At first sight, the pharmaceutical industry seems readily understandable. There is a need for drugs to treat illness. Drug companies collectively provide these treatments. And as time progresses they produce better treatments. This is big business. Take Parkinson’s: the estimated current annual cost of drugs to treat the condition is $4.24 billion in the US alone [1]. Whilst not as lucrative as fields such as cancer, it is nonetheless a reasonable contributor to the balance sheet of the average pharmaceutical company. Couple this with the predicted rise in prevalence as the population ages, and this amounts to a reliable and predictable income stream for the foreseeable future ($5.69 billion in 2022 [1]).

Pharmaceutical companies answer to their shareholders.  They are not philanthropic organisations. Without profit, they don’t exist. But as long as they produce new and/or better treatments, they continue.This is simple business and we, as patients, should not begrudge them reasonable profits. The alternative is the cancellation of research programs and ultimately a reduction in choice for patients. And none of us want that.

The drugs we have currently available for Parkinson’s have one thing in common – they are all symptomatic treatments. They ameliorate symptoms, or attenuate the side-effects of other drugs used to treat Parkinson’s, but do nothing (with the faintly possible exception of rasagiline) to slow the progression of the condition.

Not surprisingly there are, particularly among the patient community, those who feel that a cure for Parkinson’s will not arise – for the simple reason that the pharmaceutical industry has no interest in developing such drugs or approaches. Indeed, many feel that there is a positive disincentive for drug companies to develop a cure. And it’s easy to see how this thinking evolves.

A cure for Parkinson’s, or even a drug that halted progression, would have significant implications for sales of symptomatic treatments. Development of a cure by the pharmaceutical industry would, by this logic, be tantamount to biting the hand that feeds. On that basis, drug companies might be expected to close ranks and implement a policy, implicit or explicit, not to develop disease modifying agents.

Now I’m not saying for one second that such a policy exists. On the whole, I don’t subscribe to conspiracy theories. But the current situation is, it has to be said, convenient for shareholders in the pharmaceutical industry. There is a steady supply of patients and the drug companies can continue to meet that with an equally steady supply of new symptomatic treatments. A cure for Parkinson’s would, in financial terms, be decidedly inconvenient. Although literally life-saving for patients, it could amount to a serious financial knock to those sectors of the industry making only symptomatic treatments. It’s easy to see that companies would be reluctant to invest money in avenues that would potentially cut off their own income streams.

However this position is untenable, being based on the false premise that any cure, were it to come, will emanate from the pharmaceutical industry. For the most part, and bearing in mind the amount of time it takes to develop a new treatment from lab to patient, this has historically been true. Only drug companies have had the resources to conduct such work.

But the old models of drug development through cellular approaches, screens in laboratory animals then healthy volunteers and ultimately patients no longer hold. Drugs are no longer developed through such rigid methods. Increasingly the regulatory agencies are open to other approaches, particularly the repurposing of medications. And the patient voice is growing louder and louder. Patient want cures. The doors are open for academic institutions and the charity sector to engage in drug discovery. And to do this to an agenda driven by patients.

This changes everything. The pharmaceutical industry no longer holds a monopoly on drug discovery. The introduction of other players into the arena changes the rules. And the rules no longer allow for ‘olde worlde’ symptomatic drug treatments. The race is on for a cure. And that cure, whisper it, may not come from pharma.

Think of it as a cake. Instead of a modest Victoria sponge being sliced up among many companies, we have a single fabulous cake, a gigantic Sachertorte, as the prize. And that prize will go to one destination – the institution, charity, university or drug company that develops a cure for Parkinson’s. The pharmaceutical industry has a stark choice – either join the race or lose by default.  After all, shareholders are tough taskmasters but they understand the rules. And the new rules are very simple. Winner takes all.


Winner takes all