I think this is a great "test case", so to speak, for a kind of modern, market-hybrid, computer-enabled central planning. Insulins, even highly effective modern insulins like Lantus (insulin glargine) and Humalog (insulin lispro), are very easy to synthesize in vast quantities, are made from cheap precursors, and are relatively easy to deliver compared to other drugs, requiring only commodity refrigeration. They are expensive literally only due to greed and the inherent inefficiency of the capitalist system in delivering life-critical services.
In addition, the state has an inherent interest in improving the lives of diabetics in this way; many type-1 diabetics rely on state programs to afford their insulin due to price-gouging, so the state may actually save money by doing this.
Same folks that historically develop most drugs and health advances, academic and national research labs.
These kinds of questions always have this undercurrent that capitalism+pharmaco is the answer to everything. I am not going to litter this with hedges, but to prescribe that solutions need to be solved a certain way is manipulative.
> Same folks that historically develop most drugs and health advances, academic and national research labs.
As far as drugs are concerned, this is simply not true, not even close. I believe the actual fraction of new drug approvals developed by academic research (including national labs) is more like 20%.
Pharma can afford the trials. The molecules are developed by research funding. There isn't anything _special_ about pharma vs public research. They all employ the same folks.
> The molecules are developed by research funding.
Also incorrect. The underlying scientific knowledge driving new therapies is overwhelmingly academic in origin, but academic research does very little actual drug discovery. I think the practice of university PR departments writing stories like "university professor discovers new cancer treatment" every time someone finds an effective in-vitro inhibitor has contributed to the confusion; most of these "drugs" never make it out of trials. Even for major advances like immuno-oncology and CRISPR that originated in academic labs, it takes many years of development (and hundreds of millions of dollars in private funding), most of which will not result in breathless press releases.
There are many good arguments for changing the incentives and IP laws involved in biomedical science, but "academic labs will pick up the slack" is not one of them, and fundamentally misunderstands what academic institutions do well (or poorly).
> drug approvals developed by academic research (including national labs) is more like 20%.
By your own admission, the number is quite high. I am talking about capabilities that can be enhanced. Not the ways things currently are. Nothing precludes the NiH funding drug discovery and manufacture.
All we need are immortalized mouse kidney cells of the right flavor, but everybody close to the problem benefits from the GMO Chinese mouse industry. /quantumly uncertain sarcasm/
This debate is tiresome, and is the Ctrl-V'd response to every article that even implies we Americans pay too much for healthcare. I realize this particular subject is insulin, but really Diabetes is just the poster child for the larger issue. Is it not a problem that we bankrupt ourselves for the medical necessity of keeping ourselves alive? I don't understand how you can look at the current situation and say "Not broken, no need to fix"
Americans are bankrupting themselves through a mixture of overeating, substance abuse, and sedentary lifestyles. As a society we are getting sicker every year. We should do more to reduce the prices of insulin and other biologics, but that won't solve the fundamental problem. Much of the insulin used today is by type-2 diabetics, and the vast majority of those cases are caused by lifestyle.
You say it "won't solve the root problem" but it literally will solve the root problem for type 1 diabetics - a lack of insulin! The only more "root" you can get there is, like, regrowing beta cells I guess?
The relevant question from philodelta was about how to stay alive without going bankrupt paying for insulin. Excessive insulin prices are a problem, but most type-2 diabetics can greatly reduce or even eliminate their need for exogenous insulin through permanent lifestyle changes. This is much cheaper (and healthier) than paying for insulin.
Yes they are, because any intelligent or rational capitalist will want to avoid competition and form monopolies. Some will succeed, because of economies of scale incumbents can easily keep out new entrants in many markets. Saying this isn't inherent to capitalism really sounds like the "that wasn't real communism" people. It's something that appears very frequently (always?) in capitalist economies so not addressing it isn't a very compelling argument
Not sure, "human condition" is poorly defined and we don't have experience of any true human condition that isn't deeply embedded in our current culture. Do un-contacted tribes have these things?
Either way, it's not really the point whether it's inherent to human condition. It's obviously a failure mode that can happen in lots of circumstances. I think the difference is that in capitalism it's highly incentivized by economics and culture and capitalism as a system doesn't have many great defenses against it. Anti trust legislation is as you pointed out vulnerable to regulatory capture.
