There are a variety of issues around private companies producing pharmaceuticals. They basically come down to: (1) It’s expensive; (2) There are huge regulatory barriers to entry, and; (3) People who need medicine will often pay almost any price for it.
Worse, companies that sell medicine don’t want cures, they want palliatives–drugs you have to take for the rest of your life which don’t actually heal what’s wrong with you.
The simple, obvious solution is as follows:
- The government takes over all manufacturing of cures and the distribution system. Even if this is “inefficient” the government’s “inefficiency” will not result in the price gouging in which these private actors engage.
- The government offers bounties for new medicines. Very large bounties in the billions.
Yes, there are plenty of details to be worked out, but this outline works because government, when not captured by private actors, is incentivized to want cheap medicines and cured people; sick people don’t pay as much tax and government pays so much of the health-care bills. This is true even in the US. Between Medicare, Medicaid, and huge subsidies, the US government pays as much per capita as most universal health care countries, without actually getting universal health care.
Bounties will change the focus from palliatives (though some are good) to cures, simply by offering huge bounties for cures.
Yes, some research funds are necessary, but the bounty must be large enough that people won’t want to keep doing research to get those funds, but will want the big payoff at the end.
This isn’t my idea, many economists have suggested bounties.
But it’s a good, obvious, idea.
There are other ways to do this. In particular, you could just move all research to the public sector (which funds most of it anyway) and have an agency which is responsible for getting new medicines through the approval process, which is most of what Pharma does. Make sure scientists will get a modest bonus for a cure and know they’ll be moved to another problem rather than let go, and voila, they’ll want to create cures.
Add in a patent fix of mandatory licensing and shorter patent periods, and you’re pretty much done. (EpiPen and insulin prices are not patent issues, but patents are the cause of much elevated price-related suffering elsewhere.)
Fixing Pharma is like fixing most other problems. It’s only difficult because we refuse to do the obvious, and we refuse to do that because the people who are making a killing at it have bought the government.
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Phil Perspective
Fixing Pharma is like fixing most other problems. It’s only difficult because we refuse to do the obvious, and we refuse to do that because people who are making a killing have bought government.
Why do you hate LGM, baby kittens and shitty Democrats?!?
highrpm
at least 5 crisis issues need fixing by the government:
medical care
blacks
war
trade/ employment
budget deficit
neither party nor congress is up to the task. the players in the 3 branches of government would rather the country go down than their own careers/ reputations.
two recent narratives on the black problem worth some thoughts:
Milwaukee – The Unz Review
Milwaukee, Cedar Falls(!), Melbourne: Three Black Riots—Three Explanations – The Unz Review
highrpm
hell, i think it might be nigh time to toss the relic constitutio and let fascism temporarily reign while the country, in a desperate last ditch move appoints proven corporate leadership of a generation younger than the ancients hillary and donald, the likes of jeff bezos or the google triumvirate of schmidt/ page/ brin with the generational task of putting in place a collective that has a likely life span of at least 100 years.
when will the current relic group of pols admit they’ve utterly failed and leave governing in the hands of a newer generation of proven corporate leadership. most countries are, after all, just giant collectives. like it or not, collectives require corporate governship, corporate by-laws as the rule of law.
what the hell is wrong with the idea of tossing our ancient sacred tome, the constitution, nothing more than a religious relic housed in some holy of holies somewhere in washington d.c. — how many citizens can even say where? — i can’t. and it’s functionally irrelevant to the current leadership as this great sacred corporate by-laws no way no how permits the government to pursue world governorship using the tool of world wars or any other tool.
lets take the sacred rolls to next weekend’s burning man event at black rock and dose it in flammables and ignite it with all the other articles of art scheduled to go up in flames.
Ivory Bill Woodpecker
Mr. Welsh, is highrpm the kind of customer you want at your place?
If yes, he’ll ultimately be the only kind you have.
TW Andrews
You could achieve a similar effect with price regulation of medicines (manufacturing cost + x%) and bounties, which would be quite a bit easier than the gov’t taking over the manufacturing and distribution system itself.
V. Arnold
@ highrpm
August 30, 2016
Stellar idea; tossing the constitution; it’s ignored by the powers who be anyway.
