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

TimV wrote:
"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.

that's not 'nanny', it's part or at least very close to the core functions of government (preventing fraud, enforcing contracts, physical protection, etc.). but saying i can't buy something even after i've been informed of the risk is pure nannyism.

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).

lawsuits are the result of government laws/court decisions, medical ethics are often codified in laws - so we should toss these costs into the government bin with regulations as well. and as you note below, many of the regulations are tied to lawsuit issues.

still seems like to a significant extent the government creates the need for its funding with all these mandated costs.

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.

DC's care about making money, and figuring out how vaccines work together could be profitable ...

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.

do you have any stats on government vs. private funding of basic research and pharms?

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.

the OC's and barriers to entry into the vaccine market can be quite high, but as we've noted, a lot of that hundreds of millions cost comes from government regulations.

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.

Interesting. I guess the last question to be answered is that one about federal government vs. private funding of basic research into pharmaceuticals.


--
"when i visited Aden before collectivization,
all the markets were full of fish product. After
collectivization, the fish immediately disappeared."

- Aleksandr Vassiliev, Soviet KGB official
.

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