[kragen]

R&D and quality control provides benefits to patients, and it is critically important to figure out how to reduce the cost of R&D and quality control so we can do a lot more of them. That's what Four Thieves Vinegar and other biohackers are doing.

Regulatory compliance doesn't provide benefits to patients; it's a deadweight loss. As you are presumably aware, to a significant extent, the reason that regulatory compliance is so costly is that, being costly protects established drug companies from competition.

Quality control and initial R&D have nothing to do with why Epi Pens, insulin, or Daraprim are absurdly overpriced in the US. That's purely monopoly rent extraction.

[dekhn]

Nothing I said above disagrees with the fact that many pharma are indeed doing what you call "monopoly rent extraction". I think all of those drugs are overpriced for non-economic reasons.

Regulatory compliance, for example, with the FDA approval process, isn't a deadweight loss; it's a process that reduces the risk a dangerous drug will be given to the public. It's mostly costly due to incompetence and bureaucracy, not because pharma is evilly plotting to continue to be the only people who can get stuff through the FDA.

If somebody comes up with magical ways to reduce the costs of R&D and QC in pharma, I'm all for it. Just be aware: I've worked around pharma for decades and it will only get more expensive to do any of this. Nobody is going to come in and magically disrupt the business with a new technology pharma didn't think of yet.

[erosenbe0]

Umm, the variance in prices in only very slightly due to quality, like often 5% or 1% or less than 1% of the variance. Please show data accounting for why anti-parasitics that costs 5 cents per dose for a horse or 5 cents per dose in India with 20 high quality generic versions are $50 in the US. Hint. BECAUSE WE DO NOT HAVE A FREE MARKET ON HIGH-QUALITY AND SAFE DRUGS. WE HAVE A PAY TO EXTRACT RENT SYSTEM.

[kragen]

I wish you wouldn't post things like this because, although what you are saying is factually correct, you are saying it in a patronizing and shouting way, which will lead people to associate these insights with acting like an asshole. That makes it harder for them to assimilate them, even when I'm the one explaining them and even if I'm managing not to act like an asshole.

[erosenbe0]

I'm sorry but I used to work in healthcare and we see people suffer because they can't afford the $10 monthly copay on drugs that should cost no more than $10 or $20 for a year supply, like a giant bottle of generic aspirin. The fact that they suffer due to pure exploitation is disturbing.

[kragen]

I understand, and I appreciate your compassion.

[kragen]

Also, the person you were shouting at and saying "Hint" to probably knows about 100 times more than you do about the economics of drug companies.

[erosenbe0]

Sure, if we are talking about on-patent drugs I don't know that much. But if we are talking about off-patent generics there isn't a lot to know. We in the United States have a variety of financial, temporal, regulatory, and competitive barriers that bloat prices, sometimes by a factor of 100, over consumer market price in somewhere like India, or even Mexico.

[kragen]

What reduces the risk that a drug will be dangerous is testing, quality control, replication, and transparency. Regulatory compliance is, at best, a means to those ends, not an end in itself. At worst, and far too often, it's a major obstacle to them.

People don't have to be evilly plotting when their incentives are set up to empower only people who do evil things. Don't forget that, in the US, we're talking about the same regulatory regime that rejected magainin, hasn't brought a new class of antibiotics to market in half a century, has outlawed the flavored vape liquids that help people quit smoking, won't allow you to buy a blood sugar meter until after you have diabetes, prohibited covid testing at the beginning of the pandemic, delayed covid vaccination until five or six months after China was doing mass vaccination, and routinely cuts off opiate addicts cold turkey. It's a Kafkaesque farce, as you know very well, and quite possibly the primary cause of death in the US today.

[dekhn]

So, uh, how are we going to ensure that all that testing, QC, and transparency occurs... without some sort of regulatory agency that enforces it? and that agency woudl use compliance (submit this and that form and follow this and that process)... so it would seem that they act as proxies for the value of the things you listed.

[kragen]

In the comment you responded to, I am not taking up the subject of how to achieve testing, replication, QC, and transparency. I am merely pointing out that, to reason clearly about the issue, it is essential to distinguish these goods—genuinely valuable benefits to drug users which should be maximized—from any potential means for achieving them, such as regulatory compliance, which is a deadweight loss to be minimized, even if it is an unavoidable one, as you claim it is.

To do otherwise is similar to measuring the progress of a software project in lines of code, measuring the quality of an airframe design by its weight, or measuring the security provided by the TSA in the number of fingernail trimmers confiscated. It's counting regulatory compliance activities on the wrong side of the ledger.

[erosenbe0]

The people who write the rules take money from the rent extractors and the people who enforce the rules have huge conflicts of interest and go immediately to and from working with the rent extractors. It is a corrupt system of rent extraction that has some quality benefit for the consumer that is extremely inefficient. CRONY-CAPITALISM, MONOPOLIES past patent expiration, and A LACK OF A FREE-MARKET extracts rent from the consumer and destroys a countries' industrial competitiveness as does any form of corruption. Just look up how many generics are available in somewhere like India, or look at drug costs on the Mexican [more] free-market, or just do some research into what is actually happening.