You do realize this doesn't work, right? Pharma "profit margins are very high", okay, but that means 10% (yes like everywhere there's that one company that does 30% for a while, averages however).
So 100% nationalizing them would change the cost of a $300,000 per year treatment to ... $270,000 per year. Nobody is waiting for that. Frankly even a 30% reduction, the top of the line, would not really matter to people.
The only thing separating medicine and the profit motive will do is stop the development of new drugs. There's no way in hell the government will invest even 10% of what the private sector invests in new drugs. That would be a 10000%+ budget increase for universities. It's not happening. So drug and treatment development will slow to a crawl. So is it better to die because no-one cares to look at you at all than to die because someone doesn't want to pay for your cure?
Apparently it is, according to responses here, but I truly don't understand why.
And if that's what you want to do, let people die, then why not just legislate that you can't buy coverage for diseases with <N cases per year? That would avoid all the inefficiency.
That's not what the data showed. Doctor-run hospitals, before ACA disallowed new ones and restricted existing ones from expanding, had overall better patient outcomes than state run hospitals.
MRI scans, which could sometimes mean the difference between life-saving diagnoses, or a missed diagnosis, were cheaper and easier to come by in the U.S. because clinics could run a scanner at a profit and specialize in MRI scans. Locking them away under government rationing destroys the cycle of signal and response a market can bring. We've seen this in other countries where it is exceedingly difficult to get one when you need one.
That doesn't mean there aren't sensible cases for government-funded research. But looking at the current health system with massive government interventions already in place and saying the problem is not enough government intervention seems like a mistaken conclusion.
> We've seen this in other countries where it is exceedingly difficult to get one when you need one.
Well, I don’t know which country you refer to but it’s not the case in France and lots of European countries where healthcare is totally free.
Yes you have to wait months for a scheduled PET scan or an MRI but you also can have access to one as soon as you enter the hospital as long as the medical team think it may save your life. It’s just ressource planning. I know it because it saved my life twice and for 0.00€.
edit : Just to be clear, I’m not writing this as « US bashing » but to help you consider that free and effective healthcare is totally possible and that working models already exists around the world. Free healthcare IS a solved problem.
As someone who lives in a country with “free” healthcare, no it’s not a solved problem in the least. There is a constant struggle over budget control and selecting what healthcare is worth funding and what isnt.
I live in a country with public and private healthcare. One thing that people don't realize is that the public healthcare system has better equipment because they have a much larger budget than private hospitals. So for MRI or PET scans, it's better to go through the public healthcare system.
Now you don't get 5 star service that the private healthcare has like luxury rooms and better food, but that's not the core focus when your life is on the line.
The cost of healthcare should be borne by society without a profit motive for the exact same reason we do it that way for firefighting services. Many nations other than the USA pay less overall and also receive better care and have better health outcomes, there is no good reason to preserve the current US system.
The US (and Canada) invents more drugs than the rest of the world combined. Maybe Americans are paying the price for all those other countries to get those better outcomes cheaper and without their sacrifice, everybody would lose.
the pharma drugs investment sees returns for pharma drugs investors.. USA has the highest prescription medication prices in the entire world, not even close. Who can buy them?
Because the USA pays massively more than anyone else for its medicine, it's logical that the USA has more pharma industry, producing more medicine, than anyone else.
But because the US Pharma industry is profit-driven, as TFA says, it is interested in making only profitable medicine. And as TFA says, curing things may not be profitable.
If the USA adopted socialised medicine, would we see less drugs but better outcomes? Would the pharma industry get more spread out, and less focused on making vast piles of cash in the USA and more focused on actual cures for everyone?
Put it like this: does a hypothetical Indian biochemistry genius with a passion for solving hard pharmaceutical problems work on some interesting but tricky disease in India that could save millions of lives, or do they go to the USA to earn lots of money creating expensive drugs for not-so-many rich people that doesn't even cure them?
The US are the dominant science and technology power in all domains and pharma companies also make good profits in Europe. I'm not sure that there is a causation here.
It's easy to talk about this "sacrifice" until you have an American friend or family member with a serious chronic health condition. There's no reason to financially ruin sick people and their caretakers for the benefit of private drug companies.
In any case, the basic research behind >90% of US drug inventions is publicly-funded, with private companies productizing this research and reaping huge profits:
>This report shows that NIH funding contributed to published research associated with every one of the 210 new drugs approved by the Food and Drug Administration from 2010–2016. Collectively, this research involved >200,000 years of grant funding totaling more than $100 billion.
Not saying it's right, just that perhaps American people are paying a price to help everyone else - for whatever reason the system ended up in that state.
Expensive treatments only seem bad when they're just about within reach then people pour all their money into it. Normal people just get old and die because there's nothing available to save them at any price.
It's a bit of both in my country with free healthcare because some treatments aren't funded by the government so poor people just die or endure the chronic condition while those who can afford it have the option to pay full price like those unfortunate Americans.
So you're saying that by having worse and more expensive health outcomes ourselves, we're helping everyone else? My God, those highly compensated medical company CEOs and their boards and shareholders are heroes!
Anecdote - 20+ years ago my colleague told me how his wife worked in the pharma industry.
She was studying a potential product to 'cure' some disease or other. Apparently her initial tests on the company's product worked amazingly well, removing all trace of the disease with just a few doses.
She was excited to report this success to her boss, who replied "That's Horrible!". The company wasn't interested in a cure that requires only a few doses, but something that requires a longer-term rent-seeking subscription plan.
