Does the pharmaceutical model still hold water?

Prescription drugs have no consumer or client. A 'normal consumer' is someone who selects, pays for and consumes a product. In Europe and other parts of the world, Rx drugs are selected by one person (the doctor) paid for by another (society) and consumed by a third (the patient or consumer). The dynamics of pharmaceutical economics are a totally irrational contradiction of supply/demand logic. Patients cannot choose or influence their own consumption or choose a brand between equal products. Nor can the patient influence the price, which has been fixed by negotiations between industry and the authorities. The patient generally does not actually care, either, since he or she is not paying.

This dysfunction amongst market forces is the 'normal' business logic for the pharmaceuticals industry. The most profitable business for the industry depends on the creation or discovery of an NCE (New Chemical Entity) that in some way or other can be shown through human trials to be effective against a disease or condition and therefore can be registered as an Rx drug. Profitability is greatest when the disease is a common one, such as arthritis. The next step is to convince doctors to prescribe it and the public to welcome it. Clearly, there is financial temptation and incentive along this pathway to exaggerate the benefits and underplay any negatives such as side effects. And in Europe, at least, nobody worries about income, since these drugs are reimbursed by the social security system.

This system offers no choice to the patient other than to be a consumer. Furthermore, a large proportion of the prescriptions would be totally unnecessary and perfectly avoidable if the consumer was able to choose between a natural alternative and a synthetic drug.

The R&D paradoxes
The first R&D paradox has to do with the types of disease that are the primary interest of the industry. From a global perspective, there are massive health problems affecting millions of people in the Third World, where resources to combat these problems are extremely scarce.

Nevertheless, by far the major part of the total R&D spending in the world is concentrated on lifestyle diseases such as ulcers, depression, nervous problems and other stress issues. Should not R&D efforts be concentrated on the underlying problems in the Western world and on combating the very severe diseases that occur on a massive scale in developing countries? In fact, R&D resources are allocated to the Western world health care systems because profitability is greatest there and not in economically weak geographic areas where profitability is low and uncertain.

The second paradox is that the industry defends its high gross profits as warranted because of 'high R&D costs.' The truth is that the industry is conducting very little discovery research. Almost all products on the market are based on molecules discovered by independent academic institutions. Industry spends most of its budget on development costs, including huge amounts on clinical trials that are used more as marketing tools than in the search for scientific truth.

The target group paradox
The target group for the pharmaceutical industry is unhealthy or sick people. These are classified into 'therapeutic groups,' meaning that they suffer from a clearly defined illness such as cancer or condition such as obesity. This means that the industry is concerned only with sick people and how to cure them. Frankly, I have never heard of a discussion based on the underlying causes of an illness and how a patient could avoid those causes becoming a health problem. Is it really useful, you could ask yourself, for the pharmaceutical industry to keep people healthy when their business is based on sick people?

The system has become a bad habit at best and functions at least as much to prevent as to enhance public health
This classical pharmaceutical mindset is deeply ingrained in health authorities all over the world. The people who work in these bureaucracies have the same background as those in the pharmaceuticals industry. It is common for professionals to find employment back and forth between pharmaceutical companies and the public agencies that regulate them and set policies concerning them. This cozy relationship between the authorities and the industry is obviously a major obstacle to developing alternative strategies for better health care and a more focused interest in preventive health care and natural alternatives.

The registration paradox
Most countries require approval of and registration for health care products. Greatest profitability goes to NCEs that gain patent or other official protection. Pharmaceutical companies cannot patent natural remedies such as common herbs long known to be effective in particular uses. In fact, they have an incentive to find the chemical component of natural botanicals that seems responsible for a therapeutic effect and to extract it and gain a patent for that fraction. The result is a high-priced Rx drug often no more effective than the common botanical source and frequently having an increased number and severity of side effects because it lacks the symbiosis of substances in the source.

The pharmaceutical and official health care communities have so far sustained a mystique favouring pharmaceutical products as being 'modern,' 'scientific' and 'pure' and stereotyping natural remedies as outdated, unscientific and impure. Inexpensive natural remedies and an emphasis on preventive health care are pushed aside.

It all adds up to an effective protectionist system preserving the very lucrative interests of the pharmaceutical industry. The system has become a bad habit at best and functions at least as much to prevent as to enhance public health.

Two major issues
I have adopted a new paradigm, shared with a minority of other professionals, that emphasizes preventive health care and a shift to natural products.

Preventive health care: The keys to dealing with lifestyle illnesses are food intake and exercise. The quantity and quality, as well as the balance in food intake, is by far the major factor in directing our health status. The lack of sufficient and appropriate physical exercise amongst Western societies is an associate factor.

Natural products: Modern agriculture has delivered food in quantity but at a cost of diminished quality. Industrialized food such as fast food, semi-prepared food and other convenience food products has substituted convenience for nutritional quality and has introduced many ingredients that are synthetic or artificial and that have proven negative effects on human health.

From thinking to doing
It is astonishing to see how little effort is made by health authorities in the Western world on behalf of preventive health care. It is also amazing to see how little effort governments make to control and reform agriculture and the food industry in ways that would benefit public health. On the other hand it is equally amazing, and gratifying, to see the great interest that consumers are taking in issues concerning natural ingredients, a balanced diet and exercise.

Now that I am an industrialist in the natural ingredients and healthy diet business, I am optimistic that more and more information will drive demand toward healthier consumer behaviour as more and more people realize that our health is like a car—good maintenance gives a trouble-free vehicle. When the dashboard warning lamps start flashing, it is too late.

Preventive health care is the answer to how to combat the enormous health care costs the industrialized world is suffering. Preventive health care is a lifestyle response that calls for major efforts in information and education in order to motivate consumers to make the choices that will lead them to a healthy lifestyle. Much more needs to be done by health authorities around the world to re-direct consumer habits toward preventive health care.

The opinions expressed in this article are those of the contributor and not necessarily those of FF&N. If have an opinion on a current hot topic or feel strongly about an industry issue and would like to contribute an article to this column, please contact Peter Sofroniou, editorial director at [email protected]

Jean Nordström is CEO of Novodieta, a natural ingredients company in Castellón, Spain. For more than 30 years he has held senior management postions in many different industries including steel, paper, textiles, electrical equipment, food and pharmaceuticals.

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