Tamoxifen from failed contraceptive pill to best-selling breast cancer medicine: a case-study in pharmaceutical innovation

Today, tamoxifen is one of the world’s best-selling hormonal breast cancer drugs. However, it was not always so. Compound ICI 46,474 (as it was first known) was synthesized in 1962 within a project to develop a contraceptive pill in the pharmaceutical laboratories of ICI (now part of AstraZeneca). Although designed to act as an anti-estrogen, the compound stimulated, rather than suppressed ovulation in women. This, and the fact that it could not be patented in the USA, its largest potential market, meant that ICI nearly stopped the project. It was saved partly because the team’s leader, Arthur Walpole, threatened to resign, and pressed on with another project: to develop tamoxifen as a treatment for breast cancer. Even then, its market appeared small, because at first it was mainly used as a palliative treatment for advanced breast cancer. An important turning point in tamoxifen’s journey from orphan drug to bestselling medicine occurred in the 1980s, when clinical trials showed that it was also useful as an adjuvant to surgery and chemotherapy in the early stages of the disease. Later, trials demonstrated that it could prevent its occurrence or re-occurrence in women at high risk of breast cancer. Thus, it became the first preventive for any cancer, helping to establish the broader principles of chemoprevention, and extending the market for tamoxifen and similar drugs further still. Using tamoxifen as a case study, this paper discusses the limits of the rational approach to drug design, the role of human actors, and the series of feedback loops between bench and bedside that underpins pharmaceutical innovation. The paper also highlights the complex evaluation and management of risk that are involved in all therapies, but more especially perhaps in life-threatening and emotion-laden diseases like cancer

Making space for disability in eco-housing and eco-communities

There is continued failure to build homes for diverse and disabled occupancy. We use three eco-communities in England to explore how their eco-houses and wider community spaces accommodate the complex disability of hypotonic Cerebral Palsy. Using site visits, video footage, spatial mapping, field diary observations, surveys and interviews, this paper argues that little attention has been paid to making eco-communities and eco-houses accessible. There are, we argue, three useful and productive ways to interrogate accessibility in eco-communities, through understandings of legislation, barriers and mobility. These have three significant consequences for eco-communities and disabled access: ecological living as practised by these eco-communities relies upon particular bodily capacities, and thus excludes many disabled people; disabled access was only considered in relation to the house and its thresholds, not to the much broader space of the home; and eco-communities need to be, and would benefit from being, spaces of diverse interaction