
Obstacles to Developing Cost-Lowering Health Technology: The Inventor’s Dilemma - wormold
http://jama.jamanetwork.com/article.aspx?articleID=2429454
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ucha
I like the example of the MI and stroke reducing polypill. However, if the
only reason why this pill's not sold is because it delivers a low return on
investment due to the high cost of the clinical trials, why aren't countries
where medical research is less privatized stepping in?

Surely, this miracle pill would be tested and ultimately sold in Cuba and some
European countries with excellent medical facilities where the public sector
shares a larger part in healthcare costs.

What's preventing this?

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ams6110
Um, the high cost of the clinical trials is not due to privatized medical
research.

 _the cost of the large clinical trials required for FDA approval_

It is FDA regulations, not privatized medical R&D.

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ucha
I didn't say that the cost was high because of private medical search. Only
that a private pharmaceutical company will not want to have negative returns
regardless of the origin of the costs.

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a3n
Yes, a public good, which a country can decide to acquire and provide or not.

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angersock
Oh dear christ.

A lot of the medical devices that could actually help people are well within
the ability of even a small team of undergrads to produce--and many do!

It's the sheer fuckheadedry of the market and regulatory environment and
capture of the FDA and insurers that basically make bringing anything to bear
a tedious, hair-graying experience.

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pinaceae
totally, who needs the FDA. a little thalidomide is good for you, nothing like
untested and unproven stuff to shove into your veins.

let's also abolish the FAA, air travel needs to be freed from the shackles of
safety.

because innovation and disruption and stuff.

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angersock
How many things have _you_ gotten through the FDA, friend?

The fact is, and it's well-documented, that there are many scientifically
unsubstantiated claims and procedures being done, that there is a vast paucity
of decent software, that patients are being injured and maimed and killed and
empoverished. And yet, there are these super-strict market-approval processes
and weird regulatory requirements on where and how you can open hospitals
(which is how they killed a lot of abortion clinics in Texas, by the way) and
a cartel-enforced supply-shortage of trained physicians.

Things are fucked.

The interactions of the government and the not-quite-free-market have produced
this sort of perverted and broken system.

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shard
If there's $300B in annual costs due to health care expenditures and lost
productivity which can be reduced with a $1/day drug, it seems like the
medical insurance industry should be very interested in such a drug. Is the
medical insurance industry unable to carry out the research or pay a research
lab to do the work? Or are there other reasons they don't do this kind of
research?

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DougWebb
What makes you think the Medical Insurance Industry is interested in reducing
medical costs? They benefit from higher costs.

If medical costs were much lower, fewer people would need/want insurance.
Premiums would have to be lowered, which means less cash coming into the
insurance company, and claims would be fewer and/or smaller which means less
cash flowing through the insurance company. Cashflow is where the insurance
company makes its profit.

The other profit center is captured premiums: money people pay in that they
never get back out. The insurance company doesn't care how high your medical
bills are or how much you wind up paying for them; the company only cares
about reducing its share as much as possible. Lowering the overall cost
doesn't alter the payment distribution, so the insurance company has no
inventive to lower overall costs.

If there was a pill you could take which would allow you to pay a larger
proportion of your medical costs, without reducing your premiums, the
insurance company would be all over it.

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srunni
> Although the polypill could produce substantial public health benefits,
> people in the United States are unlikely to find out anytime soon. This is
> because the pill’s price is so low (≤$1 per tablet) and the cost of the
> large clinical trials required for FDA approval is so high, it is
> unattractive to investors.

Here are two great articles on this topic by Ben Roin of MIT:

 _Unpatentable Drugs and the Standards of Patentability_ :
[http://dash.harvard.edu/bitstream/handle/1/10611775/Unpatent...](http://dash.harvard.edu/bitstream/handle/1/10611775/Unpatentable%20Drugs%20and%20the%20Standards%20of%20Patentability%20-%202009.pdf)

 _Solving the Problem of New Uses_ :
[http://dash.harvard.edu/bitstream/handle/1/11189865/Solving%...](http://dash.harvard.edu/bitstream/handle/1/11189865/Solving%20the%20Problem%20of%20New%20Uses%20.pdf)

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wehadfun
Here is article about the pain of dealing with Medical Industry

[0]
[http://www.washingtonmonthly.com/features/2010/1007.blake.ht...](http://www.washingtonmonthly.com/features/2010/1007.blake.html)

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hmahncke
100% correct in my experience with medical device VCs.

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coldcode
What were the drugs they wanted to combine?

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worik
FFS Solution 6: Nationalise the pharmaceutical industry and get health experts
deciding priorities

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aswanson
Sure. Creating an even greater bureaucracy unanswerable only to themselves
with guaranteed taxpayer cashflow is certain to produce pure innovation.

