a pill case with pills coming out

Having written dozens of articles on medications, studied pharmacology, and pried way too much into my friends’ personal lives, I’ve gained a good feel for what a drug is, what it does, and how it is packaged.

All those things seem to be minor issues but there is a lot more to it than meets the eye.  From the pharmacological aspect to the marketing, each part of drug development and sales holds reams of information for the curious.

How good a drug is, for instance, is often not nearly as important as how well it can be marketed.  There are dozens of medications that are all in the same big family, pretty much, for treating depression or high blood pressure, yet one can sell much better than another.

How much innovation is going on?

The medications we use for the psychological conditions were all pretty much found by accident around the World War II period and have stayed about the same since then.

Depression medications, for instance, were discovered by accident when people being treated for another condition (possibly tuberculosis) started ‘dancing for joy.’  Since then, medications that work on almost the exact same model – the serotonin pathways – have gotten more specific, have less side effects, but are pretty much the same.  Despite 40 years of research, they aren’t any more effective.

Schizophrenia medications were also discovered by accident when an anti-allergy medication had sedative effects.  Their effect, which was likened to a “chemical lobotomy” was soon shown to have effect in treating psychosis.  Since then, we’ve developed medications that work almost exactly the same, just have less side effects.  Again, in terms of effectiveness, there is almost no improvement over the medications we used 40 years ago.

Anxiety medications have an almost identical history (going from the barbiturates to the benzodiazepines), as well as medications for bipolar-disorder.  Same for ADHD treatment.

40 years with no breakthrough or significant change in how we treat any of the psychological conditions.

On the other hand, in some areas where new drugs can be extremely lucrative, there has been progress.  We developed the statin family of drugs fairly recently, which, in addition to pulling in billions of dollars in revenue, are fairly decent at lowering cholesterol levels.  And in cancer treatment, there have been some exciting and fascinating innovations just recently.

Gleevec, for instance, is a highly targeted treatment that targets a specific molecule associated with a rare cancer.  It is extremely expensive, however.

And Herceptin, which is an antibody to a specific receptor associated with breast cancer, or Tarceva, a chemical targeting a specific receptor for growth factor, and so on.  What the new cancer treatments have in common is their extreme specificity as well as their high cost, up to $100,000 per year per patient!

If psychological treatments were discovered by accident and have remained the same over 40 years, cancer treatments are being discovered at break-neck speed and target increasingly specific targets based off scientific methods of drug discovery.