
Is it time to nationalise the pharmaceutical industry? - DanBC
https://www.bmj.com/content/368/bmj.m769
======
toohotatopic
There is no need to nationalise at all. The solution is not reduced
competition but increased competition.

The power of the pharmaceutical industry comes from artificial monopolies in
the form of patents, approvals and import restrictions. Since the public funds
the initial research anyway, those limitations can be reduced until
competition exists and medicine is once again affordable.

~~~
Zelphyr
The pharmaceutical industry is getting really good at gaming the patent
system. My sons inhaler was pretty cheap for a long time until all of a sudden
it jumped in price. Like, from $30 to $300.

Turns out, all they did was change the delivery mechanism--slightly--and the
next thing you know it's somehow covered under a different patent. The
medication stayed exactly the same.

~~~
burntoutfire
Assuming the previous patent expired, can't someone else just make the
medicine according to the original formula, and sell it for $30?

~~~
leetcrew
I think the usual issue is that when a patent expires, a competing product
still has to pass extensive (and expensive) safety tests before it can be
sold. this is how you end up with pathological cases of price gouging on low
volume generic drugs.

this might be a good place for a government agency to step in and manufacture
out of patent drugs and delivery devices at a reasonable price. it would at
least be interesting to see the difference between the "reasonable price" and
the actual cost to produce.

~~~
basch
Doctors also have a duty to prescribe the best available drug, which is why
you dont see people who cant afford modern insulin prescribed "last gen
insulin."

~~~
gowld
Do you have a source for that? This doctor disagrees:
[https://www.statnews.com/2018/04/03/doctors-cost-
prescribing...](https://www.statnews.com/2018/04/03/doctors-cost-prescribing-
medications/)

~~~
basch
PMID: 25785977

>What’s surprising is that the trailing edge of old insulin products did not
generate a market for generic competition but rather became a set of obsolete
products that were promptly removed from the U.S. market. Pork and beef
insulins are not merely underutilized, they are unavailable for human use in
the United States. Even when practitioners prescribe NPH and R insulin in
place of insulin glargine and insulin aspart, these cheaper prescriptions are
filled with newer recombinant products sold under brand names. And yet on the
whole, it’s hard to say that contemporary patients who cannot afford their
insulin (let alone the patent-protected glucometers and test strips required
to adjust the dose) are well served by having as their only option an agent
that is marginally more effective than those that could have been generically
available 50 or 30 or 10 years ago, had generics manufacturers introduced
cheaper versions when patents expired.

I shouldnt blame the doctors, my comment was a little facetious.

Some "low cost" versions did come out in 2019, but it feels more like the
diamond industry selling both natural and lab made diamonds at different price
points.

Back to my original point, Doctors seem to agree that analog insulin is
preferable to older formulas. - [https://www.healthline.com/diabetesmine/why-
not-more-afforda...](https://www.healthline.com/diabetesmine/why-not-more-
affordable-generic-insulin)

>Since we’re talking about cheaper insulin, Novo Nordisk’s Novolin ReliOn
brand deserves a mention here. Sold for just $25 a vial without a prescription
at Walmart, ReliOn includes “Regular” (short-acting), NPH (longer-acting), and
70/30 (biphasic insulin), a combination of the other two. These ReliOn
products are not generics or biosimilars, but rather older “human” insulins —
as opposed to the newer “analog” versions being produced today. Many patients
and doctors agree that these older formulations clearly don’t provide the same
level of blood glucose management as newer insulins. But if you’re forced to
choose between using them and doing without or rationing insulin, these older
insulins are certainly preferable.

The risk is real. [https://www.usatoday.com/story/news/nation/2019/08/09/man-
di...](https://www.usatoday.com/story/news/nation/2019/08/09/man-dies-otc-
insulin/1942908001/)

------
mc32
No. Nationalizing it will politicize pharmaceuticals. (and parties change
control every few years of so). Private industry may chase the longevity
dollars (expensive drugs for rich people who want to make their later years
easier), but they also do lots of research in lots of other mundane areas.

