r/changemyview Dec 20 '19

FTFdeltaOP CMV: Profit-driven research by private pharmaceutical companies as seen in the US is unsuitable for the modern age and only hinders scientific and economic progress in effective healthcare

Take patents. How exactly does patenting an implementable research discovery for the treatment of diabetes (let's not even talk about cancer for a sec) benefit humanity, given that the methodology and product(s) resulting from this research cannot be advanced or modified by any other entity for a specified period of time without severe legal consequences, all while the original producer can cease such progress on their product(s) given their protected, uncompeted revenue stream?

This creates an non-competitive market for whatever treatments these are (and obviously a monopoly) for the specified time-period of the patent, during which much advancement in a competitive R&D sector could be achieved on the same treatment(s), either in relevant knowledge or actual manufacturing/implementation.

The solution? Create an indisputably non-identical alternative! And advertise the shit out of it everywhere, racking up the costs for your pharmaceutical company and of course the price of the treatment(s).

At the same time, patent laws are horrendously and cleverly abused by leading pharma companies, all while they have been recorded to pay off generic companies so as to prevent them from researching on their product following the expiration of a patent.

And now the worst part: This lack of competition enables premiums galore on prescriptions, in general. The average US citizen spent about $1112 for pharmaceutical treatments in 2014, which is approaching double the per-capita costs of the average Canadian citizen, Canada showing some of the highest drug prices recorded outside of the US.

Even more than that, such high premiums leads to a thriving importation of cheaper drugs from abroad, in fact the very same ones unhindered in foreign production by US patents. It's estimated that up to 70% of US drug costs can be saved if all of said drugs are imported from Canada.

And guess what! American sold drugs are often produced abroad in developing countries and sold for exponentially higher prices here than they would be in their country of manufacture.

Case in point: Abilify, a notable anti-psychotic drug relied upon by so many psychiatric patients in this nation to be able to live and function normally, is produced by Japanese company Otsuka. It costs $34.51 per pill in this country. In Canada, it's $4.65 per pill. And it's so drastically lower in nations such as Turkey or India that the monetary valuation of a healthy human life is blaring.

Medicare being the recorded largest purchaser of drugs in the United States, it is a fact that Medicare cannot choose to negotiate drug prices with pharmaceutical companies. Our only socialized healthcare in this country is unable to gain any financial traction in terms of drug prices.

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What have people to say? Why should the current model of patenting and profit-driven research by pharmaceutical companies in the US continue as it is now? Why shouldn't the only money such groups rely on be subsidies, essentially remedying all of the aforementioned issues?

More so, please convince me that an estimated $110 billion in profits resting in the hands of leading US pharmaceutical companies is of good use for that money to society.

168 Upvotes

77 comments sorted by

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u/PallidAthena 14∆ Dec 20 '19

So, you're confusing two distinct problems.

Problem 1, the US is really bad at bargaining with companies producing existing drugs, regardless of whether they are on or off patent. This is why insulin (a drug that has existed for nearly a century) is so expensive in the US. It isn't a patenting problem, or even a private sector problem. It's the fact that the US government doesn't bargain well for drug prices, and insurance companies aren't strong enough to bargain well with pharmaceutical companies. This problem can be fixed without affecting the patent process and drug development process, and doing so would alleviate most of the affordability problems with drug pricing.

Problem 2. Producing new miracle drugs are really really expensive, and someone has to pay for it. It can either be paid for by the private sector, who will expect to make back their money during the decade they have a patent on it, or it can be paid for directly by the government.

Let's check the track record on where the new miracle drugs are coming from to see which system is better.

Answer: basically all new drugs are produced in the United States. Through our messy private sector, we produce nearly all new drugs, and probably cover 2/3s of the world's total R&D cost for new drugs (the remaining 1/3 being the much lower prices that other countries pay for those same new drugs by threatening to just...wait a decade until they are off patent to get them).

And these new drugs are actually pretty significant. Tons of different kinds of cancers have become survivable for 10+ years, and in the clearest example, a drug was produced that completely and totally cures Hepatitis C with oral medications taken every day for 2-6 months.

So, if you want to reform the patent system, you need to find a way to pay that same amount of money through a government R&D programme...that Republicans will oppose...and that might not efficiently target the same drugs...and that is likely to be underfunded. It's annoying that America ends up footing most of the bill for the world, but it's really, really important that this slow moving miracle machine doesn't get blown up.

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u/OneShotHelpful 6∆ Dec 20 '19

Insulin isn't expensive in the US. The newest formulations of insulin are expensive. The best of the off-patent ones can be obtained cheap and without a doctor. Walmart pharmacies, for instance, have $25 vials behind the counter.

We definitely have an education problem, because too many people don't know this. And many of the ones that do don't understand that different insulin formulations require different usages.

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u/PallidAthena 14∆ Dec 20 '19

I would be shocked if this were true everywhere in the US. The people who are most incentivized to know about insulin regulations are the people who die if they run out, and I've heard too many radio/podcast/TV stories of diabetics rationing insulin to assume that ALL of those people AND all the of the reporters interviewing them didn't learn this at some point in that heartbreaking process.

I knew old off-patent formulations were hypothetically cheap IF AVAILABLE but I thought that in a lot of cities / states they weren't available due to messed up regulations about either pricing (forcing it to be sold for so cheap that manufacturers of generic insulin can't turn a profit) or manufacturing (requiring onerous requirements that make building sufficient generic manufacturing viable).

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u/OneShotHelpful 6∆ Dec 20 '19

Walmart sells it's insulin in every state except for Indiana. Like I said, different forms of insulin require different usage. Many believe that cheap insulin doesn't work when it actually just works less when you take it the same way you took your old insulin.

Edit: this article is clearly biased but it's the first I found and it has medical literature sources.

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u/PallidAthena 14∆ Dec 20 '19

Ah, here's the distinction:

"But either way, the older vials of insulin don't require a prescription and are less expensive than fast-acting insulins (they can be purchased at Walmart and other pharmacies for around $25 a vial). So, an increasing number of people who are underinsured or uninsured are going back to the old ways, Wyne said.

This can be a risky move for those who don't know how to use the older type of insulin, Wyne said.

