Asymmetrical Information

Jane:

"It's commonplace among pharma-bashers to hear that drug companies don't really do any research at all -- they just swoop in to cash in on government-funded academic research."

I thought we were just dismissing that argument out of hand, with a blithe "you don't understand the healthcare market." Wha' happ'ned?

You probably saw this, but I thought I'd throw it out there as chum: "Angell used to be the editor-in-chief of The New England Journal of Medicine, which is among the most powerful positions in American medicine, and in her view drug companies are troubled and corrupt. She thinks that they charge too much, engage in deceptive research, produce inferior products, borrow their best ideas from government-funded scientists, and buy the affections of physicians with trips and gifts."
http://www.newyorker.com/printable/?critics/041025crat_atlarge

Congo Red? I would bet against it even if it did cross the blood-brain barrier. Aromatic amines do nasty things to one's liver, among other things. Red dye #2, anyone? But then again, there are many potential hepatotoxins that have FDA approval (with caveats to monitor liver enzymes), and Alzheimer's patients would probably accept such risks.

This does sound like some ivory tower types extrapolating too far from some test-tube research, in many ways.

And which message did the artist occasionally called Tim intend to communicate? In other words - what sense, if any, are we the unenlightened readers supposed to make of his statement?

Tim, did you read the rest of Gladwell's article, where he basically says that Angell is full of [censored]?

To be fair to the authors of both the article and the commentary, I doubt they really buy into the thought that it could be a drug. I'm guessing that it busts the hell out of the rule of five. Finally, it should be noted that the tone of both the articles are in the vein of "this is really neat trick" as opposed to the Gina Kolata "Jonah is going to cure cancer" hype.

Jane:

"Tim, did you read the rest of Gladwell's article, where he basically says that Angell is full of [censored."

No, I was just being snide. (Snide is the new "snark"). We just lost the election, and y'all have got four years (or maybe two, but I'm betting four) to do to us what you will. Dems like me are probably going to pop off occassionally just out of irritation. But it'll go away as we get used to our new head-bowed positions. I'm already practicing saying, "Chief Justice Thomas? Why, that's a great idea!"

Tim,

Thank God your side lost. You're clearly much more interested in venting than in saying anything substantive.

Memo: no amount of snark will make a huge, unwieldly Congo Red derivative into a drug that actually will cure a single human being.

Un-C, you're right that the article and commentary don't make it sound like this is the cure everyone's been waiting for. But to someone in the drug industry, even mentioning this as a possible therapy rings false. You could come away thinking that the whole thing just needs a bit more tinkering and it'd be off to the clinic.

Jane Galt wrote:

Tim, did you read the rest of Gladwell's article, where he basically says that Angell is full of [censored]?

If anything Gladwell didn’t go far enough in debunking Angell’s screed. Angell wrote a review in the New York Review of Books about her latest work of fiction which was filled with a number of inaccuracies:

Drug industry expenditures for research and development, while large, were consistently far less than profits. For the top ten companies, they amounted to only 11 percent of sales in 1990, rising slightly to 14 percent in 2000. The biggest single item in the budget is neither R&D nor even profits but something usually called "marketing and administration"—a name that varies slightly from company to company. In 1990, a staggering 36 percent of sales revenues went into this category, and that proportion remained about the same for over a decade.13 Note that this is two and a half times the expenditures for R&D.
Source: http://www.nybooks.com/articles/17244

The study she cited to support this passage is (per the footnote) the Henry J. Kaiser Family Foundation, "Prescription Drug Trends," November 2001 which can be found here:

http://www.kff.org/rxdrugs/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=13796

The comparison Marcia Angell cited is found on Exhibit 31 (Page 45) and it’s actually “Marketing, General, and Administrative” that is cited which is defined as “the costs of promoting and selling the goods plus general business expenses.” In other words everything but R&D and the Cost of Sales (“cost of raw materials and production costs for manufacturing the finished goods to be sold”) not just the parts used to market and promote the product which seems to be Marcia Angell’s contention. Kaiser to their credit actually did provide numbers and a breakdown on “Promotional Spending” (which would have been a more valid comparison than picking specific item from the budget like R&D and trying to compare with a catch all like MGA) that can be found here on Chart 9 of the Chart Book for this study.