The problem is more in the healthcare _system_ whose incentives are not
aligned with the patients foremost, but rather is more geared towards
extracting as much as possible from insurance companies who in turn are
disincentivized to give their patients decent care, in many ways.

~~~
bitwize
> Nationalizing it will politicize pharmaceuticals. (and parties change
> control every few years of so).

That's easy to fix. Pass a law forbidding any non-progressive political
parties from forming or having a say in government. What could possibly go
wrong?

~~~
mc32
> “Pass a law forbidding any non-progressive political parties from
> forming...”

What? That runs against the bill of rights right out of the gate.

------
jfengel
FTA:

 _Big pharma excels at the subsequent stage: taking the best ideas generated
by scientists and bringing them to market, using its huge financial firepower
to navigate the complex regulatory environment._

If the government were to nationalize the industry, wouldn't the regulatory
environment become simpler? Regulations exist because of the fundamental
antagonism between profit-making and safety & efficacy. If the sector were
nationalized, that would shift (and possibly diminish) that conflict.

Industry may well have expertise in the expensive process of ensuring safety
and efficacy, but if that's made more expensive by having regulations thrust
on it from outside, why not save the cost?

~~~
kichik
Won't you just get similar cost in the form of bureaucracy?

~~~
TheOtherHobbes
Bureaucracy is rarely as expensive as aggressive profiteering.

In fact the opposite is more likely. If pharma is nationalised - or better,
internationalised - it would become economic to fund solutions for common
conditions that aren't currently considered profitable.

~~~
throwaway3157
> Bureaucracy is rarely as expensive as aggressive profiteering.

Have you seen the DoD and other gov entity contracting? Perhaps we can expect
the same level of contracting that the DoD has today, outsourcing those
expensive mistakes to others, for them to take the blame/fall/

I can see a situation where pharma bureaucrats refuse to approve or pursue
things, because government mistakes are more unforgivable than business
mistakes (where failure and experiments are often encouraged). I would expect
more layers of approval/red-tape to develop as no-one wants to accept the
blame of approving.

~~~
Seenso
>> Bureaucracy is rarely as expensive as aggressive profiteering.

> Have you seen the DoD and other gov entity contracting?

DoD contracting seems like worst of both worlds: a combination of bureaucracy,
aggressive profiteering, and rare real-world evaluation of the products.

I'm kinda surprised military production hasn't been nationalized. It seems
like it's mainly done by a handful of companies that are almost wholly
dependent on government contracts, and the government is loathe to steer too
much work away from any of these entities in order to preserve their
capability.

------
RcouF1uZ4gsC
I think a lot of issues can be solved not by nationalizing the pharmaceutical
industry, but by setting up a competing government funded drug company. What
the drug company researches and what it charges for it's drugs can be
determined by government policy. If done, it would be interesting to look at
how efficient it was vis-a-vis the private sector and what drugs actually got
developed at what cost.

~~~
eganist
You mean like a public option, but for drugmaking?

or a drugmaking co-op chartered and initially funded by the feds?

I'd be down for this.

~~~
Seenso
I'd be fine with either, and I think it'd also help with price-gouging like
Turing Pharmaceuticals engaged in with Daraprim.

A public drugmaker could be obligated to have implemented processes to
manufacture _every_ approved drug. If a maker engaged in price-gouging, or had
its facilities disrupted, the public drugmaker could supply an alternative
supply at fair prices.

------
pkaye
> During last year’s election campaign the Labour leader, Jeremy Corbyn,
> highlighted patients being “held to ransom” by one manufacturer, Vertex,
> which was locked in a battle with the National Institute for Health and Care
> Excellence (NICE) over Vertex’s £100 000-plus price tag for the cystic
> fibrosis drug Orkambi.15 It wasn’t pretty, but it was resolved by
> negotiation, and the drug is now available on the NHS.

