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This feels like it raises the question of what kind of drug development pipeline we want to invest into. Drug company profits generally come from serving the n

This feels like it raises the question of what kind of drug development pipeline we want to invest into. Drug company profits generally come from serving the needs of the well-to-do in the global north. We will obviously need new vaccines and antibiotics as time goes on. I wonder if the expensive research infrastructure setup to target the high-profit drugs is the same as the one we would build to target vaccines and antibiotics. There's an element of systemic & structural dissonance here too - if we start dying from drug resistant strains of endemic diseases, those high profit drugs probably aren't going to keep selling well. We need to think seriously about how to construct a drug development ecosystem that balances our needs. I don't think it's as simple as "nationalize the drug companies" (though I think they are pretty morally bankrupt).

reaperducer 7y ago
It would be nice if we could come up with a system that rewards doing the most good. The problem is, does "the most good" mean treats the largest number of people, or treats the most virulent conditions, or something else. Right now, we're largely using "the most good" to mean "the most good for shareholders," which is how we ended up with a bunch of different wiener pills and breast cancer is still a thing.
- JamesBarney 7y ago
  Viagra exists yet breast cancer is still a thing because cancer is way harder to solve. And there is an enormous amount of money in cancer. Cancer drugs are some of the most profitable drugs to research right now. And discovering viagra was a complete accident while trying to develop a pill for cardiovascular disease.
  - RcouF1uZ4gsC 7y ago
    > Viagra exists yet breast cancer is still a thing because cancer is way harder to solve. I am not sure that breast cancer is a good example. There have been a lot of exciting advances in breast cancer therapy including therapy that tries to cure the cancer but still preserves the breast. Five year survival rate is near 90%. https://seer.cancer.gov/statfacts/html/breast.html https://seer.cancer.gov/statfacts/html/breast.html
- s1artibartfast 7y ago
  >we're largely using "the most good" to mean "the most good for shareholders An alternative framing is that, "doing the most good" is determined by what the public is willing to pay for. The public thinking cancer treatments are very good because the impacts are immediate and obvious. The public also cares deeply about their wiener.
  - JohnFen 7y ago
    > "doing the most good" is determined by what the public is willing to pay for I think that's a very seriously flawed metric to measure what's "doing the most good".
    - s1artibartfast 7y ago
      Yeah, it is far from perfect. It relies on people in mass, and collectively, to want good things. That said, it is a hell of a lot better than most of the alternatives.
JamesBarney 7y ago
We basically regulated away antibiotic development. Here's an explanation from a founder on why the numbers for anti-biotic R&D don't work. https://endpts.com/biopharma-has-abandoned-antibiotic-development-heres-why-we-did-too/ https://endpts.com/biopharma-has-abandoned-antibiotic-develo...
- aeturnum 7y ago
  We've "regulated [it] away" in the sense that drugs that only pull in $1m a year aren't considered economically viable. I'm not sure regulation is the appropriate villian in this case. FTA: >new antibiotics typically end up with list prices in the $2,000 — $3,000 range (for a one-time cure!) while payers gladly shell out tens or hundreds of thousands for cancer drugs or medicines for rare genetic diseases. Low sales volumes (due to stewardship) and low price points (due to DRG-driven pricing pressures) result in minimal sales for novel antibiotics. Achaogen’s new antibiotic was seeing unimpressive sales of around a million dollars per quarter before the company folded. At these sales figures, the company would have never recouped the cost of developing the drug. Of course, we don't want antibiotics to cost $10k a unit, much less $100k. Thus my question about the implicit assumption that the same development pipeline that's working on $100k+ cancer drugs is suitable for antibiotic development.
  - JamesBarney 7y ago
    The current regulations are setup so that it costs a mountain of money to make an antibiotic and you can only make a molehill of money. That seems like regulating the R&D away. Of course what you want is antibiotics to cost a dollar and be as safe as apply pie and as plentiful as salt water. But that's not really an options. Our options are the status quo, heavily subsidize antibiotic research and pricing, reduce regulations so they can be developed incredibly cheaply, or change regulations to drive up sales.
    - magduf 7y ago
      >The current regulations are setup so that it costs a mountain of money to make an antibiotic and you can only make a molehill of money. That seems like regulating the R&D away. So why can't pharma companies move their operations to countries with fewer regulations?

