A társadalmi felelősségvállalás tendenciái a gyógyszeriparban = Corporate Social Responsibility in the Pharmaceutical Industry

A gyógyszeripar egyszerre tartozik a leginkább csodált és a legtöbbet kritizált iparágak közé. Az iparág produktumai életeket menthetnek, emberek millióinak könnyítik meg az életét, és a gyógyszereknek köszönhetően számos korábbi gyilkos kór vált ismeretlenné a fejlett országokban. Mindezek mellett azonban az iparágat számos kritika is éri: túl magas árakkal dolgozik, etikátlan promóciós praktikákkal él, magára hagyja a világ szegényeit, kétes etikai hátterű klinikai kísérleteket végez, és állami intézményekkel köt háttéralkukat. A CSR koncepciójának intenzív jelenléte az iparágban többek között a fenti ellentmondásokra adott válaszként is értelmezhető (erre utalnak a későbbiekben bemutatandó kvalitatív kutatás eredményei is). Az alábbi tanulmányban arra teszek kísérletet, hogy feltárjam, a magyar gyógyszeripar szereplői hogyan látják társadalmi felelősségüket, milyen programokat valósítanak meg CSR kezdeményezéseik során. Milyen kihívások várnak a gyógyszeripari cégek vezetőire, és milyen dilemmákkal szembesülnek társadalmi felelősségvállalásuk kapcsán? Mennyiben találhatók meg a nemzetközi kutatások által feltárt nézőpontok a hazai cégek CSR interpretációiban, illetve vannak-e a magyar gyógyszeriparnak sajátosságai ebben a tekintetben? / === / The pharmaceutical industry is among the most admired and most criticized of all. The pharmaceutical products can save lives, they make the lives of millions of people lot easier, and many legendary diseases were eradicated from the world thanks to the innovations of the industry. However, the industry receives many criticisms in the same time: the big pharma is often accused of working with high prices, applying immoral marketing practices, abandoning the poor, having a no money-no cure attitude, doing ethically questionable clinical trials, etc. This contradiction can be one reason why pharmaceutical industry is among the most CSR-oriented sectors. In this paper I investigate what the CSR initiatives and activities of the pharmaceutical companies look like in Hungary. How do the managers of these firms react to the challenges of the industry? What is their perception about the contradictions described in the previous paragraph? Are there Hungarian peculiarities regarding CSR principles and actions? During research I also wanted to identify patterns of CSR activities of the Hungarian pharmaceutical firms in order to create clusters that group companies with similar characteristics.

Kereslet-előrejelzés sporadikus keresletű termékekre: Egy gyógyszer-nagykereskedelmi vállalat esettanulmánya (Forecasting of Sporadic Products - A Case Study of a Pharmaceutical Wholesaler Company)

A vállalatok jelentős része szembesül azzal, hogy termékei jelentős része iránt viszonylag kevés alkalommal jelentkezik kereslet. Ebből következik, hogy az ilyen termékekre a klasszikus előrejelzési módszerek, mint pl. a mozgó átlag számítása, vagy az exponenciális simítás nem alkalmazható. Azon termékeket, amelyek iránt viszonylag ritkán jelenik meg kereslet, sporadikus keresletű termékeknek nevezzük. A megkülönböztetés a sporadikus és nem sporadikus termékek között sokszor csak hüvelykujj szabály alapján állapítható meg, de erre vonatkozóan a szakirodalomban találunk iránymutatást. A nemzetközi szakirodalomban már megjelentek olyan új kereslet-előrejelzési módszerek, melyeket kimondottan az ilyen, sporadikus kereslettel rendelkező termékek estében javasoltak. Cikkünk célja, hogy ezeket a szakirodalmi ajánlásokat egy konkrét hazai vállalat valós adatain esettanulmány jelleggel tesztelje. A nemzetközi szakirodalomban is ritkán publikálnak tudományos dolgozatokat, amelyek ezt a témakört valós alkalmazási környezetben tárgyalják; ismereteink szerint magyar nyelven erről tudományos dolgozat pedig még nem született. Elméleti bevezetőnk után egy gyógyszer-nagykereskedelmi vállalatnál valós adatait használva vizsgáljuk a kérdéskört. Sor kerül a vállalat termékportfóliójának a kereslet-előrejelzés szempontjából történő tipizálására, majd sporadikus keresletű termékek keresletének előrejelzésére és ennek során a szakirodalomban az alkalmazandó módszerekre vonatkozó ajánlások vizsgálatára. _____ Significant numbers of companies have the problem that demand for their products are sporadic in nature. Demand of such products is not continual in time; its demand is diffused, is random with large proportion of zero values in the analyzed time series. The sporadic character of a demand pattern actually means that available information on the demand of previous selling periods is leaky resulting in lower quality of data available. In these cases traditional forecasting techniques do not result in reliable forecast. Special forecasting algorithms have been developed during the last decade dealing with this problem. The paper introduces these techniques and offers suggestions for application. It also presents the case study of a Hungarian pharmaceutical wholesaler company. Based on real data we develop a topology of the company's product portfolio, carry out forecasts using different techniques including those developed for products with sporadic demand and also analyze the quality of these forecasts.