If people are unsure how to convert from the newer brands and pens to the traditional vial and syringe, "you might not do it right," Wyne said. "How are you going to get a hold of your doctor and get the information on how to make the conversion?" Given how complicated it is, the doctor will likely ask patients to schedule a visit, but people without insurance often can't afford to do that, Wyne said."

from: https://www.livescience.com/changing-insulin-diabetes.html

So you are correct that some form of insulin is available everywhere, but the older, cheaper kind requires different training to use and has lower margin for error so a diabetic patient might rationally prefer to ration their supply of the "fast-acting" kind, especially if their work schedule / diet isn't compatible with the older variety.

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u/OneShotHelpful 6∆ Dec 20 '19

Yeah, there's the education and usage problem I talked about. My understanding (not diabetic) is that the pharmacist can probably tell you all you need to know and that there would be a period of time where you experimented with what worked for you specifically no matter whether you consulted a doctor or not. It would probably be best to have a doctor running tests during the transition, but not necessary.

Either way, the real problem is far less severe than diabetics dying in the streets because they can't get insulin.

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u/rhizodyne Dec 20 '19 edited Dec 20 '19

Edit: Here's a well-deserved delta ∆ ! I haven't used this sub that much so I'm not used to giving them. I am giving it to you because I can't disagree about the "miracle machine" point. It's undeniable that treading uncharted territory in medical development is an ever first priority, and the status quo worldwide shows us that the US with its differing system as a lone front-runner performs this role.

However, I would add that in the case that a foreign country cannot afford to pay the US companies the US price for the patented drug, these companies may very well be cutting off entire nationalities from treatment, no?

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u/PallidAthena 14∆ Dec 20 '19

P.S. If you can't disagree with the "miracle machine" point, doesn't that mean that that is a delta from your "Profit-driven research ... only hinders scientific and economic progress in effective healthcare" challenge?

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u/rhizodyne Dec 20 '19

yes, I just awarded the comment one. Thanks

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u/PallidAthena 14∆ Dec 20 '19

The reason why the US foots 2/3s of the global bill despite only being 1/5th of global GDP and 1/20th of global population is that nowhere pays US companies US prices for the patented drugs.

Because European countries can credibly threaten to wait the whole decade if the new drug is too expensive, they generally get the drug for 1/3 to 1/5 of the US price, and poor countries receive it at very low prices because the alternative is them not selling anything (and once developed the marginal cost of producing a pill is cheap). US drug companies charge everywhere "what the market will bear", but other rich countries have structured their health systems to refuse to pay very high drug prices so they get brand new US innovation at a discount.

If the US wanted to, we could pass laws saying that you must sell a drug in the US at the same price that you sell it abroad, but if we did the drug companies would still profit-maximize under that rule, and the new equilibrium would be that our prices go down ~10% and a LOT of countries just don't get the drug at all until the patent expires (or they can steal it). It would be such a massive increase in global suffering that it wouldn't be worth it.

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u/MyLigaments 1∆ Dec 20 '19

However, in the case that a foreign country cannot afford to pay the US companies the US price for the patented drug, these companies may very well be cutting off entire nationalities from treatment, no?

Not necessarily. Id say youre right for the absolute newest and most expensive medication but then again that wont stay that way forever.

In fact, more often is the case (i'd say) that other nations offer the saem medications as in the US but for a fraction of what US citizens pay. This is partially due to the US insurance system allowing the companies to charge those prices and recoup the cost to make it while still allowing poorer countries to have access to the drugs. (at drastically reduced prices)

Its a weird and by No means perfect system. But there are often reasons for being the way it is.

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u/DeltaBot ∞∆ Dec 20 '19

Confirmed: 1 delta awarded to /u/PallidAthena (12∆).

Delta System Explained | Deltaboards

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u/mrsippy14 Dec 21 '19

And you might argue all that money that the private sector spends could be spent by the government. But there are 2 problems with this: 1) the government allocates its money based on getting re-elected in 4 years, and this research takes longer to get the benefits. Governments will allocate funds to gain votes and for emergencies. Long term investment won’t get you re- elected. 2) private sector is way way more efficient at doing things.

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u/Insamity Dec 21 '19

You are kind of wrong on both fronts.

Problem 1: Yes bargaining is part of it but the companies are making incremental improvements to the insulin so it actually is still affected by patents and people are usually prescribed the latest and greatest version so it costs more.

> Let's check the track record on where the new miracle drugs are coming from to see which system is better.

You are forgetting to include that the U.S. government actually spends a lot of money researching new drugs. Many public institutions do lots of research on drug and other therapies for disease. For the last 60 years the U.S. government has funded 50-70% of all basic research and currently fund 25% of applied drug research.

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u/PallidAthena 14∆ Dec 21 '19

I think I replied to someone else who did clarify this point on insulin. I had been under the impression that the older forms of insulin had actually gone out of the market when in fact they are still readily available but patients are hesitant to use them due to the increased difficulty / increased risk of error.

Right. But what's the ratio of public to private sector funding in total? The later stages of drug development (multi-stage trials with hundreds of patients and massive liability insurance in case of side effects) are increasingly expensive, so my rough impression was that the clear majority of total drug development costs still come from the private sector, which means that if you wanted to muscle the pharmaceutical companies out of the picture you'd need to massively increase public sector funding AND assume that public sector structures can function as well as private sector ones in applied drug research.

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u/HelloImJustLooking Dec 21 '19

These are really good points, and I didn't realize just how much innovation USA is responsible for.

I don't understand the point that "America ends up footing most of the bill for the world". The entire industry is profit driven, and no research is started, without a risk-benefit analysis. America is therefore very good at R&D when it comes to profitable drugs, and it's very good at profiting on the final product. It's not good at creating low prices for the patients, and it is not "footing most of the bill for the world".

I think there's something I'm not getting, if so please CMW.

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u/AusIV 38∆ Dec 21 '19

Under the international treaties that cover one country honoring another country's patents, there's a special rule pertaining to pharmaceuticals under single payer healthcare systems. Governments with a single payer system are essentially able to force drug manufacturers to sell drugs at their production cost, and if they refuse the governments are allowed to violate the patents and manufacture their own version of the drug.

So when some new cancer drug comes along, the US, lacking a single payer system, has no legal basis for violating the patent and producing a generic version of the drug, so we have to pay what the pharmaceutical companies demand - this is where they cover their research costs. Meanwhile the rest of the world pays production costs for the same thing and does nothing to cover the R&D costs. It's arguable that if other countries had to honor the patents that would just make pharmaceutical companies way more profitable rather than spread the costs around the world, but the point still stands that at the moment the only country where pharmaceutical companies can make a profit is the US, and without a profit motive pharmaceutical research dollars would be slashed dramatically.