This seems implausible. It’s extremely difficult to find cures in the first place, and in the event a company does, the US is willing to pay a ton for them (see recent Hep C medications).
I would need more proof before being able to believe an executive team would throw away a sellable cure for an extremely low probability of finding a longer term rent seeking subscription plan.
I am not aware of any diseases where the US government would not pay for a cure if there is a known cure for it because the price to “how bad is the disease” ratio is too high.
I actually meant that Medicare/Medicaid/Tricare (aka US government) do not specifically reject treatment because of price. ACA also requires managed care organizations (aka health insurance companies) to cover pretty much all proven treatments.
As an example, the new Hep C medications are $80k+ per dose or something if I recall correctly, and Medicaid pays for it.
This is certainly true, but it describes why companies don't start or continue the research. This has nothing to do with killing off a clinical stage drug because it was "too successful".
The latter, as reported by GP, doesn't seem very plausible.
I recently learned of some research that had a human trial that looked like it could potentially cure Multiple sclerosis (MS) and even potentially many (maybe all?) autoimmune diseases. However, it was too expensive, so no pharmaceutical companies picked it up. It was only when the researchers found a cheaper way of doing it that biopharmas were interested.
The incentives of capitalism means that the ideal goal for pharmaceutical companies is Amazon Prime, but you need to subscribe to stay alive. We need to change the incentives because this is a bad outcome for society.
The ideal goal for everyone is getting paid (in increasing amounts) on a regular basis, regardless of “-ism”.
The purpose of patents is to allow for a period to earn an ROI and then release it to everyone. Alternative could be taxpayers paying for it and it going into the public domain immediately.
> The ideal goal for everyone is getting paid (in increasing amounts) on a regular basis, regardless of “-ism”.
no, that parenthesis, (in increasing amounts), is a feature of capitalism, not inherent to all human motivation. the need for ever increasing income stems from the need to provide capital investors with a return.
I would wager the ideal goal of the vast majority of people would be increasing income due to wanting to consume more and more, for various reasons, but at its most basic, for the reason of attracting mates.
This is a complete straw man with no scientific basis at all. Desire for constantly increasing consumption could just easily be an artifact of culture. There's no reason to believe it's biological
The biological part is seeking out a desirable mate (per my amateur understanding of biology - it could be completely wrong). Desirable for many animals includes ability to procure resources (and defend them). Being able to consume displays this (and not necessarily plastic things). Consuming leisure time and activities are a signal that you have the power to do more of what you want to do or obtain it.
But I do not claim this is a scientific conclusion, I simply landed on this model as it seemed to match up with my reality.
Sorry, that's bullshit. Most sexual behaviors are culturally conditioned and empirically money doesnt make men or women linearly and indefinitely more attracted.
What is attractive is social status - in capitalism this is linked mostly to wealth but that's not a given at all. Another thing that's attractive is stability, but that doesn't have anything to do with consumption, in today's world it means having stable access to housing, ideally owning it, mainly.
>means having stable access to housing, ideally owning it, mainly
Having access to shelter in a desirable place is currently one of the best signals about one's ability to procure resources and I would categorize it as consumption. You can have stable access to housing where few people want to live, but it will not help you in attracting from a larger pool of mates (if that is your goal).
No, it simply isn't. The valuable part of housing is land and land cannot be consumed by housing.
Its not a signal of the ability to procure resources, it's that housing is the single most major cost and homelessness is the most major financial risk. What's attractive about it isn't that you can consume endless amounts of plastic and steel by proxy, it is that you eliminate risk.
>Its not a signal of the ability to procure resources, it's that housing is the single most major cost and homelessness is the most major financial risk.
In my opinion, that one can afford the single most major cost and avoid the most major financial risk is a possible signal of the ability to procure (or defend) resources.
>What's attractive about it isn't that you can consume endless amounts of plastic and steel by proxy, it is that you eliminate risk.
I agree. But I choose to define the word "consume" in this context to refer to being able to walk away with a contested resource. The more contested the resource, and the more you obtain of it, the more you signal your ability to procure and defend it.
That is why I distinguished access to housing in places with high demand versus access to housing in places with low demand in my previous post.
This is still very contrived. If all housing does is signal income, then why is housing so much more attractive than an expensive car or an expensive watch?
Even in places with low demand stable access to housing is still attractive. It's just rarer in places with high demand. This is reproduced in many cultures, for example in some Arab countries "renter" is an insult to someone you are dating.
>If all housing does is signal income, then why is housing so much more attractive than an expensive car or an expensive watch?
I do not understand what you mean by this, but I do not claim that "all housing does is signal income".
Let me re-characterize my statement for the basis of this discussion, which is that the vast majority of people would have an ideal goal of earning an ever increasing amount of money, regardless of capitalism.
My contention is that due to the way people rank themselves versus each other, they will be interested improving (or at least maintaining) their position in the rankings. Why would they want to rank themselves? I posit that it helps for attracting mates. One can even go deeper and attribute it to the function of an ego, or some mechanism in the brain that incentivizes one to assert their priorities over others', allowing them the ability to not only survive, but compete.
Going back to your initial reply:
>What is attractive is social status - in capitalism this is linked mostly to wealth but that's not a given at all. Another thing that's attractive is stability, but that doesn't have anything to do with consumption, in today's world it means having stable access to housing, ideally owning it, mainly.
