Ch. 4— The Pharmaceutical Industry • 79 
for them v\ ill he felt on an international scale 
and w ill in\ oK e luindi'eds of millions of people. 
rhe new technologies may also lower the 
risks of \accine production. For e.xample, the 
FMD\ vaccine produced hv (ienentech is con- 
structed out of 17 of the 20 genes in the entire 
v irus— enough to confer resistance, hut too few 
to dev elop into a v iable organism. 
I'he new technologv' may also supplv piiarma- 
ceuticals with effects heyond therajn'. .At least 
tw o promise ini[)acts vv ith hroad consequences: 
MSH AC FH 4-10 can he e.\[)ecled to he used on a 
wide scale if it is shown to improve memory; 
and homhesin and cholecystokinin might e.\- 
pand the appetite suppression market. But nei- 
ther of these compounds has yet been found to 
he useful. U bile genetic technologies may pro- 
vide large suj)plies of the diugs, they do not 
guarantee their v alue. 
•Antibody -based diagnostic tests, developed 
through genetic engineering, may eventually in- 
clude early warning signals for cancer; they 
should he able to recognize any one of the 
scores of cancers that cause about a half-million 
deaths per year in the United States. If anti- 
bodies prov e successful as diagnostic screening 
agents to predict disease, large-scale screening 
of the population can occur, accelerating the 
trend toward preventiv e medicine in the United 
States. 
In addition to drugs and diagnostic agents, 
proteins could be produced for laboratory use. 
E.xpensive, complex media such as fetal calf 
serum are presently required for growing most 
mammalian tissue cells. Genetic cloning could 
make it possible to synthesize vital constituents 
cheaply, and could markedly reduce the costs of 
cell culture for both research and production. 
Ironically, genetic cloning could make economi- 
cally competitive the very technology that of- 
fers an alternative production method for many 
drugs: tissue culture. 
Xevertheless, the mere availability of a phar- 
macologically active substance does not ensure 
its adoption in medical practice. Even if it is 
shown to have therapeutic usefulness, it may 
not succeed in the marketplace. Consumer re- 
sistance limits the use of some drugs. The Amer- 
ican aversion to therapies that rec|uire frequent 
injection, for instance, is illustrated by the opin- 
ion of some that a drug like AC^TH offers few, if 
any, adv antages over steroids. 
The use of Atn il is somewhat greater abroad 
than in the United States. This is due in part 
because physicians in other cultui'es make far 
less use of systemic steroids than their Amer- 
ican counterparts, and in part because frequent 
injections are more acceptable hence more com- 
mon. Sales of ACnil in Great Britain— with 
its much smaller population— ecpial American 
sales. 
■At present, the need for injection is a far 
more likely deterrent to the wider use of AC FH 
than the cost of the drug itself. Keports that it 
can he ap()lied by nasal spray suggest that its 
use may grow. Implantable controlled-release 
dosages may also become available within the 
next 5 years. Fhis dependence on appropriate 
drug delivery mechanisms may lead to another 
line of research— increased attempts to develop 
technologies for drug-delivery. 
As new pharmaceuticals become available, 
disrufjtion can be expected to occur in the sup- 
ply of some old ones. Pharmaceuticals whose 
production is tied to the production of others 
might become increasingly expensive to pro- 
duce. Clotting factors, for example, are ex- 
tracted with other blood components from 
plasma. Nevertheless, producing any of the 14 
currently approved blood plasma products by 
rDNA would reduce the incidence of hepatitis 
caused by contamination from natural blood 
sources. 
Whether new pharmaceuticals are produced 
or new production methods for existing phar- 
maceuticals are dev'ised, future sources for the 
drugs may change. Currently, the sources are 
div'erse, including many different plants, nu- 
merous animal organs, various tissue culture 
cells, and a wide range of raw materials used 
for chemical synthesis. A massive shift to fer- 
mentation would narrow the selection. The im- 
pacts on present sources can only be judged on 
a case-by-case basis. The new sources— micro- 
organisms and the materials that feed them— 
offer the guarantee that the raw materials won’t 
dry up. If one disappears, another can be found. 
