7 ms·

Crazy idea: all pharmaceutical research should be publicly funded and publicly-owned. No private ownership of drug patents, period. "But this will disincenti

Crazy idea: all pharmaceutical research should be publicly funded and publicly-owned. No private ownership of drug patents, period. "But this will disincentive research!" Maybe. Or, tax people more in order to fund the research. The tax revenue would go directly to researcher salary, equipment, expenses. Even a large tax increase can't be worse than today, where people have to pay huge $$$ anyway, of which a large cut goes to executives, shareholders, the marketing machine, etc. I believe by and large, people that go into pharma research do it because they're interested in the science and the cause, not because of any privatized profit motivation. Which is to say, people will still go to grad school in the same fields and continue carrying on the research work (so long as the facilities and equipment is available, which we can solve). The downside is that many senior executives would be displaced or be forced to accept lower compensation. Someday in the distant future, people will look back and be as shocked that private companies profited from medicine, as we're shocked today about the for-profit firefighters in ancient Rome.

ianai 8y ago
It’s clearly a market where large expenses are required to make progress. I’m thinking the discoveries should be made public goods through rewarding breakthroughs somehow. Or, devote some fraction of the National gdp to research. We’re talking at least the amount the market currently allocates, but preferably more.
- gred 8y ago
  > I’m thinking the discoveries should be made public goods through rewarding breakthroughs somehow. Maybe the people who create new medicines could be given a temporary monopoly to recoup costs and make some money, and in exchange their research becomes part of the public domain? I'm just spitballing here, but something like that might work...
  - khazhoux 8y ago
    The article specifically addresses the fact that today the monopolies can be effectively permanent.
RcouF1uZ4gsC 8y ago
You do that and in in a few decades, after a few rounds of negotiations, most of your research money will go to funding ex-researchers pensions. For an example, take a look at where California's tax revenues go. In addition, public funding tends to more risk averse. Private industry generously rewards innovation. Public funding tends to reward not rocking the boat.
- HarryHirsch 8y ago
  Private industry generously rewards innovation The drug industry is generally happier to develop new drugs against targets that are well established and for conditions that physicians are trained to prescribe for. That's why we are now at fifth-generation statins, and also why "first-in-class" compounds are so rare. For something really new you need to find the target, devise an assay and make a case for use. It's a billion-dollar gamble. Statins on the other hand, they are well established.
  - RcouF1uZ4gsC 8y ago
    That is why I am so glad that Solvadi the Hepatitis C cure is making so much money.
- jhayward 8y ago
  > Private industry generously rewards innovation. This is a unfounded assertion, not a fact. A more correct statement would probably be: private industry sometimes generously rewards some innovation, as long as that innovation can be captured, monopolized, and monetized. There are many innovations, both realized and that one can imagine, that would absolutely not be rewarded but would be nonetheless hugely significant in health and well-being. As example, consider the whole “Is curing patients a sustainable business model?” question raised by a Goldman Sachs analyst. [1] [1] https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie...
lend000 8y ago
Did Rome suffer from more fires than similar cities in that era? Something tells me it's the other way around... On average, group behavior can best be studied when assuming average humans have selfish, rational motivations. It's possible to create incentives in the public sector but you can imagine it would be much like academia -- a focus on pushing out high volumes of papers, getting grants, and theoretical/laboratory breakthroughs without any consideration of bringing them to market. Most of the breakthroughs in medicine used by countries around the world were invented in the US and originally held by US companies -- the US has effectively subsidized and enabled foreign socialized healthcare systems by being a global exporter of medical technology. So the US adopting a state run medical system would likely have an interesting effect on the global medicine market, in a way much different than any other country (i.e. a massive reduction in global progress). Most people advocating that seem to think the US system is a failed example of a 'free marketplace,' which is an embarrassingly incorrect belief but a product of significant misinformation littering both sides of the argument these days. The US healthcare system is in most ways further from a free market than that of any other country I know of. First of all, we have universal healthcare but only for the elderly (medicare) and the poor (medicaid), which creates an artificial demand imbalance that pumps the prices up for non-participants in those programs, which is even worse than a singular universal system. Then look at the ridiculously overpowered IP law in the US (especially in pharmaceuticals), the oppressive occupational licensing (harder to become a doctor here than anywhere else so naturally we have an artificial shortage of people qualified to do mostly very basic things), FDA-imposed pharmaceutical monopolies, inability to opt-in to experimental treatment (which also means malpractice insurance is always a significant expense), amongst others. This is not a free market, and even if we adopted universal healthcare tomorrow, it does not fix all the other problems listed.
jandrewrogers 8y ago
