So Let's Speculate about the Future of a Full Trump Presidency...

[GuitarStv]

If any citizen is living one major medical emergency away from bankruptcy and financial ruin because they can't afford insurance, your health care system is very, very, very bad.  That doesn't mean the quality of medicine available to those who can afford it is bad.

My best friend died of stage four lung cancer this year.  He had been surviving on experimental treatments for more than two years.  At one point last year we had a very frank discussion where he expressed a tremendous amount of relief that he chose to come to Canada rather than the US when immigrating from Trinidad . . . because the costs of the medication he was on would have bankrupted him many times over.  In the US (even with pretty good health coverage) he would have had to choose between seeking the best treatment possible to extend his time with his two young girls, and leaving them and their mother with some money to get by after his death.

[Roland of Gilead]

It is debatable though if your friend would even have had access to those medications without the capital market driven drug development.  I looked it up awhile back but it was something the USA was responsible for over 45% of new drug development.   It really does not seem fair to us as a country if we are doing that much research and testing and the rest of the world just gets the benefits.   How do you fix this?   Do you cut back on USA development so that other countries can do their fair share?

[GuitarStv]

It is debatable though if your friend would even have had access to those medications without the capital market driven drug development.  I looked it up awhile back but it was something the USA was responsible for over 45% of new drug development.   It really does not seem fair to us as a country if we are doing that much research and testing and the rest of the world just gets the benefits.   How do you fix this?   Do you cut back on USA development so that other countries can do their fair share?

Lot to unpack here.

- Why do you believe that drug development in the US would cease with universal health care?
- If (as you appear to be insinuating) drug development is entirely paid for by the huge excesses that Americans pay for their capitalist health care, and that this is somehow unfair, wouldn't implementing the same sort of socialized medicine as the rest of the world put everyone on a more even footing (and thus provide incentive for more development to be done in other countries)?
- Why is US development of drugs (that American companies then sell around the world for huge profits to countries with socialized medicine) a problem that needs to be fixed?

[FIPurpose]

It is debatable though if your friend would even have had access to those medications without the capital market driven drug development.  I looked it up awhile back but it was something the USA was responsible for over 45% of new drug development.   It really does not seem fair to us as a country if we are doing that much research and testing and the rest of the world just gets the benefits.   How do you fix this?   Do you cut back on USA development so that other countries can do their fair share?

Not debatable. Companies receive government grants in order to do their research. The majority of new drug research is paid for with government taxes already and then we pay again to buy them with huge profits added on top.

[Glenstache]

It is debatable though if your friend would even have had access to those medications without the capital market driven drug development.  I looked it up awhile back but it was something the USA was responsible for over 45% of new drug development.   It really does not seem fair to us as a country if we are doing that much research and testing and the rest of the world just gets the benefits.   How do you fix this?   Do you cut back on USA development so that other countries can do their fair share?

Lot to unpack here.

- Why do you believe that drug development in the US would cease with universal health care?
- If (as you appear to be insinuating) drug development is entirely paid for by the huge excesses that Americans pay for their capitalist health care, and that this is somehow unfair, wouldn't implementing the same sort of socialized medicine as the rest of the world put everyone on a more even footing (and thus provide incentive for more development to be done in other countries)?
- Why is US development of drugs (that American companies then sell around the world for huge profits to countries with socialized medicine) a problem that needs to be fixed?

See also:
https://www.healthaffairs.org/do/10.1377/hblog20170602.060376/full/

[former player]

Medicine is not just about the drugs.  There's a list of medical firsts developed within the "socialised" NHS here -

https://www.med-technews.com/features/the-nhs-at-70-inventions-decade-by-decade/

[RetiredAt63]

It is debatable though if your friend would even have had access to those medications without the capital market driven drug development.  I looked it up awhile back but it was something the USA was responsible for over 45% of new drug development.   It really does not seem fair to us as a country if we are doing that much research and testing and the rest of the world just gets the benefits.   How do you fix this?   Do you cut back on USA development so that other countries can do their fair share?
[/quote

The US is the largest capitalist economy in the world, so it is not surprising that it produces 45% of new drugs.  45% means that 55% are being developed elsewhere.

[Roland of Gilead]

Not debatable. Companies receive government grants in order to do their research. The majority of new drug research is paid for with government taxes already and then we pay again to buy them with huge profits added on top.

Ok, I will take it at your word that the majority of new drug research is paid for with government taxes.  Heck, let us just say 100% of new drug research is paid for with taxes.

So great, you now have some government financed chemical compounds that work in mice.   Now spend about $4 billion dollars of investor money to figure out which one out of the hundreds of those compounds will work in humans with few side effects and efficacy over existing drugs.   Convince the government over a period of 5 to 10 years that your drug is safe.   Finally at that point you can start to pay back the investor, who has been waiting for those years with no income.

Exactly what incentive will there be for investors to wait those 5 to 10 years if you remove the chance for a large return on their money?   It would be so much safer to invest in utilities or Coca Cola or Mcdonalds.

