About this Author
DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: Twitter: Dereklowe

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May 12, 2009

Book Review Department

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Posted by Derek

For those who are interested, I have a review up at Nature Biotechnology of Reasonable Rx: Solving the Drug Price Crisis, a book that proposes an. . .interesting solution for reworking the drug industry.

And as Fate would have it, I also have a review in the latest issue of Nature Chemistry of Drug Truths: Dispelling the Myths About Pharma R & D, from Pfizer's John LaMattina. The only reason these are showing up at the same time is that I took an unconscionably long time to come to grips with Reasonable Rx - it wasn't something that I could just dismiss, but it has (I think) a lot of things wrong with it.

Comments (11) + TrackBacks (0) | Category: Drug Industry History | Drug Prices | Regulatory Affairs


1. RB Woodweird on May 12, 2009 10:02 AM writes...

I would love to read these. How about posting them here so we don't have to buy access to Nature?

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2. Anonymous on May 12, 2009 3:25 PM writes...

32 dollars to buy those reviews! Each! Must be serious long en involved reviews, as they are more expensive then the book they review!!!

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3. Lucifer on May 12, 2009 3:36 PM writes...

Comedy du jour
Pfizer CEO’s Three Tips for Research Success

The conventional wisdom in the drug business these days is that smaller and more entrepreneurial is better when it comes to research. And it’s no secret that Pfizer, with its multi-billion-dollar research budget, has had its share of R&D troubles.

So we took note today when Pfizer CEO Jeff Kindler, on a visit to Health Blog HQ, laid out a few principles he’s tried to use in remaking Pfizer’s research operations. He managed to boil it down to three basic ideas as the company has created research groups focused on specific diseases.

1. Each group should have between 100 and 150 scientists — few enough that they can all get together in the cafeteria to talk about what they’re doing.

2. Each should be run by a chief scientific officer prominent in the field.

3. They should be left alone “to create their own culture,” and should be judged, for the most part, on a single metric: Discovering drugs that demonstrate proof of concept.

It’s too early to say how well this will work. In any case, Pfizer certainly isn’t alone in trying to push its labs in this direction.

GlaxoSmithKline started breaking up its labs years ago, and more recently launched a push to have its scientists compete for $1 billion in internal funding from a board that includes a venture capitalist and the CEO of a biotech company. Sanofi-Aventis’s new CEO suggested he may cut his company’s early-stage research budget in half, and spend more on licensing compounds from other companies. And Merck’s chief strategy officer recently pointed out that 75 cents of every dollar the industry spends on R&D “goes to fund failure,” and said Merck is going through a “painful” restructuring of its research divisions.

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4. milkshake on May 12, 2009 4:37 PM writes...

what Kindler proposes sounds completely sensible and it could work - until it runs into entrenched interests, cliques and old-fashioned bureaucratic morass. I think for Pfizer to remake itself the best approach would be to nuke, pave over and start again at the other hemisphere.

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5. Lucifer on May 12, 2009 5:17 PM writes...


They are not interested in following their own advice.. The system , as it is set up, punishes and destroys those who do anything other than care about the next quarterly (made up) revenue numbers.

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6. pfired on May 12, 2009 5:18 PM writes...

milkshake, what Kindler suggests look remarkably similar to Pfizer's therapeutic areas, which worked until Pfizer needed to reduce headcount

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7. CMCguy on May 12, 2009 5:33 PM writes...

Like milkshake I see what Kindler advocates could actually hold promise (with correct combo of disciplines, leader(s), sustained resources and freedom) for promoting sparks of innovation if indeed could break away some of the baggage ingrained with current organization. Unfortunately suspect that milkshake's remedy might be the best option to achieve this.

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8. CMCguy on May 12, 2009 5:37 PM writes...

Question to all: How many readers of this blog out there have been lucky enough to work on projects that made into clinic much less gain approval?

