MEDICINES, SOCIETY, AND INDUSTRY III

Products of the modern pharmaceutical industry have improved the outlook for patients with many disorders. Drug manufacturers have been highly successful in translation of discoveries into successful products. Despite these successes, pharmaceutical companies have come under increasingly critical public scrutiny,1,2 for example, the unsuccessful legal campaign against the South African government, their tardiness in lowering of prices for antiretroviral drugs in the face of the pandemic of AIDS, and the high price of many drugs in the USA compared with other countries.3–6 Despite these controversies, companies have remained profitable, with better margins than other industries.6 International companies now face increasingly demanding customers, constrained expenditure on drugs, an expanding generics business, and imminent expiry of patents for several very profitable products. The combination of these factors is creating uncertainty about the continued growth of the industry. Access to drugs WHO has maintained a list of essential drugs since 1977; the 12th version of the list contains 325 drugs, many of which are available in bulk generic forms from low-cost suppliers.7 Despite the relatively low prices that can be obtained on the international market, availability of essential drugs remains deficient, and over half the poorest people in Africa and Asia still do not have access to these drugs.8 High prices (in part attributable to inappropriately high taxes, mark-ups, and dispensing fees), poor purchasing and distribution programmes, uncertain product quality (including counterfeit drugs), and inappropriate prescribing practices continue to undermine availability.5,