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View Diary: Science Friday: The Breath of Life (138 comments)

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  •  Capitalism is the problem (17+ / 0-)

    Nobody who has read any of my posts can ever accuse me of being anti-capitalist. But I am not one of those who thinks "the market" is a universal panacea. Healthcare is one of those areas in which capitalism fails utterly to provide the best solutions.

    The reason is simple: no one chooses to get sick. Nobody looks at their bank account one day and says, "Hey Marge, we did really well this year. You can finally afford that cancer you always wanted. And I think I'll have a heart attack!"

    Capitalism doesn't work in healthcare because the consumer either cannot choose not to buy or in most cases cannot shop around for a cheaper price, "No Mr. EMT, take me to another hospital to treat my cardiac arrest, I've negotiated for hours with these doctors and they just want too much money."

    Not to mention the enforced price fixing by insurance companies designed to ensure profits rather than to ensure coverage.

    Your main point about "orphan drugs" is a similar one.

    Big pharma tries to convice us that drug development is so terribly expensive that they have to charge high prices. The fact is that advertising budgets are far higher for their products. If we were to ban consumer advertising for drugs (a position suported by the medical community) the pharma companies could save hundreds of millions of dollars a year which could be used to support orphan drugs.

    Furthermore, most drugs, other than "me too" drugs -- drugs which are just analogues of existing drugs, Levitra and Cialis are just "me too" Viagra, for example -- are primarily developed in the academic environment. Only when some promise of profit and efficacy are shown do the pharma companie step in to bring the drug to market. The common pharma company complaint that it takes "billions" to bring a drug to market are belied by the facts. There is no doubt that it is expensive, but much of the cost is written off as tax deductions and borne by other, often public or government, entities.

    And finally, in a country that spends more than a billion dollars a day on "defense" there must be a better way to ensure vital healthcare for all our citizens. Each of us is far more likely to suffer a life-threatening disease at some point than to need the intervention of the military in our personal lives (unless the Bush doctrine is allowed to continue and the world finally decides to wipe us off the map in the interest of their own safety).

    •  I wish I could could give you 10 check marks (4+ / 0-)
      Recommended by:
      mbc, TiaRachel, Fabian, anais

      For this instead of just one. You hit the nail on the head. Capitalism may be fine when it comes to many sectors of our economy, but NOT to health care! And unfortunatly, too many of the "national health care" proposals advanced by the Democrats would merely shift the costs of a broken system onto the taxpayers.

      We need to say the words, folks: "socialized medicine". Not "national health care" or even "single payer" but, yes, "socialized medicine." True, it has its problems too and is no panacea, but what is? If we went at it with the best interests of the public in mind and let health care professionals and not the government and insurance companies run the system, we can make it work.

      •  general welfare (3+ / 0-)
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        mbc, nyceve, Allogenes

        i keep thinking about that phrase in the very very first sentence of the constitution "promote the general welfare".

        That should be a plus blue ribbon golden rule number one when it comes to ANYTHING touching on the topic of healthcare.

        I'm kind of stalling for time here...They told me what to say. George W Bush, 03-21-2006 10:00 EST Press Conference

        by Tamifah on Fri Jul 21, 2006 at 04:51:46 AM PDT

        [ Parent ]

        •  The Myth of the Market (6+ / 0-)
          Recommended by:
          mbc, elfling, Tamifah, snowmoon, anais, ignatz uk

