Drug creation needs to be nationalized, 100% tax funded all the way from researcher to trials to manufacture, and the drugs sold at cost thereafter.
And the pharmaceuticals industry needs to just go away.
And the pharmaceuticals industry needs to just go away.
There may be a need to look at enforcing some more openness to formulas and manufacturing process so that after patents expire it's less possible to maintain an exclusive on a generic. That is consistent with the intent of patent protection and encourages open markets and competition.
https://en.wikipedia.org/wiki/AllTrials
But, nationalizing the industry is impossible. We don't spend anywhere near enough on medical research for it to be possible. The UK government for instance spends about £500m a year on all medical research, even if you redirected all that money into clinical trials, you would be lucky to produce a handful of drugs each year.
This is academic, perhaps, given the likelihood of it happening.
If the federal government had locked down all IT development in the 1980s as you proposing they do for pharmaceuticals, we wouldn't have this forum to comment on, much less the industry it is built around.
Computers are tools. Drugs are health. They are a public good and a natural human right. Holding people's health hostage is unacceptable whether you do it with a knife in an alley, or a capitalist health system.
Mixing them up like the USA system does is a category error.
Want to see real innovation? See for example the home made radio receivers people made in WWII, that fit in a small tin can, or visit an Amish settlement (http://kk.org/thetechnium/amish-hackers-a/). Not to mention hacker/maker spaces and fablabs, which all work on open source principles and sustain themselves through donations or member fees.
That said, there's also application. Curiosity may lead to someone discovering a particular complex chemical, but curiosity won't turn it into a cheaply produced pill available at your corner pharmacy.
Hobbyists tinkering in a hanger did not create modern airlines - giant corporations like Boeing managed the capital required to make it happen.
Hobbyists tinkering in a garage are not going to be able to carry out years of dedicated research followed by years of study followed by years of clinical trials.
When they do get corrupt what do we do, since it's the same guys with the guns and court houses?
There are some very messed-up public works, but most of the time it works pretty well.
FWIW unlike 90% of this thread, this suggestion doesn't sound insane to me. We could look at the number of people with a disease, and the QALY swing caused by the treatment, and then pay the team which designed the drug for the patent for (expected number of treatments) * (expected gains in QALYs).
This would allow the drugs to be any price the government liked once created, but still convince financially motivated smart people to work in medicine. Bonus points if the solution included ever-rising-prices for long untreated diseases (kind of like an auction).
Pharma research does not have network effects
Imagine if in the early 90s we had stiffed cellular phone technology because "only the rich have access to it" or general internet/network technology because "only banks and giant corporations have access to it."
Thanks to capitalism, the technology is now so permeates all sectors of society that some have argued that access it that internet access and smart phones are a human right that should be socialized by the government.
Tax would pay their grants, tax would fund the trials, and tax would fund the production and packaging.
Do roads and public water sanitation materialize out of thin air?
Researching drugs or developing IT applications are not basic commodities.
Ahh, hmm, I'm wanting to ask if you know anyone working on drugs without sounding rude.
In my experience they are like doctors. Lilly researchers do enjoy the thought of helping people, but mostly in the abstract. In the concrete they like complaining about people and regulation :) they also very much like living the "good life".
I'm not saying we'd lose all drug researchers if it were nationalized, but I do think we'd lose a lot of them -- at the end of the day, most people do want money, and end up being motivated to pursue careers which are financially rewarded. A full time doctors without borders just wouldn't work IMO.
As to the claim that drugs come from universities... You can take an interesting research finding and turn it into a potential drug... but there's a tremendous amount of work remaining, which isn't particularly interesting / researchy, and still requires someone very smart to do it. Essentially the more financially motivated people in academia are the ones who volunteer for what is often a fool's errand (a failed drug). I think the "new drugs come from universities" position is also true in the sense that "biologists get degrees from university" -- but as others pointed out, that sense is true for all industries.