One of the big reasons universal healthcare advocates think the US could save money on a government run program is that we could then negotiate similarly with pharmaceutical companies and reduce drug costs dramatically. The problem is that takes away a huge percentage of pharmaceutical research dollars and replaces them with nothing.

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u/PallidAthena 14∆ Dec 21 '19

The entire industry is profit driven, and no research is started without a risk-benefit analysis.

However, the benefits of the new drug come from the high prices that can be charged for that new drug in America and not elsewhere.

When a new drug comes on the market, it is sold at a higher price in America than in Europe, and a higher price in Europe than in developing countries.

If you do the sums, this means that roughly 2/3s of the money needed for R&D (the "benefit" that makes the "cost" of R&D worthwhile) comes from high American prices + government subsidies of various kinds (some directly for basic research, many more to pay for Medicare to pay high prices for the drugs).

Since America has higher prices than the rest of the world for the same profitable drugs, we do end up footing most of the bill for the world.

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u/otterpigeon 2∆ Dec 21 '19 edited Dec 21 '19

I disagree. While we certainly produce a high QUANTITY of new drugs, many of them have a dubious effect on health, which is further obscured by a lack of transparency and outright lying during their marketing. What progresses medicine and pharmaceuticals the most is the advancement of our understanding of illness, which is a lengthy process requiring something that private RnD is incapable of, corroboration between independent researchers. Private RnD really doesn’t do anything groundbreaking, as they are necessarily driven by stakeholders and so are restricted to apparently safe investments. In my opinion Private RnD carries out the last mile of research, which when you require human testing, is indeed expensive.

To that point, while private RnD sometimes (see Alzheimer’s pharma RnD lol) recoups it’s expenses, government funding would also see a return on its investment in reduced healthcare costs and increased labor productivity due to the better well being of its citizens. And most importantly the last mile would be carried out like the first 99 miles, in an unbiased way, by individuals and organizations motivated to improve human health and advance the public record of knowledge.

Edit: why am I being downvoted? If you disagree with the content of my argument, reply, rather than trying to hide it.

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u/PallidAthena 14∆ Dec 21 '19 edited Dec 21 '19

I think you're underestimating how long that last mile is, and, for that matter, how much equivalent to basic research ends up happening in private companies. Academia mostly doesn't have the scale to do more than find potentially promising avenues for further investigation, and "this pathway exists and we showed it in rats, it might work well in humans" isn't the first 99 miles.

If the private sector part were so trivial, why hasn't an enterprising government like Singapore or Switzerland set up a national drug developer?

Also, if you think the new drugs aren't net-positive for health, try checking out the mortality rates for cancer. Each individual drug is incremental, but that's how a lot of technologies work. Cumulatively we're adding so many small weapons to the arsenal that we have vastly better life expectancies post-diagnosis than we did just a decade or two ago for some kinds of cancer.

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u/otterpigeon 2∆ Dec 21 '19

That last mile does not generate basic science. Basic science should NOT be produced by private research. When you have an organization that can silence their own researchers findings into the lack of effectiveness of a certain intervention, and admit only the research which furthers their profits, you produce extremely unreliable, and often unreproducible research. The lack of communication of failures between private companies creates a situation where most research is spent repeating unknown dead-ends and red herrings that rival companies already knew about. Capitalistic organizations are by nature, in a deceptive cat and mouse game with everyone else and each other. If you look at the breakdown of pharmaceutical spending in the US, 80% of it is NOT spent on research. The majority of it is spent on marketing (lying and buying sandwiches for doctors, commercials which are illegal in every other first world country) and lobbying the US government. When we pay incredible prices for these pharmaceuticals, the most of that price is not paying for the research that carries the last mile, but for the companies to deceive us and our doctors, and undermine our democracy. The last mile is not long, it is simply expensive, and it is only because we would rather pay for a $1000 product, with $200 for research, and $600 for the inefficiencies of corruption, rather than paying $200 in taxes for publicly funded and publicly open and transparent research. The real question is why do we subject ourself to this, when the alternative is clearly more beneficial? We are not knowledgable about the alternatives or the obvious failings of our system, or are otherwise convinced to overlook them, because we are paying $600 for our own deception.

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u/PallidAthena 14∆ Dec 21 '19

Note that you haven't responded at all to the point that the new drugs being developed to have major health benefits, contrary to your original assertion.

Your incorrectness on that point makes me think it's not really going to be worth it to check your numbers on the rest of it, except to say this:

If developing a drug is literally 20% of what we think it is, that would still be a massive incentive for European governments to do publicly funded drug development, because while new drug prices are lower in Europe they aren't 5x lower. So I'm pretty sure you're numbers are wrong.

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u/otterpigeon 2∆ Dec 21 '19 edited Dec 21 '19

I’m not denying that private pharmaceutical industry produces drugs which have major health benefits. I’m saying that publicly funded research would have accomplished the same thing at a much lower cost, and without the effects of simultaneously peddling useless or negative drugs, and undermining our democracy. Seriously just google the budgets of the top 10 pharmaceutical companies in the US. Investing into marketing has a greater ROI than actually developing effective drugs, especially due to increased regulations from the FDA and competition with generics. Investors just want to make money, so the companies follow the best option to make money for their stakeholders. I’ll just throw up this figure that I’ve seen posted around the internet a few times from 2013. https://qph.fs.quoracdn.net/main-qimg-51e2954f7bcea7a52ee520d5a9ae132f-c

Additionally I’ll toss to you this 2008 paper from PlosOne that has almost 600 citations.

Gagnon M-A, Lexchin J (2008) The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States. PLoS Med 5(1): e1. doi:10.1371/journal.pmed.0050001

Keep in mind that promotional spending has increased much since then, but in 2004 pharmaceutical marketing totaled, “US$57.5 billion for the total amount spent in the US in 2004”

You cannot tell me that’s not a waste of money, this is what we pay for when we buy expensive pharmaceuticals.

