He mostly sums up about how I feel about the recent standoff.
Quote
Editor's note: David Frum writes a weekly column for CNN.com. A special assistant to President George W. Bush from 2001 to 2002, he is the author of six books, including "Comeback: Conservatism That Can Win Again," and is the editor of FrumForum (http://www.frumforum.com/).
(CNN) -- I'm a Republican. Always have been. I believe in free markets, low taxes, reasonable regulation and limited government. But as I look back at the weeks of rancor leading up to Sunday night's last-minute budget deal, I see some things I don't believe in:
Forcing the United States to the verge of default.
Shrugging off the needs and concerns of millions of unemployed.
Protecting every single loophole, giveaway and boondoggle in the tax code as a matter of fundamental conservative principle.
Massive government budget cuts in the midst of the worst recession since World War II.
I am not alone.
Only about one-third of Republicans (http://firstread.msnbc.msn.com/_news/2011/03/03/6179186-first-thoughts-chased-by-a-tiger) agree that cutting government spending should be the country's top priority. Only about one-quarter of Republicans (http://www.gallup.com/poll/148472/Deficit-Americans-Prefer-Spending-Cuts-Open-Tax-Hikes.aspx) insist the budget be balanced without any tax increases.
Yet that one-third and that one-quarter have come to dominate my party. That one-third and that one-quarter forced a debt standoff that could have ended in default and a second Great Recession. That one-third and that one-quarter have effectively written the "no new taxes pledge" into national law.
There was another way. There still is.
Give me a hammer and a church-house door, and I'd post these theses for modern Republicans:
1) Unemployment is a more urgent problem than debt.
The U.S. can borrow money for 10 years at less than 3%. It can borrow money for two years at less than one-half a percent. Yes, the burden of debt is worrying. Yet lenders seem undaunted by those worries.
Meanwhile, more than 14 million Americans (http://www.bls.gov/news.release/empsit.nr0.htm) are out of work, more than 6 million for longer than six months. The United States has not seen so many people out of work for so long since the 1930s.
2) The deficit is a symptom of America's economic problems, not a cause.
When the economy slumps, government revenues decline and government spending surges.
Federal revenues have collapsed since 2007, down from more than 18% of national income to a little more than 14%. To put that in perspective: That's the equivalent of losing enough revenue to support the entire defense budget.
Federal spending has jumped to pay for unemployment insurance, food stamps and Medicaid benefits.
Fix the economy first, and the deficit will improve on its own.
Cut the deficit first, and the economy will get even sicker.
3) The time to cut is after the economy recovers.
Businesses are hoarding cash. Consumers are repaying debt. State and local governments are slashing jobs. (Since 2009, the number of Americans working for government has shrunk by half a million, the biggest reduction in civilian government employment since the Great Depression.) Right now, there's only one big customer out there: the federal government. How does it help anybody if the feds suddenly stop buying things and paying people?
4) The place to cut is health care, not assistance to the unemployed and poor.
The United States provides less assistance to the unemployed and the poor than almost any other democracy. It spends 60% more per person on health care than almost any other democracy -- and gets worse results. The problem is not that Americans use too much medicine. People in other countries use more. The problem is that Americans pay too much for the medicine they use. Go where the money is, cut where the waste is grossest.
5) We can collect more revenue without raising tax rates.
Republicans stand for low taxes to encourage people to work, save and invest. But how would it discourage work if we reduced the mortgage-interest deduction again? Did it hurt the economy when we reduced the maximum eligible loan to $1 million back in 1986? Do Canadians and Brits -- who lack the deduction -- work less hard than Americans?
Why are state and local taxes deductible from federally taxable income? Wouldn't higher taxes on energy encourage conservation? Who decided to allow inflation to corrode federal alcohol taxes by 80% over the past 50 years? (http://www.cspinet.org/alcohol/taxes.html)
6) Passion does not substitute for judgment.
Republicans and conservatives have worked themselves into a frenzy of rage and contempt for President Barack Obama. House Speaker John Boehner's post-deal PowerPoint for Republican House members was actually labeled "Two Step Approach to Hold President Obama Accountable" (PDF) (http://www.speaker.gov/UploadedFiles/3-7-31-11-Debt-Framework-Boehner.pdf) -- as if the supreme goal of policy in this time of economic hardship were to fix the blame for all problems on the president. This exercise in finger-pointing satisfies the emotions of the Republican base. It does not accurately explain the causes of the crisis or offer plausible remedies.
7) You can't save the system by destroying the system.
In their passion, Republicans convinced themselves that the constitutional republic and the free-enterprise system were threatened as never before. Their response? To threaten to blow up the free-enterprise system and wreck the republic unless they gained their point.
Republicans have become so gripped by pessimism and panic that they feel they have nothing to lose by rushing into a catastrophe now. But there is a lot to lose, and in these past weeks America nearly lost it. Let's hope that as America steps back from the brink, Republicans remember that it's their job to protect the system, not to smash the system in hopes of building something better from the ruins.
That's how student radicals think -- not conservatives.
The opinions expressed in this commentary are solely those of David Frum.
The Tea Baggers have a point, but they are making the same mistake the MoveOn crowd did about the war in Iraq. Sadly (in respects to the current situation, obviously not in respects to the moveon crowd), the moveon crowd was actually less successful - could that be because the Dems in general are a less cohesive party, and hence less beholden to their nutjobs? An interesting theory - the Dems tend to not be able to get as much done because they lack that loyalty, but at the same time seem less susceptible to being dragged much further into the extremes than the Republicans.
I *like* David Frum, but I question this piece from it's very first two sentences. Always been a Republican - was that when you were still a Canadian David?
Beyond that, as a right wing Republican, what exactly does he suggest to do about #2? How do you "fix the economy"? Typical right wing thought is that governments can not simple push a button and create jobs - that it is only by setting out the right stable, predictable and low-cost environment that businesses can then create jobs.
Beyond that, I like that he actually says America provides less assistance to the poor than anywhere else - so don't cut there.
But as his own seven thesis, they are mostly listing what he is opposed to, not what he would do, and are generally lacking.
Yeah I can't say I'm a fan of this.
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
Yep. Anytime a politician or a political operative talks about 'waste', you know that it's all horseshit.
Horseshit isn't waste.
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
Meh, that is details. His basic point is that the radical nutbars need to realize that tossing the baby out with the bathwater isn't going to help anything, least of all themselves.
Quote from: Berkut on August 01, 2011, 10:40:08 AM
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
Meh, that is details. His basic point is that the radical nutbars need to realize that tossing the baby out with the bathwater isn't going to help anything, least of all themselves.
I don't know. Aren't the tea party et al. just doing what they said they'd do?
Quote from: The Brain on August 01, 2011, 10:37:39 AM
Horseshit isn't waste.
It is as far as the horse is concerned.
Quote from: Faeelin on August 01, 2011, 10:41:18 AM
Quote from: Berkut on August 01, 2011, 10:40:08 AM
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
Meh, that is details. His basic point is that the radical nutbars need to realize that tossing the baby out with the bathwater isn't going to help anything, least of all themselves.
I don't know. Aren't the tea party et al. just doing what they said they'd do?
In a general sense, yes. But IMO agreeing to a compromise on this particular issue does not necessarily conflict with what they said they'd do, either (as long as there are no real tax increases).
I generally support the tea party movement but the reality is that the GOP only controls half a branch. Better to win some small victories & build its case for the 2012 elections than to insist on everything & get nothing.
Quote from: derspiess on August 01, 2011, 10:57:48 AM
Quote from: Faeelin on August 01, 2011, 10:41:18 AM
Quote from: Berkut on August 01, 2011, 10:40:08 AM
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
Meh, that is details. His basic point is that the radical nutbars need to realize that tossing the baby out with the bathwater isn't going to help anything, least of all themselves.
I don't know. Aren't the tea party et al. just doing what they said they'd do?
In a general sense, yes. But IMO agreeing to a compromise on this particular issue does not necessarily conflict with what they said they'd do, either (as long as there are no real tax increases).
