E-drug: Science vs Shareholders (cont)
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In reply to Scott Hillstrom's latest note, several points are noteworthy.
First, drug development is a complex, multi-disciplinary undertaking,
which, to be done well, requires astute, experienced people -- many
specialists, plus a few with strong integrative skills. Most of the
capital needed for new drug development goes into paying their
salaries and other financial incentives, giving them the motivation
to perform the kind of "hyperwork" that, when focussed correctly,
makes some small companies much more productive than most large ones.
Second, a potential role of foundations is exemplified by the Population
Council's development of NORPLANT. As I mentioned before, NORPLANT
was not a particularly encouraging example of either swiftness or
astuteness in product development, given the years required to
develop it, only to flop in the marketplace, after a tantalizing,
rocket-like, initial takeoff..
Instead of waiting for an unlikely, radical transformation in human
behavior, we might contemplate the possibility of an innovative
foundation's creation of an institution -- let's call it LDC-Pharma
Project A, Ltd -- that provides financial incentives for its
employees to mimic those of the most lively, high-risk/high-reward
part of the private sector, so that LDC-PPA could recruit the best &
brightest to develop pharmaceuticals targeted to problems largely
unique to the poorest countries. One needn't have literal profits to
create a
system of attractive financial incentives that were arrived at on the
basis of a product's adoption and usage in its marketplace. The
notion of limiting the scope to 'Project A' is that the firm would
eventually finish its work and close down, rather than striving to
evolve into a 'normal' pharmaceutical firm, in which stodgy
bureaucrats would gradually replace the richly-rewarded wunderkind
who performed the original miracles of bold innovation and swift,
astute product development.
It is noteworthy that most of the large foundations have had large
increases in their assets, as they benefitted from the recent bull
market. A venturesome foundation might consider converting some of
their newly-found gains from the private sector into something along
these lines. It would probably require a small army of tax lawyers
to carve a path through the present tax code, but that's part of the
overhead of doing business. The US needn't be, and perhaps shouldn't
be, the locus of LDC-PPA, but it would have to locate somewhere where
people could reasonably want to reside, and the tax man has almost
invariably already gotten there and is spinning his webs.
Foundations have a rich history of innovating in ways that neither
governments, universities, nor private enterprise seem able to do.
(One should acknowledge, however, the remarkable gift of ivermectin
that MSD provided some years ago for treatment of onchocerciasis in
the Volta River basin.) Before it disappeared into Glaxo, the firm
of Burroughs-Wellcome was a nonprofit institution, operated by the
Wellcome Trust, and something of a model for what I'm suggesting.
Wellcome had a long history of special involvement in what used to be
called Tropical Medicine, though most of its products were aimed at
affluent countries. My impression, however, was that B-W was more
like big pharma, than the early ALZA, early Genentech, or early
Amgen, though perhaps it was specially catalyzed in the time of its
development of AZT.
In any case, rather than trying to convert the Pfizers, Glaxos, and
Novartises of the world into eleemosynary institutions, effort might
be usefully directed toward discussions with some of the foundations.
John Urquhart, MD, FRCP(Edin)
Professor of Pharmaco-epidemiology, Maastricht University, Maastricht, NL
Chief Scientist, AARDEX Ltd/APREX Corp, Zug, CH & Union City, CA, USA
Professor of Biopharmaceutical Sciences, UCSF, San Francisco
home office: 975 Hamilton Ave, Palo Alto,CA 94301 USA
tel: +1-650-321-3961; fax: +1-650-324-9739
email: urquhart@ix.netcom.com
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