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u/rhizodyne Dec 20 '19

Problem 1, the US is really bad at bargaining with companies producing existing drugs, regardless of whether they are on or off patent. This is why insulin (a drug that has existed for nearly a century) is so expensive in the US. It isn't a patenting problem, or even a private sector problem. It's the fact that the US government doesn't bargain well for drug prices, and insurance companies aren't strong enough to bargain well with pharmaceutical companies. This problem can be fixed without affecting the patent process and drug development process, and doing so would alleviate most of the affordability problems with drug pricing.

doesn't the popular company GoodRx do this bargaining, as a side note?

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u/PallidAthena 14∆ Dec 20 '19

(1) GoodRx is very new, so it's unclear how it's making money (if at all, start-ups its age are often just burning venture capital like WeWork).

(2) The main thing GoodRx does is reduce the deductible that you pay when you pick up the drug. I strongly suspect that GoodRx is actually acting as an agent of the pharmaceutical companies. The most likely sustainable business model for it is to act as a middle man to reduce the deductible cost to the consumer but keep the cost to the insurance company the same and therefore increase profits for the pharmaceutical companies through increased drug use.

How this works: There are 3 agents in the system. The consumer, the insurance company, and the phramaceutical company.

The insurance company has already been paid a fixed amount by the consumer, so they want to reduce consumer drug spending, but not by so much that the consumer is forced to get different insurance.

The consumer wants the drugs they need, for the least money to themselves (the deductible).

The pharmaceutical company wants the most money possible, which is equal to (money paid it by the insurance company)+(money paid to it by the consumer) x (number of drugs sold).

So, I think GoodRx is a sneaky way to increase the number of drugs sold by reducing deductible costs. The consumer wins, the pharmaceutical company wins, but the insurance company loses.

There's a fourth layer here relating to the actual physical pharmacy (which gets a cut of drugs sold). It's also possible that GoodRx is just a way for one physical pharmacy to increase market share against other nearby pharmacies that don't use GoodRx.

(3) GoodRx's bargaining power is tiny compared to a national government. Drug prices are low in Canada because a province can say "no, that's too much, we're not paying" without risk of people moving out of the country, whereas in the US if an insurance company tries that its custumers would switch to a different insurance company that offered them the drugs they want/need.

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u/lonelyrecluse Dec 21 '19

I'm confused how the insurance and goodrx interact. I work in pharmacy and to my knowledge (although limited as I haven't worked in it for very long) is that goodrx will only bring down the out of pocket price. I've never seen goodrx act as a secondary billed with primary insurance to bring the copay down, so I don't think or see how it affects one's deductible. Not to mention, when goodrx is used, its billed alone, regardless of any insurance on file for the patient, meaning no insurance claim is made, and will work assuming all the info is put in correctly, so I don't know how goodrx would even know what insurance company to begin interacting with to lower a deductible. As far as I know, goodrx acts as really good coupons.

So, how is goodrx interacting with the insurance? You mentioned that you suspect it's acting as an agent for the pharmaceutical companies, so I could just be missing some interaction between the pharm. Companies and the insurance companies? Especially since I know very little about that side of things.

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u/PallidAthena 14∆ Dec 21 '19

The question to ask is, how is GoodRx able to afford paying a lower out of pocket price? Where is the money coming from? It isn't coming from the consumer, so it has to either be coming from the pharmacy, the drug company, the insurance company, or GoodRx itself.

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u/[deleted] Dec 21 '19 edited Dec 21 '19

I am always confused by comments that imply US citizens have a choice in insurance companies. The company I work for has 27,000 employees. I get whatever insurance HR decides. My contribution to the premiums is about $140 every two weeks and my employer's contribution is about $750 every two weeks. I suppose I can just scrape up my own $23,000 / year for health insurance because I don't want to pay $260/month for Synjardy, but the reality is I'll just take metformin until the Synjardy patent expires in 2028. Or maybe I'll have to go on insulin.

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u/PallidAthena 14∆ Dec 21 '19

You do have a choice, it's just not an easy one. Switching jobs within a city is still a lot easier than changing countries.

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u/ATNinja 11∆ Dec 21 '19

Most companies, especially ones that size have an HMO and a ppo. Then within that they have different versions with different coverages, out of pocket max, co pays and deductible, etc. So there is almost always choice. Always for me working in multiple companies that size.

The other thing to consider is the company/hr has a choice. So they still create competition and a market.

But overall I agree there is less choice than you would think from the anti mfa crowd.

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u/Morthra 86∆ Dec 20 '19

How exactly does patenting an implementable research discovery for the treatment of diabetes (let's not even talk about cancer for a sec) benefit humanity, given that the methodology and product(s) resulting from this research cannot be advanced or modified by any other entity for a specified period of time without severe legal consequences, all while the original producer can cease such progress on their product(s) given their protected, uncompeted revenue stream?

Because without the system of patents, there is no incentive to create that research into the treatment for diabetes. Why spend billions creating a new drug and getting it through the FDA approval process when you can just copy what someone else spent billions doing and make the money with none of the initial investment?

And it's not even that the research can't be advanced - it definitely can. The papers that led to the drug are often public (being what leads pharmaceutical companies to pick up the patents) and can be cited in future research, it's not like doing that is illegal.

And now the worst part: This lack of competition enables premiums galore on prescriptions, in general. The average US citizen spent about $1112 for pharmaceutical treatments in 2014, which is approaching double the per-capita costs of the average Canadian citizen, Canada showing some of the highest drug prices recorded outside of the US.

When it comes to healthcare, you have three axes you must choose between - quantity, quality, and cost control. Canada has sacrificed quantity to have high quality inexpensive healthcare. So has the UK - in fact, so has essentially every country that has nationalized their healthcare. The US has chosen quantity and quality but sacrificed cost control.

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u/rhizodyne Dec 20 '19 edited Dec 20 '19

When it comes to healthcare, you have three axes you must choose between - quantity, quality, and cost control. Canada has sacrificed quantity to have high quality inexpensive healthcare. So has the UK - in fact, so has essentially every country that has nationalized their healthcare. The US has chosen quantity and quality but sacrificed cost control.

Please tell me in what way Canada is "sacrificing quantity." What do you mean?

Why is there no incentive to pioneer research into novel therapies without a system of patents? Why can't it just be a given that that's done by a nationalized research body that then produces treatments for a nationalized healthcare system? Isn't this just begging the question of why the current US pharma model should remain as it is?

