The sick need more than just healthy profits
When the Financial Times listed the
50 largest businesses by market capitalisation in May, nine pharmaceutical companies were included. When it listed the 50 most respected businesses last week, only one of them Johnson & Johnson made it on to the list.
For an industry that depends more than any other on public trust, that demonstrates a problem. And the consequence was vividly illustrated on the front page, where Raymond Gilmartin of Merck was defending his handling of Vioxx, its now-withdrawn painkiller. A decade ago, Merck was always among the most admired companies. It is no longer in the FT's most respected 50 and is struggling to keep its place in the top 50 by market capitalisation.
Not only has the pharmaceutical industry lost status with other business leaders, it is under attack. In books by novelist John le Carré, journalist Merrill Goozner, and doctor Marcia Angell. In the stance of New York attorney-general Eliot Spitzer and film maker Michael Moore, as well as Food and Drug Administration officials, anti-globalisation protesters and senior citizens.
George Merck, Mr Gilmartin's predecessor, understood the implicit deal between the industry and the public when he said: “We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear.” And for decades the formula worked well: the industry produced a stream of new drugs and received a stream of dollars in return.
But these sentiments were out of fashion in the 1990s. Financial markets required corporate action and double-digit growth in earnings per share. So the companies spent the money the public had given them for research on buying each other. They raised the market prices of successful drugs. They hired representatives to promote their products. They focused on imitative versions of established therapies at the expense of genuine innovation.
Keeping treatment out of the reach of terminally ill patients in southern Africa is bad public relations. Companies that derive their revenues from governments and the sick must take special care with their pricing. Selective dissemination of research results undermines trust. It is surprising that generous remuneration for senior executives failed to attract people with the acumen to see these consequences. Or, perhaps, motivated by share options, they did not care.
The pharmaceutical industry, more than most, does rely on exceptional talent, but these gifted people are in laboratories, not boardrooms. And while they were once content to work in large drug companies for modest salaries, they are now able to attract venture capital for their own show.
Tougher regulation might restore confidence in the industry but the companies have sought to undermine regulation by political action. Drug company lobbyists have won some victories. But members of Congress ultimately need the votes of senior citizens even more than campaign finance. Healthcare reform is not an issue that will go away.
The funding and technology of healthcare is now likely to develop in ways that marginalise the giants. Today, one dollar is retained in profit and one spent on marketing for every dollar that goes to research. You need to be very confident of the quality of the research dollar for the equation to represent value for money. And that confidence has largely evaporated.
The old model worked best for traditional blockbusters, products that relieved but did not cure the chronic illnesses of the affluent, such as hypertension, depression and flagging virility. Future drugs will be targeted more at individuals and at rarer conditions, cocktails of treatments will take the place of single therapies. Perhaps, also, the west will recognise that simple drugs for debilitating illnesses are among the most effective forms of foreign aid. All these developments suit the public and philanthropic funding of basic research, with incremental innovation and peer review, better than proprietary programmes directed at mass-market drugs of big pharmaceutical companies. Their fat market capitalisations reflect their past achievements and present profits, but not their future prospects.
www.johnkay.com “病号”要的不仅是利润
当《金融时报》在5月份公布市值最大的50家企业排行榜时，有9家制药公司位居其中。而当《金融时报》上周公布50家最受尊敬企业的排行榜时，制药公司中只有强生(Johnson Johnson)一家上榜。
制药业比其它任何行业都更依赖公众的信任。对于这样一个行业来说，上述现象说明了一个问题。这样的后果在本报头版上有生动的描述――默克(Merk)公司的雷蒙德?吉尔马丁(Raymond Gilmartin)为他对万络(Vioxx)的处理手法进行辩护。万络是现已撤出市场的镇痛药。在10年前，默克总是位居最受尊敬的公司之列。如今，这家公司已经排不上《金融时报》最受尊敬的50家公司了，它正竭力维持在市值50强公司中的位置。
不仅制药公司的地位落后于其它行业领先企业，而且它们还受到攻击。这些攻击反映在小说家约翰?勒卡雷(John le Carré)、记者梅里尔?古兹内尔(Merrill Goozner)和医生玛西娅?安吉尔(Marcia Angell)的书中，而且还反映在纽约总检察长艾略特?斯皮策(Eliot Spitzer)、电影制片人迈克尔?摩尔(Michael Moore)，以及美国食品药物管理局官员、反全球化抗议者和老年公民的言论中。
其实吉尔马丁先生的前任乔治?默克(George Merck)明白到制药业和公众之间所隐含的交易。他曾说：“我们尽量紧记：药物是为人类、而不是为利润而生产的，利润会跟随而来。如果我们记住这点，利润总会出现。”数十年来这一原则很管用：制药业源源不断地生产新药，然后得到源源不断的资金回报。
但在上世纪90年代，这种观点落伍了。金融市场要求公司采取行动，务求每股盈利以两位数的速度增长。于是制药业把公众给它们用来研发的资金花在互相并购上。它们提高了成功药物的市场价格，聘请销售代表促销产品，并放弃真正的创新，转而把重点放在对已有疗法的仿制上。
不让南部非洲那些身患绝症的病人得到治疗其实是公关上的失利。从政府和病人那里赚取收入的公司在定价上必须特别小心。有选择地公布科研成果会削弱公众的信任。令人惊异的是，高管人员的优厚报酬并未吸引到能够预见这些后果的高明人士。或者，也许在股票期权的激励下，这些高管人员并不在乎这些后果。
制药业确实比其它多数行业都更倚重杰出人才，但这些人才都在实验室里，而不在董事会中。而且，虽然他们一度满足于为大制药公司工作而拿一份微薄的薪水，但现在他们已能够吸引风险投资而自己大显身手了。
加强监管也许能恢复人们对该行业的信心，但各公司一直在寻求通过政治手段来削弱监管。制药公司游说人士已取得了一些胜利。但国会议员最终更需要老年公民的投票，甚至超过了对竞选资金的需要。医保改革这一问题是不会消失的。
医疗保健的融资和技术发展可能会将这些制药业巨头边缘化。今天，在研究上每投入一美元，就有一美元的利润被提留，以及一美元花在市场营销上。你必须对研究资金的质量非常有信心，上述等式才能反映出资金的价值。但这种信心已基本上消失了。
旧模式对于传统的畅销药品最管用，这些产品能够减轻但不能治愈慢性的富贵病，如高血压、抑郁症和男子性功能减退。未来的药品将更多地针对个人，而且在一些较罕见的病症中，混合疗法将取代单一疗法。也许西方国家还将意识到，提供简单的药物来治疗一些摧残人的疾病，是对外援助最有效的形式之一。上述这些发展都更适合为基础研究提供公共及慈善资金的资助，加上创新和同行评审逐渐增加，这些都比大型制药公司针对大众市场的专利药品研究更有好处。大型制药公司丰厚的市值只反映了它们过去的成就和目前的利润，但并不反映其未来的前景。