I agree that it is about social status, which is what I am referring to by people ranking themselves (and each other). But money or not, the root of the ranking is power. Who has more power than who. Money is a proxy for power, which can exist with or without capitalism, so as long as there is money, I would bet that people (in general) will want more and more of it.
I work in this industry and this doesn't ring true.
It would never be the case that a single researcher does some tests and reports them to the boss except in the very earliest stages of drug development. The "boss" in this situation would be another research scientist, far removed from business strategy.
Even then, success in a petri-dish doesn't mean much - it would be years of research with a large team to determine if it was safe and efficacious in human trials.
The idea that the pharma industry suppresses viable medicines because they are "too good" is just conspiracy theory.
I'm not in the industry, but I've read a lot about how drugs get to market and this sounds valid. It takes a LOT of time and money for a drug company to get to the point of knowing how safe and effective a drug is in humans. That's pretty much the last step of drug manufacturing.
By the time a company has spent that amount of research effort and money, there's no way they'd just abandon a drug because it isn't rent seeking enough. Businesses want to recover whatever investment they can.
If a company is aware that a new drug could cure a previously managed disease, it’s pretty obvious that you’d like to be the one pocketing any available profits before a competitor does. The conspiracy only works to the extent that nobody else in the world could create the same drug, and that every person aware of its existence is prepared to keep it secret and lose out on the money to be made selling it.
> that nobody else in the world could create the same drug
Could create it and make a profit selling it.
If the cure generates less profit than current treatment, and if you’re currently selling treatment, then that’s not going to be worth it for you.
If you don’t, well you still need to get it to market, which requires substantial investment.
My point is that the described scenario is not entirely unlikely. For example, type 1 diabetics in the US need something like $600 worth of insulin, every single month for the rest of their lives. Say that’s 60 years, you’re looking at $430k, not even counting needles, sensors, and other stuff they might need (or absolutely need). Average patients won’t be able to cough up nearly as much for a cure.
Pharma has just been way faster than tech in realizing that the subscription model has far better yields.
In reality, a company will look at the cure and know that it will end the market in management. They will also understand that whoever brings the cure to market first will take the majority of the profits, and the other will just lose. A company will not refrain from selling a cure to protect the market share of its competitors.
Your idea only works if you believe there is a global conspiracy of businesses and scientists who all agree to embargo research into cures, and who are all willing to forgo any profits on the cure while also recognizing any scientist and company not in their conspiracy could wipe out their profits at any time.
Let me repeat. If treatment brings in more profit than cure, and you and your competitors have a treatment, then it is in none of your interests to bring out the cure, since anyone who does it would reduce their own profit besides killing that of their competitors.
There is no "global conspiracy" required at all. Not actively doing research towards reducing your own profit is enough.
Outsiders could theoretically come in, yes. But the hurdles are huge for biotech startups, and of course the established players are lobbying to keep it this way, so I won't be holding my breath. It's different from the tech world.
Any business who followed your logic would be then vulnerable to the first competitor who was willing to sell the cure instead. To prevent that from happening, it would take a global conspiracy of every company who could develop said drug, along with the complicity of every scientist who knew about said research and who would be tempted to develop or leak its it themselves.
Established players have no incentive to fund the research and every incentive to keep the difficulty of curing illnesses at scale high to keep new players out.
There is no need for a global conspiracy. Just a little lobbying.
Then we have the dental industry. Drill, fill, and bill, without much care for anything else. Not so much active suppression as it is neglecting anything that might disrupt the industry.
This sounds like it went through a few rounds of telephone and lost some details. There are numerous details to this anecdote which are incompatible with the simple interpretation "pharma actively avoids cures"
Since we’re sharing anecdotes, a relative of mine is a retired oncologist and he’s pretty cynical towards big pharma as well. He’s witnessed patents on drugs for chemotherapy expire only for the company to introduce basically the same chemical compound with minimal changes as a new pharmaceutical, obtaining a fresh patent and of course the ability to set near arbitrary prices again. These “new” drugs could easily have worse side effects than the previous ones, too. Then they’d buy out the committees responsible for setting treatment guidelines so they’d recommend the new drugs, and to complete the puzzle, if doctors deviate from these guidelines they’re liable for potential damages. Note this is Europe and I’m not too clear on the details, but you get the gist of it.
> It also suggests that companies be innovative and constantly expanding their portfolio of treatments.
This is the right approach, both for a company and for society. In fact, it's so obvious, that it's weird anyone thought they needed a report to say it.
Even if you only look at the business side (instead of the human side), only developing chronic treatments instead of cures only makes sense if there's no cure on the horizon. Once there is a cure, the people who sell endless treatments will lose money (they'll make basically nothing & they'll have a lot of sunk cost they can't recoup), while those who sell the cure will make practically all the money.
Besides, the people who run companies also have bodies (who knew?)), as well as family & friends with bodies. Eventually they'll want those cures too.
I suspect the answer will be something like "maybe they won't, but their competitors are incentivised to", which naturally ignores the long history of price fixing and collusion.
i don't buy there will be no research. no trials/commercialization maybe.
Once there is enough research, you can have grey-ish market commercialization.
cancer immunotherapy works, and at times (maybe even often) is curative. Same with stem cells. Zolgensma, a one time cure that costs 2 million dollars, also exists.
Public goods funding as a thing also exists.
I'm not so pessimistic about it. There is still a profit incentive.
>That completely misses the point. The problem is that companies won't do the research to find cures -- because cures don't make money.
