Why Pharma Matters

By Bruce Grant
In 1948, the year I was born, the average American man did not retire at age 65. He died of a heart attack. There were no thrombolytic drugs then to break up the clots that were starving his heart of oxygen, no beta-blockers to ease the strain on his heart. There were no cardiac surgeons. Coronary artery bypass grafts lay a dozen years in the future, and though cardiac catheterization had just been developed, it would be nearly three decades before it would be used to reopen blocked coronary arteries with balloons and stents. There were no effective and tolerable drugs that might have prevented his heart attack by lowering the high blood pressure that over years had damaged his heart muscle, valves, and arteries. There were no drugs to prevent the buildup of artery-clogging plaques that triggered his heart attack. Not until the 1960s would science begin to understand the role that cholesterol plays in this process and to develop drugs to prevent it. There was also little that medicine could do to prevent the long-term debility and decline that almost inevitably followed a heart attack. Doctors admitted coronary patients to the hospital, placed them in an oxygen tent, administered morphine to ease the crushing pain and blunt the terror that are the hallmarks of a myocardial infarction, nitroglycerin to increase blood flow to the heart muscle, and perhaps a diuretic to decrease the load on his gravely injured heart. Then, all they could do then was hope for the best. Between 25% and 30% of their patients would die without ever going home. Those that did survive rarely returned to work or normal activity but spent the rest of their lives as semi-invalids, slowly giving way to the heart failure, angina, and arrhythmias that were the virtually inevitable consequences of a heart attack. Our progress against heart disease since then has been impressive. But the most dramatic advance between then and now has been the near disappearance of fatal infectious diseases, which were once ubiquitous. Just five years before my birth, Albert Schatz and Selman Waksman discovered a bactericidal substance produced by Streptomyces mold in a soil sample at their Rutgers lab. And in 1948 the commercial antibiotic streptomycin gave doctors the first partially effective medical treatment for tuberculosis, which then killed over 33,000 Americans each year. Until then, there had been no treatment other than long-term and typically ineffective confinement to a TB sanatorium. But even with streptomycin, it would be four more years before the introduction, in 1952, of oral isoniazid would make it possible to actually cure the ferociously contagious White Plague, which had been felling humans in the prime of life since the Stone Age. 1952 also marked the worst outbreak of polio in the US, striking nearly 60,000 infants and children, killing over 3,000 of them and leaving more than 21,000 paralyzed. Mothers kept children indoors during the summer polio season no movies, no swimming, no playing with friends and few of us living then were without a friend, acquaintance, or family member who was strickenand for whom there was no effective treatment. The worst cases, which paralyzed the diaphragm and muscles of respiration, were confined for weeks in iron lungs until their nerves and muscles could recover enough to breathe on their own. Many walked with braces or crutches for the rest of their lives

I was in second grade when the injectable Salk polio vaccine was first given to children in the US. Five years later, I was in middle school when the now universal Sabin oral vaccine was introduced. But not until 1994, when I was a mid-career pharmaceutical copywriter, were the Americas declared polio-free by the World Health Organization. The progress we have made in the last six decades in vanquishing disease and helping people to live healthier lives has required the skills, knowledge, and dedication of tens of thousands of people from many professions and walks of life from the academic scientists who have helped elucidate the causes and mechanisms of diseaseto the pathologists, radiologists, and diagnosticians who have enabled us to see into the human body, its cells, and its biochemical processesto the physicians and surgeons who have continued to develop and refine new and better techniques for treating diseaseto the foundations, public institutions, and individuals who have funded the research that has advanced medicine And to the pharmaceutical industry, which has conducted the basic science, the clinical research, and the communication programs that have brought new medicines to patients and physicians who need them. A measure of the success of the pharma industry over its relatively brief lifespan dating back only to the late 1940s is the sheer number of medicines it has brought into being. Before the 40s, physicians had only a handful of effective drugs in their medicine bags aspirin, codeine, and morphine for pain; digitalis, nitroglycerin, and quinine for heart disorders; insulin for diabetes; a few antitoxins and biological vaccines; and even fewer synthetic drugs. Even by the late 1960s, when I first began working at the Massachusetts General Hospital, the Physicians Desk Reference today a massive three-inch-thick tome weighing nearly seven pounds was a slender volume no bigger than the telephone book for a small city like nearby Worcester, Massachusetts.

In my lifetime alone, the pharmaceutical industry has

Reduced the vast majority of infectious diseases previously a death sentence for over 100,000 people per year to routinely treatable or preventable disorders through the development of new anti-infectives and vaccines Enabled most of the 1.25 million Americans each year who suffer a heart attack to return to full productive lives, with less residual damage to their hearts and a lower incidence of subsequent heart failure or arrhythmia. Protected eight million more with coronary heart disease risk factors, such as high cholesterol with medications that can greatly reduce their risk of heart attack Helped prevent tens of thousands of cases of kidney failure and stroke through safe, effective, and affordable treatments for high blood pressure Offered greatly prolonged survival and even cures for people with cancers that once were inexorably fatal In just two decades, helped transform HIV-AIDS from an incurable, rapidly lethal disease of unknown cause into a manageable and possibly preventable chronic condition Liberated thousands of people with psychotic illnesses from a lifetime of confinement and suffering to functional lives in society And raised realistic hopes that chronic, progressive neurological diseases such as Parkinsons, MS, ALS, and Alzheimers may, in our lifetimes, be similarly conquered.

This is not just the industry we serve. It is the cause we serve.

Yes, it is a regulated industry because regulation is essential to protect the public health. In 1949, when proving the safety of new drugs was much more loosely regulated than today, FDA approved Chloromycetin, the first broad-spectrum antibiotic. For most patients, it was a true miracle drug, able to cure life-threatening infections that no other antibiotic could touch. But as market experience grew, it became clear that in a small minority of patients perhaps 1 in 20,000 it caused a fatal reaction called aplastic This experience, combined with that of thalidomide, a sedative and anti-nausea drug for pregnant women that proved to cause severe birth defects, led to the passage of the FDA regulatory structure we know today, requiring companies to provide conclusive clinical evidence of the safety and efficacy of its products before they could be approved and, once their products are on market, to communicate accurately and responsibly to their customers about both the benefits and the risks of their products.

Which is where we come in.

We are the creators and stewards of responsible and effective communications about our clients products products that can make the difference between health and illness, life and death for patients worldwide. Yes, we work within constraints in doing so but so do those who write sonnets or play chess or fly supersonic aircraftor, for that matter, who create marketing for cars, mutual funds, and real estate. The measure of our creative and strategic skill is our ability to craft compelling, persuasive, truthful, balanced and most of all helpful communications within those constraints. Its intellectually challenging, often exciting, always a learning experienceand, when we do it right, ultimately of real value to society. Its not for everybody, but for the last 30 years it has been for me. And I hope it is for you.