Abstract Although developing a new drug produced with bio-technologies is a time-consuming and costly process, the patent of such kind of new products can only be protected for only few years. Therefore, the launch for new drug can not be made without thorough consideration of the market and its environment. Introducing a new medicament to the market needs considering various factors, such as its efficiency, side-effects, and safety. The introduction requires also the approval from relevant government authorities. The sales of a new drug depend on the purchase from hospitals, the prescription from doctors and the utilization from patients to complete the process. If one of these three elements is missing, the whole process will be broken up. Therefore, it is helpful to take the sales process and its model as a reference to define the strategy for launching a new drug to the local market. The model to introducing a new drug includes two sides of analysis ¡V external and internal analysis. The external analysis covers mainly areas such as studies of customers, market and competitors, it includes as well issues concerning regulatory and geography area division. The internal analysis is with focus on studies regarding efficiency, strategy alternatives, products and relevant technologies. Only after the analysis as such, the key factors for a successful marketing can be identified. Taking lessons learnt from products, the strategy can be defined accordingly and implemented. Today although the market for antidepressants is well developed, there are areas which remain unsatisfied by doctors and patients, inter alia, its low response and remission rate, the difficulty of a total recovery, and the high probability of relapse. Any new antidepressants, should it wish being the leading medicament in the market, the satisfaction from both users ¡V the medical doctors and the patients ¡V is a must. Secondly, the product must be introduced through all kind of relevant channels to reach out to actual and potential users (not necessarily those working in the hospitals and clinics). Last but not least, the society should remove any stigma on people suffering from depression and encourage them (and their relatives) to go for the treatment and complete the treatment for their own and the society¡¦s well-being. Finally, new drug launch model is a useful tool for developing marketing strategy. Market of antidepressant is a mature market. Nevertheless doctors and patients remain unsatisfied vis a vis certain aspects of the antidepressant. Any new antidepressant if it can meet the requirement, it certain has chance to enter niche market. Key word: new drug launch model, competitive benchmarking, strategy, depression, antidepressant

none

no / The role of mutations in genes associated with phenotypic resistance to bedaquiline (BDQ) and delamanid (DLM) in Mycobacterium tuberculosis complex (MTBc) strains is poorly characterized. A clear understanding of the genetic variants' role is crucial to guide the development of molecular-based drug susceptibility testing (DST). In this work, we analyzed all mutations in candidate genomic regions associated with BDQ- and DLM-resistant phenotypes using a whole-genome sequencing (WGS) data set from a collection of 4,795 MTBc clinical isolates from six countries with a high burden of tuberculosis (TB). From WGS analysis, we identified 61 and 163 unique mutations in genomic regions potentially involved in BDQ- and DLM-resistant phenotypes, respectively. Importantly, all strains were isolated from patients who likely have never been exposed to these medicines. To characterize the role of mutations, we calculated the free energy variation upon mutations in the available protein structures of Ddn (DLM), Fgd1 (DLM), and Rv0678 (BDQ) and performed MIC assays on a subset of MTBc strains carrying mutations to assess their phenotypic effect. The combination of structural and phenotypic data allowed for cataloguing the mutations clearly associated with resistance to BDQ (n = 4) and DLM (n = 35), only two of which were previously described, as well as about a hundred genetic variants without any correlation with resistance. Significantly, these results show that both BDQ and DLM resistance-related mutations are diverse and distributed across the entire region of each gene target, which is of critical importance for the development of comprehensive molecular diagnostic tools.

Contract Research Organization (CRO) industry has been a fast growingservice sector within the pharmaceutical and biotechnology industry since the early 1980’s. Aiming at assisting its clients in obtaining product registration and market approval from the health authorities (i.e. Food and Drug Administration of the US and Department of Health of Taiwan), CRO’s provide extensive consultations as well as clinical research and management services, covering both pre-clinical and clinical arenas. In recent years, global CRO’s have been expanding towards the Southeastern Asian (thereafter “SEA”) region targeting, Singapore, Taiwan, Hong Kong, China, and South Korea. While most of the empirical research on market entry mode has targeted the manufacturing industries, more recent studies have been completed on service sectors targeting advertising and financing industries. Since the history of CRO is relatively short, limited study has been performed on this industry, especially on the international entry patterns and behaviors for the CRO industry. This research document examines the current environments of CRO industry in Taiwan and Singapore and the factors influencing international company’s decisions on the entry mode. A recommendation of the best options to enter Taiwan and Singapore for the international CRO’s is presented. The paper concludes with findings as well as recommendations for further investigation directions.