I generally support the tea party movement but the reality is that the GOP only controls half a branch. Better to win some small victories & build its case for the 2012 elections than to insist on everything & get nothing.
Or more to the point is that even when you are elected on a bunch of BS rhetoric about not compromising, the reality is that politics is the art of the possible, and bringing down the government rather than compromising is missing the point of the entire process.
Which really means that it sucks that a few hard core extremists have so much influence.
Quote from: derspiess on August 01, 2011, 10:57:48 AM
In a general sense, yes. But IMO agreeing to a compromise on this particular issue does not necessarily conflict with what they said they'd do, either (as long as there are no real tax increases).
But then the GOP won by not blinking, right?
Spicy--do you mind if they don't count the expiring Bush tax cuts as a tax increase?
Quote from: Barrister on August 01, 2011, 10:07:05 AM
I *like* David Frum, but I question this piece from it's very first two sentences. Always been a Republican - was that when you were still a Canadian David?
Beyond that, as a right wing Republican, what exactly does he suggest to do about #2? How do you "fix the economy"? Typical right wing thought is that governments can not simple push a button and create jobs - that it is only by setting out the right stable, predictable and low-cost environment that businesses can then create jobs.
Beyond that, I like that he actually says America provides less assistance to the poor than anywhere else - so don't cut there.
But as his own seven thesis, they are mostly listing what he is opposed to, not what he would do, and are generally lacking.
I thought his key points were that a) you're going to have to raise taxes at some point, and to pretend otherwise is foolish and b) massive austerity measures in the midst of a recession are lunacy, particularly when the US (previous to this fiscal brinkmanship, at least) was still considered a safe bet for investors looking to buy government debt.
Maybe I got it wrong from my skim read, but neither of those seem unreasonable.
Quote from: Faeelin on August 01, 2011, 11:06:08 AM
Quote from: derspiess on August 01, 2011, 10:57:48 AM
In a general sense, yes. But IMO agreeing to a compromise on this particular issue does not necessarily conflict with what they said they'd do, either (as long as there are no real tax increases).
But then the GOP won by not blinking, right?
I honestly don't know who won.
Quote from: MadImmortalMan on August 01, 2011, 11:06:47 AM
Spicy--do you mind if they don't count the expiring Bush tax cuts as a tax increase?
That depends on whether not they're certain to expire. We may not know that until December 2012.
Quote from: Warspite on August 01, 2011, 11:18:54 AM
I thought his key points were that a) you're going to have to raise taxes at some point, and to pretend otherwise is foolish and b) massive austerity measures in the midst of a recession are lunacy, particularly when the US (previous to this fiscal brinkmanship, at least) was still considered a safe bet for investors looking to buy government debt.
Maybe I got it wrong from my skim read, but neither of those seem unreasonable.
I don't see anything unreasonable about those two points. However, I think he was foolish to mention all these different items and details leaving easy (and reasonable) avenue of attacks.
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
:bleeding:
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices.
Really?
I was under the impression that marketing costs are a bigger factor than research when it comes to expenses in bringing pharmaceuticals to the US market.
Not entirely sure, though. In any case, the whole "Americans pay for the research and everyone else free rides" thing is mentioned with frequency in some circles, but I've never seen any sort of numbers to back it up. Do you have anything readily available?
Quote from: Jacob on August 01, 2011, 12:25:09 PM
I was under the impression that marketing costs are a bigger factor than research when it comes to expenses in bringing pharmaceuticals to the US market.
You can't separate the two. Marketing costs are a function of having a private, competitive, profit-seeking drugs sector. A company is only going to spend on marketing if every $1 of spend gives more than $1 of return. So it is all part of the same cost - if we want to take advantage of private-sector research efforts, then marketing costs are part of the overall resource expenditure that produces those results.
That said, from the EFPIA, it would appear that total pharma R&D spending approaches $100 billion. US marketing is not that high.
QuoteNot entirely sure, though. In any case, the whole "Americans pay for the research and everyone else free rides" thing is mentioned with frequency in some circles, but I've never seen any sort of numbers to back it up. Do you have anything readily available?
According to EFPIA, 42.3% of total pharma sales takes place in the US; the figure rises to 61% when new medicines are considered. In addition, these figures, which relate to gross slaes, don't take into account that the higher margins for US sales supply an even greater proportion of the profit used to fund R&D.
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
other countries may subsidize their health care industry and offer generous fiscal incentives for R&D. They ain't just leeching.
Quote from: garbon on August 01, 2011, 11:44:09 AM
Quote from: Warspite on August 01, 2011, 11:18:54 AM
I thought his key points were that a) you're going to have to raise taxes at some point, and to pretend otherwise is foolish and b) massive austerity measures in the midst of a recession are lunacy, particularly when the US (previous to this fiscal brinkmanship, at least) was still considered a safe bet for investors looking to buy government debt.
Maybe I got it wrong from my skim read, but neither of those seem unreasonable.
I don't see anything unreasonable about those two points. However, I think he was foolish to mention all these different items and details leaving easy (and reasonable) avenue of attacks.
Dude's probably getting paid by the word.
Quote from: Berkut on August 01, 2011, 10:00:12 AM
Sadly (in respects to the current situation, obviously not in respects to the moveon crowd), the moveon crowd was actually less successful - could that be because the Dems in general are a less cohesive party, and hence less beholden to their nutjobs? An interesting theory - the Dems tend to not be able to get as much done because they lack that loyalty, but at the same time seem less susceptible to being dragged much further into the extremes than the Republicans.
This has long been my theory. The Republicans are a movement with a party, the Democrats are a coalition. That makes Republicans more coherent, more likely to achieve their goals but also more likely to prize purity over pragmatism and more likely to occassionally blood-let. While I think the Democrats are more likely to compromise, fragment, internally bitch up to the point where they have to wield the knife. I think the MoveOn crowd want the Democrats to be like the Republicans, but I've always thought people here overstate their influence to a huge degree.
It could happen too.
Quote from: Sheilbh on August 01, 2011, 02:49:01 PM
Quote from: Berkut on August 01, 2011, 10:00:12 AM
Sadly (in respects to the current situation, obviously not in respects to the moveon crowd), the moveon crowd was actually less successful - could that be because the Dems in general are a less cohesive party, and hence less beholden to their nutjobs? An interesting theory - the Dems tend to not be able to get as much done because they lack that loyalty, but at the same time seem less susceptible to being dragged much further into the extremes than the Republicans.
This has long been my theory. The Republicans are a movement with a party, the Democrats are a coalition. That makes Republicans more coherent, more likely to achieve their goals but also more likely to prize purity over pragmatism and more likely to occassionally blood-let. While I think the Democrats are more likely to compromise, fragment, internally bitch up to the point where they have to wield the knife.
I think that there's some truth to that, and I that it largely stems from the fact that the Republican party was the opposition party for almost the entire period from 1933-1981, and still in many ways thinks of itself as the opposition party.
Quote from: The Minsky Moment on August 01, 2011, 12:54:23 PM
Quote from: Jacob on August 01, 2011, 12:25:09 PM
I was under the impression that marketing costs are a bigger factor than research when it comes to expenses in bringing pharmaceuticals to the US market.
You can't separate the two. Marketing costs are a function of having a private, competitive, profit-seeking drugs sector. A company is only going to spend on marketing if every $1 of spend gives more than $1 of return. So it is all part of the same cost - if we want to take advantage of private-sector research efforts, then marketing costs are part of the overall resource expenditure that produces those results.
That said, from the EFPIA, it would appear that total pharma R&D spending approaches $100 billion. US marketing is not that high.
QuoteNot entirely sure, though. In any case, the whole "Americans pay for the research and everyone else free rides" thing is mentioned with frequency in some circles, but I've never seen any sort of numbers to back it up. Do you have anything readily available?
According to EFPIA, 42.3% of total pharma sales takes place in the US; the figure rises to 61% when new medicines are considered. In addition, these figures, which relate to gross slaes, don't take into account that the higher margins for US sales supply an even greater proportion of the profit used to fund R&D.