          The problem is in part that the conservative movement has cultivated the notion that the capitalist marketplace is somehow value-neutral, a mechanism for allocating resources according to people's real desires, and thus a true manifestation of human freedom, as opposed to anything government does, which is arbitrary.
          The market is not neutral, because money follows money, and success however gained breeds more success.
          Decisions as to what goods and services are available get made not on the basis of what everyone most wants, or objectively needs, but on the basis of where lies the greatest prospect of gain for the few big players.
          Hence all the attention to the development of expensive pharmaceuticals. Not that they aren't valuable, but far less expensive public health measures - more restrictions on tobacco, using the health care system to encourage better preventive care - would do much more to improve the health of more people; and they don't get done because there's no profit in them for anyone.
          Suppose some scientist has the idea that a simple, readily available, inexpensive food item, if eaten regularly, could reduce the rate of some cancer. I'll bet he/she would have a much harder time getting the funding to do the tests to prove the case than if it were a matter of something someone could make and sell for a lot of money.
          Markets have their place, like Captain Frogbert I am not anti-capitalist; but government needs to reclaim an independent voice to speak in the public interest. Meaning the people must reclaim the government.

          •  capitalism is all about (0+ / 0-)

            me getting all the money. so ok that's fine when it comes to selling you cable tv, or internets, or car insurance, or frosted flakes.

            but when it comes to your personal health, that should be more important to me than getting dollars.

            so it's not just one of the points where lassiez-faire doesn't do so hot, it's a moral failing on the part of those doing the business.

            I'm kind of stalling for time here...They told me what to say. George W Bush, 03-21-2006 10:00 EST Press Conference

            by Tamifah on Fri Jul 21, 2006 at 05:51:10 AM PDT

            [ Parent ]

    •  Federally Fund Drug Research (1+ / 0-)
      Recommended by:

      That would be one of the partial solutions. There could then be a complicated algorithm vis a vis profitabiltiy and what percentage the company gets vs reinvestment in further research. That problem could be solved, imho.

      Also many drugs often have dual uses. E.g. A certain class of anti-depressants works against hot-flashes. That is to say, research needs to be done on drugs that are already on the market, but have promise in other areas. For that clinical trials could be set up.

      And one more thing. If a company has a block-buster drug there should/could be some obligation for them to use the profits from sales of that drug to engage in research for treatments of "rarer" diseases. Or...should they not have that research/technical expertise then a certain percentage of their profits from the sale of the blockbuster drug could be sent to the companies that are doing such drug research. The details could be worked out.

      Captain Frogbert is correct, in this instance capitalism is part of the problem.

      •  The Federal Government Does Fund Drug Development (1+ / 0-)
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        thru the NIH. In fact, quite a few "new" drugs have been developed at NIH and the rights sold/licensed to drug companies. Of course the NIH doesn't get back all the costs of development in these deals, but I suppose it's more than they would get otherwise, and the drug would not be developed otherwise.

        Likewise, academia produces a lot of good basic research and drug leads (though not generally ready for prime time) which are either licensed by drug companies or the inventor starts up his/her own company to develop the drug. The latter is quite difficult as it requires a large infusion of cash to develop (and the necessary evil of VC money), and the bottom line is that many of these will fail in trials anyway, so there's a real and large risk to doing this. That's one reason the drug companies are better or more able to do it--they can better absorb a failure than a startup.

        But I don't think you'll see the feds actually develop and provide drugs to the public. Imagine if you will the law suits that would be filed against them if they did (e.g., Viox) if a drug had an otherwise unknown side-effect. And who would decide on the direction of research and priorites with a limited federal budget? In the case of drug companies, the company decides, but if they don't make a profit, they pay a price in the market.

        I agree with the Captain that stopping DTC advertising would be a big improvement (they tend to be the stupidest ads I've ever seen anyway--remember Bob Dole?).

        But I think the greatest single improvement could be made in the regulation and approval of drugs. FDA no longer has the guts to approve a new drug on the basis of the science unless it's totally non-controversial, but take all kinds of special interest group pressure into account, and if they are afraid of any of them, will hold up approval on totally meritless grounds (I've seen this numerous times). As a good example, look back to RU-486. If FDA were run by scientists and doctors--experts in their respective fields--and were not political appointees, I think we'd see a big improvement. I've seen some sobering things happen at FDA...