Globalization in clinical research and development has increased since the 1990s. Products approved in the United States (U.S.) and European Union (EU) include increasing numbers of research participants from low- and middle-income countries. The purposes of this quantitative correlational study were to investigate the lag time, or drug lag, between U.S. approval and the approval of selected drugs in all countries that hosted their pivotal clinical trials. The study population was limited to products approved first in the U.S. between 2006 and 2015. The health capability model and research for health justice framework were the theoretical frameworks for the study. Data were collected from public reports and websites of the U.S. Food and Drug Administration (FDA), European Medicines Agency, National Institutes of Health, local ministries of health, National Association of Securities Dealers Automated Quotations, New York Stock Exchange, the World Bank, and a subscription-based report from Springer Publications. Data were analyzed descriptively, with inferential statistics performed via Wilcoxon and chi-square tests. Independent variables were FDA approval year, drug indication, FDA review type, orphan indication, host country World Bank income category, sponsor market capitalization, and sponsor headquarters country. The dependent variable was drug lag, in months. The U.S. to EU drug lag was significantly shorter than U.S. to last host country drug lag. Lower host country income was also associated with longer drug lag. Reducing drug lag may create justice for research participants, improve health outcomes, and yield positive social changes.

八零年代起，我國政府即對生技新藥產業寄予厚望，為促使生技醫藥產業成為明星產業，行政院也自1982年起，將生物技術列為國內八大重點科技產業之一，並投入相當大的金額補助產業之發展；至今已歷經35年，卻仍僅極少由台灣本土研發之新藥成功上市。 本研究主要採用文獻探討以及個案訪談作為主要的研究方法，先藉由文獻探討建立起論文整體之架構，之後再透過兩間國內本土新藥研發公司的訪談加以實證。本研究探討衛生福利部中央健康保險署現行之藥價政策對於國內本土研發新藥上市策略之影響，以及《全民健康保險藥物給付項目及支付標準》第17-1條實施後，是否有助於國內本土研發新藥上市的問題，進行深入分析與探討。而可得到以下初步之研究結論： 一、我國政府的鼓勵措施對於台灣的新藥發展之影響 我國政府多以科技專案補助臨床試驗的形式協助國產新藥公司研發新藥。 二、比較在台灣及其他國家研發新藥的鼓勵措施 我國與日本政府皆有提供新藥不同形式之新藥相關加成給付；本研究未發現韓國政府有針對新藥提供相關加成給付措施。 三、台灣健保藥價制度與台灣研發的新藥藥價 1.對新藥開發類型之國產新藥公司而言，期望政府在設定參考藥品之藥價時，可以選擇使用參考藥品之初始藥價作為reference price。 2.對新藥開發類型之國產新藥公司而言，期望在選擇參考藥品時，可以鼓勵創新藥理作用之新藥、跳脫侷限治療相同疾病用藥之思維。 3. 對新藥開發類型之國產新藥公司而言，全民健康保險藥物給付項目及支付標準第17-1條規範參考類似藥品之十國藥價不合理，因為若以台灣為第一上市國，則尚未在其他國家取得藥價，此法規自相矛盾。 四、我國藥品政策與台灣研發新藥上市策略 對新藥開發類型之國產新藥公司而言，健保給付國產新藥之藥價無法符合國產新藥公司期望之藥價，國產新藥公司改採取由病患自費購買藥品的方式銷售。 / Since the 1980s, our government has placed great hopes toward the industry of biotech and new drugs in order to take such industry to a booming stage. The Executive Yuan has also listed biotechnology as one of the eight key technological industries in the country since 1982. Furthermore, large amounts of subsidies have aided the development of this industry. This industry has been in development for 35 years, however, very few new drugs developed by domestic pharmaceutical companies have been launched successfully in Taiwan. This study mainly used literature review and case interview as the main research methods. Firstly, the structural development of the thesis was built on reviewing past literature. Then, the empirical study was conducted through interviews with two domestic new drug research and development pharmaceutical companies. This study examined the impact of the current drug pricing policy of the National Health Insurance Administration on the domestic market for research and development of new drugs. Moreover, the effectiveness of implementation of Article 17-1 of the "National Health Insurance Drug Payment Program and Payment Standards" was investigated in relations to the development of domestic new drugs in the country. In-depth analysis was employed to explore and discuss our research. The following preliminary conclusions were obtained: First, the influence of the government's encouragement measures on the development of Taiwan's new drugs was examined. Results revealed that the government have mainly been funding domestic new drug companies to research and develop new drugs through subsidized clinical trials of technological projects. Second, the encouragement measures for developing new drugs in Taiwan and other countries were compared. Results showed that both Taiwan and the Japanese government have been providing new forms of new-drug-related premiums for new drugs. However, in this study, we did not find the Korean government providing relevant premiums measures for new drugs. Third, we explored the drug price system of Taiwan's national health insurance and the prices of new drugs that were developed domestically. We found that 1) for domestic pharmaceutical companies that specializes in developing new drugs, they anticipate the government to use the initial drug prices of the reference drugs as reference prices when setting the prices of reference drugs; 2) for domestic pharmaceutical companies that specializes in developing new drugs, they anticipate the government to encourage innovations of new drugs leading to new pharmacological effects and overcoming the idea of limiting treatment to the same illness or conditions when they are selecting reference drugs; 3) for domestic pharmaceutical companies that specializes in developing new drugs, under Article 17-1 of the "National Health Insurance Drug Payment Program and Payment Standards", the statement that drug prices should be referenced from ten countries is unresonalbe because prices cannot be obtained from other countries if Taiwan is the first country to launch the new drug. Thus, the regulation is contradictory in itself. Fourth, we examined Taiwan’s pharmaceutical policy and the marketing strategy of new drugs developed domestically. Findings showed that for domestic drug companies that specializes in developing new drugs, when the drug payment provided by the national health insurance does not meet the drug prices set by the new drug companies, these companies employ a strategy that the patient pay for the drugs instead of the national insurance system.