Dr. LaMattina, who has a PhD in organic chemistry, made a number of very memorable statements. For instance, he expects cancer to be “very controllable” within the next 10 years, much as diabetes is today. He mentioned the dramatic consolidation in the industry, as demonstrated by PhRMA member companies, down from over 50 over ten years ago to 12.
Also compelling is the fact that four big pharma companies top the list of corporate philanthropists, even exceeding Microsoft. In 2006, he noted, Pfizer contributed $1.7 billion, Merck, $826 million, J&J and BMS over $500 million. He also listed their research institutes and the work they are doing. Dr. LaMattina explained the apparent slump in innovation as the result of industry consolidation, and regulatory agency demands for more extensive studies, including data demonstrating the value of each new drug.
Debunking the NIH Myth
LaMattina began his presentation by responding to statements made in the past by Marcia Angell, Ray Moynihan and others about the dearth of pharma innovation, the industry’s highjacking of NIH know how and high cost of drugs. As he mentioned, the early research spade work only goes so far. “It leads to hypotheses, but only after clinical trials do you see whether the compounds will work.” True. Those studies are expensive.
He also mentioned how the spending for drugs has continued to account for 9-11% of overall healthcare spending, a figure that has remained relatively stable for the past decade, and presented some cogent analysis of the impact that drugs have on patient’s lives, citing highly active antiretroviral therapies (HAART) and their impact on AIDS, since their introduction in the 1990s. The monthly cost of treatment using HAART was only about $200 per month more than previous treatments, yet they had a tremendous impact on patient mortality. Absolutely true.
Chantix: Insurers Not Grasping Benefits
He pointed to Pfizer’s drug, Chantix, as a success story, noting that nearly half the patients in a Phase II study stopped smoking after treatment with the drug. Given the high cost of treatment for lung cancer ($150,000 per year per patient, excluding the more expensive surgical route), the $350 required for treatment seems a pittance. Yet, he noted, insurers don’t reimburse for Chantix treatment--in Australia, patients must pay out of pocket, while in the U.S. only 30% cover the treatment. That statement spoke volumes about insurer mindset, echoing observations that former Pfizer CEO made in his book about the need for preventative healthcare.
Cox 2 Inhibitors
Dr. LaMattina then went on to address the touchy subject of cox 2 inhibitors, mentioning that most members of FDA’s advisory panel had still suggested that the inhibitors be marketed in the U.S., given their risk versus benefit profile. He also mentioned the fact that, early on, developers saw their promise as potential treatments in GI problems associated with cancer and Alzheimer’s.
He then mentioned the $300-million clinical trial now being coordinated by the Cleveland Clinic, due to be completed by the end of 2010, which is examining the risk vs. benefit of using these medications to treat older arthritis patients. So many arthritis patients, of all ages, have lamented the loss of Vioxx and the results will be extremely interesting.
Pharma Pipeline Growth
Dr. LaMattina also debunked the notion that Big Pharma innovation is passé, by highlighting the growth that has occurred in big pharma pipelines, comparing Merck and Pfizer’s pipelines of Phase I, II and II drugs in 2007 vs. 2002:
Phase I Phase II Phase IIIMerck
December 2002 4 5 7
December 2007 25 15 7
August 2002 22 21 6
August 2007 38 47 11
Dr. LaMattina wrapped up his presentation with the story of a Pfizer IT director, David Leventhal, who sent a letter to Pfizer management about how happy he was to work for a company that is developing cures, like the therapy that saved his father’s life. I love stories like that. People who work in the industry should be proud of its successes (but equally critical about areas where it hasn’t succeeded).
I genuinely hope that I am wrong, but the thought did occur to me that Mr. Leventhal probably doesn’t work at Pfizer anymore. If his job wasn’t eliminated entirely, his office is likely occupied by a lady or gentleman from India here on a work visa. That would not have happened while the speaker worked at the company, and, again, I do hope that I am wrong.
A SOCMA meeting is not really the venue for confrontational questions. But I had wanted to ask Mr. LaMattina, politely, about the future of the industry’s innovation base in the U.S. Why should anyone want to get a Ph.D. in pharmaceutical chemistry in the U.S. today, knowing how very unstable that choice may be, given the comparative salary levels and job security, and seeing how many highly trained and brilliant professionals are being laid off? A career in the theater seems just about as secure.
Other questions during the staid Q&A session addressed bits and pieces of my question, so I kept quiet. At one point, in answering one question, the speaker mentioned how many chemists he knew were working for smaller innovative bio companies, venture capital firms, or were exploring other career options. He even mentioned, if I heard him correctly, one colleague who had taken up carpentry.
New Career Paths: Carpentry?
The chemistry studies that equip anyone to pursue a career in drug discovery are anything but trivial. People who make the effort do it for love of the subject matter, but also for purely altruistic reasons. Is this what they deserve, at the end of the trail?
Of course, Mr. LaMattina isn’t personally responsible for all the turmoil within Pfizer or the industry, although some of the wheels may have been set in motion during his tenure. Nobody brought up Exubera. Or Torcetrapib. Then there is the whole issue of innovation through acquisition, and the impact that it has. Pfizer is reportedly abandoning several of its own late stage drugs entirely, because it will get similar products by acquiring Wyeth.
Doesn’t that fact already say something about pharma’s innovation? And how many years and billions of dollars did that work represent? Pfizer’s already abandoned its innovation centers in Ann Arbor and slashed jobs at its other showcase in Groton.
It's important not to harp on doom and gloom, given the positive things that the drug industry does. But, at the same time, wasteful and redundant practices are not pharmaceutical myths, but realities. Perhaps that fact could be openly admitted and acted upon? Here’s hoping that the future brings positive change, and that the U.S. innovation base remains intact, and a vital contributor to the world.