Government money for funding healthcare research is better than private funding.

Discussion in 'Topics in Healthcare' started by 2BeDentist, May 11, 2008.

  1. 2BeDentist

    2BeDentist New Member
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    Please comment on the subject title.

    What do you reckon are the pros and cons of public funding/government spending on research and healthcare? Or in general, even?

    Do you think private funding is better off than public funding?

    I want to have an honest and intelligent discussion overhere. Would love to hear everyone's opinion on this topic. :)
     
  2. 2BeDentist

    2BeDentist New Member
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    Any thoughts? :D
     
  3. cpants

    cpants Member
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    Government funding is good because it can focus on the questions that have the most impact healthwise for the US population, as opposed to the questions that have the most profit potential. Also, unlike some industry sources, the funding source is not necessesarily looking for a specific result from your research. The drawback is that the money comes out of the taxpayers' pockets. Also there is no constitutional justification for most government-funded research (I know most of you probably don't care about that.) I think a happy medium would be independent non-profit organizations that provide funding to researchers to investigate important questions.
     
  4. Miami_med

    Miami_med Moving Far Away
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    Everyone is looking for a specific result. The distinction is just that the motivator of the desired result is politics instead of a specific profit. All research needs to be taken with a grain of salt, public or private. Also, while government research seems to be the better option in terms of having more money, the idea that it is, "better," sort of falls apart when you think outside the box. Government taking over research has lead to all of the same types of restrictions and abuses that occurred when it took over medicine. The paperwork is equally overwhelming. Also, there are no good alternatives as the market tends to eliminate some of its private funding sources as charity seeks less well funded alternatives. Finally, more money in research doesn't equal better. A million dollars towards learning about the ideal diet for a child with PKU or a pill that increases HTN control by 0.8% isn't necessarily better than people who are struggling to make ends meet keeping their own tax dollars.

    Remember, the value of the market is efficiency, which tends to create more money overall. It is not always the best way to funnel money towards a specific pet project. Moscow had some of the most beautiful subway stations in the world at the height of the USSR. Of course, most of the people in the US just hopped in their personal cars that the Russians couldn't dream of affording at the same time. The stations were better, but subway stations wasn't the best use of the money at all, just like medical research is good but is not always better than other uses of the money. That's just an example.
     
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  5. cpants

    cpants Member
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    In general I agree with you. I think lessening our dependence on government AND private money from interested parties would be a positive step. The more research that is funded by uninterested third party organizations the better.

    I do think your Soviet example is slightly ironic considering our current energy predicament. If our government had invested more in our public transportation infrastructure over the past 50 years, we would be a lot better off right now.
     
  6. southerndoc

    southerndoc life is good
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    The perfect healthcare solution (in my opinion at least) would be all hospitals and healthcare organizations being non-profit or at least not-for-profit, and all insurance companies also being non-profit.

    Eliminate the profit motive of healthcare and you could really get quality, affordable care. You wouldn't have to deal with government red tape either.
     
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  7. docB

    docB Chronically painful
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    I just can't reconcile this quote with your Ron Paul avatar.
     
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  8. docB

    docB Chronically painful
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    This is the exact opposite of what we find in every other industry. You'll never get quality and affordability by removing the incentive to control costs.
     
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  9. cpants

    cpants Member
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    I was just responding to the OP's question. Constitutionally and logically, I don't believe that government funding is a good option, but there are some pros to it when comparing it to private companies providing the funding.
     
  10. kronickm

    kronickm even par.
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    Health insurance, or more generally insurance as a whole, is unique in that a company's profit is directly at odds with the service it is providing. I see this as a problem.
     
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  11. Miami_med

    Miami_med Moving Far Away
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    This is a perfect example of government malinvestment. The road infrastructure that supports the use of personal transportation was built by the government with the money that could have built a public transportation system. The entire transportation infrastructure in almost all countries is built by the government.
     
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  12. Miami_med

    Miami_med Moving Far Away
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    Yet it's not usually the disaster that it is in health insurance in other industries. Insurance should be used to pay for big ticket items that you could never dream of paying cash for. Homeowner's insurance is the example. Fighting with the insurance company would be a lot easier if it were only over experimental cancer treatment, as opposed to every bottle of Augmentin or annual physical.