The problem with the US system is that drug companies are indifferent to whether their dollars are earned from (1) inventing new cures to benefit all of humanity, or (2) evergreening existing patents, advertising directly to consumers, and paying docs in various ways to prescribe their products, through "phase 4" trials and the like.
The point being that drug research by private companies is perhaps not the most efficient method: for various reasons having to do with the absolutes of life and death, medicine and medical care are not well suited to pure capitalism. Americans are not being well-served by their system, and the fault is not that of other countries.
Take direct-to-consumer advertisement for prescription drugs. What point does it serve? I can think of two, neither of them good: it can get patients to put pressure on docs to prescribe certain drugs - leading to over-medication; or it can get patients to prefer one drug over another for the same condition where either drug would be as good - leading to a pointless consuming of resources beggar-thy-neighbour style.
More to the point, if you are actually ill and really need a drug to survive, what would the market bear? All that you have, of course, since most would rather give up their money than die.
Quote from: Malthus on August 01, 2011, 05:34:09 PMthe US system
You are being very generous about our organizational skills.
Quote from: Malthus on August 01, 2011, 05:44:15 PM
Take direct-to-consumer advertisement for prescription drugs. What point does it serve? I can think of two, neither of them good: it can get patients to put pressure on docs to prescribe certain drugs - leading to over-medication; or it can get patients to prefer one drug over another for the same condition where either drug would be as good - leading to a pointless consuming of resources beggar-thy-neighbour style.
I can think of a positive one - it gets patients involved in their treatment. Hearing about drugs, you can then research them and become an informed consumer. Nothing worse than slavishly following what your MD prescribes. So many cranks and/or overworked docs out there.
Case in point: It really depressed me when I was doing in-person interviews about rheumatoid arthritis in Europe. Many of the patients would talk about wanting specific delivery methods for their medication, that were often available (even for the same drug they were taking) but their physician never told them about the wealth of options.
Quote from: Malthus on August 01, 2011, 05:34:09 PM
The problem with the US system is that drug companies are indifferent to whether their dollars are earned from (1) inventing new cures to benefit all of humanity, or (2) evergreening existing patents, advertising directly to consumers, and paying docs in various ways to prescribe their products, through "phase 4" trials and the like.
I've no idea as to the accuracy, but I thought this was interesting: http://www.foundersfund.com/uploads/ff_manifesto.pdf
See page 4.
Quote from: garbon on August 01, 2011, 06:06:40 PM
Quote from: Malthus on August 01, 2011, 05:44:15 PM
Take direct-to-consumer advertisement for prescription drugs. What point does it serve? I can think of two, neither of them good: it can get patients to put pressure on docs to prescribe certain drugs - leading to over-medication; or it can get patients to prefer one drug over another for the same condition where either drug would be as good - leading to a pointless consuming of resources beggar-thy-neighbour style.
I can think of a positive one - it gets patients involved in their treatment. Hearing about drugs, you can then research them and become an informed consumer. Nothing worse than slavishly following what your MD prescribes. So many cranks and/or overworked docs out there.
Case in point: It really depressed me when I was doing in-person interviews about rheumatoid arthritis in Europe. Many of the patients would talk about wanting specific delivery methods for their medication, that were often available (even for the same drug they were taking) but their physician never told them about the wealth of options.
I could think of things worse. For instance, self medicating.
True.
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
Usually your posts are too long and boring for me to give too much of a shit about but I've always echoed these sentiments, some years ago I had a debate here with Malthus about it and he in his faggot Canadian lawyer way essentially argued that no such thing was true.
Quote from: Malthus on August 01, 2011, 05:34:09 PM
The problem with the US system is that drug companies are indifferent to whether their dollars are earned from (1) inventing new cures to benefit all of humanity, or (2) evergreening existing patents, advertising directly to consumers, and paying docs in various ways to prescribe their products, through "phase 4" trials and the like.
Right, that's why all the major HIV drugs, cholesterol medications and blood pressure medications come from Canadian pharmaceutical companies. The failed US system obviously cannot compete with the overly regulated Canadian market.
Just face it, Canada is a small, 30m large market that is only able to negotiate with big pharma because they would have easy supply of generic forms of the drug from U.S. generics companies if they revoked big pharma's patents. For 90% of the world and all of Africa that option isn't on the table, and if that option was on the table for America no one would have these drugs at all.
Quote from: garbon on August 01, 2011, 06:06:40 PM
Quote from: Malthus on August 01, 2011, 05:44:15 PM
Take direct-to-consumer advertisement for prescription drugs. What point does it serve? I can think of two, neither of them good: it can get patients to put pressure on docs to prescribe certain drugs - leading to over-medication; or it can get patients to prefer one drug over another for the same condition where either drug would be as good - leading to a pointless consuming of resources beggar-thy-neighbour style.
I can think of a positive one - it gets patients involved in their treatment. Hearing about drugs, you can then research them and become an informed consumer. Nothing worse than slavishly following what your MD prescribes. So many cranks and/or overworked docs out there.
Patients don't need to be involved in their treatments in 99% of cases.
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
You could also reform your tort law and place "actual financial loss" cap on damages for medical errors (excepting stuff like wilful misconduct) and do away with "moral damage" claims. But I can see why you would find this option unmentionable, counsellor. ;)
Quote from: Razgovory on August 01, 2011, 06:57:01 PM
I could think of things worse. For instance, self medicating.
What if you are listening to your body?
Quote from: Martinus on August 02, 2011, 04:06:43 AM
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
You could also reform your tort law and place "actual financial loss" cap on damages for medical errors (excepting stuff like wilful misconduct) and do away with "moral damage" claims. But I can see why you would find this option unmentionable, counsellor. ;)
That's already happened in several States, where you are now seeing caps of $250,000 - $500,000 for medical malpractice claims.
Quote from: Martinus on August 02, 2011, 04:08:35 AM
Quote from: Razgovory on August 01, 2011, 06:57:01 PM
I could think of things worse. For instance, self medicating.
What if you are listening to your body?
How? Voices in your body coming through on the radio?
Quote from: Zoupa on August 02, 2011, 12:36:30 AM
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.
Quote from: garbon on August 01, 2011, 06:06:40 PM
Quote from: Malthus on August 01, 2011, 05:44:15 PM
Take direct-to-consumer advertisement for prescription drugs. What point does it serve? I can think of two, neither of them good: it can get patients to put pressure on docs to prescribe certain drugs - leading to over-medication; or it can get patients to prefer one drug over another for the same condition where either drug would be as good - leading to a pointless consuming of resources beggar-thy-neighbour style.
I can think of a positive one - it gets patients involved in their treatment. Hearing about drugs, you can then research them and become an informed consumer. Nothing worse than slavishly following what your MD prescribes. So many cranks and/or overworked docs out there.
Case in point: It really depressed me when I was doing in-person interviews about rheumatoid arthritis in Europe. Many of the patients would talk about wanting specific delivery methods for their medication, that were often available (even for the same drug they were taking) but their physician never told them about the wealth of options.
It's a valid but minor point.
Any patient not involved in his treatment is a total moron. Even a good doctor will not have the time to tell you everything there is to know about your illness. That's where associations come really handy. Ours organizes regular meetings with specialists for that very purpose. And you can always take a look at the Web. I've read about quite a few studies and listened to very good broadcasts.
BTW, I went for pen instead of IV drip for the kind of medication you are probably talking about. I'd rather be elsewhere than wasting a few hours at the hospital every two weeks.
Quote from: OttoVonBismarck on August 01, 2011, 10:37:46 PM
Quote from: Malthus on August 01, 2011, 05:34:09 PM
The problem with the US system is that drug companies are indifferent to whether their dollars are earned from (1) inventing new cures to benefit all of humanity, or (2) evergreening existing patents, advertising directly to consumers, and paying docs in various ways to prescribe their products, through "phase 4" trials and the like.
Right, that's why all the major HIV drugs, cholesterol medications and blood pressure medications come from Canadian pharmaceutical companies. The failed US system obviously cannot compete with the overly regulated Canadian market.
