2024 LC Thread: Name That Tune

Politics & News
5773

Thanks for the well thought out post. It’s a coherent and well argued position.

I also think pharmaceutical industries are better than tobacco, for the reasons you say.

Likewise. Most people in the energy industry want to provide an essential service, keep the lights on, and address climate change.

Back to the question. You are right, the funds need to come from somewhere.

Your argument is that without all the drugs and dick pills aimed at rich boomers, there wouldn’t be any funding for life saving drugs development. I.e. they are creating the money they are spending.

My view is to cut out the middle man. Tax the fuck out of those rich boomers, then put the funding into Malaria research, AND other stuff like primary medical care, exercise programs, free insulin, and mass roll out of Ozempic etc, together with extensive research budgets into medicines where lives saved is the measure of success, not profit made.

Regarding your point around. “Well aids drugs wouldn’t even exist without the private sector”

Again, I would request you examine these ideas more deeply. This is the second time you’ve assumed the answer from pre existing assumptions rather than gone and done the work to find out if it’s true.

For example. The first effective AIDS drug was initially funded by the NIH (for cancer) in 1967, and the formula was public domain. It was then re-synthesized by a private company who then made it the most expensive drug in history…

HIV research has been heavily supported by government funding throughout. So while “HIV drugs were developed by private companies” is a true (but incomplete) statement, it does not follow that “HIV drugs could not have been developed without private companies” is true.

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5774

Thanks.

I think my argument goes further.

It’s not necessarily the profit extracted that is the problem. It’s the choices that is made in allocating resources.

Private medical insurance in the US massively overspends on hospitals and ultra expensive treatments, and under spends on primary care and preventative treatment.

Likewise, pharmaceuticals allocate resources to things which can be patented and sold, rather than things which save lives.

5775

Monstrously evil, quelle surprise

5776

I have to be in the top 0.0001 of political followers yet there is no amount of money that could get me to watch the debate. Listening to Trump for hours might be the single worst fate on this earth.

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5777

You are the one who made an absolutist statement. Just because I’m adding that some of the funding in this research isn’t just from investors or reinvested profits doesn’t mean I am making the opposite claim and saying none of the money comes from investors or reinvested profits.

There’s some disconnect here. What was my absolutist statement? Big Pharma isn’t allocating NIH money. They only get to allocate their own, that’s all I said. That’s what you quoted.

5778

Ok, prolly a nit and I could be wrong, but “allocate” is a little fuzzy and Pharma companies are getting grants. Perhaps that money is directed so strictly that there is no room to call anything companies do with it “allocating”.

5779

Everybody knows that technology is capitalism. But what this book presupposes is, maybe it isn’t?

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5780

Your argument is that without all the drugs and dick pills aimed at rich boomers, there wouldn’t be any funding for life saving drugs development. I.e. they are creating the money they are spending.

Not exactly my argument. Some life savings things generate enough revenue that industry will solve it. E.g. various cancer treatments, I expect in 10 years the industry will have much more advanced treatments for Parkinsons or Alzheimers, (if you’re a westerner with good insurance). And then further down the line those treatments will lose exclusivity and be available to others. But yeah Pharma needs to answer to shareholders and can’t just plow billions into an Apollo program for Malaria without some indication how they will generate a return on capital. If society isn’t willing to pay them to cure malaria then they can’t just gift their shareholders money except for amounts you would consider trivially insufficient relative to the human impact of the disease.

My view is to cut out the middle man. Tax the fuck out of those rich boomers, then put the funding into Malaria research, AND other stuff like primary medical care, exercise programs, free insulin, and mass roll out of Ozempic etc, together with extensive research budgets into medicines where lives saved is the measure of success, not profit made.

I think one doesn’t preclude the other. Government could do their own development of solutions where there’s a societal benefit but not sufficient demand due to patient not having the resources, and Pharma could continue to develop expensive oncology treatments or weight loss pills or lifestyle drugs where there’s a market for it.

Regarding AZT I disagree that Burroughs Wellcome (today part of GSK) should have been able to get a patent. And their actions are indefensible. There are a lot of bad actors in the Pharma industry (Martin Shkreli as an obvious example) and people who abuse mechanisms of regulatory capture. I think big players in the industry in modern day does better with patient support programs as tools to get drugs to patients who cannot afford them (in USA at least), but what happened with AZT is pretty shameful.

Regardless, AZT isn’t the main reason mortality has gone down in Africa, it’s HAART. And even after HAART was developed the components were constantly refined and improved by the industry. This is one of the things capitalism and competitive forces does well that I question would happen in a purely government run drug development regime. Companies like Merck and Roche developing slightly better versions of the same type of treatment which have different characteristics as the initial innovation gets refined into a varied and mor effective toolbox with different options (yes at different price points for the latest and greatest)

5781

For what it’s worth I agree with everything you’ve said here, although often the things which can be patented and sold are things that save lives. It’s really a situation where things that threaten the lives of poor people but not rich people get left behind

5782

Sure, lots of clinical trials fail, but it’s not like NH-funded research turns into useful therapeutics at a 100 percent clip, either. Instead, the NIH makes a lot of educated guesses. Of those, a few hit and often turn into windfalls for academic institutions via Tech Transfer licensing. Then of those, a few turn into actual things that make people’s lives better.

Private research isn’t willing to speculate as much, and the academic middlemen usually don’t have that kind of budget. Yet when tax payer funding pays off, the tax payer sees very little except some difficult-to-recoup taxes on the newly fabulously wealthy.

