The demand for new drugs and, therefore, for the product of pharmaceutical R&D originates in the health care market. This is true regardless of the method of drug development and whether the drug is a synthetic or natural compound. Ethical pharmaceuticals are just one method of treating ill health.1 Surgery, irradiation treatment, manipulation of diet and lifestyle, herbal medicines, physiotherapy, faith healing, etc. are all active means of providing health care to those whose lives are impaired by disease. In addition to treatments that may either cure disease or ameliorate its effects, the use of preventive medicine must be included as an alternative, proactive means of satisfying the demand for good health. While principally founded on exercising care in the choice of diet and lifestyle (including exercise), the preventive efforts may also rely on the judicious use of surgery, drugs and other treatments.
1 The US Pharmaceutical Manufacturers Association (1992) defines 'ethical pharmaceuticals' as those biological and medicinal chemicals useful in both humans and animals that are marketed primarily to the health care profession. This definition includes both prescription and over-the-counter ethical sales. The emphasis in this paper is on prescription medicines useful in treating humans.
In addition, there exists the option of relying on the body's natural recuperative powers: the do-nothing option. Over the past millenia the human immune system has evolved into a competent and sometimes fearless combatant of disease. A large percentage of all afflictions and diseases will be vanquished by the human immune system if it is left to do the job. In fact, many diseases from which we suffer today, such as breast cancer and coronary heart disease, are just beginning to be understood as a 'healthy' body's reaction to a change in lifestyle away from patterns to which the body had become adapted on an evolutionary time scale. The do-nothing option is the baseline used in evaluating the costs and benefits, or cost-effectiveness, of particular products in the health care market. Thus, discussion of promising pharmaceuticals, whether derived from plant or other sources, must not lose sight of the ultimate market in which performance is measured.
Such discussion should not ignore the larger system of policies in which the incentives governing the provision of health care are set. As industrialized countries grapple with rapidly expanding health care costs in the coming decade, the pros and cons of different forms of health care are likely to receive increasing attention. The pharmaceutical industry, with its healthy profit margins, may be an easy target in the effort to cut health care costs. The fall-out from changes to the existing incentives system will affect research into both plants and synthetic substances.
In looking to the potential of plants to serve as a veritable cornucopia of new drugs, conservationists must recognize that linking the prospects of biodiversity conservation with its pharmaceutical potential means joining forces with the pharmaceutical industry. Whether this is an 'unholy' alliance or an admirable example of business-led 'sustainable development' depends on the preconceptions and expectations of the observer. In the short term, increased investment in the exploration of the potential pharmaceutical properties of plants is likely to come from budgets that would have been spent on research into 'synthetic' chemicals; however, over the longer term such investment must be viewed as coming out of the larger health care research budget. Thus, calls for the rapid exploration of the pharmaceutical potential of tropical biodiversity are, in a larger sense, in competition with the other forms of established and 'radical' approaches to health care listed above.
The application of standards of efficacy to highly capital-intensive surgical treatments such as already apply to pharmaceuticals might shift health care investment towards plants. On the other hand, increased reliance on preventive action and the body's natural recuperative powers by way of an increased emphasis on the role of nutrition, exercise and lifestyle management might shift investment away from the R&D aimed at developing pills and tablets.
This is not to imply that the use of a single form of health care or a single method for the development of new drugs is either inevitable, or even desirable. In the quest for health it is fair to say that all 'guns' should be brought to bear. An economic approach to health care implies that there are inevitable trade-offs to be made between the cost-effectiveness of different health care portfolios, even that of pharmaceuticals based on plants. Having raised these larger issues, this chapter now focuses on only a narrow area of this portfolio: the development of pharmaceutical products.
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