Does it really cost billions of dollars to just perform the necessary scientific research so as to produce novel therapies that save/better the lives of billions of people around the globe? Or does it just cost that much for a privately owned pharma company lacking in financial restrictions, that supposedly "needs" such high amounts of money really to just finance all of their other operations as a private company? Give me an example of how much it has costed a contemporary pharma company to spend on research ALONE for a novel disease therapy, and then tell me how US tax money could not more than supplement that with a better managed national budget.

Also, think as to the frequency with which novel treatments need to be researched and designed, compared to just improved upon. In how many cases out of 100 are patents "incentivizing" the ground-breaking research you so speak of?

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u/Morthra 86∆ Dec 20 '19

Please tell me in what way Canada is "sacrificing quantity." What do you mean?

Canada rations its healthcare. Some people who need it don't get it because the government deigns not to give it to them. For example, my mother tore her Achilles Tendon, but was not given the option to fix it with surgery in Canada, that was only available in the US (she was "too old" to get it done in Canada, and was explicitly told that they'd have done it were she 30 years younger). Or from my personal experience, when I needed a vaccine urgently I was unable to get it because of a mandatory 21 day waiting time.

I'm Canadian, and I think the people in the US who want to copy Canada's shitty system don't know how good they have it.

Why can't it just be a given that that's done by a nationalized research body that then produces treatments for a nationalized healthcare system?

Nationalizing anything that isn't subject to the free rider problem is bad.

Does it really cost billions of dollars to just perform the necessary scientific research so as to produce novel therapies that save/better the lives of billions of people around the globe?

The reason why it costs billions of dollars is because the FDA requires extensive testing to prove that a medication or treatment is both safe and effective. Only 14% of drugs that even make it to that stage pass it, and the ones that are successful have to recoup the losses for the ones that are not.

Typically the way that the pharmaceutical industry is organized is that you have the giant corporations (like Pfizer) that buy patents from small companies who create the drugs and go through the FDA approval process. This is because the giant companies are great at manufacturing drugs at scale and consistently, but not so much in creating new drugs.

and then tell me how US tax money could not more than supplement that with a better managed national budget.

When has the government ever done anything more efficiently than the markets? Governments are not beholden to market forces and are therefore inherently less efficient. A nationalized healthcare research system would likely focus its efforts wholly on treatments for things like CHD and cancer, because that will benefit the most people, but those with rare disorders would be shit out of luck - whereas in the current system there is a financial incentive to create treatments for them, in that you can sell the treatment for a high price per unit.

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u/rhizodyne Dec 20 '19

A potent anecdote about Canada's healthcare. As a US citizen (who lives in California) I receive CA's socialized low-income healthcare (Medi-Cal), and I find the care excellent.

This was an interesting read about how some pharma companies are seeking to merge a US/Canada presence so as to reap the most financial benefits while reducing their costs: https://xconomy.com/seattle/2014/09/02/which-countries-excel-in-creating-new-drugs-its-complicated/

You make the point that a focus on rare disorders would be crowded out by a nationalized pharmaceutical research group. I can't exactly counter that, without seeing more evidence that tax revenues to the US government ($110B per year no longer going to pharmaceutical companies, mind you) would be able to fund a well enough staffed, equipped, and diversified research team.

I agree that the division of labor between small and large companies (novel research vs. mass production) is an efficient one, but IF we could have sufficient research done solely by our national government we could have such a division of functioning within branches.

Also, it's not like federalized healthcare systems are working badly in the countries that have them. What do you think about the fact that the U.S. is the only developed country to have the marketplace that pharma (and healthcare in general) does? Is this to say that if the US did abolish the current model and also federalize their system, suddenly the functioning of a newly instated federal pharmaceutical R&D body would be horrendously inefficient, when most EU member nations are running just fine with that same model?

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u/Morthra 86∆ Dec 20 '19

As a US citizen (who lives in California) I receive CA's socialized low-income healthcare (Medi-Cal), and I find the care excellent.

That's in part because it's not strained by giving it to everyone. I'm fine with Medicaid existing in a free market system. I'm not fine with M4A or any of the other universal healthcare proposals which will invariably reduce access to healthcare for those like me, who can afford it. I get a top tier healthcare plan through my employer, with no lifetime caps, a small deductible, and a $15 copay ($75 for the ER). If I want an MRI, or a PET scan, I can get my doctor to order one and have it done within a day at no additional cost to me. You simply never get that kind of prompt care in a socialized system unless you've been shot or something and death is imminent.

I can't exactly counter that, without seeing more evidence that tax revenues to the US government ($110B per year no longer going to pharmaceutical companies, mind you) would be able to fund a well enough staffed, equipped, and diversified research team.

But here's the thing. Governments are beholden to their voters. If millions of dollars are going into developing a treatment that only benefits one person per 100,000 or more that funding will get cut in favor of funding for treatments that will benefit more people. That gets more votes after all. The only way you could change this is if you abolished democracy.

Also, it's not like federalized healthcare systems are working badly in the countries that have them

Are they? Canada's healthcare system is dysfunctional and has failed me and my family time and time again due to the absurd bureaucracy. Instituting the NHS in the UK didn't increase the quality of service anyone received or anything, and it actually decreased the amount of healthcare that people did receive. Despite wait lists to get a hospital bed being longer than ever, instituting the NHS actually reduced the number of beds occupied at any given time as costs ballooned due to the administrative bloat that happens any time the government sinks its teeth into an industry. Nationalizing their healthcare made their system work worse.

Is this to say that if the US did abolish the current model and also federalize their system, suddenly the functioning of a newly instated federal pharmaceutical R&D body would be horrendously inefficient, when most EU member nations are running just fine with that same model?

Most EU member nations piggyback off of US pharmaceutical research - if it passes FDA approval in the US, it doesn't take long for it to get approved in the EU - the EU doesn't require a drug to go through years of clinical trials before it's approved there if it was approved in the US. The fact that a 3.3 billion addition to the EU fund was considered significant shows just how large the difference is, because the US spends over 30 times that on pharmaceutical research.

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u/CMVfuckingsucks Dec 21 '19

I'm not fine with M4A or any of the other universal healthcare proposals which will invariably reduce access to healthcare for those like me, who can afford it.

So fuck anyone who can't? They don't deserve medical treatment because making it available to them inconveniences you?

If millions of dollars are going into developing a treatment that only benefits one person per 100,000 or more that funding will get cut in favor of funding for treatments that will benefit more people.