Determinants of pharmaceutical innovation diffusion: social contagion and prescribing characteristics

This article studies the determinants of pharmaceutical innovation diffusion among specialists. To this end, it investigates the influences of six categories of factors—social embeddedness, socio-demography, scientific orientation, prescribing patterns, practice characteristics, and patient panel composition—on the use of new drugs for the treatment of type 2 diabetes mellitus in Hungary. Here, in line with international trends, 11 brands were introduced between April 2008 and April 2010, outperforming all other therapeutic classes. The Cox proportional hazards model identifies three determinants—social contagion (in the social embeddedness category) and prescribing portfolio and insulin prescribing ratio (in the prescribing pattern category). First, social contagion has a positive effect among geographically close colleagues—the higher the adoption ratio, the higher the likelihood of early adoption—but no influence among former classmates and scientific collaborators. Second, the wider the prescribing portfolio, the earlier the new drug uptake. Third, the lower the insulin prescribing ratio, the earlier the new drug uptake—physicians’ therapeutic convictions and patients’ socioeconomic statuses act as underlying influencers. However, this finding does not extend to opinion-leading physicians such as scientific leaders and hospital department and outpatient center managers. This article concludes by arguing that healthcare policy strategists and pharmaceutical companies may rely exclusively on practice location and prescription data to perfect interventions and optimize budgets.

Improved sampling and detection of ignitable liquid residues and explosives by mass spectrometry and ion mobility spectrometry

Fire debris evidence is submitted to crime laboratories to determine if an ignitable liquid (IL) accelerant was used to commit arson. An ignitable liquid residue (ILR) may be difficult to analyze due to interferences, complex matrices, degradation, and low concentrations of analytes. Debris from an explosion and pre-detonated explosive compounds are not trivial to detect and identify due to sampling difficulties, complex matrices, and extremely low amounts (nanogram) of material present. The focus of this research is improving the sampling and detection of ILR and explosives through enhanced sensitivity, selectivity, and field portable instrumentation. Solid Phase MicroExtraction (SPME) enhanced the extraction of ILR by two orders of magnitude over conventional activated charcoal strip (ACS) extraction. Gas chromatography tandem mass spectrometry (GC/MS/MS) improved sensitivity of ILR by one order of magnitude and explosives by two orders of magnitude compared to gas chromatography mass spectrometry (GC/MS). Improvements in sensitivity were attributed to enhanced selectivity. An interface joining SPME to ion mobility spectrometry (IMS) has been constructed and evaluated to improve field detection of hidden explosives. The SPME-IMS interface improved the detection of volatile and semi-volatile explosive compounds and successfully adapted the IMS from a particle sampler into a vapor sampler. ^

Tailoring heme -thiolate proteins into efficient biocatalysts with high specificity and selectivity