What we could do is establish a special tax on drug companies and use that money to pay for the grants for research.   Then the 2% or so of a drug's true cost to develop would not be borne by the taxpayer.   Would that make everyone happy?

[partgypsy]

Medicine is not just about the drugs.  There's a list of medical firsts developed within the "socialised" NHS here -

https://www.med-technews.com/features/the-nhs-at-70-inventions-decade-by-decade/

Same thing for the "socialized" Veteran's health system, including the first pacemaker, big advances in prothethesis including those which work with feedback from brain. Some big areas of current research are non-drug pain relief for vets, reducing suicides, and TBI research. This research (and the resulting benefits to veterans) is made possible because it IS socialized medicine. Veterans stay in the VA system life long, and so anything that improves well being and function is a win, even if it is a not an easily marketed drug or expensive procedure. Privatized healthcare, since they do not see the patient through their lifetime do not have a similar incentive.

[Roland of Gilead]

Same thing for the "socialized" Veteran's health system, including the first pacemaker, big advances in prothethesis including those which work with feedback from brain. Some big areas of current research are non-drug pain relief for vets, reducing suicides, and TBI research. This research (and the resulting benefits to veterans) is made possible because it IS socialized medicine. Veterans stay in the VA system life long, and so anything that improves well being and function is a win, even if it is a not an easily marketed drug or expensive procedure. Privatized healthcare, since they do not see the patient through their lifetime do not have a similar incentive.

That stuff is great and definitely needed but it is not the reason that is ever given for the problem with US healthcare.

I do not know the budget of a VA hospital compared to a private hospital...are they run cheaper?

[FIPurpose]

Same thing for the "socialized" Veteran's health system, including the first pacemaker, big advances in prothethesis including those which work with feedback from brain. Some big areas of current research are non-drug pain relief for vets, reducing suicides, and TBI research. This research (and the resulting benefits to veterans) is made possible because it IS socialized medicine. Veterans stay in the VA system life long, and so anything that improves well being and function is a win, even if it is a not an easily marketed drug or expensive procedure. Privatized healthcare, since they do not see the patient through their lifetime do not have a similar incentive.

That stuff is great and definitely needed but it is not the reason that is ever given for the problem with US healthcare.

I do not know the budget of a VA hospital compared to a private hospital...are they run cheaper?

https://www.herc.research.va.gov/include/page.asp?id=va-vs-non-va

The most thorough study comparing the relative cost of VA provided care was an HSR&D study that compared actual VA costs at six VA medical centers in 1999 to the hypothetical fee-for-service payments for the same services that would have been paid by Medicare. The final report (Nugent, 2004) found that VA provided care at a lower cost. Details from this study appeared as a series of papers in a special supplement of Medical Care in 2003. The overview paper for the papers in this supplement is cited below (Nugent, 2003). The supplement includes papers with detailed comparisons for difference services, including acute hospital stays, outpatient care, nursing home, and other types of care.

[FIPurpose]

Here's from a 2014 paper:

https://www.cbo.gov/sites/default/files/113th-congress-2013-2014/reports/49763-VA_Healthcare_Costs.pdf

Very few studies have applied such a rigorous methodology, however. Several studies from the 1970s and 1980s
compared VHA’s costs for inpatient care with costs in
private-sector hospitals and generally concluded that
VHA’s costs were lower, but those studies used less
thorough research methods. By 2000, only two studies
had attempted to calculate the costs of the services VHA
provided using private-sector payment rates, and those
studies were limited to the costs of inpatient care and
excluded the costs of clinicians.5
 The studies estimated
that VHA’s inpatient care cost about 10 percent less, on
average, than comparable services in the private sector.

[Roland of Gilead]

If people are truly happy now with the current quality of VA services, a 10% cost saving is nothing to sneeze at.   That is several tens of billions of dollars.

[FIPurpose]

Now we just need a presidential candidate create a "VA healthcare for all" plan and we could save 350 billion/year

[talltexan]

I've been following the conversation, and it seems that a nice pro-Trump group has been active lately: can one of you unpack this executive order on health care price transparency for us? Should we be excited about it?

[Kris]

I've been following the conversation, and it seems that a nice pro-Trump group has been active lately: can one of you unpack this executive order on health care price transparency for us? Should we be excited about it?

Sounds like you only want a Trump supporter to answer this for you, which is... odd.

But here's what looks like a fairly objective rundown of it.

https://www.npr.org/sections/health-shots/2019/06/24/735578519/trumps-plan-to-lower-your-hospital-costs-heres-what-you-need-to-know

In theory, it sounds like a good thing. My only question is, since this is an executive order, it may never lead to finalized HHS rules... in which case I'm not sure if it would ever be enforced.

[scottish]

Trump has denied Jean Carroll's sexual assault claims, stating that "Number one, she’s not my type. Number two, it never happened."

It seems strange that the prez would tell us that Ms Carroll is not his type.   Does this mean he would have assaulted her if she was his type?

I can see the late night hosts having fun with this.   What are the top 5 reasons Jean Carroll is not Trump's type?

[KBecks]

This is how he yanks the media's chain.

[Glenstache]

This is how he yanks the media's chain.