Only a sick (person/group/society/culture) would link them like this. Drugs are, in fact, dis-ease. They are the opposite of health.
Real food, real exercise, real work and real sleep. That's health. Drugs are at best dis-ease and at worst tools of predation and exploitation.
You're making my point for me.
No they aren't. Saying that is equivalent to saying that you would be justified in putting a gun to a chemist's head and forcing him to make a drug for you even if he didn't want to. But there's no reason to say that your "right" to a drug trumps his right to be free from threat of violence and denial of agency.
What you're talking about is more of an entitlement than a right.
Holding people's health hostage is unacceptable whether you do it with a knife in an alley, or a capitalist health system.
Why exactly should I feel like society owes me health care that I can't pay for? Especially when the model involves a scenario where my getting health-care possibly involves using violence, or threat of violence, to make somebody else provide that care? How is that ethical?
Even from a selfish perspective, public health is so crammed with positive externalities it pays for itself.
Nobody's going to force chemists to make drugs. Instead the way tax works is that you force everyone to pay a fraction of their productivity into a fund that gets spent paying the chemist to make drugs, the pharmacist to deliver them, etc. It's very similar to insurance except that it doesn't have the perverse motivation to deny you care, and it's compulsory because a civilized society values people not writhing in pain and dying from uncured curable disease more highly than losing a fraction of their time working for the state to prevent it.
I don't believe that anything as extreme as the parent suggests is necessary but I do believe that we should have enforceable transparency in the pharmaceuticals industry R&D costs and/or decoupling the drug trials system so that the trials have to be carried out by an independent third party.
Yes, the dumb pipes of internet are.
The applications, like this website, that actually make use of those dumb pipes are not.
The only thing that made it useful though was commercialization.
For 20+ years, they've been moving more and more of their R&D and manufacturing overseas to save on labor costs. They then get Congress to approve of anti-competitive laws that disallow citizens from importing cheaper drugs from overseas for both use and resale. Big Pharma should have to compete on the same level as labor.
In typical US fashion, though, the profits are privatized.
Actually, I don't believe letting the government take over would be good in the long run. The most direct fix would be to immediately revoke the various laws that disallow American citizens and companies from buying approved drugs in foreign markets at massively reduced prices and then reselling them in the US.
Big pharma has for years now been slashing their US workforce and moving to third world countries. Another example of labor getting to compete in the global market, while capital enjoys privileged advantages.
One of the reasons the US has good health outcomes for some things like cancer is because of the huge amounts of government spending.
Original post:
No, it's not true. In 2010-2011[1], US had the highest expenditure in the world on health per capita according to WHO and OECD, but those stats are combined public _and_ private expenditure.
World Bank stats show Norway & Switzerland as spending more per capita[2] over the same period, but then says that 'data is in current U.S dollars'. The data for these stats is from WHO, so not sure if currency fluctuation or something else is a factor here?
According to [3], per capita public healthcare budget for 2011 was $3,768 vs. an overall spend of $9,146, so 41% of the total healthcare spend was public money.
In any case, I think all these stats can reliably posit is is that combined public and private spending on healthcare in the U.S per capita is one of the highest, if not the highest.
1: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
2: http://data.worldbank.org/indicator/SH.XPD.PCAP?order=wbapi_...
3: http://www.usgovernmentspending.com/year_spending_2011USdn_1...
4: https://www.oecd.org/unitedstates/Briefing-Note-UNITED-STATE...
Now, if you had said "Virtually all national healthcare system provide better care based on cost" I would have agreed with you.
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"We need to be careful when comparing US and UK cancer care"
http://scienceblog.cancerresearchuk.org/2009/08/17/we-need-t...
http://www.thelancet.com/journals/lancet/article/PIIS0140-67...
numbers in the US are good, but not significantly better than, say, germany.
http://www.commonwealthfund.org/publications/fund-reports/20...
Excluding 15% of the population from all but emergency care pretty much guarantees this outcome.
