[tptacek]

That's part of it, but pharma is also a portfolio business, like VC or music; the winners have to pay for the losers.

(I don't know how much that matters in this case, where a tiny company lucked into a blockbuster and then used every lever in the system to protect their exclusivity).

[throwanem]

Yeah, nobody serious is really arguing the winners shouldn't pay for the losers. How many times over, though?

[tptacek]

I sort of don't care, as long as investor value isn't being protected abusively, by anticompetitive schemes with the patent system and exclusivity. We pay lots of money for all sorts of things, most of which don't actually matter to our lives; pharmaceuticals matter a great deal, and I'm OK with the idea that advancements are incentivized by a time-limited lane for nosebleed pricing.

(Pharmaceutical costs, all in, across the board, are a relatively small component of total health spending in the US. They're not why your health insurance is so expensive.)

This is mostly a story about anticompetitive abuses, so that question isn't super relevant to the story. I'm just answering the claim that invisible marketing/SG&A costs are why drugs cost so much. They also cost a lot because most drugs fail, sometimes after billions invested.

[throwawaymaths]

well but the portfolio managers in this case could really do a much better job at picking hits. we wouldn't have 20 years of failing Alzheimer's drugs if pharma identified that the protein hypothesis was junk (which people were talking about in the aughts)

[throwanem]

That's a really interesting point, yeah. Not that I'm really equipped to evaluate the technical arguments, but it's striking on reflection how absent from the discussion the question seems to be of how efficiently on average the funding to trial a given drug and indication is allocated. The governing assumption appears to be that the status quo is acceptably close to optimality.