Whenever medication is prescribed to you by a doctor, given to you in a hospital or sold to you over-the-counter, almost every substance you ingest, inhale or inject will have a long and tangled history behind it. This will be a history of research, development, trials, patents, regulation, policy and commerce, involving a complex set of interests that are often in conflict with one another. Recent pharmaceutical controversies attest to difficult tensions that exist between private interests, the public interest and scientific disinterest, making it difficult to develop drugs that reward investment and are affordable while also being proven to do more good than harm.

One major controversy involves statins, the most widely prescribed drugs in medical history, which lower blood cholesterol and are given even to healthy people who have no history of heart problems. In 2014, a leading journal published, and then issued corrections to, papers suggesting that the side effects of statins pose a significant risk. This prompted accusations and counter-accusations of bias, vested interest, undisclosed research data and inadequate peer review, which are ongoing. Another perennial controversy is antibiotic resistance, with the UK prime minister, David Cameron, recently blaming ‘market failure’ for a lack of new industry-developed antibiotics to tackle the threat of superbugs. And then there is also the question of access to drugs. 

When politicians aren’t worrying about Big Pharma’s capacity to innovate, they’re concerned about its capacity to sustain the economy. Pharma giant Pfizer’s 2011 closure of its 60-year-old UK research plant dealt a major blow to British industry, while the same company’s attempted takeover of Anglo-Swedish firm AstraZeneca in 2014 prompted concern and calls for intervention at the highest levels of government. The decision in August by the National Institute for Health and Care Excellence’s (NICE) not to offer a life-extending drug to prostate cancer sufferers until after they have received chemotherapy, was described as a ‘kick in the teeth’ for patients by one charity. NICE defended its decision by explaining the drug was ‘not cost effective at its current price’, a reasonable point for a cash-strapped NHS. But as any new drug roughly takes 10 years to reach the market, at a cost of approximate £1 billion, how can we square the ethical circle? Indeed, protagonists in all of these controversies have issued dire warnings that failure to follow a certain course of action will cost lives.

If it’s true that the stakes are this high, then how - and by whom - can drugs best be developed and prescribed, for the longer term and the greater good?

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