MEDICAL INNOVATION, UNMET MEDICAL NEED, AND THE DRUG PIPELINE

Main Article Content

Charles M Mather

Keywords

Recombinant DNA, technical efficiency, organizational efficiency, anthropology

Abstract

This paper outlines and illustrates the working of a theoretical approach from the social sciences for analyzing medical innovation, unmet medical need, and the drug pipeline. Using the social history of three drugs made from recombinant DNA (insulin, human growth hormone, and tissue-plasminogen activator) the paper shows how drugs can be both technically and organizationally efficient while the needs  they  satisfy  can  be  created  or  identified.  The  paper  posits  that  drugs  that  require  more organizational efficiency tend to satisfy identified, rather then created needs.

Abstract 138 | PDF Downloads 65

References

1. Mather C. The pipeline and the porcupine: Alternate metaphors for the physician-industry relationship. Soc Sci Med 2005;60:1323-1334.
2. Mather C, Fleising U, Taylor L. Translating Knowledge from Bench to Bedside: The Controversial Social Life of t-PA. Risk Management: An International Journal 2004;6(2):47-58.
3. Spilker B. Multinational Pharmaceutical Companies. New York: Raven Press, 1989.
4. Economist. Hippocrates meet Mammon. The Economist 1990, Sep 22, 95.
5. Latour B. Science in Action. Cambridge: Cambridge University Press, 1987.
6. Strauss A. A social world perspective. Studies in Symbolic Interaction 1978;1:119-128.
7. Van Gennep A. The Rites of Passage. Translated by Vizedom MB, Caffee GL. Chicago: University of Chicago Press, 1960.
8. Turner V. The Forest of Symbols. Ithaca, N.Y.:Cornell University Press, 1967.
9. Appadurai A. The Social Life of Things: Commodities in Cultural Perspective. Cambridge: Cambridge University Press, 1986.
10. Van der Geest S, Whyte SR, and Hardon A. The anthropology of pharmaceuticals: a biographical approach. Annual Review of Anthropology 1996;25:153-178.
11. Fleising U. In search of genohype: A content analysis of biotechnology company documents. New Genetics and Society 2001;20(3):239-254.
12. Lock M, Scheper-Hughes N. A Critical- Interpretive Approach in Medical Anthropology: Rituals and Routines of Discipline and Dissent. In: Sargent CF, Johnson TM, eds. Medical Anthropology: Contemporary Theory and Method. Westport, CT: Praeger, 1996:41-70.
13. Star SL, Griesemer JR. Institutional ecology, ‘translations’ and boundary objects: Amateurs and professionals in Berkeley’s museum of vertebrate zoology, 1907-1939. Social Studies of Science, 1989;19(3):387-420.
14. Van der Sluijs J, van Eijndhoven J, Shackley S, Wynne B. Anchoring devices in science for policy: The case for consensus around climate sensitivity. Social Studies of Science, 1998;28(2):291-323.
15. Fujimura J. Crafting Science: Standardized Packages, Boundary Objects and "Translation". In: Pickering A, ed. Science as Practice and
Culture. Chicago: University of Chicago Press, 1992:168-211.
16. Abbott A. The System of Professions: An Essay on the Division of Expert Labor. Chicago: University of Chicago Press, 1989.
17. Lowy I. Between Bench and Bedside. Cambridge: Harvard University Press, 1996.
18. Goodell RS. (1979) Public Involvement in the DNA Controversy: The Case of Cambridge, Massachusetts. Science, Technology, and Human Values 979;4(27):36-43.
19. Krimsky S. Genetic Alchemy: The Social History of the Recombinant DNA Controversy. Cambridge, Massachusetts: MIT Press, 1983.
20. Hughes SS. Making Dollars out of DNA: The First Major Patent in Biotechnology and the Commercialization of Biotechnology, 1974-1980. Isis 2001;92(3):541-575.
21. Waddell C. Reasonableness versus Rationality in the Construction and Justification of Science Policy Decisions: The Case of the Cambridge Experimentation Review Board. Science, Technology, and Human Values 1989;14 (1):7-25.
22. Wright S. Molecular Politics: Developing American and British Regulatory Policy for Genetic Engineering, 1972-1982. Chicago: University of Chicago Press, 1994.
23. McKelvey M. Evolutionary Innovations: The Business of Biotechnology. Oxford: Oxford University Press, 2000.
24. Bogner WC, Thomas H. (1996). Drugs to Market: Creating Value and Advantage in the Pharmaceutical Industry. New York: Pergamon,1996.
25. Callahan P, Abboud L. A new boost for the vertically challenged -- FDA panel gives initial nod to use of growth hormones for healthy but
short kids. Wall Street Journal 2003; Eastern Edition, 11 June, pp. D.1.
26. 2Langreth R. Sweet syringe of youth. Forbes 2000;11 December, pp. 218.
27. Kolata G. New Growth Industry in Human Growth Hormone? Science 1986;234:22-24.
28. Cheseboro JH, Knatterud G, Roberts R, et al. Thrombolysis in myocardial infarction (TIMI) trial, phase 1: A comparison between intravenous plasminogen activator and intravenous streptokinase. Circulation 1987;76:142-54.
29. Barnett HJM, Buchan AM. The Imperative to Develop Dedicated Stroke Centers. JAMA 2000;283(23):3125-3126.
30. Indredavik B, Bakke F, Slørdahl SA, Rokseth R, Håheim LL. Stroke Unit Treatment Improves Long-term Quality of Life. Stroke 1998;29:895-899.
31. Lenzer J. Alteplase for stroke: money and optimistic claims buttress the "brain attack" campaign. British Medical Journal 2000;324:723-729.
32. Wolff SP. Trying times for ‘human insulin’. Nature 1992;356(6368):375-376.
33. Teuscher A, Berger WB. Hypoglycaemic unawareness in diabetics transferred from bee/porcine insulin to ‘human insulin’. Lancet 1987;2(8555):382-385.
34. Greene K. Scientists battle spammers over HGH sales. Wall Street Journal 2003;June 12, pp. B.1.