    The profit is ALWAYS at odds with the service to a degree, but in a healthy market, the service must remain good, or the provider will be eliminated. As a restaurant, my incentive is to use the cheapest food possible, hire the cheapest chefs, and invest as little in ambiance as possible. I don't because people won't eat at my restaurant if I do that. Similarly, a healthy insurance market (which doesn't exist due to regulation), would havfe to do the same thing. Getting a reputation for not paying would get you to lose your clients

    Insurance falls apart in two places. One, is using insurance to pay for things that everyone needs. Using a middle man to pay for a physical is ALWAYS less efficient. I could pay the doctor $80 or pay him a $40 copay and have him fight for $20 from the insurance company while I pay the insurance company more money per month to get the physical included. It makes no sense.

    Two is chronic conditions. Insurance becomes complex in that respect, because a chronic patient is one who you DON'T want on your patient panel. This could be best handled one of two ways: #1: Have people buy a disability insurance that provides a flat amount of money for chronic conditions and have the medical providers fight over it or #2: Buy into a savings plan at a young age to create a chronic conditions fund. You still cut out the middle man, and most of us will have chronic conditions in old age.
     
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  13. JHopRevisit

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    Never mind, sorry.
     
  14. cpants

    cpants Member
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    You are off base here buddy. The interstate system was built back in the Eisenhower administration, mostly for strategic reasons. The malinvestment wasn't in building an interstate system. At the time that was a good investment, and our roads have been great for the nation. The malinvestment was building a huge welfare state while allowing our infrastructure to languish for the past 50 years. We never invested in a proper railroad system, and our roads and bridges are now literally falling apart due to neglect.
     
  15. Miami_med

    Miami_med Moving Far Away
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    I don't think that I mentioned the interstate system. The interstates outside of the cities aren't usually where the problem is. If I want to travel from Miami to NY, I can drive I-95, fly, take Amtrak, take Greyhound, etc... This is no problem, and it is relatively easy. It's within the cities of the last century that the lack of public transportation is a major problem. In this case, it's often the local governments that created the problem. I live in one of the fastest growing cities in the country. There are close to 6 million in the metro. We have a horribly inefficient bus system, two trains that go along one specific line and avoid most non-terrible neighborhoods, and we have a road system. What's worse, the train actually blocks the traffic in many places, which makes traffic worse. It's a local problem. It's a local government failure.

    A large scale interstate rail system is a horrible investment. We have heavily subsidized rail all across America right now. It's called Amtrak. They can't get ridership for $49 across multiple state lines. It's inefficient. The airlines are much more efficient for personal travel over significant distance. There's nothing wrong with the majority of Amtrak rides (except for the occasional spectacular crash). It just takes 3 days to take a trip that takes 3 hours on an airplane.
     
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  16. cpants

    cpants Member
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    Obviously you don't make this trip very often, because all 4 of those options are pretty awful. Expensive, slow, not easy.

    Amtrak is a subsidized mess, but the reason it is so bad is because the government subsidizes them instead of improving the infrastructure with that money. Our rail system is over a century old in most places. The trains are expensive and they are never on time.

    The airlines are in a shambles. Cancellations, unending delays, skyrocketing fares.

    The Greyhound is SLOW and not great for interstate travel beyond 4-5 hours.

    I-95 is legendary for being one of the most treacherous roads in the country. The congestion is horrible in almost every state it passes through.

    I agree with you that the local and national government needs to invest in transit infrastructure, both on the local and interstate levels. We need subways, rails, and airports all over this country. Like I said before, for 50 years we have been beefing up entitlements instead of filling a legitimate role of government, improving infrastructure.
     
  17. southerndoc

    southerndoc life is good
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    Taking Amtrak from Miami to NYC isn't easy, even with a direct route. It gets even harder to travel from Atlanta to St. Louis, where you must first go through DC.

    We need to really increase our rail infrastructure.
     
