Disagreeing with a reader’s comment on the pharmaceutical industry

A stellar commenter, RG, writes:

There is also a deeply held impression that these new drugs have revolutionized medical care in this country, as Doug Bandow seems to believe in his article. That may only be true to a certain extent.

In a compelling book, THE RISE AND FALL OF MODERN MEDICINE, Dr. James Le Fanu, a renowed medical writer from London, made the point that the fall of the pharmaceutical industry started around the late 1970s, when nothing new was added to our pharmocopeia in comparison to the drugs that were discovered and synthesized from after World War II to the end of the 1970s. And he is probably right.

There may have been a profusion of drugs over the last 25 years, but Dr. Le Fanu again pointed out that most of these were copy-cats from previously released drugs, costing much more and with at most marginal benefits. We can think of anti-inflammatories, antibiotics, hypertensive drugs, H2 acid antagonists, and a host of other me-too drugs that really have not made a dent in revolutionizing treatment. In short, he is suggesting Big Pharma had met a dead-end, a reason why it had to concentrate on life-style drugs (Viagra for impotence, Rogaine for baldness, the ill-fated phen-phen for weight loss) and forced many of the companies to merge into mega-giants to consolidate their dwindling new-product potential.

I beg to disagree. Having graduated from medical school in 1975, I would bring this perspective to argue the point. Let us start with heart failure. Back in 1975 we had no ACE inhibitors, or ARBs. The first study showing the CHF survival benefit of an ACE inhibitor was published in 1988.

The profusion of anticoagulants, helpful in treating acute coronary syndromes, which range from thrombolytics to platelet inhibitor drugs, have made signficant strides. We see more such drugs under development, enhancing our options to care for such patients.

In cardiac prevention, we have the statins – first represented by lovastatin. These drugs represent the only major class which clearly helps in secondary prevention and probably helps some patients in primary prevention.

Adult onset diabetes mellitus has several classes of hypoglycemics to draw on. We had first generation sulfonylureas.

AIDS is a new disease, and all the antivirals developed to treat AIDS have arrived over the past 15-20 years.

The proton pump inhibitors have revolutionized the treatment of acid disorders, and are not a me too drug when compared with H2 blockers. They represent the application of further physiologic understanding.

Since the 70s we have made remarkable progress in treating heart disease – and prolonging quality life! We have more specific cancer cures, especially with regards to lymphomas and leukemias. We have a greater assortment of antimicrobial agents, from newer antibiotics, to antifungals, to a variety of antivirals. We have a plethora of options for ameliorating mental illnesses (from depression to psychosis).

I do not accept Dr. Le Fanu’s argument. While I have quibbles with the pharmaceutical industry, I cannot argue that they have done nothing worthwhile. Au contraire, they have provided me the tools to often modify the natural history of disease. Our profession (and here I speak principally of internal medicine as I am most familiar with internal medicine) is intellectually richer and more satisfying because of these and other pharmaceutical advances.

db descends from his soapbox. Back to pimping.