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Comment by jfengel | Hacker News Reader

FTA:

Big pharma excels at the subsequent stage: taking the best ideas generated by scientists and bringing them to market, using its huge financial firepower to navigate the complex regulatory environment.

If the government were to nationalize the industry, wouldn't the regulatory environment become simpler? Regulations exist because of the fundamental antagonism between profit-making and safety & efficacy. If the sector were nationalized, that would shift (and possibly diminish) that conflict.

Industry may well have expertise in the expensive process of ensuring safety and efficacy, but if that's made more expensive by having regulations thrust on it from outside, why not save the cost?

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The core of FDA regulatory power covers issues like how much evidence is enough to declare a drug fit for the public, how bad can the side effects be for its intended purpose, how to deal with ethical questions regarding everything from patient welfare to clinical trials, and regulating all of the infrastructure necessary to carry out the former activities. None of that disappears just because you nationalize the industry because it's all infrastructure necessary to innovate in medicine without causing significant collateral damage. The FDA is particularly heavy handed due to that fundamental antagonism but all that work still needs to be done and it's really complex. A lot of it is done by contract research organizations, some of them in the billions of revenue themselves, and nationalizing the pharmaceutical industry would make their work even more important.

Won't you just get similar cost in the form of bureaucracy?

Bureaucracy is rarely as expensive as aggressive profiteering.

In fact the opposite is more likely. If pharma is nationalised - or better, internationalised - it would become economic to fund solutions for common conditions that aren't currently considered profitable.

> Bureaucracy is rarely as expensive as aggressive profiteering.

Have you seen the DoD and other gov entity contracting? Perhaps we can expect the same level of contracting that the DoD has today, outsourcing those expensive mistakes to others, for them to take the blame/fall/

I can see a situation where pharma bureaucrats refuse to approve or pursue things, because government mistakes are more unforgivable than business mistakes (where failure and experiments are often encouraged). I would expect more layers of approval/red-tape to develop as no-one wants to accept the blame of approving.

>> Bureaucracy is rarely as expensive as aggressive profiteering.

> Have you seen the DoD and other gov entity contracting?

DoD contracting seems like worst of both worlds: a combination of bureaucracy, aggressive profiteering, and rare real-world evaluation of the products.

I'm kinda surprised military production hasn't been nationalized. It seems like it's mainly done by a handful of companies that are almost wholly dependent on government contracts, and the government is loathe to steer too much work away from any of these entities in order to preserve their capability.

>it would become economic to fund solutions for common conditions that aren't currently considered profitable.

How would eliminating the profit margin make it more economically attractive develop these products?

Perhaps more solutions would be developed, but they would have to be subsidized.

That doesn't seem to be true in terms of public education, libraries, the postal service or transportation.

It still has to be done.

If the regulations are unnecessary, then why not dispense with them and let the free market work. Surely you don't think government is more efficient than the market.

For national-scale infrastructure, it clearly is.

We've had appalling experiences with privatising critical infrastructure in the UK. Not only is privatisation almost invariably more expensive for tax payers and end users, and privatised companies reliably behave like bad actors, but privatised companies tend to continue to benefit from state-sponsored monopoly positions - because the cost of entry for national-scale operations is too high for start-ups.

For healthcare, a single price negotiated by a single state-owned org is hugely more efficient at reliable and economic service provision than any privatised alternative.

The only thing it's less efficient at is generating shareholder profits.

Why wouldn't I think that?

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