Pharmaceutical Industries: Do They Prefer Treatment to Cure?

Science and Society

Pharmaceutical industries: do they prefer treatment to cure? Downloaded from http://portlandpress.com/biochemist/article-pdf/27/3/32/7274/bio027030032.pdf by guest on 25 September 2021

by James Mittra Despite the emergence of novel life-science-based approaches to dominated by large incumbent firms (Edinburgh, UK) drug discovery and development and the unprecedented growth developing small molecule treatments of new companies and research organizations competing in the for diverse therapeutic markets, to a healthcare sector, the industry continues to be dominated by the complex ‘distributed innovation marketing of small-molecule ‘blockbuster’ therapies developed by system’, began when large, fully- large multinationals.The hope that ‘genomics’ would shift the focus integrated drug-discovery companies from the treatment of symptoms associated with disease to the were confronted by ‘disruptive’ prevention or cure of many debilitating illnesses has yet to translate life science technologies. They were into reality.The question is whether traditional pharmaceutical forced to develop ‘innovative capa- companies simply prefer treatment to cure and, if so, where must city’ within fields where they had no society look to ensure that the best science is translated into the previous expertise, and adapt to a most innovative, effective and beneficial clinical products. changing industry structure. Although advances in biology I argue that although traditional dominating the industry exhaust undoubtedly opened up new big pharma companies do currently their existing models and processes avenues for drug discovery and appear to prefer treatment to cure, for drug R&D. development, and helped create in the long term, change will be and shape new kinds of industry inevitable. Radically new and com- A complex and evolving relations and business models, it plex options for healthcare are pharmaceutical sector appears that we may have been too emerging from the growing num- optimistic in our expectation that ber of small, innovative biotech The pharmaceutical sector has under- radically new, safer and more effec- and genomics companies, and gone profound structural change over tive therapies or cures would soon truly novel basic research is being the past 20 years. It is now commonly be made available to patients. conducted within the public sector. referred to as a complex ‘system’ Coupled with various social, or ‘network’ in which innovative ‘Treatment’ versus ‘cure’: commercial and technological activities are widely distributed and what is happening in big challenges now facing traditional depend upon diverse actors and insti- pharma companies? pharmaceutical innovators1, big tutions; including small, medium and pharma companies will probably large pharmaceutical and biotechnol- While most big pharma companies be forced to reconsider the wisdom ogy firms, genomics companies, have recognized the importance of of the ‘blockbuster pill’ approach. public sector research organizations, life science based approaches to However, change is likely to be universities, financial institutions, drug R&D, as evidenced by the slow, as the major companies regulatory authorities, governments, growing trend for them to acquire health care systems, consumers and or become partners of smaller Key words: cure, innovation, life science, citizens2. This transformation, from biotech and genomics companies, pharmaceutical, therapy. a relatively homogenous industry there is little evidence yet that the

largest and most profitable companies are actively pursuing an alterna- tive to the ‘treatment paradigm’. A cursory glance at the R&D pipe- lines of the top ten pharmaceutical companies and their most recent product launches, reveals the contin- uing dominance of traditional therapeutic products. While innovations in discovery techniques and instru- mentation, such as combinatorial chemistry, high-throughput screen- Downloaded from http://portlandpress.com/biochemist/article-pdf/27/3/32/7274/bio027030032.pdf by guest on 25 September 2021 ing and biotech approaches to target identification and validation, have certainly had an impact on early-stage R&D, the vast majority of products marketed by big pharma companies, and currently being developed in- house, are small-molecule treatments in complex, but high-value, therapeutic areas, such as cardiovascular, oncology, depression and the central nervous system. Some authors have argued that the very idea of a ‘biotech revolution’ in big pharma companies extracting as much value as possible So where are ‘cures’ is a myth and that any major changes from models that have proved so likely to be researched in products and processes will be successful for them in the past. and developed? slow and incremental3. The large It is still an open question whether number of ‘me-too’ therapies cur- big pharma has the technical ability If there is little evidence of any major rently in pharmaceutical develop- or commercial inclination to really pharmaceutical company actively ment also suggests that simply abandon the ‘blockbuster treatment’ seeking cures, from where are the rad- altering existing chemical-based drug model and push for novel cures. To ically new and innovative approaches treatments continues to be the most remain competitive, such companies going to emerge, and how likely is it efficient and lucrative strategy for a already have to rationalize internal that they will translate into deliver- big pharma company to employ. processes and product foci. Identi- able healthcare options? There is great Although it is easy to blame large fying potential markets for new drug expectation that the life sciences will pharmaceutical companies for the treatments is a core activity for the eventually lead to cures for many lack of radically new therapies or modern big pharma firm. To develop common diseases, and publicly cures on the market, one cannot a cure for diabetes, heart disease or funded research has perhaps been at really expect rapid change in a for- cancer would represent a fundamen- the forefront of new developments. profit industry that has built its tech- tal change to its traditional business In 2003, it was reported in the nological capabilities and fortunes on model and could potentially render magazine Chemistry and Industry a highly specialized and expensive existing high-value therapies redun- that scientists had for the first time research trajectory. At a time when dant. To invest money and resources been able to convert the liver cells of big pharma companies are struggling into a paradigm of prevention and mice into pancreatic cells using a to deal with the challenges of innov- cure, big pharma companies would single injection, and that a treatment ation deficit, rising costs of R&D, have to perceive either realistic com- for people with diabetes might be regulatory hurdles, cost-containment mercial benefits, or potentially signif- available in the next 10 years4. More pressures and increasing competition, icant losses accruing from a failure to recently, it has been reported by the it is not surprising that they focus on adapt and change. BBC that scientists at The London