Yep.  Unfortunately, it seems to be effective.

[marty998]

Not debatable. Companies receive government grants in order to do their research. The majority of new drug research is paid for with government taxes already and then we pay again to buy them with huge profits added on top.

Ok, I will take it at your word that the majority of new drug research is paid for with government taxes.  Heck, let us just say 100% of new drug research is paid for with taxes.

So great, you now have some government financed chemical compounds that work in mice.   Now spend about $4 billion dollars of investor money to figure out which one out of the hundreds of those compounds will work in humans with few side effects and efficacy over existing drugs.   Convince the government over a period of 5 to 10 years that your drug is safe.   Finally at that point you can start to pay back the investor, who has been waiting for those years with no income.

Exactly what incentive will there be for investors to wait those 5 to 10 years if you remove the chance for a large return on their money?   It would be so much safer to invest in utilities or Coca Cola or Mcdonalds.

What we could do is establish a special tax on drug companies and use that money to pay for the grants for research.   Then the 2% or so of a drug's true cost to develop would not be borne by the taxpayer.   Would that make everyone happy?

The tin foil hat I'm wearing suggests some of your drug companies are deliberately investing in discovering drugs that manage disease and illness but don't cure it.

Can't go around eliminating demand for a product now can we?

That being said I see a need for the capitalist drive here (altruism from scientists in respect of wanting to better the human race isn't going to be enough). However, there needs to be appropriate regulatory frameworks in place to stop gouging of the sick and vulnerable.

[former player]

This is how he yanks the media's chain.

Yep.  Unfortunately, it seems to be effective.

It's how he shows he's a completely shitty human being.  And also guilty, if you've seen the TED talk about how to spot a lie.

[talltexan]

I've been following the conversation, and it seems that a nice pro-Trump group has been active lately: can one of you unpack this executive order on health care price transparency for us? Should we be excited about it?

Sounds like you only want a Trump supporter to answer this for you, which is... odd.

But here's what looks like a fairly objective rundown of it.

https://www.npr.org/sections/health-shots/2019/06/24/735578519/trumps-plan-to-lower-your-hospital-costs-heres-what-you-need-to-know

In theory, it sounds like a good thing. My only question is, since this is an executive order, it may never lead to finalized HHS rules... in which case I'm not sure if it would ever be enforced.

Thanks for sharing the link. I was hoping to give the pro-Trump people a constructive conversation-starter rather than just another opportunity to whine about a media who seem determined to make him look bad at every opportunity. I figured the executive order seemed weak, but decent, and Trump deserved some credit for it. Your link supports that.

[Roland of Gilead]

The tin foil hat I'm wearing suggests some of your drug companies are deliberately investing in discovering drugs that manage disease and illness but don't cure it.

Can't go around eliminating demand for a product now can we?

Maybe some do.  I would hope not but if you look at an example recently of a drug company developing a drug that cured Hep C...cured, not managed, the sales start to fall off a cliff very fast.   That is a big problem with developing a cure for an infectious disease...you are eliminating your market as you cure them.   If you spend over $11 billion dollars developing this drug (they did), exactly what do you do to recoup the cost?   You sell it for a lot of money.  You can't sell it super cheap because your market is dwindling after someone takes the first pill and gets cured.   And this is exactly what we are seeing with Hep C.   The sales are falling off a cliff and the drug has only been on the market for a few years.   Any other business and this would be pretty horrible.  Imagine only ever needing to buy one box of detergent or one pair of shoes that lasted your whole life.   Not so good for shoe makers.

[Roadrunner53]

The tin foil hat I'm wearing suggests some of your drug companies are deliberately investing in discovering drugs that manage disease and illness but don't cure it.

Can't go around eliminating demand for a product now can we?

Maybe some do.  I would hope not but if you look at an example recently of a drug company developing a drug that cured Hep C...cured, not managed, the sales start to fall off a cliff very fast.   That is a big problem with developing a cure for an infectious disease...you are eliminating your market as you cure them.   If you spend over $11 billion dollars developing this drug (they did), exactly what do you do to recoup the cost?   You sell it for a lot of money.  You can't sell it super cheap because your market is dwindling after someone takes the first pill and gets cured.   And this is exactly what we are seeing with Hep C.   The sales are falling off a cliff and the drug has only been on the market for a few years.   Any other business and this would be pretty horrible.  Imagine only ever needing to buy one box of detergent or one pair of shoes that lasted your whole life.   Not so good for shoe makers.

Roland, what you say is somewhat true, but don't you think Hep C will continue to be a scourge that will affect generations to come and in all countries? It is a cure, but not a preventative. There are many other drugs that prevent diseases such as measles and polio that need to be administered to new generations so the need will always be there.

[Roland of Gilead]

Roland, what you say is somewhat true, but don't you think Hep C will continue to be a scourge that will affect generations to come and in all countries? It is a cure, but not a preventative. There are many other drugs that prevent diseases such as measles and polio that need to be administered to new generations so the need will always be there.

Yes I am sure Hep C will continue to pop up, especially in third world countries, however the drug is already sold there at cost (or even below cost as a sort of charity) so there is no money there to repay investors.

