Of medicine and medicinesBMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39532.436667.47 (Published 27 March 2008) Cite this as: BMJ 2008;336:0
- Tony Delamothe, deputy editor
This week’s journal captures modern medicine’s ambivalence about modern medicines. On one hand, we look to new drugs to deliver us from illness and disease. On the other, we view the companies who deliver them with suspicion or disdain.
The journal has articles to buttress both viewpoints. Firstly, drugs as salvation. According to WHO, African trypanosomiasis (sleeping sickness) affects 50 000-70 000 people, with only two drugs available for treating the late stage of the disease. One of them, eflornithine, had a chequered production history until Aventis agreed to resume production in 2001 as part of an extraordinarily generous package to help reduce the incidence of the disease. In a large study, Priotta and colleagues (doi: 10.1136/bmj.39485.592674.BE) report that eflornithine shows acceptable safety and effectiveness, and an editorial (doi: 10.1136/bmj.39505.490544.BE) recommends it as the first choice in stage 2 disease.
Brucellosis is another infectious disease that exacts a high toll on its sufferers and whose optimal treatment has been debated. A systematic review recommends dual or triple therapy including an aminoglycoside (doi: 10.1136/bmj.39497.500903.25). In his accompanying editorial (doi: 10.1136/bmj.39497.431528.80) Georgios Pappas identifies much that is still baffling about this disease and looks forwards to the results of large clinical trials that are currently underway.
In another editorial, Jonathan Waxman discusses a new class of drugs for treating renal cancer: multitargeting kinase inhibitors (doi: 10.1136/bmj.39469.564734.80). In randomised controlled trials they have increased median overall and progression-free survival by a few months (only). Waxman believes that the UK shouldn’t have to wait two more years for NICE to approve their use.
Which brings us to the criticisms of drug companies for their sometimes sharp practices over drug licensing and advertising. Robin Ferner and Keith Beard look at the risks and benefits of shifting drugs from prescription only status to over the counter availability (doi: 10.1136/bmj.39504.389676.AD). One incentive for drug companies to seek reclassification is that, unlike prescription only drugs, over the counter drugs can be advertised directly to consumers, which drives up sales.
The ground may be moving there, at least in the European Union. A proposal to allow direct to consumer advertising of prescription only drugs was “soundly rejected by the European Parliament in 2002,” says Tessa Richards (doi: 10.1136/bmj.39527.454560.59), but it has bounced back in another guise. Manufacturers want the right to provide information about their prescription drugs directly to the public, using TV, radio, and print to do so. A raft of organisations is trying to convince the European Commission otherwise..
The UK’s drug companies are not happy at present, as Andrew Cole reports (doi: 10.1136/bmj.39526.738345.DB). In the coming year, they expect to cut staff, production, and research and development—largely because the government is scrapping its 50 year old pharmaceutical price regulation scheme. This set the cost of prescription drugs as well as the national standard for non-transparency of government negotiations (defence deals always excepted). The director general of the Association of the British Pharmaceutical Industry says that the government should watch it: “If the UK falters there are many other countries that are ready to take up the challenge.” As a negotiating tactic, this is reminiscent of the response of Glaxo-Wellcome’s chief executive to NICE’s rejection of its flu drug, Relenza: he threatened to move some of his company’s activities out of Britain.
It’s easy to recognise the mutual dependency that binds patients, governments, and drug companies together—but much harder to agree how each party should behave.