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BRIAN DEER:
HARD SELL Page 3
If Henry
Wellcome's ghost stalks 183's marble and bronze, he
might well be thinking that, with the passage of
years, in some sense, the last laugh was his. At the
time of their divorce, he could hardly stomach
Syrie's betrayal, and the humiliating rumours about
Maugham's sexuality. But in the final quarter of the
twentieth century, it was precisely such lifestyles
that was to create vital markets upon which his
empire would thrive.
In
the 1960s, which saw gonorrhoea cases jump 300%, the
Wellcome Foundation was an obscure English
enterprise, strong on publicity (and caffeine-based
home remedies), but with few bright scientists -
mostly in the US - and a modest reputation in cancer.
But as "adultery" fell out of popular
usage, and “promiscuity” began losing its
stigma, the empire based in Euston Road was on the
spot with relevant products.
The
1970s saw the rise of its antibacterial, Septrin,
Septra or Septran, used commonly for urinary tract,
and some sexually-transmitted, infections. The 1980s
saw the unveiling of Zovirax, its antiviral for
herpes simplex. And the 1990s was its decade for AZT,
its therapy for HIV/Aids.
Septrin
(in the UK) and Septra (in the US) was the first real
blockbuster from the Wellcome Foundation - a true
heir to the founder’s Big Idea. Although rooted
in the inspiration of the company's US science chief
Dr George Hitchings (who later won a Nobel Prize),
where it really triumphed was in its packaging and
marketing. Just like the magic ink.
Septrin
is actually two drugs put together, both of which
inhibit folic acid synthesis. One, trimethoprim, was
patented by the company in 1957. The other is an
obsolescent sulphonamide (called sulphamethoxazole)
from the Swiss drugs giant Hoffman-La Roche.
Tabloided together into a single pill, their
worldwide gross is more than $5 billion.
But
for nearly all infections, the drugs didn't need
combining. There was no advantage in taking two.
Reports in the medical literature said so plainly,
beginning in 1973. The journal Chemotherapy said so.
The Annals of Clinical Research said so. So did the
Journal of Clinical Pathology. In 1978, the British
Medical Journal said so. And in 1980, a team declared
in The Lancet that, compared with Septrin
"single therapy with trimethoprim has the
advantage of smaller tablets and fewer side effects,
and it is cheaper".
But
in the 1960s, Roche was a major company and the late
Henry's empire was still small. So a deal was done to
piggyback the drugs together, and to market them,
beginning in 1969, as possessing the magic ingredient
of “synergy”.
It
was classic Henry Wellcome, all set out in the will:
the house style and corporate culture. Remembering
the success of his Tabloid promotions, the founder
had advised his successors in his memorandum: "I
consider it in the best interests of the several
industrial organisations and of all concerned that
the publicity, advertising and other propaganda shall
be steadily increased as the output is increased in
volume and in profits."
With
Septrin, moreover, his ideas were rolled-out for what
was yet to come. The next phase was to tackle
moneymaking another way: instead of selling more
drugs by getting people to take two, selling more
drugs by doubling the numbers who were considered to
be suitable consumers. This was the story in the
1980s and 1990s with Zovirax and AZT.
At
the level of science, Zovirax's compound, acyclovir,
was even more of a landmark than trimethoprim.
Synthesised in Wellcome's American labs in 1974, it
was the first significant treatment ever licensed
that could safely block viral replication. Although
it did not cure the often recurring herpes attacks,
it showed that, in principle, viruses, like bacteria,
could be chemically blasted without killing the
patient.
Since
Zovirax was launched in 1982, it has saved lives and
relieved distress. Particularly in intensive care,
Aids and transplant surgery, where immune suppression
is a critical problem, the inhibition of the herpes
simplex virus has proved to be a godsend. But the
volume of sales such patients generate is by no means
on blockbuster scale. The real opportunities are for
mass-market conditions - and for those the situation
is less clear.
"’You
have genital herpes’ can be a hard line to
follow. We can make it easier for you to help.”
This
was the theme of advertising to US doctors, promoting
acyclovir in 1993. But, despite such pitches, the
wider benefits of the drug were not quite what many
supposed. For genital herpes, it can reduce the
symptoms, but research suggests sufferers continue to
be infectious. With acyclovir cream, used for common
cold sores - most often caught from kissing -
research has found that its plain cream base is as
effective as the actual drug. And a Wellcome
initiative to sell acyclovir for chickenpox, has been
dubbed a pointless therapy.
AZT,
meanwhile, (branded "Retrovir") was a
breakthrough upon its launch in 1987. But,
unfortunately, its benefits have remained mired in
controversy, due to massive, and inappropriate
prescribing. First synthesised in 1964 as a candidate
treatment for cancer, it was abandoned for that
purpose because it proved too toxic, sickening
patients before zapping their tumours. But for people
with Aids, in short sharp courses, it gave a few
months of respite.
But,
true to Henry's will, the company went further,
seeking its prescription to HIV-positive people who
had no symptoms of disease. In a worldwide campaign,
medical journals were stuffed with advertising and
promotional articles, doctors were bombarded with
calls from sales reps, and perhaps most worryingly,
patients were targeted with what seemed like
objective advice:
“People
are finding ways to stay healthier, strengthen their
immune systems,and develop positive attitudes.
They've found that proper diet, moderate exercise,
even stress management can help. And now, early
medical intervention could put time on your
side.”
The
potential market was one hundred times bigger than
possible sales for full-blown Aids. But even as the
campaign to push the drug raged, scientists were
disputing this strategy. In April 1994, the medical
journal The Lancet published a giant European study
which found no evidence of such life-prolonging
benefits.
Is
the Wellcome empire worse than other drug businesses?
No. That isn't the point. What Henry Wellcome
bequeathed was not more of the same, but a template
which the others have employed. It's no exaggeration
to say that, with his partner Burroughs, he pioneered
putting marketing above medicine.
If
the founder's ghost still wanders 183, you would have
to wonder in what frame of mind. Is he is moaning
over Syrie and Somerset Maugham, who turned him in on
himself? Or is he chuckling over the markets for his
empire's pharmaceuticals that such progressive
lifestyles have bequeathed?
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