How a Drug Becomes a Pill

And you thought the cable guy was slow. Tufts Center for the Study of Drug Development researchers say it takes about 10 to 15 years and $800 million for a drug to go from bright idea to pharmacy shelves. Industry critics such as Public Citizen call that figure inflated, saying that drug companies include massive marketing costs and that the real cost is closer to $100 million. Still, just one in 1,000 compounds graduates from the lab to a human clinical trial. It would be nice to know how a drug performs along the way, but drug companies aren’t required to publish study results (so they often “forget” to announce poor outcomes). Medical journals and the American Medical Association are now demanding that pharma tell all in a registry of trials and results. Here’s how a little pill goes to market.

STEP 1

Preclinical Testing
Old style: Researchers whip up a zillion compounds and stay up all night throwing them at HIV in test tubes, petri dishes and lab animals to see what sticks. New style: They use high-tech computerized models to “design” drugs to hit the virus. This stage includes in vitro studies (compounds are studied in human or animal cells and tissues) and in vivo studies (testing in living animals).
Takes: 3 to 4 years
Ticker: About 5 in 5,000 survive

STEP 2

Investigational New Drug Application (IND)
The Food and Drug Administration (FDA) has 30 days to nix an IND (rejection is rare if the paperwork is complete). An IND allows researchers to start clinical trials.Takes:Investigational New Drug Application (IND)The Food and Drug Administration (FDA) has 30 days to nix an IND (rejection is rare if the paperwork is complete). An IND allows researchers to start clinical trials.
Takes: Up to 1 month
Ticker: Just about all of the 5 left standing after Step 1 Up to 1 month

STEP 3

Phase I Trial
The first of three clinical-trial stages (only humans need apply) tests safety, not effectiveness. A med’s sponsor (drug company, academic group or federal agency) might pay healthy college kids to sit in a room and take a drug, then watches for rashes, pains or other toxic effects that would torpedo the drug. Healthy subjects are used (except when late-stage patients desperately need a med, say, for cancer or AIDS)—it’s easier to see that any symptoms they develop are from the drug, not a disease.
Takes: About 1 year
Ticker: 3 or 4 of the original 5,000

STEP 4

Phase II Trial
This phase determines safe dosage (enough to work but not enough to turn your hair green) and involves small numbers of people with the condition targeted by the drug. Testers begin looking at whether it works, too.
Takes: About 2 years
Ticker: 2 or 3 of the 5,000 starters

STEP 5

Phase III Trial
To test the drug’s effectiveness, hundreds or thousands of patients with the targeted condition take it. Most of these studies are controlled: Some people get the drug while others get a placebo (sugar pill) or a treatment already known to work.
Takes: About 3 years
Ticker: 1 of the original 5,000

STEP 6

Approval (or Not…)
Once the sponsor thinks it has proved a drug safe and effective, it submits a New Drug Application (NDA). This can run thousands of pages and includes animal and human test results. It details the compounds that make up the drug, how it’s manufactured and metabolized and samples of how it will be labeled. For HIV meds, the FDA accepts surrogate markers—measures of health improvement such as CD4 count and viral load—to indicate a drug’s success, rather than making pharma prove increased lifespan. That would take, well, a lifetime.
Takes: As little as 6 months—but averages about 21/2 years
Ticker: The 1 left standing after III

STEP 7

Marketing and Phase IV
Once a drug is approved, the ads and scrips roll out, but technically, the trials aren’t over. In Phase IV post-surveillance marketing, the sponsor should monitor patients for side effects detectable only in very large populations and in the long run: If there’s a rare side effect that afflicts one in 10,000 people, you won’t see it until 10,000 people are taking the drug. All HIVers who take a new med are part of this phase, so squeak up to Doc about sfx.