http://www.kff.org/rxdrugs/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=13709

In 2000, Promotional Spending was about 14% as a percentage of sales (about even with R&D) but what’s interesting and more useful is that it breaks down Promotional Spending into the Retail Value of Sampling (the revenue the company loses from the free samples it gives to your physician), Detailing, and Advertising (both Journal and Direct-to-Consumer). The largest category has consistently been RVS which represents over half of Promotional Spending. In other words, over half of the cost of promoting pharmaceuticals is actually in giving away free samples.

How anyone can continue to take her seriously as a credible authority when she doesn’t actually read or understand her own source material or deliberately tries to deceive her readers as to its plain meaning is rather disturbing considering she was once an editor for the New England Journal of Medicine.

If we are lucky, the anti-pharmaceutical company hysteria will be viewed in 25 years as among the most inane aspects of political debate at the turn of the century. If we are unlucky, there will be several milllion, or maybe even tens of millions, corpses mouldering in graves that could have been metabolizing humans, absent the desperate political effort to ensure that nobody made obscene profits by making little pills.

Looks like some serious Angell-bashing going on here.

I'd encourage anyone interested in this issue to sit down and read her entire book. When you do so, you'll find that, for example, she in fact fully addresses the issues brought up by Gladwell's New Yorker article.

Ive never heard anyone say the pharmaceutical companies do no research. But they do benefit greatly from university research, and they do get government money. Ive read several sources that dispute what the ratio is between R and D and advertising spending. Most of what I read here comes strictly from pro business sources, and much of what Ive read elsewhere comes from a populist perspective, imo the truth is likely somewhere in between the two.

Im sick of commercials that constantly address male erectile dysfunction, it suggests that Boomer hard ons are a larger concern then say finding treatment for the more aggressive cancers that are currently untreatable. Im also sick of the 10 year monopolies that prevent the free market from reducing the cost of drugs. The reps want a free market for everything but the drugs that could save peoples lives. The pharmaceutical companies are in the business of putting prices on lives, they make alot of money for the negative press they recieve, I see no need to defend these guys, they know exactly what they are doing.

Well, begbee, it isn't often that you get an anti-pharma type who will just come right out and advocate getting rid of patents. Why on earth would anybody freely allocate capital for drug research, if they knew the moment they put a new product on the market, Acme Generic, Inc. could come out with it's version, and price it marginally above the cost of manufacture? Are you saying that private capital allocation is unimportant to developing new, life-saving, drugs?

Yes, patents are a deviation from a purely free market. No, a world without patents would not be superior. If you wish to argue that reducing patent lengths could strike a more optimum balance between price competition and innovation, go ahead and argue that. However, you best bring to the table reams of empirical data supporting such a claim (it really would be an interesting avenue of inquiry), otherwise one suspects that such assertions are mere bloviations.

Finally, gosh, I hope your value system doesn't lead you to wish upon me a painful, long, terminal illness.

I suppose it's important to mention that our friend Viagra was originally tested as a blood pressure medicine, which is not so trivial as erections.

But really, are erections trivial? Those that truly suffer from ED (as opposed to those who just want a 'back-up') may say no.

I even question the implication that ED drugs are trivial for those who just want a 'back-up.'

After all, most health plans don't cover ED drugs, right? And yet Viagra has sales of something like $2B/y. If that many people are willing to pay out of pocket, who are we to tell them that they're spending money on something trivial?

On a related note, I think it's a big fallacy to suggest that we'd get more life-saving drugs for currently untreatable diseases, if only we could convince the big pharmas to quit spending all their time on me-too drugs. If anything, pharma's ability to earn big profits in me-too categories like ED or statins is critical to offset the much higher risks involved in trying to cure, say, metastatic colon cancer, or Alzheimer's disease.