Just face it, Canada is a small, 30m large market that is only able to negotiate with big pharma because they would have easy supply of generic forms of the drug from U.S. generics companies if they revoked big pharma's patents. For 90% of the world and all of Africa that option isn't on the table, and if that option was on the table for America no one would have these drugs at all.
Sure, Canada is a small market. That would of course be true no matter what system Canada adopted.
Though the Canadian public research system has historically punched above its weight in terms of biotech discoveries. Case in point: insulin.
You guys keep discounting the importance of public research, and inflate the importance of private research. Fact is, much of private "research" is of dubious worth, aimed as much at prolonging patent monopoly by developing "me too" products than at discovering fantastic new breakthroughs, or at essentially selling existing product through the fiction of "phase 4" trials.
The reason is quite simple: actual breakthroughs are rare and unpredictable creatures, best deveoped by pure science, which is unpredictable. Think of the discovery of DNA - what company would have the patience to fund pure speculation?
Obviously, tyhere is a role for private research, but the notion that Americans (or anyone) has to pay absurdly inflated drug prices to fund it, and that the whole world is beholden to Americans selflessly paying, is a mirage. I can understand why this mythology would ease the pain of being had by the drug companies, but there is no reason for intelligent peopole to buy into it.
Quote from: garbon on August 01, 2011, 06:06:40 PM
Quote from: Malthus on August 01, 2011, 05:44:15 PM
Take direct-to-consumer advertisement for prescription drugs. What point does it serve? I can think of two, neither of them good: it can get patients to put pressure on docs to prescribe certain drugs - leading to over-medication; or it can get patients to prefer one drug over another for the same condition where either drug would be as good - leading to a pointless consuming of resources beggar-thy-neighbour style.
I can think of a positive one - it gets patients involved in their treatment. Hearing about drugs, you can then research them and become an informed consumer. Nothing worse than slavishly following what your MD prescribes. So many cranks and/or overworked docs out there.
Case in point: It really depressed me when I was doing in-person interviews about rheumatoid arthritis in Europe. Many of the patients would talk about wanting specific delivery methods for their medication, that were often available (even for the same drug they were taking) but their physician never told them about the wealth of options.
This is probably true to an extent; but advertising is probably not the best or even the major source for patient involvement these days - there are tons of resources on the 'net.
The reality is that companies advertise because it sells their products. In the case of prescription drugs, this can only come about as a result of patients pressuring physicians to prescribe where they would not otherwise - meaning over-medication, or switching from one brand to another. Resources devoted to over-medication or brand-switching are essentially resources thrown away in terms of public benefit; drug companies can charge less in jurisdictions with strict advertising controlls and still make a profit, in part because they do not carry the cost of this type of competition among themselves.
It is the problem of having a competitive system with a "learned intermediary" who is supposed to actually make the decision.
Quote from: Malthus on August 02, 2011, 08:23:45 AM
Obviously, tyhere is a role for private research, but the notion that Americans (or anyone) has to pay absurdly inflated drug prices to fund it, and that the whole world is beholden to Americans selflessly paying, is a mirage. I can understand why this mythology would ease the pain of being had by the drug companies, but there is no reason for intelligent peopole to buy into it.
Are you arriving at this conclusion based on the evidence, such as an examination of pharmaceutical volumes sold in Canada that were researched using private vs. public funds, or from first principles?
Quote from: Iormlund on August 02, 2011, 08:10:04 AM
It's a valid but minor point.
Any patient not involved in his treatment is a total moron. Even a good doctor will not have the time to tell you everything there is to know about your illness. That's where associations come really handy. Ours organizes regular meetings with specialists for that very purpose. And you can always take a look at the Web. I've read about quite a few studies and listened to very good broadcasts.
BTW, I went for pen instead of IV drip for the kind of medication you are probably talking about. I'd rather be elsewhere than wasting a few hours at the hospital every two weeks.
I don't think it is a minor point. We did hear a lot about education from the associations in Spain, but really on both large quals that I did, the "ignorance" of European patients about their options was rather vivid in contrast to the interview American patients. Especially in France where a great many patients stated that they trusted their doctor and that they would feel bad if they tried to second guess him - after all they hadn't gone to medical school. And that wasn't just old folk.
Quote from: Malthus on August 02, 2011, 08:30:37 AM
This is probably true to an extent; but advertising is probably not the best or even the major source for patient involvement these days - there are tons of resources on the 'net.
The reality is that companies advertise because it sells their products. In the case of prescription drugs, this can only come about as a result of patients pressuring physicians to prescribe where they would not otherwise - meaning over-medication, or switching from one brand to another. Resources devoted to over-medication or brand-switching are essentially resources thrown away in terms of public benefit; drug companies can charge less in jurisdictions with strict advertising controlls and still make a profit, in part because they do not carry the cost of this type of competition among themselves.
It is the problem of having a competitive system with a "learned intermediary" who is supposed to actually make the decision.
Obviously that is why anyone advertises - that doesn't mean that their can't be secondary benefits. You might not be inclined to look certain things up if you don't know they exist.
Besides, how exciting is DTC advertising? It typically shows some happy individual enjoying life, the product name, a long scary list of side effects and then often nary a mention of what the product is actually for. Seems a bit overblown to suggest that those ads cause physicians to beat down their physicians until they give them what they saw in the advertisement.
The main place where I've seen somewhat compelling and detailed DTC ads are the patient brochures that pharma companies leave with physicians for their patients. My physician handed me the "ads". :lol:
Quote from: Admiral Yi on August 02, 2011, 08:35:56 AM
Quote from: Malthus on August 02, 2011, 08:23:45 AM
Obviously, tyhere is a role for private research, but the notion that Americans (or anyone) has to pay absurdly inflated drug prices to fund it, and that the whole world is beholden to Americans selflessly paying, is a mirage. I can understand why this mythology would ease the pain of being had by the drug companies, but there is no reason for intelligent peopole to buy into it.
Are you arriving at this conclusion based on the evidence, such as an examination of pharmaceutical volumes sold in Canada that were researched using private vs. public funds, or from first principles?
I'd welcome solid evidence in terms of numbers either way. The problem is that such numbers are hard to get. The reason is that drug companies lump spending to 'research' that is really better termed 'product promotion and patent prolongation'.
What I know, is the use that drug companies make of research money - because that's part of what I do, business-wise; I know the situation here in Canada and in the US.
I can explain how it works but obviously I can't put actual numbers to it, without doing a study.
Hell, you still see that here in the US.
My wifes sister was diagnosed recently with breast cancer. Her doctor sent her to a specialist of course, who decided she needed surgery. Which is fine, I am sure the specialist knows what they are doing.
However, my wife's mom had also had breast cancer, and it happens that she was and is being treated at the best cancer treatment hospital in the region, and happens to have one of the leading experts in breast cancer treatment as her doctor. Normally this guy is nearly impossible to see - he is the best, after all. Well, since he treated her mother, he would be willing to consult with the sister and go over her options.
Sister actually refused to get this second opinion at first, because she thought it might be kind of rude to her first doctor. WTF? You are dealing with a potentially deadly disease, and you are worried about being rude to your doctor by consulting with someone who is the acknowledged best in their field? My wife told her she was being ridiculous and it would be foolish to not at least see what super-doc has to say about her options and her current doctors treatment plan. So she is going to see him in a couple days.
But it is rather odd how ingrained it is in many people to NOT question their doctors.
Quote from: garbon on August 02, 2011, 08:49:06 AM
Quote from: Malthus on August 02, 2011, 08:30:37 AM
This is probably true to an extent; but advertising is probably not the best or even the major source for patient involvement these days - there are tons of resources on the 'net.
The reality is that companies advertise because it sells their products. In the case of prescription drugs, this can only come about as a result of patients pressuring physicians to prescribe where they would not otherwise - meaning over-medication, or switching from one brand to another. Resources devoted to over-medication or brand-switching are essentially resources thrown away in terms of public benefit; drug companies can charge less in jurisdictions with strict advertising controlls and still make a profit, in part because they do not carry the cost of this type of competition among themselves.
