Maybe drug "companies" should be government entities then and not for-profit at all.
1. The time horizons involved don't work well with government. The US can't get anything done over a 20 year time horizon, and the highly delayed ROI means projects would always be first on the chopping block when it came to cost cutting. As a side note, currently we can't even agree to adequately fund basic research in the country, let alone drug development.
2. R&D would inevitably be politicized. Some senator would want disease X researched because their kid has it etc. Some tax payers won't want to fund disease Y.
3. It places R&D and regulatory in the same high level entity. That sets up all sorts of conflicts of interest.
4. It complicates international trade. What if the US develops most drugs. What should Europe be charged for them? Surely products can't be open sourced because one group of tax payers paid for them and would want ROI etc.
5. Similarly, who decides pricing for all the US buyers? Get ready for massively complicated procurement based on tons of different rules.
I am ignorant of these things so I have to ask if it is assumed that your assertions are common knowledge. For example: "the US can't get anything done over a 20 year time horizon".
If international trade is a larger sticking point then I would suggest an international consortium? Like a WHO entity that collects dues from member states and member states in turn benefit from drugs produced?
Just spit balling here to be sure.
In the US, the policy agenda is (still) broadly defined by tribalism along polarizing issues (e.g. abortion). In other countries, it's slightly less bad but the phenomenon is similar. If less social goods were coupled to politics the world might be a better place, but it also might take a paradigm shift where we don't dualize social activity into two bins: stuff you do because you make money doing and stuff you get done by taking from your neighbors because they "owe it to everyone".
It's true that it is coercive: that the individual may not want to live in a society where that is the rule. But this is also true of all laws, including private property laws. The idea that property laws are natural and obvious, whereas other laws are impositions is utterly unhelpful and the source of a lot of issues, especially in the US where it seems pretty much all non-military public programs are underfunded.
> But this is also true of all laws,
Yes, that's true for all laws. It's funny that no one says it's part of the "social contract" when someone gets choked out and killed by the police for selling bootleg cigarettes on the corner.
I'm also going to point out that the central problem with income tax is that we think it's great because it's "punishes" the wealthy, but the equilibrium state is that due to bracket creep, it winds up screwing over the poor and middle class while the wealthy find escapes. Of note: I remember a year when I paid more in income taxes (as a proportion of my income) having made 30k than Bernie Sanders did.
The general paradigm among the liberal left is that the poor are screwed over by the political power because they are poor. I think it might be worth rethinking that - the poor are and continue to be poor because they don't have political power. The problem is that political power is a zero-sum game, so any solution that gives those in power more power will only make matters worse.
Anyone who says they believe in "small government". That small set of rules always happens to include property laws.
> when someone gets choked out and killed by the police
That's also illegal. I would also advocate enforcing the law against law enforcement officers. Stronger than against ordinary citizens if anything.
> we think it's great because it's "punishes" the wealthy
Actually, I think that (even assuming that it were enforced) it does little to no harm to the wealthy. They have sufficient wealth that having less has almost no impact on their well-being.
> The problem is that political power is a zero-sum game, so any solution that gives those in power more power will only make matters worse.
Giving money to the poor gives them political power. Or rather economic power, which is a good substitute, and often what the rich use to gain political power.
Ideally we'd have some kind of basic income which provides this function directly. But other socially funded initiatives such as healthcare and education are also helpful in this regard.
Legislation is stuck in the mud, but government is very much still getting things done.
Drugs, as a whole, aren't that expensive today compared to other healthcare. They make up 9.8% of US health care expenditure, which is pretty much middle of the pack compared to OECD countries. Hospitals, largely "non profit" (but sometimes massively profitable) make up 35%. But drugs feel more expensive bc copays are typically higher for drugs than for medical care
As it stands today the drug industry spends ~$200B a year to get 20-50 new FDA approved drugs a year. Virtually no fda approved drugs are developed solely by academia. NIH budget is $30-35B and on a steady long term decline. So you'd have a massive taxpayer expense just to build out that r&d function
Then you'd have to build out manufacturing. And some sales and marketing analog -- even if you aren't trying to profit, somebody needs to go out and tell doctors about your new drug and share with them very detailed data about how the drug works, what patients it works for, compared to the competition. Doctors can't stay on top of this themselves -- they are too busy and there's too much info
Then you'd need to build out some administrative function and some way to decide what projects move forward at what stage. This is where publicly funded drug research would probably massively underperform private for profit r&d
If you are making drugs for profit, you have a strong incentive to be efficient with your research. If not you go out of business. The more these decisions are driven by politics rather than profit motive, the less productive r&d is. And r&d cost and productivity is the reason drugs are expensive
There's evidence that startups are 10x more productive at r&d than pharma and it isn't crazy to attribute a lot of that to less politics
As of now something like 30-50% of published academic findings are thought to be false. 30%+ of all NIH money goes to "overhead", i.e. Profit to universities. And yields no fda approved drugs without private company investment
That sounds like a pretty interesting argument, but I notice that you didn’t actually make it. The rest of your post is full of claims sans evidence, and a lot of numbers out of context. For example how many of those newly approved drugs are novel therapies vs. rejiggered stereochemistry to keep a patent or compete in an existing field? How many are significant improvements over existing therapies and not just potential profit centers?
Those approvals are all for new molecular entities. In 2018 39% of those were first in class, i.e. Drugs with a new or unique mechanism of action. The percentage of first in class drugs approved among all NMEs has been trending upwards. My guess would be that most of the rest are second / third in class, not just "lifecycle management" plays
It's actually much harder to do lifecycle management bs in pharma these days compared to 20 years ago. Yeah you can get patents, some may be enforceable, but insurance companies will not put up with that unless the "new" drug provides a real clinical benefit
http://www.hbmpartners.com/media/docs/industry-reports/Analy...
Can someone tell me how this patent extension works? If they improve on something, is that a new patent? Does the original patent expire or gets extended? Why couldn't someone else have discovered the new stereochemistry before the original inventor dose so? If the new discovery is not significant, wouldn't its be sufficient to use the generic form of the original chemistry?
As to why some other company didn’t snap up the patent, it’s an expensive proposition and not trivial to make enantiopure drugs, so a lot of the R&D budget touted by apologists and shills is entirely self-serving. Now sometimes an isomer is actually superior to a racemic mixture and there are plenty of cases where one isomer is therapeutic and the other is ineffective or toxic. Of course in those cases none of this patent fuckery applies, and there is no way to get a new patent issued or FDA writ because only one viable form of the drug exists.
It’s also true that a generic in the case of something like Esomeprazole vs. Omeprazole is viable, and that’s where the astronomical marketing budget that dwarfs R&D comes into play. Advertising directly to patients and doctors ensures that plenty of people won’t understsnd the value of a generic is they were even aware of it. You also get cases, as with Epi-pens, where supplies of the generic are scarce compared to the expensive branded version.
Good list of this kind of thing found here: https://en.m.wikipedia.org/wiki/Enantiopure_drug
Unless you provide a real clinical benefit, most payers will make docs write an rx for the 3x a day generic vs new 2x a day patent. So these lifecycle extension games certainly happen but it's not really that effective
Yes NIH is biggest single spender but pharma industry as a whole spends much more
Please, do.
Has this been successful anywhere? What purely run state enterprises that are charged with creating new and innovate things have been success stories?
I think that while private enterprise has had a jaded role in healthcare, I'm not sure what the better alternative is.