The patent life is actually pretty short too.   Generics will take over and meet the need of the new cases that pop up so there is no money to repay investors long term from that either.

It is a tough nut.   On the one hand you do want to cure people and provide drugs at a low cost so everyone has them but on the other hand, you have to attract speculative money for a product that has no guarantee it will ever return a dime.

[sol]

It is a tough nut.   On the one hand you do want to cure people and provide drugs at a low cost so everyone has them but on the other hand, you have to attract speculative money for a product that has no guarantee it will ever return a dime.

Fortunately, as we've previously discussed, investors don't have to bear the burden of developing speculative drugs by themselves. Governments heavily subsidize that R&D pipeline with our tax dollars.  There also a significant marketshare and "good will" benefit for the corporation that cures horrible diseases.  Those can make it attractive it do great work even with a slimmer immediate profit motive, if doing so brings more R&D money your way.

In this particular example, the new hep C cure daclatasvir appears to have been funded through a partnership with the CDC.  Uncle Sam subsidizes clinical trials for drugs with high public benefits but low profit potential.

And hilariously, nobody is paying for these drugs anyway.  People in third world countries get it for free through negotiated aid programs, and people in the US get have it paid for by their insurance programs, which are now ALSO subsidized by the government.  Seems like the only people in the world who can't get it are US citizens who are denied coverage by their insurer (also a profit-selling entity, so let's not pretend capitalism is the solution to this problem).

[KBecks]

I think one thing to always keep in mind is that the president of the USA is not a monarch. This lack of power gives me assurance. Say if Trump wants to do something batshit crazy, his inner circle can convince him otherwise. Or the senate could block it. Or the congress. Or the Supreme Court. Or the department being tasked could follow the order with negligence. Or the next general election.

Personally, I'm not convinced his inner circle can convince him otherwise.  Yes, he can be held in check through the "checks and balances" system but his spur-of-the-moment tweets are troublesome. 

Although not within his presidential powers, I would not be surprised to read a DJT tweet declaring war on North Korea or contemplating declaring war on North Korea or any other threatening remark.  That's the batshit crazy stuff that nightmares are made of.

Only congress can declare war.

Correct. However, I think there is a high possibility that the current president would tweet and insult North Korea in the next 3.5 year. Next thing we know, they are bombing South Korea with nukes, artillery or both. Seoul is only 35 miles from the border, so it is within North Korea artillery range. Guess what, now we are getting dragged into war. So yes, while only congress can declare war, that does not mean we can avoid war.

No doubt we will crush North Korea if it comes to that, but it will be very costly in money and life.

I remember protesters yelling, "we're all gonna die!" when our state's electoral votes were cast in the election.  So far, we have been surviving OK in relative peace.

[Roland of Gilead]

Fortunately, as we've previously discussed, investors don't have to bear the burden of developing speculative drugs by themselves. Governments heavily subsidize that R&D pipeline with our tax dollars. 

Sounds good in theory Sol, but take some real world examples and it looks like the investor burden is pretty harsh.

Look at Celsion, who tried to develop a liver cancer cure.    I am an investor in 2014 when the shares are $40, I am not so happy right now with the shares at $1.75.   It gets much much worse as you go back in time because of reverse splits, the shares were once hundreds of dollars.

The government takes the risk on the first 2% or so, the investors take 98% of the rest of the risk.  I mean this is basic stuff here.   Very easy to see in red and white.

[GuitarStv]

Fortunately, as we've previously discussed, investors don't have to bear the burden of developing speculative drugs by themselves. Governments heavily subsidize that R&D pipeline with our tax dollars. 

Sounds good in theory Sol, but take some real world examples and it looks like the investor burden is pretty harsh.

Look at Celsion, who tried to develop a liver cancer cure.    I am an investor in 2014 when the shares are $40, I am not so happy right now with the shares at $1.75.   It gets much much worse as you go back in time because of reverse splits, the shares were once hundreds of dollars.

The government takes the risk on the first 2% or so, the investors take 98% of the rest of the risk.  I mean this is basic stuff here.   Very easy to see in red and white.

What are you claiming that this is a real world example of?  Investors abandoning a company because it decided to research a cure rather than disease management?

[nereo]

There's very little profit to be made for eliminating a disease by developing a vaccine.  There's a great deal of profit to be made by treating chronic conditions.  That's the driving reason why most pharma companies spend very little capital on vaccine development.   It's not a conspiracy per se, it's just the natural result of free-market capitalism at work... and why we need to publicly fund such endevours.

[Glenstache]

Fortunately, as we've previously discussed, investors don't have to bear the burden of developing speculative drugs by themselves. Governments heavily subsidize that R&D pipeline with our tax dollars. 

Sounds good in theory Sol, but take some real world examples and it looks like the investor burden is pretty harsh.

Look at Celsion, who tried to develop a liver cancer cure.    I am an investor in 2014 when the shares are $40, I am not so happy right now with the shares at $1.75.   It gets much much worse as you go back in time because of reverse splits, the shares were once hundreds of dollars.