She wasn't there one morning and I asked where she was. She died - something to do with her kidneys and she didn't have health insurance.
Now the US gets to statistically ignore her death and claim it provides excellent health care to its citizens?
http://healthcarereform.procon.org/view.resource.php?resourc...
And roads, electricity, emergency services, internet service...
> performing better (in every sense)
Oh, I see, you didn't really want a fair comparison. No matter how far you separate the means of two gaussians their tails will always overlap, and therefore you are tautologically correct. I'll try to remember that next time I go to pay 2x what I would pay in a contemporary social system for health insurance, I'm sure it will make me feel better.
"Socialised healthcare" is a system where a public institution puts capital to take care of a patient by using private-made products and services. i.e. the needles, IT systems, ambulances, drugs, etc, the public system is a platform, but not an industry.
Let the market be free, private companies are better at solving real problems. If the price of a drug is expensive (i) a public health system will take care of it, and (ii) new players will want a slice of that expensive drug by making one better and cheaper. This is my point. Governments are not good at making realiable and quality products and services.
It is strange that you seem to believe the free market is the only way to achieve efficiency.
Showing just a healthcare expenditure vs GDP figure doesn't address the root cause problem, and it defiently doesn't explain that public is better than private, and vice versa. I'm not talking out of ignorance, as my father is a orthpeadic surgeon in the public healthcare system here in Europe, and the above is a logical fallacy that doctors are well aware of.
A great example of this in action is the silly Post Office pre pay benefit requrement. It's making the Post Office look really bad because they appear to not have enough to operate. The truth is they operate just fine, and are self-funded. Congress changed rate structures and imposed prepament of multiple decades of benefits, both of which would make no sense to any reasonable organization.
The nationalized health care programs seem to be performing better in other countries than ours.
Or, in one extreme case - the same healthcare outcomes at 1/10th of the cost (Cuba).
>In any nationalized system with controlled prices, you will have shortages.
In any system where there is scarcity you will have shortages. Period.
The problem with US outcomes is really disparity. A lot of people have very little access to health care and that drags our averages down like crazy. If we could get these kind of "solved-problem" drugs out to everyone who needs them, our average outcomes would jump quite a bit.
Cost is a whole different situation, and that's a much more difficult one to solve. Everyone from manufacturer to insurer to doctor wants their cut, the elasticity of demand for a good without which you will die is zero, so there's very little incentive to keep cost down. There's a few places you can point that are particularly excessive (direct-to-patient marketing, excessive spending on terminal patients circling the drain, etc), but in general it's the death of a million cuts.
Pumping generics is one of those cases that's clearly abusive. With regard to the specific problem, if you try to limit their profits pharmas will simply take their ball and go home - they won't produce it. For a real-world example of this, you can no longer get the Lyme Disease vaccine for humans - nobody makes it anymore, you can only get it for the veterinary market. Evergreening is a similar problem.
In such cases the government really needs to either contract out production of a supply, at-cost (including interest, distribution, etc). If no one will do it, bite the bullet and make it ourselves. If our national labs can figure out how to manufacture high-quality biological or chemical agents, we can figure out how to make high-quality vaccines and drugs as well. Public health is a matter of national security when you get right down to it. Shouldn't we be able to ramp up production of an Ebola vaccine if we really needed it?
Pharma needs outright nationalization or competition from the public sector at the very least.
We've played these games before where monopolistic private companies threaten to flip the switch on critical services. The solution to this one is the same as it was to companies that refused to provide mail service or electricity when it "wasn't profitable enough". Nationalize them and provide it at cost. It's simple and proven. Hell, it's likely that the mere threat of it would be enough to panic pharma execs into playing ball.
A great deal of pharma profits comes from taking research from the public sector and commercializing it anyway. Cutting the fat from the process (executive salaries, marketing, bribes to doctors) would be vastly improve the efficiency of the system.
