[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.

[throwanem]

It's indicated as a diabetes medication, but never mind, I'm not going to cavil about off-label use for obesity. What if the dietary changes are made alone?

[nradov]

That rather depends on the patient. Medically supervised ketogenic diets have shown good results for putting type-2 diabetes into remission. But many patients don't stick to the diet long term.

https://www.virtahealth.com/research

[cogman10]

They'd probably work. From what I've read, after cessation there is some typical weight gain even with the same diet, but it levels off.

That indicates to me it's doing a bit more than just appetite suppression.

[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.