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BRIAN DEER:
HARD SELL Page 6
No blame
attaches to Elion for drug promotion - and she says
she doesn’t even use allopurinol for her own
gout. "That aspect of the marketing, I have
nothing to do with," she explains. "Once
the thing is established, sometimes they do things
that are commercially feasible, and commercially
important, and perhaps not medically important. And
that's a decision that I don't have to make."
But exactly
who is responsible isn’t easy to pin down. In
London, Wellcome points to doctors and regulators who
prescribe and rule on proper usage. Whether you talk
with the commercial Wellcome plc, or the charitable
Wellcome Trust, they take the position that it is
neither company nor charity which decides on who gets
what.
It is not
surprising that they speak as one: it is what the
founder, Henry Wellcome, had intended. In his will
documents, filed in 1932, he stressed his belief in a
co-ordinated approach, with marketing the name of the
game.
"It is my
special desire that there should be no material
reduction in the proportional expenditure for
publicity and other forms of propaganda of the
several organisations,” he stipulated for his
posthumous empire. “As I wish my trustees and
the directors continuously to develop and increase
the output and sale of the products of the industrial
organisations of the Foundation throughout the world.
The consistent pursuance of this policy will
ultimately result in greatly increased profits."
But today the
trust sponsors some of the most prestigious medical
departments. It has an advisory system of more than
3,500 doctors and scientists. It owns one of the
finest medical libraries and on-line retrieval
systems. It has a multi-million pound research
institute at its Euston Road headquarters. Its
seven-person governing board includes a doctor and
four professors. If it cannot evaluate its
medicines’ profiles, then it is hard to know who
could.
In a structure
that distributes a share of its profits to
researchers, moreover, there may be conflict of
interest anxieties. When asked whether grant-seeking
experts may feel inhibited from criticising Elion and
Hitchings’ big four products because of the
organisation's enormous reach, Dr Bridget Ogilvie,
the trust’s director, did not refute the
suggestion. She declined to comment.
This issue is
sensitive, touching on ethics and propriety in an
ever-more competitive world. Increases in research
costs, and tight controls on public spending for
science, mean that the trust is bombarded with
requests for sponsorship - two thirds of which it
refuses. Last year, even on the British government's
Committee on the Safety of Medicines, 19 of the 21
members either worked in institutions which received
Wellcome money, or were granted a share of it
themselves.
The potential
for a ménage between company, charity and experts,
is a worrying feature of the founder’s legacy.
Collusion was central to Henry Wellcome's thinking,
with his will documents noting that some granted
research money would produce "much of purely
technical interest," but that even this
"should also contribute to the discovery of
remedies and curative agents and new methods of
treatment which may be of practical interest and
importance to the industrial organisations of the
foundations".
In the United
States, the Burroughs Wellcome Fund (of which Elion
and Hitchings were for many years directors) has kept
particularly close to this prescription. One of its
biggest recent grants is a $350,000 award for
"innovative methods in drug design and
discovery", which in 1992 went to Dr Susan Amara
in Oregon. Her work relates to brain chemicals which,
according to the fund "may help physicians
combat cocaine addiction". Meanwhile, Wellcome
has a drug, bupropion, "undergoing clinical
trials in the USA for the treatment of cocaine
addiction".
In Britain,
cross-fertilisation between company and trust has
reached even the highest levels. One distinguished
figure, whose profile has risen with Wellcome’s,
is Sir Roy Calne of Cambridge University, one of the
most accomplished transplant surgeons. As a young
man, he helped Elion and Hitchings to develop
azathioprine and, in the years that followed, was
endowed by the charity with grants, research help and
expenses.
Another
example of how working with the company can be
followed by trust support involves two professors:
John Stenlake of Strathclyde University and James
Payne of the Royal College of Surgeons. Both were key
figures in developing atracurium, a top-selling
Wellcome muscle-relaxant. Stenlake received trust
grants for his work between the late 1960s, when
atracurium's development began, and the mid-1970s.
Payne got assistance in the early 1970s and the late
1980s.
Another
instance recently is the case of Herman Waldmann,
professor of therapeutic immunology at Cambridge, and
a fellow of the Royal Society. With financial support
from the trust, he advanced a revolutionary Wellcome
product, Campath, the world's most developed
monoclonal antibody. After assigning it to the
company, he became an adviser to the charity and
sought to obtain further sponsorship. This, however,
was blocked last year - he believes on the advice of
lawyers.
Nobody
suggests impropriety by these respected figures, who
are bound to seek funding where they can get it. And
the trust would flatly deny that there is any quid
pro quo when it offers its financial support. But it
is clear that at least some collaborators hope for
the trust’s rewards after furthering the
company’s goals.