It is the problem of having a competitive system with a "learned intermediary" who is supposed to actually make the decision.
Obviously that is why anyone advertises - that doesn't mean that their can't be secondary benefits. You might not be inclined to look certain things up if you don't know they exist.
Besides, how exciting is DTC advertising? It typically shows some happy individual enjoying life, the product name, a long scary list of side effects and then often nary a mention of what the product is actually for. Seems a bit overblown to suggest that those ads cause physicians to beat down their physicians until they give them what they saw in the advertisement.
How exciting? Obviously, exciting enough to spend millions of dollars on it. Companies don't pay for ads that don't work - and the *only* way these ads work, is in ways that are not condusive to the good of the public.
I would not deny that there are secondary benefits. But they are not the reason for the ads.
Quote from: Malthus on August 02, 2011, 08:53:24 AM
How exciting? Obviously, exciting enough to spend millions of dollars on it. Companies don't pay for ads that don't work - and the *only* way these ads work, is in ways that are not condusive to the good of the public.
I would not deny that there are secondary benefits. But they are not the reason for the ads.
Certainly but then are the doctors folding because their patients threaten to leave or because medication y isn't so different from medication x and so if the patient expresses a preference, why not try it? After all when I first when on depression meds, I was given a few choices. I eventually fought for Lexapro after the provided choices, at different physicians, proved insufficient.
Secondly, who cares why they are doing it if they are doing it? Biotech companies don't produce new drugs mainly for the reason of helping humanity - they want to make a profit. Nevertheless I'm really happy that they do, as there are "secondary benefits."
Relevant ppt posted on the FDA's site. Although sadly yes, it cites research more than a decade old. :P
www.fda.gov/downloads/AboutFDA/CentersOffices/CDER/ucm095993.ppt
Quote from: Malthus on August 02, 2011, 08:49:50 AM
I'd welcome solid evidence in terms of numbers either way. The problem is that such numbers are hard to get. The reason is that drug companies lump spending to 'research' that is really better termed 'product promotion and patent prolongation'.
What I know, is the use that drug companies make of research money - because that's part of what I do, business-wise; I know the situation here in Canada and in the US.
I can explain how it works but obviously I can't put actual numbers to it, without doing a study.
You're talking as if demonstrating that pharmaceutical companies spend money on aspects of business promotion that are not directly tied to researching new drugs demonstrates the ROTW is not free riding on US R&D. It does not. In order to prove your assertion you would need to show that (most? all?) of the drugs people are consuming around the world were developed in a "system" other than the one which relies on charging US customers monopoly prices to amortize private research costs.
Quote from: Martinus on August 02, 2011, 04:06:43 AM
You could also reform your tort law and place "actual financial loss" cap on damages for medical errors (excepting stuff like wilful misconduct) and do away with "moral damage" claims. But I can see why you would find this option unmentionable, counsellor. ;)
Many states are doing this now. But then you run into the problem of caring for someone who is totally disabled by medical malpractice. Those damages fall under 'non-economic damages', and are thus capped. When you're dealing with the costs of caring for, say, a severely retarded child for the rest of their life, the caps are often somewhat inadequate.
:hmm: Let me hazard a guess. Minksy has clients in the pharmaceutical industry. Malthus does not.
Quote from: Martinus on August 02, 2011, 04:06:43 AM
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
You could also reform your tort law and place "actual financial loss" cap on damages for medical errors (excepting stuff like wilful misconduct) and do away with "moral damage" claims. But I can see why you would find this option unmentionable, counsellor. ;)
In this country, "moral damage" claims are fairly small.
Where you get to exorbitant damage awards are where you can spin up a huge "actual financial loss" claim. Loss of future earnings is usually the biggest one - imagine what an injured child might earn over the course of their entire lifetime, adjusted for inflation, and you'll see what I mean.
Quote from: Barrister on August 02, 2011, 09:34:07 AM
Quote from: Martinus on August 02, 2011, 04:06:43 AM
Quote from: The Minsky Moment on August 01, 2011, 10:28:11 AM
Other countries control health care costs by putting price controls on pharmaceuticals. Then they free ride on the research and development that gets done out of the profits earned on the back of the US consumers who pay (relatively) uncontrolled prices. Frum buries this and instead talks about unspecified "waste" which sets off the automatic B.S. alarm.
You could also reform your tort law and place "actual financial loss" cap on damages for medical errors (excepting stuff like wilful misconduct) and do away with "moral damage" claims. But I can see why you would find this option unmentionable, counsellor. ;)
In this country, "moral damage" claims are fairly small.
Where you get to exorbitant damage awards are where you can spin up a huge "actual financial loss" claim. Loss of future earnings is usually the biggest one - imagine what an injured child might earn over the course of their entire lifetime, adjusted for inflation, and you'll see what I mean.
Under Polish law, you only count future earnings based on actual, not hypothetical, income and qualifications prior to the accident. So a child would probably not qualify for anything.
The way it works, you usually get the following costs:
- costs of medical treatment,
- costs of ongoing medical care/treatment, and
- "decrease in quality of life" (which involves some element of lost income, but to a limited degree only and is more about giving you money necessary to survive at an average level to the extent you are unable to make money on your own).
What I guess also differs under Polish law is that, as a rule, you are given a pension/period payment rather than a lump sum on anything that is not an immediate out of pocket expense.
Quote from: Admiral Yi on August 02, 2011, 09:05:35 AM
Quote from: Malthus on August 02, 2011, 08:49:50 AM
I'd welcome solid evidence in terms of numbers either way. The problem is that such numbers are hard to get. The reason is that drug companies lump spending to 'research' that is really better termed 'product promotion and patent prolongation'.
What I know, is the use that drug companies make of research money - because that's part of what I do, business-wise; I know the situation here in Canada and in the US.
I can explain how it works but obviously I can't put actual numbers to it, without doing a study.
You're talking as if demonstrating that pharmaceutical companies spend money on aspects of business promotion that are not directly tied to researching new drugs demonstrates the ROTW is not free riding on US R&D. It does not. In order to prove your assertion you would need to show that (most? all?) of the drugs people are consuming around the world were developed in a "system" other than the one which relies on charging US customers monopoly prices to amortize private research costs.
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.
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?
Quote from: DGuller on August 02, 2011, 09:24:34 AM
:hmm: Let me hazard a guess. Minksy has clients in the pharmaceutical industry. Malthus does not.
I dunno who Minsky's clients are, but I do a lot of work for the pharma industry. Innovative-side, not generic-side.
The US is still piggybacking on German medical research in the 1933-45 era.
Quote from: The Brain on August 02, 2011, 09:56:36 AM
The US is still piggybacking on German medical research in the 1933-45 era.
:D
Quote from: Malthus on August 02, 2011, 09:51:36 AM
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.
Quote from: Malthus on August 02, 2011, 09:51:36 AM
- 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).
Quote from: Martinus on August 02, 2011, 09:53:24 AM
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.
Quote from: Admiral Yi on August 02, 2011, 09:57:06 AM
Quote from: Malthus on August 02, 2011, 09:51:36 AM
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.
Quote from: The Brain on August 02, 2011, 09:56:36 AM
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.
Quote from: Martinus on August 02, 2011, 09:53:24 AM
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.
Quote from: ulmont on August 02, 2011, 09:58:43 AM
Quote from: Malthus on August 02, 2011, 09:51:36 AM
- 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).
Quote from: Martinus on August 02, 2011, 09:53:24 AM
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.
Quote from: DGuller on August 02, 2011, 09:24:34 AM
:hmm: 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.
Quote from: Admiral Yi on August 02, 2011, 09:57:06 AM
Quote from: Malthus on August 02, 2011, 09:51:36 AM
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.
Quote from: Neil on August 02, 2011, 10:09:01 AM
Quote from: DGuller on August 02, 2011, 09:24:34 AM
:hmm: 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.
Quote from: garbon on August 02, 2011, 07:36:42 AM
Quote from: Zoupa on August 02, 2011, 12:36:30 AM
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.
