Does Brussels need a wake-up call on medicines?

In the week that President Barack Obama announced his bold plans to bring nearly 50 million US citizens into healthcare coverage, and PriceWaterhouseCoopers delivered a clarion-call to the world's pharmaceutical industry to plan ambitiously for a very different world in 2020, the best that Brussels could do was to hold a timid two-day meeting on a limited and parochial agenda of minor changes to its regulatory framework. It was hard to escape the notion that Europe risks losing its way in the big debates on medicines.

The new US administration wants to make healthcare affordable and accessible to all, eradicating at last the depressing spectacle of nearly a quarter of the population being deprived of treatments. It will not be an easy task, but Obama and his team have struck early and struck hard in a bid to remedy a deficiency that has blotted the face of the US for decades.

The same energy and vision is apparent — on a much smaller scale — in the latest PWC report in its Pharma 2020 series: "Marketing the future. Which path will you take?" Deliberately provocative, the report urges profound and strategic shifts in the way that drug firms should plan to survive and prosper in a rapidly-changing context of more specialised therapies and more discriminating customers. One of its key recommendations is for companies to recognise that the traditional view of successful marketing is no longer valid.

The evidence of the failure in current strategies is clear, PWC argues. In 2006, it points out, only five Big Pharma companies earned more than 10% of their revenues from major products launched within the previous five years, and there are no immediate signs of improvement.

Designing a company's product portfolio should no longer depend merely on assessing the intrinsic merits of the candidates in the development pipeline. Companies will have to be much more rigorous in their assessment of what payers, providers and patients regard as innovation if they want to be successful. The customer is becoming king, and no amount of knocking on doctors' doors by industry sales reps is going to dethrone the new decision-makers in health ministries and insurance companies, suggests PWC.

Meanwhile, in Brussels, pharmaceutical industry executives and senior officials were closeted in discussions that — despite the pretentions of the title: "A renewed European strategy for pharmaceuticals in Europe" — were looking inward far more than looking forward. Rather than seeking new approaches and new thinking, the focus was on warding off the worst and on defending the industry against attack.

Much of the attention was devoted to combating counterfeiting and illegal distribution of medicines — important of course, but hardly a determining factor for the future of the industry in Europe. Another of the discussions explored strengthening of the safety monitoring of medicines. And yet another topic was information to the public on prescription medicines — similarly, a nice-to-have rather than a need-to-have factor in the evolution of the sector.

Even the supposedly forward-looking EU plan published last December for "a renewed vision for the pharmaceutical sector" — which was at the top of the meeting's agenda — contains little that suggests strategic grasp. The EU's own description of the plan notes that "Europe has been losing ground in pharmaceutical innovation," and goes on to the timid conclusion that "It is important to slow down or even reverse this trend." The stated objectives suffer from the EU's characteristic institutional obsession. The main aim is "to make further progress towards a single and sustainable market in pharmaceuticals." And it diffidently suggests — but in a strictly non-legislative context — that it might be good to "discuss with member states ways to improve market access" or to "develop initiatives to boost EU pharmaceutical research."

The limited agenda of this meeting is emblematic of a gap at the centre in European thinking on pharmaceuticals. The same introversion and defensiveness and institutional obsession is evident in so much of the discussion that takes place on pharmaceuticals in the EU. The European Parliament is following slavishly the same agenda, as is the EU Council of Ministers. The overwhelming impression is of an industry — and the attendant officials and politicians — sleepwalking into obscurity. Will someone out there please wake the European drug industry up?