The Pharmas face a critical problem, "declining productivity in drug innovation" (‘DPDI’), and operate under intense and increasing pressure because of it. The continuing existence of the Pharmas depends on their solving and/or adapting to the DPDI problem – at the same time emphasising that they are key to cracking the health problems we face.

Over the past decade, the Pharmas have responded to the DPDI problem mainly by increasing investment in marketing, lobbying and public relations:

  • The introduction of Direct-to-Consumer drug promotion in 1997 underlines the present trend - more aggressive and intrusive emphasis on products, brands and ‘health needs’
  • At the same time, the Pharmas have invested massively to secure systematic and forceful involvement in professional, governmental and public affairs.

This has led to the creation of a new health climate in the Pharmas’ main markets, especially the USA. The result is overmedication; it stands for three distinct threats to personal and public health. The first is iatrogenesis – personal, social and cultural – resulting from the spread of ‘health anxiety’. The second is unsustainable demand leading to breakdown of national health services, and divisive inequity in access to them.

The third problem is that, as richer countries succumb to overmedication, they strengthen a drug establishment that necessarily perpetuates health deprivation elsewhere. Undermedication is the main problem for the two billion people worldwide who cannot get the essential drugs they need; improved access to medicine could save 10 million lives a year. What a waste of the talent, energy and commitment that medicine should mean.

No-one should count on immunity from Pharmageddon. Even in the richest countries, personal health seems overwhelmingly predicted by the health and well-being of others – by their action, example, attitudes, traditions and behaviour. We are all in this together: everyone is affected when other people feel ill or are impoverished, desperate, miserable or insecure.

The drug establishment, on its own, is no more able to contain the threat of health climate change, than energy companies can protect the physical environment. The definition of remedies is a matter of public interest, mainly in our hands.

Charles Medawar
24 September 2007


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