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The pharmaceutical industry since 1870 has become gargantuan, but consumers cling to a love-hate relationship with drugs for health


Since the mid-19th century, pharmaceuticals have moved from the periphery to the center of health care. In the course of that transition, a new industry sector expanded to global scope, the field of medicinal chemistry rose to its current prominence, and governments adopted dual roles of supporting basic research and regulating drug safety and efficacy.

For patients--and we are all patients at various points in life--drugs have taken on new medical roles and value. In recent years especially, it has become common for people to take drugs for years, even decades, to reduce risks of disease and increase life span. Taking drugs for life has intensified a long-standing hybrid of scientific, emotional, and policy issues around side effects and widespread resentment of companies that profit from drug invention and marketing.

This 1971 photo from a Pfizer plant in Groton, Conn., shows one of the many stages between discovery of a medicinal compound and it's eventual introduction to the market PFIZER PHOTO

PRODUCTION This 1971 photo from a Pfizer plant in Groton, Conn., shows one of the many stages between discovery of a medicinal compound and it's eventual introduction to the market.

Combined with public health initiatives, new pharmaceuticals have contributed significantly to an improved quality of life and helped increase human life span. In the U.S., for example, life span increased from an average of 47 years in 1850 to 78 years today. Advances in medicinal chemistry have marginalized or eliminated health scourges once prevalent around the world. This special issue of Chemical & Engineering News contains 46 essays devoted to specific drugs or classes of drugs. Among the threads explored are the role of chemical professionals in inventing new therapies; the complex interplay of scientists, industry, government regulators, physicians, and patients in converting laboratory molecules into medical therapies; and the changing professional roles of scientists and physicians in the wake of increased government regulation and patient activism.

Recently, drug safety issues have come to the fore in the wake of concerns about COX-2 inhibitors and antidepressant use among teens. Press attention and congressional investigations have highlighted the complex choices faced by industry and regulators as new medicines come to market. Government officials who act too slowly while reviewing mountains of documents--applications are typically 50,000 pages long or longer--face complaints from patients, disease-based organizations, physicians, and economists and politicians with antiregulatory sentiments. When regulators decide against approval, they may be accused of undermining a key sector that provides employment to thousands of skilled workers and serves the public interest by producing medicines. Approve a drug that later causes adverse reactions,however, and regulators are pilloried in the press, asked to testify before Congress, and told to tighten controls.

Industry faces its own set of difficult choices. Firms that commit too strongly to a small development portfolio face the possibility of failure in clinical trials and disruption of their competitive standing. Those that push broad drug pipelines risk investor dissatisfaction with their failure to focus their research and develop blockbuster drugs. Market incentives drive companies to invent medicines for ailments prevalent in the U.S., Europe, and Japan, while the absence of cures or affordable treatments for diseases prevalent in developing countries, especially HIV/AIDS and malaria, opens pharmaceutical firms to criticism. Another challenge in the past two decades has been the rise of a generic pharmaceutical industry of increasing global scope.

A recent Harris Poll thus recorded a 35% decline in consumers' approval of the industry, down from 79% in 1997 to 44% in 2004. For scientists involved in drug research and for the industry more broadly, this shift reflects the quandary of balancing an ethos of research in the interest of the public good against the necessity of running pharmaceutical firms as businesses.

NEXT PAGE: Emergence Of Pharmaceutical Science And Industry: 1870-1930


The Top Pharmaceuticals
That Changed The World
Vol. 83, Issue 25 (6/20/05)
Table Of Contents