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One could make a pretty good argument that a government funded drug research system would end up with more expensive drugs (in the form of higher taxes) than a

One could make a pretty good argument that a government funded drug research system would end up with more expensive drugs (in the form of higher taxes) than a for profit system Drugs, as a whole, aren't that expensive today compared to other healthcare. They make up 9.8% of US health care expenditure, which is pretty much middle of the pack compared to OECD countries. Hospitals, largely "non profit" (but sometimes massively profitable) make up 35%. But drugs feel more expensive bc copays are typically higher for drugs than for medical care As it stands today the drug industry spends ~$200B a year to get 20-50 new FDA approved drugs a year. Virtually no fda approved drugs are developed solely by academia. NIH budget is $30-35B and on a steady long term decline. So you'd have a massive taxpayer expense just to build out that r&d function Then you'd have to build out manufacturing. And some sales and marketing analog -- even if you aren't trying to profit, somebody needs to go out and tell doctors about your new drug and share with them very detailed data about how the drug works, what patients it works for, compared to the competition. Doctors can't stay on top of this themselves -- they are too busy and there's too much info Then you'd need to build out some administrative function and some way to decide what projects move forward at what stage. This is where publicly funded drug research would probably massively underperform private for profit r&d If you are making drugs for profit, you have a strong incentive to be efficient with your research. If not you go out of business. The more these decisions are driven by politics rather than profit motive, the less productive r&d is. And r&d cost and productivity is the reason drugs are expensive There's evidence that startups are 10x more productive at r&d than pharma and it isn't crazy to attribute a lot of that to less politics As of now something like 30-50% of published academic findings are thought to be false. 30%+ of all NIH money goes to "overhead", i.e. Profit to universities. And yields no fda approved drugs without private company investment

Pharmakon 8y ago
One could make a pretty good argument that a government funded drug research system would end up with more expensive drugs (in the form of higher taxes) than a for profit system. That sounds like a pretty interesting argument, but I notice that you didn’t actually make it. The rest of your post is full of claims sans evidence, and a lot of numbers out of context. For example how many of those newly approved drugs are novel therapies vs. rejiggered stereochemistry to keep a patent or compete in an existing field? How many are significant improvements over existing therapies and not just potential profit centers?
- pkaye 8y ago
  > rejiggered stereochemistry to keep a patent Can someone tell me how this patent extension works? If they improve on something, is that a new patent? Does the original patent expire or gets extended? Why couldn't someone else have discovered the new stereochemistry before the original inventor dose so? If the new discovery is not significant, wouldn't its be sufficient to use the generic form of the original chemistry?
  - coryrc 8y ago
    It is a new patent and the original can made generically once the old patent expires. Marketing is the difference. For example, you may have seen people talking about the excessive price of insulin in the US, but they ignore the fact that you can still get the old versions for very cheap. It's also done with "extended-release" versions of the old version.
  - Pharmakon 8y ago
    A great, easy to understand example is found in the drug Prilosec vs. Nexium, the latter of which is a stereoisomer of the former. Prilosec is Omeprazole, which is part of a class of drugs called Proton Pump Inhibitors (PPI’s) which treat severe recurrent heartburn and GERD, as well as esophageal erosion from those conditions. Prilosec (Omeprazole) was due to go generic, so the company decided to isolate and purify the S isomer and worked hard to convince the FDA that it represented a truly new treatment. IIRC the rationale was that the enantiopure drug was half the dose of the racemic mixture, and regulatory capture did the rest of the work. Of course there was no tangible benefit to taking 10mg of Esomeprazole vs 20mg of Omeprazole, except the monetary benefit for the company. As to why some other company didn’t snap up the patent, it’s an expensive proposition and not trivial to make enantiopure drugs, so a lot of the R&D budget touted by apologists and shills is entirely self-serving. Now sometimes an isomer is actually superior to a racemic mixture and there are plenty of cases where one isomer is therapeutic and the other is ineffective or toxic. Of course in those cases none of this patent fuckery applies, and there is no way to get a new patent issued or FDA writ because only one viable form of the drug exists. It’s also true that a generic in the case of something like Esomeprazole vs. Omeprazole is viable, and that’s where the astronomical marketing budget that dwarfs R&D comes into play. Advertising directly to patients and doctors ensures that plenty of people won’t understsnd the value of a generic is they were even aware of it. You also get cases, as with Epi-pens, where supplies of the generic are scarce compared to the expensive branded version. Good list of this kind of thing found here: https://en.m.wikipedia.org/wiki/Enantiopure_drug https://en.m.wikipedia.org/wiki/Enantiopure_drug
samfisher83 8y ago
The NIH is by far the single largest contributor to drug R+D in this country. Pretty much every big pharma company is cutting R+D.
- aaavl2821 8y ago
  Johnson and Johnson invested $10.8B in r&d in 2018 compared to $34b nih budget. Merck spent $9.6b. Pfizer spent $8b. Bristol Myers spent $5b Yes NIH is biggest single spender but pharma industry as a whole spends much more
dmitriid 8y ago
> One could make a pretty good argument that a government funded drug research system would end up with more expensive drugs (in the form of higher taxes) than a for profit system Please, do. Meanwhile: https://news.ycombinator.com/item?id=19264699 https://news.ycombinator.com/item?id=19264699