I think capitalism stans would have more credibility if they would acknowledge that any complex system for distributing resources will obviously have edge cases and failure modes that need to be addressed. Denying that anything is the system's fault again just sounds like the "that wasn't _true_ communism" people
"Two years later Banting and his colleagues, Charles Best and James Collip, were awarded the US patent for insulin. They sold it to the university for just $1, and Banting refused to put his name on the patent. For a doctor to profit from so essential a medical intervention would be unethical, he believed."
My God. What happened to the world in the last 100 years?
Don't fall prey to the fallacy of rose colored glasses. Greed and unethical behavior has existed perhaps since the dawn of human civilization. The richest man in ancient Rome (Marcus Licinius Crassus) operated like something in between a private equity investor and a gangster:
"The first ever Roman fire brigade was created by Crassus. Fires were almost a daily occurrence in Rome, and Crassus took advantage of the fact that Rome had no fire department, by creating his own brigade—500 men strong—which rushed to burning buildings at the first cry of alarm. Upon arriving at the scene, however, the firefighters did nothing while Crassus offered to buy the burning building from the distressed property owner, at a miserable price. If the owner agreed to sell the property, his men would put out the fire; if the owner refused, then they would simply let the structure burn to the ground. After buying many properties this way, he rebuilt them, and often leased the properties to their original owners or new tenants." [0]
Business ethics and morality have varied widely across history. Of course there are stories like this from a similar time frame (Salk not patenting the Polio Vaccine and Florey not patenting Penicillin come to mind), but there are also plenty of counter examples.
I'd actually say that there's an argument to be made that we're living in a period of the best business ethics ever. This is mostly driven by regulation, empowered consumers, the current state of tort law (at least in the US) and wide availability of information. Stuff like Martin Shkreli bragging about cranking the price on live saving medication and then ending up in jail is a powerful signal to other business people not to behave like that.
Of course things ebb and flow, while the crass behavior of Crassus is noteable. So is the ethical behavior of scientists a hundred years ago. I don't think anyway would infer from the OP's comment that the world was always more moral or ethical.
> Martin Shkreli bragging about cranking the price on live saving medication and then ending up in jail
Shkreli was jailed for scamming investors, not extorting the sick.
This is just a failure of the US healthcare system. NovoLog costs like $40 in Denmark without any government subsidy and it's similar in other first world countries. Some don't charge you at all.
The reason for the high prices is mainly the involvement of insurance companies.
I've spent some time volunteering my expertise with the Open Insulin team (fantastic group of humans) and my experience is that while the effort is very worthwhile and necessary in the current corporate pharmaceutical environment, the reality is that this medication should be price regulated at the governmental level.
The "free market" has (once again) failed to provide anything more than wild overpricing and forced rationing of a drug that costs literally pennies to make. In this case, the situation being exploited is so cut and dry that it's hard for most reasonable people to debate it in good faith.
Hearing and understanding the real stories from people affected by this disease really makes you furious that some of our smartest people solved this problem, and the only reason we're still discussing it is because unethical people seeking endless capital grow don't care if people die.
Medicine will never be a free market because it isn’t subject to free market forces. Demand isn’t related to supply, and price isn’t related to either.
These aren’t consumer goods. People buy them because they are told they need them
I appreciate your activity in helping to bring insulin prices down.
For clarification, I want to add that the free market is working best when there are hundreds of suppliers as opposed to just one or even a handful of suppliers. In that light, more people taking up the challenge to manufacture insulin without taking a profit would be a good thing and could reduce prices significantly. I am too old, otherwise I would consider doing it myself. Many universities have scientists working on fermentation of genetically modified bacteria and yeasts. The resources and expertise are out there.
Or we could just cut out the middleman of private insurance like most of the developed world? I don't want 100 competing brands of insulin — I want my NovoLog and I want it at cost.
32 comments
[ 3.1 ms ] story [ 85.6 ms ] threadIn addition, the state has an inherent interest in improving the lives of diabetics in this way; many type-1 diabetics rely on state programs to afford their insulin due to price-gouging, so the state may actually save money by doing this.
> are very easy to synthesize in vast quantities
Biologics are not synthesized.
Same folks that historically develop most drugs and health advances, academic and national research labs.
These kinds of questions always have this undercurrent that capitalism+pharmaco is the answer to everything. I am not going to litter this with hedges, but to prescribe that solutions need to be solved a certain way is manipulative.
https://www.sciencehistory.org/historical-profile/frederick-...
