Physicians diagnose and excise neoplasms but to perform operations, cure diseases and manage medical problems they depend upon pharmacologists, biochemists, the pharmaceutical industry, and pharmacists. To Olga Zvonareva the Soviet period was a golden age for pharmaceuticals production. In Chapters 1 and 2, she emphases that despite shortages, social justice ideals guided the Soviet pharmaceutical industry. Soviet pharma eschewed the profit motive, avoided the duplication and waste of market economies, and innovated methods of production if not many products. The breakup of the Soviet Union and rejection of communist ideals in 1991 tragically affected pharmaceutical production. Trade links were severed between Russia, which produced pharmaceutical substances, and the Baltic states, Belarus, and Ukraine, which produced finished medicines. Neoliberal ideas led to the privatization of state-owned pharmaceutical companies. Their new owners lacked business expertise and investment. The number and kinds of drugs produced domestically shrank. Foreign drugs flooded the Russian market. In 2009/2010, the Russian Federation Ministry of Trade and Industry lamented that 80 percent of medicines were foreign, with provenance largely from India and China. The ministry's 2020 Project aimed for parity between domestic and foreign drugs by that date, through luring back biochemist and virologist emigres and financial aid to the domestic industry. In Chapters 3 through 6, Zvonareva surveys the results of the 2020 project, particularly in comparison with western pharma, though curiously not vis-a-vis Indian or Chinese pharma. One of the benefits of rebuilding post-Soviet pharma has been the introduction of clinical trials. In contrast to the west, however, where new drugs and placebo controls are tested on healthy individuals, in Russia ethical concerns require that promising new therapies be given to the sick. Project 2020 pushed collaboration between academics and pharmaceutical companies. Envisioned synergies did not fully emerge because academics were not familiar with business methods and businesses considered academics naïve. Nevertheless, innovation has occurred—mainly from private investment. By 2016, amongst twenty top companies—British, American, German, Japanese—accounting for 47 percent of the Russian market, one Russian company, OTC, placed fifth and Farmstandart, though placing nineteenth, outpaced Roche, which derived a quarter of its income from Russia before 1917 (166–67).
Zvonareva's analysis of Russian pharma from 1991 to the present is enlightening. However, her account of Russian pharma's Soviet and pre-Soviet antecedents do not mesh with my findings in archival materials, publications of the period, and for the late Soviet period, my on-site experiences and interviews with Soviet citizens. Soviet pharma was never self-sufficient. In the 1920s and 1930s, Soviet pharmaceutical factories imported large quantities of pharmaceutical substances from the west and pharmaceutical/medical apparatus from Germany. American lend lease aided in World War II; Hungary was a major supplier of medicines after the war. Central planning and social justice visions of Soviet pharmaceutical executives—like Onisim Magidson—did not result in adequate supply, distribution, and quality. A profit motive reared when factories on khozraschet produced and unloaded cheap products on local purchasing entities. Red Streptotsid was used as hair dye. In 1963, antibiotics were scarce, as were soap, disinfectants, detergents, and anesthesia through 1991. Feminine hygiene products were non-existent. Public toilets were filthy. Citizens begged me for aspirin, asthma medication, and insulin. If these negatives did not cause large-scale mortality, they did make life difficult. Soviet colleagues were compensated with medicinal botanicals they cultivated and acquired, thus preserving time-honored phytotherapy.
Zvonareva misstates my depiction of late imperial pharma. It was not primitive. Approximately 300 chemical factories, including 100 pharmaceutical factories, some large, operated throughout the empire (Khimicheskoe delo v Rossii, Odessa, 1913) supplying urbanites with soap, disinfectants, cough syrups, Vaseline, salicylic acid, and therapies of the time. Some zemstvos sourced predominantly or entirely domestically. Institutes produced vaccines against diphtheria, smallpox, scarlet fever, and rabies. The 1918 American Dispensatory recommended A. V. Pel's Spermine; Russian licorice was important to American pharma; Santonin was vital to the American hog industry. Zvonareva noted that Russian factories did not synthesize aspirin, Novocaine, phenacetin, or Salvarsan, but she ignored the reasons: Swiss and German firms held patents, low customs duties made it economical to import, the Medical Council of the MVD was slow to approve new medicines, and medicinal botanicals abounded. For context, the Swiss army derived vitamin C from rose hips until Roche synthesized the vitamin in the 1930s. During World War I, Russia produced synthetics and sourced iodine and opiates domestically, despite active ingredients too low for the Pharmacopoeia. Ferrein, Keler, and other imperial firms continued as major Soviet factories.
Ironically, these flaws validate the book's thesis: political systems influence pharma. Imperial pharma might have been more competitive had the government been less paternalistic. Had Bolshevik nationalization and sequestration not ruined imperial pharma, Civil War mortality would have been lower. With brilliant scientists throughout Russian history, had the Soviet experiment not intervened, Russian pharma might be world-class today.