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第12801号 / 論医博第2073号 / 新制||医||1001(附属図書館) / 80845 / 京都大学大学院薬学研究科創薬科学専攻 / (主査)教授 川上 浩司, 教授 松原 和夫, 教授 今中 雄一 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

A medicina clínica apresentou a partir dos anos 1960 uma certa inflexão em seus mecanismos internos de produzir conhecimento, assim como em sua forma de aplicar esses conhecimentos na prática. A principal diferença em relação ao passado foi que, a partir dessa época, os problemas de natureza clínica, como diagnóstico diferencial, terapêutica e estimativa de prognóstico, passaram a ser processados predominantemente por instrumentos de análise padronizados e, principalmente, submetidos ao escrutínio de uma razão empírico-matemática. A entidade paciente deixou de ser um ente emissor de sintomas e sinais que são processados por um médico, para ser uma nova entidade em que esses signos, previamente estabelecidos e validados pelos estudos clínicos e pela razão matemática, são encaixados pelos médicos nas manifestações dos pacientes. Na mesma época em que esse processo ocorreu o mundo ocidental vivia um período de crise que se caracterizava por um baixo crescimento econômico e por um questionamento por parte da sociedade dos princípios normativos, tanto éticos quanto morais, que regiam sua forma de viver. Nos Estados Unidos, a partir de 1962 passou a ser uma exigência legal que toda droga nova, antes de ser comercializada, deveria provar, através de testes científicos, que ela tinha eficácia terapêutica, que de fato funcionava na patologia que se propunha tratar. A metodologia para promover esse tipo de demonstração foi construída a partir dessa exigência. As regras de prova científica de eficácia foram construídas a partir dessa demanda legal, e são chamadas genericamente de Epidemiologia Clínica. Vários agentes participaram ativamente do processo de definição das regras do método científico que foram então, a partir dessa data, implementadas e sedimentadas. Destacam-se nesse debate, a comunidade acadêmica, a sociedade civil, os economistas, os advogados e juizes, os agentes do governo, e, finalmente, a indústria farmacêutica. Essa última assumiu uma posição de destaque, secretariando, e, de certa forma impondo uma agenda de discussão. O motivo por detrás dessa atitude foi uma profunda crise de legitimidade das regras de operação do negócio farmacêutico em dois de seus principais componentes: os desenvolvimentos tecnológicos, responsáveis pelas inovações na área terapêutica, e, a garantia de um mercado historicamente monopolístico, legitimada pela instituição secular da lei de patentes. Ambos esses institutos passaram, nas décadas de 1960 e 1970, por um conturbado processo de rediscussão de seus fundamentos. Defende-se que essa função de secretariar a discussão por parte da indústria farmacêutica teve um papel de destaque na construção das regras de cientificidade que passaram, desde então, a regular o ato médico. A implementação, aceitação e sedimentação como princípio normativo de prova de verdade dessa metodologia científica, sobretudo na comunidade médica, ocorreu de uma forma muito particular. Discute-se nesse trabalho a história dessa implementação sob duas perspectivas: a história oficial conforme descrita pelo Departamento de História do Food and Drug Administration (FDA, Agência Federal Norte-americana), e, alternativamente, através de uma análise dos discursos proferidos por personagens que direta e efetivamente participaram dessa discussão. Médicos, farmacologistas, advogados, legisladores, economistas, profissionais da indústria farmacêutica e agentes do governo emitiram e discutiram opiniões, e estas foram registradas e publicadas. Esse material compõe a matéria prima em cima da qual trabalha-se no sentido de compor uma história que acaba por ter alguns pontos diferenciais em relação à versão oficial. Em torno desses pontos procura-se produzir um discurso sobre a relação entre ciência, lei, economia, e, prática médica. A dimensão científica dessa história se mistura intensamente com outros aspectos igualmente importantes como: debates legislativos, interesses econômicos de segmentos privados, papel do Estado na regulação econômica, confiabilidade na neutralidade das publicações científicas, participação do mundo acadêmico no desenvolvimento tecnológico de um país, etc.. Defendese que a fusão desses discursos em um formato consensual construiu uma situação em que a referida dimensão técnico-científica