The reality is that governments have demonstrated limited interest in effective biomedical R&D. Europe does not invest proportional to their population or economy, their governments are happy to outsource it to the US (and Asian) private sector. And there is the longstanding issue that what governments do fund is biased by political fashion and not the areas of research that will maximize benefit. There has been a huge growth in private foundations that fund biomedical research that governments should fund but do not. Also, pharma researchers will accept massive pay cuts "for the science and the cause" as soon as Silicon Valley software engineers take massive pay cuts "to make the world a better place". I have many friends in biotech and they are as interested in maximizing their paycheck as software engineers, it would be naive to expect anything different.
- danShumway 8y ago
  Many software developers do take massive pay cuts to make the world a better place. People like Linus Torvalds could be much, much wealthier if they wanted to. Jason Scott is probably the single most important digital archivist alive right now; he's currently running a podcast to help himself get out of debt while he works for a company that doesn't offer a pension plan. I'm not just talking about fringe developers either[0]. A huge portion of our modern tech industry is built on the backs of people who made a conscious choice to prioritize public good over their own good. I've nothing against developers who make money, but my takeaway from the tech industry has actually been that pure profit-driven motivations are simply not enough to build sustainable, resilient technology. I really hope it's not naive to expect at least some small portion of the population to be charitable because my experience has been that it's often the charitable people who end up getting crap done. Pharma research may be different, because that comes with equipment costs. You need access to that equipment. But if that's the case, the software industry is maybe a bad example to compare it to. Generally agreed on government funding though; maybe I'm too pessimistic but I just can't see the US government investing serious effort into drug research. [0]: https://arstechnica.com/information-technology/2014/04/tech-giants-chastened-by-heartbleed-finally-agree-to-fund-openssl/ https://arstechnica.com/information-technology/2014/04/tech-...
  - 8y ago
KKKKkkkk1 8y ago
Back when the HIV epidemic started, President Reagan and his administration took the view that HIV is a deserved punishment from god for homosexuality and promiscuity. Now what are the chances that that administration would have invested even $1 in developing drugs for AIDS? Do we want to live in that kind of world?
- khazhoux 8y ago
  That's a singular example. And, that viewpoint eventually gave way.
  - v_lisivka 8y ago
    But the root problem is still relevant: what will happen when you have only one way to receive help, and this way is blocked for any reason? Government is special: it can create generally accepted vision for a solution and it can enforce it vision, unlike a company on the free market.
  - rayiner 8y ago
    It’s also a really glaring one, because so many people are affected and the private sector made such a huge improvement in the decades it took for public opinion to turn around. I’d bet drugs for depression, sexually transmitted diseases like herpes, cervical cancer, etc., would be treated similarly.
aaavl2821 8y ago
would you advocate government taking over other industries, or is there something special about biomedical research?
- khazhoux 8y ago
  The intersection of pay-or-die, competitor lock-out, and sky-high prices.
SilasX 8y ago
Would you advocate that for every other technology? Why not?
rayiner 8y ago
It’s a huge flaw in thinking to assume that the money is going to “senior executives.” There are a thousand employees making $150,000 (costing the company $150 million) for every “senior executive” making $15 million. (This is, by the way, true at most companies. Apple computers wouldn’t be cheaper if you cut “senior executive” salaries.)
throwaway84742 8y ago
This sounds like an excellent way to burn a trillion dollars with no tangible result. Government == money black hole, with very few exceptions.
- EliRivers 8y ago
  Aren't governments meant to be money holes? You put money in, you get governing out. They're not meant to be turning a profit.
  - throwaway84742 8y ago
    They are also not meant to do R&D. For one thing they don’t pay market rate, so their access to top talent is non-existent. For another, there’s no accountability and no “fear of death”, since the government essentially can’t run out of money. Why try to use resources wisely if you can just tax people, or if that doesn’t work, print more money, and thereby tax their children and grandchildren. No, I’d much rather this risk was compartmentalized. Another issue is, you’re de facto giving the rest of the world a free ride on US taxpayer largesse. Even better free ride than what they’re getting now: paying a dime on the dollar for newest genetic drugs without spending any money on their development. I’d go along with that in the poor countries like India, but I see no reason whatsoever why I should be paying 5-6x as much as some dude in Western Europe, all while he tries to lecture me about their “free” healthcare. I’d much rather I paid less and they paid the same as me.
    - EliRivers 8y ago
      But there is a lot of beneficial R&D that, were governments not paying for it, would never have been done. Surely the kind of R&D that is beneficial but would never get done privately should be picked up by government? Without that, less modern computers, less modern aerospace, less modern medicine, less modern lots of things.
basch 8y ago
Public/Private hybrids are not uncommon. Let research universities and private drug companies compete for grants. The rub is to make it ok to fail, and reward treating causes not just symptoms. You are right though, it does require some government intervention to incentivize long term gambles with huge up front costs. NASA and The Manhattan Project are no different. Spend lots of money now, knowing you wont reap benefits for years. Our current system of using temporary intellectual property ownership of the formula is broken.