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  18. Miami_med

    Miami_med Moving Far Away
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    You'd probably want to find someone who wants to take the train first. Amtrak is heavily subsidized, and it still can't find many takers. The concept of bullet trains taking us from city to city sounds great until we realize that very few people are interested in using them.
     
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  19. cpants

    cpants Member
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    Amtrak service is crap. People would want to use bullet trains from city to city. They don't want to use molasses-slow, unreliable trains, subsidized or not.
     
  20. Miami_med

    Miami_med Moving Far Away
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    If there is such a demand that is obvious to everyone, why haven't any private enterprises put their money into it? I'm not very familiar with the law as it relates to the railway, but I'm going to guess that: a)there are restrictive laws to protect Amtrak that make this illegal or b) no one really thinks the demand is there to make money. It's pretty much got to be one or the other.
     
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  21. cpants

    cpants Member
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    There are tons of reasons that private companies would not want to put their money into improving rail infrastructure. For one thing, they probably can't. Building new/better rails will involve using eminent domain, fighting local and state governments, and investing many, many billions of dollars. There just aren't many companies that have the resources to do something like that. This is a project that probably must be undertaken by government.

    Regardless, I wasn't trying to claim that building better rails would be profitable. The point of huge infrastructure projects like this are not to turn a profit, but rather to improve the nation.

    Your claim that there isn't demand for the better rail service based on Amtrak's ridership is pretty silly. Look at the rest of the world. Europe and Asia have great rail service and plenty of business. Why would America be any different? No matter how much we subsidize Amtrak, people are not going to ride it if the service sucks.
     
  22. Miami_med

    Miami_med Moving Far Away
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    Well, for one, Europe is MUCH more condensed than the US, with major national capitals often closer to each other than the big cities within states in the US (with the exception of the NE where there actually IS a reasonable amount of rail service). The rail infrastructure to go from Madrid to Paris to London or Berlin is infinitely cheaper than the infrastructure to go from even say, Miami to Chicago. On top of that, there are many more major cities along the way, a generally denser population, etc... It's really not the same.
     
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  23. mshheaddoc

    mshheaddoc Howdy
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    Gov't money would sufficiently pay for everything if we had higher taxes but as a society we do not want that (or so I'm assuming since people don't like to pay taxes because the gov't doesn't offer alot of services that everyone can use - vicious little cycle isn't it?).

    I believe that private funding is no different than gov't funding. The sooner we realize that our government involvement isn't going to be necessary, unless we want to end up in a communistic society with everyone having 1 child, and we work with private/public funding in order to solve our problems the better. Witht he red tape up throughout our "democratic" system, I don't see many of our problems solved (from a healthcare perspective) with governmental funds.
     
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  24. Sol Rosenberg

    Sol Rosenberg Long Live the New Flesh!
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    This has to be one of the dumbest statements I've read in a long time. First off, "Asia" (the continent) doesn't have great rail service -- some countries (like Japan) do. What is common between Europe and Japan? Well, probably lots of stuff, but most relevant here is high population densities. Name me some other countries with geographical areas comparable to ours that have a successful national rail system? Russia? Nope. Canada? Nope. China? Nope. Along those same lines, Amtrak DOES have some successful areas of service, namely their "Northeast Corridor" (Boston - Washington, DC) and, I believe, southern California (San Diego - Los Angeles,) but I could be wrong about the latter. What can you tell me about the population density of those areas? It's just not viable to travel from NY to San Francisco via rail. The service "sucks" because trains can't travel 300+ MPH over long distances.
     
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  25. Miami_med

    Miami_med Moving Far Away
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    With the exception of the "dumbest statement," point which we should try and avoid, this pretty much sums up what I was trying to say quite nicely.
     
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  26. cpants

    cpants Member
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    First of all, you don't have to get nasty. Fine, I should have said Europe and parts of Asia.

    True, it is probably not feasible to have high speed service from coast to coast, but the Northeast, the West coast, and parts of the southeast are plenty dense to support high speed rail travel. I don't know where you are getting the NY - San Fran thing from. I never claimed that rail would be able to compete with the airlines on routes like that.

