I didn't realize, "the wealthy or somewhat flush of the world" were the ones doing cutting edge R&D. Medical R&D requires funding. Who funds it? Well, here in the United States, it's largely the NIH and bio-pharmaceutical companies. Where the NIH gets money is self-evident. How do bio-pharmaceutical companies make money and reinvest money into R&D? They sell pharmaceuticals. Where do bio-pharmaceuticals make a massive part of their revenue? From Americans. Why? Because we don't have a universal healthcare system which negotiates rates. We pay sticker. Americans paying sticker price allows other countries to get cheap drugs researched and developed by the worlds bio-pharmaceutical companies. If you take away/curtail that American market, naturally the bio-pharmaceutical industry will contract. How much? Who can say but it will not be a good day for the bio-pharmaceutical industry or their R&D departments the day the United States switches to a universal health care system.
Again, you are assuming no one picks up the slack, which I think is absurd. Where do military weapons companies get most of their revenue? I'm pretty sure "American ingenuity" will find a way to fund bio-pharma, even if their main profit margin is not gouging uninsured American consumers... People like medicine for a reason - they like to try to stay alive.
Why should I assume some unknown source is going to pick up the R&D those companies will no longer be doing? I assume, if the bio-pharmaceutical industry contracts you’ll just see less R&D in the medical world. Im not necessarily against universal healthcare but this is one of the things that has to be considered. If we wreck the American piggy bank there will likely be some downsides.
We have a product that most people never use: advanced military hardware. It has no individual use. Most of us never interact with it. Yet it gets huge (socialist mostly) funding, makes huge advances, supports a huge (bloated) industry... Yet we believe a product/industry that will keep us, our kids, our parents, our siblings alive, increase our comfort, our lifestyle, etc will not develop a similarly (probably still bloated) infrastructure? I'm dubious. That tends not to be how human nature works.
Wow. People think biomedical R&D only happens in the USA? USA produces about 40% of the pharmaceutical patents in the world, and about a third of the medtech ones, and 42% biotech. And that was back in 2015, last year with comprehensive stats. Since then, China has rocketed, and Russia & Brazil have also increased significantly. https://stats.oecd.org/Index.aspx?DataSetCode=PATS_IPC
I shudder to even dip my toe into this morass. but you do understand Because national defense is a constitutionally mandated appropriate function of the government (not at all saying I agree with the excesses of the military-industrial complex - although I am a beneficiary thereof - but at least it's in the damn rule book.) Health care, though obviously a worthy human endeavor, is not intrinsically a function of the federal government. Both you and I are old enough to remember a better health system before the Corporatist States of America stuck their fat nose into it.
To be clear - 1) that is not my argument. I was arguing against the idea that health care advance (R&D) would suffer if US gov't was buyer vs. hospitals. I don't think that makes sense. Even if we went to a "pure" nationalized health system (which we won't and don't even need to - we just need portable and universal. even Canada, Germany and others maintain private insurance as well as provincial administered "universal" health etc.) Military, space, etc shows that innovation continues, and often the federalized system provides great profit for the engaged industries. (I'm looking at you NorthrupBoeingRaytheonEtcEtc) 2) TBH the "constitutionally mandated" argument is a bit, uh, exaggerated. What we have as a military and what the Constitution specifically "mandates" ain't even the same kinda bird. But that's an argument for a different day. meanwhile, this is for Bruce: 1248358785288146946 is not a valid tweet id
This is getting toward my sweet spot. The question is, and always will be, what is a significant improvement? What is obvious?
Of course. And that will always be the debate, but I think any objective "meta" look at the current US/worldwide patent/IP situation finds many, many, many more hours/$$ spent/collected by "Patent Jumpers" and "Patent collectors" than $$ going to actual innovators/creators. The system is "arbitraged" by big $$ lawyers and firms/people that simply vulture/manipulate/exploit technical legalistic issues in the system, at the expense of real innovators who don't care enough/have enough $$$ to aggressively defend their "real" innovation/creative contribution (and this circles back to China and other countries as well...) But it's also a very big discussion and, of course, is full of exceptions.