This is only true if a company is confident that all other companies are also not working on a cure. That may be feasible when dealing with a local service or commodity (as you only have to come to a wink wink agreement with other companies in the local area) or when only a few companies control a large amount of a limited resource (like OPEC). That does not work well when dealing with an idea or technology.
Any company anywhere in the world could decide to research a cure. A Nation State-run research group could do it and just give the patent away. It is virtually impossible to get all of them to not research it, and if any of them anywhere find a cure, your treatment profits fall off a cliff. So it makes fiscal sense to sell the treatment, use your market position to get the best data on the condition, and research a cure so you can be first to market and control the distribution of the cure and ensure that the profits go back to you.
Releasing a cure for a condition with treatments in the market already is a much easier sell than releasing yet another treatment that you now have to market to everybody on the current thing. If the first couple players are in a treatment-only business, newcomers are incentivized differently than those initial players were.
The more complicated answer is that if it's something poorly-understood where you came make different-but-similar treatments that will work better for some patients than others, and the current patient base isn't fully covered, there's still lots of incentives for treatment. Look at something like chronic inflammatory/immune stuff, and all the biologics out there.
But then the answer to "why didn't someone just develop a cure" isn't just economics and greed, but also nobody knows how.
In the surgical space, we actually do push expensive procedures over chronic therapy fairly often for things like joint or back issues. Of course, in that case, the economics are obvious - the surgeon and facility make their money that way. So if you can similarly convince the governments and insurance companies that your expensive cure is gonna save money compared to a lifetime of treatment (for surgery, this is being increasingly questioned, even), you can charge a lot for it.
A non profit-motivated actor might well want to do this just for the societal good it would bring. I think this though underlines a key flaw in the idea that everything ought to be market driven. In some cases you end up driving yourself in contortions working out how to incentivise the market to behave in a certain way. Sometimes it better just to fund the damn thing directly.
The right approach for a company is to give up making medicine. Why would you spend billions of dollars on scientists to research a cure and fighting the bureaucracy for its approval, only to have the people and the government turn around and scream at you that they cost too much, and demand you should give them away for free? Heck, just look Biden giving away the coronavirus vaccines — not buying the vaccines (or licenses to the vaccines) and giving them away, which would be eminently defensible and a fine expenditure on foreign policy outreach — just saying it'd be fine if no one enforced the IP rights on these things, giving away someone else's work.
So forget it. If the dollars work out so that the smart investor should spend his money on something else, it will happen. Will this result in fewer cures? Yes, but society has decided punishing people for making money is a more important priority than actually finding these cures, and our democracy operates on the premise that we've made our bed, so we can damn well sleep in it.
(There will of course continue to be a few cures coming out of publicly funded research and academia, but if they need to fight for grants with every other project out there, there's no way they'll have enough money to have the same output.)
Background: in the Star Trek series Deep Space 9, some of the bad guys are an expansionist empire led by shapeshifters who've bred a race of perfectly loyal super-soldiers whose loyalty is ensured, in part, by an inborn need for a substance called Ketracel-white, which substance is very difficult to synthesize, so they're dependent on their overlords for a consistent supply, else they get sick and die. It's basically the lysine deficiency from Jurassic Park, but for humanoids.
There's also an episode of Star Trek: The Next Generation in which one alien planet has hooked a second alien planet's entire population on addictive drugs, having convinced the addicts that withdrawal symptoms are a terrible, incurable disease that the drugs are treating.
As a type 1 diabetic, I feel this. It sure seems like there's a lot more money to be made from me selling insulin, testing supplies, pumps, etc, that I'll need to use for life (29 years and counting) than in finding a cure, which perhaps they can sell me once, or maybe yearly. I know there are people working hard to find a cure, but I also know that they struggle with getting funding.
Same situation, same feeling. I also don’t have high hopes for disruption from some startup, people seem to underestimate how much harder startups in biotech are compared to tech.
As they say, technically correct is the best kind of correct but also the most useless.
Parent's point is well received: it's much harder to be a startup when you need to fund laboratories, complex supply pipelines, diverse and deep know-how, interaction with government agencies etc.
From the little I've read manufacturing insulin and testing supplies doesn't seem terribly complex. I'm not too sure why there's so much profit to be made other than regulatory capture.
Different formulations of insulin offer different benefits to diabetics. Ones that are more slow acting more closely resemble the body's natural regulation of insulin, and therefore do less harm to the body. Or so I hear.
Most type 1 diabetics take 2 types of insulin (except for people on pumps). One is your bolus insulin, which is faster acting, usually used before meals or to bring down high blood sugar more quickly. The other is your basal insulin, which is slower acting, typically taken once or twice a day, which provides insulin for your body's background metabolic processes. People on pumps typically just use the bolus type insulin, since the pump can continuously supply small doses every few minutes, which allows for finer tuning more quickly.
Until about 25 years ago, the normal bolus insulin was Regular insulin, which is just like what your body makes. However, injecting it into fat makes it work more slowly, so you'd take it a half hour before eating, and it would peak a couple hours later. Currently bolus insulins are a genetically tweaked version that allows the body to absorb it more quickly, within a few minutes, with a peak in an hour or so. In the human body, there's an even faster phase 1 insulin response, but to get it as a type 1, you'd need to inject insulin into a vein. It can be done, but it is considered extremely dangerous.
Basal insulins are generally regular insulin mixed with something to delay action or modified to do the same. Older ones like NPH needed to be taken roughly every 12 hours, but had a relatively high peak, which sometimes meant you needed to time a snack to deal with that. Newer ones offer a much flatter action curve, and can often be taken just once a day.
