I’m here for the Mehdi Hasan-Jordan Peterson slap fight.
https://x.com/mehdirhasan/status/1804749915857518633?t=f2jPAM8dlYD4TwpsSvqTCA&s=19
Apparently, Twitter thinks it is unacceptable violent speech to wish for Peterson to go back into his medically-induced coma.
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I don’t think it’s obvious that government funded research would be superior to private market. To the contrary, there’s the same resource allocation issues you would have with central planning vs a free market in any industry.
And the drug development industry is not just research–>selling. Between R&D, development is like 85-90% of the cost of bringing a drug to market. And that’s precisely to answer your question. How can we ensure they don’t result in people dying? Or more specifically, how can we understand the safety, efficacy, and risk benefit equation for the patient populations we are bringing it to market for? It usually takes 3 stages of clinical trials with massively increasing costs, and a whole lot of smart capitalist investors determining if the investment is worth the cost of running the trials needed to generate the data that can answer the questions at each stage.
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How would the government decide how much to allocate between technologies like CRISPR, MRNA, stem cells, antibody drug conjugates, adeno-associated virus gene editing, or more traditional small molecule and biological drug development? I actually think it makes a lot more sense for government to run things like hospitals but still have private markets to develop innovative but risky new technologies. Private markets are better at driving innovation and allocating resources among many risky investments.
Not that anybody asked, but I agree wholeheartedly with the position that Pharma marketing expenses are way too big of a percent of the industry’s budgets. And marketing expense is still way too high in countries where there is no direct to consumer advertising. It takes a lot of money to educate and influence doctors to adopt new and better treatments, Pharma companies do it because it’s necessary to drive uptake. I don’t know the answer there.
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Probably is more expensive to wear doctors down with rep traveling all around to push 500 ten dollar lunches than one raging party in the Bahamas like in the past
I understand even those lunches are hard to get post Covid. Every Pharma is trying to do more of an omnichannel + influencer approach with the influencers being thought leaders in their particular specialty. I’m not really an expert in that though, I’ve never worked for the commercial part of the business
The NIH does this all the time.
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Sort by lives saved instead of profitability
This sounds sus to me. If a treatment is truly better, it really will sell itself, imo. Unless you’re saying the makers of the inferior treatments are bribing them also and you need to out bribe them.
I very much believe that if you build a better mousetrap the world with beat a path to your door.
But there’s lives improved, not just lives saved. Like is the value of birth control or Viagra zero? And this is what Pharmas do anyway. They have to negotiate pricing with governments and health insurers. There’s a field within the industry called Health Economics and Outcomes Research (HEOR) that basically does this, linking profitability to health outcomes. But it works better when there’s a supply side and a demand side both doing their own calculations and negotiating than if a single bureaucrat would make their own calculation.
Obviously I oversimplified and these calculations exist. But why would it work better now vs. the same system but without the need to negotiate with someone who cares about profitability?
Sometimes the new treatment comes out. The pharma publishes data in a journal. Most physicians aren’t reading every issue of every journal. So they find some specialist who is an expert in that therapeutic area and really is positive on their data. They pay them a consulting fee to present that at a conference for Oncologists or cardiologists or whatever therapeutic area the product is in and start to build a consensus. And a lot of doctors are actually skeptical of new drugs. Old drugs data efficacy probably isn’t as good but if you’ve been on the market for years there’s better safety data than a product that just cleared phase III.
More importantly it’s rarely new vs. old. More often the new product is competing with other new products in a similar drug class from competing pharmas. Like, for example, I have genetic high cholesterol. Mine is so bad it is too high even on the maximum tolerable dose of statins and a good diet. There is a newer class of drugs called a PCSK9 inhibitor which I take. There are 3 of those on the market (Praluent, Repatha, and Leqvio) Each of them got approved based on advantage of the standard of care (statins), but did not do clinical trials against each other. Different cardiologists are going to have different preferences as will my health insurance. This may seem like a waste but there are some people who don’t respond to Praluent who get a good result from Leqvio or vice versa, but still a lot of muddled data and cardiologists can be influenced by sales reps, MSLs, or colleagues.
The Pharmas are also doing observational studies post commercialization based on real world data (like health insurance claims) for competitive purposes but these are usually conflicting and more biased that a double blind phase III trial. Each company will be sending sales reps and MSLs to present data favorable to their product and offer a different interpretation of a competing company’s data (maybe the initial efficacy is lower but the treatment is more durable or whatever I’m not an expert on these kind of things)
Clearly it’s all about good faith education of doctors, everyone knows pharma reps historically have been chosen for their ethics, intellect and teaching abilities as opposed to any other attributes
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Partly because you’re often talking about assigning value to quality of life and there are different perspectives and judgements possible. A negotiation or adversarial system, is better than a single person’s judgement. Even better is a real market with multiple buyers and sellers.
This is also at the heart of the Economic Calculation Problem and I know this board will be like LOL Austrian school but I do see this as one thing they’re mostly right about
You’ve said this multiple times and I’m not sure why.
Are you suggesting it would be better if (like pretty much all NIH grants) the judgments were determined by a committee of experts? I don’t think there’s an argument there. I’m just confused as to why a profit motive is absolutely essential to the process.
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I doubt many sales reps feel they’re acting in bad faith. The truly believe in their products and have been somehow indoctrinated on their company’s perspective.
But of course they are measured on how much they can impact sales and the will be selected for those qualities because that’s what works
I can’t tell if you’re saying this as a defense or an indictment of the industry?
For one, I still think committees within the same organization and susceptible to groupthink.
Another reason is that drug development involves a lot of risks. The vast majority of compounds don’t make it to market. I think profit motive is the best way to guide investments in that kind of market. To use a cliche, profit gives clear signal where resources are valued in the economy. It you have data in phase 2 that’s not as promising as you expected but still potentially slightly better than the standard of care, should you invest 100s of millions in phase III? I think market forces provide better answers to that type of question than government bureaucracies. Maybe that’s my personal bias, but even the successful social democracies of our day do it that way.
I don’t know of any examples of socialist countries where development is centrally planned providing the kind of innovation we see in capitalist countries.
Neither, that’s how all industries work. Sales reps get trained on products. That training includes the company’s perspective on their products advantages over their competition and why their competitors’ messages should not be taken at face value.
Is Ins000(?) in pharmaceutical sales now?