    Have you people ever even taken these Amtrak trains? The NE corridor line is plagued by delays. Like I've been saying, the rail infrastructure is more than 100 years old in most places. Stuff breaks. Our other transit infrastructure is having problems too. Bridges collapsing, airport delays, train delays...these problems are the result of neglecting our infrastructure for the past 50 years. We are trillions in debt, and what do we have to show for it?
     
  27. Geri_Gal

    Geri_Gal Loving Life
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    This. Big Pharma has been allowed to propagate unchecked and where has that left us? We have 3 drugs for erectile dysfunction, massive quantities of expensive direct to consumer/provider ads, very expensive drugs financially crippling our senior citizens and chronically ill, and enormous profits for pharma executives/shareholders.

    In an ideal world, this would be perfect. We Americans need to see that the rhetoric about unfettered capitalism (which has become much like what existed at the turn of the last century) given by main stream media and politicians only exists to strengthen for-profit corporations...NOT to better our lives.

    In the real world, health care/research cannot exist as a purely for profit model as it serves the needs of shareholders/corporations above serving the needs of the people.

    Our government derives its strength from reflecting the needs of the society. It reflects us..we, the people. If we are unhappy with, fear, or distrust our government, then it is our responsibility to advocate for change.
     
  28. Miami_med

    Miami_med Moving Far Away
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    Well, I'd blame physicians for this, not big pharma. We prescribe expensive drugs over cheaper alternatives all the time. Consumers ask for the expensive drugs. We're usually the ones who stick an -artan on every HTN without trying HCTZ, lisinopril, etc..


    [/QUOTE]
    The needs of shareholders reflect the desire for profit, which should reflect the desires of the people. If there is a disconnect, you need to find the regulation causing it. In this case, 3 drugs for ED is probably perfectly in line with the will of the people, and your anger should be aimed at the culture at large over which the decision to market ED drugs is made. The people want ED drugs. If they wanted to support cheap drugs for seniors, they are quite capable of doing so. The drug companies only give the people what THEY want.
     
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  29. Geri_Gal

    Geri_Gal Loving Life
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    Physicians need to work together to help change things...and avoid self-flagellation. Why do physicians prescribe "-artan" drugs? Those drugs are heavily marketed. HCTZ is not.

    My continuity clinic is at the VA. If I do not prescribe HCTZ as a first line drug for HTN, then the EMR "flags" me and I am asked to justify why I did not do this. Despite what you'll hear in the media about the VA, our outpatient outcomes are good in terms of HTN, DM II care, etc.

    The people want inexpensive drugs for seniors and that was the motivation for Medicare Part D. Unfortunately, it was only a boon for the insurance and pharma industries and a boondoggle for most seniors.
     
  30. Miami_med

    Miami_med Moving Far Away
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    We don't have to listen to the marketing. We choose to. We do it BECAUSE our patients are largely covered by insurance (regardless of what the media shows) and because we are so incredibly liable outside of the VA for even the most minute of bad outcomes, that we always want to look like we did everything possible. This is a problem with the legal system. All pharma does is make a product and market it. We choose to prescribe it, and the patient chooses to buy it. We are not exempt for the responsibility here. The VA can operate differently because a)they have a nationally negotiated formulary and b) they are not legally liable for any adverse events associated with restrictions to its use.

    No. If the people wanted inexpensive drugs for seniors, they would open their wallets and attempt to fund it themselves. Medicare Part D is simply a classic example of a bunch of guilty feeling people trying to assuage their own consciences by telling the government to solve the problem with OTHER people's money. It's sort of like, "yeah, I think seniors should have cheap drugs. We should provide them with the tax money from those 'rich people.'" Of course, the government ALWAYS indulges its special interests when passing policy. Giving more power to the government in research funding simply allows them to indulge these interests with the research money. Medicare D is a perfect example of what happens when you turn the power over to the federal government. It falls behind the littany of other boondoggles that they've exacted upon the american public by playing one set of interests against the other.

    People want to buy ED drugs. People want other people to buy cheap drugs for seniors. It's that simple.
     
