[rsynnott]

This… is a think that people believe, but it’s not as simple as that. Most basic research is universities, all over the place. Many drugs are developed in Europe. A lot of medical machinery is developed and made in Europe (Siemens, Philips and Roche are huge in this space). Like most things, med tech is fairly globalised.

[simondotau]

And let's not forget that a substantial amount of medical research performed in the USA is not market-based but rather publicly funded through the NIH.

[jjcob]

And performed by researchers that received free education in their home country before moving to the US because they hope for a better career there...

[philipallstar]

That's not an "and" - the NIH is funded by businesses in the US.

[philipallstar]

Most of that is funded by the NIH and not by the local systems. Spending money is easy.

[disgruntledphd2]

> This… is a think that people believe, but it’s not as simple as that.

This is a thing people believe because pharmaceutical companies keep repeating it. And to be fair, they're not entirely wrong in that getting a drug/treatment from the lab to the pharmacy is incredibly expensive because most drugs don't work and clinical trials are super expensive.

It does seem to me that a better system would be to split out the research/development and manufacturing of pharmaceuticals into the lab development (scientists), the clinical trials (should be government funded) and the manufacturing (this could easily be done via contract).

[WorldMaker]

Which the US had a situation exactly like that until very recently: development labs, often at Universities, with scientists paid for by grants (some private, but the majority being public, government grants), with clinical trials overseen by government agencies like the National Institute for Health (NIH), and winning research eventually being tech transferred for cheap to Pharmaceutical companies to manufacture, distribute, and market.

The companies have the biggest PR arms, so took the most credit for a system that had been balanced on a lot of government funding in the earlier, riskier stages. Eventually the marketing got so unbalanced people didn't realize how much the system was more complex than the marketing and voted for people that decided it was a "free market" idea to smash the government funding for the hard parts of science.

[disgruntledphd2]

> Which the US had a situation exactly like that until very recently: development labs, often at Universities, with scientists paid for by grants (some private, but the majority being public, government grants), with clinical trials overseen by government agencies like the National Institute for Health (NIH), and winning research eventually being tech transferred for cheap to Pharmaceutical companies to manufacture, distribute, and market.

Yeah, this isn't a particularly new idea. Like, most of the risk in pharma is on testing, and there's so much waste in spinning up plants for drugs that may not even succeed in Phase III. So I'd like to split that out.

[philipallstar]

> It does seem to me that a better system would be to split out the research/development and manufacturing of pharmaceuticals into the lab development (scientists), the clinical trials (should be government funded) and the manufacturing (this could easily be done via contract).

The market is there to risk money in the world of imperfect information trying to predict what would be good to pursue. That is one of the hardest parts of the process, but it's not even made your list.

[disgruntledphd2]

Exactly. This was entirely deliberate as I (personally) believe that market signals are profoundly useless in healthcare. Like, there's no free market in life or death, nobody will quibble over cash when they're in pain so I'm not sure how a market is supposed to work.

Fundamentally, the incentives of society and private companies are misaligned with respect to healthcare. Society wants a cheap, simple treatment that basically works forever (like sterilising vaccines). However, because of how the patent system works, companies want a treatment that is recurring, and can easily be patented multiple times.

Because of this, so much money goes into lifestyle treatments for the rich world, and not enough into re-using things that can't be patented. I think this is a giant waste of resources, hence my suggestions above.