I think it is past time to reform the Orphan Drug Act. It is open to exploitation by bad actors (Martin Shkreli, etc.), and the problem seems to only be getting worse. While we are at it, we should expand the act to try and help address the problem that treatments are less profitable than cures.
We also need to start putting in sunset provisions in laws of this nature. Governmental intervention in the economy should have mandated expiration/review dates.
If more people learned what "managing," really means, the idea of the business of managing disease instead of curing it would be more intuitive.
It seems simple, but only if you know it. Managing means you have at least two factors that form a 'dynamic,' so that there is a differential between them that you can extract variable levels of value out of. Managing a team means you have different people whose work is like cylinders of an engine firing at different times to create continuous motion. Some people have a knack for maintaining the equillibrium that produces power. Managing a product is a dynamic of market demand and feature cadence that produces sales.
From this perspective, a disease is a dynamic, however dubiously ethical it may to treat it as one, whether as a business making money or a government effecting policy.
However, curing patients is only a business model insomuch as you can produce cures dynamically to create a cure-machine to rent out. From a business perspective, curing diseases is zero-sum and destroys long term value. If you cured covid, the ~$100bn+ of value you created would be a one-off, and it would remove a powerful dynamic from both government and industry, and just be another relatively small capital management problem instead of a long term growth disease mangement problem, like say, periodic booster shots.
Solving problems collapses uncertainty and in-effect, destroys opportunity for people who use the dynamic to manage the world. Viewed this way, disease management is not a conspiracy, it's just a lot of people with a certain skill set who respond to the same incentives. It's truly a banal sort of evil.
Kind of a crappy article. The example of Sovaldi is a terrible one.
Prior to Sovaldi, the best selling drugs were Lipitor, then Humira which made ~$10B per year at peak worldwide (peak being a decade or more post launch). Think about the time value of money when your R&D investment hit peak revenue 10-15 years later.
Sovaldi made $12B in its first year full year. What did Gilead make across all its hepatitis C drugs that year? $19B. That blew all records out of the water. And 6 years later it’s pulling in $4B. Note this is in an industry where exceeding $1B at peak is a success.
The hepatitis C cures are an absolute blockbuster by any stretch of the imagination.
There definitely are. State run pharma agencies that compete against the private companies and stringent IP restrictions on treatments VS cures can help.
Ultimately you're never going to be able to coax the market into valuing 40+ years of rent over a cure.
The issue with state run pharma is we're not doing it. We cut the budget so morons could pay a tiny amount less a year in income tax. As long as we're reliant on the market, we're reliant on the market sadly...
This is the problem of planned obsolescence but in a medical context where it’s especially harmful. Why produce a lightbulb that lasts 2000 gotta when you can sell twice as many that lasts 1000 hours
Would shorten the patent expiration on chronic treatment help address the problems? Making chronic trainer competitive and cheap would discourage the tent seeking behavior.
When it comes to curing some chronical conditions, I am intrigued by the research of Prof. Roy Taylor of Newcastle University, England.
Taylor et al. have been studying effects of short-term fasting on diabetes 2nd type and they claim that they can cure or at least significantly improve the condition by fasting, especially if the fasting therapy is introduced soon enough after the initial diagnosis of T2D. Even NHS England is paying attention to their work.
This is about as cheap cure as it gets. Eating nothing for some periods of time does not cost any money and there are no patents/royalties attached. The only trouble is that it might be less comfortable than taking pills.
If Taylor is right, we could get rid of a significant part of our disease burden. Fast food producers would fall on harder times, though.
This was indeed good news. But most obese diabetic people find it nearly impossible to follow such a diet. I have such a diabetic friend who is trying, but even with the Covid quarantine and his daughter policing his diet he has yo-yo'ed in weight, losing 35 lbs only to regain 15, partially due to his cravings for snacks & candy bars that he smuggles into the house or eats while out.
A possible 'solution' is for governments to offer lucrative bounties on cures, e.g. $50b to cure Thyroid cancer. And then have the cure's IP freely available.
More and more as our capabilities increase we have more options than ever before in deciding what to do and how to do it. In the past, any treatment for any prevalent condition was a no-brainer benefit to society.
Now we're heading into territory where our government+economics+capitalism is a solution to an X-Y problem. There will come a tipping point where capitalism is less efficient than alternatives. Healthcare is perhaps the largest, most visible, and pressing one of these. Once we recognize the pattern, more will become apparent.
Money should not be The Goal. It is a means to reduce friction in trade and we need to keep it in its place.
Historically, many cultures put medicine and spirituality under the same umbrella. A "medicine man" was both a spiritual leader and a healer.
You need someone to actually care about you to get you well. When their relationship to your disease is rooted in profit motive, the end result is torturing you so you die slowly.
This needs to stop.
I don't know how we fix our medical system, but such things exist to serve humanity. Humanity should not be a prisoner or slave to such garbage.
Healthcare is not "business". Well it shouldn't be anyway. Same goes for other essentials that one cannot do without such as food, water, air, etc. But the current system is insufficient (or unwilling to) to model this reality.
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[ 4.3 ms ] story [ 157 ms ] threadSo 100% nationalizing them would change the cost of a $300,000 per year treatment to ... $270,000 per year. Nobody is waiting for that. Frankly even a 30% reduction, the top of the line, would not really matter to people.