The U.S. is a constitutional oligarchy; although Shelden Wollen called it the Specter of Inverted Totalitarianism (he coined the term, so often quoted by Chris Hedges). Which does seem a better fit.
The Epipen situation is utterly barbaric; they invented nothing and discovered nothing; epinephrine was discovered in the late 1800’s and the U.S. government invented the self injection device during WWII. Those bastards at Mylan should be shot!
The only effective fix for pharma and the medical system, in general, is to nationalise the whole shebang, as Ian said in a previous thread.
Daize
“Even if “inefficient” the government’s “inefficiency” will not add up to the price gouging private actors engage in;”
This is what so so many people never get to realizing. The profit motive is HIGHLY in efficient in a very many circumstances: basically in any markets for things that people actually “need”, asides from food which is by its nature highly diverse and distributed, although even that is changing rapidly with big aggro.
Caoimhin Laochdha
Mylan CEO Heather Bresch stated that Obamacare is the “reason for the price hike.”
Two issues regarding this. (1) Her statement is a deliberate lie; and (2) what she said is absolutely true.
(1) Obamacare did not CAUSE the price hike. Greed, exploitation and corporate avarice against the public interest is the cause of the price gouging. The U.S. is a country of War Profiteers (Haliburtin, Congressional/Pentagon/Military Industrial Complex, etc.) and illness/vulnerable population profiteers (health insurance, pharma etc.). Remember when being a ‘war profiteer’ was considered treasonous rather than something for which one received an MBA or served in Congress? Sad.
(2) Obamacare – the American Care Act – IS the reason, as opposed to ’cause,’ of widespread endemic Rx price gouging. Obamacare does not make health care more available, more efficient and it does not prevent it from being needlessly expensive.
Rather the ACA is a set of laws that expands commercial health care coverage rather than expanding access to health care itself. Price gouging is perfectly consistent with the letter of the ACA law. ACA doesn’t “cause” gouging, but it certainly gives it a green light; and this fact was both known and intentional when Pres. Obama gave responsibility for drafting and passage of the ACA to the most conservative members of the U.S. Senate in 2009-2010 (e.g. Ben Nelson, Max Baucus, Joe Lieberman etc.). In fact Pres. Obama promised PHARMA lobbyists and CEOs that this would be the case at the very beginning of the doomed health care “reform” attempts in Congress during his first two years as President.
So Heather Bresch is an unrepentant bald-faced liar. She also, however deceptively, underscores the truth regarding HOW MYLAN is permitted to prey on vulnerable populations, and use its monopolistic powers to obscenely price gouge with legal impunity.
Phil Scarr
Normally I agree with you, but the statement,
Worse, companies that sell medicine don’t want cures, they want palliatives: drugs you have to take for the rest of your life which don’t actually heal what’s wrong with you
requires some evidence. Simply asserting it, as so many anti-pharma people do, absent evidence, is disingenuous. There is no vast pharma conspiracy to keep disease cures away from people. “Cures” don’t exist because disease states were hard to attack with small-molecule (i.e. chemical)-based drugs. But now we’re moving into the biologic (large-molecule)-based drug age as well as the age of genetic disease prevention. This is the time when many things which are currently symptomatically treated will be attacked at the root and “cured.”
Please explain why you believe in the vast pharma conspiracy for which there is no evidence.
Caoimhin Laochdha
Re: Simple & Obvious.
I agree with you Ian. There are other “simple and obvious” approaches to this problem (legal and/or economic policy or both.
The “simple and obvious” underlying problem, however, is that we do not have a President and we have not had a congress since Bill Clinton’s first two years in office, that is willing or wants to fix the problem of “access to healthcare” — as opposed to “access to private insurance.”
In fact, a majority of the members of Congress and the totality of the GOP wingnuts who control Congress, hate and have fought to prevent health care reform. Subsidizing health insurers and PHARMA is a priority for them, and it is perfectly acceptable and President Obama who belatedly steered the ACA in this direction toward the end of 2010.
“Access” to health care has never been a Congressional policy priority since Bill & Hillary Clinton’s bumbling and mistake fraught attempts to make basic & relatively uncontroversial reforms in 1993 & ’94.