Because there are people in the world outside of the States who are scientists as such, not in for the big bucks, but for their intellectual curiosity. I dunno if you're aware of the fact that in all universities around the world scientists are researching cures for diseases, studying diseases and I dunoo if you're aware of how many of those people were enlisted with their research in their head by big pharma to morph their research into a profitable product? You think only big pharma does research worth while? This is a guy from my Alma Mater, Casper van Eijck. He's the world leading authority on iirc the deadliest form of cancer. People like Steve Jobs and Sonia Gandhi were among his patients. He's researching innovatieve forms of treatment as there's been little progress in the last decades in it. He does it from a university, not a pharmacy giant. https://www.erasmusmagazine.nl/en/2...-zomaar-een-virus-inspuiten/?noredirect=en_US “You can’t just inject yourself with a virus” Cowboy in Science Casper van Eijck is experimenting with an innovative new cancer treatment.
Is the university going to spend the $1 billion required to get a drug treatment through the US FDA? The article mentions a half a million euro subsidy - that will barely cover the filing fees the FDA bureaucracy requires.
Nope, of course not. The subsidy mentioned was pure for funding safety measures. The funding of the research is done by actions to fill the wallet of the foundation he has, Support Casper". On a regular base Feyenoord and it's supporters have special actions to give a boost to the donor revenues. Here's mentioned in the article what they intend to do and that's to retain the rights on it but give the knowledge away for free, so that anyone can use it to produce the cure. Which means it will be cheap. You must have spoken to people who said: Van Eijck, what the hell do you think you’re doing? “Of course I have. What we do definitely goes against the established order. You see, normally it is pharmaceutical companies who determine what follow-up studies are to be carried out. But we feel this should be up to the doctors. What makes our study so good is that we have gathered a team representing a wide range of specialists – immunologists, virologists, neurosurgeons, urologists, medical oncologists – who really want to get this project up and running. This is not a one-man project. There are many advantages to doing it all ourselves. For instance, our data will remain public property. Furthermore, we will retain intellectual ownership, meaning that the medications will be affordable. There is a reason why the health insurance company is now saying: we will pay for these medications. Brilliant.” He's by the way working with our virology department, that gave the US gouvernment a scare as they gave them more than the US Gov asked for. http://content.time.com/time/specials/packages/article/0,28804,2111975_2111976_2112158,00.html
Unfortunately not in English, but if interested and willing to spread it around to make Casper's war chest filled: https://www.supportcasper.nl/nl/
The thing folks are missing is the idea that the system does not change to accommodate the new economics, which is silly. Universal health, in whatever form, is just insurance. Prices still are negotiated, and supply and demand laws (even in their distorted new forms, which will be different, but likely no more distorted than the current distorted form) will still apply. People will not suddenly want to stop staying alive. And they won't stop being willing to pay something for it. Many medical advances come out of other countries. Do you think, if our Congresspeople have the same or similar health insurance to average Josephine, they will make it impossible for folks in the US to make use of, I dunno, Canada's innovative heart surgery through the rip cage (to name on thing of the past decade that a Canadian friend of mine got before it came to the US.) The regs follow the economics. We aren't going to stop medical advance 'cuz "Universal Health Insurance" - we will adjust the economics of Universal Health Insurance to reward R&D/innovation. But there will be some saving due to cutting out middlemen and excess/slack - and then some other costs due to adding Federal/State bureaucracy... There will be drop off/change in some places - (Canada, for instance, has a very centralized cancer care system. It's very good, but does require more travel than some US patients are used to, although many lucky US cancer patients do make the trek to Mayo, Anderson, Sloan, Farber etc. if they think it will help.) And improvement in others. But not having to check the bank balance before taking the kid to see an urgent care specialist (will be more of those walk-in clinics, probs.) would be a nice change for many economically challenged families.