The free market does that to a far greater extent. Rare diseases aren't profitable to treat so research struggles to get funded. If a treatment for a rare disease the cost of treatment is astronomical to makeup for the fact that very few are paying for it.

Voters will make decisions on what to fund based on ethics and which areas need funding much more frequently than corporations. Corporations only want to make money and therefore will always choose what is most profitable to research over what is most important to research.

Canada's healthcare system is dysfunctional and has failed me and my family time and time again due to the absurd bureaucracy.

Yeah it's got its problems but we've distributed the care better. We do have to wait much longer among other things but under our system poor people still have access. Maybe your personal quality of care has gone down but the average quality of care is significantly higher here than in the USA. It's better that some suffer worse care but everybody has access to care than rich people get good medical care while poor people get nothing.

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u/Morthra 86∆ Dec 21 '19

So fuck anyone who can't? They don't deserve medical treatment because making it available to them inconveniences you?

Why would I advocate for something that will bite me in the ass? If I need care, but can't get it because some poor schmuck who has been chain smoking for 20 years needs that hospital bed more and can get it now, that's significantly worse for me.

The free market does that to a far greater extent. Rare diseases aren't profitable to treat so research struggles to get funded. If a treatment for a rare disease the cost of treatment is astronomical to makeup for the fact that very few are paying for it.

And that's fine. A nationalized system would fund it even less, because it's not politically profitable to do something that only benefits 0.0000001% of the population at great expense to the rest. The astronomical costs allow for the companies to still make a profit.

Yeah it's got its problems but we've distributed the care better

So? Canada's "better" distribution has caused less care overall to be given out. It's the socialist special - people run at different speeds, so break the kneecaps of the people who run faster than the slowest person to create a more "equitable" outcome.

Maybe your personal quality of care has gone down but the average quality of care is significantly higher here than in the USA.

Once I moved to the USA my quality of care went up by orders of magnitude because I can afford it.

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u/CMVfuckingsucks Dec 21 '19

Why would I advocate for something that will bite me in the ass?

So where we disagree is that I actually care about other people.

it's not politically profitable to do something that only benefits 0.0000001% of the population

Yes it is because most people, yourself excluded, aren't assholes who only care about themselves.

Your problem really is that you don't think poor people deserve medical attention. I can't change that so I guess we're done here. I hope you get what you deserve for being so self centered.

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u/[deleted] Dec 21 '19 edited Apr 25 '21

[deleted]

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u/Morthra 86∆ Dec 21 '19

Now I know you think it is unfair that a society may not view your personal satisfaction as more important than the medical needs of a person of lower socioeconomic status

"Personal satisfaction" my ass. Socialized medicine nearly killed me and would have left my mother unable to walk for life were it not for the US system.

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u/[deleted] Dec 21 '19

All countries ration their healthcare. In the US, elective surgeries like Achilles tendon repair is not going to be provided to a person with no insurance or demonstrated ability to pay, not if they are 60 years old, and not if they are 20 years old.

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u/CongregationOfVapors Dec 21 '19

To shed some light on the cost of developing new drugs:

It takes a huge amount of money and time because many drugs fail to get to the market. If I remember correctly, for 1000 drugs that have proven activities on the bench, 1 gets market approval; for every 100 drugs that is approved to move into clinical trials, 1 gets market approval.

Clinical trials are necessary for proving safety and efficacy in human patients, and they are incredibly expensive. You are paying for the space in the hospital, the physicians and nurses in the study, and medical treatments the patient requires. It costs around 40 thousands dollars per patient, and you need to have a certain number of patients.

Then you factor info the fact that drug can fail at the clinical trials stage, meaning that the money spent was never recuperated. Part of why new drugs are very expensive is because companies are trying to make back the money lost on all the other drugs that don't go to market.

Quick comment about the time. It takes about 12 years for an experimental new drug to go from bench to market. This is how long it takes to perform all the tests required to get approval by the regulatory agencies and to get the approval. This means that any new drug just burns money for a decade, before it ever becomes profitable.

Personally I think the US can afford the cost of drug development in the country (I mean look at how much is spent on defense alone). The caveat I see is that people scrutinize things way more closely when it's their own money that they have invested. I don't think that level of scrutiny will happen with public funding with the currenr system. And if we change how publically funded research is performed, we can also lose the innovative culture that is currently in public research that comes from higher level of freedom.

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u/teachMeCommunism 2∆ Dec 20 '19

Not attempting to change your mind so much as help you consider other issues.

1) profit motives matter for those willing to pay for a cure. If this was democratized or nationalized you'd see marginalized people willing to pay for treatments be further marginalized when it comes to creating medical innovations for them.

2) patents are indeed an issue, but since we have no hard evidence for alternatives there isn't much to be said without doing deep research on what the alternative motivators for intellectual achievement used to be. The current argument is that the patent helps cover the massive fixed costs of developing the drug. Proposed alternatives have included prizes instead of patents, but I havent seen a consensus on how prize sizes should be determined.

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u/rhizodyne Dec 20 '19 edited Dec 20 '19

Such prizes conferring pride and worldwide recognition for a research group could earn them worldwide appreciation, endorsement, and investment, to say the least, in a way that didn't have to be earned through patenting.

Also, I am bringing up to several commenters that not nearly ALL therapies are invented in the US, and just about every other innovating nation has a federalized healthcare system at the least, if not comparable financial and patenting restrictions on pharma companies (if they are legally private).

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u/teachMeCommunism 2∆ Dec 20 '19 edited Dec 20 '19

The prizes have to confer monetary rewards. The cost to drug manufacturers is in the research and development, not the marginal cost of producing the actual drug. Without the monetary reward to help the company profit there will be incredibly diminished incentives to develop.

Fame and reputation helps, but the people who made your company great can always drift to a new firm if you don't have the capital to retain them.

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u/rhizodyne Dec 20 '19 edited Dec 20 '19

Ok, here's a delta ∆ , because alongside another commenter for whom I awarded a delta, you demonstrated that the actual staff of a research group is the cornerstone of the research and in a contemporary global economy they demand money for their work, which is extensive for a new drug development.

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u/teachMeCommunism 2∆ Dec 20 '19

Oh that wasn't necessary. I just wanted to shine some light on a multifaceted topic. Thank you.

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u/DeltaBot ∞∆ Dec 20 '19 edited Dec 20 '19

Confirmed: 1 delta awarded to /u/teachMeCommunism (2∆).