NHS Trust believe they are close of therapeutic proteins produced by that the traditional model is unsustain- to developing a miracle cure for biotechnology. It has also begun to able. Companies have already had to heart disease, using stem cells from explore the potential of new tech- adapt to new technologies and come the patient’s own bone marrow. nologies for curing diabetes. It to recognize the importance of inno- A four-year research programme recently established the Hagedorn vation within public sector research involving 600 patients is currently Research Institute to perform peer- organizations and small- and being established5. reviewed research on stem cells, and medium-sized biotech companies. Reports like these are becoming has secured access to Transition These organizations are at the fore- increasingly common and generating Therapeutics’ technology for regen- front of exploring new technological hope for many patients and health- erating insulin-producing cells in a and business paradigms for healthcare providers that cures are now on $48 million deal. There are commer- care, and are likely to affect the future

the horizon. However, because the cial companies now willing to invest strategies of big pharma companies. Downloaded from http://portlandpress.com/biochemist/article-pdf/27/3/32/7274/bio027030032.pdf by guest on 25 September 2021 pharmaceutical industry remains so in potential cures, even though their Policymakers, healthcare providers powerful, and large companies are existing business models might be and the public must now begin to rec- often still required to develop late- disrupted. Companies like Novo- ognize the diversity of firms within stage products, there is concern that Nordisk, which have sought to build the pharmaceutical industry, and these scientific breakthroughs will market leadership in narrow thera- their very different capabilities and not fulfil their promise. peutic areas such as diabetes, may be business objectives, when consider- Nevertheless, the increasing diver- seeking to ensure that they benefit ing how to ensure potential cures sity of firms in the industry may help from any cure that is developed. reach the market. renew our early optimism. It is no Maybe they are now beginning to longer just the public sector that is realize that the ‘treatment paradigm’ References pursuing new approaches to health- cannot last forever and that they must care. Many biotech companies (e.g. now adapt. 1. Tait, J. and Mittra, J. (2004) Chem. Indust. Amgen, Biogen and Genzyme), as 23,24 well as a few medium-sized pharma- Looking to the future 2. Gambardella, A., Orsenigo, L. and ceutical companies (e.g. Novo- Pammolli, F. (2001) Global Competitiveness Nordisk and Ferring Pharma- It is desirable for society that the in Pharmaceuticals. A European ceuticals), appear open to research in latest lifescience technologies and Perspective. European Commission Report this area and quite willing to collabo- approaches to healthcare are used to for Directorate General Enterprise of EC rate with scientists in the public sec- improve the therapeutic options for (http://europa.eu.int/comm/enterprise/ tor. Many of these companies built those suffering many common debili- library/enterprise-papers/paper1.htm) their success on the development of tating illnesses. The evolution of the 3. Nightingale, P. and Martin, P. (2004) novel treatments for niche markets, lifesciences has provided hope that Trends Biotechnol. 22, 564–569 so they were never constrained by the prevention and cure of today’s major 4. Anonymous (2003) Chem. Indust. 3,8. blockbuster model favoured by big killer diseases, as happened in the past 5. Triggle, N. (2005) Is the UK Losing its Way pharma companies. By focusing on with infectious disease, might come to with Stem Cells? BBC News Health, 7 March areas of unmet medical need, and replace treatment as the primary goal 2005 (http://news.bbc.co.uk/1/hi/ developing therapies based on the of health policy. However, the speed health/4319293.stm) latest life science technologies, these at which such radically new therapies companies have demonstrated much reach the market will depend on the Dr.James Mittra is a greater willingness to adopt very balance of initiative between multi- research fellow at the ESRC’s Innogen Centre different business models. national companies that continue to based at the University of Edinburgh. He is cur- Novo-Nordisk, a medium-sized be driven by the marketing of small- rently working on a 4- year project looking at Danish company, is a good example of molecule, ‘blockbuster’ treatments, the evolution of life science innovations within this. The company specializes in dia- and companies that choose to develop the pharmaceutical industry, but has much broader research interests betes products, where it has a global strategies aimed at prevention and in the sociology of science and technology; public engagement and participation; gene ethics and the market share of 46%. From 2002, it cure rather than long-term treatment. regulation of novel technologies.

began to shift resources from small- There is now growing recognition, [email protected] molecule development to the research even within big pharma companies,