Pharmakon 8y ago

One could make a pretty good argument that a government funded drug research system would end up with more expensive drugs (in the form of higher taxes) than a for profit system. That sounds like a pretty interesting argument, but I notice that you didn’t actually make it. The rest of your post is full of claims sans evidence, and a lot of numbers out of context. For example how many of those newly approved drugs are novel therapies vs. rejiggered stereochemistry to keep a patent or compete in an existing field? How many are significant improvements over existing therapies and not just potential profit centers?

pkaye 8y ago
> rejiggered stereochemistry to keep a patent Can someone tell me how this patent extension works? If they improve on something, is that a new patent? Does the original patent expire or gets extended? Why couldn't someone else have discovered the new stereochemistry before the original inventor dose so? If the new discovery is not significant, wouldn't its be sufficient to use the generic form of the original chemistry?
- coryrc 8y ago
  It is a new patent and the original can made generically once the old patent expires. Marketing is the difference. For example, you may have seen people talking about the excessive price of insulin in the US, but they ignore the fact that you can still get the old versions for very cheap. It's also done with "extended-release" versions of the old version.
- Pharmakon 8y ago
  A great, easy to understand example is found in the drug Prilosec vs. Nexium, the latter of which is a stereoisomer of the former. Prilosec is Omeprazole, which is part of a class of drugs called Proton Pump Inhibitors (PPI’s) which treat severe recurrent heartburn and GERD, as well as esophageal erosion from those conditions. Prilosec (Omeprazole) was due to go generic, so the company decided to isolate and purify the S isomer and worked hard to convince the FDA that it represented a truly new treatment. IIRC the rationale was that the enantiopure drug was half the dose of the racemic mixture, and regulatory capture did the rest of the work. Of course there was no tangible benefit to taking 10mg of Esomeprazole vs 20mg of Omeprazole, except the monetary benefit for the company. As to why some other company didn’t snap up the patent, it’s an expensive proposition and not trivial to make enantiopure drugs, so a lot of the R&D budget touted by apologists and shills is entirely self-serving. Now sometimes an isomer is actually superior to a racemic mixture and there are plenty of cases where one isomer is therapeutic and the other is ineffective or toxic. Of course in those cases none of this patent fuckery applies, and there is no way to get a new patent issued or FDA writ because only one viable form of the drug exists. It’s also true that a generic in the case of something like Esomeprazole vs. Omeprazole is viable, and that’s where the astronomical marketing budget that dwarfs R&D comes into play. Advertising directly to patients and doctors ensures that plenty of people won’t understsnd the value of a generic is they were even aware of it. You also get cases, as with Epi-pens, where supplies of the generic are scarce compared to the expensive branded version. Good list of this kind of thing found here: https://en.m.wikipedia.org/wiki/Enantiopure_drug https://en.m.wikipedia.org/wiki/Enantiopure_drug

samfisher83 8y ago

The NIH is by far the single largest contributor to drug R+D in this country. Pretty much every big pharma company is cutting R+D.

aaavl2821 8y ago
Johnson and Johnson invested $10.8B in r&d in 2018 compared to $34b nih budget. Merck spent $9.6b. Pfizer spent $8b. Bristol Myers spent $5b Yes NIH is biggest single spender but pharma industry as a whole spends much more

dmitriid 8y ago

> One could make a pretty good argument that a government funded drug research system would end up with more expensive drugs (in the form of higher taxes) than a for profit system Please, do. Meanwhile: https://news.ycombinator.com/item?id=19264699 https://news.ycombinator.com/item?id=19264699