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Comment by acchow | Hacker News Reader

How do you respond to people that say the profit motive is what drives innovation, and in the long term we’d rather have better, novel treatments sooner

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Profit motives for medical / biotech research, yes. What innovations have insurance companies made in the last 100 years besides to squeeze out more profit?

A lot of that research is primarily done in university labs, mind you. On the taxpayer dime. Somehow the research escapes a lab and Pfizer manages to put some stupid name on it and reaps billions in profit.

It requires billions of dollars and a decade+ to translate academic research into a clinical outcome. Most academic research is not reproducible or robust enough to even be replicated outside of the lab that performed it - and this will only be discovered after spending millions of dollars of private funding.

I get that completely - and you're completely correct: most research isn't ready for clinical trials let alone commercial distribution. And even then, only a small amount of reproduce-able work matures into a finalized product. Yes, there needs to be financial incentives for the private sector to find promising work, and funding the next steps once it escapes the University ecosystem. I'm all for that. But as a society we need to be clear about where the initial funding comes from, and who those are who pay for that first round of funding are.

I'm not trying to go to the mat for Big Pharma, but I'm certain that they do a lot more than slapping a stupid name on the research right at the end of the pipeline. Most universities can't fund sustained, large or diverse clinical trials, for instance; they also can't generally do the long-term post-market research/surveillance once a drug has been released.

So the only contribution of Big Pharma is that they take the risk, collect the funding and do some administrative stuff. It sounds to me like we can get rid of this middle man with some well managed governmental institutions.

> So the only contribution of Big Pharma is that they take the risk

That seems to me like the big thing you're kind of glossing over. Like I said, I don't really want to go to the mat for them, but I'm sure there's plenty of risks Big Pharma corps have taken buying up research they thought would pay off and then failed to bring to market.

Maybe it'd be better to have governments buying the research and bringing it to market, but as this subthread hints at, profit is one of the big motivations for researchers to do what they do. Hopefully the government would still be paying big bucks for the research, and hopefully the taxpayers wouldn't vote in someone who wants to gut whatever arm of the government is responsible for that after enough failed purchases.

>and hopefully the taxpayers wouldn't vote in someone who wants to gut whatever arm of the government is responsible for that after enough failed purchases.

Oh, well, that would never happen now would it?

A government, by its size, can spread the risks.

I don't disagree, my point is that it would introduce different risks.

Most pharma companies can't even fund clinical trials. That's why big pharma (Pfizers of the world) are more like holdings companies that buy smaller pharma companies (biotechs) with novel molecules and they big pharma eats the risk of putting the smaller companies' inventions through trials.

There should be a method + requirement to pay royalties back to public funding for basic research, but pharmaceutical companies really bear 99% of the risk and complexity of bringing a drug to market. It's not all that expensive to find molecules that might do something useful, it's obscenely expensive and risky to prove one does something useful.

>There should be a method + requirement to pay royalties back to public funding for basic research,

You mean the patent system? The university of california holds patents on CRISPR, for instance.

CRISPR was obviously commercializable, most academic research is quite a bit further from commercialization and some tiny portion ends up being extremely valuable way downstream nonetheless.

That's a fair criticism, although I've worked in both industry and research -- a lot more directed practical research to reach commercial viability happens in industry, whereas a lot of the fundamental research happens in academia. And as a sibling commented, a lot of unreproducible research comes out of academia. Also, there are spinoffs from academia regularly that allow the original researchers to profit directly from their efforts.

Still, that doesn't justify insurance companies siphoning off money for their shareholders. Especially in these cases where they own/control both the insurance company and the pharmaceutical distribution.

I guess they have their own labs, you just never learn about their failed experiments.

> failed experiments

Wasn't that what Milla Jovovich was called in to deal with?

Even if that's true for the actual pharmas, how are insurance companies like UHC innovating? They're just middlemen.

They prevent unnecessary treatments! /s

I'm not sure about UHC specifically, but insurance companies do innovate. Some insurers have invested pretty heavily in biotech and wearables, and they're also a big driver behind telehealth/remote health monitoring tech. We can cynically say that they're just in it because they want to reduce costs – and that's probably true – but it'd be simplistic to say investing to reduce costs is purely selfish.

> they're also a big driver behind telehealth/remote health monitoring tech

Until COVID, insurers in my area wouldn't cover telehealth at all. They opposed it tooth and nail.

> biotech and wearables

Tracking and data harvesting, excellent!

Or encouraging healthier lifestyles by blending technology with behavioral health incentives.

Or both.

We are talking about delivering care, not innovative medical technology. The biggest single target for innovation in care delivery is to get rid of private insurers.

I think the graph at the top of this article really says it all: https://www.economist.com/graphic-detail/2019/05/22/republic...

They're totally wrong. War is what funds innovations.

Imagine all the innovation we're missing on every day a country isn't being invaded!

By informing them that most of that is funded by taxes and students doing all the work, not corporations and not based on their revenue. If anything, they have an incentive not to make better treatments because better often means less profitable.

You don't, because they are trolls.

You can't possibly argue in good faith that being able to provide less than 0.1% of novel treatments is somehow more valuable than providing good, standard healthcare with already existing drugs and treatment protocols to the other 99.9% at a sane cost.

Competition is what drives innovation. There are many ways to chase profits without innovating.

Xerox parc is a good counter-example.

I'd say we have an unsustainable system, and innovation that makes it less sustainable is not particularly helpful.

Profit motive can also drive profiteering.

What "innovation" is UnitedHealth doing, pray tell me?

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