This issue celebrates the first 25 years of Pharmaceutical Executive—and the past 25 years of the pharmaceutical industry. What a quarter century it has been! The period from 1981 to 2006 coincides
with the rise of biotech (bringing with it whole new classes of drugs); the start of the global AIDS epidemic; and the creation
of targeted therapies for cancer. It has witnessed the prime (and perhaps decline) of the blockbuster model of drug marketing;
direct-to-consumer advertising with all its good points and bad; and the consolidation that has turned the largest pharmas
into giants. Meanwhile, the once-sleepy generics industry has become a force to reckon with; the industry has become truly
global; and public opinion about it has taken a full pendulum swing, from too slack to too restrictive and back.
Behind these big themes is a larger one, which began in the 1950s and has become clearer with each passing year. Where once
the pharmaceutical industry was a sideshow to medicine, in recent decades it has become more and more a full partner in patient
Yes, doctors remain necessary, but the physician's role has become inextricably intertwined with the products created by pharmaceutical
companies. That's a good development, and one there's no turning back from. Hardly anyone would deny that we're better off
with products that effectively fight cancer, control diabetes, reduce the risk of heart attack, and hold AIDS at bay. But
there's obviously a lot of discomfort with the idea of for-profit companies taking a full seat at the healthcare table.
A 2003 survey from Harris Interactive showed hostility across the board toward for-profits in healthcare:
- More than half of respondents said the government or non-profits should provide health insurance. Only about one in five thought
for-profits should be involved
- Just 16 percent wanted for-profits involved in medical research
- Some 37 percent thought it was OK for commercial companies to handle pharmaceutical manufacturing, but even there, the rest
either wanted non-profits in charge or weren't sure.
Those numbers make a point. Consumers, not unreasonably, want their healthcare to come to them through a different system
than the one that brings them cars, DVD players, and frozen pizzas.
The system is different of course, with FDA and physicians there to put a rein on the optimism, enthusiasm, and (from time to time) greed
of pharma companies. But that system seems to have worked a lot better when pharma played a less significant role in treating
and informing patients. Physicians, as they're fond of pointing out, feel beleaguered; FDA is under fire, less for anything
it has done than for the reputation of the industry it regulates; and trust in pharma is approaching snake-oil levels.
That needs to change. The road forward for pharma—and for public health—is going to involve more trust and intimacy between
patients, physicians, pharma, and FDA. Sharing of data, an intelligent approach to risk management, a cooperative approach
to achieving compliance—all these and more are needed. But they can't happen until we work out a way to fix the basics. Patients
need to look at a mixed system of medical professionals, government regulators, and for-profit companies and perceive it not
as an embodiment of conflict of interest, but as a fully functioning system of checks and balances.
That's a lot to accomplish. But look what industry has done in 25 years. It's not impossible.