Rogaine was also developed & approved by the FDA as a pill for treatment of hypertension. The lotion was developed after the 'side-effect' of hair growth was noted.

Drug companies don't spend money on research? Than what does the R&D = 14% of revenue mean? Recreation & Diversion? Must be vacations for MDs.

Beeebee - That's like saying hardcover books are overpriced because it only costs $2 to print the book, and the rest is admin, profit, and ads, and that a 50 year copyright should be abolished.

Hm. Oops. I know the result would be no new books written by anyone but bored housewives and idle-rich fame-seekers, I think I might have just convinced myself that would be good. "Starting Monday, All Books $2 Each!" Tuesday: odd, Borders is closed. . . OK, bad idea.

Patents are different, but copyright is a place where the public, increasingly, is getting screwed. We are now up to life + 70, I think. It's a wierd thing to lock up value for increasingly long lengths of time in a throw-away world.

Do I hear a bevy of postings completely uncritical of the pharma industry here? Do a search for the phrases Nexium and Shark Fin. Patents are necessary but can be abused. Examples abound in the pharma and high tech fields.

W Allen I never said a word about eliminating patents. You put words in my mouth then expand on YOUR WORDS a whole lot. You suck. Although allowing generic drugs to compete a whole lot sooner then ten years would be good policy, you guys are the party of middle Americans values, right? Its pretty Christian to cut a little bit out of the pharmaceutical companies profits in order to get more lifesaving drugs into the hands of more people who need it, right? WWJD?

Dave D I dont agree with you Hardcover book analogy is in any way similar to the pricing of medicine. But trade paperbacks suck!

There is another cost ignored by the left. The cost of research to find a way to produce the drug in quantity-with a high level of quality.

Frequently, finding a way to produce the drug is harder than discovering the drug.

If producing the drug was easy, the Universities would be making the drug themselves.

Begbee, if you weren't functionally illiterate, you would have noted that I explicitly allowed for the fact that you may have been advocating shorter patents, and then I asked that you produce empirical data to establish that such action would provide a better trade-off between competition and innovation. To repeat myself (a necessary action, given your reading difficulties), it would be a worthwhile avenue of inquiry. Of course, you have no such data, and, as is your wont, you are simply foaming and yammering away. Well, we'll consider it an improvement over your typical excretions, given you haven't yet wished a deadly,debilitating, and painfull illness on anyone yet. Foam on.

The attitude that companies shouldn't be making a profit out of life-saving drugs is really weird. It implies that people who do something that saves lives should not be rewarded, while apparently being perfectly okay with people who make a living out of supplying much more trivial needs, e.g. writing horror stories, making millions.

If grandma invests her life-savings in a drug company looking at cancer treatments, she shouldn't get to keep a penny, but if she puts it into Toy Story 4, hey, no worries if she earns a million.

It's an attitude that isn't even as rational as "from each according to his ability, to each according to his need". If an expert scientist invents a cure for asthma, he should give it away for nothing, but if he decides to quit medicine and invent the next Grand Theft Auto computer game, well that's okay.

Begbee - have you in any way thought through what sort of society you're advocating here? Surely we want to reward people for saving lives, or investing in saving lives? That strikes me as good from both a practical and a moral viewpoint.

Um, SomeCallMeTim, would you please explain what you mean by "life plus 70" for patents? I think you're confusing patents with copyright, in which case you should do a little background reading.

As someone who works in the drug industry, let me assure you that patent lifetimes can be extended a bit by various strategies, but no matter what, inside of 20 years from issuance they're history.

And keep in mind that years of that patent lifetime is already gone by the time a drug makes it to market. Recent drugs that have gone off patent include Prozac, Glucophage, and Cipro, and Zocor goes off next year. We'd hold onto these if we could. But we can't, so we run our business accordingly.

W Allan, you said that I advocated getting rid of patents, I never said that. What you "allowed" for later in no way eliminates the lie thats the first sentence of your post. Your either dishonest or stupid, so which is it?

