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Comment by twoodfin | Hacker News Reader

No matter what drugmakers spend money on, you hear complaints:

- Marketing, to learn what / whom / how to sell: “They spend more on TV ads than R&D!”

- Basic R&D: “Look at all the conflicts of interest in this academic research!”

- Commercial R&D: “They’re just looking for ways to extend the patent lifetime of drugs that only exist because of government-funded basic R&D!”

- Back to the shareholders (mostly pensions and retirement accounts): “Billions of stock buybacks for Wall Street!”

What should the pharmaceutical companies with billions coming in from GLP-1’s be spending their money on?

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What’s the concern here? Too much justice? Holding powerful institutes to account frequently seems like a good thing to me.

The concern is the aversive mind that tries to find fault in everything which then leads to politicians creating policies which prevent or hinder medical discoveries and treatments.

This isn’t what justice is. It’s also not holding people (or orgs) to account. It’s complaints against an entity that people often don’t understand or like.

You may be right that they are in a bind wrt public opinion. But that is not a defence against any specific criticism. What is your opinion on the conflict of interest mentioned above?

How is it a conflict of interest for GLP-1 makers and the scientists who work with/for them to look for new medical value in an academic setting with willing collaborators and all the usual peer review?

It's not but there's a lot of historical evidence that those situations are more likely to produce research that looks favorible to the sponsoring company. So it means you have to be a little more careful when looking at those results.

What evidence are you talking about? Do you think industrial scientists collaborating with academics and vice-versa is unusual?

https://en.wikipedia.org/wiki/Funding_bias

Academic research is subject to dozens of potentially corrupting biases, named and otherwise. We still do it and get great benefit from it.

Again, what’s the evidence that this research in particular should be suspect? It looks a lot like all the other research that goes on in this space. Experimenting with biological systems & real humans is expensive, even when you’re mostly doing data collection. It needs funding!

All research from people who financially benefit from the outcome that they have reported should be suspect. Being questioned is not a punishment.

If you ask your child who enjoys video games to stop playing video games and do their homework, and they tell you they don't have any homework, you're silly (trying to use a kind word) if you don't apply far more scrutiny than if they told you that they had an enormous amount of homework that would keep them from playing video games for the next few days.

You don't need evidence to question this. That the reply is convenient is itself evidence. The reply is consistent with someone who is lying in order to play video games. It is not proof.

In addition to the funding bias wikipedia article someone else already cited:

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.MR...

> Sponsorship of drug and device studies by the manufacturing company leads to more favorable efficacy results and conclusions than sponsorship by other sources. Our analyses suggest the existence of an industry bias that cannot be explained by standard 'Risk of bias' assessments.

And no! It's not unusual, nor does it mean the results are wrong. It just means there's a known bias towards results that favor the sponsor's interests that needs to be taken into account when evaluating the research. Again, that doesn't make it wrong. But it should make you cautious before thinking that a single study (in a very specific sub-population, at that) is necessarily going to generalize. It might. I hope it does! GLP-1's are awesome. But cautiously.

This is a federally funded study. Says so in the bright yellow “Key takeaways” box at the top of TFA.

But ok, sure, drug companies bad. Man hn is really turning into Reddit these days.

Dude. From the paper itself:

"Competing interests G.A.M. serves as a research consultant for Merck, GlaxoSmithKline/ViiV, and Gilead. M.J.C. serves as a scientific advisor for TruDiagnostic. V.D. and R.S. are employees of TruDiagnostic. All other authors declare no competing interests."

These are known risk factors. I've never said drug companies are bad. I literally take corporate funding for my own research. But you also don't get to stick your head in the sand and ignore the competing interests that all make the research more likely to show favorable results. Again for those in the back: These results probably _are_ correct! But do they generalize? Will they hold up on replication with a larger population? Do they matter, or is the proxy they're measuring not actually relevant for long term things in humans? Dunno. That's the thing about a _statistical likelihood of bias_ -- you have no idea exactly how to apply it to a single paper other than to say "ok, known possibility of bias, interpret accordingly."

From your cite, as you quote:

Sponsorship of drug and device studies by the manufacturing company leads to more favorable efficacy results and conclusions than sponsorship by other sources.

This isn’t that. It’s just FUD in this context. Nobody casts aspersions about Google authors on their latest database query optimizer paper with Stanford.

Because Google doesn't have much of a financial interest in that kind of paper. Drug companies have a financial interest in studies that evaluate their drugs.

If you want a CS analogy, the google-co-authored papers about internet policy do get a lot more scrutiny. And rightfully so! That doesn't make them bad -- many of these are written by friends of mine whom I hold in great esteem -- it means we have to be aware of the potential for all of us to be influenced by the money.

Both opinions can be true, drugmakers should still spend money on R&D, and consumers should hold academic research with significant financial ties to interested sponsors to a higher standard of scrutiny.

Criticism does not have to mean preventing work, we can be critical especially of work that we find important.

I'm inclined to agree with your point, but it seems like there's an obvious thing they could do that I think people wouldn't complain about: Reduce their prices. Of course that would just look like not getting so many billions from GLP-1 drugs, rather than like any specific action one could complain about.

(If anyone reading this feels inclined to say something like "But how would that benefit them?" -- well, if you restrict consideration to things they could do that benefit them, then it no longer seems so unreasonable if all their options look bad to the critically-minded. Maybe they should be doing things that benefit the rest of the world more and themselves less.)

Outside of the occasional spike from a real blockbuster, pharmaceutical companies are not particularly profitable. Without those temporary (patent-protected) “windfall” profits, the business model doesn’t work.

To whatever extent they couldn't afford to reduce prices while staying in business, they also couldn't afford to spend those alleged billions of dollars on basic R&D or stock buybacks.

Investing in potential future blockbusters and encouraging investors to value the equity by returning some fraction of profits is the business model.

One thing they are spending them on is tons of new research. Lilly is spinning up massive facilities in Indiana, of all places. I know some absolutely fantastic researchers at Indiana University but I had never thought of it as a biotech hub before.

Lilly is headquartered in Indiana so it isn’t some huge surprise..

Much like the conspiracy that pharma companies are uninterested in curing diseases, the complaints aren't based on data or facts.

I'll offer cystic fibrosis as an example. Trikafta may as well be a miracle drug. And CRISPR-based gene editing and replacements are being researched that could be an outright cure, as opposed to a 90% cure.

The problem is these treatments on the bleeding edge of biological understanding are going to start out expensive.

That puts most Western governments with limited budgets in a pickle, having promised their citizens modern medicine equitably at affordable cost, tax or otherwise.

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