5 ms·

Why would making it government funded make new treatments like this 1) available or 2) accessible? Obviously it's extremely expensive to R&D something like this

Why would making it government funded make new treatments like this 1) available or 2) accessible? Obviously it's extremely expensive to R&D something like this and no one is going to make that investment--least of all a cash-strapped government bureaucracy--unless there's some payoff. And if it were government funded, the cost to taxpayers would be many times the benefit to taxpayers for something like this; there's obviously a point at which even the proudest humanitarian has to look at the big picture. Obviously America wouldn't bankrupt itself to save one life--the price really does have to be looked at. Besides, there's nothing humanitarian about spending other peoples' money. That requires no humanitarianism, just political access to taxpayer coffers. The best way for more medical innovation like this is for it to be expensive at first. Over time, competition and demand drives prices down. Pretty much all the medical technology we now take for granted was only accessible to the rich at first.

albertgoeswoof 9y ago
> The cost to taxpayers would be many times the benefit to taxpayers for something like this Really? Do you know how expensive supporting braille is? Accessibility requirements for software? Fitting a blind person's house out with accessible features? Providing public services and transit for the blind? Income support? All of these things are costs absorbed by society, which you cover one way or another (e.g. taxes, additional costs in products & services etc.). Being blind is a major disability, the lifetime cost to society of a single blind person is many multiples of 425k per eye. > The best way for more medical innovation like this is for it to be expensive at first. Over time, competition and demand drives prices down. Pretty much all the medical technology we now take for granted was only accessible to the rich at first. What?? What if there are no rich blind people competing for this care? How is the cost going to come down then?
- DanBC 9y ago
  But this treatment isn't going to cure all blindness, so you're still going to have to have all those adaptations.
- bmmayer1 9y ago
  Certainly society doesn't absorb these costs evenly, and only a fraction of these costs are paid by taxpayers. I'd bet if you add up the total expenditure on the federal government level for services for the blind, it wouldn't justify trading it for curing people who suffer from this one genetic adaptation (given all the other people who are blind for other reasons). Plus, it's not as if every person will even get the procedure if it is free. There are complications. There are religious objections. There are personal preferences. Higher prices don't come down because rich people buy them. They come down because it creates incentives for new innovators to produce cheaper and more efficient methods.
barrkel 9y ago
The best way for more medical innovation like this is for it to be expensive at first That's a bold assertion, and you haven't supported it with an argument. What about diseases of poverty in the third world? Is the best way of getting medical innovation here by making the cures expensive? The trouble with this kind of thinking is that it (a) conflates the value of an intervention with the price it can command, which is most problematic when it (b) requires large upfront payments and cannot efficiently aggregate or amortize costs over time. Here's some food for thought for a different approach: prizes. If there were funds made available to pay a prize for working cures, drugs, etc. for medical problems, it could replace patents as a reward mechanism and permit market behaviour to increase the efficiency via generics and widespread application directly, rather than needing exclusivity and high prices for a long period. See e.g. https://en.wikipedia.org/wiki/Prizes_as_an_alternative_to_patents https://en.wikipedia.org/wiki/Prizes_as_an_alternative_to_pa...
- bmmayer1 9y ago
  It's not a bold claim, it's quite supported by evidence. AZT, the first commercially available drug to treat AIDS, was made available in 1989 at the extraordinary cost of $18000 per year in today's dollars ($8000 per year at the time). It was reported by the New York Times at the time that such a cost was 'inhumane' much as headlines do today when expensive new treatments come out.[1] Now the same drug is packaged with Lamivudine and costs $6600 per year[2]. There are now generic retrovirals on the market as well. Now, of course the total suite of treatments is higher which means the overall cost for patients can be higher, but over time the cost of these drugs will go down too. The point is that something being expensive at the beginning ensures long-term development and accessibility for the drug, doesn't hinder it. Looking at a less life threatening example, LASIK eye surgery used to cost $12,400 with inflation.[3] Now it can cost as low as $299 per eye.[4] The list of examples is long and exhaustive. > What about diseases of poverty in the third world? To be clear, I'm talking about new medical innovation, not the proliferation of existing medical solutions which obviously can be paid for by governments and nonprofits without harming the development of new methods. That said, there are quite a few 'last mile' solutions getting medicine to poor parts of the world that organizations like the Gates Foundation have identified.[5] > Here's some food for thought for a different approach: prizes I like the prize method as a way of incentivizing innovation--and it should certainly be tested. But I would be hesitant to endorse it as a replacement for the patent system unless it was proven to work more effectively in creating more cost effective innovations. It could, of course, be tested by allocating a percentage of the NCI's budget for prizes. But I think you'll find that the appetite for that sort of risk is sorely wanting on the governmental level, as it should be. We want investors to be taking these risks with their own money (and get rewarded when they pay off), not gambling with our money and losing it when they don't. Remember that, like startups, only a small fraction of drug ventures make it to the market and we only hear about the ones that do. [1]http://www.nytimes.com/1989/08/28/opinion/azt-s-inhuman-cost.html http://www.nytimes.com/1989/08/28/opinion/azt-s-inhuman-cost... [2]https://www.healthline.com/health/hiv-aids/cost-of-treatment https://www.healthline.com/health/hiv-aids/cost-of-treatment [3]https://www.forbes.com/sites/larahoffmans/2012/03/23/they-unblinded-me-with-science https://www.forbes.com/sites/larahoffmans/2012/03/23/they-un... [4]https://www.lasik.com/category/cost-of-lasik/ https://www.lasik.com/category/cost-of-lasik/ [5]https://www.youtube.com/watch?v=GlUS6KE67Vs https://www.youtube.com/watch?v=GlUS6KE67Vs

