Abstract

WHY SO FEW NOBEL LAUREATES IN PHARMACY?

While chatting casually with a young teacher who shares my office in Amrita Vishwavidyalaya, he asked me why very few have ever won a Nobel Prize in pharmacy or drug discovery. A curious question indeed!

Why, even Paul Janssen didn’t make it to the Nobel list, despite having directly or indirectly contributed to introducing about 80 medicines, of which as many as four figure in the WHO list of essential medicines. 

It is indeed true that only a few have won Nobel prizes for contributions to xenobiotic remedies with a pharmaceutical flavour.  Paul Ehrlich, Domagk, Alexander Fleming, James Black, Hitchings, Gertrude Elion, Salman Waksman, Tu You You, Satoshi Omura and William Campbell are among the few names that immediately come to my mind. There may be more, but not many more.  If Yellapragada Subbarow did win the Nobel prize, which he didn’t, it would not have been for methotrexate or tetracycline, which he helped identify. It would have been, perhaps, for discovering ATP, the energy currency of the living world. Alas, Subbarow was dead nearly 20 years before ATP became the subject of a Nobel Prize! Remember, Nobel Prizes are never awarded posthumously. Julius Axelrod did give us paracetamol, but he won the Nobel Prize for something else: catecholamine reuptake. We cannot attribute Axelrod’s Nobel Prize directly to drug discovery, but to unravelling the catecholamine reuptake mechanism, which did result in many drugs, including blockbuster SSRIs. There are dozens of Nobelists who have discovered vitamins, vaccines and hormones, but they are not xenobiotics that strictly fall under category of pharmaceuticals. Banting and Best did not contribute anything to pharmacy, although, the pharmaceutical industry did make plenty of money selling insulin. 

 Nobel prizes in Physiology or Medicine have been awarded 115 times since inception. Because many Nobel prizes are shared by two or three persons, there are 229 Nobel laureates in physiology or medicine between 1901 and 2024.

Ofthe 229 awardees who shared 115 prizes, only about 10 contributed directly todrug discovery and pharmaceutical innovation. Nobel prizes are ambitious; they go to those who unravel the veryfundamental mysteries in medicine. If the knowledge of medicine can be comparedto a tree, the Nobelists help us understand its trunk, and major branches.Little twigs that sprout from the main body do not win adequate attention; theydon’t change the direction of cure, they say.

Andyet, paradoxically enough, medicines that heal constitute the most visible partof the tree of healthcare. If Molecular biology, biochemistry, pathology andphysiology are the trunk and the big branches, medicine is the fruit.

Andfamously, the tree is known by its fruit! No wonder ‘healthcare’ is synonymouswith 'medicine.' It is also a fact that the fruit fetches the bulk of theprofit from the tree.  No wonder thepharmaceutical industries were on top of the fortune 500 companies until thedigital revolution displaced them over a few decades.

Having lost their position on top, thepharmaceutical industry has been moving closer to money and away from science per se. It is not unusual to find thesales team dictating the research agenda to the core team of scientists workingin pharmaceutical innovation. The emphasis is more on what sells, not what heals.  I think the world will continue to chasemoney and profit, but the Nobel Foundation is not likely to be impressed. Xenobioticremedies seem to matter less to the Nobel Foundation than the core science thatled to their discovery. I don’t think someoneworking on Novel Drug Delivery can ever hope to win a Nobel prize. Pharmacywill continue to remain a peripheral player in the knowledge enterprise.