Our view: Developing drugs that sell themselves
Everyone has ideas about what ails pharma and how it might reinvent itself to be more productive and regain the trust of the consuming public.
By on Apr 2, 2009Everyone has ideas about what ails pharma and how it might reinvent itself to be more productive and regain the trust of the consuming public. As in everything, some of these ideas are better than others. But Greg Critser of the Los Angeles Times recently wrote an op-ed piece ( What's ailing Big Pharma) that, in my opinion, made some very good points.
Critser chronicles a recent visit he made to Scripps College in Claremont, California during which he says he found students there to be more than a little disillusioned with pharmas drugs. The students spoke to him, Critser says, of author David Foster Wallaces battle with depression and blamed his death on ineffective anti-depressants.
Critser believes the students have a point, noting that most of the drugs introduced to treat chronic disease over the last 20 years work for only about 50% of patients. Thats a general and fairly simplistic assessment, and I would argue isnt entirely applicable to the circumstances surrounding Wallaces death.
Help or hindrance?
Wallace suffered from severe depression for more than 20 years, which he eventually controlled with the help of Nardil. But concerns about the drugs side effects, and a well-documented desire to be normal, pushed Wallace to seek other treatments for his depression. According to a 2008 Rolling Stone article ( see it here ), when nothing else gave him the relief that Nardil had, Wallace tried to go back on the drug, but it no longer seemed to work as well for him as it once had. Then, while still searching for medical relief from his debilitating disease, Wallace tragically took his own life.
Did pharmaceutical science fail Wallace? Maybe. But I would argue that his life may have ended even sooner without medication. Its clear from the accounts of those who knew him well and his own recollections that he was spinning dangerously out of control and rapidly deteriorating before seeking medical intervention and beginning treatment with Nardil. But his family and friends say that he had some happy and productive years after finding Nardil. No one knows what might have happened if Wallace had stayed on that medication. The sad fact is: depression is an illness that medical science still does not fully understand and for which we have no cure.
Why doesnt pharma produce better drugs?
Completely removed from the issue of Wallaces death, however, Critser has a valid question about why pharma doesnt produce better drugs? He argues that since deregulation in the early 1980s, drug companies have transformed themselves from science enterprises into consumer goods companies, behemoths that see their principal mission not as developing new and better drugs, but as developing new ways to sell drugs.
On this point, I have to agree with Critser. I too believe the industry has put the cart before the horse and focused too much on selling drugs (often the 10th iteration of something we already have) without adequately filling its pipelines with new and innovative treatments for unmet patient needs.
From time to time, the industry seemed to realize that it was going down the wrong path and took to research again, usually by scooping up cash-strapped start-ups with promising new compounds, Critser says. But even then pharma continued to search for ways to turn expensive experimental drugs into blockbusters. The result is an industry without a clear mission.
Science at the helm
And Critser insightfully argues that pharma lost its way when it substituted marketers, lawyers and businessmen for the scientists that once manned its helms.
One way out might be through enlightened medical and scientific leadership, but the same forces that transformed pharmaceutical companies Wall Streets demand for higher profits, competition from generics and pressure to discount also transformed their executive suites, he laments. Pfizer is now run by a lawyer. Other giants are run by marketing whizzes and career functionaries.
And as a result, Critser says, scientific innovation has plummeted and drug safety recalls have skyrocketed. He urges pharmas leaders to look back in time to the example of Roy Vagelos, a pioneering cholesterol researcher who lead Merck through the 1980s and earned the company the respect of not just stockholders but managers, scientists, patients and the general public.
Vagelos apparently bought into and embodied the beliefs of George W Merck, president of Merck beginning in 1925 and son of the companys founder, who said: We try to remember that medicine is for the patient. We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.
Back to our roots
Critser recalls that Vagelos publicly criticized the industry for its emphasis on media and even accused it of wasting a lot of goodwill. Critser believes pharma must return to treating consumers not as a malleable audience, but as something once known as patients.
He has a point. For the largest share, pharma is no longer guided by science or scientists. And I have to agree that the industry probably shot itself in the foot when it went down that path.
But in Pfizers defense, Jeffrey Kindler, the lawyer Critser alludes to who now serves as the companys CEO, actively recruited a top scientist, Corey Goodman, to lead the companys Biotherapeutics and Bioinnovations Center in an effort to help snap Pfizer out of its inefficient downward spiral of drug development. Goodman, a renowned academic who spent more than 20 years at some of Californias most respected research universities, including Stanford and U.C. Berkeley, also has been a successful entrepreneur, co-founding two biotech companies Exelixis and Renovis.
Kindler has, by all accounts (see Business Week), given Goodman quite a bit of rope to try to figure out how to better develop major new drugs. And early signs are that his approaches are beginning to pay dividends in productivity and are spurring scientists on by giving them more ownership of their discoveries.
Goodmans strategies, such as smaller teams with an increased focus on certain types of patients and diseases, also are being mirrored in its other business units, including marketing. Although the ultimate outcome remains to be seen, one has to admit that its a fresh approach that deserves time to prove itself.
Public confidence
As I see it, rebuilding the industrys R&D foundations and giving pharmas scientists a more prominent role as company leaders certainly makes good sense when it comes to regaining patients trust. National Science Foundation surveys which, since 1973, have tracked public confidence in the leadership of various institutions, including the scientific community, find that the percentage of Americans expressing a great deal of confidence in leaders is higher for the scientific community than for any other institution except the military.
NSF says the consistently high confidence in the leadership of the scientific community is in sharp contrast to a general decline in confidence in institutional leaders over the past three decades. The medical community, for instance, has seen a long-term decline in confidence.
Pharma could use an upswing in confidence in both its leadership and its products. From NSFs findings, it certainly seems that putting scientists back at the helm of the industry would go a long way toward rebuilding the publics trust in pharma.
We could get out of the business of developing sales strategies by putting the emphasis back on R&D and empowering our scientists to develop the kind of breakthrough therapies that would sell themselves. And we could regain the public's confidence (and maybe some of our own), by getting back to the business that we used to be in, where decisions were made based not on what we could sell, but on what served patients.
Lisa Roner, editor, eyeforpharma