I received the ‘Business of medicine’ within weeks of finishing John Le Carré's latest novel ‘The Constant Gardener’. Both are about the pharmaceutical industry. Le Carré's book is a fictional exposé, in an African setting, of intrigue and skullduggery by an unnamed multinational. Edgar Jones provides a factual account of the gestation, infancy, adolescence and maturity of one such industrial giant. There could hardly be a greater contrast!
Edgar Jones and his assistant, John Savage, have produced a prodigiously researched volume which reads easily despite occasional turgid passages when we are taken through profit and loss accounts, intercompany negotiations, and rearrangements of plant and personnel.
While other companies have also had humble beginnings, the origins of Glaxo in Nathans' general store in Wellington, New Zealand, in 1861, gave no hint of developments to come. The Nathans made dried milk, often modified to improve suitability for babies by the addition of milk sugar (whence the name ‘Glaxo’ – ‘an ephonious (sic) word’ derived from ‘lactose’). As the company, now located in London, grew, pharmaceuticals crept in by the side door – vitamins to fortify infant foods, and then stand-alone vitamin D, an important additive in the early decades of last century when rickets abounded. In the Second World War Glaxo, together with other companies, became involved in the production of penicillin. Post-war the company made and marketed antibiotics, and in the 1950s moved into steroid research. From the 1960s onwards the emphasis moved more exclusively to new drug discovery, and the increasing success of the company in the later decades of the 20th century was founded on the establishment of excellent research teams, sound direction and also more than a measure of luck. The discovery of salbutamol in 1966 exploited the newly recognized diversity of β-adrenergic receptors. Building on this came labetalol – a combined α- and β-receptor antagonist in 1977. But the block-buster, ranitidine, on which the later fortunes of Glaxo were built, was not the first of its kind, the selective inhibition of gastric histamine H2-receptors having been pioneered by James Black and colleagues working with Smith Kline and French (SKF). It was SKF who launched the first commercially successful H2-receptor blocker, cimetidine, and Glaxo's ranitidine had to compete against a well-established therapy. The marketing strategy was to emphasize the (in most cases) relatively minor clinical advantages of ranitidine and exact a financial premium as a consequence. The strategy worked, and the fortunes of Glaxo were secured.
For me the most interesting sections of this book were the early company history with its photographs, the very well written account of research and development in recent years, and the history of the establishment and growth of Glaxo in the USA.
My disappointments were the lack of any real definition of the personalities of those who led (and lead) the company, the almost total lack of reference to industrial relations, and the overall feeling that this book was written from a desk placed securely in the Board Room. There are more than 1800 notes and references, and the preponderant sources are Board minutes and interviews with Board members and company executives.
Orphan drugs get a tiny mention, but nowhere are the economic realities of the present day touched upon, or the attitude of the company to research into treatments for, for example, prevalent diseases of poorer countries.
I enjoyed reading the ‘Business of Medicine’, and it will find a place on my library shelves – probably alongside ‘The Constant Gardener’.