reaperducer 7y ago

It would be nice if we could come up with a system that rewards doing the most good. The problem is, does "the most good" mean treats the largest number of people, or treats the most virulent conditions, or something else. Right now, we're largely using "the most good" to mean "the most good for shareholders," which is how we ended up with a bunch of different wiener pills and breast cancer is still a thing.

JamesBarney 7y ago
Viagra exists yet breast cancer is still a thing because cancer is way harder to solve. And there is an enormous amount of money in cancer. Cancer drugs are some of the most profitable drugs to research right now. And discovering viagra was a complete accident while trying to develop a pill for cardiovascular disease.
- RcouF1uZ4gsC 7y ago
  > Viagra exists yet breast cancer is still a thing because cancer is way harder to solve. I am not sure that breast cancer is a good example. There have been a lot of exciting advances in breast cancer therapy including therapy that tries to cure the cancer but still preserves the breast. Five year survival rate is near 90%. https://seer.cancer.gov/statfacts/html/breast.html https://seer.cancer.gov/statfacts/html/breast.html
s1artibartfast 7y ago
>we're largely using "the most good" to mean "the most good for shareholders An alternative framing is that, "doing the most good" is determined by what the public is willing to pay for. The public thinking cancer treatments are very good because the impacts are immediate and obvious. The public also cares deeply about their wiener.
- JohnFen 7y ago
  > "doing the most good" is determined by what the public is willing to pay for I think that's a very seriously flawed metric to measure what's "doing the most good".
  - s1artibartfast 7y ago
    Yeah, it is far from perfect. It relies on people in mass, and collectively, to want good things. That said, it is a hell of a lot better than most of the alternatives.

JamesBarney 7y ago

We basically regulated away antibiotic development. Here's an explanation from a founder on why the numbers for anti-biotic R&D don't work. https://endpts.com/biopharma-has-abandoned-antibiotic-development-heres-why-we-did-too/ https://endpts.com/biopharma-has-abandoned-antibiotic-develo...

aeturnum 7y ago
We've "regulated [it] away" in the sense that drugs that only pull in $1m a year aren't considered economically viable. I'm not sure regulation is the appropriate villian in this case. FTA: >new antibiotics typically end up with list prices in the $2,000 — $3,000 range (for a one-time cure!) while payers gladly shell out tens or hundreds of thousands for cancer drugs or medicines for rare genetic diseases. Low sales volumes (due to stewardship) and low price points (due to DRG-driven pricing pressures) result in minimal sales for novel antibiotics. Achaogen’s new antibiotic was seeing unimpressive sales of around a million dollars per quarter before the company folded. At these sales figures, the company would have never recouped the cost of developing the drug. Of course, we don't want antibiotics to cost $10k a unit, much less $100k. Thus my question about the implicit assumption that the same development pipeline that's working on $100k+ cancer drugs is suitable for antibiotic development.
- JamesBarney 7y ago
  The current regulations are setup so that it costs a mountain of money to make an antibiotic and you can only make a molehill of money. That seems like regulating the R&D away. Of course what you want is antibiotics to cost a dollar and be as safe as apply pie and as plentiful as salt water. But that's not really an options. Our options are the status quo, heavily subsidize antibiotic research and pricing, reduce regulations so they can be developed incredibly cheaply, or change regulations to drive up sales.
  - magduf 7y ago
    >The current regulations are setup so that it costs a mountain of money to make an antibiotic and you can only make a molehill of money. That seems like regulating the R&D away. So why can't pharma companies move their operations to countries with fewer regulations?