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Comment by jerojero | Hacker News Reader

I have heard this argument before but it's interesting to see where the money for R&D is actually spent.

It's not on these kind of diseases, this kind of work is usually done with public money, grants.

Money in big pharma is usually spent in researching weight loss and alternative drugs for common diseases. After all, the return of investment on these types of drugs is much higher.

For a big company to make a drug that costs 1 million dollars but only 1000 people in the world have it, and from those only perhaps 100 live in countries that can afford the drug might be a business opportunity but it's honestly not a huge profit which is why they will turn to public funding to research these.

Imo, if you use public money then the products should be free of intellectual property. Public money, public goods.

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> and alternative drugs for common diseases. After all, the return of investment on these types of drugs is much higher.

This isn't just some greedy behavior. Treating common diseases is how you reduce discomfort/misery the most, in aggregate. Aspirin for 100 million people who are 1.5 on the pain scale is more effective than some $50,000/pill analgesic for that one guy who happens to be at 11.

Aspirin already exists and improvements to it are marginal.

This kind of extreme utilitarian approach seems flawed when you view healthcare as a human right. Reducing pain from 1.5 to 1.4 to millions of people is not really as valuable as saving one person's life. That's my opinion at least.

Of course, developing a drug that could save thousands of lives or one life is a real problem that governments and pharmaceutical companies need to face. And I would agree that in this case a utilitarian view is helpful.

But on the other hand, companies are not making these decisions based on ethical frameworks. They're making them on a basis of shareholder profit maximization. When you talk about "reducing the pain" do you actually care about reducing pain or is that simply a positive externality to the profits you'll make.

> When you talk about "reducing the pain" do you actually care about reducing pain or is that simply a positive externality to the profits you'll make.

people will pay a lot of money to save their life. to the extent that people cannot afford to save their life, government should subsidize.

> This kind of extreme utilitarian approach seems flawed when you view healthcare as a human right.

Of course it seems flawed when you're delusional and view absurdities as human rights. Do you have a right to rollercoaster rides? Do you have a right to jazz music? What about a right to gold jewelry? If you have these rights, then all sorts of other sensible principles seem flawed.

> But on the other hand, companies are not making these decisions based on ethical frameworks.

Why would that be necessary? Why do you think that whatever outcome you want actually requires making decisions in that way? And how could you ever guarantee that the decisions were made "based on ethical frameworks" even if law mandated it?

>Imo, if you use public money then the products should be free of intellectual property. Public money, public goods.

How much % of research today is publicly funded but privately patented? The principle of "public money, public goods" sounds good, until you you start mixing public and private funding. If you make a drug that's based on public research (that costs say, $1B), and then spend another $1B bringing that to market, should anyone be able piggy back off your work and compete against you? Why would anyone want to be the first company to do that? This is basically the exact problem that intellectual property laws are trying to solve.

Your example makes the public money side sound far too good because I promise you the government is not spending even close to $1b on making a single drug. that's like 1/4 of what we spent on all covid research and that was unprecedented.

I don't think that's true. Even a cursory search turns up, as the first response, this:

NIH has received almost $4.9 billion to date to fund important COVID-19 research on diagnostic tests, vaccines, and treatments. More than $940 million came from the Coronavirus Aid, Relief, and Economic Security (CARES) Act in March 2020, with supplemental funding coming from the U.S. Congress .

Edit: I guess that you could argue that it wasn't all for a single drug

Covid was different because of the urgency. A nation which gets vaccine first could easily recoup much more than $5B when the rest of the world is closed.

You're right - 1/5 more so than 1/4. And yes, it wasn't all for a single drug at all.

I misread your post as meaning there was not more than approximately 250 million spent. Sorry, my mistake.

That is bullshit, public spending is really massive here, and this study just looks at investments made by NIH not accounting other governments:

> In this cross-sectional study of 356 drugs approved by the US Food and Drug Administration from 2010 to 2019, the NIH spent $1.44 billion per approval on basic or applied research for products with novel targets or $599 million per approval considering applications of basic research to multiple products. Spending from the NIH was not less than industry spending, with full costs of these investments calculated with comparable accounting.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10148199/

The industry might spend more overall, but if you look at typical drugs they are typically publicly funded.

Edit: I think the main point people miss is all the research done by universities that is government funded. MRNA vaccines were made possible by decades of university research based on public funding, the private corporations just came in and did the easy part at the end. Novel medicines are mostly based on such research and hence mostly publicly funded, we would continue to make such progress regardless of private investments.

Interesting, I agree that study seems at first glance to contradict what I am saying. Will look into it further.

This includes amortized spending for failed drugs I think, but so does pharma spending so seems like a fair comparison.

I agree on the first part, hard disagree on the second part.

Publicly funded research part is on the characterization of the disease and the mechanisms, not the actual design of the drugs themselves. A lot more intellectual effort goes into the actual development of the compound that can safely treat the patients.

> It's not on these kind of diseases,

I think we should publicly fund more drug development, but it is simply false that most drug development money is from government. I'm not sure which 'these kind' of diseases you are referring to.

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