6 ms·

Not mentioned: the US research complex and healthcare spending subsidizing development of state-of-the-art therapies for other countries. They don't bear the c

Not mentioned: the US research complex and healthcare spending subsidizing development of state-of-the-art therapies for other countries. They don't bear the cost so expecting the US to do better at same or lower cost is structually impossible.

cjbenedikt 4y ago
Do you have any data to backup your claim? For example Cuban healthcare/treatment/outcome is excellent based on its own research. Roche(Swiss) nor Merck ( German, not related to US Merck) don't benefit much (if at all) from US subsidies.
- ch4s3 4y ago
  Cuba has developed a few drugs and exports doctors as chattel for foreign income but their actual healthcare is abysmal. They larger operate without antibiotics, pain killers, and at times clean water. They can’t provide 24h power to hospitals so most modern tech is pointless there. The notion that anything else is true is just Cuban propaganda. There are tons of accounts from NGOs and doctors who have defected.
- mjewkes 4y ago
  >Do you have any data to backup your claim? I would suggest The Great American Drug Deal, by Peter Kolchinsky. Also - https://www.rand.org/pubs/research_briefs/RB9412.html https://www.rand.org/pubs/research_briefs/RB9412.html >For example Cuban healthcare/treatment/outcome is excellent based on its own research Cuba does not contribute substantially to global pharmaceutical research. >Roche(Swiss) nor Merck ( German, not related to US Merck) don't benefit much (if at all) from US subsidies. Roche makes 55% of its revenue from US drug sales (https://assets.cwp.roche.com/f/126832/x/db9d31e8a7/fb20e.pdf https://assets.cwp.roche.com/f/126832/x/db9d31e8a7/fb20e.pdf p22) EMD Serono (formerly Merck KgAA) is similar. These revenues are the topline driver of the drug development industry.
- lr4444lr 4y ago
  Cuba's data is pretty suspect. Too lazy to find it at the moment, but I recall reading that their cancer rates or deaths were some absurd fraction of what would be expected given smoking rates even compared with better developed countries. They also had some eye raising way of counting perinatal infant death that makes their infant mortality rates look a lot lower.
biorach 4y ago
You'd really need to show some numbers to back this up. Is the cost of funding the "research complex" included in the expenditure on health care? At least some of this cost is born by the Federal government, foundations etc, is this counted as general health care expenditure (I doubt it) Some of the research is funded by companies - since they sell globally this funding cannot be counted as purely of US origin. Other countries also have significant health research - e.g. UK, France, Germany - your point would also apply to them. Overall your point is dubious, and vague - you'd need to present some solid numbers to back it up.
- mjewkes 4y ago
  Hey biorach - I would suggest: https://www.rand.org/pubs/research_briefs/RB9412.html https://www.rand.org/pubs/research_briefs/RB9412.html and The Great American Drug Deal, by Peter Kolchinsky. Specific claims: - The US pays more for new drugs than the rest of the world - The US contribution is disproportionate, and is major driver of the drug development industry. -If the US paid less for new drugs, the entire industry would slow, and we would have fewer more effective treatments. ... Routine medical procedures being crazy expensive is unrelated and pathological.
  - raverbashing 4y ago
    You're assuming that most of the "extra" money goes back in research and not to shareholders and management bonuses Given how pharma companies operate, I kinda doubt it.
    - mjewkes 4y ago
      No assumptions. The rand article addresses that directly.
awinter-py 4y ago
on the research side, this would tend to reduce prices, right? clinical trials usually aren't charging (per [1]). this 2017 article[2] claims that the US pharma $ premium is more than R&D spending for 13 of 15 top pharma cos. (Note: this isn't even talking about profit, it's talking about the excess profit from higher US prices). Maybe you can make an argument that R&D is lockstep to margins, and would shrink if margins went down? 1. https://www.hhs.gov/ohrp/sachrp-committee/recommendations/november-20-2019-attachment-a/index.html https://www.hhs.gov/ohrp/sachrp-committee/recommendations/no... 2. https://www.healthaffairs.org/do/10.1377/forefront.20170307.059036/ https://www.healthaffairs.org/do/10.1377/forefront.20170307....
byecancer21 4y ago
This mirrors my personal experience. To make a treatment decision, against the advice of my local doctors, that was key to survival I relied on US research. To compare costs: For an extremely rare cancer, total cost of treatment was 100k EUR in Germany, whereas US patients report case costs of >2m USD. Part of these savings stem from the public healthcare system not providing adequate treatment, while strictly necessary for a reasonable chance of survival in this case. What happens in Germany then is the amazing doctors do stuff anyway (if you can convince them), bill whatever they can, and write off the remainder. Profits from privately insured patients make up for this shortfall here. Public healthcare being adequate is somewhat of a myth, for Germany at least.