The government takes the risk on the first 2% or so, the investors take 98% of the rest of the risk.  I mean this is basic stuff here.   Very easy to see in red and white.

High returns are generally associated with higher risk. Seems like the risk part of that has hurt your share price. Imagine if there was some mechanism to spread that risk out across mulitple trials and share the benefits across the population? Maybe gov't research programs? Government is the mechanism through which societies can pool resources to do things more effectively than private entities.

[KBecks]

Biotech investing is extremely difficult.

[Roland of Gilead]

High returns are generally associated with higher risk. Seems like the risk part of that has hurt your share price. Imagine if there was some mechanism to spread that risk out across mulitple trials and share the benefits across the population? Maybe gov't research programs? Government is the mechanism through which societies can pool resources to do things more effectively than private entities.

So either you have to keep the high drug prices so you can have high returns or you need to stop private research and have the taxpayer start paying a lot more for research and then reap the rewards from that research via extremely cheap drugs.

All I am saying is that if you eliminate the reward part, private investors (other than charity) will not want to take on the high risk part.   The government must step in, and not just by price controls on drugs but by fulling funding not just the initial R&D for the chemical compounds but the 5 or 10 years of drug trials to prove those compounds are safe for the population and work better than current drugs.

I have yet to hear any candidate say they were going to do this.  Republican or Democrat.

[Midwest]

There's very little profit to be made for eliminating a disease by developing a vaccine.  There's a great deal of profit to be made by treating chronic conditions.  That's the driving reason why most pharma companies spend very little capital on vaccine development.   It's not a conspiracy per se, it's just the natural result of free-market capitalism at work... and why we need to publicly fund such endevours.

When you say "we" do you mean the US or the world?  If the US is truly producing nearly 50% of the new drugs and they are being sold much cheaper in other countries, maybe part of the solution is making other countries pay more for those drugs. 

[sol]

ty harsh.
Look at Celsion, who tried to develop a liver cancer cure.    I am an investor in 2014 when the shares are $40, I am not so happy right now with the shares at $1.75.   It gets much much worse as you go back in time because of reverse splits, the shares were once hundreds of dollars.

I am SUPER unconvinced about the "risks" to investors in healthcare/pharma companies based on share prices.  We can't forget that unless you're handing your money to Clesion directly, you're not investing in their company.  You're buying a share of future profits from another guy.  IPOs and new stock offerings can raise cash for a company, but that is a tiny tiny fraction of their total stock sales.  Shares can trade hands a thousand times at a thousand different prices without raising one cent for the company.

So did you invest in Celsion directly, or did you buy shares from someone else long after the stock was issued?  Share prices for stocks are loosely based on the expectation of future profit distributions, and if the company's future starts to look gloomy those expectations drop along with the share price.  That's purely a function of the market, and has virtually nothing to do with what industry we're talking about.

You can totally lose money on individual stocks.  Any individual stock.  But whether your make a profit or loss on your purchase is determined by what other people will pay you for your share of future profits, not whether or not the company's miracle drug turns out to be a fraud.  They're not unrelated, but you seem to be saying that you personally funded this drug, and then you personally took a loss because the drug didn't work out.  I would argue that you were uninvolved in the drug-funding process as anything other than a secondary bystander trying to speculate on the company's broader future, and your speculation didn't pay off in this case just like it didn't for thousands of other companies you could have bought.

[Roland of Gilead]

Well, Celsion lost actual money based on their quarterly and yearly reports due to the costs of running the drug trials.   It is called a burn rate and can be fairly high, like $100m a quarter while a company is running several trials.   Yes some of this is pretty high pay for the researchers and CEO but like any business there are costs.

If a company has never generated a profit and burns up $50m a quarter for 10 years, it is pretty easy to see where the losses come from.

[former player]

Finding a cure for liver cancer is a very high risk endeavour.   Not surprising if it doesn't pay off.

[nereo]

There's very little profit to be made for eliminating a disease by developing a vaccine.  There's a great deal of profit to be made by treating chronic conditions.  That's the driving reason why most pharma companies spend very little capital on vaccine development.   It's not a conspiracy per se, it's just the natural result of free-market capitalism at work... and why we need to publicly fund such endevours.

When you say "we" do you mean the US or the world?  If the US is truly producing nearly 50% of the new drugs and they are being sold much cheaper in other countries, maybe part of the solution is making other countries pay more for those drugs.

I was speaking of vaccine development (i.e. R&D), not about the sale of those vaccines.

[GuitarStv]

There's very little profit to be made for eliminating a disease by developing a vaccine.  There's a great deal of profit to be made by treating chronic conditions.  That's the driving reason why most pharma companies spend very little capital on vaccine development.   It's not a conspiracy per se, it's just the natural result of free-market capitalism at work... and why we need to publicly fund such endevours.

When you say "we" do you mean the US or the world?  If the US is truly producing nearly 50% of the new drugs and they are being sold much cheaper in other countries, maybe part of the solution is making other countries pay more for those drugs.