Tracey, you apparently have gone to school at the W Allen school of basing an argument on words that havent been said. How republican. I never said there should be no profit for the pharmecuetical companies, merely that they should take less of a profit to get more people the drugs they need.

Derek:

Criticism works better if you READ THE WHOLE THING (as I learned a few comments above by trying to be snide on the cheap). The relevant sentence for you to note is: "Patents are different, but copyright is a place where the public, increasingly, is getting screwed." This sentence seems to indicate that (a) I understand there is a difference between copyright and patents, (b) I think copyright is the area of concern. So what, given that context, could I be talking about when I reference," life + 70"?

Hey, we all make asses of ourselves from time to time (as I learned a few comments above by trying to be snide on the cheap).

I think you misrepresent the position of said pharma-bashers. Nobody's saying they do no research whatsoever. But something like 60% of the profits for their drugs are put into more marketing. The astronomical profits aren't put into R&D to quite the extent that pharma-apologists suggest. And I suspect the FDA establishment does much more to protect this business model (putting more emphasis on hype than actual production) than change it.

No, begbee, I said it wasn't often that someone advocated getting rid of patents, asked why would someone would do such a thing, then I posited that you were advocating shortening them, followed with a request for some empirical data supporting the proposition that such action would improve matters. You are still illiterate and you have yet to produce any evidence. What's next in the Begbee School of Rhetoric for Illiterates; wishing disease upon up someone?

Begbee, you state that "allowing generic drugs to compete a whole lot sooner then ten years would be good policy."

That may or may not be true. I'm sure you're aware that there are trade-offs involved.

On one side, there's economic benefit to everyone who pays the generic price X years sooner (whatever X is). There's also potential health benefit to people who can't pay the proprietary price. They can afford to access the benefits of the drug X years sooner.

But on the other side, isn't it a given that prices during the exclusive period will be higher? (This assumes the "true" costs of drug development and mkting stay the same, whatever they really are.) And if so, won't there be fewer people who can afford the drug during that period?

How do you know that on the balance, shorter patent life is a societal benefit?

We can even stipulate, for the sake of argument, that pharma exaggerates its R&D expenses, and downplays marketing efforts. (Like you, I suspect reality is somewhere in between the critics and the shills.) Wouldn't you agree that pharma only pursues those marketing efforts because it brings them more profit?

So isn't it also a given that reducing their profits means they will risk less in developing new drugs?

Now, I will freely admit that the net effect could easily be a benefit to society. Obviously, any patent term is more or less arbitrary. I don't know that the current term is optimal. But you've already agreed that the optimal term is >0. So why do you assume the optimal term must be less than it is currently? Maybe a longer term would be better.

Please note - I am not at all trying to continue the snideness. If you're basing your statement on some objective analysis, please share. I'd love to learn more. If it's just personal opinion, that's fine too, but obviously much less convincing.

W Allen, you said, "Well Begbee, its not often that you see an antipharma type that come right out against patents." Your most recent comments prove that you are both stupid and dishonest. Since your so sure I wish bad health on you W Allen, let me assure you thats not the case. But I wouldnt mind an industral accident that left you without fingers, the pencil in mouth technique might not stop but would surely limit your lies and personal attacks.

Getzal my comment about the length of drug patents is based on the free market principle that competition lowers price and improves quality. Much of this discussion hinges on knowing exactly how profitable these companies are, and theres alot of disagreement on these numbers. I think that the huge ad campaigns of drugs like Viagra and Levitra allows for the criticism of what PCs spends on advertising drugs that are purely recreational. Im not doubting that they make alot of money off those drugs, but do they need to have them on TV every fifteen minutes?

Heres the main point. The Pharmaceutical companies are making huge profits, they are subsidized by the government, the reps claim to represent middle American values, and imo middle America would rather see cheaper drug prices and smaller drug company profits.

Well, Begbee, apparently you really are illiterate, given you believe that there is a substantial difference between...