Quote from: Zoupa on August 02, 2011, 12:03:43 PM
Quote from: garbon on August 02, 2011, 07:36:42 AM
Quote from: Zoupa on August 02, 2011, 12:36:30 AM
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.
Quote from: Zoupa on August 02, 2011, 12:03:43 PM
Quote from: garbon on August 02, 2011, 07:36:42 AM
Quote from: Zoupa on August 02, 2011, 12:36:30 AM
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.
Quote from: garbon on August 02, 2011, 12:21:05 PM
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.
Quote from: garbon on August 02, 2011, 12:21:05 PM
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.
Quote from: Zoupa on August 02, 2011, 12:27:10 PM
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.
Quote from: Zoupa on August 02, 2011, 12:27:10 PMIn 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.
Quote from: Zoupa on August 02, 2011, 12:27:10 PMAnd 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.
:huh:
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.
Quote from: Zoupa on August 02, 2011, 12:27:10 PM
Quote from: garbon on August 02, 2011, 12:21:05 PM
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.
It's not just about mistakes however. As humans we want to put things into predictable patterns or categories, because doing so is more often than not correct. Usually you can tell almost the entire story about a person as soon as you look at them - but not always.
We had a ratehr unhappy trip to the ER last night. Nurse on shift started to tell my wife it was heartburn because they've seen a lot of cases of that recently. After we said "no, let us tell you some more" the now likely diagnosis is some form of gall bladder problem.
Quote from: Zoupa on August 02, 2011, 12:27:10 PM
Quote from: garbon on August 02, 2011, 12:21:05 PM
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.
I don't think of it so much as a matter of doctors making mistakes, but that there are a lot of different options about what treatment decisions are made, and doctors choose one way over another based on the training, experience, biases, etc., etc. A given option may not be wrong, but that doesn't necessarily mean it is the right choice for the patient. At the end of the day, it is the patient who has to choose what treatment they want, hopefully with the advice of their doctor about what the options are, the risks and benefits of each option, etc. etc.
Sometimes there is one "right" choice, but often there are several options, and the right option is based on factors the doctor may not even be aware of, or may very well weight very differently from the patient.
Quote from: Martinus on August 02, 2011, 04:06:43 AM
You could also reform your tort law and place "actual financial loss" cap on damages for medical errors (excepting stuff like wilful misconduct) and do away with "moral damage" claims. But I can see why you would find this option unmentionable, counsellor. ;)
Not so, i support that concept.
And the fact that I don't do any med mal work is just coincidental,
I'm not a doc, and from my perspective there is nothing wrong and much that is right about having patients be involved and aware in their own treatment.
But there are many ways to achieve this, and I don't think prescription drug DTC advertisng is necessary for it - particularly in the era of the Internet, when so much is so easily available without advertising.
Seems to me that the potential harm - of stirring up pressures for over-medication - outweigh the benefit of informing people and thus getting them involved in their own treatment.
Quote from: Malthus on August 02, 2011, 12:48:08 PM
I'm not a doc, and from my perspective there is nothing wrong and much that is right about having patients be involved and aware in their own treatment.
But there are many ways to achieve this, and I don't think prescription drug DTC advertisng is necessary for it - particularly in the era of the Internet, when so much is so easily available without advertising.
Seems to me that the potential harm - of stirring up pressures for over-medication - outweigh the benefit of informing people and thus getting them involved in their own treatment.
Not everyone uses the internet to look up meds and DTC med ads exist online as well. :P
Quote from: Malthus on August 02, 2011, 12:48:08 PM
I'm not a doc, and from my perspective there is nothing wrong and much that is right about having patients be involved and aware in their own treatment.
But there are many ways to achieve this, and I don't think prescription drug DTC advertisng is necessary for it - particularly in the era of the Internet, when so much is so easily available without advertising.
Seems to me that the potential harm - of stirring up pressures for over-medication - outweigh the benefit of informing people and thus getting them involved in their own treatment.
I may not be following this argument very well, but are you arguing that something should be done about medical prescription drug advertising, because convincing people they want to use a product might cause them to, uhh, want to use the product, and that could be bad for them?
Quote from: Malthus on August 01, 2011, 05:44:15 PM
The point being that drug research by private companies is perhaps not the most efficient method: for various reasons having to do with the absolutes of life and death, medicine and medical care are not well suited to pure capitalism. Americans are not being well-served by their system, and the fault is not that of other countries.
Drug research by private companies has resulted in many useful treatments. I agree that "pure capitalism" shouldn;t apply here, and it doesn't. There is a lot of research done in the US through the non-profit and public sectors. that's a good thing. There is value in being able to have research not subject to market pressures; OTOH there is also value in having research that is responsive to market needs and subject to makret discipline. There is place for both. Problem is that financing the private effort has to be done out of profits, and due to how health care systems operate in elsewhere, most of those profits have to be taken out of the US consumer. That isn't an attack on Canada or the Euro countries - they are doing what they think best for their own national interest.
Quote from: Berkut on August 02, 2011, 12:51:19 PM
Quote from: Malthus on August 02, 2011, 12:48:08 PM
I'm not a doc, and from my perspective there is nothing wrong and much that is right about having patients be involved and aware in their own treatment.
But there are many ways to achieve this, and I don't think prescription drug DTC advertisng is necessary for it - particularly in the era of the Internet, when so much is so easily available without advertising.
Seems to me that the potential harm - of stirring up pressures for over-medication - outweigh the benefit of informing people and thus getting them involved in their own treatment.
I may not be following this argument very well, but are you arguing that something should be done about medical prescription drug advertising, because convincing people they want to use a product might cause them to, uhh, want to use the product, and that could be bad for them?
Medication is not just any other product. Allowing advertisement for prescription medication is incredibly counterproductive.
Quote from: Berkut on August 02, 2011, 12:51:19 PM
Quote from: Malthus on August 02, 2011, 12:48:08 PM
I'm not a doc, and from my perspective there is nothing wrong and much that is right about having patients be involved and aware in their own treatment.
But there are many ways to achieve this, and I don't think prescription drug DTC advertisng is necessary for it - particularly in the era of the Internet, when so much is so easily available without advertising.
Seems to me that the potential harm - of stirring up pressures for over-medication - outweigh the benefit of informing people and thus getting them involved in their own treatment.
I may not be following this argument very well, but are you arguing that something should be done about medical prescription drug advertising, because convincing people they want to use a product might cause them to, uhh, want to use the product, and that could be bad for them?
To want to use the product when they don't, in fact, need to.
Put it this way: a consumer can't just go to the store and buy prescription meds when they want them. A prescription is necessary. Why is that? One reason is that such drugs are in fact somewhat dangerous and the risks of taking them are only justified if they are outweighed by the benefits - and only a trained professional can make that determination.
If a
phyiscian (or other HCP) is the only person who can prescribe a drug, why advertise to the
patient? There are two basic reasons:
1. So that the patient puts pressure on the doc to prescribe a drug (as opposed to doing nothing, or advocating a non-drug treatment). Docs are humans too, and if a patient really really wants something, they can sometimes be persuaded - even against professional judgment - to give it to them, particularly if the doing nothing/non drug option isn't *that* much better.
2. To get docs to prescribe brand X rather than brand Y.
Quote from: The Minsky Moment on August 02, 2011, 12:52:17 PM
Quote from: Malthus on August 01, 2011, 05:44:15 PM
The point being that drug research by private companies is perhaps not the most efficient method: for various reasons having to do with the absolutes of life and death, medicine and medical care are not well suited to pure capitalism. Americans are not being well-served by their system, and the fault is not that of other countries.
Drug research by private companies has resulted in many useful treatments. I agree that "pure capitalism" shouldn;t apply here, and it doesn't. There is a lot of research done in the US through the non-profit and public sectors. that's a good thing. There is value in being able to have research not subject to market pressures; OTOH there is also value in having research that is responsive to market needs and subject to makret discipline. There is place for both. Problem is that financing the private effort has to be done out of profits, and due to how health care systems operate in elsewhere, most of those profits have to be taken out of the US consumer. That isn't an attack on Canada or the Euro countries - they are doing what they think best for their own national interest.
