Nobody remains indifferent to the presence of pharmacologist Gilberto De Nucci. Tall, corpulent, and fast walking, De Nucci is the owner of a grave voice and goodhearted look that help him to make friends with almost the same ease that he picks up enemies. It is because this 46-year-old doctor has opinions as sturdy as they are polemical, and is not afraid of saying what he thinks. "At least two thirds of medicaments do not produce the desired effect", he asserts. To put it more plainly, they have an action that is more psychological than pharmacological. Even so, he advocates the use of remedies: the greatest advances in medicine are due to the adoption of new drugs.De Nucci is currently developing three medicaments. The first to reach the market – possibly as early as 2005 – is lilafil, intended to treat difficulty in keeping up an erection. Produced by him for the Brazilian laboratory Cristália, lilafil’s molecule is similar to Viagra’s, and began to be tested on human beings in August. The researcher is also working on synthesizing an anti-inflammatory and a new class of antihypertensives.

If his ideas are controversial, his competence is undeniable: De Nucci is one of the country’s most productive researchers. Since 1985, he has published 217 scientific articles in international magazines. Today, he is still one of the three most influential Brazilian researchers, whose works appear amongst those most cited by other studies, according to a survey of the ISI Highly Cited database, which includes the 4,800 most influential researchers of a total of 5 million scientists. De Nucci has now registered 22 patents with the National Institute of Industrial Property and 8 with the World Intellectual Property Organization. He has also been the target of 12 legal, administrative, or ethical proceedings. According to him, he has only lost one, in the first instance, was the case started by one of the institutions where he gives lessons – the State University of Campinas (Unicamp) – for using staff from the university as volunteers in clinical studies. "Later on, I won the fight in the State ofSãoPaulo Regional Medicine Council", he says.

Educated at the Ribeirão Preto School of Medicine, of the University of São Paulo (USP), he went to study pharmacology in England, through a personal identification with one of his professors, the pharmacologist Sergio Henrique Ferreira. In 1986, De Nucci concluded his doctorate at the Royal College of Surgeons of England and, two months later, published in the Proceedings of the National Academy of Sciences one of his most important scientific articles, about the role of endothelin, a vasoconstrictor hormone released by the inside wall of the blood vesselsBesides teaching pharmacology at Unicamp, De Nucci gives lessons at the University of São Paulo (USP), where he helped to create the Cartesius Analytic Unit, responsible for 60% of the studies of bioequivalence carried out in the country. As if that were not enough, two years ago he opened his own research laboratory in Campinas: the Galeno, where bioequivalence tests are carried out on medicaments and the analysis of toxic substances in chicken and crustaceans intended for export.

A few months ago, you declared in an interview that 80% of the medicines did not work. Last December, one of the vice-presidents of the GlaxoSmithKline laboratories, Allen Roses, told the British newspaper The Independent that the major part of the remedies produced by his company did not act as expected in over half of the people. Could you explain this question better?
— At least two thirds of medicines act like a placebo [an innocuous substance]. They do not produce any effect. Or there is no scientific evidence that they work, since it is not possible to assess their action against a series of pathologies. Imagine a person who has suffered a stroke. In this case, the effect of the medicament depends on several factors, such as the kind of stroke and the area affected. As there is no way of knowing what the behavior and the memory used to be like before the problem, it is difficult to know if the medicine is assisting the recovery. The same happens with Alzheimer’s disease. The medicine is given in the belief that the person is going to improve, but there is no certainty. After all, we do not know how this pathology arises. We know how it evolves, and to measure whether the evolution is for better or worse with the medicine is complex. There is no evidence that the medicine works against the disease. Actually, in this case, it’s not even necessary.

It isn’t necessary?
— In the case of Alzheimer’s disease, there is an accumulation of certain proteins, it is enough to show that the medicament reduces this accumulation [for it to be regarded as useful]. Sometimes, it is not even known whether the problem is really important for the appearance of the disease. But, as there is no way of discovering this, it is better to put the drug onto the market and see what happens. When one does not know whether a medicine works, it’s because we do not yet have means for verifying this.

But don’t you have to know that the medicine at least does no harm, before prescribing it?
— Supposedly. Clinical tests are done to find out whether the medicine, a priori, does no harm. Now this doesn’t mean to say that undesired effects will not arise, when it is administered to human beings. This risk is accepted.

Does it make sense to prescribe medicines like this?
Yes, it does. And people prescribe them even so. There’s an interesting phrase on this issue said by Sir William Osler [a Canadian author and the author of The principles and practice of medicine, of 1892,a landmark in the area of health at the beginning of the 20th century ]. He says that the wish to take medicines is perhaps the main characteristic that differentiates the human being from other animals.