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The pharmaceutical industry is huge and touches the lives of people every day. Chances are that you, your friends, your family members and most people you know use pharmaceuticals, but it wasn't always this way. How did the pharmaceutical industry become so important and influential?
Until the nineteenth century, medical knowledge confined the pharmaceutical industry to apothecaries - a precursor to the pharmacies of today, where "wise women" sold various concoctions. Various plants, animal parts and minerals were popular as remedies.
Remedies that we still use today have roots as far back as Ancient Egypt - such as the use of peppermint for indigestion.
Greek doctor Galen also had a pioneering influence as one of the first people to realise that purity was vital and plants needed to be at the correct stage of maturity to be effective as medicines. During the Renaissance, the advent of the printing press in the 1400s was instrumental in spreading new ideas, including those of Galen; however, illiteracy was high among the general population and the scientific base of knowledge was scarce, meaning there was little progress.
The pharmaceutical industry had to wait until the nineteenth century before it really had an AIM:
One of the problems with the medicines from apothecaries was that they were sometimes impossible to swallow. In 1853, Charles Gabriel Pravaz created the hypodermic syringe with a hollow needle to inject medicine directly into the bloodstream as a new method of delivering medicine. In the same year, Scotsman Alexander Wood made some subtle alterations to the design, replacing Pravaz's metal with glass and using it to treat disease.
With an increased understanding of the necessity for purity, the isolation of specific ingredients found in plants was far more common and in 1804 scientists extracted morphine from opiates. This reduced toxicity and allowed for accurate doses to be devised.
It also allowed scientists to begin studying chemical structures, giving scope for creating artificial compounds that mimicked the effects of a certain ingredient and could be produced on a large scale, without harmful side effects.
Some key breakthroughs in the second half of the nineteenth century moved medicine into its now recognised position as a science.
With the continuous progress made in chemistry and biology, universities were soon given funding to help develop the pharmaceutical industry. The integration of science into medical departments was key to its progress.
As medical knowledge grew, there was a clear role for the pharmaceutical industry alongside scientists.
Biologists | Chemists | Pharmaceutical industry |
Understanding insulin, for instance, is vital in maintaining blood sugar levels for people with diabetes. |
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Let's examine a couple of important breakthroughs that demonstrate this process.
Paul Ehrlich and his team managed to find the first synthetic chemical compound for fighting a specific disease - sexually-transmitted syphilis which had plagued mankind for hundreds of years. This differed from the vaccines created by Jenner and Pasteur, which were weakened versions of bacteria.
After isolating the bacteria that caused syphilis in 1905, Ehrlich tried over 600 different compounds to see if any could cure the disease without affecting other areas of the body. Finally, in 1909, Sahachiro Hata discovered that compound number 606 was effective.
Under the trade name Salvarsan 606, it went on to treat syphilis until the 1940s.
By chance, Alexander Fleming discovered penicillin in 1928. He was searching for a substance that killed staphylococci bacteria as it had resulted in the deaths of many soldiers from bacterial infections during World War I.
He noticed a fungal spore on an old culture plate that effectively killed this bacteria and published his findings. However, as penicillin had been growing organically there was no guarantee that it would be pure enough to have a pharmaceutical application.
Oxford scientists Howard Florey and Ernst Chain played an important role in purifying penicillin. Their implementation of the freeze-drying technique was an effective way to do this. Eventually, in 1941 the United States and later the British government saw the necessity for penicillin in World War II.
They gave economic incentives to manufacturers who mass-produced the first antibiotic that could be used for various infections.
We can see that despite its effectiveness, penicillin took a while to be mass-produced. Consequently, to truly grasp the gradual process by which a new medicine arrives on pharmacy shelves we need a deeper understanding of the industry itself.
Large companies with greater financial aspirations such as Bayer, which perfected aspirin in 1897, replaced apothecaries. In the UK, after its establishment in 1948, the National Health Service (NHS) became a singular government-funded buyer for all manner of prescription and non-prescription drugs.
The journey of a substance from laboratory to general sale is a long process. Let's examine the journey from discovery to market in the UK.
