Intent and coincidence in pharmaceutical discovery. The impact of biotechnology

Drug research developed around a purpose: the cure of diseases. This intent to cure, however, offered no clue to the understanding of diseases and to their treatment. Instead such guidance had to come from scientific disciplines which laid the foundations for drug research and offered specific opportunities for the solution of therapeutic problems. In the sequence of their appearance, these scientific disciplines were: chemistry, pharmacology/physiology, microbiology, biochemistry and molecular biology. It can be shown that new therapeutic classes of drugs like muscle relaxants, diuretics, L-dopa, antibiotics, recombinant proteins, monoclonal antibodies and others were generated on the basis of scientific opportunities rather than therapeutic need. All of these drugs were created within the confines of a chemical paradigm of medicine and drug therapy. We are now witnessing the entry of a new informational paradigm into medicine which is most prominently represented by genomic sciences. This paradigm will bring two important changes to the therapy of diseases. First, molecular biology has matured to such a degree that it can now study complex genomes and their functionality in complex organisms such as humans. Therefore, results from these studies no longer have to be translated into the context of medicine: they are already within this context. Secondly, drug therapy which used to be largely symptomatic, will now aim at targets which are closer to the causes of diseases than previously. Therapeutic progress, which used to be indirect, conjectural and coincidental, is about to become more directed, definitive and intentional. At least from the limited and utilitarian perspective of medicine, drug discovery will be more often based on intent rather than coincidence. But industry and, for that matter, society as a whole should not forget that this situation has come about through the evolution of science which was not, and can never be, predictable.