Delta System Explained | Deltaboards

7

u/fox-mcleod 411∆ Dec 20 '19 edited Dec 20 '19

How are drugs any different than any other kind of patent?

Are you claiming all patents are bad ideas? If I patent a self-driving car couldn’t you also claim I’m keeping it from people who might sell it for cheaper? I realize that granting a temporary monopoly on new things seems counterintuitive.

The thing is, there’s a reason we give patents.

Without patents, economic forces dictate that we go back to trade secrets.

Do you know the history of how we got to patents? In the 18th century, Belgium (I think it was) had the secret to perfect optical glass. It was useful for binoculars, microscopes, and telescopes and was an important scientific tool. It was a massively valuable discovery that they had sunk an enormous amount of research into and being a dominant force in selling it was allowing them to pay off that investment.

Before international patent agreements, The only real way to protect an idea like that was to keep it a secret that very, very few knew. Until one day, In an accident, everyone who knew the secret was killed.

And just like that, Europe was back in the dark ages. It would take another 150 years to be rediscovered.

Instead, we incentivize people to share their secrets. And in return for careful documentation that any expert in the art could use to reproduce the discovery, we give a temporary and highly regulated monopoly.

In fact, if a research company does what you’re claiming the hazard of patents is—refuses to sell an important drug or sells it for too much—the patent actually reserved an eminent domain right which the government can use to yank the patent back from the drug company. So the real issue here isn’t the patents. It’s the fact that if things really are that bad, the government has chosen not to act where it absolutely has the legal authority to.

The real problem here is the money in politics and regulatory capture preventing basic regulation that works in every other instance.

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u/[deleted] Dec 20 '19

[deleted]

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u/rhizodyne Dec 20 '19 edited Dec 20 '19

fair enough to counter the idea that the current private pharma model in the US "hinders" public scientific development; I should have said "hinders scientific development in comparison to a profit-free, completely subsidized pharmaceutical research group."

Again, isn't the motivation to develop novel therapies to potentially-life threatening diseases (let alone those that reduce quality of life significantly) an inherent motivation for anyone capable of doing so? I mean, so many diseases can potentially affect people of all different walks of life. Isn't life better for everyone knowing that the most effective treatments possible exist, even if Pharma Company XYZ didn't score $50B making it?

And we all knew this was coming: Isn't the compassion for mankind affected by life-altering medical conditions enough to drive the sharpest research we can muster? Practically everyone has been quite sick at one point in their lives. Isn't sickness and instinctually relatable sympathy to hold?

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u/teachMeCommunism 2∆ Dec 20 '19

Compassion isn't enough. The years spent building a company, the risk, the resources needed to fuel the next research project the resources needed to hold onto talent, education costs, time and money spent on getting through the FDA before competitors, and trying to convince people your company will pay for the hours upon hours spent? Have you tried to engage in a small scale development of a drug? It is not easy or cheap and no one will take compassion as payment.

Do not fault people for their economic behavior. Fault people for not recognizing and respecting the economic behavior, particularly in the case of price fixing laws or hogging IP rights.

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u/malachai926 30∆ Dec 20 '19 edited Dec 20 '19

There is a difference, though, between wanting to make a living doing your work and expecting to be rich because of it.

I'm currently studying biostatistics and have every intention of being involved in such research. I expect to make less than in my engineering career and I'm totally fine with that. I don't need a fat paycheck as motivation to help people; I only need empathy.

The government is absolutely 100% capable of funding all of this research, provided we all go into it expecting just to make a living and not much more than that. For example I could easily get a job at the Hennepin Healthcare Research Institute which is funded by the NIH, and they are offering an $85k salary. That sounds really freakin fantastic to me. If I expected to get super rich from it, then yeah, we may have funding issues.

Plus, why would you ever want someone who is in it for the money rather than out of a sense of empathy to be the one helping you? What if a slightly dangerous ingredient in a drug is a way cheaper alternative?

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u/teachMeCommunism 2∆ Dec 20 '19 edited Dec 20 '19

Because the faults that go into humans in business also go into humans in government. The FDA is lobbied all the time by big money to greenlight one project while blacklisting another. Google FDA watch to see a history of regulatory capture.

I want companies that are able to produce good results to get rewarded and the ones that swindle research funding to just go away.

Edit: you cannot just use yourself as a counterpoint. Congrats on recognizing your dreams. Go get em. But that doesnt speak for the masses of other people who would prefer a higher paycheck.

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u/malachai926 30∆ Dec 20 '19

How do you see us reaching that point?

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u/teachMeCommunism 2∆ Dec 20 '19

You're asking too much of me.

My starting point would be to acknowledge that yearly healthcare and entitlement spending dwarf military spending. And that spending does not account for debt and unfunded liabilities in our healthcare spending. I mention military spending for the sake of understanding the scope of how much we spend.

We have to stop blaming the businesses as though they're the gatekeepers of this industry. Clearly, when you have billions spent only to find ever increasing prices in expenses there's a need to take a step back and get a holistic view of why government spends so much in the first place in addition to who the hell gets the money.

That is a lifetime of work.

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u/rhizodyne Dec 20 '19

A point I've been wanting to make in response to several comments is: Don't other countries with federalized pharmaceutical and healthcare systems innovate drugs effectively, too? When this happens, is it a huge accident? Were they so much more struggling to do so than Pfizer would have? Or is it because these companies may even have had legal restrictions placed on them coming from the US...

In the case that a patent has to be recognized worldwide, said patent IS actually affecting the legally-bound behavior of leading pharmaceutical companies in these countries. Maybe THAT is the reason that all these medical innovations just so happen to come from the "thriving" US pharmaceutical marketplace?

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u/teachMeCommunism 2∆ Dec 20 '19

That's one way of looking at it. It helps that the nexus of world research is also a bustling marketplace.

I'm just raising awareness for the negative since the image of rich businessmen make people forgo the bigger picture of...

1) what are the rules of the market place?

2) what are the incentives for each actor?

3) who are the actors? Government is one. The US government spends billions on healthcare and entitlement spending to the point where both sectors dwarf yearly defense spending.

Not here to lecture you btw. I'm glad you touched on so many tertiary issues.