Even if research done in the private sector were 40% less efficient than that done by Pharma companies (and there's no evidence that it's any less efficient), by slashing marketing costs to zero we'd still come out ahead by nationalizing them.
The thing with marketing is that it's a win-win for the person doing the marketing. Direct-to-patient marketing has real-world returns (ask your doctor today if the purple pill is right for you!) and a rational player will put money into that investment until returns no longer exceed costs. However on the whole it drives up costs for everyone since people who don't actually need it seek treatment, and then get prescriptions. Regardless of anything else you do, you just need to outlaw direct-to-patient marketing. It's a perverse incentive and we're the only nation that allows it.
A good example of a market which works well almost without intervention could be the coffee market, since it's really difficult to have a monopoly on any side (farming, distribution, selling) and the incentive is aligned with the customer's best interest (selling coffee to get more money). A lot of physical consumer goods are in this category.
In between, you have markets with a high cost infrastructure but where the main goal is to be a public good. These market need constant input because their interest is not entirely aligned with the consumer. ISPs can be a good example of this, if you don't put laws to correct the default behaviour, it will never work well. But with good laws, it's fixable.
At the opposite end I suspect there is markets where the private system will never work, whatever laws you put in place. Education, Health related industries, Prison and Justice system would fall in this category. There will be no law strong enough to change their incentive so it's aligned with the public.
http://www.cepr.net/publications/reports/the-benefits-and-sa...
You really don't want medical science led by popular opinion.
The SLS program is jokingly called the Senate Launch System: https://en.wikipedia.org/wiki/Space_Launch_System
As for the NASA comparison... I don't really want drug research to be chronically underfunded.
Instead I have to go ask permission from the government, fight for funds, wait for approval, build massive infrastructure just to prove to the government I'm not wasting their money, and so on?
I've worked on government contracts - defense - most of my career. It is not a model of innovation, low costs, fast delivery, friction-less pivots, and the like. It's a story of incumbents, outdated regulations (waterfall for the win!), inability to get money for great ideas, buckets of money thrown at bad ideas, cronyism, lobbying, you get the idea.
It's trivial, and lazy, to talk about "big pharma" - to paint them as evil. Yes, there is plenty of less than stellar activity, and I had a gf that was in the business. But she also worked for a small start up that would probably be impossible under your model. That world is full of idealistic people that want to do good in the world. And yes, there is also unsavory business practices. But so much good has come from people with a dream. Bethesda is the pharma equivalent of SF in tech. Lots of money flowing, lots of great ideas, lots of moon shots, lots of quick failures, lots of success. It ain't ideal (great ideas, no funding, for example), but I'd suggest your idea needs substantial sketching out to explain how it would successfully replace this sort of activity.
edit: my first job was working for a small company that contracted for NIH. In my short time there I heard so many stories of research being started, then something becomes the hot topic of the day, funding is withdrawn to throw it at this new topic, and the old project is left to die. Not that the new topic was a bad thing to pursue, but if you keep switching focus before getting results you are wasting tons of money. The NIH is regularly criticized for taking only 1 approach to a problem - investigate drug X or treatment Y. It's unbelievably hard to convince Congress that you should spend a ton of money on a research program, but then go and run 10 other programs that assume that that research program will not pan out. No, that's stupid. It's incredibly believable. I recall pulling all nighters, being called on the phone by congressmen or their aides, trying to pull data together for a presentation on the hill to get or continue funding. Ultimately politicians were making research and health decisions. Madness. Everyone I worked with had their hearts in the right place (beware the easy, lazy assumptions!). Individual politicians that I've run across are intelligent and trying to do the right thing as they understand it, and often that understanding is very sophisticated. But the system doesn't have a heart, whether that system is capitalism, start ups, or government.
As opposed to approaching private companies for permission, funds, approval, adhere to their compliance and management policies, and so on?
> So, I have a great but perhaps hare brained new idea for a drug/treatment. I'm willing to throw my tens of millions (heh) at it.
