Why I love Big Pharma, and why you should too

A great video that lays out similar arguments to my own why big pharma is actually great, and addresses the audience here that sometimes tries to make their flawed but mainstream, contrarian, opinions, heard.

I will look at more of what he does / has done. He has some videos on longevity as well.

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Not everything Big Pharma is bad, but their sins are too numerous to mention.
Anything they say should be taken with a big grain of salt.

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Just one of many. But worth reading if you will find time.

the industry finances most of the clinical trials into its own products and much of doctors’ continuing education, that clinical trials are often conducted on small groups of unrepresentative subjects and negative data is routinely withheld, and that apparently independent academic papers may be planned and even ghostwritten by pharmaceutical companies or their contractors, without disclosure.

Goldacre argues that the clinical trials undertaken by drug companies routinely reach conclusions favourable to the company. For example, in a 2007 journal article published in [PLOS Medicine], researchers studied every published trial on statins, drugs prescribed to reduce cholesterol levels. In the 192 trials they looked at, industry-funded trials were 20 times more likely to produce results that favoured the drug.

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Wow - this is a loaded and potentially very controversial post :slight_smile: I can see both sides of this… yes, many great drugs that have made life better and longer for millions of people.

The flip side are stories like the Sacklers / Oxycontin, Perdue Pharma and hundreds of thousands of addicted people and a high death rate in large segments of the US populations.

The company manufactured pain medicines such as hydromorphone, fentanyl, codeine, hydrocodone and oxycodone, also known by its brand name, OxyContin. The Sacklers developed aggressive marketing tactics persuading doctors to prescribe OxyContin in particular. Doctors were enticed with free trips to pain-management seminars (which were effectively all-expenses-paid vacations) and paid speaking engagements. Sales of their drugs soared, as did the number of people dying from overdoses.[3] From 1999 to 2020, nearly 841,000 people died from drug overdoses in the United States, with prescription and illicit opioids responsible for 500,000 of those deaths.[4] The Sackler family have been described as “the worst drug dealers in history”[5][6] and the “most evil family in America”.[7][8][9][10]

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“There are no bad people, only bad incentives.” Big Pharma is doing its best with the incentives it gets from the system. Putting aside some obvious fraudsters (probably the same % as in every industry in the world; it’s just that here, the damage might be more significant), Big Pharma is not inherently evil.

We should make sure that the incentives given to Big Pharma are aligned with the common good and with our individual health. I think, to a large extent, it’s true today, but not always. Here’s an example of how patent law can kill people: Negative innovation: when patents are bad for patients Drug repurposing is another example; after their drugs become generic, pharmaceutical companies have 0 incentives to repurpose them, even though it could save lives.

That being said, I’m thankful to big pharma for some wonderful drugs they found, such as SGLT2 inhibitors and GLP1RAs.

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Yes, i imagine a lot of strong views on this.
The high-stakes, binary outcome profit motive in big pharma is undoubtedly a risk. It leads to misrepresentation of data, focus on incremental advancement and sometimes even outright fraud. But it also leads to genuine and large scale improvement in health and healthspan.

I think the really interesting question is how it could be improved. Reducing the cost and time of clinical trials would certainly help, financially encouraging the pooling of research costs between conglomerates of companies, forced full data release of all registered trials. What about an optional 10% subsidy for stage 3 trials which then translates into a 1% global revenue tax if the trial is successful. A change to patent laws for a two track patent system with a “mini patent” (with lesser clinical trials?) on preexisting drugs and supplements.
There must also be some whistleblowing lessons to be learned from Oxy!

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The issue is that this view assumes everyone has the same wants and desires. That incentive are desirable to everyone equally. That the saying… “One man’s meat is another man’s poison” …is wrong.

The reality is that different people desire different things. That an incentive mechanism that should turn out loads of good people, occasionally turns out a Hitler.

No. No one wants a drug that kills just because the previous one that worked better had an expired patent: Negative innovation: when patents are bad for patients | Nature Biotechnology And everyone would like big pharma to also work on existing drugs to see if there are low-hanging fruits (e.g., rapamycin…) instead of just chasing new compounds because that’s the only way for them to make money because of how incentives are designed.

