Comment by beloch | Hacker News Reader

Comment by beloch | Hacker News Reader

Parent Full thread

It's a really odd system at first blush. People pay taxes. Taxes fund research. Research is then developed by private corporations into products that are sold back to the people.

It does solve a few key problems though. If universities and other research institutions were encouraged to bring products to market, they'd change what they work on and how. Basic curiosity driven research would give way to commercially oriented research. Moon-shots that might take multiple decades to develop would be replaced with things that can be brought to trials in just a few years. Brilliant researchers that might have made multiple earth-shaking discoveries over the course of their careers might get bogged down bringing one product to market. There's a lot to be said for insulating academia from quarterly reports.

However, things go awry when corporations that turn government funded research into private profits start lobbying too much and regulatory capture occurs. Even if it takes a decade to turn novel research into something you can buy at a pharmacy, the debt pharma companies owe to taxpayers should not be lost sight of. There should be stringent regulations on how drugs based on public research are priced. Yes, pharma company investments, market size, projected sales, and all that should be factored in, but drugs based on public research should be made available to the public at reasonable prices. That's not happening in the U.S..

Bottom line, public money must come with strings attached that serve the public interest. Pharmaceutical companies should be under heightened scrutiny and regulation because of where they get their IP.

> Bottom line, public money must come with strings attached that serve the public interest. Pharmaceutical companies should be under heightened scrutiny and regulation because of where they get their IP.

Drugs go off patent, and generics don’t have to undergo clinical trials. Sounds like the public benefits quite a bit. After a relatively short period of time (usually 10 years post FDA approval) a generic comes in the market for a fraction of the price.

The problem is, once a drug gets approved everyone thinks they are entitled to it. It is fundamentally a selfish problem; “I deserve XYZ” as opposed to “everyone will benefit after it’s paid for”.

1. Drug companies do a complex song and dance to avoid/delay the release of equivalent generics. For many drugs, they continually release modified preparations that keep generic competitors locked out decades past when they should have been available.

2. Drug prices in Canada or other nations versus the U.S. should be paid attention to. I'm Canadian, and there's absolutely no way I'd go to a pharmacy when cross border shopping. Americans are being gouged to a massive degree, in large part because of the idiotic American medical insurance system. Drug prices in the U.S. are a complex issue and it's not solely the fault of drug companies, but they are taking every advantage of the situation.

You can still make generics based on the original recipe. The only reason "modified preparations" would work are if they are legitimately more effective or if the public/doctors dont know about the generic options.

1. There's nothing a drug company can do to avoid/delay the release of equivalent generics. Releasing modified preparations does not lock out competitors from copying the original preparation

2. You have no idea how drug prices work. You don't have health insurance so you should be using prices from goodrx, not the list prices at the pharmacy. Americans either have health insurance or use the cash discount. Simplifying this would be great, but drug companies are not making the massive profits that breathless journalists claim

1. They can trickle out improvements one at a time, ensuring that there is always demand for a non-generic.

2. Perhaps you should look into how other countries regulate drug prices[1]. This is related to why residents of Florida recently pushed the FDA to allow them to buy drugs from Canada. There is a massive price difference, yet pharmaceutical companies somehow manage to make money off the Canadian market.

I'd like to think the U.S. is subsidizing development costs for the rest of the world, as some big pharma executives have claimed in the past, but it's now evident that research would be easy to sustain at a lower price point.

[1]https://www.canada.ca/en/patented-medicine-prices-review/ser...

1. Which drugs have trickled out improvements?

2 That's about new drugs, not generics. Generics are dirt cheap in America. Again, look at goodrx prices not the fake retail prices

I love how circular neoliberals argue, lobbying and regulatory capture are a real problem with big pharma, to fix it the government really should put them under heightened scrutiny and regulation. These politicians are really corrupt, they should really stop being corrupt.

Here is a wild idea: Perhaps the core of the problem just simply IS for-profit health care itself. Perhaps if someone has cancer, nobody should profit?

