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Comment by Alex3917 | Hacker News Reader

The real solution is that we need single payer healthcare that only covers generics. Then if people want to experiment with patent medicine, they can get supplemental insurance from the private markets or pay for it out of pocket. Until then the whole system is fucked.

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Not sure where you're going with this. That would mean that no one would have access to any drug until it had already been on the market for at least 8 or more years, unless they were willing to pay it out of pocket (if they can't afford the insurance).

On Medicaid and have HER+ breast cancer? Tough, you can take some horrible chemotherapy that will give you 6 months, not the new HER2 drugs that will give you 5+ years of life.

How would that even work?

> On Medicaid and have HER+ breast cancer? Tough, you can take some horrible chemotherapy that will give you 6 months, not the new HER2 drugs that will give you 5+ years of life.

Which is exactly how it should work. The government should allow limited monopolies as an incentive for innovation, but it shouldn't be subsidizing them with taxpayer dollars.

The vast majority of new drugs have few if any benefits over existing drugs, they're just government handouts to the wealthy. So I fail to see how a system that provided the best possible treatments for 99% of health problems for every American at a fraction of the current cost wouldn't be vastly better than our current system.

So I fail to see how a system that provided the best possible treatments for 99% of health problems for every American at a fraction of the current cost wouldn't be vastly better than our current system.

If you're excluding patented drugs, you're excluding some of the best possible treatments out there.

Also, your statement that "the vast majority of new drugs have few if any benefits over existing drugs" is not true. Some drugs are not any better, but most are better, although many only slightly.

You have to realize that similar to tech, not every new drug can be a breakthrough. Most new drugs have incremental benefit, but it expands the boundaries of what's possible. If you look at the treatment of colon cancer, each new drug only added a few months of life, but after 10 years, the benefit had extended to over 5 years.

> If you're excluding patented drugs, you're excluding some of the best possible treatments out there.

The issue is that allocating taxpayer dollars to the best treatments is bad policy, if you can get better outcomes from worse treatments for the same amount of dollars. E.g. for most diseases the most effective treatments are probably alternative medicine, but it's also probably not cost effective for the government to be paying for everyone to get whatever alternative medicine they want.

Many of the "best possible treatments" are expensive crap, barely better than a cheap generic or even than no treatment at all (especially cancer treatments).

I consider myself relatively libertarian, so I find myself nearly in shock that I believe a single payer system is the inevitable, and perhaps best, solution. (Although your generic vs branded thing makes no sense, no offense) Our problem is that we have made thing SO dysfunctional that a few laws here and there probably cant fix it - that's how broken it is. There would be drawbacks for sure, but we're at the point where things are so bad that the incremental drawbacks would be far outweighed by the benefits. It's pretty depressing to think about in all honesty.

Why do you assume a single payer is inevitable? Are there some countries with great healthcare systems that are multi-payer? Switzerland comes to mind. Singapore?

There was a really interesting episode of the podcast called White Coat Black Art that generally covers the Canadian health care system. In the recent election a single payer pharamacare system was part of one of the platforms, so the podcast host went to Sweden to see how they do it.

http://www.cbc.ca/radio/whitecoat/blog/pharmacare-sweden-sty...

This would be fine, so long as we made drugs go generic much faster. Which would require more public funding for drug research. Which would turn the system on its head.

The FDA allowing the purchase of generics from reputable manufacturers in India and China, regardless of patent law, would also decimate the current system.

So basically invalidate the patents that exist? That would certainly disrupt the system and would likely results in no new drugs.

You mean no new drugs funded by for-profit companies. Drugs would continue to be developed by governments and non-profits.

Please list all of the drugs that have been developed by government and non-profits. And by developed, I mean actually brought to market. The list will be very short.

Yes, the NIH funds basic scientific research. The NIH does not create new drugs. Even if an NIH research had discovered a new drug (they usually don't, they discover new science that leads to new drugs), that's about 5% of what it actually takes to get a drug to market.

If you look R&D spending by pharma companies, the research part costs about 1/3rd. The development part is 2/3rds of the cost.

Take a look at the Nature article that traced who discovered new drugs over the past decade or so. Over 2/3 were NOT invented by gov't or non-profit funding.

> If you look R&D spending by pharma companies, the research part costs about 1/3rd. The development part is 2/3rds of the cost.

You left off the marketing expense:

"In 2012, the pharmaceutical industry spent more than $27 billion on drug promotion— more than $24 billion on marketing to physicians and over $3 billion on advertising to consumers (mainly through television commercials)."

http://www.pewtrusts.org/en/research-and-analysis/fact-sheet...

> Take a look at the Nature article that traced who discovered new drugs over the past decade or so. Over 2/3 were NOT invented by gov't or non-profit funding.

But that doesn't mean government can't invent or fund drug discovery.

You left off the marketing expense

It seems like we're on a different topic now. My original point was private companies do most of the drug discovery now with gov't funds helping out. The marketing expense doesn't change that.

As for the marketing expense, selling drugs is a high touch business. You can't just run ads, you need sales people to go and visit doctors, answer their questions, provide educational materials. That costs a lot of money. The $24B in marketing to physicians is likely mostly the salary of sales reps.

And before you say that it's not needed, I've spoken to a number of doctors that have a good relationship with sales reps and find them helpful. They don't have time to keep up on every new piece of data on a drug.

If you're drug is crap, you won't be able to sell it, period. A great example is Pfizer's inhaled insulin, Exubera. It barely sold $20M at peak. You'd think a company like Pfizer who are marketing geniuses could move anything, but they couldn't move Exubera because it was a crap drug.

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