"No, begbee, I said it wasn't often that someone advocated getting rid of patents....."

...and...

""Well Begbee, it's not often that you see an antipharma type that comes right out against patents."

..neglecting that you apparently are still unable to read the rest of the post. As to attacking you, well, yes, I usually attack people who engage in evil, and wishing painful illness upon others is evil.

Begbee,

In all seriousness, do you really subscribe to everything in your last post?

[M]y comment about the length of drug patents is based on the free market principle that competition lowers price and improves quality.

The drug market is NOT free. The developer of a new drug needs government permission to sell it. He has to prove safety and efficacy of the new drug, through extensive animal and human testing. It takes years and costs a lot of money. Doesn't matter if you believe the Tufts figure of $800 million, or the critics' figure of $100 million. It's a lot. And the innovator is only going to develop the drug if he thinks he can make that money back, plus profit.

The generic maker needs gov't permission, too. But he doesn't have to prove safety and efficacy of his version of the same drug. The innovator already did that. The generic guy just has to prove that his pill is the same as the innovator's. Basically, he gives the generic pill to some people, and gives the original pill to some other people, and proves that both groups end up with the same drug levels in the blood. Obviously much, much cheaper. So the generic guy can charge a lot less, because he had much lower development costs.

The problem is, if you let the generic guy start selling his cheap pills before the innovator makes back the cost of the original development, the innovator loses money. Sure, the people taking the pills make out better in the short run. But later, when they need a different pill, it doesn't exist. The innovator decided not to develop it because he knew he'd just lose money doing so. Or if he decided to develop it anyway, he charged 2 or 3 or 10 times as much while the patent lasted, so he could recoup his costs.

I think that the huge ad campaigns of drugs like Viagra and Levitra allows for the criticism of what PCs spends on advertising drugs that are purely recreational. Im not doubting that they make alot of money off those drugs, but do they need to have them on TV every fifteen minutes?

How can you object to advertising of lifestyle drugs that most people willingly paying out of pocket for? Where is the harm? If you want to argue about the propriety of pushing cox-2 inhibitors to people who would do fine on nsaids, by all means, but this is silly.

[I]mo middle America would rather see cheaper drug prices and smaller drug company profits.

Middle America, myself included, would also rather eat lots of rich fatty food, and not worry about exercising if we don't feel like it. And we can do just that. We can even pretend there are no associated costs, but that won't make it true.

Smaller drug company profits means smaller &/or fewer drug companies, which means fewer new drugs. I'm sorry, but in the current system, those are the rules.

I'm not saying that automatically means it's wrong to try to lower prices. Maybe having fewer new drugs is an acceptable trade off for getting lower prices on the drugs that remain. Maybe the number of new drugs would only decrease a tiny bit. (I severly doubt it, but I could be wrong.)

But if you really think you can just declare lower drug prices without having trade-offs, you're deluding yourself.

Qetzal just made all the arguments that I had ready to go, for which I thank him. We go way out on the line in the industry when we introduce a new drug, thus our interest in making a profit as quickly as we can. And "me-too" drugs aren't the safe way out that you'd think they are for this problem - ask Bayer about Baycol, which was about the fifth statin to enter the market and blew up in their hands spectacularly.

Begbee's comment reminds me of people who support the reimportation of price-controlled drugs under the banner of "free trade."

And while I'm here, in reference to an earlier item, I did indeed misread SCMTim's comment - sorry about that! I'll serve up the snark next time; doubtless there will be an opportunity.

Getzal, I never said the drug market was a free market. I said the length of the patents should be shortened because of free market principles. Im well aware of the trials and costs involved in bringing a drug to market, my point is the length of the patent is much to long in many cases considering the profits of pharmaceutical companies. To a degree this argument has to be made in generalities, each pharmaceutical company has a different bottom line in terms of profits. But from my reading, most pharmaceutical companies are making huge profits, they are partially subsidized by the government, and the public health is dependent on much of what they do, so I think its entirely reasonable to reduce the length of the patents and the profits because its in the public interest. In any case, your argument about who will produce different drugs when you "need a new pill" has already been answered in todays system, the answer is not nearly enough pharma companies will make the new "pill" when profit projection is low, as the flu shot shortage proved. The current system needs to be fixed with the public health in mind.