We reached the Godwin point fairly quickly, by the way… Godwin's law - Wikipedia

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:joy:
The point still holds if you replace ‘Hitler’ with any of your favourite villains.

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I think you dismiss my point too quickly. I am not saying that someone would want to make a poisonous drug and kill people.
I think a better example would be prioritising discovery of treatments (that result in a fixed steady revenue source) over one hit cures (that don’t result in a fixed steady revenue source). (The subscription model of healthcare, like the shift away from purchasing software on your PC to having to pay a monthly subscription).

Aligning incentives with human health promotion is your proposal (no bad people only bad incentives). I’m saying - the issue is that health isn’t like any other commodity where economic incentives (or any incentives) can act as proxies for human welfare (to be utilitarian about this). Human health must be valued by the economic actors as a good in and of itself.

To return to the subscription example, irrespective of the incentive - rather than it being larger for cures than treatments - the solution would be a company that found it abhorrent to create treatment-dependents (drug-slaves if you allow me that description). They would find the incentive of making a person healthy important.

I realise that this is very contrarian to the standard line put out by Adam Smith that the reason the butcher provides meat isn’t out of the goodness of their heart. And with Smith I agree - for all other commodities

Health throws up unique issues that cannot fit within the standard economic incentives view (e.g. making drug slaves).

That, is my point.

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I don’t understand your point at all. I want one-hit disease-modifying cures and not palliative/symptomatic drugs that you take until you die. However, the current system does not incentivize this. So we should change the system. That’s all that I say.

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I agree with you 100%. I don’t think we ever disagreed then :slight_smile:

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All good then :wink: :pray:

Still, it’s not easy to design the optimal incentive structure. Here’s what my friend Savva (Patent lawyer) is advocating for: Leveraging Pharmacoeconomics and Advance Market Commitments to Reduce Healthcare Expenditures - Federation of American Scientists

People would do trials on whatever intervention they want (new drug, repurposed drug, supplement, yoga, diet, etc.), if they prove a benefit on health (and it doesn’t have to be for a specific disease, it could just be for “reduces all-cause mortality”) then they would get x% of the realized healthcare savings over the next n years thanks to your intervention. So that the initial innovator would get money even if generics are prescribed for instance. And you could get generic to enter earlier. So drugs would be cheap to buy (at marginal cost), but the innovator would still be paid (just not based on the actual sales of their own product). It’s fairly easy to measure for drugs and supplements: doctors would prescribe them and the innovator would be paid based on that. (Example: if you prove that you can increase cancer survival in T2D by taking an SGLT2, then you’d get paid for each T2D patient being prescribed a SGLT2i for cancer.) If you find a one-hit cure for Alzheimer’s, you’d get millions from the gov (or private insurers) for each patient taking it, even though they would only take it once. For non-pharmaceutical interventions like diet and exercise it’s harder: how do you make sure that people actually follow the diet or exercise? But you can do that with apps. Some countries are actually already re-imbursing diet and exercise apps. However, the devil is in the details and this scheme is complex. There’s a reason why all countries use “You get money based on the drug you sell and after a few years this drug is available in generic”: because it’s much easier to implement;

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Thank you. Will look into this deeper. I am not just a dillitonte on this topic. I got interested when living in South Africa during the HIV/Aids pandemic and wrote Patents, Pills, Poverty and Pandemic: the ethical issues.

I’m doing my PhD in this topic part time at the moment at Durham. Part time and not making much progress as I work full time too.

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Very nice! Let me know if you want to talk to Savva. Here’s his 2014 thesis: Deadly gaps in the patent system : an analysis of current and alternative mechanisms for incentivising development of medical therapies.

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I do not entirely dismiss this viewpoint:

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Exactly right @desertshores :joy:

They are far from being prisoners of the system because they have enormous power to shape the system. Indeed, some argue that they have captured the system. Big Pharm’s strong influence over the FDA and the drug approval process is inherently evil, in my view.

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Yes, this is now true: their incentive is to keep the system as it is, increase barriers to entry, and avoid new entrants.

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