Haven't we already established that the US isn't making these drugs at the moment . . . it's privately owned companies?  The privately owned American companies are allowed to do whatever they want with their product.  You seem upset that they're happy to overcharge US citizens and charge foreigners less.  It feels like you should be upset at these companies and the capitalist system that lets them do what they're doing, not the rest of the world.

[Midwest]

There's very little profit to be made for eliminating a disease by developing a vaccine.  There's a great deal of profit to be made by treating chronic conditions.  That's the driving reason why most pharma companies spend very little capital on vaccine development.   It's not a conspiracy per se, it's just the natural result of free-market capitalism at work... and why we need to publicly fund such endevours.

When you say "we" do you mean the US or the world?  If the US is truly producing nearly 50% of the new drugs and they are being sold much cheaper in other countries, maybe part of the solution is making other countries pay more for those drugs.

I was speaking of vaccine development (i.e. R&D), not about the sale of those vaccines.

If approximately 50% of the drugs are being developed in the US and the US is paying higher drug costs than the rest of the world, the US consumer is paying for the drugs costs of the world.

If we (I assume you mean the US), were to fund vaccine development via public funds as you suggest (ie the cure for HEP C), would you envision the US taxpayer on the hook for those developments or would other countries feel obliged to contribute?

The high costs of new drug is linked to the high cost of development so with regards to new drugs, the sale and R&D are linked in a capitalist economy. 

[Midwest]

There's very little profit to be made for eliminating a disease by developing a vaccine.  There's a great deal of profit to be made by treating chronic conditions.  That's the driving reason why most pharma companies spend very little capital on vaccine development.   It's not a conspiracy per se, it's just the natural result of free-market capitalism at work... and why we need to publicly fund such endevours.

When you say "we" do you mean the US or the world?  If the US is truly producing nearly 50% of the new drugs and they are being sold much cheaper in other countries, maybe part of the solution is making other countries pay more for those drugs.

Haven't we already established that the US isn't making these drugs at the moment . . . it's privately owned companies?  The privately owned American companies are allowed to do whatever they want with their product.  You seem upset that they're happy to overcharge US citizens and charge foreigners less.  It feels like you should be upset at these companies and the capitalist system that lets them do what they're doing, not the rest of the world.

Without the capitalist system, we wouldn't have many of these new treatments. 

I think $84k is insane for a treatment that is $900 in India.  I would like to see drug companies get a reasonable profit and get more of their profit outside the US. 

https://www.snopes.com/fact-check/hepatitis-c-drug-prices/

[GuitarStv]

There's very little profit to be made for eliminating a disease by developing a vaccine.  There's a great deal of profit to be made by treating chronic conditions.  That's the driving reason why most pharma companies spend very little capital on vaccine development.   It's not a conspiracy per se, it's just the natural result of free-market capitalism at work... and why we need to publicly fund such endevours.

When you say "we" do you mean the US or the world?  If the US is truly producing nearly 50% of the new drugs and they are being sold much cheaper in other countries, maybe part of the solution is making other countries pay more for those drugs.

Haven't we already established that the US isn't making these drugs at the moment . . . it's privately owned companies?  The privately owned American companies are allowed to do whatever they want with their product.  You seem upset that they're happy to overcharge US citizens and charge foreigners less.  It feels like you should be upset at these companies and the capitalist system that lets them do what they're doing, not the rest of the world.

Without the capitalist system, we wouldn't have many of these new treatments. 

Every time someone says something like this, I think of how important insulin is for treating diabetes.  And how the people who developed it gave it away for free because they felt it was important.

So, I disagree with your claim that without the motive of greed medical advances in pharmaceuticals would not be made.

I think $84k is insane for a treatment that is $900 in India.  I would like to see drug companies get a reasonable profit and get more of their profit outside the US. 

Perfectly valid point of view to hold.  What you're asking for is a direct result of the capitalist approach to medicine in the US, and the lack of such in India though.  It sounds like you want more control of what happens with pharmaceuticals in order to make things more fair for your fellow citizens . . . this scenario can't exist unless the government owns the pharmaceuticals.  Which is sensible but also confusing, because it's the opposite of the capitalist approach that you appear to be so enamored of.

[Midwest]

There's very little profit to be made for eliminating a disease by developing a vaccine.  There's a great deal of profit to be made by treating chronic conditions.  That's the driving reason why most pharma companies spend very little capital on vaccine development.   It's not a conspiracy per se, it's just the natural result of free-market capitalism at work... and why we need to publicly fund such endevours.

When you say "we" do you mean the US or the world?  If the US is truly producing nearly 50% of the new drugs and they are being sold much cheaper in other countries, maybe part of the solution is making other countries pay more for those drugs.

Haven't we already established that the US isn't making these drugs at the moment . . . it's privately owned companies?  The privately owned American companies are allowed to do whatever they want with their product.  You seem upset that they're happy to overcharge US citizens and charge foreigners less.  It feels like you should be upset at these companies and the capitalist system that lets them do what they're doing, not the rest of the world.

Without the capitalist system, we wouldn't have many of these new treatments. 

