5 ms·

It might reduce prices, but I wouldn't trust pharma companies to put safety over profit. We've seen time and time again that pharma companies will do the bare m

by yosame 4y ago

It might reduce prices, but I wouldn't trust pharma companies to put safety over profit. We've seen time and time again that pharma companies will do the bare minimum to prove safety, which has lead to a large amount of harm (see Vioxx, Thalidomide, etc). I don't think reducing what safety measures they have to prove will make therapies safer.

ETH_start 4y ago
The study on medical devices indicates that safety actually improves with deregulation, due to the combination of a larger market and litigation. In any case it's obvious to me at least that in the long run, if medicine sees the same pace of innovation that, say, smartphones have seen, or even that the cosmetic surgery field has seen, we would have much safer medical products and services just by virtue of them being significantly more sophisticated, less invasive etc. Finally - even if all this weren't true - without price reductions, it will be increasingly the case that the safest and most effective treatments will be out of reach of the masses, due to simple economics/scarcity. I would rather have some lower quality products/services available to the public, and the best quality ones be more accessible, than remove the lower quality offerings but also deprive the public of the best quality ones.
- candiodari 4y ago
  Why this choice? In the case that a treatment is life-saving the ethics board can approve experimental treatments on a case-by-case basis. Medical laws just don't allow patients to make this choice for themselves.
  - ETH_start 4y ago
    The problem with the centralization (regulation) approach is that it assumes one body can be chosen that will be optimal at risk assessment. In practice, the process of developing good risk analysis frameworks - that strike the right balance between cost, risk and efficacy - is often best discovered through trial and error, and that requires the freedom to try new products in the market.
    - candiodari 4y ago
      There's an ethics board per hospital. And there's different countries. You can in fact shop around if that's what you want to do. You can do this, both as a patient and as a pharmaceutical company. It's just really expensive.
      - ETH_start 4y ago
        Even a law requiring an ethics board, with statutory requirements for how that ethics board is constituted, is a one-size-fits all meta-solution, created by one body: the national regulator.
- worik 4y ago
  > The study on medical devices indicates that safety actually improves with deregulation, due to the combination of a larger market and litigation. I doubt it, very much. Appropriate regulation, not deregulation, is the name of the game.
  - ETH_start 4y ago
    >>Appropriate regulation, not deregulation, is the name of the game. Based on what case studies of industries? Look at the prices in the most regulated sectors. In medicine, it makes the most effective treatments inaccessible to the wider public, with innovation that reduces costs progressing at a glacial pace.
    - worik 4y ago
      Pharmac and Medsafe in New Zealand. Medsafe regulates medicines, what is effective, and Pharmac buys them, for the whole country. Pharmac drives hard bargains with pharmaceutical companies. There is a lot of money to be made (even in a small market like New Zealand) if a medicine is -bought (read subsidised) by Pharmac. The effective treatments are available. The highly experimental, might work, might not, might kill you, might make you sicker, might cure you medicines are held at bay by medsafe, and when approved are made affordable by Pharmac. Of course Pharmac is under constant attack by the completely unethical pharmaceutical industry and equally unethical senior doctors - all hopelessly corrupted by the enormous sums at stake. Huge astroturfing campaigns exploiting ill people and their families. But the benefits are so huge that it has survived. There is talk about extending the model to medical devices and consumables. Appropriate regulation is absolutely needed because the incentives that drug companies and medical equipment manufacturers face are opposed to the incentives of the community. Free markets, in this case, make people sick and impoverished.
      - ETH_start 4y ago
        >>Medsafe regulates medicines, what is effective, and Pharmac buys them, for the whole country This is no different than what happens in the UK and you're gonna run into the same problems that the UK has where cutting edge treatments cost too much for the government healthcare program to cover them. The problem in medicine is that innovation is too expensive, and too slow to rollout, and this applies just as much to New Zealand as anywhere else. Cancer and heart disease should have been cured by now, considering the pace of innovation we know is possible. >>medicines are held at bay by medsafe, and when approved are made affordable by Pharmac You can't legislate affordable cutting edge treatments into being. Pharmaceuticals have to be incentivized to spend vast sums on developing them, and a mechanism needs to exist to select the best amongst those treatments for further development. Evidently, that selection and resource allocation role is best left to consumers and their doctors, as opposed to one centralized body. >>Appropriate regulation is absolutely needed because the incentives that drug companies and medical equipment manufacturers face are opposed to the incentives of the community. Their incentives are to be selected by consumers, and the best way to do that in medicine, like any other industry, is to produce high quality products at low cost. See the study on the positive effects of down-regulating medical devices, which are lower prices and greater safety. >>Free markets, in this case, make people sick and impoverished. I still don't see the basis for this assertion.
jojobas 4y ago
Safety can legitimately be in the backseat when you're trying to cure a disease that has a 50% chance to kill you in a year.
- bawolff 4y ago
  Its not just safety, but to prevent shady people from taking advantage of desperate people.
- worik 4y ago
  > Safety can legitimately be in the backseat when you're trying to cure a disease that has a 50% chance to kill you in a year. Yes. Standards are lower in that case. Back in the 1990s when I was up to date, clinical trials for HIV ad cancer treatments were truncated. We saw the rapid development of COVID vaccines recently, much quicker than normal drug development
concordDance 4y ago
Sometimes availability is more important than safety. Let the patient decide if they want to take the risk, just mandate they be informed.
zo1 4y ago
I'd be curious to see what would happen if reasonable regulations stayed in place but we capped/removed the risk associated with litigation (assuming regulations were followed). I.e. what portion of "adhering to regulation" is reducing the speed of advancement because of fear of litigation, as opposed to just the cost of sticking to the regulation.

