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Comment by aaavl2821 | Hacker News Reader

without for profit companies, all that taxpayer funded research would be sitting on a shelf, never becoming medicines to treat patients. In the last 2 years I think every drug that got approved by FDA was developed by a for profit company.

Drugs don't emerge fully formed from academia, just waiting for pharma to patent them and jack up the price. Pharma spends more on r&d than academia

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Please provide conclusive proof this process is not consequence of neoliberal policies, aimed at defunding public spending and encouraging for-profit spinoffs, aligning the research process to its ideology

If you're going to make such a conspiratorial claim, then the onus is on you to provide the proof.

I think the answer is probably a little bit more grey FYI.

Seems likely either drugs would end up being used, or government would stop funding drug R&D research.

Saying funding would continue without any benifits seems to be the least likely outcome. Personally, I would be fine stopping all public drug research, but I suspect more people would want to continue...

How would the drugs be used? They still need another 5 years and hundreds of millions of dollars before they are approved?

Presumably, if they continue to fund research, public entities would then pay to finish the process. This would mean either fewer drugs or more money for R&D.

In the end when you change one part of the process you need to assume other parts of a related system will change in some manor.

The ones doing basic research today have zero capability to do the development part. So you'd be looking at spending a ton of money to try and develop the needed expertise to bring a molecule all the way to market. Would that also include commercialization - things like marketing?

I don’t know. Clinical trials can already be outsourced, so that’s not a major issue. And only two countries allow for direct to consumer drug marketing so that’s clearly unnecessary.

Honestly, this is simply not going to happen in the US so it’s hard to say what’s realistic.

I wasn't referring to DTC marketing. DTC is a small percentage of the marketing companies do.

Any yes, you can outsource running a trial, but you still need someone to design it, process the data, put together an NDA and submit for approval.

I can only imagine the complete clusterfuck that would be if it was all done by public employees.

I understand you have some concerns, but it’s not like people doing cutting edge drug research don’t know how to do research.

Large drug companies are not bringing magic recipes to the mix here. Often it’s the same researchers who found the drug who end up starting drug a company to profit from their research.

As to advertising to doctors their is plenty of evidence this is harmful. It’s easy to for doctors to keep up with relevant drugs as so few are added each year and many are extremely specialized. Advertising results in over prescription which is known to be extremely harmful with opioids being an obvious example.

A very large portion of R&D costs for drugs are in doing phase 3 clinical trials. These will always be expensive because you have to recruit and closely monitor several thousand people with a relevant condition to determine if a treatment is better than existing alternatives and what sort of side effects a medication has. Many drugs which were developed by academia using federal dollars and which passed phase 1 and 2 trials fail phase 3. Pretty much every phase 3 trial is paid for by private industry.

I don’t agree that phase 3 trials must be that expensive.

Currently they cost ~19 million each which is frankly not that big of a deal. A larger issue is only ~15% of drugs make it through the process. With ~20 new drugs a year this only adds up to 2.5 billion per year which a frankly a drop in the bucket compared to drug costs.

This is an important point. There's nothing to stop Harvard or Stanford from commercializing their research directly. They have massive endowments of financial and human capital.

The flip critique of the drug industry is to suggest they're basically taking miracle cures developed in toto in publicly-funded labs and taking pure profits.

If that were the case, shouldn't one of the dozens of well-capitalized research institutions just go to market?

The reality is the drug companies take on a tremendous burden turning high-level research into a product that works, including:

+ Formulating a product that will work at scale,

+ In widely diverse populations,

+ While eliminating potential side effects, + Adapting for human UX limitations,

+ Exhaustively guarding against adverse reactions,

+ At the same time, building production capacity,

+ Creates marketing materials for patients, but also to educate doctors who don't have scads of time to study new treatments,

+ Physically distributing the product

+ Monitoring the product fastidiously once it's on the market for negative reactions,

+ Sending humans to almost every doctor's office to answer any questions about the product,

+ While staffing a 24/7 customer service number to sort out any problems

It's not as easy as it's made out to be!

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