With Democratic super majorities in Congress in 2009-2010, President Obama empowered the most conservative and/or corporatist Democrats in the U.S. Senate to choose access to expensive and unnecessary private health insurance, rather than access to health care. This predictably and effectively buried any attempt at health care reform then and for the foreseeable future. Even minimal U.S. health care reform will most likely not happen in my lifetime, if at all.
Caoimhin Laochdha
@Phil Scarr
August 31, 2016
Normally I agree with you, but the statement,
Worse, companies that sell medicine don’t want cures, they want palliatives: drugs you have to take for the rest of your life which don’t actually heal what’s wrong with you requires some evidence.
I disagree that the author needs to anticipate every research issue that comes with making a larger, different and accurate policy point.
Rather than asserting that Ian is being “disingenuous,” I suggest it is your burden to show concrete (or even flimsy) evidence disproving Ian’s comment before hurling accusatory adjectives.
If we disagree with Ian or cast doubt on a statement or argument, our initial burden is to do our own research, rather than demand he do it for us. Disagreement, at least in this particular context, does not rise to the level of making such a harsh accusation.
Ché Pasa
Yes, of course, it is a policy matter, and policies can be changed, sometimes in a twinkling.
However, “we”, as in We, the Rabble, have very little or no say in making those policies. They are largely if not entirely the result of collaboration (conspiracy?) between Our Rulers and Their Owners. What happens is what they want, only rarely is it what we want or need.
The system, including the Constitution, is set up that way; has been from the beginning. And so far nothing has really changed fundamentals.
If you believe that the system is not the problem, then you’re likely to believe that “we” can change these policies — Ian describes how simple a change for the better would be — but bitter experience over a lifetime shows that changes such as he is proposing, if they come at all, will take years, decades or even generations to accomplish. And even then, they will only be done to the extent the High and the Mighty profit.
If that’s OK, then by all means, proceed.
Our great grandchildren may benefit. You never know.
Brian
Ian I think this would be a major step forward in actually helping people. I used to work in research. I do not trust private sector to do research. Many major pharma have gashed their research departments because advertising and reformulation are far more profitable. If the manufacturing side was tightly regulated and the finder’s fee was sufficient it might support a robust enough research effort to create useful products. My fear is that in biological research too much is still a result of serendipity and that a profit oriented research approach would ultimately be too limited in a long term. The current system is broken. The number of truly new medicines is shrinking every year and most are reformulations. So this would be better even if it’s not the best long term.
Steve Ruis
This would facilitate my idea of how to win the War on Drugs. Offer a huge bounty for the development of five intoxicant drugs. These drugs need not only get people high but they have to be designed at be non-abusable, that is if one exceeds the recommended dose one receives a buzzkill. These drugs, sold through the normal channels would displace most of the current illicit drug traffic, even marijuana (those who think that marijuana does no harm missed the lesson tobacco taught us about the dangers of smoke inhalation). The taxes would support treatment for the few who couldn’t resist the “bad boy” image projected by continuing to use illicit drugs and would pay for the bounties (and probably most of the other costs of government).
The contest could be renewed every 20 years and the top five drugs (maybe some of the old but maybe some new) would again be given bounties. There would have to be some regulation as Big Phama has a proven track record of cheating, but still …
MrClark
Brian wrote: Many major pharma have gashed their research departments because advertising and reformulation are far more profitable.
Making advertising drugs illegal (again) would be a worthy endeavor, if not sufficient.
Notorious P.A.T
But keep in mind there are other ways to ingest marijuana besides smoking it.
Cures show up on the market. The HPV vaccine can sort of be thought of as a cure, I think. If a company discovered a cure for something, I believe their short-sightedness would lead them to marketing it right away.
Tom
Liwa al-Tahrir defected back to the FSA and seized Ayn Issa and five surrounding villages. Full scale fighting between them and YPG.
http://syria.liveuamap.com/en/2016/2-september-raqqa-arab-sdf-fighters-captured-5-villages-at
Tom
Hit submit too soon.
Also Interim Syrian Government supported by Turkey has set up shop in Jarabulus and is prepping to begin civilian Administration of the Syrian territories under FSA Control.
