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Comment by breatheoften | Hacker News Reader

This. It's explicitly capitalistic to be against socializing risk and privatizing profits -- which the is game being played with the current setup of trying to fund drug creation via patent monopolies combined with per unit regulatory pricing games.

Academia should be the primary means of drug discovery. Drug manufacturing and distribution _should_ be a commodity business. Anything otherwise and all research on the the outcome, scale of use, and effectiveness of different drugs becomes hopelessly distorted by marketing incentives and the influence of complex dependencies from the entire rest of the healthcare service pricing model.

Measuring drug creation effectiveness by trying to maximize the number of drugs on the market is like measuring software design effectiveness by number of lines of code.

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> Academia should be the primary means of drug discovery. Drug manufacturing and distribution _should_ be a commodity business

As mentioned below, the discovery is not the biggest driver of costs.

But you should also ask yourself: why is this not already the case? Currently, there's nothing stopping other countries from using taxpayer money to fund drug development locally. Except, by and large, they don't - as mentioned in the article, most of the drug development that happens worldwide is funded by the United States, even for companies that are headquartered in Europe.

The answer isn't that those countries aren't interested in consuming the benefits of that research, because they are more than willing to purchase those drugs that were developed in the US at lower prices. The answer is that they just choose not to fund the research, either because it's too expensive to conduct clinical trials with taxpayer money, or because it's more effective to have that funded by the market, especially when that market is US patients, rather than European taxpayers.

I would be surprised if the cost of running clinical trials paid by sponsors is anywhere near the infrastructure cost needed to develop the institutions which perform them. I very much suspect that the price paid to "sponsor funding" for clinical trial research serves more as a barrier to entry to reduce competition in the drug market than it does as a means to cover the cost of running the research (with the enormous infrastructure costs paid via other means that makes running the research possible) ... and if I am right -- us taxpayers pay enormous amounts of money into infrastructure processes that then are used below cost by private companies to capture patent monopolies. Socialized risk, privatized profits.

The solution is the same regardless of the behavior of other countries -- reduce the role of government granted monopolies, redirect public subsidies that go toward funding commercial clinical trials into more public development outfits, and commodities the drug production/distribution (as cost is minimal once the drug is discovered and validated for use).

If we think private drug companies are actually any good at "picking winners" and dealing with risk of unknowns with respect to drug efficacy -- establish a derivatives market where they can gamble about which drugs in the development pipeline are likely to work -- and see if any of them are still around in a few years ...

"Currently, there's nothing stopping other countries from using taxpayer money to fund drug development locally. Except, by and large, they don't - as mentioned in the article"

Come on!! Hasn't anybody actually read the article?? Unless the economist is showing different articles to different people the only phrase that mentions research implies that is an argument made by the industry and not clear at all. The "the US subsidizes drug research for the rest of the world" is a huge lie that cannot die soon enough.

> The "the US subsidizes drug research for the rest of the world" is a huge lie that cannot die soon enough.

It's a trivially verifiable fact. If you don't like the Economist, here's another source, showing that the US used to fund over 50% of the entire world's medical research. That number has dropped to 44% in the last decade, but only because China and India are growing so fast.

http://www.npr.org/sections/health-shots/2015/01/13/37680135...

Given the lack of transparency in the billing process for health care services -- there is no part of me that thinks these numbers could provide an accurate representation of expenditures toward actual research. How much research investment actually gets funneled into direct payments towards insurance companies or hospital providers (possibly co-owned by the research funds). The space for financial gamesmanship in the way medical facilities operate in the us is so big that I there's no possibility that this kind of thing is not occurring on a large scale ... if us public/private investment into medical research is so healthy -- why have the job prospects for anyone with a biomedical degree been declining for a decade straight?

Academia should be the primary means of drug discovery. Drug manufacturing and distribution _should_ be a commodity business

You're missing a big step! The key role drug companies play today: drug development.

Discovery is the cheapest step in the process. Running clinical trials is where most of the money goes. I just can't picture academia funding tens of billions of dollars of drug development. Where would that money come from? Are they up for the risk?

I don't write contracts but my current day job is "Information Technology 'stuff'" at a company that is related to this field.

While I couldn't talk about and have made no effort to remember the (obviously confidential) details of conversations I've overheard, I have heard enough to know the general trend in this area.

There are two main components to worry about here.

1) Cost of the procedure. Currently medical trials are activities by the 'drug company', except for things that a patient in that position 'should' need anyway. If academia were developing (at testing!) the new medicine/techniques then the 'medical research' system would need to cover it. Obviously this is more likely to work out with a 'single payer' system.

2) Risks. The unknown is risky. It can lead to worse outcomes and increased expenses. Similar to point 1, there would need to be coverage of this built in as well. As a special addition to point 1 it would also involve fixing 'malpractice' lawsuits and the like.

I think that if I were ever to be involved in a malpractice circumstance what I would actually want would be:

  * If the involved practitioners are //at fault// them to be barred from the profession and related fields.
  * If anyone lied or covered up information that would have lead to a better outcome them to go to jail.
  * The absolute best effort at fixing and/or treating the resulting issue to be provided (a single payer system just should).

> Academia should be the primary means of drug discovery.

But it isn't. Why?

I could put out a list of potential reasons, but I have no real knowledge of the complexity of drug discovery. I have some knowledge of the complexity of FDA approval, but nothing sufficient. My best guess - it's too expensive.

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