Your model where the financier is the same person as the scientist is not a common one.
If your motivation is to make the world a better place, you just publish your idea and if it will indeed be as good as you think it is, things will roll (in the supposed system) by themselves from there on. If your motivation is to get (much) more money than you pour in it when there are lives at stake, then this rises a red flag and should be treated as a public threat.
And that doesn't include the tens of billions in biotech VC funding.
But my view might be myoptic, so I was double-checking.
The last number I saw was $6B invested in 2014.[1]
[1]https://www.pwc.com/us/en/technology/assets/pwc-life-science...
Eli Lilly, for example, spent ~$4.5 billion on R&D in FY 2014 (24% of their total revenue) - http://www.lilly.com/about/key-facts/Pages/key-facts.aspx ... I'm not sure how big the VC deals were for 2014, but I feel like if you include Pfizer, Genentech, 3M, GSK, and then all the smaller ones big enough to be listed on https://en.wikipedia.org/wiki/List_of_pharmaceutical_compani..., VC funding will be maybe 2-5% of the total private pharma spend.
This is actually a lot like what Intel, Nvidia, and Google do. Basically your revenue takes over where the VCs left off. If the VCs are doing their jobs correctly, reinvested profit R&D is in aggregate much higher than VC dollars... Intel spent $3 billion last year on R&D for example... https://ycharts.com/companies/INTC/r_and_d_expense
Perhaps I am simply stating a tautology b/c of the narrow definition, but I'm on the same page with refurb.
This process can be short circuited by an acquisition, but of course the acquisition is ultimately paid for by past customer profits too.
In the context of https://news.ycombinator.com/item?id=10251676 's assertion that "Drug creation needs to be nationalized, 100% tax funded all the way from researcher to trials to manufacture, and the drugs sold at cost thereafter" which was followed by brixton's reply that "The drugs might end up being cheaper, but there will be much less research for drugs" this remains a very important point: drug R&D folk aren't in it for the VC funding... they're in it for the profit margin. If you remove that light at the end of the tunnel, there are no startups, and the smartest of us go work for the Googles of this world.
(Though FWIW I do think you, refurb, and I are all roughly on the same page if we limit our scope to startups.)
The article pointed out that the drug in question is over 60 years old. I doubt the original creators thought about profitability at a time frame where they are most probably dead anyway.
Poor people have been voting for Democrats for 50 years and they're still poor.
Getting people out of poverty is a lot more complicated than which political party one supports.
A Mayor can put together a deal that will bring an employer(and all of the jobs that it brings along) to a municipality, congress doesn't do that.
A Governor can influence the business climate of a state. There's a reason why manufacturing jobs are moving to southern states.
The error in your thinking is that curing a patient results in less money than just chronically treating one. Not so!
Come again? Please explain how that works.
Imagine the kudos that would go to the researchers and the company that cured the common cold! And a pill for that would sell well enough to offset the losses from palliative lozenges, decongestants, etc. And it's not like they are short of other pills to sell.
There is a big danger in the approach I gave, but it's political interference. If the god-botherers can be forced to keep their mitts off, I expect my way would create more basic research and more simple effective drugs.
Greed motivates chasing the slight change that will let your company replace an ageing-out-of-patent drug with a freshly patented one, drugs for rich people, drugs aimed at insurance payers, and it de-motivates improving the basics.
I see those as an adverse outcomes, so I would prefer a different way of funding drug development.
"The Benefits and Savings of Publicly-Funded Clinical Trials of Prescription Drugs"
http://www.cepr.net/publications/reports/the-benefits-and-sa...
"Patent Monopolies and the Costs of Mismarketing Drugs"
http://www.cepr.net/publications/reports/patent-monopolies-a...
Greed in here can also be a cause for the tragedy of the commons, which is more serious than any opportunity progress! Because of the said greed the drugs reached agriculture having all kinds of unintended effects, the most serious of which being development of many drug-resistant pathogens.