Drug companies do not sell drugs in Canada and Europe out of the goodness of their hearts - of course they are making profits here as well. Just not the obscenely inflated profits made in the US.
I do not doubt that private research is a good thing. I am simply pointing out that the notion that we would not have progress without allowing the drug companies to fleece US consumers is simplistic. The US companies do indeed spend more on "research", but much of that is aimed at goals that are not really condusive to progress. Take that spending away, and it is not at all certain that companies spend more in the US on beneficial research.
Quote from: Malthus on August 02, 2011, 01:15:57 PM
Just not the obscenely inflated profits made in the US.
:rolleyes:
Quote from: garbon on August 02, 2011, 12:21:05 PM
Oddly enough, Iorm has stated in this thread that a patient is foolish if they aren't involved in their treatments.
And I stand by it.
Doctors are human beings and they occasionally make mistakes. Furthermore, medicine is a huge field and few will be specialized in your area of interest. For example, chances are your random dentist won't know what antibiotics will go well with my illness or treatment. And of course few like to admit there are limits to what they know. Human nature. My advice there is to look for another doc in those cases.
Finally, as you own the body it is much easier for you to notice certain things which will later help with diagnosis and quality of life. In my case knowing what, how much and when to eat is a very necessary skill. I can also tell easily without any test whether a blockage is bad enough to require suction through NG tube, when the situation is finally resolved, etc.
Quote from: Malthus on August 02, 2011, 01:15:57 PM
Drug companies do not sell drugs in Canada and Europe out of the goodness of their hearts - of course they are making profits here as well. Just not the obscenely inflated profits made in the US.
The problem with drugs is that they're the kind of good that take very high fixed expenses to come up with, and very low variable expenses to produce. These kinds of goods are problematic for a number of reasons. One of the problems with them is that it allows price discrimination.
Since the variable costs are low, you can sell the drug at a profit per unit even if you sell it for a pittance. Therefore, you can sell with profit per unit at a wide range of prices. Those who can tolerate the highest prices are financing the biggest chunk of your fixed expenses or profits on top of that.
Quote from: Malthus on August 02, 2011, 01:15:57 PM
Drug companies do not sell drugs in Canada and Europe out of the goodness of their hearts - of course they are making profits here as well. Just not the obscenely inflated profits made in the US.
This is saying nothing at all. Of course drug companies are selling at a profit. But that's only true because the US consumer is covering their fixed costs (including R&D) and they can sell to Canadian consumers at a markup over marginal cost, which in the cost of a pill is pennies, if even that.
Prices in Europe are not THAT low. It depends a lot on the drug in question. For example a single injection pen for my latest treatment goes for around € 1100. That's median wage over here.
I've never asked a doctor for a medication. I don't feel reading the advertisements for a medication make me any more competent to decide if I should have it. Even doing a bit more research doesn't really make me much more knowledgeable whether one medication is better for me then another. Note that I mostly take Psychiatric medications and those are kind of hit and miss.
I did have a doctor come by when I was in the hospital and asked me what medications I wanted. I a bit flabbergasted. That struck me as weird.
Quote from: Admiral Yi on August 02, 2011, 01:39:38 PM
Quote from: Malthus on August 02, 2011, 01:15:57 PM
Drug companies do not sell drugs in Canada and Europe out of the goodness of their hearts - of course they are making profits here as well. Just not the obscenely inflated profits made in the US.
This is saying nothing at all. Of course drug companies are selling at a profit. But that's only true because the US consumer is covering their fixed costs (including R&D) and they can sell to Canadian consumers at a markup over marginal cost, which in the cost of a pill is pennies, if even that.
You owe me royalties for this response, Yi. That would be $20, please. :)
Quote from: DGuller on August 02, 2011, 01:31:38 PM
Quote from: Malthus on August 02, 2011, 01:15:57 PM
Drug companies do not sell drugs in Canada and Europe out of the goodness of their hearts - of course they are making profits here as well. Just not the obscenely inflated profits made in the US.
The problem with drugs is that they're the kind of good that take very high fixed expenses to come up with, and very low variable expenses to produce. These kinds of goods are problematic for a number of reasons. One of the problems with them is that it allows price discrimination.
Since the variable costs are low, you can sell the drug at a profit per unit even if you sell it for a pittance. Therefore, you can sell with profit per unit at a wide range of prices. Those who can tolerate the highest prices are financing the biggest chunk of your fixed expenses or profits on top of that.
Yes, and that is why innovators get patent protection in both US and Canada.
The prices in Canada are not "a pittance". They are of course appreciably lower, but this varies by type of drug. In Canada, manufacturers can get a big increase over comparable prices, in fact closer to the US price, if they can prove to the PMPRB that your drug is truly "innovative". You can't if your drug is basically a line extention. That's where the big price differential comes into play - in the US, consumers pay radically more for not-particularly-innovative drugs. Evergreening of patents is what is being funded on the backs of US consumers.
I suppose you could argue that the extra profits, no matter how derived, are necessary for innovation - but what's the limit to that?
Quote from: Razgovory on August 02, 2011, 01:57:21 PM
I've never asked a doctor for a medication. I don't feel reading the advertisements for a medication make me any more competent to decide if I should have it. Even doing a bit more research doesn't really make me much more knowledgeable whether one medication is better for me then another. Note that I mostly take Psychiatric medications and those are kind of hit and miss.
I did have a doctor come by when I was in the hospital and asked me what medications I wanted. I a bit flabbergasted. That struck me as weird.
I think asking a crazy person what medicines they would like to take is a great idea. ;)
Quote from: DGuller on August 02, 2011, 01:57:41 PM
You owe me royalties for this response, Yi. That would be $20, please. :)
As soon as you show me the copyright. :)
Quote from: derspiess on August 02, 2011, 01:23:14 PM
Quote from: Malthus on August 02, 2011, 01:15:57 PM
Just not the obscenely inflated profits made in the US.
:rolleyes:
I call a spade a spade. :P
Note that drug prices are high because innovators get a monopoly. This isn't a case of capitalism red in tooth and claw - it is a case of a government-enforced monopoly. The problem, in the US, is that the patent laws can be manipulated so that non-so-innovative products can get a monopoly, as well. Way it works is this: company comes up with a lifesaving drug; gets its years of patent protection; then, when that starts to run out, invents a new type of capsule, or some other molecule that is basically the same as the wonder-drug, and patents that - thus "evergreening" the patent; continues to charge innovator's rents on it. That's what a goodly portion of "research" consists of, those famous "fixed costs" that the US consumers have to pay to benefit the whole world.
The price controls in Canada and elsewhere are an attempt to balance that out, to restrict price increases to drugs that are actually innovative. Of course, it is a bureaucratic nightmare, but that's the price you pay.
Though drugs are significantly more in the US than other OECD countries I was under the impression that the real difference in the US cost (where the US costs more than you'd expect) is in hospital treatments and administration. The drugs are more costly but they're not as ridiculously more costly.
Quote from: Malthus on August 02, 2011, 01:59:49 PM
The prices in Canada are not "a pittance". They are of course appreciably lower, but this varies by type of drug. In Canada, manufacturers can get a big increase over comparable prices, in fact closer to the US price, if they can prove to the PMPRB that your drug is truly "innovative". You can't if your drug is basically a line extention. That's where the big price differential comes into play - in the US, consumers pay radically more for not-particularly-innovative drugs. Evergreening of patents is what is being funded on the backs of US consumers.
Yep. Most biologics are very expensive, but in that case it does makes sense. They are brand new (less than 10 years in use), costly to develop and manufacture and provide real alternatives to current treatments.
