6 ms·

I think the UN or governments themselves should get into the business of bad business medicine. The fact drug companies are prioritizing research of chronic med

I think the UN or governments themselves should get into the business of bad business medicine. The fact drug companies are prioritizing research of chronic medications is an obvious outcome of our current structure. The government or quasi governmental organization can continue to subsidize industry research and buy licenses for discoveries they then productionize at cost. This wouldn’t directly compete with industry and it would incentivize public private research across large areas of otherwise unprofitable areas of medicine such as this.

evrimoztamur 2y ago
This is what the Turkish government has been up to and it has driven drug costs, and therefore overall costs of healthcare provision and insurance, down. More countries should nationalise production of generics, it works.
- selimthegrim 2y ago
  Does the cost of letting everyone see a specialist whenever they want cancel that out?
  - sfn42 2y ago
    It's well known that the US healthcare system costs more for the taxpayer than single payer systems, while also bankrupting those unfortunate enough to get hurt/sick and requiring ridiculous monthly payments for the individual on top. So I wouldn't worry about that. Healthcare is not nearly as expensive as US providers make it. Single payer systems aren't perfect either but from my perspective having lived with one my entire life it works fine. I have always gotten the help I need in reasonable time. I also have private options if I want to spend money, and they're far cheaper than private options in the US. But so far I haven't felt any need for it. A colleague was recently diagnosed with testicular cancer, he was admitted for surgery within a few days and back to work in a few weeks. Didn't cost him anything. And just to reiterate - this is cheaper per capita, just comparing tax costs, than the US system and that's ignoring insurance premiums and copays etc.
    - selimthegrim 2y ago
      I was talking about Turkey specifically where it’s driving specialists to leave the country
- ajmurmann 2y ago
  If everyone did this, how would it impact creation of new drugs?
  - evrimoztamur 2y ago
    New drugs to solve new problems or old problems better would continue receiving protections, and the incentives would remain in place. How do you think about the nationalisation of generics of existing drugs being detrimental to new drugs' development?
xyzzy123 2y ago
We also need regulation (and effective enforcement) as much as research. Even if you discover a groundbreaking new antibiotic under current incentives it's going to get fed to pigs in China until it's useless. Arguably the kinds of antibiotics we need the most are ones with significant side effects; effective enough that they can save humans but with side effects that are severe enough that they are not over-prescribed or fed to livestock.
- dartos 2y ago
  > Arguably the kinds of antibiotics we need the most are ones with significant side effects I don’t think there can be a better example of perverse incentives than this.
- cchi_co 2y ago
  [dead]
- raincole 2y ago
  > the kinds of antibiotics we need the most are ones with significant side effects What? Absolutely not. The patients would have a very strong incentive to not finish the whole course of treatment.
  - shellfishgene 2y ago
    These are typically only used in the hospital after all else fails.
    - duskwuff 2y ago
      Right. Only a small fraction of antibiotics are regularly prescribed for outpatient use; a lot of the more "serious" antibiotics (like vancomycin, for instance) are primarily given as IV infusions in an inpatient setting.
- skyyler 2y ago
  Why call out Chinese pigs specifically? American meat farms also overuse antibiotics... Do Chinese farms do it more / worse?
mft_ 2y ago
Agree, on two fronts. Firstly, while pharma collectively spends a lot of money (many, many billions) on drug discovery and development, in the grand scheme of collective global governmental spending, it’s not so very much. If the (e.g.) 20 richest nations got together and shared out the cost according GDP it wouldn’t be too much for them to bear at all. Secondly, as a race we’re currently very bad at ‘global’ cooperation, especially if it requires ’vision’. Even when there’s a strong incentive to cooperate across borders (like, say, an immediate threat from a global pandemic) we mostly sucked. And even relative success stories coming out of the pandemic, like the development of mRNA vaccines spectacularly quickly, had less to do with global coordination and cooperation than might have been the case. It would be wonderful to start to address this broad topic, and the constant threat from antibiotic resistance would seem like a great place to start, before we get to the stage that any operation brings the threat of death by untreatable infection with it.

evrimoztamur 2y ago

This is what the Turkish government has been up to and it has driven drug costs, and therefore overall costs of healthcare provision and insurance, down. More countries should nationalise production of generics, it works.

selimthegrim 2y ago
Does the cost of letting everyone see a specialist whenever they want cancel that out?
- sfn42 2y ago
  It's well known that the US healthcare system costs more for the taxpayer than single payer systems, while also bankrupting those unfortunate enough to get hurt/sick and requiring ridiculous monthly payments for the individual on top. So I wouldn't worry about that. Healthcare is not nearly as expensive as US providers make it. Single payer systems aren't perfect either but from my perspective having lived with one my entire life it works fine. I have always gotten the help I need in reasonable time. I also have private options if I want to spend money, and they're far cheaper than private options in the US. But so far I haven't felt any need for it. A colleague was recently diagnosed with testicular cancer, he was admitted for surgery within a few days and back to work in a few weeks. Didn't cost him anything. And just to reiterate - this is cheaper per capita, just comparing tax costs, than the US system and that's ignoring insurance premiums and copays etc.
  - selimthegrim 2y ago
    I was talking about Turkey specifically where it’s driving specialists to leave the country
ajmurmann 2y ago
If everyone did this, how would it impact creation of new drugs?
- evrimoztamur 2y ago
  New drugs to solve new problems or old problems better would continue receiving protections, and the incentives would remain in place. How do you think about the nationalisation of generics of existing drugs being detrimental to new drugs' development?

xyzzy123 2y ago

We also need regulation (and effective enforcement) as much as research. Even if you discover a groundbreaking new antibiotic under current incentives it's going to get fed to pigs in China until it's useless. Arguably the kinds of antibiotics we need the most are ones with significant side effects; effective enough that they can save humans but with side effects that are severe enough that they are not over-prescribed or fed to livestock.

dartos 2y ago
> Arguably the kinds of antibiotics we need the most are ones with significant side effects I don’t think there can be a better example of perverse incentives than this.
cchi_co 2y ago
[dead]
raincole 2y ago
> the kinds of antibiotics we need the most are ones with significant side effects What? Absolutely not. The patients would have a very strong incentive to not finish the whole course of treatment.
- shellfishgene 2y ago
  These are typically only used in the hospital after all else fails.
  - duskwuff 2y ago
    Right. Only a small fraction of antibiotics are regularly prescribed for outpatient use; a lot of the more "serious" antibiotics (like vancomycin, for instance) are primarily given as IV infusions in an inpatient setting.
skyyler 2y ago
Why call out Chinese pigs specifically? American meat farms also overuse antibiotics... Do Chinese farms do it more / worse?

mft_ 2y ago

Agree, on two fronts. Firstly, while pharma collectively spends a lot of money (many, many billions) on drug discovery and development, in the grand scheme of collective global governmental spending, it’s not so very much. If the (e.g.) 20 richest nations got together and shared out the cost according GDP it wouldn’t be too much for them to bear at all. Secondly, as a race we’re currently very bad at ‘global’ cooperation, especially if it requires ’vision’. Even when there’s a strong incentive to cooperate across borders (like, say, an immediate threat from a global pandemic) we mostly sucked. And even relative success stories coming out of the pandemic, like the development of mRNA vaccines spectacularly quickly, had less to do with global coordination and cooperation than might have been the case. It would be wonderful to start to address this broad topic, and the constant threat from antibiotic resistance would seem like a great place to start, before we get to the stage that any operation brings the threat of death by untreatable infection with it.