Tom
Hazm Movement, Jabhat Thuwar Syria and Jabhat al-Haq have now announced they have quit SDF ad are rejoining the FSA and have begun turning on YPG Forces and calling for Turkish Support.
YPG is now done for. Obama will not save them.
V. Arnold
Steve Ruis
August 31, 2016
This would facilitate my idea of how to win the War on Drugs. Offer a huge bounty for the development of five intoxicant drugs. These drugs need not only get people high but they have to be designed at be non-abusable, that is if one exceeds the recommended dose one receives a buzzkill.
~~~~~~~~~~~~~~~~~~~~~~~
Humanly impossible; and, understandably, you do not understand addiction.
Nature has supplied myriad intoxicants; marijuana, peyote, psilocybin mushrooms (and others), Ayahuasca, opium poppy, alcohol, and the list goes on.
Yes, I know, opium poppy and alcohol; highly addictive; and if you understood addiction you’d also understand that in healthy societies, addiction to these two is not a problem.
Of all listed intoxicants, alcohol is the only deadly intoxicant of the lot. It destroys health when abused; but then we come back to the reasons for abuse; unhealthy societal issues and abuse of the inhabitants of those societies.
Prohibition is the enemy and making all intoxicants legal is the only solution.
Far to complex for this venue to cover in a meaningful way; study up and learn…
V. Arnold
Above;
Far to complex for this venue to cover in a meaningful way; study up and learn…
Make that: Far TOO complex for this venue to cover in a meaningful way; study up and learn…
Caoimhin Laochdha
@ V. Arnold; Sept 2:
Offer a huge bounty for the development of . . . [medications]
designed at be non-abusable, that is if one exceeds the recommended dose
one receives a
buzzkillceiling effect. . . sold through thenormal [legal] channels [can help displace some] current illicit drug traffic
One of those medications is already on the market. It addresses several objectives wish to see, but it’s not perfect and we need more medications like it. It’s called Buprenorphine (sold at Subutex). (http://www.ncbi.nlm.nih.gov/pubmed/16148422).
Buprenorphine is a relatively mild opioid, but has a low side effect profile and “ceiling” effect so that over-use/misuse, to achieve an opioid “euphoria,” is not a serious concern. The big advantage is the lack of major cognitive or somnolent side effects (or euphoria that may lead to misuse by non-legitimate pain patients) often associated with other opioids.
While its side effects are minimal, its analgesic properties are weaker than its much stronger opioid cousins (oxycodone/hydromorphone, etc.), which are more likely to be diverted from “prescription” drug status to “street drug” status.
(FWIW – do not confuse “Subutex” with “Suboxone.” Both are Buprenorphine products. However, the former is for pain patients and the latter is used for people who are recovering opioid addicts. It helps those with substance disorders for some of the reasons I’ve listed above.
-cl
V. Arnold
Caoimhin Laochdha
September 3, 2016
Buprenorphine is a relatively mild opioid, but has a low side effect profile and “ceiling” effect so that over-use/misuse, to achieve an opioid “euphoria,” is not a serious concern. The big advantage is the lack of major cognitive or somnolent side effects (or euphoria that may lead to misuse by non-legitimate pain patients) often associated with other opioids.
~~~~~~~~~~~~~~~~
Alas, then people won’t use it. People use drugs to gain an “effect”.
I’ve had decades of first hand experience on both sides of the “fence”.
Nature is rich with myriad pharmacopeia and humans have known from the beginning, of and how to use them. Most of the cultures I’m aware of have used “drugs” in ceremonial rituals.
Modern civilization is anything but civil; rather bent on the subservience of populations and putting unimaginable stresses on those citizens.
Drugs are an escape and there is no solution to the “drug problem” possible under the present world wide paradigm.
The only populations not abusing drugs are the very few indigenous peoples, in their native environment, left on this planet.
I am also aware there are small groups of U.S. citizens attempting to practice ritualized drug use with marijuana, peyote, psilocybin mushrooms (and others), and Ayahuasca,; but do to barbaric laws, are in great danger of jail if caught.
V. Arnold
Addendum: The “fence” was as a user and a volunteer at a street clinic. I saw absolutely no conflict of interest in that.
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