[ahoyhere]

The best health advances of all time were developed by passionate, and sometimes uneducated, volunteers -- people who were not working for a profit motive, but for a good-of-all motive. Case in point: the discoverer of penicillin, and the inventor of the vaccine, the inventor of the public blood bank, and on, and on, and on.

Inventing then was (arguably) less costly and technical than it is now, because those were low-hanging fruit. A lot of the low-hanging fruit has probably been discovered by now, though we can't be sure, meaning that future research aims at higher-hanging fruit and so, metaphorically, the would-be inventors need ladders.

These people need help, not profit, because profit isn't what motivates them anyway.

EDIT: Let's not forget public health reform can save more lives than just about anything else (thank you Oliver Wendel Holmes/Ignaz Semmelweis http://www.accessexcellence.org/AE/AEC/CC/hand_background.ph..., Sara Josephine Baker, http://en.wikipedia.org/wiki/Sara_Josephine_Baker and their present day equivalent, Atul Gawande).

[_delirium]

Somehow it seems that the profit motive in pharmaceuticals motivates good science, but targeted at relatively strange things. "Lifestyle" drugs are huge: everyone wants the next Viagra, basically. Perhaps not surprising, because recreational drugs have always been popular, and the "fluff" end of legal pharmaceutical development is the part that sort of bleeds into recreational, since it tends to target something closer to "enhancing" the lives of already fairly healthy people with money, rather than "treating" the ill.

[prodigal_erik]

Viagra was discovered by accident (it was a heart medicine that didn't work out). And I've never understood why it's sneered at. Are there really that many people out there who could face no sex again ever and shrug it off? I think that would be utterly soul-crushing, worse than most of the diseases they have charity walks and telethons for.

[ahoyhere]

They don't rant about it because it solves a truly-no-sex scenario, but because it's essentially a recreational drug for the majority of users.

I think the ability to have sex is at least as important as the ability to not piss yourself (e.g. incontinence medication) if not more, but still, its profit center comes from its recreational use. That's why the drug companies love it.

[yummyfajitas]

Why do you believe most Viagra sales are primarily recreational?

[ahoyhere]

Because there is no reason to believe that the % of men who have true ED matches up with the amounts of Viagra sold; because I've known many young men who talk about getting drunk or high and taking it, and because their companions agreed or in the least were not surprised; because the market for it online seems to be mostly young, healthy men who want to have greater stamina, not who have anything dysfunctional to begin with...

Etc.

[yummyfajitas]

You don't see the tremendous amount of selection bias in your sample?

Very quickly: people who need viagra don't like to talk about it, unlike drunken frat boys. The online market is targeting men who can't get it from their doctor because they don't have ED. That doesn't mean the vast majority of viagra users aren't suffering from ED, it just means that online ads are targeting a niche market.

[ahoyhere]

Yes, exactly: if pharma is good business, and not philanthropy, then they have to focus on the people who will pay the most, the most readily, and the most often. End of story.

Case in point: I'm an American who lives in Vienna, Austria, and I have recurring upper-respiratory/immune system problems.

Here, I am treated with a so-cheap-it's-almost-free immune system booster called Broncho Vaxom. It's nothing but dead bacteria, but it's extremely effective (essentially an oral vaccine).

It's used to save lives of children in the poorest of nations -- but it's not available in the US, because it's not profitable, whereas continuous rounds of antibiotics are.

http://www.google.com/search?q=broncho%20vaxom

[Vivtek]

Coral snake antivenom is a similar thing - the last manufacturer left a supply of a few years that is now running out, but the process for approving a new manufacturer for the same drug is so expensive that the market won't support it.

So first responders in Florida have a problem. No coral snake antivenom.

A similar market situation applies to flu shots.

The current system favors "maintenance pharmaceuticals", not cures. Who wouldn't prefer to have a cash cow that costs the customer a few hundred dollars every month for the rest of their life, in comparison with something that actually cured them? A cure isn't very lucrative at all.

Generally, free marketeers protest that this isn't true, in the face of all evidence I can see, but look at the business logic; it's inescapable.

[ahoyhere]

Excellent examples.

A free marketeer, as you say, would say that the reason nobody is making more antivenin is because the "process for applying" is so expensive - but of course, there has to be quality control, and more importantly, there's every reason to believe that the manufacture would be more expensive than the applying.

Govt regulation is used as a scapegoat. The market for creating this product is just not desirable, because snake bites are extremely rare compared to just about every other medical malady. There was a reason the original manufacturer willingly gave it up in the face of no competition.

Public health is a public concern, and should be funded with public money. It is cheaper in the long run because of increasing working years/tax dollars, and reducing bankruptcies, and reducing the number of orphans, etc.

Even Mr Invisible Hand, Enlightened Self-Interest himself wrote that the whole edifice of his economic philosophy had to rest on the foundation of respect for human life -- and compassion: http://en.wikipedia.org/wiki/The_Theory_of_Moral_Sentiments

[stretchwithme]

I am not against government or rules. I am against the idea that coercion is the means. Voluntary cooperation, not the use of force, is the means by which we create solutions to all sorts of problems.

Health is no different. It suffers over the long term when people think the use of force to get some short term benefit.

Somehow we live our lives with the understanding that forcing those around to do what we want would destructive, even if it was somehow benevolent. But collectively, we've convinced ourselves that this cannot be the case.

Perhaps it is because the dominant opinion is actually propagated with our own money even if we don't agree and alternative perspectives buried by the mesh of financing and media access of government.

[Vivtek]

Yes, voluntary compliance with regulations works so well to preserve the Commons - it was clearly in BP's interest to comply with regulations in the Gulf, for instance, and clearly in Goldman-Sachs's interest to preserve the global financial structure. Only idiots would choose short-term savings or profit-taking over long-term global stability, after all; enlightened self-interest will take care of everything!

I like your overall philosophy that coercion is wrong, and in principle I agree with it. I wish that human nature didn't contradict it. Sadly, on every hand I see that actual, real live human beings must be coerced to do good if even the slightest amount of consistency is required.

[stretchwithme]

what people need is the freedom to act and create. government, especially when it takes by force from some to give to others for whatever purpose, distorts the decisions people make

and, as its activities destroy capital, government delays innovation. its easy to point to the things governments have achieved. what the people would have achieved had they been freer is not so easily pointed out.