passou a ter uma importância relativamente maior do que as outras como instrumento de legitimação da verdade em medicina na sociedade, e que esse fato teve algumas importantes conseqüências práticas, destacando-se: um processo progressivo de desumanização do atendimento médico e a produção de um sistema de barreiras que dificultam o exercício de uma critica eficiente e positiva por parte dos profissionais ligados à pratica médica. Por último, em torno do conceito de humanismo, abordado particularmente dentro da tradição filosófica ocidental, discute-se o quanto essa hipertrofia da dimensão técnica e suas conseqüências práticas, podem ser questionadas em seus fundamentos epistemológicos visando a reconstrução de uma prática médica mais humana e emancipadora. / Since 1960 Clinical Medicine suffered a kind of inflection in its internal mechanisms of producing theoretical knowledge, as well as in the way that this knowledge is applied in practical life. The most important difference in relation to the past was that problems of clinical nature like, differential diagnosis, therapeutical decisions, and prognosis estimation, started to be predominantly processed by standardized analytical instruments, and most important, they were always previously submitted to an empirical-mathematical reasoning. Individual patients were no longer a being that reported signs and symptoms that were processed by a physician, they started to be a new entity in which these signs, previously established and validated by clinical studies have to be necessarily engrafted by the physicians in patients manifestations. At the same time that this process occurred, western world was living an important critical period, characterized by a very slow economic growth, and by a reevaluation of its ethical and moral values. After 1962, in the United States, it became obligatory to prove, through empirical scientific evidence that a new drug was effective, before marketing and sales authorization was issued to a company who wanted to launch the drug. The scientific method designed to prove efficacy of a drug was actually developed after this legal demand. This method is called generically Clinical Epidemiology. Several actors participated in the discussion of the rules of this method. Medical Schools, government representatives, pharmaceutical industry can be cited; the latter played a very special role, since it acted as a secretary of the whole process. The reason behind this was that, at those times, the two major pillars of the pharmaceutical business, innovation capacity and patent law, were being severely criticized, and proposals for changing the way this things were being conducted in American society were about to become a reality. We defend the position that the attitude of the pharmaceutical business representatives, were crucial for the establishment of the scientific rules that were considered consensual, and that these rules, for many reasons, started to be the paradigm of medical reasoning and individual decision in medical problems. Implementation, acceptance, and maintenance of this new clinical scientific method that was born after the legal demand for prove of efficacy of a new drug, particularly in medical community, occurred in a very particular way. We discuss the history of this process under two separate perspectives: the official history, as described by History Department of the Food and Drug Administration, and alternatively, through an analysis of the speeches of persons who actually participated directly in this discussion. Physicians, pharmacologists, lawyers, legislators, economists, pharmaceutical industry representatives, government members and politicians, all these groups, emitted their opinions and these were registered and published. This is the row material that was used to composite a new story of the whole process, and the result of this work is somehow different from the official history reported before. The scientific dimension of this story is mixed up with other important aspects like: legislative debates, private economical interests, the role of the State in regulating the economy, academic participation in decisions related to economic growth of a country, etcWe try to prove that the intersection of all these interests in a consensual framework built up a situation in which the previously referred technical-scientific dimension started to have a relatively bigger importance in relation to the other aspects as an instrument to legitimate what is truth (or what is false) in clinical medicine, to the whole body of the society. This fact brought two important practical consequences: a progressive reduction in other human aspects of clinical medicine apart from technology, and, the development of a system of barriers that jeopardize the possibility of a critical attitude towards the scientific method from those who practice medicine. Around the concept of humanism, studied particularly inside western philosophical tradition, we discuss how much this so called hypertrophy of the technical-scientific dimension and its practical consequences can be scrutinized and questioned in its epistemological foundations in order to rebuild a new medicine more human and critical.