Every time someone says something like this, I think of how important insulin is for treating diabetes.  And how the people who developed it gave it away for free because they felt it was important.

So, I disagree with your claim that without the motive of greed medical advances in pharmaceuticals would not be made.

I think $84k is insane for a treatment that is $900 in India.  I would like to see drug companies get a reasonable profit and get more of their profit outside the US. 

Perfectly valid point of view to hold.  What you're asking for is a direct result of the capitalist approach to medicine in the US, and the lack of such in India though.  It sounds like you want more control of what happens with pharmaceuticals in order to make things more fair for your fellow citizens . . . this scenario can't exist unless the government owns the pharmaceuticals.  Which is sensible but also confusing, because it's the opposite of the capitalist approach that you appear to be so enamored of.

Per the Snopes article I quoted, the low price in India is at least partially due to their patent laws  which don't protect IP.  Assuming the article is correct, India's weak IP protection is a factor in driving down the cost.  That's a case where the US govt should intervene to protect US IP. 

I am all for altruistic medicine, but it is expensive to develop these new drugs/treatments. 

[GuitarStv]

There's very little profit to be made for eliminating a disease by developing a vaccine.  There's a great deal of profit to be made by treating chronic conditions.  That's the driving reason why most pharma companies spend very little capital on vaccine development.   It's not a conspiracy per se, it's just the natural result of free-market capitalism at work... and why we need to publicly fund such endevours.

When you say "we" do you mean the US or the world?  If the US is truly producing nearly 50% of the new drugs and they are being sold much cheaper in other countries, maybe part of the solution is making other countries pay more for those drugs.

Haven't we already established that the US isn't making these drugs at the moment . . . it's privately owned companies?  The privately owned American companies are allowed to do whatever they want with their product.  You seem upset that they're happy to overcharge US citizens and charge foreigners less.  It feels like you should be upset at these companies and the capitalist system that lets them do what they're doing, not the rest of the world.

Without the capitalist system, we wouldn't have many of these new treatments. 

Every time someone says something like this, I think of how important insulin is for treating diabetes.  And how the people who developed it gave it away for free because they felt it was important.

So, I disagree with your claim that without the motive of greed medical advances in pharmaceuticals would not be made.

I think $84k is insane for a treatment that is $900 in India.  I would like to see drug companies get a reasonable profit and get more of their profit outside the US. 

Perfectly valid point of view to hold.  What you're asking for is a direct result of the capitalist approach to medicine in the US, and the lack of such in India though.  It sounds like you want more control of what happens with pharmaceuticals in order to make things more fair for your fellow citizens . . . this scenario can't exist unless the government owns the pharmaceuticals.  Which is sensible but also confusing, because it's the opposite of the capitalist approach that you appear to be so enamored of.

Per the Snopes article I quoted, the low price in India is at least partially due to their patent laws  which don't protect IP.  Assuming the article is correct, India's weak IP protection is a factor in driving down the cost.  That's a case where the US govt should intervene to protect US IP. 

I am all for altruistic medicine, but it is expensive to develop these new drugs/treatments.

Why do you believe that the US should have sovereignty over the legal systems of foreign countries?

[Midwest]

There's very little profit to be made for eliminating a disease by developing a vaccine.  There's a great deal of profit to be made by treating chronic conditions.  That's the driving reason why most pharma companies spend very little capital on vaccine development.   It's not a conspiracy per se, it's just the natural result of free-market capitalism at work... and why we need to publicly fund such endevours.

When you say "we" do you mean the US or the world?  If the US is truly producing nearly 50% of the new drugs and they are being sold much cheaper in other countries, maybe part of the solution is making other countries pay more for those drugs.

Haven't we already established that the US isn't making these drugs at the moment . . . it's privately owned companies?  The privately owned American companies are allowed to do whatever they want with their product.  You seem upset that they're happy to overcharge US citizens and charge foreigners less.  It feels like you should be upset at these companies and the capitalist system that lets them do what they're doing, not the rest of the world.

Without the capitalist system, we wouldn't have many of these new treatments. 

Every time someone says something like this, I think of how important insulin is for treating diabetes.  And how the people who developed it gave it away for free because they felt it was important.

So, I disagree with your claim that without the motive of greed medical advances in pharmaceuticals would not be made.

I think $84k is insane for a treatment that is $900 in India.  I would like to see drug companies get a reasonable profit and get more of their profit outside the US. 

Perfectly valid point of view to hold.  What you're asking for is a direct result of the capitalist approach to medicine in the US, and the lack of such in India though.  It sounds like you want more control of what happens with pharmaceuticals in order to make things more fair for your fellow citizens . . . this scenario can't exist unless the government owns the pharmaceuticals.  Which is sensible but also confusing, because it's the opposite of the capitalist approach that you appear to be so enamored of.

Per the Snopes article I quoted, the low price in India is at least partially due to their patent laws  which don't protect IP.  Assuming the article is correct, India's weak IP protection is a factor in driving down the cost.  That's a case where the US govt should intervene to protect US IP. 

I am all for altruistic medicine, but it is expensive to develop these new drugs/treatments.

