For personal use. Only reproduce with permission from The Lancet Publishing Group. MEDICINES, SOCIETY, AND INDUSTRY II 1498 THE LANCET • Vol 360 • November 9, 2002 • www.thelancet.com The pharmaceutical industry is by far the main manufacturer of drugs, with an estimated annual worldwide budget for drug development of US$6 billion. 1 The market for prescription drugs in the USA is about US$130 billion, and in the UK it is about UK£7 billion. 2 Some of the largest and most successful companies employ a workforce of about 100 000 worldwide, 3 and register pre-tax profits of over UK£1·3 billion in a quarter. 4 Such efforts have produced many drugs of great benefit to man. Under these circumstances, the commercial interests of the industry and the public-health interests of patients coincide. However, drug disasters, adverse drug reactions (ADRs), 5 and industry’s unwillingness to do trials in children, 6 show that industrial interests can sometimes diverge from, or even conflict with, public health. Governments have developed systems to regulate the pharmaceutical industry, which ascertain whether drug products are safe and efficacious enough to be permitted on the market, because they have a responsibility to protect public health. Pharmaceutical companies want the safety and efficacy standards of regulators to be high enough to avoid frequent drug disasters, which bring the industry into disrepute, but not so high that they threaten their commercial viability. For example, a manufacturer can lose on average
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