Color me doubtful that the economics of M4A will be effectively used to reward R&D/innovation: will it "stop medical advance"? nope, but it'll slow it down. What government entity is well run and respected and rewards R&D/innovation? The usual lists are NASA, CDC and special forces and each of those has dropped the ball in terms of ability. I'll ask again, who's going to fund the $1 billion to get drugs approved by the FDA? Let's not forget that many go through the process and fail so each successful drug has to make up for many that didn't.
Drugs get approval in Europe etc. based on own trials and foreign drugs often on trusted approvals. In Europe it's the EMA in general, but several countries have their own agency, like the Dutch. So if this pancreas cancer treatment is there, the researchers have to find partners for testing etc. As is mentioned research is spread over all medicine, research is already de facto paid by insurance companies. So instead of being presented the bill afterwards, they can pay the research bill in advance and in that way make medicine affordable as it gets produced by non monopolists.
The FDA process will change if it's too cumbersome. It's a regulatory process, not natural law. Again, there are huge distortions in the "market place" of Pharma/med at the moment (it's almost impossible to call it a "market place") and those distortions will, for sure, be different. But "$1 Billion" for FDA approval is not an immutable natural law of physics it's current, bureaucratic distortion (for good reason, of course) that can be adjusted by legislation/regulatory changes. Just like insurance rules can be. Yes, things will be different. No, the R&D, innovation and will to live longer/better won't end.
No. Nor did I ever say that. Go back and read what I wrote instead of trying to put words in my mouth. Obviously, there is tons of public funding/charitable funding in medical research but there is also lots of R&D funding from bio-pharmaceutical companies and their investors looking to make as much money as they can from their R&D. If the American market becomes significantly less profitable, it only stands to reason the bio-pharmaceutical industry will contract and when they contract they will take their R&D with them. Americans paying sky high pharmaceutical prices is good for the advancement of medical R&D and for everyone else is the world besides Americans. Since Americans are footing the bill those bio-pharmaceutical companies can afford to take cut rate prices from universal health care systems. You're welcome.
It's not about where bio-pharmaceutical companies are located, it's about the markets they have access to. Take away a large percentage of the money generated by the U.S. market and what does biomedical R&D look like in the world? That's the question.
Why would that happen? If a medicine is approved by the EMA and proves successful in Europe and other countries, what makes you think it can't/willnot appear on the US market?
Because, if the United States goes to a universal healthcare system, that system will be a drug buying monopoly for the United States population and will have enormous power to drive down the price it pays for drugs, as seen in every other country with a universal healthcare system all of whom pay significantly less for pharmaceuticals then Americans do. Therefore, without the ability to make nearly as much money in the American market as it did before, the bio-pharmaceutical industry will naturally contract. That contraction will lead to less medical R&D from the aforementioned bio-pharmaceutical companies. Everyone else, Europeans especially, are getting a great deal from Americans paying so much for pharmaceuticals.
Change "companies" to Bio-Medical University Research Institutions and you have a winner. The cozy, pure profit-motivated intersection between Academia, Wall Street and Big Pharma streets has much to answer for in the outbreak of this pandemic. Just PLEASE spare us another insipid interview with that sanctimonious do-gooder Bill Gates.
Speaking of the NIH "the biggest funder of medical research in the world, with a budget of $42 billion"... . get a load of what the head honcho said on February 7
If you look at the history of US government negotiations with major international conglomerates/corps/industires, I think you will find the US government (and the tax payer) are rarely overly aggressive. Hence the "DOD premium" for all "private" defense industries. Sure, little (esp non-US) companies might get squeezed now and again, as they won't have the same K-street muscle... but your big or home-grown Pharma? Harvard, Stanford, Penn, BU, BYU, etc etc research? Nobody is gonna get killed. Sure, some of the outrageous profit margins might go, but in general... rarely does big business starve when making a deal with big government in the US of A.