I’m a little confused now about whether you guys want to argue against capitalist systems in general (which I don’t really want to keep doing), or if there is some argument why Pharma should be treated differently in an economy that is otherwise using a capitalist system for other industries, which is more interesting to me and where I might be able to add some insight how the industry works in the current status quo
Why would they need to be? FDA advisory committees for drug approvals are made of wide array of experts in various relevant fields who I believe generally are not part of the FDA otherwise. Doesn’t seem hard to imagine similar committees could guide development just as well as a rooms full of Shkreli type characters deciding where to ship the cash
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Because some people need drugs to live.
I don’t really care if the bourbon industry or the headphones industry or the role playing games industry is super capitalist or not. Those aren’t essentials.
Surely you can see why charging exorbitant prices for medicine because capitalism is potentially problematic.
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I don’t know anything about the FDA approval process, but this is definitely how NIH grants work.
The standard argument is that if there is no capitalism, then the companies would not be incentivized to develop the drugs and the wonder drug would not even exist in the first place.
That may be true, but is also kind of unfalsifiable. Who knows what innovation there would be if all the research was managed by the government?
But it doesn’t even have to be that model. Could easily have drug companies role converted to highly regulated non-profits doing their own thing and could still pay huge (regulated) salaries to their management/etc but cut out the funnel of cash to shareholders
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If you take away the market system then it is a single organization deciding which drug to invest in. That organization will have some hierarchy and culture which leads to bias (groupthink or otherwise). What asset to invest in or technology category to invest in is a very different decision than whether the data presented backs up the claim made by the people presenting it (what an approval board is tasked to do). Even big pharmaceutical often struggle with it because management of large organizations tends to be risk averse. It’s often smaller biotechs who are run by entrepreneurial true believers backed by venture capital that are getting assets to a stage where big pharma can take over. I just don’t see a government bureaucracy delivering that kind of innovation. I can’t think of any area where government has ever done that better than private markets.
I still don’t believe that the pharma rep is indispensable in this process. If it is published in a journal, some academic docs will surely read it and if it really works and provides some advantages (even if it is just for a certain subgroup), then they will present the findings at the conferences and so on.
A lot of these clinical trial happen at large academic institutions, because the pharma companies need some source of patients. So those docs running the trial will know and then their job is to publish stuff and speak at conferences so that they can get promoted and such. So I think there is little chance of something remaining undiscovered. Will the pharma company speed up the process with an army of reps? Maybe. But the pharma reps are also surely pushing some suboptimal drugs and treatments (e.g. newer expensive drug that is like maybe if you squint at the data just right 0.1% better than a virtually free generic treatment), so you would have to balance that against any perceived benefits.
I guess you either believe entrepreneurship is part of a secret sauce for innovation or not. I do, whether that’s in pharma, software, bourbon, or whatever. But this is getting back to a general argument about capitalism which I don’t really want to do because it will be never ending and no one’s going to change their mind
They’re going to make the same argument. Under your system they can’t get quite as rich so they have a bit less incentive to try to make magical drugs. Of course, this is also unfalsifiable.
Seems strange given NIH funded researchers are the backbone of the entire medical world’s advancement. Clearly there a role for entities outside of the government to help translate that to the market but they just as easily could be non profit entities
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Have we reached a level of advancement in medicine where it would be better if we made existing drugs cheaper and more available with no new treatments being developed and no new cures vs continuing to develop new shit but health care never becoming cheaper or more widespread?
Trials are often run by clinical research organizations but the data is collected and published by the sponsor company. The new drug has to win over regulators, prescribers, payers, and patients to be sold. Most industries you just have to win over the end consumer. The .01% better is an oversimplification because competing products might have different characteristics that make them better for different patient groups. So it’s often product A and B are comparable but for a certain patient A is much safer due to other medical condition or other product they’re taking and for another patient B product B is better for a different reason but for patient C the data is not clear and each company has compelling reasons it might be better.
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Pretty bold claim. Please elaborate
I don’t think so.
One of the funny things about health care (in the US anyway) is that it’s not enough that everyone has access to health care. Everyone has to have access to the best health care.
Imagine 2 alternative realities.
#1 everyone has cheap access to all health care that was developed prior to 2024. There is nothing better available and there never will be. Maybe if you’re rich you can pay for a team of round the clock nurses or something but no better drugs or treatments.
#2 the bottom 99% of the population has access to everything in #1. However, the top 1% has access to treatments that are even better.
It would seem that #2 is objectively better from a utilitarian standpoint, but I think if we had a vote, people would choose to live in the reality #1.
Most pharma PhD or MD researchers Ive know started out on NIH grants either during training or early career and take that knowledge private.
I think the taxpayer getting a shitty return on that monetary investment
Normally the primary authors on these studies aren’t full-time pharma employees. Generally, they are professors at a medical school. For some drugs it’s practical to do trials in a private setting, but even then the primary authors are general not full-time pharma employees.
However, I agree that the pharma company has to do a lot of work coordinating a study, especially if it takes places at numerous sites. However, that’s not (for the most part) a drug rep job. I am not disputing that the pharma company is playing an important role. I’m questioning whether we really need a pharma rep going by doctors offices and pimping the drug.
I guess if you’re counting the pharma company recruiting centers to participate in a drug trial as “educat[ing] and influenc[ing] doctors to adopt new and better treatments”, I’m fine with that. I thought you were saying that we really needed reps to be shills for the drug. I don’t think the reps are really necessary in the process.
I think the crux of our disagreement is that you think what I am saying is that “pharma companies are not critical” when what I’m actually saying is that “pharma reps (i.e. the kind that visit docs and try to persuade them to use their drug) are not critical”.
Agreed, but I was only talking about the prescribers. My comments were not related to any of the other players you have listed.
I understand that scenario may come up, I just don’t think the medical community needs drug reps to figure this out.
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And doesn’t a lot of their R&D dollars come from tax payer funded subsidies to boot?
I was initially thrown by your first sentence but I also question your second. Does it make a difference? In USA #1 hospitals and universities are generally not for profit entities but those are some of the most greedy actors and most fucked up industries. And with them, the not for profit means not for taxes. They still bank massive revenue, and behave like profit seeking entities with hundreds of MBA figuring out how to wrangle any little bit of customer surplus value into their pocket. Harvard is sitting on how many billions? At least Pfizer pays taxes
Corporate R&D excels at making things faster, cheaper, more efficient, etc. Big-picture stuff like putting things into space or decoding the human genome are what the federal government is outstanding at. Ultimately I think you want a huge chunk of research funding being directed by stuffy government bureaucrats who at least have a notional interest in the public’s well-being.
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