Doctors, drugs, information and ethics: a never-ending story

Combining commercial interests and public good is a broad social, political and ethical challenge

Health care, the practice of medicine, provision of medicines and medical information management are big business. There are deep, inherent tensions and potential for conflict between the needs and vulnerabilities of the sick, and the conduct of a large proportion of health care as a commercial activity. Every doctor in private practice spans this ethical tension each working day. Commercial organisations which provide essential health care and health goods, such as pharmaceutical companies, also tread this fine line. Industry is the largest funder of medical research and provides needed medicines and vaccines. The timelines, costs and risks of product development are substantial — around 80% of pharmaceutical and vaccine candidates which enter human clinical trials do not make it to registration, and the road to registration is formidable. An average of around a decade’s preclinical research, up to 9 years’ clinical development, and a highly variable but average cost of around US$500–800 million are involved in bringing on-stream a new product that is a new entity rather than a “me-too” product.1-3 Coupling these realities with the benefits of global reach to access the best knowledge, candidates and processes means that innovative drug and vaccine development needs big, responsive organisations with diverse skills.