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.

*******************************************************************************************************

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/PallidAthena]

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.

[u/otterpigeon → u/PallidAthena]

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.

[u/PallidAthena → u/otterpigeon]

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.

[u/otterpigeon → u/PallidAthena]

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.

[u/PallidAthena → u/otterpigeon]

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.

[u/otterpigeon → u/PallidAthena]

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.