albertgoeswoof 9y ago

> The cost to taxpayers would be many times the benefit to taxpayers for something like this Really? Do you know how expensive supporting braille is? Accessibility requirements for software? Fitting a blind person's house out with accessible features? Providing public services and transit for the blind? Income support? All of these things are costs absorbed by society, which you cover one way or another (e.g. taxes, additional costs in products & services etc.). Being blind is a major disability, the lifetime cost to society of a single blind person is many multiples of 425k per eye. > The best way for more medical innovation like this is for it to be expensive at first. Over time, competition and demand drives prices down. Pretty much all the medical technology we now take for granted was only accessible to the rich at first. What?? What if there are no rich blind people competing for this care? How is the cost going to come down then?

DanBC 9y ago
But this treatment isn't going to cure all blindness, so you're still going to have to have all those adaptations.
bmmayer1 9y ago
Certainly society doesn't absorb these costs evenly, and only a fraction of these costs are paid by taxpayers. I'd bet if you add up the total expenditure on the federal government level for services for the blind, it wouldn't justify trading it for curing people who suffer from this one genetic adaptation (given all the other people who are blind for other reasons). Plus, it's not as if every person will even get the procedure if it is free. There are complications. There are religious objections. There are personal preferences. Higher prices don't come down because rich people buy them. They come down because it creates incentives for new innovators to produce cheaper and more efficient methods.

barrkel 9y ago

The best way for more medical innovation like this is for it to be expensive at first That's a bold assertion, and you haven't supported it with an argument. What about diseases of poverty in the third world? Is the best way of getting medical innovation here by making the cures expensive? The trouble with this kind of thinking is that it (a) conflates the value of an intervention with the price it can command, which is most problematic when it (b) requires large upfront payments and cannot efficiently aggregate or amortize costs over time. Here's some food for thought for a different approach: prizes. If there were funds made available to pay a prize for working cures, drugs, etc. for medical problems, it could replace patents as a reward mechanism and permit market behaviour to increase the efficiency via generics and widespread application directly, rather than needing exclusivity and high prices for a long period. See e.g. https://en.wikipedia.org/wiki/Prizes_as_an_alternative_to_patents https://en.wikipedia.org/wiki/Prizes_as_an_alternative_to_pa...

bmmayer1 9y ago
It's not a bold claim, it's quite supported by evidence. AZT, the first commercially available drug to treat AIDS, was made available in 1989 at the extraordinary cost of $18000 per year in today's dollars ($8000 per year at the time). It was reported by the New York Times at the time that such a cost was 'inhumane' much as headlines do today when expensive new treatments come out.[1] Now the same drug is packaged with Lamivudine and costs $6600 per year[2]. There are now generic retrovirals on the market as well. Now, of course the total suite of treatments is higher which means the overall cost for patients can be higher, but over time the cost of these drugs will go down too. The point is that something being expensive at the beginning ensures long-term development and accessibility for the drug, doesn't hinder it. Looking at a less life threatening example, LASIK eye surgery used to cost $12,400 with inflation.[3] Now it can cost as low as $299 per eye.[4] The list of examples is long and exhaustive. > What about diseases of poverty in the third world? To be clear, I'm talking about new medical innovation, not the proliferation of existing medical solutions which obviously can be paid for by governments and nonprofits without harming the development of new methods. That said, there are quite a few 'last mile' solutions getting medicine to poor parts of the world that organizations like the Gates Foundation have identified.[5] > Here's some food for thought for a different approach: prizes I like the prize method as a way of incentivizing innovation--and it should certainly be tested. But I would be hesitant to endorse it as a replacement for the patent system unless it was proven to work more effectively in creating more cost effective innovations. It could, of course, be tested by allocating a percentage of the NCI's budget for prizes. But I think you'll find that the appetite for that sort of risk is sorely wanting on the governmental level, as it should be. We want investors to be taking these risks with their own money (and get rewarded when they pay off), not gambling with our money and losing it when they don't. Remember that, like startups, only a small fraction of drug ventures make it to the market and we only hear about the ones that do. [1]http://www.nytimes.com/1989/08/28/opinion/azt-s-inhuman-cost.html http://www.nytimes.com/1989/08/28/opinion/azt-s-inhuman-cost... [2]https://www.healthline.com/health/hiv-aids/cost-of-treatment https://www.healthline.com/health/hiv-aids/cost-of-treatment [3]https://www.forbes.com/sites/larahoffmans/2012/03/23/they-unblinded-me-with-science https://www.forbes.com/sites/larahoffmans/2012/03/23/they-un... [4]https://www.lasik.com/category/cost-of-lasik/ https://www.lasik.com/category/cost-of-lasik/ [5]https://www.youtube.com/watch?v=GlUS6KE67Vs https://www.youtube.com/watch?v=GlUS6KE67Vs