Pharmaceutical Innovation: Revolutionizing Human Health (review)

Ralph Landau, Basil Achilladelis, and Alexander Scriabine, eds. Pharmaceutical Innovation: Revolutionizing Human Health. Chemical Heritage Foundation Series in Innovation and Entrepreneurship. Philadelphia, Chemical Heritage Press, 1999. xxiv, 410 pp., illus. $44.95.

Pharmaceutical Innovation is a collection of six rather disparate chapters on the pharmaceutical industry. A brief introduction is followed by an approximately 150-page history of the industry; a chapter only slightly smaller that serves as a de facto hit parade of major pharmaceuticals, arranged like a pharmacology text; an overview of the biotechnology industry over the past two decades and some key biotech firms that have contributed to drug development; a brief compilation of the "most important drugs" from the nineteenth century to the present; an economic analysis of the fact that pharmaceutical discovery has decreased overall since 1965 even though research and development spending increased during that time; and an examination of a relatively recent handful of case studies to argue that clinicians play a vital role in pharmaceutical discovery. As one might imagine, this book tries to cover a lot of ground. Each chapter includes a list of sources, but this volume is not documented (with the exception of some of the many tables and graphs).

The introduction by Ralph Landau is a bit unfortunate, and certainly not representative of the rest of the book. It seems a little too polemical for a work like this, resembling a missive from the ethical industry’s primary trade association, the Pharmaceutical Manufacturers Association (renamed a few years ago the Pharmaceutical Research and Manufacturers of America) rather than a suitable forecast of what is to come in the volume and how the chapters might be tied together. The author claims, for example, that the nascent Clinton administration’s "political attack [on the industry] (along with the administration’s entire health plan) ultimately failed in the face of the industry’s real accomplishments" (p. xxi). No one can deny the drug industry’s contributions to the public health; indeed, this book is a testament to it. But there was plenty of political attacking over the attempt to reform health care in the 1990s–much of it by those who would be reformed.

The first chapter, "Innovation in the Pharmaceutical Industry," by Basil Achilladelis, will be of most interest to historians. This is primarily a business history of international drug manufacturing, with considerable detail about sales, production, shifting positions within the industry, mergers, selected therapeutic innovations, comparative research and development expenditures, and other subjects. The author not only avoids some of the heavy handedness of the introduction, but actually points out specific firms and how they erred in failing to develop their research programs over the years. He also supplies compelling evidence that tempers the mantra of industry and its supporters in academe and think tanks that big government was to blame for the lag in new drug introductions after the early 1960s. One reason not cited by the author for the difference in numbers of drug introductions before and after the Kefauver-Harris Drug Amendments of 1962 was that that subsequent products actually had to work (a review of the pre-1962 prescription drug market mandated by the new law revealed that hundreds of prescription drugs were completely ineffective, and hundreds more probably did not work). There is comparatively little published from this standpoint, so it would have been helpful to see the author push this point a little more. Historians also will benefit from the author’s discussion of how some firms, strong on marketing but rather weak in research, remained innovative through a series of mergers; the same can be said about the author’s treatment of industry diversification in the 1960s.

A few errors crept into the first chapter. For example, the author ascribes priority to Paracelsus for the concept of a healing essence within all medicines. If this is an attempt to connect what...