ianai 8y ago

It’s clearly a market where large expenses are required to make progress. I’m thinking the discoveries should be made public goods through rewarding breakthroughs somehow. Or, devote some fraction of the National gdp to research. We’re talking at least the amount the market currently allocates, but preferably more.

gred 8y ago
> I’m thinking the discoveries should be made public goods through rewarding breakthroughs somehow. Maybe the people who create new medicines could be given a temporary monopoly to recoup costs and make some money, and in exchange their research becomes part of the public domain? I'm just spitballing here, but something like that might work...
- khazhoux 8y ago
  The article specifically addresses the fact that today the monopolies can be effectively permanent.

RcouF1uZ4gsC 8y ago

You do that and in in a few decades, after a few rounds of negotiations, most of your research money will go to funding ex-researchers pensions. For an example, take a look at where California's tax revenues go. In addition, public funding tends to more risk averse. Private industry generously rewards innovation. Public funding tends to reward not rocking the boat.

HarryHirsch 8y ago
Private industry generously rewards innovation The drug industry is generally happier to develop new drugs against targets that are well established and for conditions that physicians are trained to prescribe for. That's why we are now at fifth-generation statins, and also why "first-in-class" compounds are so rare. For something really new you need to find the target, devise an assay and make a case for use. It's a billion-dollar gamble. Statins on the other hand, they are well established.
- RcouF1uZ4gsC 8y ago
  That is why I am so glad that Solvadi the Hepatitis C cure is making so much money.
jhayward 8y ago
> Private industry generously rewards innovation. This is a unfounded assertion, not a fact. A more correct statement would probably be: private industry sometimes generously rewards some innovation, as long as that innovation can be captured, monopolized, and monetized. There are many innovations, both realized and that one can imagine, that would absolutely not be rewarded but would be nonetheless hugely significant in health and well-being. As example, consider the whole “Is curing patients a sustainable business model?” question raised by a Goldman Sachs analyst. [1] [1] https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie...

lend000 8y ago

Did Rome suffer from more fires than similar cities in that era? Something tells me it's the other way around... On average, group behavior can best be studied when assuming average humans have selfish, rational motivations. It's possible to create incentives in the public sector but you can imagine it would be much like academia -- a focus on pushing out high volumes of papers, getting grants, and theoretical/laboratory breakthroughs without any consideration of bringing them to market. Most of the breakthroughs in medicine used by countries around the world were invented in the US and originally held by US companies -- the US has effectively subsidized and enabled foreign socialized healthcare systems by being a global exporter of medical technology. So the US adopting a state run medical system would likely have an interesting effect on the global medicine market, in a way much different than any other country (i.e. a massive reduction in global progress). Most people advocating that seem to think the US system is a failed example of a 'free marketplace,' which is an embarrassingly incorrect belief but a product of significant misinformation littering both sides of the argument these days. The US healthcare system is in most ways further from a free market than that of any other country I know of. First of all, we have universal healthcare but only for the elderly (medicare) and the poor (medicaid), which creates an artificial demand imbalance that pumps the prices up for non-participants in those programs, which is even worse than a singular universal system. Then look at the ridiculously overpowered IP law in the US (especially in pharmaceuticals), the oppressive occupational licensing (harder to become a doctor here than anywhere else so naturally we have an artificial shortage of people qualified to do mostly very basic things), FDA-imposed pharmaceutical monopolies, inability to opt-in to experimental treatment (which also means malpractice insurance is always a significant expense), amongst others. This is not a free market, and even if we adopted universal healthcare tomorrow, it does not fix all the other problems listed.

jandrewrogers 8y ago

The reality is that governments have demonstrated limited interest in effective biomedical R&D. Europe does not invest proportional to their population or economy, their governments are happy to outsource it to the US (and Asian) private sector. And there is the longstanding issue that what governments do fund is biased by political fashion and not the areas of research that will maximize benefit. There has been a huge growth in private foundations that fund biomedical research that governments should fund but do not. Also, pharma researchers will accept massive pay cuts "for the science and the cause" as soon as Silicon Valley software engineers take massive pay cuts "to make the world a better place". I have many friends in biotech and they are as interested in maximizing their paycheck as software engineers, it would be naive to expect anything different.