This thesis assesses the current status of Canadian prescription drug regulation and the policy drivers that guide this process. This analysis is accomplished by first providing a general survey of the steps, law, and institutional players involved in the full life-cycle of a drug. Next the evolution of current clinical trials and the gaps that the present legal regime creates in the scientific standards employed in clinical research is reviewed. This is followed by a discussion of how commercialization (innovation) and speed of approval (market access) are slowly becoming the dominant policy drivers for the Canadian regime. Finally a discussion of the proposed Progressive Licensing model, and Bill C-51-An Act to Amend the Food and Drug Act, raises the concerns with a shift to a system largely based on risk assessment and post-market monitoring (pharmacovigilence).

A medicina clínica apresentou a partir dos anos 1960 uma certa inflexão em seus mecanismos internos de produzir conhecimento, assim como em sua forma de aplicar esses conhecimentos na prática. A principal diferença em relação ao passado foi que, a partir dessa época, os problemas de natureza clínica, como diagnóstico diferencial, terapêutica e estimativa de prognóstico, passaram a ser processados predominantemente por instrumentos de análise padronizados e, principalmente, submetidos ao escrutínio de uma razão empírico-matemática. A entidade paciente deixou de ser um ente emissor de sintomas e sinais que são processados por um médico, para ser uma nova entidade em que esses signos, previamente estabelecidos e validados pelos estudos clínicos e pela razão matemática, são encaixados pelos médicos nas manifestações dos pacientes. Na mesma época em que esse processo ocorreu o mundo ocidental vivia um período de crise que se caracterizava por um baixo crescimento econômico e por um questionamento por parte da sociedade dos princípios normativos, tanto éticos quanto morais, que regiam sua forma de viver. Nos Estados Unidos, a partir de 1962 passou a ser uma exigência legal que toda droga nova, antes de ser comercializada, deveria provar, através de testes científicos, que ela tinha eficácia terapêutica, que de fato funcionava na patologia que se propunha tratar. A metodologia para promover esse tipo de demonstração foi construída a partir dessa exigência. As regras de prova científica de eficácia foram construídas a partir dessa demanda legal, e são chamadas genericamente de Epidemiologia Clínica. Vários agentes participaram ativamente do processo de definição das regras do método científico que foram então, a partir dessa data, implementadas e sedimentadas. Destacam-se nesse debate, a comunidade acadêmica, a sociedade civil, os economistas, os advogados e juizes, os agentes do governo, e, finalmente, a indústria farmacêutica. Essa última assumiu uma posição de destaque, secretariando, e, de certa forma impondo uma agenda de discussão. O motivo por detrás dessa atitude foi uma profunda crise de legitimidade das regras de operação do negócio farmacêutico em dois de seus principais componentes: os desenvolvimentos tecnológicos, responsáveis pelas inovações na área terapêutica, e, a garantia de um mercado historicamente monopolístico, legitimada pela instituição secular da lei de patentes. Ambos esses institutos passaram, nas décadas de 1960 e 1970, por um conturbado processo de rediscussão de seus fundamentos. Defende-se que essa função de secretariar a discussão por parte da indústria farmacêutica teve um papel de destaque na construção das regras de cientificidade que passaram, desde então, a regular o ato médico. A implementação, aceitação e sedimentação como princípio normativo de prova de verdade dessa metodologia científica, sobretudo na comunidade médica, ocorreu de uma forma muito particular. Discute-se nesse trabalho a história dessa implementação sob duas perspectivas: a história oficial conforme descrita pelo Departamento de História do Food and Drug Administration (FDA, Agência Federal Norte-americana), e, alternativamente, através de uma análise dos discursos proferidos por personagens que direta e efetivamente participaram dessa discussão. Médicos, farmacologistas, advogados, legisladores, economistas, profissionais da indústria farmacêutica e agentes do governo emitiram e discutiram opiniões, e estas foram registradas e publicadas. Esse material compõe a matéria prima em cima da qual trabalha-se no sentido de compor uma história que acaba por ter alguns pontos diferenciais em relação à versão oficial. Em torno desses pontos procura-se produzir um discurso sobre a relação entre ciência, lei, economia, e, prática médica. A dimensão científica dessa história se mistura intensamente com outros aspectos igualmente importantes como: debates legislativos, interesses econômicos de segmentos privados, papel do Estado na regulação econômica, confiabilidade na neutralidade das publicações científicas, participação do mundo acadêmico no desenvolvimento tecnológico de um país, etc.. Defendese que a fusão desses discursos em um formato consensual construiu uma situação em que a referida dimensão técnico-científica passou a ter uma importância relativamente maior