and the industry should try harder to secure public confidence and trust; in the past it had provided much ammunition to detractors. The drug-regulation authorities should accept that their object is to bring forward new drugs, not only safely but also quickly and economically. There was scope here for more international collaboration-all the safeguards and restrictions ultimately had to be paid for in one way or another. We know very little about the economic effects of medical treatments. Thus it is hard to say what drugs a community needs and can afford. Meanwhile, drug prices engender strong emotions. Perhaps we ought to think more in comparative terms. In 1976, for example, the average cost of an N.H.S. prescription was 130 p.33 The average duration of treatment provided is not known, but if, for the sake of argument, it was 13 days, the daily cost of drug treatment would be 10 p. What can you buy for that? A small bar of chocolate or a ticket for two stations on the London underground; maybe seven minutes in hospital, certainly not a cup of tea or coffee in a public place. The N.H.S. pharmaceutical services that year cost C561 million.3 In the same period the nation spent over five times more on tobacco and, in addition to its direct costs, smoking caused 30 000 extra deaths, the loss of over 1000 babies, the loss of 50 million working days, a lot of fires, and an enormous cost to the Health Service.4 2. Lancet, 1977, i, 1016. 3. Association of British Pharmaceutical Industry Annual Report, 4. Atkinson, A. B., Townsend, J. L. Lancet, 1977, ii, 492.
1976-7.