Why do you believe that the US should have sovereignty over the legal systems of foreign countries?

I believe developed countries come to a reasonable agreement on IP often through trade agreements.  That's not enforcing sovereignty on another country, but coming to an agreement that respects IP and benefits all.

Here's an article on India's IP situation - https://www.wsj.com/articles/indias-lawless-war-on-intellectual-property-1395600765

[nereo]

@Midwest - you are conflating research and developing vaccines to prevent illnesses with drug treatments meant to treat diseases.  Understand they are not the same thing.

A US company who holds the patent on a Rx is free to decide if and how to market a drug to foreign markets congruent with each country’s laws and regulations. In essence what you are suggesting (free-market autonomy for US drug makers) and what you are objecting to (price disparities between countries) are born out of the same, currently existing laws.

As Glenstd said, unless you are arguing for the US to surrender it’s sovereignty to a UN type entity or are arguing that the US should be able to dictate other country’s laws, the end result will be a mosaic of markets.

This of course is sidestepping the rather callous suggestion that we can ignore the ethical responsibility of sharing potentially lifesaving developments among our own citizens or with all of humanity.

[Midwest]

@Midwest - you are conflating research and developing vaccines to prevent illnesses with drug treatments meant to treat diseases.  Understand they are not the same thing.

Fair enough.  To the original question, should the developed world contribute to vaccine development or just the US?  How should it be funded?

A US company who holds the patent on a Rx is free to decide if and how to market a drug to foreign markets congruent with each country’s laws and regulations. In essence what you are suggesting (free-market autonomy for US drug makers) and what you are objecting to (price disparities between countries) are born out of the same, currently existing laws.

As Glenstd said, unless you are arguing for the US to surrender it’s sovereignty to a UN type entity or are arguing that the US should be able to dictate other country’s laws, the end result will be a mosaic of markets.

I'm suggesting that India's lack of IP protections may be allowing for price that does virtually nothing to contribute to the cost of developing the drug.  India's economy is developing and they need to respect patents/IP of other countries. 

There's no need for a UN entity.  Developed nations should bring pressure to bear on countries with weak IP protections.  The WSJ article I tagged discussed how India is hurting the EU and itself.

This of course is sidestepping the rather callous suggestion that we can ignore the ethical responsibility of sharing potentially lifesaving developments among our own citizens or with all of humanity.

If these developments aren't funded, there won't be anything to share.  It would be wonderful if these drugs were free.  Unfortunately, society has to pay to develop and produce these drugs.  Production is typically a small part of the equation.

[Kyle Schuant]

Fair enough.  To the original question, should the developed world contribute to vaccine development or just the US?

https://www.thebetterindia.com/129080/rotovac-indias-first-completely-indigenous-vaccine-who-pre-qualification/

[GuitarStv]

If these developments aren't funded, there won't be anything to share.  It would be wonderful if these drugs were free.  Unfortunately, society has to pay to develop and produce these drugs.  Production is typically a small part of the equation.

Neither "society", nor the American people pay significantly to develop and produce the drugs that you seem to be upset about though.  It's largely done through privately owned business and private capital.  Then the privately owned businesses charge the American people as much as they can to recoup their losses.

I'm really struggling to understand what you want.  Please lay out the option that you're supporting here:
- The current capitalist system as it stands where the US doesn't develop/produce drugs, private companies do (many of them in America) and then are free to charge whatever they want for 'em to whoever they want
- A more socialist system where the US people (I assume through the government?) develop/produce drugs so that they can better control the prices that US citizens are charged

[Midwest]

If these developments aren't funded, there won't be anything to share.  It would be wonderful if these drugs were free.  Unfortunately, society has to pay to develop and produce these drugs.  Production is typically a small part of the equation.

Neither "society", nor the American people pay significantly to develop and produce the drugs that you seem to be upset about though.  It's largely done through privately owned business and private capital.  Then the privately owned businesses charge the American people as much as they can to recoup their losses.

Society (US and otherwise) pays those companies once those drugs are produced.  Those privately owned businesses wouldn't produce the drugs otherwise.

I'm really struggling to understand what you want.  Please lay out the option that you're supporting here:
- The current capitalist system as it stands where the US doesn't develop/produce drugs, private companies do (many of them in America) and then are free to charge whatever they want for 'em to whoever they want
- A more socialist system where the US people (I assume through the government?) develop/produce drugs so that they can better control the prices that US citizens are charged

None of the above.  I think drug companies need to be reasonable incentives to create these drugs and when they are successful a reasonable worldwide profit.  In the case of the HEP C drug, if the patent holder can't expect a reasonable profit in India, they make up the margins in other countries.  Part of the reason the drug is so cheap in India is they were going to ignore the patent.  That leaves other countries picking up the tab for the R&D on the drug.

I haven't studied their financials, but $80k per treatment seems completely insane and India's position seems unreasonable as well.

One thing I want to be clear about, I think there needs to be some reform in the US system as well.  Drug companies are gaming IP law.  Exec's are price fixing old drugs.  I'm not saying the US is blameless, but I think there are many other factors as well.