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The Wellcome Trust

The Sunday Times

Wellcome: Hard sell

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?

Henry Wellcome | Wellcome Trust
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