Good (IMO) editorial from David Frum

[Admiral Yi]

Just to clarify a few points:

- in every jurisdiction, not just the US, drug manufacturers enjoy patent monopoly. The issue is controlls on price and advertising, not existence of monopoly.

- the issue of "free riding" is whether the US manufacturers spend a disproportionate per-population amount on research that actually benefits people by developing beneficial new drugs. Obviously, no matter what systems are involved, the US as a rich and gigantic market, would pull a lot of weight. The issue is whether it pulls above its weight because of its unique system.

- To determine this, it is necessary to determine what portion of US company's reserach budget is actually spent on beneficial research.

That's a reasonable framing of the issue, as long as you included the beneficial qualifier for everyone's research.

Canada and other countries may have patent monopolies too, but in a single-payer system the patent holder doesn't have the ability to charge monopoly prices.

[ulmont]

- in every jurisdiction, not just the US, drug manufacturers enjoy patent monopoly. The issue is controlls on price and advertising, not existence of monopoly.

I don't think this is accurate.  India in particular has or had a different system (I believe has no drug patents for any drug produced before 1995, and definitely has a compulsory licensing scheme that has yet to go very far).

Yeah, I am not sure I understand the patent monopoly argument. Is the patent monopoly period longer in the US than in other Western countries?

No.  Practically all Western couintries run a "20 years from the oldest patent in a patent family" scheme.

[Barrister]

Just to clarify a few points:

- in every jurisdiction, not just the US, drug manufacturers enjoy patent monopoly. The issue is controlls on price and advertising, not existence of monopoly.

- the issue of "free riding" is whether the US manufacturers spend a disproportionate per-population amount on research that actually benefits people by developing beneficial new drugs. Obviously, no matter what systems are involved, the US as a rich and gigantic market, would pull a lot of weight. The issue is whether it pulls above its weight because of its unique system.

- To determine this, it is necessary to determine what portion of US company's reserach budget is actually spent on beneficial research.

That's a reasonable framing of the issue, as long as you included the beneficial qualifier for everyone's research.

Canada and other countries may have patent monopolies too, but in a single-payer system the patent holder doesn't have the ability to charge monopoly prices.

In Canada we do not have a single payer system for prescription drugs.  You can go to the doctor for free, but not the pharmacist.

[Viking]

The US is still piggybacking on German medical research in the 1933-45 era.

Unit 731 studies into the nature of Hypothermia are still cutting edge. Grant proposals where human slaves are frozen to death in cold ponds in arctic winter conditions are few and far between. Mengele et.al., however, made little or no contribution to medical knowledge.

[Malthus]

Yeah, I am not sure I understand the patent monopoly argument. Is the patent monopoly period longer in the US than in other Western countries?

No, it is just that the US lacks the types of controls on costs that some other countries (notably, Canada) have.

In Canada, the price of obtaining patent protection is - you are only allowed to increase your price above that of "comparable" drugs if you can demonstrate substantial improvement or innovation, as judged by an expect committee (the PMPRB, or patented medicine price review board).

This affects all drugs. There is an entirely sepreate system by which the provinces only agree to "list" certain drugs on their Formularies (that is, drugs the province will pay for out of the public insurance system) if the manufacturers agree to a certain price.

In addition, in Canada it is prohibited to advertise prescription drugs directly to the public.

The argument is that in the US the practice of charging *unrestrained* monopoly prices for drugs gives drug manufacturers a big pool of money to fund future innovations, and that those countries with price controls are in effect "free riding" on the backs of the US consumers.

The problem is that proof of this theory lacks. Certainly the US drug companies spend vast amounts on "research". Problem is, that much of that spending is on so-called "me too" drugs - that is, drugs that are essentially the same as existing drugs, but whose sole purpose is to obtain a new patent (thus "evergreening" the patent). Another wack of the "research" budget is spent on "phase 4" trials - which in many cases are simply intended as vehicles to pay physicians to use the manufacturer's product.

Thus it is very difficult to tell if Americans (and the world) actually get a great benefit that would be lost if America adopted the Canadian system, which is the argument. The better view is that the US system is essentially enriching the shareholders of US drug companies, but the benefits to the woorld are less readily apparent.

[Malthus]

- in every jurisdiction, not just the US, drug manufacturers enjoy patent monopoly. The issue is controlls on price and advertising, not existence of monopoly.

I don't think this is accurate.  India in particular has or had a different system (I believe has no drug patents for any drug produced before 1995, and definitely has a compulsory licensing scheme that has yet to go very far).

Yeah, I am not sure I understand the patent monopoly argument. Is the patent monopoly period longer in the US than in other Western countries?

No.  Practically all Western couintries run a "20 years from the oldest patent in a patent family" scheme.

I meant every advanced Western jurisdiction.

[Neil]

Let me hazard a guess.  Minksy has clients in the pharmaceutical industry.  Malthus does not.

Malthus does enormous amounts of work for pharmacoms and health care.  It's at the top of his bio, and you might call it his specialty.

[Malthus]

Just to clarify a few points:

- in every jurisdiction, not just the US, drug manufacturers enjoy patent monopoly. The issue is controlls on price and advertising, not existence of monopoly.

- the issue of "free riding" is whether the US manufacturers spend a disproportionate per-population amount on research that actually benefits people by developing beneficial new drugs. Obviously, no matter what systems are involved, the US as a rich and gigantic market, would pull a lot of weight. The issue is whether it pulls above its weight because of its unique system.