Cytochrome P450 monooxygenases, one of the most important classes of heme-thiolate proteins, have attracted considerable interest in the biochemical community because of its catalytic versatility, substrate diversity and great number in the superfamily. Although P450s are capable of catalyzing numerous difficult oxidation reactions, the relatively low stability, low turnover rates and the need of electron-donating cofactors have limited their practical biotechnological and pharmaceutical applications as isolated enzymes. The goal of this study is to tailor such heme-thiolate proteins into efficient biocatalysts with high specificity and selectivity by protein engineering and to better understand the structure-function relationship in cytochromes P450. In the effort to engineer P450cam, the prototype member of the P450 superfamily, into an efficient peroxygenase that utilizes hydrogen peroxide via the “peroxide-shunt” pathway, site-directed mutagenesis has been used to elucidate the critical roles of hydrophobic residues in the active site. Various biophysical, biochemical and spectroscopic techniques have been utilized to investigate the wild-type and mutant proteins. Three important P450cam variants were obtained showing distinct structural and functional features. In P450camV247H mutant, which exhibited almost identical spectral properties with the wild-type, it is demonstrated that a single amino acid switch turned the monooxygenase into an efficient preoxidase by increasing the peroxidase activity nearly one thousand folds. In order to tune the distal pocket of P450cam with polar residues, Leu 246 was replaced with a basic residue, lysine, resulting in a mutant with spectral features identical to P420, the inactive species of P450. But this inactive-species-like mutant showed catalytic activities without the facilitation of any cofactors. By substituting Gly 248 with a histidine, a novel Cys-Fe-His ligation set was obtained in P450cam which represented the very rare case of His ligation in heme-thiolate proteins. In addition to serving as a convenient model for hemoprotein structural studies, the G248H mutant also provided evidence about the nature of the axial ligand in cytochrome P420 and other engineered hemoproteins with thiolate ligations. Furthermore, attempts have been made to replace the proximal ligand in sperm whale myoglobin to construct a heme-thiolate protein model by mimicking the protein environment of cytochrome P450cam and chloroperoxidase.

Development of advanced capillary electrophoresis techniques with UV and mass spectrometry detection for forensic, pharmaceutical and environmental applications

Capillary electrophoresis (CE) is a modern analytical technique, which is electrokinetic separation generated by high voltage and taken place inside the small capillaries. In this dissertation, several advanced capillary electrophoresis methods are presented using different approaches of CE and UV and mass spectrometry are utilized as the detection methods. ^ Capillary electrochromatography (CEC), as one of the CE modes, is a recent developed technique which is a hybrid of capillary electrophoresis and high performance liquid chromatography (HPLC). Capillary electrochromatography exhibits advantages of both techniques. In Chapter 2, monolithic capillary column are fabricated using in situ photoinitiation polymerization method. The column was then applied for the separation of six antidepressant compounds. ^ Meanwhile, a simple chiral separation method is developed and presented in Chapter 3. Beta cycodextrin was utilized to achieve the goal of chiral separation. Not only twelve cathinone analytes were separated, but also isomers of several analytes were enantiomerically separated. To better understand the molecular information on the analytes, the TOF-MS system was coupled with the CE. A sheath liquid and a partial filling technique (PFT) were employed to reduce the contamination of MS ionization source. Accurate molecular information was obtained. ^ It is necessary to propose, develop, and optimize new techniques that are suitable for trace-level analysis of samples in forensic, pharmaceutical, and environmental applications. Capillary electrophoresis (CE) was selected for this task, as it requires lower amounts of samples, it simplifies sample preparation, and it has the flexibility to perform separations of neutral and charged molecules as well as enantiomers. ^ Overall, the study demonstrates the versatility of capillary electrophoresis methods in forensic, pharmaceutical, and environmental applications.^

Essays on Competition in the Pharmaceutical Industry

Chapter 1: Patents and Entry Competition in the Pharmaceutical Industry: The Role of Marketing Exclusivity Effective patent length for innovation drugs is severely curtailed because of extensive efficacy and safety tests required for FDA approval, raising concern over adequacy of incentives for new drug development. The Hatch-Waxman Act extends patent length for new drugs by five years, but also promotes generic entry by simplifying approval procedures and granting 180-day marketing exclusivity to a first generic entrant before the patent expires. In this paper we present a dynamic model to examine the effect of marketing exclusivity. We find that marketing exclusivity may be redundant and its removal may increase generic firms' profits and social welfare. Chapter 2: Why Authorized Generics?: Theoretical and Empirical Investigations Facing generic competition, the brand-name companies some-times launch generic versions themselves called authorized generics. This practice is puzzling. If it is cannibalization, it cannot be profitable. If it is divisionalization, it should be practiced always instead of sometimes. I explain this phenomenon in terms of switching costs in a model in which the incumbent first develops a customer base to ready itself against generic competition later. I show that only sufficiently low switching costs or large market size justifies launch of AGs. I then use prescription drug data to test those results and find support. Chapter 3: The Merger Paradox and R&D Oligopoly theory says that merger is unprofitable, unless a majority of firms in industry merge. Here, we introduce R&D opportunities to resolve this so-called merger paradox. We have three results. First, when there is one R&D firm, that firm can profitably merge with any number of non-R&D firms. Second, with multiple R&D firms and multiple non-R&D firms, all R&D firms can profitably merge. Third, with two R&D firms and two non-R&D firms, each R&D firms prefer to merge with a non-R&D firm. With three or more than non-R&D firms, however, the R&D firms prefer to merge with each other.

