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Comment by coldtea | Hacker News Reader

>Lets also not forget that if you can't make money off lifesaving drugs, you also won't bother to invent any new ones.

Let's not forget that there are people who invent stuff and do research outside of monetary concerns too. Not to mention state funded research, which is how we got most of the foundations of the core science/technology we have now (either that or heavily subsidized "private" research, including pharmas).

And let's also not forget that by several accounts, the costs of research for most of those life saving drugs are dwarfed by the costs of marketing and other BS the companies spend their money on, and not even for them (as life saving drugs practically advertise themselves anyway) but for non life-saving drugs like Viagra and co...

>the media has decided he's a villain

And for one, in this particular case, nobody can blame them!

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Yes, although the cost bottleneck isn't the primary research to find drug candidates, but the clinical trials needed to see which of the hundred drug candidates i) works and ii) is safe. And public funding of medical research is nowhere near what would be necessary to fund current levels of clinical research, let alone expand to meet the enormous unmet demand. For instance, UK government medical research funding is significantly less than £1bn, and estimates are the the cost of clinical trials to demonstrate the safety and efficacy of just one drug costs £0.2-1bn. So the UK could divert all pure and early-stage research and develop only 1-5 drugs each year.

Agree about marketing, I think most people agree the purpose of the pharma industry is finding objective treatments for objective diseases, and not generating spurious demand. I think we could potentially optimize strongly for the first part if we heavily restricted the latter part.

as life saving drugs practically advertise themselves anyway

Ummm.... no, they don't. I have a friend who works in the industry and you'd be surprised how cautious some physicians are. The decision to treat a patient with a new drug isn't "oh! it's better, let's use it!", it's much more complicated than that. Even great drugs need to be promoted.

Also, you can't compare the costs of marketing and R&D. You don't spend marketing dollars unless you think the return is greater than 1 (you make back more than you spent). If drug companies stopped marketing their drugs, they'd end up in a worse financial situation rather than a better one. That extra revenue means more R&D spend!

> Ummm.... no, they don't. I have a friend who works in the industry and you'd be surprised how cautious some physicians are. The decision to treat a patient with a new drug isn't "oh! it's better, let's use it!", it's much more complicated than that. Even great drugs need to be promoted.

And yet somehow the word on new drugs still gets to doctors in the rest of the world where public advertising of drugs is illegal. Any ideas on how this miracle occurs?

Huh? The answer is in your question. Non-public advertising. Medical sales.

For one thing, you're conflating marketing to consumers and marketing to physicians. There is no value in patients demanding a drug because of some contentless, sunshine-and-rainbows advert. The value in drug companies talking to doctors is arguable, but I think that doctors' very limited free time in general would also be more effectively spent talking to independent analysts, or reading independent comparative research. See the National Institute for Clinical Excellence in the UK, or the Cochrane Centre.

There is no value in patients demanding a drug because of some contentless, sunshine-and-rainbows advert.

Really? I've talked to a handful of physicians that think advertising to patients is actually a good thing. They've talked about patients who haven't seen a doctor in years coming in to have their cholesterol checked because they saw an ad on TV.

I don't know about you, but I'd prefer it if patients were more proactive when it comes to their health, not less.

> you'd be surprised how cautious some physicians are

I'd be a fuckton more surprised if there weren't hundreds of companies trying to sell drugs regardless of efficacy.

The FDA won't approve a drug unless it's efficacious. Are you inferring that it's not?

So, so many companies have been caught promoting drugs "off-label", for uses that the FDA hasn't approved. So many. Johnson & Johnson paid $1.4 BILLION to settle a suit alleging that they heavily promoted the use of antipsychotics on dementia patients.

https://en.wikipedia.org/wiki/List_of_off-label_promotion_ph...

Correct. It's illegal in the US to promote drugs for off-label uses. That doesn't mean the drugs don't work.

If J&J thought their drugs worked, I'd naively think that they could just invest a (perhaps significant) fraction of the eventual settlement to prove as much to the FDA. It would boost sales and allow them to promote them indefinitely, out in the open.

Either they couldn't be bothered, or in fact they tried to prove it, and failed. If J&J can't prove a drug works, the odds that it does actually work seems... low, given the amount of resources J&J have.

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