- A senior executive with Britain's biggest drugs company
has admitted that most prescription medicines do not work on most people
who take them.
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- Allen Roses, worldwide vice-president of genetics at
GlaxoSmithKline (GSK), said fewer than half of the patients prescribed
some of the most expensive drugs actually derived any benefit from them.
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- It is an open secret within the drugs industry that most
of its products are ineffective in most patients but this is the first
time that such a senior drugs boss has gone public. His comments come days
after it emerged that the NHS drugs bill has soared by nearly 50 per cent
in three years, rising by £2.3bn a year to an annual cost to the
taxpayer of £7.2bn. GSK announced last week that it had 20 or more
new drugs under development that could each earn the company up to $1bn
(£600m) a year.
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- Dr Roses, an academic geneticist from Duke University
in North Carolina, spoke at a recent scientific meeting in London where
he cited figures on how well different classes of drugs work in real patients.
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- Drugs for Alzheimer's disease work in fewer than one
in three patients, whereas those for cancer are only effective in a quarter
of patients. Drugs for migraines, for osteoporosis, and arthritis work
in about half the patients, Dr Roses said. Most drugs work in fewer than
one in two patients mainly because the recipients carry genes that interfere
in some way with the medicine, he said.
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- "The vast majority of drugs - more than 90 per cent
- only work in 30 or 50 per cent of the people," Dr Roses said. "I
wouldn't say that most drugs don't work. I would say that most drugs work
in 30 to 50 per cent of people. Drugs out there on the market work, but
they don't work in everybody."
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- Some industry analysts said Dr Roses's comments were
reminiscent of the 1991 gaffe by Gerald Ratner, the jewelry boss, who famously
said that his high street shops are successful because they sold "total
crap". But others believe Dr Roses deserves credit for being honest
about a little-publicized fact known to the drugs industry for many years.
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- "Roses is a smart guy and what he is saying will
surprise the public but not his colleagues," said one industry scientist.
"He is a pioneer of a new culture within the drugs business based
on using genes to test for who can benefit from a particular drug."
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- Dr Roses has a formidable reputation in the field of
"pharmacogenomics" - the application of human genetics to drug
development - and his comments can be seen as an attempt to make the industry
realize that its future rests on being able to target drugs to a smaller
number of patients with specific genes.
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- The idea is to identify "responders" - people
who benefit from the drug - with a simple and cheap genetic test that can
be used to eliminate those non-responders who might benefit from another
drug.
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- This goes against a marketing culture within the industry
that has relied on selling as many drugs as possible to the widest number
of patients - a culture that has made GSK one of the most profitable pharmaceuticals
companies, but which has also meant that most of its drugs are at best
useless, and even possibly dangerous, for many patients.
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- Dr Roses said doctors treating patients routinely applied
the trial-and-error approach which says that if one drug does not work
there is always another one. "I think everybody has it in their experience
that multiple drugs have been used for their headache or multiple drugs
have been used for their backache or whatever.
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- "It's in their experience, but they don't quite
understand why. The reason why is because they have different susceptibilities
to the effect of that drug and that's genetic," he said.
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- "Neither those who pay for medical care nor patients
want drugs to be prescribed that do not benefit the recipient. Pharmacogenetics
has the promise of removing much of the uncertainty."
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