danShumway 8y ago
Many software developers do take massive pay cuts to make the world a better place. People like Linus Torvalds could be much, much wealthier if they wanted to. Jason Scott is probably the single most important digital archivist alive right now; he's currently running a podcast to help himself get out of debt while he works for a company that doesn't offer a pension plan. I'm not just talking about fringe developers either[0]. A huge portion of our modern tech industry is built on the backs of people who made a conscious choice to prioritize public good over their own good. I've nothing against developers who make money, but my takeaway from the tech industry has actually been that pure profit-driven motivations are simply not enough to build sustainable, resilient technology. I really hope it's not naive to expect at least some small portion of the population to be charitable because my experience has been that it's often the charitable people who end up getting crap done. Pharma research may be different, because that comes with equipment costs. You need access to that equipment. But if that's the case, the software industry is maybe a bad example to compare it to. Generally agreed on government funding though; maybe I'm too pessimistic but I just can't see the US government investing serious effort into drug research. [0]: https://arstechnica.com/information-technology/2014/04/tech-giants-chastened-by-heartbleed-finally-agree-to-fund-openssl/ https://arstechnica.com/information-technology/2014/04/tech-...
- 8y ago

KKKKkkkk1 8y ago

Back when the HIV epidemic started, President Reagan and his administration took the view that HIV is a deserved punishment from god for homosexuality and promiscuity. Now what are the chances that that administration would have invested even $1 in developing drugs for AIDS? Do we want to live in that kind of world?

khazhoux 8y ago
That's a singular example. And, that viewpoint eventually gave way.
- v_lisivka 8y ago
  But the root problem is still relevant: what will happen when you have only one way to receive help, and this way is blocked for any reason? Government is special: it can create generally accepted vision for a solution and it can enforce it vision, unlike a company on the free market.
- rayiner 8y ago
  It’s also a really glaring one, because so many people are affected and the private sector made such a huge improvement in the decades it took for public opinion to turn around. I’d bet drugs for depression, sexually transmitted diseases like herpes, cervical cancer, etc., would be treated similarly.

aaavl2821 8y ago

would you advocate government taking over other industries, or is there something special about biomedical research?

khazhoux 8y ago
The intersection of pay-or-die, competitor lock-out, and sky-high prices.

SilasX 8y ago

Would you advocate that for every other technology? Why not?

rayiner 8y ago

It’s a huge flaw in thinking to assume that the money is going to “senior executives.” There are a thousand employees making $150,000 (costing the company $150 million) for every “senior executive” making $15 million. (This is, by the way, true at most companies. Apple computers wouldn’t be cheaper if you cut “senior executive” salaries.)

throwaway84742 8y ago

This sounds like an excellent way to burn a trillion dollars with no tangible result. Government == money black hole, with very few exceptions.

EliRivers 8y ago
Aren't governments meant to be money holes? You put money in, you get governing out. They're not meant to be turning a profit.
- throwaway84742 8y ago
  They are also not meant to do R&D. For one thing they don’t pay market rate, so their access to top talent is non-existent. For another, there’s no accountability and no “fear of death”, since the government essentially can’t run out of money. Why try to use resources wisely if you can just tax people, or if that doesn’t work, print more money, and thereby tax their children and grandchildren. No, I’d much rather this risk was compartmentalized. Another issue is, you’re de facto giving the rest of the world a free ride on US taxpayer largesse. Even better free ride than what they’re getting now: paying a dime on the dollar for newest genetic drugs without spending any money on their development. I’d go along with that in the poor countries like India, but I see no reason whatsoever why I should be paying 5-6x as much as some dude in Western Europe, all while he tries to lecture me about their “free” healthcare. I’d much rather I paid less and they paid the same as me.
  - EliRivers 8y ago
    But there is a lot of beneficial R&D that, were governments not paying for it, would never have been done. Surely the kind of R&D that is beneficial but would never get done privately should be picked up by government? Without that, less modern computers, less modern aerospace, less modern medicine, less modern lots of things.

basch 8y ago

Public/Private hybrids are not uncommon. Let research universities and private drug companies compete for grants. The rub is to make it ok to fail, and reward treating causes not just symptoms. You are right though, it does require some government intervention to incentivize long term gambles with huge up front costs. NASA and The Manhattan Project are no different. Spend lots of money now, knowing you wont reap benefits for years. Our current system of using temporary intellectual property ownership of the formula is broken.