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What did the industry look like in early 80s?

Squibb (later Bristol Myers Squibb and now GSK) was big in cephalosporins. Velosef (cephradine) was top selling and expensive. A 500mg capsule sold for 11.40 rupees; very high price at that time. Squibb promoted and defended their product very aggressively and kept their position. Eli Lilly was also in Cephalosporin with Ceclor (cefaclor), Kefzol (cefazolin) and Keflin (cephalothin). Glaxo joined the race with Ceporex (cephalexin). Kefzol sold well but was only injectable. Ceclor and Ceporex were only oral. Velosef had the advantage that it was both oral and injectable.

Before cephalosporins, penicillin was supreme. Beecham’s Penbritin (ampicillin), Ampiclox (ampicillin + cloxacillin) were best selling oral and injectables. Later it was reinforced (and replaced) by Amoxil (amoxicillin) which is still a top selling drug in combination Augmentin (amoxicillin + clavulanic acid).

On the anti-TB front, Lederld had changed the shape of the treatment by introducing Myambutol (Ethambutol). It replaced PAS, to be taken up to 24 tablets a day, and Streptomycin, to be injected every day. Myambutol folder showing a pin-cushion (then present on every office table, now obsolete) and the caption “Why Treat Your Patient Like A Pin Cushion” was a great hit. The idea was also hit and Myambutol became a huge product. When I joined Lederle, it was contributing over 30% revenue and was the largest product in portfolio.

Anti-TB treatment was further revolutionized by introduction of Rifampicin. Ciba marketed it as Rimactane and combination Rimactazid. General Zia somehow targeted Ciba and slashed the price of Rimactane/ Rimactazid by 50%. The company could not absorb it. It became the reason for Ciba to roll back considerably.

In Diabetes, Diabenese (chlorpropamide – Pfizer) was phasing out. Daonil (Glibenclamide – Hoechst) was top selling. Then Glipizide was introduced by Upjohn and Carlo Erba. It was a good molecule but did not do well. Then Syed Ahmed (ex-Upjohn) brought Servier to Pakistan and along came Diamicron (gliclazide). It was in the same class of sulphonyureas but it challenged the supremacy of Daonil. Hoechst claimed Daonil was superior and Servier claimed Diamicron was safer due to less hypoglycemic episodes. Diamicron caught up. It was more expensive, so it overtook in value in a few years. Later it overtook in volume as well. It is a phenomenon worth studying for marketing people.

Squibb was also the first to bring ACE Inhibitor (Angiotensin Converting Enzyme) drug Capoten (captopril). It was first in a new class and greatly impacted the treatment of hypertension and cardiovascular diseases. I am a witness to hard, laborious work Squibb did for Capoten. They established the concept of the therapy which benefitted the later players. MSD brought in Renitec (enalapril) later and overtook Squibb because the concept was already established.

Among aminoglycoside class of antibiotics, Genticyn (gentamicin – Nicholas) sold very well. Later, Nebcin (tobramycin – Eli Lilly) was a big seller but Genticyn remained first line drug.

Some big products tumbled in the late 70s/early 80s. Novalgin (dipyron – Hoechst) went into disrepute after publication of a study linking it to agranulocytosis, a potentially fatal condition. Dipyron was huge for Hoechst worldwide. They ran more studies and tried to defend very hard but country after country stopped Dipyon. This also affected their anti-spasmodic product Baralgin which also contained Dipyron. Same problem was suffered by Boehringer Ingelheim for their Buscopan compositum (hyoscine + dipyron). A little later, anti-spasmodic drugs of this class were officially stopped by the regulatory bodies. It was a big blow to Hoechst and Boehringer. The MoH Pakistan also banned the use of multi-dose vials. Heochst had three products, Novalgin, Baralgin, Avil (pheniramine) MDV, Pfizer had Oxytetracycline and so had some other companies. All these products were stopped from further production. Stocks available in the market kept selling at premium price.

Codeine was banned. Pfizer sold Corex cough syrup which was one of the best-selling cough syrup in the market. It sold by millions of bottles. There were others also but Corex was the biggest and the most popular. Some addicts also took heavy dose of Corex to get a little high. The absence of Corex was missed by genuine patients more than the addicts. The addicts had other choices; the patients did not.

Andy Grove, Founding Partner of Intel®, in his book ‘Only the Paranoids Survive’ calls this ‘Inflection Point’, when business loses its very base. Camera films, long play records, floppy discs are but some examples of ‘inflection point’.

From mid 80s onward, the industry went into big changes……

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