Re: just finished reading "And the band played on".....

"stephenj" <sjek@xxxxxxx> wrote in message
news:ECaag.22556$4H.20005@xxxxxxxxxxxxx
TimV wrote:
"stephenj" <sjek@xxxxxxx> wrote in message
news:Nj9ag.22550$4H.16168@xxxxxxxxxxxxx

TimV wrote:

my list? timV said that list includes the "low hanging fruit" (whatever
that means here) and the diseases that killed and maimed the most
people - i.e., the most important ones to cure.



You're the one claiming otherwise, that there are all of these diseases
that were cured before governments started granting the money for the
research

? i asked miami how we ever cured diseases before big government grants,
and i laughed at your claim that we really hadn't. i also noted that the
diseases that you conceded were cured or understood before big government
grants were the most important ones - at which point you said i was
misanthropic (!!).

and remember, the context of this was miami's claim that medical research
into AIDS lagged during the early 80s due to a lack of federal funding.
at that point, i was taking miami's word for the "lag" part, so i focused
on possible causes for the lag other than poor government funding. but in
the end, i concluded that in this case the philosophical issue of what
role government should have in medical research funding was pretty much
moot anyway because the evidence indicates that the US researchers did a
fine job between 81-85 on AIDS research. They made the key discoveries in
a timely manner - bested by no one else in the entire world save arguably
the french.

but if you still want to dwell on that, then if i were you i'd be
applauding the private sector for curing those most important of all
diseases, the ones that killed and maimed the most people.

and for the record - while i'm not sure that we couldn't be just as
effective or evenn moreso at understanding/curing diseases if the private
sector did all of it by itself, i do agree that of all the non-defense
related stuff the federal government spends money on, medical research is
probably in the top 2% in terms of value to society. ii'd cut just about
everything else before i cut it. and i'd cut lots of the defense stuff
before i cut it as well. might even transfer some of that cut money over
to medical research.



direct quotes

SJ>heck, how on earth did we ever discover cures for anything or
understand
SJ>any disease before the government started doling out grants?

TV>Well, you know, we didn't really start curing or understanding many
diseases
TV>until the government started doling out grants. When we did, they were
the
TV>low hanging fruit, or the things that killed or maimed so many that
you
TV>could have a "March of Dimes". Most of the drugs you see on the market
today
TV>are built on the basic research coming out of federal grants.

SV>in other words, the stuff that mattered most.

I disagree on the "stuff that mattered most".

yes, but why? isn't "maiming and killing people" the best criterion?

It's an excellent criterion. And applies to that AIDS research you're
pooh-poohing. And it sounded to me like you were discounting AIDS research
or other modern research because they didn't matter as much. Perhaps I read
too much into it.


In terms of "low hanging fruit" my point was the diseases that a vaccine
was most easily generated. Simple viruses and toxins. Even then, most of
those had a least some government funding. First, you act like we
discovered lots of cures before the era of government grants. We didn't.
Even if you move to the standard of "massive grants", that has
dramatically accelerated the research successes. I threw in the "March of
Dimes" effort because that was one of the few examples that included
significant private funding. Beyond that, research is much tougher today
and the targets are vastly more difficult than the early ones. The
toxoids, live attenuateds, etc, were things that could be done for
relatively little money. Nevertheless, all of those vaccines (except
rabies) has been replaced since they weren't effective enough not to
warrant new research (heck, even the mumps vaccine is only 90%
effective). None would even make it to the market today.

because consumers wouldn't buy them or because the government wouldn't let
them? if there was no mumps vacine and someone invented one that was 90%
effective, with a 10% chance it wouldn't work or might kill me with side
effects, i might very well choose to buy it and take my chances- unless
prevented from doing so by a nanny-state government allegedly looking out
for my interests ...

The mumps vaccine was only included in there to discuss efficacy of some of
the older vaccines. It is still useful and on the market because it has a
low incident rate of vaccine complication and you're hoping for a
significant degree of herd immunity to keep the rate of failures
artificially low. A lot of the others have been replaced over the years
because the complication rates were too high. That nanny state is also there
to make sure that the drug companies reveal the true risks.


We also have to go through far more rounds of experiments before they'll
make it to human subjects. The days of the major deaths from vaccine
experimentation are over.

seems like you're saying "the government now requires endless costly
validation trials and experiments before a drug can go to market, which no
private entity short of bill gates can afford, thus ... we need government
grants to pay for all the government mandates!". strip away the government
regulations and the associated costs and would we still need grants to
cure/understand diseases?