Quote from: Iormlund on August 02, 2011, 03:23:48 PM
Quote from: Malthus on August 02, 2011, 01:59:49 PM
The prices in Canada are not "a pittance". They are of course appreciably lower, but this varies by type of drug. In Canada, manufacturers can get a big increase over comparable prices, in fact closer to the US price, if they can prove to the PMPRB that your drug is truly "innovative". You can't if your drug is basically a line extention. That's where the big price differential comes into play - in the US, consumers pay radically more for not-particularly-innovative drugs. Evergreening of patents is what is being funded on the backs of US consumers.
Yep. Most biologics are very expensive, but in that case it does makes sense. They are brand new (less than 10 years in use), costly to develop and manufacture and provide real alternatives to current treatments.
Also with biologics copying the drug isn't so easy. The saying is that with biologics "the process is the product", meaning that the way they are produced tends to affect the drug; it isn't as easy to make truly generic biologics.
Quote from: Malthus on August 02, 2011, 02:08:43 PM
Way it works is this: company comes up with a lifesaving drug; gets its years of patent protection; then, when that starts to run out, invents a new type of capsule, or some other molecule that is basically the same as the wonder-drug, and patents that - thus "evergreening" the patent; continues to charge innovator's rents on it.
I'm not very familiar with this. Are they getting a new patent every time they make some change, or does that somehow renew the original patent?
In general I'd definitely agree that patent law and the patent process in the US is royally screwed up.
Another point to consider about medication is that many potentially effective avenues of research are not profitable at all for pharma companies. For example, studies on intestinal flora I tend to read about are mostly carried out in Euro labs with public money.
Quote from: derspiess on August 02, 2011, 03:42:51 PM
Quote from: Malthus on August 02, 2011, 02:08:43 PM
Way it works is this: company comes up with a lifesaving drug; gets its years of patent protection; then, when that starts to run out, invents a new type of capsule, or some other molecule that is basically the same as the wonder-drug, and patents that - thus "evergreening" the patent; continues to charge innovator's rents on it.
I'm not very familiar with this. Are they getting a new patent every time they make some change, or does that somehow renew the original patent?
In general I'd definitely agree that patent law and the patent process in the US is royally screwed up.
Getting a different patent or patents for essentially the same drug, by modifying the drug. The idea is to squash competition from generics for as long as possible.
http://en.wikipedia.org/wiki/Evergreening
This is why the issue isn't a straightforward one, with free marketers on one side and price-controlling socialists on the other ... high monopoly rents are why drug prices are so high in the US, and they are a creature of government-backed monopoly. The argument goes that if the government is handing out monopolies, it should place some limits on the rents that are charged pursuant to those monopolies, and make the reward match the achievement - the last thing that the "innovative" drug manufacturers want is a truly free market. They have a point, which is that innovation ought to be rewarded (and if it isn't you won't get innovation). The issue is, just how much should that reward be?
My sense is that the US system is out of wack on this - that the monopoly rents are too high. Some justify this by saying, the higher, the more innovation. But where's the limit to that?
Quote from: Malthus on August 02, 2011, 04:04:26 PM
Getting a different patent or patents for essentially the same drug, by modifying the drug. The idea is to squash competition from generics for as long as possible.
How does this prevent generics from competing with the old, unmodified drug?
Quote from: Admiral Yi on August 02, 2011, 04:13:39 PM
Quote from: Malthus on August 02, 2011, 04:04:26 PM
Getting a different patent or patents for essentially the same drug, by modifying the drug. The idea is to squash competition from generics for as long as possible.
How does this prevent generics from competing with the old, unmodified drug?
The patents relate to the old drug - just different aspects of it.
To be a "generic" for the purpose of various insurance formularies (public and private), you have to be "equivalent" to the existing brand-name product. Thus, if the original drug is put into a brand-new capsule that (allegedly) has some advanced new feature, like time-release, you have to copy that too - but surprise! That new capsule is also patented! Sorry, you can't copy that or you are sued; you can't be really equivalent if you don't have it. :D
Here's a euro generic complaint:
http://www.egagenerics.com/gen-evergrn.htm
A Canadian Supreme Court ruling on the topic:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1660583/
Quote from: Malthus on August 02, 2011, 08:23:45 AM
Sure, Canada is a small market. That would of course be true no matter what system Canada adopted.
Though the Canadian public research system has historically punched above its weight in terms of biotech discoveries. Case in point: insulin.
You guys keep discounting the importance of public research, and inflate the importance of private research. Fact is, much of private "research" is of dubious worth, aimed as much at prolonging patent monopoly by developing "me too" products than at discovering fantastic new breakthroughs, or at essentially selling existing product through the fiction of "phase 4" trials.
The reason is quite simple: actual breakthroughs are rare and unpredictable creatures, best deveoped by pure science, which is unpredictable. Think of the discovery of DNA - what company would have the patience to fund pure speculation?
Obviously, tyhere is a role for private research, but the notion that Americans (or anyone) has to pay absurdly inflated drug prices to fund it, and that the whole world is beholden to Americans selflessly paying, is a mirage. I can understand why this mythology would ease the pain of being had by the drug companies, but there is no reason for intelligent peopole to buy into it.
I'm sorry, I thought the tone of my post would have made it obvious I've no interest in debating this topic in a serious manner with you.
I would imagine that you don't.
Quote from: Neil on August 02, 2011, 05:28:12 PM
I would imagine that you don't.
You will have to admit that Otto has, on at least two occasions, seriously debated a topic here on Languish.
Probably not
many more times than two, I'll grant.
Quote from: Malthus on August 02, 2011, 04:44:32 PM
Quote from: Admiral Yi on August 02, 2011, 04:13:39 PM
Quote from: Malthus on August 02, 2011, 04:04:26 PM
Getting a different patent or patents for essentially the same drug, by modifying the drug. The idea is to squash competition from generics for as long as possible.
How does this prevent generics from competing with the old, unmodified drug?
The patents relate to the old drug - just different aspects of it.
To be a "generic" for the purpose of various insurance formularies (public and private), you have to be "equivalent" to the existing brand-name product. Thus, if the original drug is put into a brand-new capsule that (allegedly) has some advanced new feature, like time-release, you have to copy that too - but surprise! That new capsule is also patented! Sorry, you can't copy that or you are sued; you can't be really equivalent if you don't have it. :D
Here's a euro generic complaint:
http://www.egagenerics.com/gen-evergrn.htm
A Canadian Supreme Court ruling on the topic:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1660583/
I'm still a little confused. Is there no way whatsoever for a different company to copy the 'old' drug in this scenario?
Quote from: derspiess on August 03, 2011, 11:13:58 AM
Quote from: Malthus on August 02, 2011, 04:44:32 PM
Quote from: Admiral Yi on August 02, 2011, 04:13:39 PM
Quote from: Malthus on August 02, 2011, 04:04:26 PM
Getting a different patent or patents for essentially the same drug, by modifying the drug. The idea is to squash competition from generics for as long as possible.
How does this prevent generics from competing with the old, unmodified drug?
The patents relate to the old drug - just different aspects of it.
To be a "generic" for the purpose of various insurance formularies (public and private), you have to be "equivalent" to the existing brand-name product. Thus, if the original drug is put into a brand-new capsule that (allegedly) has some advanced new feature, like time-release, you have to copy that too - but surprise! That new capsule is also patented! Sorry, you can't copy that or you are sued; you can't be really equivalent if you don't have it. :D
Here's a euro generic complaint:
http://www.egagenerics.com/gen-evergrn.htm
A Canadian Supreme Court ruling on the topic:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1660583/
I'm still a little confused. Is there no way whatsoever for a different company to copy the 'old' drug in this scenario?
There are several evergreening techniques.
Sometimes, new patents are taken out on aspects of the drug that already exist. This can of course be challenged, but challenging it costs money & time. This would prevent, or make more expensive, a generic copying the "old" drug.
More effective is to create new aspects to essentially the same drug, and then patent that. This works because the major Formularies (that is, the lists of approved drugs for which insurers either public or private will pay) require equivalence to the existing product. The generic can copy the "old" drug, but people cannot get reimbursed for it. This is harder to challenge.
Point here is that much resources go into these issues. It is almost as valuable to keep being paid for an existing product as to invent a new product, and considerably easier.