You use cancer as an example, but what about other meds? Is it ok to profit off ED meds or ADHD meds? Note, just cherry picking a few that are arguably not life saving for most.

maybe if someone is hungry, farmers and supermarkets shouldn't profit? maybe if someone needs a place to live, builders and realtors shouldn't profit? maybe if my gas tank is empty, oil companies shouldn't profit.

Where do you draw the line?

You draw the line when the basic requirements for a free market aren’t available: transparent pricing, customers that have a choice between different providers, customer that actually have the time to shop around.

The vast majority of prescriptions are for treating chronic conditions. Those patients have time to shop around and consult with their physicians to decide on a course of treatment. There are multiple drugs available for most conditions, often including generics. Statins are some of the most heavily prescribed drugs and there are at least seven on the market now.

Hardly, often drugs treating same condition have different side effects, or different effect on patients. Physicians usually search for the drug that works best on a specific patient. Once you find a drug with the desired effect, it’s usually not a good idea to switch to another with different side effects.

That’s all fine, except those are all issues with our insurance model as opposed to the pharmaceutical industry. Why not fix the actual problem by addressing the labyrinth of middlemen in between the person consuming the medication, the doctor prescribing it, and the company producing it? That seems like a far better idea than making drug development non-profit, reducing the incentives for innovation and new discovery.

>>Perhaps if someone has cancer, nobody should profit?

Does that mean the doctors and nurses and others should all work for free to? If individual people can 'profit' by providing care, i.e. a doctor, why can't a collection of people providing the same service, but as a company be allowed to profit as well?

"not profit from" != "work for free"

The healthcare system in Europe doesn't gauge its sick citizens the way the U.S. healthcare system does, and yet, last I checked, doctors in Europe, while certainly earning less than in the U.S., do not "work for free" or are unable to provide for themselves and their families.

Why aren’t the Europeans cranking out new medications at cost then?

No one is saying that drugs have to be provided "at cost" (that's very similar to the fallacy of the "do you expect us to work for free?" argument).

Is not the definition of profit the excess charge after removing costs? By definition “no one should profit” does mean “at cost”.

technically yes, but sometimes people think of "at cost" meaning that people aren't getting paid (the price covers the material costs).

But what I really meant "inordinately profit from" so I should have specified that

> Here is a wild idea: Perhaps the core of the problem just simply IS for-profit health care itself. Perhaps if someone has cancer, nobody should profit?

So your idea is, rather than address known issues in the system, replace the system with one that is known not to work?

Do you have proof that non-profit health care does not work? I’d say there are plenty country that show proof that nonprofit health care works better for the majority of people then for profit health care.

There are no countries with non-profit healthcare systems which develop as many new drugs as the USA on a per capita basis. Non-profit or socialized systems can work reasonably well for care delivery but no one has figured out how to productively develop new drugs under such systems. The profit motive is highly effective.

Maybe we don’t need all those new drugs? Are they helping patients, or are they just slightly changed existing drugs that allow the industry to ask for more money?

Good thing they have to go through some of the most extensive efficacy trials of virtually any products in existence. If they aren’t more effective, the generics are still available for cheaper.

This seems to be a common paradoxical argument made whenever drug prices get brought up, particularly insulin. I’ve seen people make the argument numerous times about how outrageous it was that Eli Lilly, which was sold the patent for insulin in the early 20th century for a dollar, is charging hundreds of dollars for insulin today. And yet when it is pointed out that they sell insulin for $20 at Walmart, and the insulin that costs hundreds are newer synthetic versions, the response is that people can’t be expected to use the old stuff because the new stuff is much safer, effective, and easy to use.

Which is it? If the new medicine is ineffective, then why do you need to buy it over the older, cheap options? If it is truly an improvement, then why is it wrong for the producers to charge more to account for the R&D costs required to create the new medicine?

Reply on news.ycombinator.com