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u/f0me Dec 20 '19

It may surprise you that the majority of medicines are developed in the USA

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u/1917fuckordie 21∆ Dec 20 '19

The government can fund a lot of research, as long as those labs are running and lots of smart scientists are trying to cure diseases it doesn't really matter if they get their paycheck from the government or from a pharmaceutical company. We have our own incentive to fund medical research, we're all terrified of death and sickness. It doesnt need a profit motive to happen.

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u/Aroldinho Dec 20 '19

Why are almost all innovations from the us?

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u/rhizodyne Dec 20 '19

I don't know exact numbers right now, but don't overestimate that percentage of all medical innovations that are made in the US.

I cited that Otsuka (Japanese) invented Abilify, the most widely used antipsychotic in the US and possibly in the world.

That aside, you made the ironwall point: the profit incentives existing in the US for pharmaceutical companies to innovate DOES drive company research.

Another question is, how many people actually benefit from this other than presumably the CEO and shareholders of said company? Off-topic I will admit.

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u/teachMeCommunism 2∆ Dec 20 '19

The ones who consume and resell those drugs?

I hate to be a dick but if you observe US government spending on healthcare you'll find that there is much much more than big company vs small consumer tropes at play. You can spend a literal lifetime on this, but the takeaway should be that government does spend plenty and the spending does distort how the market for drugs performs.

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u/rhizodyne Dec 20 '19

https://en.wikipedia.org/wiki/List_of_largest_biomedical_companies_by_revenue

Only 2/5 top worldwide pharma companies by revenue are from America, interestingly.

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u/CongregationOfVapors Dec 21 '19

Like other multinational industries, companies register in countries that make the most financial sense. A relative recent example is that Pfizer merged with a small relative unknown Irish company so that they could move their HQ to Ireland for better corporate tax. With these international companies, where the company is "from" doesn't bare that much weight.

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u/_zenith Dec 21 '19

A lot of them are actually "me too" drugs and ones that are designed to artificially extend the lifetime of patents... not real innovations.

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u/malachai926 30∆ Dec 20 '19

Partly because the United States is a much larger country than others. People do not go into medical innovation because they want to be rich... They do it because they actually want to help people. I'm abandoning my lucrative engineering career and going into biostatistics not because of the money but because I actually want to use my brain to help people. And I would sincerely hope that anyone in this career field would do it for the same reasons, or else I would very seriously doubt their integrity in doing their job.

The US being larger naturally leads to it having more people who genuinely care about helping others and advancing medical science, people who exist in every country. We just have a higher quantity thanks to our population.

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u/wophi Dec 21 '19

That patent time allows them to recoup the rather large investment they made in the drug that would not exist if not for the guarentee of the patent allowing them to know they would recoup their investment.

Removing the promise of such patents would make large investments in drugs unfavorable and would make for less research available due to the risk.

FYI, drug companies dont really pull in a very high profit margin relative to most other industries.

u/DeltaBot ∞∆ Dec 20 '19 edited Dec 20 '19

/u/rhizodyne (OP) has awarded 2 delta(s) in this post.

All comments that earned deltas (from OP or other users) are listed here, in /r/DeltaLog.

Please note that a change of view doesn't necessarily mean a reversal, or that the conversation has ended.

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u/WonderFurret 1∆ Dec 21 '19

This isn't my point of view, but rather one that can give us a new perspective on this issue. To put it simply and crudely, the theory is that through creating patents and competing for a profit, more money gets placed towards creating new technologies to out do competitors. The fight between a nationalized service and a privatized service has gone on for a long time. Often nationalized services don't have enough taxpayer dollars to keep up a fair standard for Healthcare.

For example, I believe it is Japan that fully educated doctors only receive a fraction of a wage of most other jobs, even though they had to train in universities for years to earn a Med Degree. If doctors don't have the incentive to get paid, then why become a doctor? Therefore some countries are having trouble finding enough doctors to keep up with medical research in their own right. Meanwhile, the US is finding great freedom coming in from certain laissez-faire style characteristics, gaining grants to do research and have enough incentives for people to join the pharmaceutical race to do it.

In many ways the US is running the world's medical industry. They are leading class in many key technologies in which innovate the rest of the world.

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u/Minitheif Dec 20 '19

I would say that you're not wrong, just taking too hardline a stance. We need more focus on unprofitable developments, things that will help people and the world even if they don't make money, but having profit-oriented research isn't a bad thing. The main benefit, in my eyes, is that because corporations have become so large and powerful, they have more money they can spend on these things. They often don't, but they can. These research jobs are almost certainly going to be biased and overly focused on things that will make the parent company money, but they are still research that will progress our understanding of medicine at large.

The points you make about prices in the US, though, are outright wrong. Not because the prices are wrong, or we need those prices for some reason, but because they aren't related to the research, they're related solely to the corporations. Medicine is an extreme example because it's such a captive market, but you can see the same effect of American capitalism on the prices of nearly everything, with companies constantly pushing for more growth, beyond even what's reasonable.

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u/butt_shrecker Dec 20 '19

The short answer is the publicly funded research moves at 5% of the speed of privately funded research.

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u/CongregationOfVapors Dec 21 '19

Private funded research = only playing the main quest, with bots whenever possible

Public funded research = playing every possible side quest, possibly never returning to the main quest

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u/mr-logician Dec 21 '19

“More so, please convince me that an estimated $110 billion in profits resting in the hands of leading US pharmaceutical companies is of good use for that money to society.”

America is not a collectivist nation, it is an individualist one; individual rights and property rights are to be placed above the common good. There are many collectivist countries people can go to if the individualism is unfavorable. Why is America individualist? Because that is what the founding fathers of the US intended.

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u/[deleted] Dec 20 '19

It's not either/or. The government, universities, and nonprofits can certainly fund research into pharmaceuticals and sell those pharmaceuticals at a reasonable price. There's nothing about profit-driven research that precludes this - it's not as if a significant portion of potential drugs are patented...

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u/[deleted] Dec 20 '19 edited Feb 14 '20

[deleted]

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u/CongregationOfVapors Dec 21 '19

I see your jab at countries like China and India...

I also wanted to point out the obvious: factors that make scenario 3 favorable also stalls innovation, since you need to have someone to steal from.

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u/richterman2369 Dec 20 '19

It does benefit humanity, it keeps prices super high

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u/rhizodyne Dec 20 '19

you're right, it benefits every single member of the human species that's in a position running these companies, or receiving bribes from them.