Last night saw a collection of the UK’s great and the good in clinical pharmacology and medicine gather for the annual British Pharmacology Society’s President’s Lecture. The event, which has seen ever more fascinating presentations over the years, surely reached a pinnacle with Dr Nessa Carey’s ‘Big Pharma – why even the best science might not be enough to save it’. Dr Carey, who is Visiting Professor, at Imperial College London, Translational Chair for Business Development and Innovation at the Quadram Institute and non-executive director at UCL-Business is no newbie to industry, having worked many years with pharma industry stalwarts like Pfizer.
In opening her presentation, Dr Carey referred the audience to the well-known issue haunting the industry – that of increasing spend on research and development and the decreasing number of successful registrations. It was clear, she said, that all the low hanging fruit have been taken. Future progress for diseases that impact on our society, like Alzheimer’s and Type 2 diabetes, are going to take significant investment with no obvious funding mechanism. While new technology and big data hold some promise, experience from previous scientific panaceas (die eierlengde Wollmilchsau) teach us not to expect too much. History shows it takes years to convert knowledge into treatments and Dr Carey gave the example of how it took almost four decades to convert our ability to edit genes into treatments.
Clearly part of the problem lies with society as a whole expecting the pharmaceutical industry, a system shackled by its necessity to make profits and compete in share markets, to solve the endemic problems of its own creating – ageing population, diabetes, obesity, etc. In previous decades the promise behind the pharmaceutical industry lay in continuing innovation, potential for new markets in China, Brazil etc., personalised medicine and the development of cures. Dr Carey discussed how each of these is failing to deliver, further questioning whether a capitalist system that requires reimbursement and profit to thrive can be left in charge of our future health.
Reimbursement is clearly a big issue both to healthcare system and the industry. We are seeing new treatments being introduced at eye watering costs. The question was raised as to how much further this can go – who pays? And who chooses which medicines get developed? Dr Carey recounted the unhappy story of two companies developing new antibiotic therapies that recently went into receivership. Antibiotic resistance represents as big a threat to mankind as climate change and yet there is no mechanism by which new treatments can be developed. Are we to rely on philanthropical solutions though organisations like The Gates Foundation – a somewhat Victorian solution for the Modern age?
Dr Carey closed her lecture with four possible solutions, all of which require society to think differently about how drug development is conducted. She concluded that the science remains the star of the show with the number of lives saved by vaccines, antibiotics and cardiovascular drugs serving as undeniable, empirical evidence of its efficacy. It’s time for society to step up. But the industry doesn’t help itself with cases like Martin Shkreli and Theranos. It is clear that pharma bashing by 'red top' newspapers and self-appointed patient champions (focused on book sales and chat show appearances) need to be replaced by adult and rational discussion. Equally, the pharma industry needs to curtail its efforts to grab fortunes on the back of overstretched healthcare resources and long-suffering patients. It’s time to replace emotive arguments with open discussion.
The audience were clearly enthralled with Dr Carey’s views – presented engagingly and succinctly, stimulating enthusiastic discussion from the audience. I expect all attendees left the meeting eager to renew their efforts in championing science.
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