Since hearing the 3/4 failure remark I have wondered if that is overly optimistic as not sure Merck/Pharma in general are even doing that well. For Med chem/discovery folks suspect odds are extremely low (as believe Derek has acknowledged). Process people are typically starting with foot in/step away to clinic but to see all the way guess still not 1/4 achieved. To me such statistical metrics are poor gauges of contributions as lack of hard returns more reflect the complexities faced. However based on the Books above Derek reviewed some people pay attention to all these numbers games.

Related: The Gates Foundation recently funding "high risk" research with 90% failure expectation and I also think that may be too high in the end.

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9. C^3 on May 12, 2009 11:40 PM writes...

How about bringing discovery into the marketplace? Companies should sell the "rights" to each compound in their library on the open market. They can be sold on an exchange and values will rise and fall based on their progression into the clinic. This way companies can cut costs on their ridiculously inefficient methods of discovery and we can have a new lottery for people to put their retirement savings into.

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10. Doc Punk on May 14, 2009 3:20 PM writes...

Well the rate of failure right now is far, far higher than 90% in mainstream drug discovery. I suspect our leaders would bite your hand of for a 10% success rate. I think our own success rat eat the minute runs at less than 1% and that is just laughably bad. But then if you judge your managers by the number of compounds they get into the pipeline, then insist on promising 'x' compounds in 'y' years to investors that's what you get. Keep pushing on into Phase III - I'm sure the data will look better once we test it in enough patients......

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11. Jonadab the Unsightly One on May 18, 2009 6:48 AM writes...

Whoah, check out those editorial reviews on Amazon. I especially like this blurb:

"The highly original proposals for reform
will be a major stimulant to analysis
and policy-making."

Umm, yeah. Reform in the industry in question has been discussed to death over the last fifty years, so pretty much every sane reform proposal (and quite a few insane ones) has been put forward many times already (and usually not implemented; reform is easier said than done; but that's another matter).

If reform proposals in a book are really highly original, something nobody has suggested before, there's probably a reason.

Anyway, I can tell you how to get drug costs under control: stop prescribing unreasonably large numbers of drugs. If you look at the population over age forty in the US, I think the *average* number of prescription medications each person is taking is somewhere in the neighborhood of six or eight. As an average, that's clearly way more than is necessary or appropriate.

It happens for a variety of reasons. One drug doesn't work, so the doctor prescribes another and leaves the patient on the first one too. Maybe they'll be better together. (Yes, I know, there are cases where drugs *do* work better together, but physicians prescribe as if those were the majority of cases.) Or the doctor doesn't know what exactly will work (which, admittedly, is pretty hard to know), so he tries several things. Or the patient complains of mundane symptoms, which should not require medication, and the doctor prescribes a drug for it just because the patient was complaining. Or the drugs that the patient is already taking have side effects (how many drugs are there that don't?), and so what's the first thing the doctor does? Weigh the merits of the treatment against the seriousness of the side-effects? Haha. No, we invariably seek to combat the side-effects by prescribing, you've got it, more drugs. Yeah, that'll sure work. I'm sure with more drugs the patient would have a lot less side-effects overall, if we lived in some kind of wacky inverse universe.

I want to be clear here: I'm not against prescription drugs. Sometimes they're useful, sometimes very useful, and sometimes they're even necessary.

So I'm very much in favor of drug development programs that seek to find better drugs -- better in terms of effectiveness, or better in terms of having fewer or less severe side effects, or better in terms of dosing characteristics (e.g., you can take this one once a day with or without food, so it's better than the old one that had to be twice a day on an empty stomach seventeen and a half minutes before eating), whatever.

And I'm *certainly* in favor of developing drugs for treating previously hard-to-treat conditions. I wish you all the best.

But I also think it's possible to prescribe too many drugs to too many patients, and I think a lot of doctors are doing that, and I think that's a bad thing, not just because it costs a lot of money, but also because it's unhealthy.

The whole reason we have the prescription system in the first place is because people who don't actually need these drugs shouldn't be taking them. Somewhere along the line I think a lot of physicians have forgotten that.

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