You take me out of context as to Viagra and Levitra. The public doesnt really care if its paid for out of consumers pockets, the impression all these commercials give is that the pharmaceutical companies are much more intersted in developing good time drugs that turn a big profit, then they are in developing drugs that advance the public health. If you think its good PR for the flagship drugs of the pharmaceutical companies to be boomer hard on drugs, advertised at all hours with the disclaimer "erections lasting longer then four hours need medical attention", your crazy.

Qutzal clipping my quote in your, oh so intimidating, bold faced font in your last paragraph is so republican. I wasnt speaking to what middle Americans want in a perfect world, I was speaking to those middle American values you reps now claim to hold so dear. You'll find it hard to keep profits up now that the Robertson republicans are running the show. There will undoubtedly be trade offs in making the drug companies work better, but the current system isnt working. The ridiculous drug entitlement for seniors are proof of that. With each passing year the drug companies get deeper in the publics pocket, they have to better serve the public health, and cannot be considered a purely private business.

W Allen there is a large difference between eliminating patents, and reducing the length of a patent. Your not Bush, you cant just keep restating distortions and have people believe your steadfast rather then dishonest or just stupid.

Begbee, you really need to enroll in a remedial reading course. I specifically outlined two possibilities, dismissed the first, and asked you to provide empirical proof that the second would produce a better state of affairs, which you have yet to do. Are you truly so obtuse?

Begbee:

1. I didn't bold your quotes to be intimidating. I did it to set them off from my own comments. There was no hidden meaning behind my choice of font.

2. I am not a Republican.

3. You have not responded to my original question. If I have been unclear, my apologies. Let me try again.

You are claiming (quoting here from your most recent reply to me; I hope you find italics less offensive):

"[I]ts entirely reasonable to reduce the length of the patents and the profits because its in the public interest."

I have been questioning that claim. I have been trying to point out the potential bad effects that could occur, and that those bad effects could outweigh the good effects. If they did, that would be against the public interest, right?

You've already said you don't advocate eliminating patents. So I assume that on some level you agree that reducing patent lenghts too much would be against the public interest.

So again, what is your basis for claiming that the ideal patent term is shorter? Can you make (or point to) a reasoned argument that says the benefits of shorter patent terms really would outweigh the detriments?

I'm not looking to bash you here. You could certainly be right. I freely admit I don't have a factual argument that patent terms should stay the same. But you've been saying "it's in the public interest" as if that's prima facia obvious. It's not.

A couple points.

The whole "pharma is subsidized by the government" is ridiculous. The government supports basic research and occasionally gives a piddling grant to a pharma company. The vast majority of "support" from the government comes indirectly - we see what academic researchers (who are supported by the government) are doing, and get ideas about what to work on, and how. Look, a project that results in a clinical candidate - which is a minority of all projects - costs many, many millions of dollars. Phase I-III costs several hundred million, less if the compound (usually) washes out. Is it really meaningful to take a rare three million dollar grant from the government and act like pharma is thus beholden to the government and through them, the taxpaayers of this great nation? It's a non-starter, gang.

Number 2: think Jane has made this point, but any company advertises because they think they'll more than make it back as a result. It has nothing to do with how much a company spends on R&D, or company picnics, or hookers for the CEO, or anything else. It may be crass and annoying, but it doesn't take money from Grandma's pockets.

W Allen, you started your first post directed to me here by stating that I wanted to do away with patents. Thats completely false. The fact that you later contradict that statement, by commenting on the fact I said that I wanted to reduce the ten year exclusive ownership of the drug patents, prove that your opening statement was designed for dramatic effect without consideration of what I actually said.