- To determine this, it is necessary to determine what portion of US company's reserach budget is actually spent on beneficial research.

That's a reasonable framing of the issue, as long as you included the beneficial qualifier for everyone's research.

Canada and other countries may have patent monopolies too, but in a single-payer system the patent holder doesn't have the ability to charge monopoly prices.

As BB pointed out, Canada isn't a single-payor system.

What Canada has, are extremely influential public insurance schemes. In Ontario, for example, poor people and everyone over 65 is covered.

That gives the provinces hefty bargaining power, but the system of price regulation is federal and not provincial, and is entirely seperate.

Though there has been efforts to standardise the provincial sysyems. 

[DGuller]

Let me hazard a guess.  Minksy has clients in the pharmaceutical industry.  Malthus does not.

Malthus does enormous amounts of work for pharmacoms and health care.  It's at the top of his bio, and you might call it his specialty.

I have to admit that I did recall him working in the medical field, but my need to be a smartass was overwhelming, as usual.  Eventually I decided that I remembered him talking about medical devices, but not pharmaceutical stuff.

[Zoupa]

Patients don't need to be involved in their treatments in 99% of cases.

I've heard that at least 75% of the time or more that they need to.

*shrug*. I'm just telling you how it is. Patients aren't trained or taught how to treat. Doctors, pharmacists, dentists etc are.

Here's an example from last week. Girl comes in, convinced she has zona. Why? Because the day before she was outside, the sun was bright and now she has a rash on her back. So of course she rushes online and decides "OMG I HAVE ZONA".

She didn't have zona of course. I told her that. She didn't believe me, went to see a GP and then a specialist.

Verdict: heat rash.

Just let people do their jobs and the whole system works better.

[Barrister]

Patients don't need to be involved in their treatments in 99% of cases.

I've heard that at least 75% of the time or more that they need to.

*shrug*. I'm just telling you how it is. Patients aren't trained or taught how to treat. Doctors, pharmacists, dentists etc are.

Here's an example from last week. Girl comes in, convinced she has zona. Why? Because the day before she was outside, the sun was bright and now she has a rash on her back. So of course she rushes online and decides "OMG I HAVE ZONA".

She didn't have zona of course. I told her that. She didn't believe me, went to see a GP and then a specialist.

Verdict: heat rash.

Just let people do their jobs and the whole system works better.

I don't know what to tell you Zoups.

I certainly have stories from court when a lot of people would have been a lot better off if they would just shut up and listen to what their lawyer is telling them.

However... sometimes we get it wrong.  Just a couple weeks ago we were rolling along, trying to just adjourn some guy in custody over to next week, when he quite loudly insists to know why he is being held.  When we tell him it's for missing a court date, he insists that was dealt with a long time ago.  Because the uy keeps insisting, we look into it and he's right.  Guy turns out getting released, when if he'd just listend to "the experts" who knows how long he might have sat in custody.

Generally, people with training and expertise know what they're talking about and should be given deference, but only an individual knows their own situation.

[garbon]

Patients don't need to be involved in their treatments in 99% of cases.

I've heard that at least 75% of the time or more that they need to.

*shrug*. I'm just telling you how it is. Patients aren't trained or taught how to treat. Doctors, pharmacists, dentists etc are.

Here's an example from last week. Girl comes in, convinced she has zona. Why? Because the day before she was outside, the sun was bright and now she has a rash on her back. So of course she rushes online and decides "OMG I HAVE ZONA".

She didn't have zona of course. I told her that. She didn't believe me, went to see a GP and then a specialist.

Verdict: heat rash.

Just let people do their jobs and the whole system works better.

And I'm just telling you how it is. Doctors often make mistakes, have their own biases, don't choose what is actually the optimal course of treatment for their patients.  Doing research with doctors has only served to convince me that a patient needs to question what they are told and should seek out second opinions.

Oddly enough, Iorm has stated in this thread that a patient is foolish if they aren't involved in their treatments.

[derspiess]

Doing research with doctors has only served to convince me that a patient needs to question what they are told and should seek out second opinions.

My own experience + anecdotal evidence from others tends to support that notion.

[Zoupa]

And I'm just telling you how it is. Doctors often make mistakes, have their own biases, don't choose what is actually the optimal course of treatment for their patients.  Doing research with doctors has only served to convince me that a patient needs to question what they are told and should seek out second opinions.

Oddly enough, Iorm has stated in this thread that a patient is foolish if they aren't involved in their treatments.

Doctors don't often make mistakes, no. They're human like everybody else, and just as BB pointed out, shit happens. In about 1% of cases. I'm not saying you shouldn't ask questions about your condition or treatment options, just that the person you're asking knows better than you.

And don't tell me how the game goes because you "did research" with doctors for you summer internship, boy. I've been at it for 11 years, plus 5 years of schooling and training.

[garbon]

Doctors don't often make mistakes, no. They're human like everybody else

I wasn't saying that doctors make more mistakes than an average person..but just like everyone else, they make mistakes.

In about 1% of cases. I'm not saying you shouldn't ask questions about your condition or treatment options, just that the person you're asking knows better than you.

I agree. I think we're likely of similar thoughts only that you lean slightly more to support the docs and lean slightly more towards the patient side.

And don't tell me how the game goes because you "did research" with doctors for you summer internship, boy. I've been at it for 11 years, plus 5 years of schooling and training.

I've already hit my 4 year mark of doing research in the pharmaceutical sphere - excluding any internships that I've had.  I also spent a good part of last year seeing different specialists for depression.