today.
Countless millions of patients are treated and saved every year because of the effectiveness of modern medicine. Every successful drug saves or improves lives. We’ve looked at the top ten pharmaceutical companies and examined how they operate and the many challenges that they face.
It’s easy to point at the huge profits, amounting to over $100 billion1 in 2008, made by Big Pharmas and claim that they’re ripping off consumers, but it’s not that easy. Without those profits they claim that they won’t be able to continue the huge research and development efforts that produce the drugs that we need to improve our health.
In yesterday’s article we looked at the role of patents in protecting drug inventions until they can be brought to market and start producing a revenue stream for their developer. We shall now look at some of the top medical triumphs2 of the pharmaceutical industry over the years. A panel of experts in the field, including two historians, the head of pharmacology at a leading British university, and the first president of the American Association of Pharmaceutical Scientists (AAPS), singled out ten drugs as the most important of all time and seven more drugs or techniques that have been almost as important.
The panel unanimously voted the following ten drugs as the most important of all time:
- Penicillin – No other drug changed the world as dramatically. As the first antibiotic, it pointed the way to the treatment of microbial disease. Without penicillin, 75% of the people now alive would not be alive because their parents or grandparents would have succumbed to infections.
- Insulin – Insulin was the first drug to successfully treat diabetes. It proved to be a hormone. As such, it’s the grandfather of all other hormone-replacement therapies.
- The Smallpox and Polio Vaccines – Vaccines aren’t really drugs, but the experts argued that preventive medicine has to be taken into account. Few preventive medicines have had the impact of the smallpox and polio vaccines.
- Ether – Although it has now been replaced by more modern anesthetics, the discovery of ether made it clear that it is possible to have an agent that can depress a person’s brain functioning so major operations can be carried out.
- Morphine – A derivative of opium, despite the terrible problem of narcotic addiction, the experts agreed that a world without morphine would have more suffering, not less. It is the forerunner of several generations of pain-alleviating drugs.
- Aspirin – A simple pain-killer that also fights inflammation and may slow down some cancers. One expert commented that it’s amazing that just about very man over 40 and every women over 50 is supposed to be taking this 100-year-old drug.
- Salvarsan – The trade name for arsphenamine, invented in 1908. It’s also known as Ehrlich 606 because it was the 606th compound tested by the legendary German scientist Paul Ehrlich and colleague Sahachiro Hata as a treatment for syphilis. It’s a “bad news, good news” drug. It worked because the arsenic-based compound is a bit more poisonous to syphilis bacteria than it is to humans. The treatment made people dreadfully ill, but it didn’t kill them, which syphilis would eventually do.
- Psychiatric Medications – Drugs such as Thorazine made people less crazy. Haldol was one of the first drugs to bring schizophrenia under control. Those and similar drugs, such as Thorazine, allowed doctors to treat people so that they were calmer and ambulatory instead of having to commit them to asylums for the insane.
- Birth Control Pills – Oral contraceptives changed the world. By giving women control over their reproductive system, these drugs had far-reaching medical and social impact.
- Help for the Heart – Heart patients today owe a lot to two breakthrough drugs: Lanoxin (digoxin) and Lasix (furosemide), both of which prevent or control congestive heart failure conditions.
“What, no Viagra or Lipitor?”, we hear you thinking, and “I’d never heard of Salvarsan.” The first two have been huge commercial successes and will no doubt go on being so, but they haven’t had as large an impact on overall healthcare, or are less important for other reasons.
The panel also went on to nominate six other very significant drugs and one very important delivery mechanism:
- L-dopa – A major advance in treating Parkinson’s Disease.
- Steroids – Hydrocortisone and other corticosteroids have an enormous range of uses any time that control of inflammation and the immune system is needed.
- Viagra – This was a controversial choice. However, there are millions of men around the world unable to have sexual activity and it is creating a huge improvement in these men’s quality of life.
- Cyclosporine – The first drug to shut down the immune system, allowing transplants to live and not be rejected by the body.
- HIV Drugs – The class of HIV drugs known as protease inhibitors can be combined with other kinds of AIDS drugs to keep HIV levels so low that patients do not get AIDS. The drug that cures AIDS will go into the Top 10.
- Ritalin – The drug that showed that millions of kids with ADHD could have normal childhoods.
- The Capsule – It allows individual dosing and predates the tablet.
John Swann, PhD, a historian at the FDA said that it’s important to support the system that makes new medical breakthroughs possible. “I hope that people appreciate that the source for new drugs has come, and will continue to come, from a variety of sources. You have to have support for basic science, or the pipeline will dry up. And there has to be applied work for the phenomenon to continue as it has. All estates of science have an important role. The universities have a crucial role, as do pharmaceutical companies and government, too, to provide support for these organizations that support discovery3.” he said.
1 Total profit made by the top 15 pharmaceutical companies, worldwide, in 2008.
2 Please note that not all of these drugs and techniques were invented by the Big Pharmas. A compound similar to morphine was used in alchemists in Byzantine times and was rediscovered around 1522. Several others, such as Salvarsan, were invented in university laboratories.
3 Swann’s remark implies that there is a tight link between the academic researchers and the Big Pharmas. This may be partially true in the USA, where some college research departments receive large grants from industry in addition to NIH (taxpayer) funding. In many other countries the universities are wholly government funded, but there is a trend to having some degree of support from industry. The discovery of a compound plays a key role in the overall process, but it amounts to a small fraction of the overall cost of bringing a drug to market and it may be replaced by a better compound en route.
Related articles: Part 1 – Introduction | Part 2 – R&D On Steroids | Part 3 – Competition | Part 4 – Regulations and Price Controls | Part 5 – Patents | Part 7 – The Dark Side | Part 8 – Time To Take a Pill
“Every successful drug saves or improves lives” – If by “successful” you mean profitable, you need to read recent press on a couple of drugs that were very profitable and also very harmful. And, in the records of subsequent trials, is evidence that the pharma companies involved knew of this.
“Without those [huge, by your definition] profits, [the pharma companies] won’t be able to continue the huge research and development efforts that produce…” – You mean that even after they cover all their costs, they STILL need huge profits on top of that to be effective???
You mention that patents are vital to pharma to protect their investments “until they can be brought to market and start producing a revenue stream.” That’s not quite true, because the patent protection, by your own description, lasts 5 -7 years AFTER market introduction.
The way you list all the most important drugs implies these were all created by Big Pharma. However, that’s not true at all.
You paraphrase FDA’s Swann as – emphasized by you “it’s important to support the system that makes new medical breakthroughs possible.” But later you quote him (no emphasis) arguing for supporting basic science. The implication, again, seems to be that this is supporting the work of Big Pharma. I disagree – I think it’s supporting the work of NIH and NIH grantees (paid for with taxpayer funds).
No, we meant “does what it is designed to do”. I’m not sure if there’s any real correlation between the drugs/techniques on the list and profits. There’s no mention of it being a factor in the opinions of the panel. In fact, as they were mainly Europeans, excessive profits are generally regarded as being “rather vulgar” over there, so I doubt that they bothered about it. We should have been clearer, Sorry.
The revenue stream is five to seven years, but the profits from the sales have to cover the ten to fifteen years of R&D and trials. One possible model might be to make it mandatory for the Big Pharmas to license their patents to anybody who can produce a regulated (safe) generic copy and turn a profit.
Thanks for the observation regarding Big Pharma in relation to the list. Swann is indeed, talking about the whole system, not just the Big Pharmas. We’ve added a footnote.