The interesting thing about this is the Cystic Fibrosis Foundation had to fund
the research themselves in the small hopes they found anything. And then the
drug was sold to a company for a good amount which will be used for ongoing
research on Cystic Fibrosis. Now the CFF has a pile of money to persue better
treatment. Perhaps what Corbyn should have said is these treatments are
important so lets fund even more into CF research.

~~~
Der_Einzige
Even that's far better than status quo USA policy which is to simply not
negotiate on drug prices and pay 80% of whatever the bill is.

There's a reason why medicare is so bloody expensive...

------
macinjosh
No.

Who gets to decide what drugs are worth tax payer dollars?

Can we sue the government if a drug causes problems?

Why would we limit who can invent drugs and bring them to market to one
entity?

What if a president or congress tries to stop research on an important, but
controversial drug for political reasons?

Just no.

~~~
basch
You could nationalize ownership of successful necessary drugs. Not dissimilar
from eminent domain. Figure out fair market value for it, and then divide the
cost over decades, instead of price gouging the first 7 years of customers.
You dont need to nationalize the entire industry to control the intellectual
property (and lets be real, that and regulation are most of the "cost.")

Turning something with only short term incentives into a long term payout is
something government excels at. Government can afford to pay things back
slowly without quarterly returns.

Private industry can still handle invention (possibly with NSF grants involved
in initial production cost and testing, maybe leading to partial government
ownership or a rebate during the eminent domain part) and production and
distribution.

~~~
zeveb
> Figure out fair market value for it

How would one do that without a fair market?

~~~
basch
lobbying :)

------
Gatsky
This proposal seems ill-founded. The idea that the public sector takes on the
risk of early development is a misuse of the word ‘risk’. No funding agency
ever thinks of investment in terms of financial risk. The money allocated to
an individual project is extremely small in the scheme of things, and research
budgets remain a small proportion of government spending overall. Pharma in
contrast spends 8-20% of total expend on research. The long term trends don’t
support this narrative either, with government spending becoming less
important and privately funded research increasing [1].

[1] [https://www.sciencemag.org/news/2017/03/data-check-us-
govern...](https://www.sciencemag.org/news/2017/03/data-check-us-government-
share-basic-research-funding-falls-below-50)

------
AnimalMuppet
How do you feel about the federal response to the corona virus? Do you feel
like they've done a good job, or does it more seem like incompetent fumbling?
And if it's the latter, why do you think they'd do better at running the
pharmaceutical industry?

------
lsh264962
Toll-free link for the full debate (which is actually more nuanced than the
title suggests):
[http://bmj.com/cgi/content/full/bmj.m769?ijkey=wQFPxA0MpG4ta...](http://bmj.com/cgi/content/full/bmj.m769?ijkey=wQFPxA0MpG4taog&keytype=ref)

------
apocalypstyx
We need more Dr Salks.

Could you patent the sun?

[https://www.youtube.com/watch?v=erHXKP386Nk](https://www.youtube.com/watch?v=erHXKP386Nk)

------
jononomo
Unfortunately the pharmaceutical industry has become corrupt. I don't know
about nationalizing it, but something has to be done to bring the industry to
heel. Please read Bottle of Lies, Katherine Eban's incredible new book about
deadly corruption that has ravaged the generic drug industry.
[https://www.amazon.com/dp/B07JG49BQW/ref=cm_sw_em_r_mt_dp_U_...](https://www.amazon.com/dp/B07JG49BQW/ref=cm_sw_em_r_mt_dp_U_BwwyEbX0ZH2G5)

------
tacone
Why not just creating a a national pharmaceutic company? Private companies
would continue to exist and probably protest about unfair competition, but
still it would be a good method to prevent them forming a cartel and at the
same time invest in much needed but not lucrative meds.

------
gammadens
My personal feeling about this, like a lot of things in the US at the moment
is that the required approach requires cutting across current paradigms.

More competition is required, which to my mind suggests introducing public
pharmaceuticals, but also deregulating drugs in general.

------
boublepop
The pharmaceutical Industry is not the problem. Nationalize the middlemen who
are taking 2/3 of the profits and you’ll normalize the American market
overnight.

------
WheelsAtLarge
Nationalization will only destroy the system that produces life-saving
medicines. We have seen it over and over again with other industries in other
countries. Priorities change for capitalized companies and eventually, the
golden eggs that are the medicines will stop.

The problem is that these companies have the wrong incentives and are
producing products where they think they can get the best profits.

