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Defenders of drug monopolies often argue that removing the monopoly will reduce our intensive drug research spending. This may be true. However, I'd argue that the focus of this intensive drug research spending is perverted by economic incentives and overinflated because of the artificially constrained scope.

For-profit Pharma companies have a fiduciary obligation to only invest in research which they can profit from. This leads them to only invest in research in the tiny proportion of "interesting drug candidates" that can be monopolized.

Ex. - Imagine scientists find that saffron can be an effective antidepressant with few side effects. They research the active molecule and find that adding a bromine atom would make the molecule patentable, but it is slightly less effective and has more side effects. The drug company has an incentive to spend great amounts developing the less-effective patentable drug, and no incentive to research the other. Drug company has incentive to try to convince the public that their inferior molecule is actually preferable.

Now, we have a lot of data about the safety of saffron - people have included in their diets for hundreds or thousands of years. If this can be used to treat depression, it will likely have a much better safety profile than a novel molecule which has never been ingested by humans before. The therapeutic index of saffron (delta between effective dose and aversive side effect dose) is huge! Likelihood of getting it through safety trials has very high bayesian prior.

(Saffron as antidepressant is an area of recent research - all papers I've seen published by academics https://scholar.google.com/scholar?hl=en&q=saffron+antidepre..., I made up the bromine part for the example. Saffron may also be useful as anti-tumor and in ADHD treatment)

Pharma Co's may be investing intensely in researching a tiny fraction of drugs, but this fraction is less likely to contain the safest candidates and thus I don't think those dollars are being spent very effectively.

Unless money starts growing on trees, it makes sense to invest in the profitable drugs, that way you can fund future research.

Investing in a tiny market and low prices means that investment is gone and won’t support future R&D.

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