The future of pharmaceuticals - the changing environment for new drugs

The future of pharmaceuticals - the changing environment for new drugs

90 of patticular topics and which refer back IO lion. The authors point out that bodies like an invaluable data presented in previous Annuals. This...

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90 of patticular topics and which refer back IO

lion. The authors point out that bodies like

an invaluable

data presented in previous Annuals. This means that while the claim in the lntroduc-

the Committee on the Safety of Medicines in the U.K. and similar regulatory bodies

tion that the Annuals can be used indepen-

elsewhere are on the horns of a dilemma when choosing the right time and the right way to publish warnings. The ‘Vun der

adverse reacIion dala to the attention of those who need it. but (ut the risk of repeating myself) it seems IO me that their chief

dently of one another is true. full use of the book can only be made of the associated Annual volumes are available. The sidoeffects of drugs essay iu this latest Annual presents a useful overview of the ‘information lag’ or the time lag which occurs between the observation of adverse reactions~odrugsznditsgeneraldissemina-

Recommended The Future of Pharmaceuticals - The Changing Environment for New Drugs by Cletnenr Be,-uld. Job Wiley & Sons, 1981. f6.SO (xiii + 142 pagrs) ISBN 0471 083437 The obstacles. scientific. economic and political, which face the Pharmaceutical Industry in its mission IO invent. develop and market new drugs, ate growing at a mte which thteatens the very existence of some researchbased companies. It is appropriate therefore that individuals representing different interests in society should discuss me:@ issues wirh a view to Lcilitating the desirable objective of mak:ng safer and more effective medicines available to man. Clement Bezold, the authorof this book, is a political scientist and cofounder of the Institute of Alternative Futures set up in Washington. DC. in 1977 with the main aims of encouraging systematic consideration of the future in government polio-

Adds nothing DrugTherapeutic+.: Conceptr



edired by Kennc:lr L. .Mclmon. C’lwchill Ihingstone, 1981. flS.OO (xiii - 237 page.5) ISBN 0 443 0 2432 4 Bothered and bewildered, but not bewitched by this book. Bewildered by its dust cover, that promised ‘the recently dis covered long-term effects of the prescrip tion of cimetidine for mild hypertension’, of which your reviewer had not heard a whisper, and which, alas. was not,to he found within its pages. The dust cover went on to claim that ‘The emphasis throughout is on timely, relevant data that can be used to make clinical decisions easier and more comprehensible for the physician’, and that is where one became bothered. for few 01 the chapters in this book are iikely to be of value to practising physicians. at least on this side of the Atlantic. Tk tmatment of hypettemion has been admirably dealt with by many recent publications, and this conIrBnition really adds nothing. Surprisingly,

role to play

in bringing

fault lies in the fact that they are so highly priced that many (most ?) of those who

Kroef syndrome described in the previous Annual essay very well illustrated what can happen when an early warning is taken up by the news media and dispropottionately publkiwd. This Annual. and its predecessors, have

ought to have their own copies to hand tnay not buy them.

making and also mote effective public participation in the decisions that shape the future. The book is the result of a series of seminars held in Washington during 197H and 1979. attended mainly by Congressional staff, and devoted to a considerdtion of current legislative concerns together with forecasts for Pharmaceutical R&D policy. In each of the six seminars three experts, each with divergent perspectives on the pharmaceutical industry from research, industry, public interest groups or govern ment agencies. were brought together and each chapter represents a synthesis of the papers and discussion from each seminar. In general, all the major current issues such as escalating pharmaceutical R&D expenditure and increased legislative pressures are aired and thotoughly discussed. i found, however. that topics less often covered were more stimulating such as pre dictions of future pharmaceutical break-

on the influence of National Health Insurance on pharmaceutical R&l.) that no data on the topic exist. If this is true then one would expect this to be an important future research area since the existence of an independent Pharmaceutical Industry in coun. tries with a nationalized health service is dependent on a functional balance being established between legislation relating IO drug safety and government policy relating to issues such a re-imbursernent for drugs



and patent pmtection. The book is mostly clearly written and only occasionally does the jargon become overly intrusive, such as, ‘Modalities of the holistic healthmodel shareoppositiontothe conventional or allopathic, medical model’. The subject matter covered includes much which is thought-provoking and the book is recommended for those concerned with the future of the Pharmaceutical Industry. M.


through and an interesting chapter devote4 to alternatives to drug therapy. 11 was surprising to read the statement in the chapter the author suggests that multiple daily doses of pmpranolol and metopmlol are inconve? nient and impair patient compliance, and is apparently unaware that once or twice daily &lministration is successful in most patients. As found so often in American books. no mention is made of other drugs such as atenolol that am widely used out,Gde 1he U.S.A. One might have expected that a chatlter devoted to a clinical phanna cological perspective of lidocaine and procainamide in treatment of ventricular arrhythmias might have discussed their use in the context of other widely used drugs such as disopyramide. but regrettably not. It is difficult to see how the admirable objeo tive of this volume is served by a review of the history of schizophrenia, or by yet another repetition of the story of the setenjipitous discovery ot dicoumarol, known surely by all medical students by the time wheygraduate. One questions whether prascribing doctors ate significantly assisted in their therapeutic decisions by fairly basic discussion on enkephalins and endorphins, or on liposomes which have not yet estab lished themselves as drug delivery systems

in therdpeutics. The final section deals with some contemporary problems of philoscr phy, politics and therapeutics, but, not unnaturally, from a North American point of view, and it is unlikely to read with great interest elsewhere. It is true, as Kenneth Melmon, the Editor-in-Chief says in his preface, that therapeutics is an under-rated atea of medicine, and it is not surprising therefore. that pub!ishen the world over are seeing this as a potentially fenile area worth exploiting, particularly in view of the multiplicity of treatments available to doctors for their prescriptions. New books, or new series of books, like new drugs and medicines have to be presented as original and must possess novel qualities mat am of true value, if they are IO displace, or at best compete with, the established market leaders. It is difficult to see suchqualities in this particular product. PAUL TURNER