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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.

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

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