As to your request for empirical proof, I have stated several times that there is a large amount of disagreement on the ratio of R and D expenditures to advertising expenditures, and that every pharmaceutical company has a different bottom line on profits. But I think we all accept the premise that pharmeceuticals are a very profitable business, and that this is a discussion of generalities, not an attack on a specific drug company. Quesal, there is obviously a need for patents to be of a length that allows the pharmaceutical companies to recoup there expenses and turn a reasonable profit. But since the pharma companies take public money, and benefit from other government subsidized research, the government should act in a way that gets drugs that are for the good of public health into the hands of the public as cheaply and as quickly as possible. I really dont care about the length of patents on drugs like Viagra, Rogaine, or the latest diet pill, as these sort of drugs improve the quality of life, but have little if any benefit to the public health. But as the shortage of flu shots prove, the government needs to be involved in making sure the pharma companies act with the public health in mind, and not just focus on profits. Quetzal, the flu shot example shows the detriments you fear will result from shorter patents already exist. Because the pharma companies accept public money, the government should require a certain percentage of the R and D they do is for the good of the public health, and that these patents exclusivety ends upon the recoup of expenses and a minimal amount of profit.

Qetzal I apologize for mangling your name, spelling is obviously not one of my strong suits.

Begbee, you still aren't addressing my question. Either I'm unable to state it clearly enough, or you're not interested in answering, so I'll give it a rest.

No worries on the spelling.

Begbee, really, you need to enroll in a reading class. I stated that it wasn't often that someone advocated doing away with patents, and then put forth what may have been your alternate position. Second, the degree of profitability of drug companies is only one aspect of an comprehensive inquiry into whether it would be optimal to reduce patent lengths. The critical issue is whether doing so would cause less private capital to be allocated to drug development, and the current return on capital is only one element of the answer to this question. You have yet to produce any evidence, thus it can be deduced that you are simply yammering. Well, at least yammering isn't evil, so this is an improvement for you.

W Allen, Bahhhhh.

Qetzal I dont mean to be evasive, but the title of this thread suggests that this thread could easily degenerate into a battle of numbers that I dont believe would be accurate for either side. I think Ive been pretty clear to what I believe the problems and potential solutions to our sketchy public health policy as it relates to pharmaceutical companies.

corpses mouldering in graves that could have been metabolizing humans,

Hm.... you're right, that would be an inefficent use of corpses. There are a lot of humans to metabolize!

Will someone with good info please comment on the flu vaccine situation? It's my understanding that the current shortage arises from too much government involvement in the flu vaccine... um... market, or process - not sure how to characterize it. Basically, from the fact that flu vaccine is (a) produced starting early in the calendar year toward a flu that won't show up for some nine months or so, and, (b) like many other vaccines, sold to the government at a fixed price a la Hillary Clinton. From the Wall Street Journal, Dec. 9, 2003, if I have the source correct:

"The reason for today's shortage - as well as seven previous preventive vaccine shortages since 2000 - is that there are just five vaccine makers. This lack of suppliers is partly thanks to Hillary Clinton, who as first lady turned government into the majority buyer of vaccines and pushed prices so low as to make business unsustainable."

So... could we not view this current flu vaccine shortage as an illustration of the unintended effects of efforts to bring direct considerations of the "public good" into drug production?

Furthermore, would I be wrong in positing that the sale of Viagra and suchlike "lifestyle" drugs, which can (?) be priced strictly by the market rather than by negotiations with health insurance companies and/or the government, might provide a greater amount of revenue (per unit??) than sale of a chemo drug that's covered by health insurance and therefore the subject of vigorous price negotiation, and that some part of the additional revenue would go back into R&D for new drugs, only some of which would be lifestyle drugs?

Whew. Long.

I guess I'm making an "invisible hand" argument, of sorts. But part of my premise is that the pharma companies already have the public good in mind to some extent, or else they wouldn't try to develop drugs for rare or quickly fatal disorders - just stick with pain relief. Again, I have NO data, just supposition.

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