I WROTE this back in 2009, with references that relate to events around that time. Neverthesess the article still reads fresh and current. Thus ...
In 2008, I wrote that Big Pharma may go the way of Detroit. Detroit, I wrote, won't be around 10 years from now. Little did I realize how prescient I was.
An opinion piece in the LA Times (early Jan, 2009) by author Greg Critser neatly encapsulates things the patient community has been discussing over the past 10 years:
First of all, Mr Critser notes, the meds don't work well. (Assuming the drug is reasonably safe, 50 percent of patients getting 50 percent better is all that is required for an FDA indication.) Nevertheless, even badly flawed meds have amounted to licenses to print money. Think Prozac. Think Zyprexa.
But these drugs have now ridden off into the sunset - gone generic - and there is nothing to replace them.
No new drugs. How stupid is this? Imagine if the movie industry were to announce that there were no new films in production, that holiday movie-goers were going to have to make do with the likes of "Parent Trap I."
According to the LA Times piece:
"As Bloomberg News Service recently reported, the world's pharmaceutical firms need to find replacements for $84 billion in sales now generated by products ending their patent life."
Sounds like appallingly bad management, right? No, it's always someone else's fault:
"If you ask the typical Pharma executive why sales are down, you get an alternative reality. The devil isn't in their drugs, it's in - surprise - onerous government regulation, penny-pinching insurers and, of course, that perennial boogeyman: healthcare reform."
Here's my very simplified take on what happened: In the eighties and nineties, Big Pharma got lucky with a new generation of antidepressants and antipsychotics. The drugs were hardly new - they were based on the same technology as the old ones - but they were promoted as new.
Psychiatry and patients' groups bought into the hype and the result was easy money.
As any business textbook will teach you, easy money is the greatest disincentive to sound management. Bad decisions and waste do not get penalized. Innovation and efficiency do not get rewarded. Necessary course corrections are not made.
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During the easy times, the drug companies got out of the drug development business. Research went into "me-too" drugs - different versions of Prozac and Zyprexa. Corporate attention was devoted to lobbying the government (Big Pharma has way more lobbyists than any other industry) and wooing doctors (typically with drug reps who look like Heidi Klum and Russell Crowe).
The easy money, of course, ran out, but we're still stuck with the same bad management, ingrained in their easy money bad habits.
So, when, if ever, will we get meds that are a real improvement on the old ones?
Short answer: Never. Not with the current managers in place. Take my word for it - these guys are dumber than Detroit.
It's the Customer, StupidWhat went wrong? Lots of things. But it all boils down to this one cardinal sin: Pharma never listened to its customers.
My background as a finance/business journalist has given me considerable insight into this. Back in the late eighties, when I lived in Australia, I co-wrote a book with a prominent businessperson there, entitled "The Customer," which went to number two on the best-seller list.
It's all about organizing your business around the customer. If management isn't directly serving the customer, then they need to be serving the people serving the customer. It's amazing how entire industries get this principle wrong. Detroit, for instance, has always dictated the terms of the customer relationship. Marketing, to them, is about conditioning us into acceptance rather than finding out what we want.
Look at where Detroit is now.
Detroit, at least, pretends to listen to the customer. Pharma? Let me tell you a story:
In early 2007, I was at a book launch on the east coast. I grabbed some finger food and started up a conversation with a pharmacology expert from Bristol-Myers Squibb.
"Maybe you can enlighten me," I opened. I had been doing some research into dopamine and had pretty well concluded that stimulants and antipsychotics amounted to "dumb" dopamine meds.
We needed "smart" dopamine meds. Surely, Bristol-Myers Squibb was aware of the situation. Surely, such a drug was at least on their radar screens, if not their drawing boards.
We actually have a smart dopamine med, the man informed me. "Aripiprozole."
Surely, he misunderstood. Nothing against Aripiprozole (Abilify), but it's been on the market for years. I was looking into the future. I realized he wasn't in a position to disclose any company trade secrets, but he could at least fill me in on some general principles, namely: Where were the next new meds going to come from?
I'm a customer. I have a right to ask.
It was if the man hadn't heard me. Once again, he started talking about aripiprozole, undoubtedly the exact same pitch he gives to psychiatrists. For years, BMS has been telling doctors that aripiprozole is a "Goldilocks" drug - not too much dopamine, not too little, just right.
Stop trying to sell me something, I wanted to say to him. I'm a journalist. I'm not as gullible as the psychiatrists you're used to talking to.
Again, I tried to get the conversation back on track. Again, the man tied to shove his stupid drug down my throat. It never occurred to him to ask me why I was so interested in a "smart" dopamine med in the first place.
Were there special challenges I faced that a smart dopamine med might address? he could have asked.
Was there anything about my illness that he needed to know, that he wasn't finding out about from psychiatrists? If a "magic bullet" were to come on the market tomorrow, how would this affect my life? What impact would a safer and more effective med have on my compliance?
Believe it or not, this man could have learned a lot from me. So could BMS and their competitors. Let me assure you, no one in the entire drug industry has even bothered to ask. I'm a patient author and advocate, so if they're not interested in me then I know they are not interested in you, either.
Actually, BMS did bring a patient author on board, Andy Behrman, author of "Electroboy," but in the capacity as a spokesperson - a grateful patient - for Abilify. The arrangement worked fine until the drug pooped out and Andy went public. Then all hell broke loose. (Never piss off a writer: Andy at the time was working on a tell-all book.)
So what happens to companies not interested in listening to their customers? We know the answer. The evidence is there. Detroit, Wall Street, Pharma ...
"How deserted lies the city," says Lamentations, "once so full of people!"
It's tempting to say, "good riddance," but if Pharma goes down, what becomes of us?
See also: Pharma Is Dead To Us.
First published as two separate blogs, Jan 2009, revised as an article Jan 14, 2011, reviewed Dec 2, 2016.
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