The Battle Between David and Goliath

Abstract

The historically embedded tradition of magistral medicines in the Netherlands provides new compounding opportunities for twenty-first-century Dutch pharmacists in times of drug shortages and big pharma’s high-priced specialty drugs. At the end of the nineteenth century, industrially manufactured, packaged, and branded medicines increasingly replaced the manually made magistral medicines of pharmacists. With the support of doctors and health-insurance funds, though, Dutch pharmacists succeeded in presenting non-branded, compounded drugs as a therapeutically and economically competitive alternative. The international pharmaceutical industry (“Goliath”) did not appreciate the craftsmanship of the Dutch pharmacist (“David”), who could legally disregard drug patents as long as they produced medicine on a one-to-one, magistral prescription basis. From the 1960s onwards, with the introduction of Good Manufacturing Practice laws, there was a rapid decline in the magistral medicine practice in Dutch pharmacies. At first sight, big pharma “Goliath” seemed to have disciplined and defeated the Dutch “David.” But the recent re-emergence of compounding pharmacies suggests that pharmacists, doctors, and insurance companies are again prepared to challenge the economic power of the pharmaceutical industry to improve the accessibility and affordability of medicines. Within the Dutch context this has led to historical continuities in medical market alliances.