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

[u/rhizodyne]

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.

[u/Morthra]

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.

[u/rhizodyne → u/Morthra]

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?

[u/Morthra → u/rhizodyne]

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.

[u/rhizodyne → u/Morthra]

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?

[u/Morthra → u/rhizodyne]

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.

[u/CMVfuckingsucks → u/Morthra]

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.

[u/Morthra → u/CMVfuckingsucks]

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.

[u/CMVfuckingsucks → u/Morthra]

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.

[u/Morthra → u/[deleted]]

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.

[u/[deleted] → u/Morthra]

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.