do que as outras como instrumento de legitimação da verdade em medicina na sociedade, e que esse fato teve algumas importantes conseqüências práticas, destacando-se: um processo progressivo de desumanização do atendimento médico e a produção de um sistema de barreiras que dificultam o exercício de uma critica eficiente e positiva por parte dos profissionais ligados à pratica médica. Por último, em torno do conceito de humanismo, abordado particularmente dentro da tradição filosófica ocidental, discute-se o quanto essa hipertrofia da dimensão técnica e suas conseqüências práticas, podem ser questionadas em seus fundamentos epistemológicos visando a reconstrução de uma prática médica mais humana e emancipadora. / Since 1960 Clinical Medicine suffered a kind of inflection in its internal mechanisms of producing theoretical knowledge, as well as in the way that this knowledge is applied in practical life. The most important difference in relation to the past was that problems of clinical nature like, differential diagnosis, therapeutical decisions, and prognosis estimation, started to be predominantly processed by standardized analytical instruments, and most important, they were always previously submitted to an empirical-mathematical reasoning. Individual patients were no longer a being that reported signs and symptoms that were processed by a physician, they started to be a new entity in which these signs, previously established and validated by clinical studies have to be necessarily engrafted by the physicians in patients manifestations. At the same time that this process occurred, western world was living an important critical period, characterized by a very slow economic growth, and by a reevaluation of its ethical and moral values. After 1962, in the United States, it became obligatory to prove, through empirical scientific evidence that a new drug was effective, before marketing and sales authorization was issued to a company who wanted to launch the drug. The scientific method designed to prove efficacy of a drug was actually developed after this legal demand. This method is called generically Clinical Epidemiology. Several actors participated in the discussion of the rules of this method. Medical Schools, government representatives, pharmaceutical industry can be cited; the latter played a very special role, since it acted as a secretary of the whole process. The reason behind this was that, at those times, the two major pillars of the pharmaceutical business, innovation capacity and patent law, were being severely criticized, and proposals for changing the way this things were being conducted in American society were about to become a reality. We defend the position that the attitude of the pharmaceutical business representatives, were crucial for the establishment of the scientific rules that were considered consensual, and that these rules, for many reasons, started to be the paradigm of medical reasoning and individual decision in medical problems. Implementation, acceptance, and maintenance of this new clinical scientific method that was born after the legal demand for prove of efficacy of a new drug, particularly in medical community, occurred in a very particular way. We discuss the history of this process under two separate perspectives: the official history, as described by History Department of the Food and Drug Administration, and alternatively, through an analysis of the speeches of persons who actually participated directly in this discussion. Physicians, pharmacologists, lawyers, legislators, economists, pharmaceutical industry representatives, government members and politicians, all these groups, emitted their opinions and these were registered and published. This is the row material that was used to composite a new story of the whole process, and the result of this work is somehow different from the official history reported before. The scientific dimension of this story is mixed up with other important aspects like: legislative debates, private economical interests, the role of the State in regulating the economy, academic participation in decisions related to economic growth of a country, etcWe try to prove that the intersection of all these interests in a consensual framework built up a situation in which the previously referred technical-scientific dimension started to have a relatively bigger importance in relation to the other aspects as an instrument to legitimate what is truth (or what is false) in clinical medicine, to the whole body of the society. This fact brought two important practical consequences: a progressive reduction in other human aspects of clinical medicine apart from technology, and, the development of a system of barriers that jeopardize the possibility of a critical attitude towards the scientific method from those who practice medicine. Around the concept of humanism, studied particularly inside western philosophical tradition, we discuss how much this so called hypertrophy of the technical-scientific dimension and its practical consequences can be scrutinized and questioned in its epistemological foundations in order to rebuild a new medicine more human and critical.