cjbenedikt 4y ago

Do you have any data to backup your claim? For example Cuban healthcare/treatment/outcome is excellent based on its own research. Roche(Swiss) nor Merck ( German, not related to US Merck) don't benefit much (if at all) from US subsidies.

ch4s3 4y ago
Cuba has developed a few drugs and exports doctors as chattel for foreign income but their actual healthcare is abysmal. They larger operate without antibiotics, pain killers, and at times clean water. They can’t provide 24h power to hospitals so most modern tech is pointless there. The notion that anything else is true is just Cuban propaganda. There are tons of accounts from NGOs and doctors who have defected.
mjewkes 4y ago
>Do you have any data to backup your claim? I would suggest The Great American Drug Deal, by Peter Kolchinsky. Also - https://www.rand.org/pubs/research_briefs/RB9412.html https://www.rand.org/pubs/research_briefs/RB9412.html >For example Cuban healthcare/treatment/outcome is excellent based on its own research Cuba does not contribute substantially to global pharmaceutical research. >Roche(Swiss) nor Merck ( German, not related to US Merck) don't benefit much (if at all) from US subsidies. Roche makes 55% of its revenue from US drug sales (https://assets.cwp.roche.com/f/126832/x/db9d31e8a7/fb20e.pdf https://assets.cwp.roche.com/f/126832/x/db9d31e8a7/fb20e.pdf p22) EMD Serono (formerly Merck KgAA) is similar. These revenues are the topline driver of the drug development industry.
lr4444lr 4y ago
Cuba's data is pretty suspect. Too lazy to find it at the moment, but I recall reading that their cancer rates or deaths were some absurd fraction of what would be expected given smoking rates even compared with better developed countries. They also had some eye raising way of counting perinatal infant death that makes their infant mortality rates look a lot lower.

biorach 4y ago

You'd really need to show some numbers to back this up. Is the cost of funding the "research complex" included in the expenditure on health care? At least some of this cost is born by the Federal government, foundations etc, is this counted as general health care expenditure (I doubt it) Some of the research is funded by companies - since they sell globally this funding cannot be counted as purely of US origin. Other countries also have significant health research - e.g. UK, France, Germany - your point would also apply to them. Overall your point is dubious, and vague - you'd need to present some solid numbers to back it up.

mjewkes 4y ago
Hey biorach - I would suggest: https://www.rand.org/pubs/research_briefs/RB9412.html https://www.rand.org/pubs/research_briefs/RB9412.html and The Great American Drug Deal, by Peter Kolchinsky. Specific claims: - The US pays more for new drugs than the rest of the world - The US contribution is disproportionate, and is major driver of the drug development industry. -If the US paid less for new drugs, the entire industry would slow, and we would have fewer more effective treatments. ... Routine medical procedures being crazy expensive is unrelated and pathological.
- raverbashing 4y ago
  You're assuming that most of the "extra" money goes back in research and not to shareholders and management bonuses Given how pharma companies operate, I kinda doubt it.
  - mjewkes 4y ago
    No assumptions. The rand article addresses that directly.

awinter-py 4y ago

on the research side, this would tend to reduce prices, right? clinical trials usually aren't charging (per [1]). this 2017 article[2] claims that the US pharma $ premium is more than R&D spending for 13 of 15 top pharma cos. (Note: this isn't even talking about profit, it's talking about the excess profit from higher US prices). Maybe you can make an argument that R&D is lockstep to margins, and would shrink if margins went down? 1. https://www.hhs.gov/ohrp/sachrp-committee/recommendations/november-20-2019-attachment-a/index.html https://www.hhs.gov/ohrp/sachrp-committee/recommendations/no... 2. https://www.healthaffairs.org/do/10.1377/forefront.20170307.059036/ https://www.healthaffairs.org/do/10.1377/forefront.20170307....

byecancer21 4y ago

This mirrors my personal experience. To make a treatment decision, against the advice of my local doctors, that was key to survival I relied on US research. To compare costs: For an extremely rare cancer, total cost of treatment was 100k EUR in Germany, whereas US patients report case costs of >2m USD. Part of these savings stem from the public healthcare system not providing adequate treatment, while strictly necessary for a reasonable chance of survival in this case. What happens in Germany then is the amazing doctors do stuff anyway (if you can convince them), bill whatever they can, and write off the remainder. Profits from privately insured patients make up for this shortfall here. Public healthcare being adequate is somewhat of a myth, for Germany at least.