The only thing separating medicine and the profit motive will do is stop the development of new drugs. There's no way in hell the government will invest even 10% of what the private sector invests in new drugs. That would be a 10000%+ budget increase for universities. It's not happening. So drug and treatment development will slow to a crawl. So is it better to die because no-one cares to look at you at all than to die because someone doesn't want to pay for your cure?
Apparently it is, according to responses here, but I truly don't understand why.
And if that's what you want to do, let people die, then why not just legislate that you can't buy coverage for diseases with <N cases per year? That would avoid all the inefficiency.
MRI scans, which could sometimes mean the difference between life-saving diagnoses, or a missed diagnosis, were cheaper and easier to come by in the U.S. because clinics could run a scanner at a profit and specialize in MRI scans. Locking them away under government rationing destroys the cycle of signal and response a market can bring. We've seen this in other countries where it is exceedingly difficult to get one when you need one.
That doesn't mean there aren't sensible cases for government-funded research. But looking at the current health system with massive government interventions already in place and saying the problem is not enough government intervention seems like a mistaken conclusion.
Well, I don’t know which country you refer to but it’s not the case in France and lots of European countries where healthcare is totally free.
Yes you have to wait months for a scheduled PET scan or an MRI but you also can have access to one as soon as you enter the hospital as long as the medical team think it may save your life. It’s just ressource planning. I know it because it saved my life twice and for 0.00€.
edit : Just to be clear, I’m not writing this as « US bashing » but to help you consider that free and effective healthcare is totally possible and that working models already exists around the world. Free healthcare IS a solved problem.
Now you don't get 5 star service that the private healthcare has like luxury rooms and better food, but that's not the core focus when your life is on the line.
Because the USA pays massively more than anyone else for its medicine, it's logical that the USA has more pharma industry, producing more medicine, than anyone else.
But because the US Pharma industry is profit-driven, as TFA says, it is interested in making only profitable medicine. And as TFA says, curing things may not be profitable.
If the USA adopted socialised medicine, would we see less drugs but better outcomes? Would the pharma industry get more spread out, and less focused on making vast piles of cash in the USA and more focused on actual cures for everyone?
Put it like this: does a hypothetical Indian biochemistry genius with a passion for solving hard pharmaceutical problems work on some interesting but tricky disease in India that could save millions of lives, or do they go to the USA to earn lots of money creating expensive drugs for not-so-many rich people that doesn't even cure them?
In any case, the basic research behind >90% of US drug inventions is publicly-funded, with private companies productizing this research and reaping huge profits:
>This report shows that NIH funding contributed to published research associated with every one of the 210 new drugs approved by the Food and Drug Administration from 2010–2016. Collectively, this research involved >200,000 years of grant funding totaling more than $100 billion.
https://www.pnas.org/content/115/10/2329
Expensive treatments only seem bad when they're just about within reach then people pour all their money into it. Normal people just get old and die because there's nothing available to save them at any price.
It's a bit of both in my country with free healthcare because some treatments aren't funded by the government so poor people just die or endure the chronic condition while those who can afford it have the option to pay full price like those unfortunate Americans.
She was studying a potential product to 'cure' some disease or other. Apparently her initial tests on the company's product worked amazingly well, removing all trace of the disease with just a few doses.
She was excited to report this success to her boss, who replied "That's Horrible!". The company wasn't interested in a cure that requires only a few doses, but something that requires a longer-term rent-seeking subscription plan.
I would need more proof before being able to believe an executive team would throw away a sellable cure for an extremely low probability of finding a longer term rent seeking subscription plan.
As an example, the new Hep C medications are $80k+ per dose or something if I recall correctly, and Medicaid pays for it.
The latter, as reported by GP, doesn't seem very plausible.
Source is in this video, link starts at 5:35, watch until 8:15ish. https://youtu.be/J8vdDy7SN9k?t=335
The purpose of patents is to allow for a period to earn an ROI and then release it to everyone. Alternative could be taxpayers paying for it and it going into the public domain immediately.
no, that parenthesis, (in increasing amounts), is a feature of capitalism, not inherent to all human motivation. the need for ever increasing income stems from the need to provide capital investors with a return.
But I do not claim this is a scientific conclusion, I simply landed on this model as it seemed to match up with my reality.
What is attractive is social status - in capitalism this is linked mostly to wealth but that's not a given at all. Another thing that's attractive is stability, but that doesn't have anything to do with consumption, in today's world it means having stable access to housing, ideally owning it, mainly.
Having access to shelter in a desirable place is currently one of the best signals about one's ability to procure resources and I would categorize it as consumption. You can have stable access to housing where few people want to live, but it will not help you in attracting from a larger pool of mates (if that is your goal).
Its not a signal of the ability to procure resources, it's that housing is the single most major cost and homelessness is the most major financial risk. What's attractive about it isn't that you can consume endless amounts of plastic and steel by proxy, it is that you eliminate risk.
In my opinion, that one can afford the single most major cost and avoid the most major financial risk is a possible signal of the ability to procure (or defend) resources.
>What's attractive about it isn't that you can consume endless amounts of plastic and steel by proxy, it is that you eliminate risk.
I agree. But I choose to define the word "consume" in this context to refer to being able to walk away with a contested resource. The more contested the resource, and the more you obtain of it, the more you signal your ability to procure and defend it.
That is why I distinguished access to housing in places with high demand versus access to housing in places with low demand in my previous post.
Even in places with low demand stable access to housing is still attractive. It's just rarer in places with high demand. This is reproduced in many cultures, for example in some Arab countries "renter" is an insult to someone you are dating.