    •  Capitalism is NOT the problem (8+ / 0-)

      In a capitalist economy, insurers including Medicare could negotiate lower drug costs for their policyholders. (To a point, of course: there's a real cost that must be paid to keep the drugs in the devlelopment pipeline.)

      That medicare can't is the result of the cronyist kleptocracy that is our form of government. It doesn't have to be this way, even in capitalist countries.

      BTW, the claim that drugs are developed in academic labs and only "brought to market" by pharmas after they show some promise is misleading. Hundreds of "promising" compounds need to be rigorously evaluated in order to find one that is actually acceptable. And the clinical trials are by far and away the most expensive part of the drug development process. There are also costs associated with product liability. You make it sound as if the pharmas simply pick up the work of academic scientists, package it and put it on the shelf.

      •  Cure the Corporatocracy (2+ / 0-)
        Recommended by:
        TiaRachel, AyLian

        In a capitalist economy, insurers including Medicare could negotiate lower drug costs for their policyholders. (To a point, of course: there's a real cost that must be paid to keep the drugs in the devlelopment pipeline.)
        That medicare can't is the result of the cronyist kleptocracy that is our form of government. It doesn't have to be this way, even in capitalist countries.

        Then extract money from the system. Make all political campaigns federally funded. That will save us more money in the long run.

        I believe in the market.. I do not believe that large companies should be abusing the system of government to create artifical advantages for themselves.

    •  Fine, why don't YOU try to develop a drug (2+ / 0-)
      Recommended by:
      fightcentristbias, TiaRachel

      I can tell you from first hand experience that you are worng about nearly everything you just wrote except wrt marketing and advertising.  
      Drugs ARE expensive to make and test.  They are devilishly hard to find.  And people are rightfully concerned about safety.  It is getting more and more difficult to find that ever elusive perfect drug that everyone wants.  It is not cheap.  
      Think about what you are saying to researchers who are usually over 30 before they get their first paying job.  Think of all the years they spend in graduate school or as post-docs making slave wages for some government entity.  They have to make a living too and pharmaceutical companies are located in some of the hottest real estate markets in the country.  Do you think we do it for fun?  We have to make a living too.  Working for the federal government on a government salary for all of the years of hard work will go over like a lead balloon.  If you want to kill scientific research in this country that's a great way to do it.
      As for "me too" drugs, you have to consider that companies already have their new drugs in the pipeline and have spent millions of dollars on them when a new class of drugs comes out.  It is likely that Viagra, Cialis and Levitra were being developed simultaneously.  It's like turning a ship around to stop the process and ridiculously expensive.  Also, the new drugs may be improvements on the older drugs.    There are hundreds of new drug targets entering the pipeline all of the time but pharma companies sometimes work on the same targets.  That is how "me too" drugs get made.  

      -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

      by goldberry on Fri Jul 21, 2006 at 06:48:03 AM PDT

      [ Parent ]

      •  No they didn't (0+ / 0-)

        It is likely that Viagra, Cialis and Levitra were being developed simultaneously.

        No, actually.

        When Pfizer lucked out with Sildenafil Citrate, tested to reduce high blood pressure but which turned out to have other side effects and renamed Viagra, Lilly ICOS (a joint venture of Eli Lilly and ICOS) was formed specifically to fool around with Sildenafil Citrate to try and create something more effective, thus Cialis.  

        As for Levitra, Bayer and GlaxoSmithKline only started work on it after Viagra came out and the connection between drugs working with hypertension that could have a side effect regarding erections had already been discovered.  The two companies, like Lilly ICOS, wanted in on that game.

        So yes, Levitra and Cialis are perfect examples of "me too" drugs.

        •  I said it is 'likely' (0+ / 0-)

          It happens all of the time.  
          In any case, the drugs that come afterwards frequently have a better safety profile or are more effective.  I suppose you would be happy to just leave the first drug on the market without competition regardless of safety or efficacy?  
          Didn't think so.  

