Direct but shadowy information tends to lead to “disease mongering” — the creation of diseases in order to boost prescriptions. For example, the concept of “pre-hypertension” could extend the use of anti-hypertensive drugs dramatically, because everybody’s blood pressure rises with age. Likewise, the notion that blood cholesterol should be as low as possible clears a path to treating healthy people with anti-cholesteremic agents. Clearly, health authorities must take closer control of information by becoming more responsible for physicians’ continuous education.
If the conditions for drug approval and marketing become more severe, pharmaceutical companies will be forced to produce fewer me-too drugs and more products of clinical importance. Requiring longer testing periods, and possibly extra resources, could be compensated by new drugs’ greater longevity on the market, and patent coverage could be extended.
Finally, incentives must be found to encourage pharmaceutical companies to develop drugs that fulfill the needs of patients still awaiting therapy. There are more than 6,000 rare and neglected diseases — many in developing countries — that lack remedies. The challenge is how to produce new drugs that — because patients are too few or too poor — promise very limited returns.
A partnership between governments, non-profit research institutions, charities and pharmaceutical companies might be one way to clean up the approval process for new drugs. If public awareness of the current problems stimulates politicians to find a solution that works, better drugs and better drug use will be achievable.
Silvio Garattini is director of the Mario Negri Institute for Pharmacological Research in Milan, Italy.
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