I do not understand what you mean by this, but I do not claim that "all housing does is signal income".
Let me re-characterize my statement for the basis of this discussion, which is that the vast majority of people would have an ideal goal of earning an ever increasing amount of money, regardless of capitalism.
My contention is that due to the way people rank themselves versus each other, they will be interested improving (or at least maintaining) their position in the rankings. Why would they want to rank themselves? I posit that it helps for attracting mates. One can even go deeper and attribute it to the function of an ego, or some mechanism in the brain that incentivizes one to assert their priorities over others', allowing them the ability to not only survive, but compete.
Going back to your initial reply:
>What is attractive is social status - in capitalism this is linked mostly to wealth but that's not a given at all. Another thing that's attractive is stability, but that doesn't have anything to do with consumption, in today's world it means having stable access to housing, ideally owning it, mainly.
I agree that it is about social status, which is what I am referring to by people ranking themselves (and each other). But money or not, the root of the ranking is power. Who has more power than who. Money is a proxy for power, which can exist with or without capitalism, so as long as there is money, I would bet that people (in general) will want more and more of it.
It would never be the case that a single researcher does some tests and reports them to the boss except in the very earliest stages of drug development. The "boss" in this situation would be another research scientist, far removed from business strategy.
Even then, success in a petri-dish doesn't mean much - it would be years of research with a large team to determine if it was safe and efficacious in human trials.
The idea that the pharma industry suppresses viable medicines because they are "too good" is just conspiracy theory.
By the time a company has spent that amount of research effort and money, there's no way they'd just abandon a drug because it isn't rent seeking enough. Businesses want to recover whatever investment they can.
There's little reason NOT to make money on a developed drug.
Could create it and make a profit selling it.
If the cure generates less profit than current treatment, and if you’re currently selling treatment, then that’s not going to be worth it for you.
If you don’t, well you still need to get it to market, which requires substantial investment.
My point is that the described scenario is not entirely unlikely. For example, type 1 diabetics in the US need something like $600 worth of insulin, every single month for the rest of their lives. Say that’s 60 years, you’re looking at $430k, not even counting needles, sensors, and other stuff they might need (or absolutely need). Average patients won’t be able to cough up nearly as much for a cure.
Pharma has just been way faster than tech in realizing that the subscription model has far better yields.
Your idea only works if you believe there is a global conspiracy of businesses and scientists who all agree to embargo research into cures, and who are all willing to forgo any profits on the cure while also recognizing any scientist and company not in their conspiracy could wipe out their profits at any time.
There is no "global conspiracy" required at all. Not actively doing research towards reducing your own profit is enough.
Outsiders could theoretically come in, yes. But the hurdles are huge for biotech startups, and of course the established players are lobbying to keep it this way, so I won't be holding my breath. It's different from the tech world.
There is no need for a global conspiracy. Just a little lobbying.
This is the right approach, both for a company and for society. In fact, it's so obvious, that it's weird anyone thought they needed a report to say it.
Even if you only look at the business side (instead of the human side), only developing chronic treatments instead of cures only makes sense if there's no cure on the horizon. Once there is a cure, the people who sell endless treatments will lose money (they'll make basically nothing & they'll have a lot of sunk cost they can't recoup), while those who sell the cure will make practically all the money.
Besides, the people who run companies also have bodies (who knew?)), as well as family & friends with bodies. Eventually they'll want those cures too.
Why would they release a cure when they could make more money releasing their own chronic treatment instead?
People will travel to rogue jurisdictions that choose to make money by defecting, some may even invalidate patents like India.
You can't go to India for a cure that doesn't exist.
Once there is enough research, you can have grey-ish market commercialization.
cancer immunotherapy works, and at times (maybe even often) is curative. Same with stem cells. Zolgensma, a one time cure that costs 2 million dollars, also exists.
Public goods funding as a thing also exists.
I'm not so pessimistic about it. There is still a profit incentive.
This is only true if a company is confident that all other companies are also not working on a cure. That may be feasible when dealing with a local service or commodity (as you only have to come to a wink wink agreement with other companies in the local area) or when only a few companies control a large amount of a limited resource (like OPEC). That does not work well when dealing with an idea or technology.
Any company anywhere in the world could decide to research a cure. A Nation State-run research group could do it and just give the patent away. It is virtually impossible to get all of them to not research it, and if any of them anywhere find a cure, your treatment profits fall off a cliff. So it makes fiscal sense to sell the treatment, use your market position to get the best data on the condition, and research a cure so you can be first to market and control the distribution of the cure and ensure that the profits go back to you.
The more complicated answer is that if it's something poorly-understood where you came make different-but-similar treatments that will work better for some patients than others, and the current patient base isn't fully covered, there's still lots of incentives for treatment. Look at something like chronic inflammatory/immune stuff, and all the biologics out there.
But then the answer to "why didn't someone just develop a cure" isn't just economics and greed, but also nobody knows how.
In the surgical space, we actually do push expensive procedures over chronic therapy fairly often for things like joint or back issues. Of course, in that case, the economics are obvious - the surgeon and facility make their money that way. So if you can similarly convince the governments and insurance companies that your expensive cure is gonna save money compared to a lifetime of treatment (for surgery, this is being increasingly questioned, even), you can charge a lot for it.
Because the probability of finding a cure, chronic or not, is extremely small.
