As the industry adjusts to life after the patent cliff, Maxine Vaccine suggests it may be time to abandon the ‘blockbuster’ mentality and look to a new model of integrated care.
Sometimes the pharmaceutical industry needs a voice. And – regardless of rhyming slang – we could do worse than the ABPI’s Stephen Whitehead. His speech to the trade association’s annual conference this week fired a resounding shot over the bows of the austerity-fixated NHS.
In a week when we learned that the coalition’s austerity policies have plunged the UK economy back into recession, Whitehead commented that the NHS is altogether too smug about its ability to save £3 billion per year by switching wholesale to generics. That’s all well and good, he said, but what happens to that money? If it simply disappears from the NHS budget instead of being reinvested in innovative new treatments, the NHS will be a snake eating its own tail – with the pharmaceutical industry frozen out of the austerity circle.
Then he delivered the payoff: “Generic medicines do save us money, but it is innovation that saves lives. We have to be careful not to focus on cost saving when we should be focusing on patients. The effective use of innovative new medicines can often reduce costs elsewhere in the healthcare system by reducing the need for expensive primary and secondary care.
“In fact, with diseases like Alzheimer’s placing an increasing burden on NHS resources, the development of new medicines by the pharmaceutical industry will be pivotal in not only fighting disease but ensuring the financial burden they impose doesn’t cripple the healthcare system.”
This statement challenges the NHS and other health systems to match the industry’s commitment to beating the recession through innovative drug development – echoing the recent statements by GSK’s Andrew Witty and Lilly’s John Lechleiter that only robust pipeline development, not austerity measures, can ensure a strong future for their companies.
Whitehead called for more effective partnership between the industry and the NHS to ensure that innovative medicines are seen as part of the solution for a health system struggling with increasing demand and shrinking budgets.
In the same week, the BMJ published an article covering new research that suggests the clinical case for widespread antidepressant use has been overstated by suppliers and clinicians alike. Researchers at Canada’s McMaster University argue that while the therapeutic benefits of long-term antidepressant use are slight, the cumulative evidence of systemic damage is conclusive. Long-term side-effects include increased risk of stroke in the elderly, sexual dysfunction and digestive problems such as IBS.
Prozac was the blockbuster drug par excellence: a ‘happy pill’ promoted as a universal panacea for depression, and prescribed to millions. Side-effects were routinely dismissed as a small price to pay for the correction of a ‘chemical imbalance’ that could not be treated in any other way.
Except that wasn’t true. As another BMJ article explained in 2010, SSRIs do not restore biochemical normality: they create a drug-induced state, comparable to being mildly stoned, in which the symptoms of depression are masked. These days, few doctors persist in the delusion that any drug is an adequate monotherapy for a complex and chronic mental health condition. Medication can be useful for crisis management, but improvement of the patient’s systemic health through behavioural changes, lifestyle management and other medical interventions is the only adequate long-term strategy. The evidence that antidepressants can have lasting and serious side-effects strengthens the case for treating the patient, not the symptoms.
Whitehead’s speech and the debunking of the Prozac myth are two sides of the same coin. The era of the blockbuster drug is over. Innovation is not about seeking the ‘magic bullet’ that treats as many patients as possible. It’s about working with healthcare providers to build complex, flexible solutions for the patient – who is viewed not just as a composite of symptoms but as a living system that changes profoundly over the limited but unique interval we call a human lifetime.
Maxine’s views are not necessarily those of Pharmaceutical Field.