Research begins with a new understanding of biological functions such as metabolism, hormones and enzymes. Only once this occurs can specific pharmaceutical products be considered. Analysis using existing knowledge of natural or chemical products allows researchers to narrow their line of enquiry. They can decide which group of medicines the required solution belongs to.
For example, beta-blockers are a group of drugs that block the adrenaline hormone to reduce stress.
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Laboratory studies of chemical compounds before the clinical stages involve screening 5000 - 10,000 different compounds after the medical issue has been isolated and can take several years depending on the drug. Chemists will screen thousands of possible synthetic chemicals or plant-derived ingredients from their library selecting the most appropriate ones to decide if they are adequate.
Once screening is complete, preclinical trials of around 250 compounds take place. From these, around five compounds with the highest effectiveness are chosen. Paul Ehrlich, who discovered Salvarsan 606, tested his chemicals on mice but nowadays researchers often favour drug targets that focus on the interaction of specific chemicals. The clinical trials then test the medicine on healthy humans.
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Clinical trials generally involve a small group of healthy volunteers.
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Every government has a department tasked with analysing the effectiveness and safety of any new medicine before it hits the market. In the UK the Medicines and Healthcare products Regulatory Agency has performed this role since 2003.
As it is often difficult to weigh up the potential benefits of the medicine with the drawbacks, the gravity of the biological problem and current public opinion often play a significant part in dictating this. At this stage, the recommended dosages and delivery methods (oral or other) are also reconsidered. It often takes 10 - 15 years for a drug to go from discovery to market.
Despite the huge scale of the pharmaceutical industry, employing around 80,000 people in the UK, it has faced and continues to face some significant issues.
All medications today come with a set of warnings about side effects. Patients also need to be careful about high dosages, as thresholds for toxicity may vary from person to person.
Consideration of interaction with other drugs or medication is also important. Drugs normally target specific receptors; if another substance blocks these, the drug is distributed to other areas of the body, which can be harmful.
Pregnant women need to be particularly careful about the potential side effects of medications, as damage can reach a foetus.
The use of thalidomide to treat medical issues including pneumonia and flu began in 1958 in the UK. During that time it was widespread, with no warnings of the adverse effects of the drug when passing through the placenta of a pregnant woman to her baby.
Thalidomide affected around 10,000 babies worldwide in such a variety of ways that doctors were slow to establish a link to the drug, despite half of them dying within months of being born. In 1968, the UK government responded with a Medicines Act which distinguished prescription and non-prescription drugs meaning that only a set of very specific circumstances would create the necessity for thalidomide.
One criticism of the pharmaceutical industry is that it has often thrived on its ability to alleviate symptoms but not tackle the cause of health problems.
For this reason, there has been a recent increase in Complementary and Alternative Medicine (CAM). These methods, for instance, yoga, meditation and chiropractics try and isolate the natural causes of illnesses, preventing them instead of creating an addiction to a drug after it is already too late.
A study published in 2018 by the University of Bristol found that whilst only 12% of the population used CAM in 2005, 15% used CAM in 2015. 38% explained their reasons for this as back pain, which fits in with the notion of our increasingly sedentary lifestyles.1
Yoga has become increasingly popular as a form of CAM, image by Sourav Mukherjee via PixaHive
As knowledge of our genetics increases, there is a growing desire for personalised pharmaceutical programs using 3D printed technology. Already approved in the United States in 2015, these aim to depart from the traditional one size fits all approach of the pharmaceutical industry and, crucially, enable quick delivery and no wastage.
Some companies, including pharmaceutical giant Merck, are keen to break into this technology. One thing is for certain if it continues to develop - the pharmaceutical industry will undergo a huge change.
The pharmaceutical industry is a huge industry that plays a part in our everyday lives and has changed healthcare forever.
When drugs or medicine prove effective, the role of the pharmaceutical industry is to mass-produce and distribute them for widespread consumption.
The pharmaceutical industry has many parts including clinics, factories, laboratories, hospitals and pharamacies.
The future of the pharmaceutical industry involves more CAM methods and 3D printed and personalised pharmaceuticals.
The pharmaceutical industry is huge, employing around 80,000 people in the UK alone.
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