[nradov]

Sure, but that's a bit of a red herring. The largest expense in bringing a new prescription drug to market is the phase 3 clinical trial, which now costs on the order of $1B each. Those often fail, so it's a huge gamble. There is very little public funding for type of research.

[throwanem]

And a drug like Revlimid makes its manufacturer tens to hundreds of billions; the "legacy" portfolio in which BMS classes it pulled in a cool $5.6b just in Q1 '25, of which Revlimid itself was about a sixth, or just under a billion - down by almost half year on year. See https://www.bms.com/assets/bms/us/en-us/pdf/investor-info/do..., pp. 8-9.

It is as if VCs in the tech industry demanded the taxpayer guarantee them a healthy rate of profit, to a standard of health the VCs themselves are privileged to define. Indeed, as with Allred and the regional airlines, perhaps now we see whence Altman has cribbed his "innovation."

[nradov]

I don't understand your point. Some drugs are enormously profitable. Others lose money. There are no taxpayer guarantees. Pharmaceutical companies on average don't generate higher shareholder returns than other industrial sectors. A few like K-V and Dendreon have even gone bankrupt.

One could make an argument that taxpayer subsidized health plans which include prescription drug coverage such as Medicare Part D or Medicaid should limit the prices they are willing to reimburse on a QALY basis. And Medicare has started a limited drug price negotiation program. But generally, voters have been unwilling to accept the trade-offs inherent in drug price controls.

https://www.cms.gov/newsroom/fact-sheets/medicare-drug-price...

[throwanem]

My point is that if you want to provide support for the advocacy argument, you've quite a long way yet to go. A good place to start would be to pick any one claim you have made and attempt to substantiate it. Until then, I've nothing with which to attempt further to argue.

(If you want to do something else, I can't tell what it would be.)

[nradov]

What advocacy argument? You're not making any sense and are just posting lazy, low-effort criticism. None of my claims require further substantiation, you can easily look up for yourself if you want to understand how the system works and the incentives involved.

[SAI_Peregrinus]

"How can we lower the cost of phase 3 clinical trials without allowing non-functional medication (scams) to proliferate" is very important. The point of a phase 3 trial is to prove that a medication treats what it claims to treat.

[mikeyouse]

Phase 3 trials don’t cost $1B - they’re more on the order of $20M.

[nradov]

Sorry I should have been more specific. Average total cost to bring a new drug to market is on the order of $2B.

https://www.fiercebiotech.com/biotech/drug-development-cost-...

[throwawaymaths]

yes, that includes failures, which includes shit that a beginning grad student could tell you wouldn't work.

[cogman10]

The NIH already creates grants for Phase 1 and Phase 2 trials. It's a bit insane that we don't also do phase 3 trials. Heck, even drug manufacturing is already done both by the DoD and the VA. It's crazy that we have a vision that private investment will somehow make things either cheaper, more affordable, or more available.

Big pharma is providing very little benefit and a lot of cost. We've seen their playbook with people like Martin Shkreli who'll buy up patents to existing drugs and jack up the price to make a quick buck. Do we really need that sort of "private investment"?

[nradov]

I don't think anyone is seriously making the argument that private investment in drug development is making things cheaper or more available. So that's a strawman argument.

The primary claim in support of the current system is that it encourages greater levels of innovation than would happen under a socialized central planning system where government bureaucrats allocate funding for all trials. We don't have any solid evidence about that one way or the other. But year after year, US pharma companies do consistently release more new drugs than any other countries on a per-capita basis. We don't want to wreck that just because of high prices on a few patent protected drugs. Let's take a longer view and consider possible second-order effects before making any drastic changes.

[smt88]

"Number of new drugs released" doesn't feel like a good metric for pharma productivity to me.

An ideal metric would be "person-years of increased healthspan per dollar spent by the consumer," and I'd wager that's very low because the profit motive is to create drugs that treat symptoms (and are prescribed for life) rather than cure an illness.

[s1artibartfast]

Most countries do exactly that. determine how much they will pay for a drug based on person years of increased health span. The term you are looking for is quality adjusted life years (QALY). Many European countries will pay up to around €80,000, and sometimes more for cancer treatments. I think France will pay 300k or so for oncology.

Cures are hard. No companies are suppressing cures that would make them tens of billions of dollars out of long term self interest. You take the cash and move on to the next one (or not).

The time value of money means that profits more than 10 years or so into the future are essentially irrelevant compared to money today.

[cogman10]

I disagree. Curing and preventing disease brings in a pretty large paycheck for drug companies. Semaglutide is extremely effective and has made nordisk billions.

Curing cancers also will remain a particularly lucrative trade. Particularly because cancer is a million different diseases which everyone gets if they live long enough.

There is never just one person that gets a disease.

That said, it's definitely true that pharma will never spend research dollars to see if a disease can be treated with a generic drug. Universities and the NIH can and do.

[throwanem]

What does semaglutide cure? What outside the treatment period does it prevent?

[cogman10]

> What does semaglutide cure?

Prediabetes and hypertension. Assuming long term dietary changes, outside of treatment those effects are pretty permanent.

> What outside the treatment period does it prevent?

Again, assuming dietary changes, it'll prevent type 2 diabetes and heart attacks.

[cogman10]

> innovation than would happen under a socialized central planning system where government bureaucrats allocate funding for all trials.

What innovation? All the innovation with the current system happens outside the big pharma companies. They are merely swooping in at the final steps and manufacturing to benefit from the public investment.

The actual innovation is happening because of public social investment. Not because if private investment (at least in terms of medicine). Private investment here is simply leaching off of the public investment.

[nradov]

You're ignoring second-order effects. While the big pharma companies do some original drug development themselves, they also commonly acquire start-ups which have promising drugs that aren't approved yet. This is tremendously risky because many of those drugs never get approved, or don't sell very well. Most of those start-ups would never have been founded in the first place if an acquisition wasn't possible.

If we want to have new a lot of new drugs every year that meet the FDA standard for being safe and effective then someone has to put in enormous capital investments. In theory I suppose we could raise taxes and socialize the whole system but so far I haven't seen any evidence that would be a net improvement. More likely just another opportunity for graft and corruption.

[cogman10]

That's not how drug research typically works. There aren't drug research start ups (at least, not a lot of legitimate ones) because developing and researching drugs is a capital intense process.

90% of the system is socialized. The remaining 10% is what pharma funds.

> I suppose we could raise taxes and socialize the whole system but so far I haven't seen any evidence that would be a net improvement.

The entire process is already experiencing the worst parts of what being fully socialized would bring. Everyone is paying for health insurance whose rates are partially set by the cost of the drugs to the general public. We also already pay taxes to develop these drugs via the NIH. Heck, part our taxes pay to manufacture these drugs via the DoD and the VA.

The main benefit of fully socializing these drugs is that it will be cheaper for everyone and we can bring more drugs to market. We don't have to pay advertising, executives, or shareholders for new drugs. We don't have to worry about these new drugs turning a profit.

The graft and corrupting in government is nearly entirely in the form of private contractors working for the government. It's how the current system works where the public funds a huge portion of the research while a few large companies rake in exhobitant fees.

And even worse, we have examples of vioxx, Dalton, and oxy where these companies knowingly push unsafe medicine to turn a profit. That simply doesn't happen with a fully social system as there's literally no benefit to anyone to keeping unsafe drugs around.

[throwawaymaths]

that number is not correct. you can get phase trials done in 100M ish. IIRC the 1B number is average cost, all three phases, including drug failures.