The money they
get, of course, rarely goes into their pockets. The
trust's help is to support research. But it is rarely
cash in the bank that wins the hearts of people of
the highest standing and influence in science. More
often they are driven to advance medical progress, or
to win peer-recognition. It’s a popular
misconception, Elion says, that people like herself
are primarily driven by their wallets.
"They
think that we get some personal monetary reward out
of it, and that really isn't what we want," she
says of the many who misunderstand this point and
assume she must be rich. "What we want is a
chance to do research. A chance to, you know, get
some additional people in our departments, and so
on."
*****
While it is
the trust which has handed out most of
Wellcome’s money, the kind of opportunities to
which Elion is referring can also come directly from
the company. Both the Wellcome Foundation and
Burroughs Wellcome in the US make major contributions
to the medical money-go-round that is now a
mainspring of the pharmaceutical industry.
During the
last five years, Wellcome has courted particular
controversy over its financial interventions in the
field of Aids. People with this condition will often
not only use AZT, but may also take acyclovir and
Septrin as well: generating millions in profits to
distribute. Recipients have ranged from the mighty US
department of health ($5m), to countless small-time
self-help groups.
Much of this
money has created a climate to support trials of
Wellcome products. In an American coast-to-coast test
which won AZT its licence in 1987, for instance, one
hospital, Massachusetts General, received $140,000
for data on just 19 patients. Other participants were
also generously rewarded - and far from such payments
guaranteeing good work, inspectors have discovered
many flaws.
Another
example concerns one of the most powerful medical
figures: Dr Samuel Broder of the US National Cancer
Institute. Broder is the person most associated with
AZT's approval, and, crucially, was supported by
Burroughs Wellcome. Although the money went to his
laboratory, and not into his pocket, he accepted
$55,000 at the time the company's product was under
federal review.
Surprisingly,
Aids activists, including the militant group Act-Up,
have also been backed by the company. Among the
group’s many high-profile protests in the
epidemic's early years, Act-Up had even broken into
Wellcome’s US offices. But in July 1992, only
weeks before the trust floated a huge block of
shares, Act-Up leaders appeared at a New York press
conference to shake hands and accept $1m. Meanwhile,
the British company spent £60,000 last year flying
Act-Up supporters to a conference.
Even
journalists and politicians are not overlooked, as
Wellcome’s founder’s dream plays out.
Writers are often helped to attend meetings in
foreign locations, while even the European Community
held a parliamentarians' conference last year that
was sponsored by the Wellcome Foundation.
Such
techniques - now common throughout drug-based
medicine - provoke mirth from close observers. Sir
James Black - Elion and Hitchings’ fellow Nobel
prizewinner - smiles at mentions of the Wellcome
Foundation, for which he used to work. "The
industry as I've seen it, I think, takes the view
that marketing drugs is the same as marketing
anything," he says. "The promotional
methods used by the pharmaceutical industry are no
different from the promotional methods used in any
other branch of the chemical industry."
Black
addresses an issue he thinks the public still
under-appreciates: the pressure of commercial
imperatives. Wellcome's main board comprises much the
same people who might run a bank or an oil company -
and who do their job in much the same way. The
difference lies in the reputation of medicine and
science to assure us that they do their job well.
There have
been no doubts about integrity at the top. Roger
Gibbs, the chairman, has had wide business interests,
including the London Clinic and the Arsenal football
club. Another board member, Sir Peter Cazalet, is a
former oil man and a prominent industrialist. But, in
the legacy and structures set up by Henry Wellcome,
the profit-sharing scheme, that continues to grow,
may have acquired a life of its own.
Trying to
control this has proved endlessly difficult, creating
difficult management decisions. At least until 1984
(when such information ceased to be available), the
trust invested in the British American Tobacco
Corporation, as well as a string of breweries.
Possibly good investments, but not free of
controversy for a business which showcases support
for health.
More important
than such embarrassments, however, is how the trust
and the company may be preparing for years to come.
Both are deeply involved in biotechnology and genetic
engineering - areas where error, or an excess of
marketing, could lead to a catastrophe. As
Wellcome’s empire grows, through its tax-exempt
charitable arm, and the company's drug development
programme, the medical money-go-round may lead to
error that puts humanity itself into a spin.
Some doctors
and scientists look forward with hope. Elion glances
back with nostalgia. "When we first had people
working on 6-mercaptopurine, allopurinol, Imuran, we
didn't pay one cent for those studies," she
remembers. "We didn't influence them in any
way."
No doubt if
her offspring had been children instead of drugs, she
would have warned about candy from strangers.
[Vagaries
of editing mean this version is different to what was
printed in The Sunday Times. The second part of Hard
Sell, referring to Elion and Hitchings, appeared
under the heading "The Moneyspinners"]
Copyright,
Brian Deer. All rights reserved. No portion of this
article on the legacy of Henry Wellcome may be
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