This is where government policies will help. Governments need to give tax
credits for drugs that are needed and support the development of low-cost
alternatives to expensive life-saving drugs.

The Orphan Drug Act of 1983 has been responsible for the development of many
drugs that would never have been developed without a few government
incentives. We should learn from that and apply it to other drugs.

We bitch about farmers getting lots of help from the government but the result
is that we get basic foods at a very affordable price. We can learn from those
policies and apply them to pharma.

The capitalist system works. But governments need to change policies to tweak
the system so that companies develop what we need at an affordable price.

------
Der_Einzige
Now this would be actual capital S Socialism. I'm surprised to see this
advocated here

Tangentially related: Bernie Sanders should stop calling himself a socialist,
partly because he's never actually advocated for nationalizing industries
(redistributing the means of production to the "peoples state"), and partly
because it's so damn unpopular with the electorate to call yourself one.

~~~
KevinEldon
Medicare for All nationalizes the health insurance industry. The Green New
Deal would nationalize parts of the energy industry.

------
gojomo
Because we want all drug discovery, manufacturing, & distribution to be done
with the same efficiencies as the FDA, ICE, TSA, & CDC?

No, thank you.

------
lcall
Please, please, just: no.

I have some background studying Russian (including Soviet) history (a semester
class on Stalin, other reading, etc); we can observe what is happening to
Venezuela, and many other cases where it sounded good, to someone, to make
things better by more government control. I have experience dealing with
Medicare (USA) (details at
[http://lukecall.net/e-9223372036854586100.html](http://lukecall.net/e-9223372036854586100.html)
). And (I hope) some grasp of the underlying principles involved of freedom
vs. control, allowing mistakes vs. severely stifling _everyone_.

All of which most strongly persuade me that nationalizing more health-related
things is a _really_ bad idea. It prevents us from doing more good otherwise,
in the private sector.

Edit: One interesting positive is civica rx, a nonprofit that is a great
start, for example.
([https://duckduckgo.com/?q=civica+rx&ia=web](https://duckduckgo.com/?q=civica+rx&ia=web)
[https://en.wikipedia.org/wiki/Civica_Rx](https://en.wikipedia.org/wiki/Civica_Rx)
).

Other laws could be appropriate, but only very thoughtfully, with foundational
principles of liberty in mind.

------
swayvil
Obviously we should nationalize all necessities. Dead obvious.

~~~
AnimalMuppet
I can't tell if this is parody, sarcasm, or serious.

But in case you're serious: Sure, because that worked so well for the USSR's
food supply.

( _That_ was sarcasm.)

~~~
swayvil
Ya I'm serious.

The logic seems plain.

Grow your own food or hire a guy to do it for you, but the guy wants to skin
you.

------
zebrafish
My opinion is no. Share buybacks should be taxed as dividends. Tax credits
implemented for capital expenditures. Pharma patents should be subject to
export control. Nationalizing anything exposes it to the risk of flippant
regulation and pressure from the executive branch. Imagine if Trump had the
power to dictate which drugs were produced and researched.

------
ryandvm
I have never met a government employee or contractor that believes that
nationalizing ANY industry will result in increased efficiency. Anyone that
has ever spent any time in the industry usually spends the first few months of
their career trying to figure out of the organization can really be as
inefficient as it seems.

Letting government run something _may_ result in a more egalitarian
distribution of fairly shitty service (see USPS, VA Health Care, etc.) but it
absolutely will not result in a more efficient system.

~~~
kasperni
> Letting government run something _may_ result in a more egalitarian
> distribution of fairly shitty service (see USPS, VA Health Care, etc.) but
> it absolutely will not result in a more efficient system.

The US pays at least 2x more per capita for health care than pretty much any
other country on the planet. And I have never seen it even close to top-ranked
in any health care quality statistics.

------
glennvtx
No. First, it is unethical, and the antithesis of this countries founding
principal concerning freedom and free market forces. Remove the barriers to
entry and competition that government created, they have enabled the
monopolies that drive up drug cost. Holding the politicians and special
interest that lobbied for them responsible would be great as well.

