[Can we trust the drug industry?].
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The author gives a breakdown of costs for industrial drug research and development of seven German drug companies. Trends of development and fields of interdisciplinary pharmaceutical research are described. Increasing expenditures and requirements for safety and efficacy reduce the chances of innovation.
The drug industry has a major influence on drug prescribing habits through their medical representatives. We therefore set out to see whether their work was more concerned with providing information or with selling, more with demand or with supply, and how much it cost in Finland. We interviewed currently employed and former representatives and contact persons in health institutions, and analysed advertisements for vacancies for medical representatives. It seems that companies regard detailing more as a sales activity than as public relations and that this trend towards selling has gained in importance in recent years. The number of representatives engaged in the pharmaceutical industry exceeds the demand for their services. The drug companies allotted in 1975 detailing at least 5 000 Fmk (+1 300) per physician per year. Our conclusion is that drug detailing is neither necessary nor beneficial for the health services.
Studied semantic representations of drug terms as a function of reported use of illicit drugs, with young-adult industrial workers as the Ss (college students served in a preliminary study). Procedures for describing semantic organizations included the semantic differential, similarity ratings, sorting, and verbal production of drug names. In general, structured representations of drug terms were produced, in line with the categories: illicit drugs, medicinal drugs, alcohol products, and substances containing nicotine or caffeine. Increased drug use was accompanied by more positive evaluations of illicit drugs on the semantic differential and more extensive clustering on the verbal production task. It was concluded that use of illicit drugs is accompanied by distinctive semantic representations, that these patterns mainly involve drugs used illicitly, and that they are most apparent on tasks in which responses are least constrained, such as verbal production.
A review is given of the various regulations for the preclinical and clinical evaluation of new drugs, their effects on the clearance of new medicines for general use by practising physicians, and their repercussion on industrial drug research. Undoubtedly, extensive and continuously increasing regulatory procedures, which in addition have to be satisfied repeatedly in individual countries, claim an unproportionally high percentage of the industrial capacity for research and development of new drugs, leaving too little for basic research, which is a prerequisite for the discovery of new medicines that are more than just "me too" products. Despite the fact that regulatory language differs from scientific attitude and arguments, the wall of regulations should be neither too thick nor too high to impede research and to hinder the prompt application of important new drugs. Even the most sophisticated and extensive drug regulations cannot prevent the use of drugs which is not indicated, because it is impossible to regulate ignorance. To regulate drugs is necessary, but the governments and their drug agencies should also encourage drug research and should support industry in the development of new drugs. On the other hand, the drug companies must adhere to the accepted standards and create an atmosphere of confidence by presenting reliable and complete data.
Industrial accidents resulting from technical defects have decreased in the last eights because of improved safety precautions. In contrast, accidents resulting from "human error" are increasing steadily. Toxicological urine analysis for drugs--directed mainly at soporifics, sedatives, tranquilizers, and pain-relievers--on 84 patients involved in industrial accidents yielded the following results. 1. Drugs were identified in 44 patients (= 52%). 2. In 13.4 patients, more than one drug was identified (= 16%). 3. Only five of the 44 patients admitted on being questioned that they had taken drugs (= 10%). On the other hand, in a control group of 47 persons who and not suffered any accident, drugs were detected in 19 cases (= 40%). The results show that the physician will have to take into account that healthy and efficient persons, too, are very often likely to practise drug abuse. It must be considered probable that this helps to promote accidents. Medical prescription, especially of neuroleptics and psychotropics, as well as of sedatives, should be practiced more.
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1. The author sees this issue as philosophical with paradoxical moral overtones. Ethical questions may have an inhibiting effect on drug research. 2. The individual morals and professional ethics of physicians and researchers are seen as central to the conduct of psycho-pharmacotherapeutic research. 3. The effect on ethics of religion, culture and social setting is discussed. 4. Human subjects in drug research are discussed. 5. Control of the drug industry (research, quality control, distribution) is discussed and supra national control advocated.
The drug industry is now putting out specific beta 1 or beta 2 beta-blocking agents. The pA2 of various beta-blocking agents were determined on isolated organs-guinea pig atrium and trachea: practolol and acebutolol were considered as specific beta-1 inhibitors; butoxamine was a specific beta-2 inhibitor, while pindolol, oxprenolol, propranolol and alprenolol were specificity free. The pA2 quantifies the action exerted by an inhibitor. Cardioselectivity is expressed by the pA2 left atrium/pA2 trachea ratio. It exceeds 1 000 for practolol, it equals 30 for acebutolol, and is very slight for butoxamine. The pA2 therefore gives a good idea of the potential of the various drugs on the animal's isolated organ. However, these data cannot safely be extrapolated to man. Hence the necessity of conducting clinical pharmacological studies.
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