Reflections

Most blockbusters have at least one thing in common—they are widely prescribed to treat a common illness, such as hypertension, high cholesterol, pain, ulcers, allergies, and depression. The larger the potential patient population, the higher the likelihood for a drug to become a blockbuster. Obviously, the drug has to be effective. If it does not work, or works only marginally, the average patient is not going to be enthusiastic about taking it. However, efficacy alone is not good enough. For instance, the old tricyclic antidepressants worked if patients finished the full course of treatment. Unfortunately, they were nonselective, hitting many targets. As a consequence, they were so toxic and replete with side effects that only a fraction of patients (less than 20 percent) were able to tolerate them until completion of a treatment course. In contrast, the newer selective serotonin reuptake inhibitors (SSRIs) are more selective and thus possess fewer side effects. As a result, SSRIs like Prozac, Zoloft, Paxil, Wellbutrin, and revolutionized the treatment of depression. Similarly, atypical antipsychotics such as Zyprexa, Geodon, and others Abilify helped schizophrenia patients tremendously. These drugs transformed debilitating diseases into treatable chronic illnesses. Most psychiatric patients these days do not need to be institutionalized as they were half a century ago. A drug with good efficacy and a high safety profile treating a widespread disease does not necessarily sell itself, however. Direct advertisements to consumers and a strong sales force are essential to create and sustain the popularity of a drug. Blockbuster drugs save lives and support a vibrant pharmaceutical industry. What do we, as a society, do to ensure their sustainability? While realizing that there is no single prescription for this problem, one could certainly begin by talking about patent reform. The current patent system is antiquated as far as innovative drugs are concerned. Decades ago, 17 years of patent life was somewhat adequate for drug companies to recoup their investments in R&D because the life cycle from discovery to marketing at the time was relatively short and the cost was lower. Today’s drug R&D is a completely new ball game.