title: Peering into the pharmaceutical "pipeline": investigational drugs, clinical trials, and industry priorities.
abstract: In spite of a growing literature on pharmaceuticalization, little is known about the pharmaceutical industry's investments in research and development (R&D). Information about the drugs being developed can provide important context for existing case studies detailing the expanding--and often problematic--role of pharmaceuticals in society. To access the pharmaceutical industry's pipeline, we constructed a database of drugs for which pharmaceutical companies reported initiating clinical trials over a five-year period (July 2006-June 2011), capturing 2477 different drugs in 4182 clinical trials. Comparing drugs in the pipeline that target diseases in high-income and low-income countries, we found that the number of drugs for diseases prevalent in high-income countries was 3.46 times higher than drugs for diseases prevalent in low-income countries. We also found that the plurality of drugs in the pipeline was being developed to treat cancers (26.2%). Interpreting our findings through the lens of pharmaceuticalization, we illustrate how investigating the entire drug development pipeline provides important information about patterns of pharmaceuticalization that are invisible when only marketed drugs are considered.
authors.affiliation: Department of Social Medicine, University of North Carolina at Chapel Hill, 333E MacNider Hall, CB #7240, Chapel Hill, NC 27599-7240, USA. Electronic address: jill.fisher@unc.edu.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Fisher
authors.affiliation: Department of Social Medicine, University of North Carolina at Chapel Hill, 324 MacNider Hall, CB #7240, Chapel Hill, NC 27599-7240, USA. Electronic address: cottingham@unc.edu.
authors.forename: Marci D
authors.initials: MD
authors.lastname: Cottingham
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill School of Public Health, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599-7435, USA. Electronic address: kalbaugh@email.unc.edu.
authors.forename: Corey A
authors.initials: CA
authors.lastname: Kalbaugh
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D002986:Clinical Trials as Topic; D017321:Clinical Trials, Phase I as Topic; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D017277:Drug Approval; D015195:Drug Design; D004345:Drug Industry; D015507:Drugs, Investigational; D038622:Internationality; D001523:Mental Disorders / Q000188:drug therapy; D009017:Morbidity; D009369:Neoplasms / Q000188:drug therapy; D000067490:Prescription Drug Overuse; D012106:Research; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D015507:Drugs, Investigational
keywords: Cancer; Clinical trials; Global burden of disease; HIV/AIDS; Mental illness; Pharmaceuticalization; Pharmaceuticals; R&D