The right approach for a company is to give up making medicine. Why would you spend billions of dollars on scientists to research a cure and fighting the bureaucracy for its approval, only to have the people and the government turn around and scream at you that they cost too much, and demand you should give them away for free? Heck, just look Biden giving away the coronavirus vaccines — not buying the vaccines (or licenses to the vaccines) and giving them away, which would be eminently defensible and a fine expenditure on foreign policy outreach — just saying it'd be fine if no one enforced the IP rights on these things, giving away someone else's work.
So forget it. If the dollars work out so that the smart investor should spend his money on something else, it will happen. Will this result in fewer cures? Yes, but society has decided punishing people for making money is a more important priority than actually finding these cures, and our democracy operates on the premise that we've made our bed, so we can damn well sleep in it.
(There will of course continue to be a few cures coming out of publicly funded research and academia, but if they need to fight for grants with every other project out there, there's no way they'll have enough money to have the same output.)
There's also an episode of Star Trek: The Next Generation in which one alien planet has hooked a second alien planet's entire population on addictive drugs, having convinced the addicts that withdrawal symptoms are a terrible, incurable disease that the drugs are treating.
Parent's point is well received: it's much harder to be a startup when you need to fund laboratories, complex supply pipelines, diverse and deep know-how, interaction with government agencies etc.
It's not like you have AWS for medical doctors.
Until about 25 years ago, the normal bolus insulin was Regular insulin, which is just like what your body makes. However, injecting it into fat makes it work more slowly, so you'd take it a half hour before eating, and it would peak a couple hours later. Currently bolus insulins are a genetically tweaked version that allows the body to absorb it more quickly, within a few minutes, with a peak in an hour or so. In the human body, there's an even faster phase 1 insulin response, but to get it as a type 1, you'd need to inject insulin into a vein. It can be done, but it is considered extremely dangerous.
Basal insulins are generally regular insulin mixed with something to delay action or modified to do the same. Older ones like NPH needed to be taken roughly every 12 hours, but had a relatively high peak, which sometimes meant you needed to time a snack to deal with that. Newer ones offer a much flatter action curve, and can often be taken just once a day.
We also need to start putting in sunset provisions in laws of this nature. Governmental intervention in the economy should have mandated expiration/review dates.
https://en.wikipedia.org/wiki/Orphan_Drug_Act_of_1983
It seems simple, but only if you know it. Managing means you have at least two factors that form a 'dynamic,' so that there is a differential between them that you can extract variable levels of value out of. Managing a team means you have different people whose work is like cylinders of an engine firing at different times to create continuous motion. Some people have a knack for maintaining the equillibrium that produces power. Managing a product is a dynamic of market demand and feature cadence that produces sales.
From this perspective, a disease is a dynamic, however dubiously ethical it may to treat it as one, whether as a business making money or a government effecting policy.
However, curing patients is only a business model insomuch as you can produce cures dynamically to create a cure-machine to rent out. From a business perspective, curing diseases is zero-sum and destroys long term value. If you cured covid, the ~$100bn+ of value you created would be a one-off, and it would remove a powerful dynamic from both government and industry, and just be another relatively small capital management problem instead of a long term growth disease mangement problem, like say, periodic booster shots.
Solving problems collapses uncertainty and in-effect, destroys opportunity for people who use the dynamic to manage the world. Viewed this way, disease management is not a conspiracy, it's just a lot of people with a certain skill set who respond to the same incentives. It's truly a banal sort of evil.
(edited to remove digression)
Prior to Sovaldi, the best selling drugs were Lipitor, then Humira which made ~$10B per year at peak worldwide (peak being a decade or more post launch). Think about the time value of money when your R&D investment hit peak revenue 10-15 years later.
Sovaldi made $12B in its first year full year. What did Gilead make across all its hepatitis C drugs that year? $19B. That blew all records out of the water. And 6 years later it’s pulling in $4B. Note this is in an industry where exceeding $1B at peak is a success.
The hepatitis C cures are an absolute blockbuster by any stretch of the imagination.
https://www.evaluate.com/vantage/articles/data-insights/hep-...
Maybe we need to start paying for cures like we do chronic treatments?
Ultimately you're never going to be able to coax the market into valuing 40+ years of rent over a cure.
Taylor et al. have been studying effects of short-term fasting on diabetes 2nd type and they claim that they can cure or at least significantly improve the condition by fasting, especially if the fasting therapy is introduced soon enough after the initial diagnosis of T2D. Even NHS England is paying attention to their work.
https://www.ncl.ac.uk/magres/research/diabetes/reversal/#pub...
This is about as cheap cure as it gets. Eating nothing for some periods of time does not cost any money and there are no patents/royalties attached. The only trouble is that it might be less comfortable than taking pills.
If Taylor is right, we could get rid of a significant part of our disease burden. Fast food producers would fall on harder times, though.
More and more as our capabilities increase we have more options than ever before in deciding what to do and how to do it. In the past, any treatment for any prevalent condition was a no-brainer benefit to society.
Now we're heading into territory where our government+economics+capitalism is a solution to an X-Y problem. There will come a tipping point where capitalism is less efficient than alternatives. Healthcare is perhaps the largest, most visible, and pressing one of these. Once we recognize the pattern, more will become apparent.
Historically, many cultures put medicine and spirituality under the same umbrella. A "medicine man" was both a spiritual leader and a healer.
You need someone to actually care about you to get you well. When their relationship to your disease is rooted in profit motive, the end result is torturing you so you die slowly.
This needs to stop.
I don't know how we fix our medical system, but such things exist to serve humanity. Humanity should not be a prisoner or slave to such garbage.