A big part of the costs it is that the easiest targets have already been
addressed. The major illnesses that we haven't made major progress in
involve serious complications in vaccine design, especially in terms of
escape and efficacy. Further, the costs aren't just the results of
government regulations, but also lawsuits and modern medical ethics (the
days of highly unethical medical research are long over). Due to a lot of
lawsuits in the 1970s, many of the drug companies left or threatened to
leave the business. To entice them back, the government passed laws to
immunize them (pun intended) but the pre-licensure and post-licensure
research and safety studies had to be much more intense. In return, the
government compensates families for real vaccine complications.

There is also the issue that as you increase the number of vaccinations, it
dramatically alters their efficiency. Some of them when given as a single
dose work fine. Combine it with others, it is worthless. Well that might
seem to you easy to fix, it is difficult enough to get parents these days to
bring their kids in for vaccinations. Getting them to bring them in
repeatedly for the next one... well that should offend your sense of
management in the lost productivity of parents making all those doctor
visits. Yet doing the research to figure out which ones work together costs
money. But that's a public health problem, not one the drug companies
inherently care about.


I'm glad you find government funding of research to be kind of important.
However, while I am fully a believer that private enterprise usually
works best. However, in medical research, that has clearly not been the
case. You couldn't decide that privatization of fire departments and
police departments, or the army would be better than government funded
ones

We don't have any private armies, partly because it's not possible to
exclude non-payers from the benefits of having one (short of kicking them
out of the country). we do have private drug companies.

from wikipedia:

"Government funding for medical research amounts to approximately 36% in
the U.S."

So seems like the private sector is still due most of the credit, no?


Most of that is in diagnostics and therapeutic devices, the most profitable
area of medical R+D research. Basic research and pharmaceuticals are
extremely expensive and low yield, yet absolutely must be done. Major
pharmaceutical companies have made it clear that they cannot afford to do it
all and if they tried, they'd be punished by their shareholders. If they can
design a new drug off of something that came out of government-funded
research, that's great. But they cannot afford to focus on any disease that
is horrible, needs to be addressed, but is not common enough for them to
make their R+D money back. Personally, I think that some disease that kills
100 kids a year is vastly more important than some old fella getting it up.
Then again, maybe that's because I'm still relatively young.


because profit considerations would either make it unavailable for most,
or unaffordable for many.

? profit considerations drive down costs. wal-mart is the most profitable
company in the world right now because it drives its cost down down down.
and anyway, lots of people complain that they can't afford prescription
drugs or they can't afford health insurance, etc.

Profit considerations do drive down costs. However profit considerations
also drive companies not to enter some markets because the opportunity costs
are just too high. Why dedicate hundreds of millions for a vaccine that only
the developed world will be able to afford (and will only take it once each)
when you can develop the next generation of impotence drug, or cholesterol
drug, or arthritis drug. Your shareholders would have a fit if you dropped
all that cash into the latter, public benefit be dambed.


When you do go for some level of privatization, like with ambulance
services, you have to subsize it to keep it available or affordable. Same
is true with all basic science research and most vaccine research. You
can always get private firms to do applied research, but they'll only do
vaccine research these days with government contracts.

but why, other than government regulations, etc.?


As I mentioned in a previous post. In one year in the early 1990's, Zantac
generated more revenue (more than $3.5 billion) than all the vaccines in the
world combined. It has just become clear that public-private cooperation is
the only way these vaccines will be developed. They lose their shirts on
most vaccine research unless it is simply a matter of applying basic
research to finish the job.

Add to that, when you do develop one, you run the risk of crashing headlong
into politics. The new HPV vaccine is nearing approval and it looks highly
promising. There are those who suggest it should be made mandatory since it
will virtually eliminate all cervical cancers. So what's the problem?
Religious conservatives. They feel that mandating the vaccine diminishes
their message that abstinence is best. So rather than stop 5000 cancer
deaths a year in the U.S. alone, we play religious politics. It's also
expected to cost $300 a pop.

It all though comes back to basic research, which is where most of the
government money goes anyway. We'll still see new drugs coming out of the
pharmaceutical industry, but they have been downsizing their R+D departments
lately. Two things would greatly help them. One is longer patents on novel
drugs (while eliminating some of the loopholes, like small formula changing
or expanded use in children, etc) and the second is reasonable lawsuit
protection.

T


.

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