As far as drugs are concerned, this is simply not true, not even close. I believe the actual fraction of new drug approvals developed by academic research (including national labs) is more like 20%.
Pharma can afford the trials. The molecules are developed by research funding. There isn't anything _special_ about pharma vs public research. They all employ the same folks.
Also incorrect. The underlying scientific knowledge driving new therapies is overwhelmingly academic in origin, but academic research does very little actual drug discovery. I think the practice of university PR departments writing stories like "university professor discovers new cancer treatment" every time someone finds an effective in-vitro inhibitor has contributed to the confusion; most of these "drugs" never make it out of trials. Even for major advances like immuno-oncology and CRISPR that originated in academic labs, it takes many years of development (and hundreds of millions of dollars in private funding), most of which will not result in breathless press releases.
There are many good arguments for changing the incentives and IP laws involved in biomedical science, but "academic labs will pick up the slack" is not one of them, and fundamentally misunderstands what academic institutions do well (or poorly).
By your own admission, the number is quite high. I am talking about capabilities that can be enhanced. Not the ways things currently are. Nothing precludes the NiH funding drug discovery and manufacture.
https://doi.org/10.3389/fendo.2019.00348
Cartels, monopoly, and regulatory capture are not inherent to capitalism.
Cartels, monopoly, and regulatory capture are inherent to the human condition.
Either way, it's not really the point whether it's inherent to human condition. It's obviously a failure mode that can happen in lots of circumstances. I think the difference is that in capitalism it's highly incentivized by economics and culture and capitalism as a system doesn't have many great defenses against it. Anti trust legislation is as you pointed out vulnerable to regulatory capture.
I think capitalism stans would have more credibility if they would acknowledge that any complex system for distributing resources will obviously have edge cases and failure modes that need to be addressed. Denying that anything is the system's fault again just sounds like the "that wasn't _true_ communism" people
My God. What happened to the world in the last 100 years?
"The first ever Roman fire brigade was created by Crassus. Fires were almost a daily occurrence in Rome, and Crassus took advantage of the fact that Rome had no fire department, by creating his own brigade—500 men strong—which rushed to burning buildings at the first cry of alarm. Upon arriving at the scene, however, the firefighters did nothing while Crassus offered to buy the burning building from the distressed property owner, at a miserable price. If the owner agreed to sell the property, his men would put out the fire; if the owner refused, then they would simply let the structure burn to the ground. After buying many properties this way, he rebuilt them, and often leased the properties to their original owners or new tenants." [0]
Business ethics and morality have varied widely across history. Of course there are stories like this from a similar time frame (Salk not patenting the Polio Vaccine and Florey not patenting Penicillin come to mind), but there are also plenty of counter examples.
I'd actually say that there's an argument to be made that we're living in a period of the best business ethics ever. This is mostly driven by regulation, empowered consumers, the current state of tort law (at least in the US) and wide availability of information. Stuff like Martin Shkreli bragging about cranking the price on live saving medication and then ending up in jail is a powerful signal to other business people not to behave like that.
[0]https://en.wikipedia.org/wiki/Marcus_Licinius_Crassus#:~:tex...
> Martin Shkreli bragging about cranking the price on live saving medication and then ending up in jail
Shkreli was jailed for scamming investors, not extorting the sick.
https://en.wikipedia.org/wiki/Martin_Shkreli#Criminal_prosec...
Because one action robs poor, for which we don't jail and the other action robs money from rich, for which we jail.
The reason for the high prices is mainly the involvement of insurance companies.
https://elemental.medium.com/biohackers-with-diabetes-are-ma...
https://openinsulin.org/
The "free market" has (once again) failed to provide anything more than wild overpricing and forced rationing of a drug that costs literally pennies to make. In this case, the situation being exploited is so cut and dry that it's hard for most reasonable people to debate it in good faith.
Hearing and understanding the real stories from people affected by this disease really makes you furious that some of our smartest people solved this problem, and the only reason we're still discussing it is because unethical people seeking endless capital grow don't care if people die.
These aren’t consumer goods. People buy them because they are told they need them
For clarification, I want to add that the free market is working best when there are hundreds of suppliers as opposed to just one or even a handful of suppliers. In that light, more people taking up the challenge to manufacture insulin without taking a profit would be a good thing and could reduce prices significantly. I am too old, otherwise I would consider doing it myself. Many universities have scientists working on fermentation of genetically modified bacteria and yeasts. The resources and expertise are out there.