By Steve Connor, Science Editor
08 December 2003
A senior executive with Britain's biggest drugs company has admitted
that most prescription medicines do not work on most people who take
them.
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.
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.
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.
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.
"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."
Some industry analysts said Dr Roses's comments were reminiscent of
the 1991 gaffe by Gerald Ratner, the jewellery 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-publicised fact known to the drugs industry for
many years.
"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."
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 realise that its future rests on being able to target drugs
to a smaller number of patients with specific genes.
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.
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.
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.
"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.
"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."
Response rates
Therapeutic area: drug efficacy rate in per cent
* Alzheimer's: 30
* Analgesics (Cox-2): 80
* Asthma: 60
* Cardiac Arrythmias: 60
* Depression (SSRI): 62
* Diabetes: 57
* Hepatits C (HCV): 47
* Incontinence: 40
* Migraine (acute): 52
* Migraine (prophylaxis)50
* Oncology: 25
* Rheumatoid arthritis50
* Schizophrenia: 60
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