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5783

Yeah the biggest issue is the time horizon. Developing an asset takes 8-10 years today after the basic research is available and a target is selected. So funding that research involves a time horizon like 12-15 years and then there’s issues with time value of money and discount rates for private industry that make it economically unattractive. Government can be more long term and forward thinking and also has the lowest cost of capital. But generally they’re funding for public benefit of making science known and potential drugs available, not for the financial gain of the US treasury. Maybe the rules could be changed there to generate more ROI for the government but I think it would just cause the cost of drugs to go up and less assets to be developed rather than crimp the profit margins of Pharma

5784

Philosophically speaking, “society” has a very large purse of money government taxes and spending, much more than any business or sometimes whole industries, but also has to address a lot more things than even the largest company in the world. You can think of it as large companies get to choose to only do profitable business, and never spend on “unprofitable” things or recover from disaster, but societies don’t get a choice in having to deal with those issues.

A part of becoming a global economy is that protecting a whole continent or two from disease is a much cheaper and much more beneficial for the global society. It is certainly cheaper than not addressing the problem. It only takes fatality rates of 1-2% before the world needs to shelter in place or worse. So, it is in government’s interest to not only develop vaccines, but also subsidize drug development to private entities with the understanding that potential cures will be available for most people who need it. Like a vaccine shots or treatment drugs for a novel global virus.

I think there is middle ground in continuing to stimulate the pharma industry with riches (honestly no one 20 years ago realistically forsaw the size it would become), but also hold them to to the guarantee that they will not monopolize an inelastic market when it emerges, and even 10 years is way too long.

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5785

It’s something that could be tried. In general companies rarely monopolize a market for long because there are competing drugs even in novel areas (e.g. the COVID vaccines, PCSK9 inhibitors, GLP1 agonists all have competing products)

5786

ok, but the companies can’t effectively collude and duo-polize and stagnate the market with a handful of more-or-less competing drugs either. the drug formulations themselves are fair game, and NIH will need to force it becoming public domain. at least sometimes.

no idea if ozempic will pass the test of time, but if the public has to wait for 10 years to get a reasonable price on it, by which time the original patent holder might supercede the treatment with something newer and essentially shut out competitors for another decade, that also shouldn’t happen. there is a very clear case for strict regulation. if capital can’t play by those rules, i am sure there are altcoins and apes to collect.

5787

There is a non-zero chance he drops a N-bomb, but with our luck it will be when his mic is muted

5788

Not too crazy costs for people of upper to upper middle class income and access to health insurance and healthcare and no other major health crises or debt. aka, whoever can pay for it now, not the millions of people (many of color) without access to health insurance, let alone quality healthcare to even provide them this option in the first place - plus a nationwide shortage of the drug due to rich people using it as the new fad weight loss drug (lord forbid we cut the doritos, amirite?) while millions of diabetes sufferers, you know the disease that disproportionately affects those without healthcare, the poor, and PoC, that benefit far more from these drugs go without because of our glorious, perfect, inscrutable capitalism. Thanks obama/biden. 4 more years! 4 more years!

5789

He says what we’re all thiking! I like that he doesn’t cave to the woke mob!

5790

Almost a year to the day after Progozhin cut a deal with Putin to be assassinated rather than take over Russia, some general in Bolivia launched a shambolic coup attempt that immediately collapsed and ended up with him in jail:

https://www.washingtonpost.com/world/2024/06/26/bolivia-military-coup-attempt/

I can’t endorse the coup itself, but I admire the commitment to keeping the tradition of shambolic coup attempts alive.

5791

For what it’s worth I am not missing that part of it at all. I don’t have much to say. It’s not really fair to defend a current system where all the warts are visible with a poorly defined hypothetical alternative. I’ve said upthread I have a general belief that market based economic systems generally create better outcomes than centrally planned ones in virtually any industry. I understand in Pharma and medicine in general there are issues, IMO primarily due to the inelasticity of demand at the individual level.

I think others on the board who are closer to academia have a better picture of this than me, but I understand that even with the NIH funded research today, it is rarely just some government agency deciding what to research then doing that research in government labs. There are private institutions applying for grants and sometimes getting intellectual property out of the research. Is this how the industry would work? Johns Hopkins is doing drug development instead of Pfizer and applying for grants at each stage? Yes universities are nonprofit but nonprofit status doesn’t stop hospitals from charging exorbitant prices. Not sure why it would work different than drugs. Or are we proposing the government just do it all with a massive bureaucracy that decides what to fund, does the research with government employees in government facilities, then does the development and clinical trials?

What would be the model for launching a product at the end of the development cycle? In practicality how many projects would be killed halfway through because the party in power changed hands during an election? How would US government developed drugs compete globally with private companies based in EU or other countries. How would this impact existing trade agreements with the EU and other countries? How would they retaliate if they perceive our industry as an unfair subsidy?

Would the government have a bias for novel treatments or continue to refine existing treatments? Often the first product developed in a new category is superseded by better options developed by competitors and patients benefit tremendously from the diversity.

5792

Reasonable questions but I think kind of a situation of raising super specific questions just freezes thought on it in general. I’m sure would be some sort of mixed public/private model, would never happen until after a substantial change in US healthcare to be a more universal system in line with rest of world so focusing on that transition the more relevant thing first seeing as everyone else already done that

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