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The Human Face Of Pharma

June 19, 2006

The Price Of Hope

Journalist recommends investing in doctor-patient relationships

Corinne A. Marasco

Courtesy of Jacky Law

Jacky Law

As Jacky Law sees it, the fundamental problem in health care today is the decline of trust as patients increasingly perceive that the pursuit of profit is prevailing over the public good. "Things are now so commercial that there are few public scientists who are protecting our interests," says Law, a British journalist who has written about health care for 25 years.

"Large pharmaceutical companies have very big empires to maintain, so the relevant laws should be applied more vigorously than they currently are. The emphasis should be spent on ensuring that the science that is done is public."

Law, the author of "Big Pharma: Exposing the Global Healthcare Agenda" (New York: Carroll & Graf, 2006), isn't anti-big business, but she does believe that public confidence in the regulatory process has eroded because the interests of the regulators and the industry are closely aligned. Regulatory bodies are staffed by people who are more knowledgeable about science than the general public is, she notes, and the outcomes of regulation tend to favor industry. As a result, "people don't trust the companies. I am overwhelmingly in favor of somehow getting stronger public input into our medicines," she says.

"Drug companies should not be able to control clinical trials," she adds. "Clinical trials should be more of an effort to assure the public that everything is aboveboard. For example, new drugs should be compared with old drugs rather than with placebos, because the placebo effect can be quite strong. We should be devoting more public money to verifying what pharmaceutical companies say and do."

Another troubling trend Law points to is the declining output from the pharmaceutical pipeline. "In the past, the industry produced lots of fabulous drugs that made a real difference," she says. "Now it isn't producing as many effective new drugs, and managing expectations for success is hard work. So, what are they supposed to do? The industry has produced sequels of existing drugs and different methods of drug delivery and spent more on marketing."

The innovation pipeline is expensive to maintain, and Law notes that the cost of access to drugs is being questioned. The example she offers is the breast-cancer drug Herceptin, which has been approved for late-stage treatment for HER-2 breast cancer in both the U.S. and the U.K. According to a story in the May 2 Wall Street Journal, patients in both countries have been advocating for earlier access to the drug after new research published in 2005 showed that Herceptin, in combination with chemotherapy, reduced the risk of recurrence by more than 50%, compared with chemotherapy alone, in the early stages of the disease.

Herceptin costs tens of thousands of dollars per patient per year, however, and that's a price that many can't pay out of pocket. In February, Genentech asked the Food & Drug Administration to give Herceptin a "priority review" for early-stage use, meaning that the agency must make a decision in six months, but the National Health Service (NHS) in the U.K. declined to make it available for women with early-stage breast cancer even with a doctor's prescription.

How, Law asks, can you put a price on hope? "Fighting cancer is an expensive business. These drugs take medicine into a whole new pricing league," she writes in "Big Pharma." "The health gains may not be great, measured in months rather than years, but the drugs do extend life, and that's what matters most in medicine."

What, then, does this example mean for the future of personalized medicine? "It's not going to happen at a reasonable cost for everybody," she says. "It requires much more extensive medicine and further emphasizes the need to take stock of the pricing issue."

In the end, Law says the patients have to take the initiative to restore trust by building relationships with their doctors and actively participating in their own care. "AIDS patients literally changed the culture of medicine," she says, "because so many young men dying brought patients to the fore.

"There are three sides to the triangle: the pharmaceutical industry, the patient, and the doctor," she continues. "The pharmaceutical industry pours millions of dollars into relationships with doctors and millions into relationships with patients, but it puts very little into the doctor-patient relationship. But that's where ordinary people can have an influence by taking a more active role in asking their doctors questions, especially about the medicine they're taking."

C&EN SPECIAL ISSUE: Pharma's Road Ahead

Cover Page Thumbnail
Pharma's Road Ahead
Volume 84, Issue 25
June 19, 2006
Table Of Contents
Web Feature: The Human Face of Pharma

Seventeen individuals whose lives depend on, or whose livelihoods are affected by, the pharmaceutical industry offer unique perspectives on what pharma's future should be.