          -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

          by goldberry on Fri Jul 21, 2006 at 08:58:10 AM PDT

          [ Parent ]

      •  Sorry your PhD hasn't made you rich yet. (0+ / 0-)

        I never said Pharma co's don't have reasearch and evelopment costs, only that they consistently lie about the actual costs.

        See here:

        I leave you to find other sources that say basically the same thing.

        The other part of the story is that Pharma co's consistently charge more in the US than they do in other countries while doing all they can (and lying more and bribing congress to pass downright evil laws like Medicare part D) to prevent Americans from importing their drugs from Canada and other countries (you know, making it work like oh, say, capitalism). Instead we have a system that consistently privatizes the profits and socializes the costs. American taxpayers pay a huge cost for drug development in terms of tax breaks, anti-competitive laws and tax-funded research used for private profit.

        As a person who works in the Pharmaceutical marketing field and with a friend who works in FDA regulatory affairs I see this crap all the time.

        •  You're citing ... (0+ / 0-)

          ... something that gives figures from the 1980s and 1990s.  Things have changed -- not to mention that inflation alone would dramatically increase those numbers.

          A lot of the examples in the article are also skewed.  AIDS was a national emergency in the 1980s, and drug companies treated it as such.  Drug trials for AZT were actually cut short when it became clear that it was extremely effective at fighting AIDS, as the scientists determined it was no longer moral to give some patients a placebo rather than the actual drug.  Had AIDS not been such a major concern, the trials would've gone on for significantly longer.  After the drug trials were completed, AZT was rushed to market as fast as possible -- a difficult task, as the drug synthesis needed to be scaled up as fast as possible, and plants needed to be built to produce the drug.  So AZT (and other AIDS drugs) makes a horrible example to use when discussing the time involved in taking the drug to market.

          Other examples are also misleading.  For example, taxol is expensive because -- first of all -- it's derived from a natural product (some Pacific shrub -- it originally came from yew trees, but they finally discovered an alternative), and, second of all, one of the steps in the synthesis was patented by the discoverer.

          And those are just the problems I can recognize offhand.  

        •  You don't get rich in research (0+ / 0-)

          You get rich in marketing.  Hope you are enjoying all of the loot.

          -3.63, -4.46 "Choose something like a star to stay your mind on- and be staid"

          by goldberry on Fri Jul 21, 2006 at 03:01:38 PM PDT

          [ Parent ]

    •  Sometimes Government Is the Solution (0+ / 0-)

      That is, I think we sometimes forget why we even HAVE government at all. In the simplest terms, the role of government is to allow us to collectively do those things that none of us, individually, can do for ourselves.

      So if we had, say, a hundred billion dollars to spend (a fraction of what the Iraq war was supposed to cost in total). Could we channel NIH researchers into developing drugs thereapies for rare but curable diseases, build a manufacturing plant in some location that desperately needs jobs and provide the output to patients at a reasonable cost? Obviously, the current pharmaceutical industry can't do it. I can't do it. You can't do it. Let's turn the project over to the one entity that can.

      This isn't funny anymore.

      by Thaug on Fri Jul 21, 2006 at 10:15:56 AM PDT

      [ Parent ]

    •  Drug development *is* expensive .... (0+ / 0-)

      It takes drugs several years, even decades, to get from conception to release -- and for every drug which gets sold, dozens fail at some point in the testing.  This isn't a bad thing; it's simply a fact of life -- and banning drug advertisement isn't going to make orphan drugs any cheaper.  If anything, it'll make them more expensive, because it'll reduce the drug companies' profits on the drugs which do earn them money.

      And no, all the research involved in drug discovery is not done in academic labs.  And even if it were, you've still got rounds and rounds of drug testing to go through before a product can be released to market.  That's not to mention the cost of developing a economical, environmentally friendly, high-yielding drug synthesis that can be performed on a huge scale.

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