Tailoring Heme-Thiolate Proteins into Efficient Biocatalysts with High Specificity and Selectivity

Cytochrome P450 monooxygenases, one of the most important classes of heme-thiolate proteins, have attracted considerable interest in the biochemical community because of its catalytic versatility, substrate diversity and great number in the superfamily. Although P450s are capable of catalyzing numerous difficult oxidation reactions, the relatively low stability, low turnover rates and the need of electron-donating cofactors have limited their practical biotechnological and pharmaceutical applications as isolated enzymes. The goal of this study is to tailor such heme-thiolate proteins into efficient biocatalysts with high specificity and selectivity by protein engineering and to better understand the structure-function relationship in cytochromes P450. In the effort to engineer P450cam, the prototype member of the P450 superfamily, into an efficient peroxygenase that utilizes hydrogen peroxide via the “peroxide-shunt” pathway, site-directed mutagenesis has been used to elucidate the critical roles of hydrophobic residues in the active site. Various biophysical, biochemical and spectroscopic techniques have been utilized to investigate the wild-type and mutant proteins. Three important P450cam variants were obtained showing distinct structural and functional features. In P450camV247H mutant, which exhibited almost identical spectral properties with the wild-type, it is demonstrated that a single amino acid switch turned the monooxygenase into an efficient preoxidase by increasing the peroxidase activity nearly one thousand folds. In order to tune the distal pocket of P450cam with polar residues, Leu 246 was replaced with a basic residue, lysine, resulting in a mutant with spectral features identical to P420, the inactive species of P450. But this inactive-species-like mutant showed catalytic activities without the facilitation of any cofactors. By substituting Gly 248 with a histidine, a novel Cys-Fe-His ligation set was obtained in P450cam which represented the very rare case of His ligation in heme-thiolate proteins. In addition to serving as a convenient model for hemoprotein structural studies, the G248H mutant also provided evidence about the nature of the axial ligand in cytochrome P420 and other engineered hemoproteins with thiolate ligations. Furthermore, attempts have been made to replace the proximal ligand in sperm whale myoglobin to construct a heme-thiolate protein model by mimicking the protein environment of cytochrome P450cam and chloroperoxidase.

The Evolution of Pharmaceutical Care for Drug Misusers

This survey was funded by a grant from the Chief Scientist Office (CSO), Grant No: CZH/4/998.

The Evolution of Pharmaceutical Care for Drug Misusers

This survey was funded by a grant from the Chief Scientist Office (CSO), Grant No: CZH/4/998.

Sortase as a Tool in Biotechnology and Medicine

We have harnessed two reactions catalyzed by the enzyme sortase A and applied them to generate new methods for the purification and site-selective modification of recombinant protein therapeutics.

We utilized native peptide ligation —a well-known function of sortase A— to attach a small molecule drug specifically to the carboxy-terminus of a recombinant protein. By combining this reaction with the unique phase behavior of elastin-like polypeptides, we developed a protocol that produces homogenously-labeled protein-small molecule conjugates using only centrifugation. The same reaction can be used to produce unmodified therapeutic proteins simply by substituting a single reactant. The isolated proteins or protein-small molecule conjugates do not have any exogenous purification tags, eliminating the potential influence of these tags on bioactivity. Because both unmodified and modified proteins are produced by a general process that is the same for any protein of interest and does not require any chromatography, the time, effort, and cost associated with protein purification and modification is greatly reduced.

We also developed an innovative and unique method that attaches a tunable number of drug molecules to any recombinant protein of interest in a site-specific manner. Although the ability of sortase A to carry out native peptide ligation is widely used, we demonstrated that Sortase A is also capable of attaching small molecules to proteins through an isopeptide bond at lysine side chains within a unique amino acid sequence. This reaction —isopeptide ligation— is a new site-specific conjugation method that is orthogonal to all available protein-small conjugation technologies and is the first site-specific conjugation method that attaches the payload to lysine residues. We show that isopeptide ligation can be applied broadly to peptides, proteins, and antibodies using a variety of small molecule cargoes to efficiently generate stable conjugates. We thoroughly assessed the site-selectivity of this reaction using a variety of analytical methods and showed that in many cases the reaction is site-specific for lysines in flexible, disordered regions of the substrate proteins. Finally, we showed that isopeptide ligation can be used to create clinically-relevant antibody-drug conjugates that have potent cytotoxicity towards cancerous cells