by yosame 4y ago

ETH_start 4y ago

The study on medical devices indicates that safety actually improves with deregulation, due to the combination of a larger market and litigation. In any case it's obvious to me at least that in the long run, if medicine sees the same pace of innovation that, say, smartphones have seen, or even that the cosmetic surgery field has seen, we would have much safer medical products and services just by virtue of them being significantly more sophisticated, less invasive etc. Finally - even if all this weren't true - without price reductions, it will be increasingly the case that the safest and most effective treatments will be out of reach of the masses, due to simple economics/scarcity. I would rather have some lower quality products/services available to the public, and the best quality ones be more accessible, than remove the lower quality offerings but also deprive the public of the best quality ones.

candiodari 4y ago
Why this choice? In the case that a treatment is life-saving the ethics board can approve experimental treatments on a case-by-case basis. Medical laws just don't allow patients to make this choice for themselves.
- ETH_start 4y ago
  The problem with the centralization (regulation) approach is that it assumes one body can be chosen that will be optimal at risk assessment. In practice, the process of developing good risk analysis frameworks - that strike the right balance between cost, risk and efficacy - is often best discovered through trial and error, and that requires the freedom to try new products in the market.
  - candiodari 4y ago
    There's an ethics board per hospital. And there's different countries. You can in fact shop around if that's what you want to do. You can do this, both as a patient and as a pharmaceutical company. It's just really expensive.
    - ETH_start 4y ago
      Even a law requiring an ethics board, with statutory requirements for how that ethics board is constituted, is a one-size-fits all meta-solution, created by one body: the national regulator.
worik 4y ago
> The study on medical devices indicates that safety actually improves with deregulation, due to the combination of a larger market and litigation. I doubt it, very much. Appropriate regulation, not deregulation, is the name of the game.
- ETH_start 4y ago
  >>Appropriate regulation, not deregulation, is the name of the game. Based on what case studies of industries? Look at the prices in the most regulated sectors. In medicine, it makes the most effective treatments inaccessible to the wider public, with innovation that reduces costs progressing at a glacial pace.
  - worik 4y ago
    Pharmac and Medsafe in New Zealand. Medsafe regulates medicines, what is effective, and Pharmac buys them, for the whole country. Pharmac drives hard bargains with pharmaceutical companies. There is a lot of money to be made (even in a small market like New Zealand) if a medicine is -bought (read subsidised) by Pharmac. The effective treatments are available. The highly experimental, might work, might not, might kill you, might make you sicker, might cure you medicines are held at bay by medsafe, and when approved are made affordable by Pharmac. Of course Pharmac is under constant attack by the completely unethical pharmaceutical industry and equally unethical senior doctors - all hopelessly corrupted by the enormous sums at stake. Huge astroturfing campaigns exploiting ill people and their families. But the benefits are so huge that it has survived. There is talk about extending the model to medical devices and consumables. Appropriate regulation is absolutely needed because the incentives that drug companies and medical equipment manufacturers face are opposed to the incentives of the community. Free markets, in this case, make people sick and impoverished.
    - ETH_start 4y ago
      >>Medsafe regulates medicines, what is effective, and Pharmac buys them, for the whole country This is no different than what happens in the UK and you're gonna run into the same problems that the UK has where cutting edge treatments cost too much for the government healthcare program to cover them. The problem in medicine is that innovation is too expensive, and too slow to rollout, and this applies just as much to New Zealand as anywhere else. Cancer and heart disease should have been cured by now, considering the pace of innovation we know is possible. >>medicines are held at bay by medsafe, and when approved are made affordable by Pharmac You can't legislate affordable cutting edge treatments into being. Pharmaceuticals have to be incentivized to spend vast sums on developing them, and a mechanism needs to exist to select the best amongst those treatments for further development. Evidently, that selection and resource allocation role is best left to consumers and their doctors, as opposed to one centralized body. >>Appropriate regulation is absolutely needed because the incentives that drug companies and medical equipment manufacturers face are opposed to the incentives of the community. Their incentives are to be selected by consumers, and the best way to do that in medicine, like any other industry, is to produce high quality products at low cost. See the study on the positive effects of down-regulating medical devices, which are lower prices and greater safety. >>Free markets, in this case, make people sick and impoverished. I still don't see the basis for this assertion.

jojobas 4y ago

Safety can legitimately be in the backseat when you're trying to cure a disease that has a 50% chance to kill you in a year.

bawolff 4y ago
Its not just safety, but to prevent shady people from taking advantage of desperate people.
worik 4y ago
> Safety can legitimately be in the backseat when you're trying to cure a disease that has a 50% chance to kill you in a year. Yes. Standards are lower in that case. Back in the 1990s when I was up to date, clinical trials for HIV ad cancer treatments were truncated. We saw the rapid development of COVID vaccines recently, much quicker than normal drug development

concordDance 4y ago

Sometimes availability is more important than safety. Let the patient decide if they want to take the risk, just mandate they be informed.

zo1 4y ago

I'd be curious to see what would happen if reasonable regulations stayed in place but we capped/removed the risk associated with litigation (assuming regulations were followed). I.e. what portion of "adhering to regulation" is reducing the speed of advancement because of fear of litigation, as opposed to just the cost of sticking to the regulation.