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Comment by spydum | Hacker News Reader

I may be ignorant on this, but don't many of those countries benefit by the r&d funding happening in the US?

R&D doesn't happen in non-profit government corporations either (atleast not largely). Most R&D comes from the manufacturers where the state (or relevant institution) buys the drugs from.

However, in a single payer or similar systems, if a drug company decides to hike the price, the state (or institution) can swallow the cost and continue medical services to citizens until the situation is resolved (either by legislation or court cases). Since the state (or institution) is not a for-profit it doesn't matter as much if they sink a lot of cost as long as everyone can get their medical treatment.

Another thing is that people want to measure success in profit or less taxes paid. A proper healthcare system should have it's success measured in how many citizens are able to be productive because they're not chained down with accommodatable disabilities, curable chronic illnesses, and extreme medical debts.

> R&D doesn't happen in non-profit government corporations either (atleast not largely). Most R&D comes from the manufacturers where the state (or relevant institution) buys the drugs from.

IIRC, the research typically comes from state-funded academics, and the development comes from the manufacturers.

The research only comes from academics when it's actually reproducible. Otherwise it is dutifully ignored and companies perform their own research.

It's all multinational these days. Only 4/10 of the big players are in the US https://www.tharawat-magazine.com/facts/10-largest-pharmaceu... and that's quite logic if you remember that the European market is pretty much harmonized and twice as populated as the US.

The EU market is far from being harmonized medecines regulation wise. it always takes longer to get approval across all EU countries vs one approval in the US. Pricing of drugs is not harmonized at the EU level either and thats a hard block for any launch.

the US market is the primary market for all big pharma companies regardless of where headquarters are bc it is the biggest

And big pharma companies don't do early stage research. Small companies do. Most of those are in US

"in the US" is a misnomer. It all depends on if the cost allocation (e.g. HR is pharma's largest cost) has and is attributed to the US.

They may, but these institutions are keen on cures and not on treatments.

I am completely on the side of having government agencies developing cures and licensing out to companies then. This would avoid the perverse incentive of the OP. It also would stop the pervasive argument that patents are necessary to get new pharmaceuticals developed (I don't believe in patents benefit to society).

Some of the extra money does go to R&D (though that's somewhat misleading: a lot of "R&D" spending is unnecessary duplication of safety trials because the FDA doesn't recognise any foreign medical safety standards, not even e.g. the EU). But a substantial chunk of it is wasteful inefficiencies due to multiple layers of middlemen (there are typically 5 layers between the insurance company that's paying and the company that makes the drug/device) with opaque pricing structures (there are hidden rebates in both directions at every one of those layers). National healthcare systems still have bureaucratic inefficiencies but they do avoid having intermediaries with a direct incentive to bamboozle each other.

"unnecessary duplication of safety trials because the FDA doesn't recognise any foreign medical safety standards, not even e.g. the EU)"

I would say in some cases that is a good thing. https://en.wikipedia.org/wiki/Thalidomide

It's very hard to argue against a safety trial - of course if you duplicate safety trials then there will be occasional cases where you catch something that the original trial missed. But ultimately far more people have died or suffered because a medicine wasn't available yet than been killed or hurt by medicine being approved too early.

Most R&D, in the US as elsewhere, make massive use of public funds.

Which is weird, as that is not factored in the purchase price when buying the product when developed.

yes, you might ask your democratically elected representative about that...

No, that's not true. Private R&D is almost 10x what public R&D is, at least in biotech.

Including the R&D tax credit?

Nope - that's not true.

https://en.wikipedia.org/wiki/Medical_research#Privately_(in...

Private R&D is around 60% - however a large part of that is making minor changes to existing molecules in order to obtain fresh patents.The bigger, riskier research is done by the NIH and other publicly funded bodies. See

https://marianamazzucato.com/entrepreneurial-state/

Also - the quality of privately funded research is much worse, with non-reporting of negative results, data dredging and other dodgy activities being routine - see

https://en.wikipedia.org/wiki/Bad_Pharma

Your source is all medical research. Not biotech specifically.

Intriguing. I've often speculated about how private sector research compared with public research, especially in the context of the reproducibility crisis since I assumed that a lot of pharma companies knew that some research couldn't be replicated behind closed doors. I wonder what the quality of proprietary / unreleased studies is- do the links you provide take that into account?

It compares badly. Unfortunately too much private research is allowed to be kept secret - but what is known indicates it's of poorer quality - judged by the kind of metrics the Cochrane Institute use.

Goldacre's book (he also has a blog) is well worth reading - describing _many_ ways in which drug companies can cheat.

https://www.urmc.rochester.edu/news/story/4233/u.s.-slipping...

Interesting that funding only started to fall when the concept of Affordable Care act began to get traction? If I'm an investor, that sort of thing gives me cause for pause.

Like what?

Novartis? AstraZenica? Gsk? Bayer? Siemens? Hitachi? Philips? Olympus?

this works quite very much the other way as well..

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