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  31. kronickm

    kronickm even par.
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    Private industry ALWAYS indulges its special interest as well, making cold hard cash money. You can certainly say that we have three ED drugs because that is what people want to buy, or that people really want to be rid of their restless leg syndrome. But you can also see that people want what the marketing department at Pfizer tells them they want.

    In the end, the average consumer is not bright enough to make smart informed decisions about much of anything, and someone who can needs to pick up the slack and help him out.
     
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  32. Miami_med

    Miami_med Moving Far Away
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    That's why we have physicians. You'd be hard pressed to make a good argument that the government should be telling the consumer what he wants.
     
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  33. cpants

    cpants Member
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    The point is, what the consumer wants is not necessarily the best use of research dollars. I agree that the government should not be telling consumers what they want. If they are going to be using our tax money for drug research, however, they better be applying it to the areas that have the most potential to improve our health, not the most potential to generate sales.

    The best source of research funding is private, philanthropic foundations. They can sponsor projects that will help the most people, without the corruption of government or private industry. A great example is the Bill and Melinda Gates Foundation, which is pouring hundreds of millions of dollars into research of things like antimalarial drugs. Millions die from malaria every year, but there have been basically no new malaria drugs in the past 30 years. Why? There is no sales potential because only poor people get malaria. Meanwhile, the drug companies keep cranking out the SSRI's and ED drugs.
     
  34. docB

    docB Chronically painful
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    That's the best summary of the central argument for socialism I've seen recently.
     
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  35. kronickm

    kronickm even par.
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    Thank you.
     
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  36. m3unsure

    m3unsure Junior Member
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    Well, pharma does look out to real world and survey people for what drugs they would like to see. They don't just throw millions into something that wouldn't sell. Pfizer did well by tapping into American culture. Boners are more important than I don't know everything else.

    And dumb consumers are everywhere in the US. Somehow the government should bail these fools out (e.g. foreclosures). I'm sick of being responsible about my life to only see these Fers who should really just be my slaves if they are so dumb get away with stupid decisions.

    That's why I can probably never vote Democrat again ever. I can't support a fiefdom of welfare. Socialism brought dumb ideas like Medicare. Why the hell is America taking care of those older than 65? Let's do it Inuit style where they ship there old folks off on icebergs. Our old folks just whine about how the system owes them something kind of like some current generation AAs or even the illegals who think the process of naturalization doesn't include them. When oh when will this country just learn to say NO?

    Better yet, when will doctors get involved and just learn to say NO? Here's the truth. Your salary/service is worth more than your patient. Protect yourself, not your patients because they will easily turn on you to make a quick buck. Dirty savage truth of modern medicine.
     
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  37. kronickm

    kronickm even par.
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    You are one enlightened individual.
     
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  38. Geri_Gal

    Geri_Gal Loving Life
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    8/10, solid "B -" work for trolling...

     
  39. logos

    logos 100% Organic
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  40. logos

    logos 100% Organic
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  41. kronickm

    kronickm even par.
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    I don't have a problem with the R&D for these drugs, just the marketing.
     
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  42. cpants

    cpants Member
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    I don't have a problem with R&D for lifestyle drugs either. They are obviously profitable, and as private corporations, drug companies owe it to their shareholders to try and make as much profit as possible. I would argue, however, that from a public health standpoint, investing hundreds of millions in lifestyle drugs is not a wise use of the money. This is the disadvantage of relying on for-profit drug companies to fund R&D.
     
  43. Miami_med

    Miami_med Moving Far Away
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    The reason that drugs that stop infectious disease AREN'T profitable, is because the system prevents them from being so by implicitly controlling their price. For example, we have largely controlled the scourges that destroyed many a previous civilization. Smallpox is dead, TB is atleast treatable in countries that don't get in the way, Polio, all of the flavors of the MMR, etc... We also ALL know that if we're sick, we can pop into the ED. No one will ever withold treatment (regardless of what all of the people claiming that people can't access healthcare in the US say.) The drugs that we use to save you come at a price, but it is a price that is always regulated by the fact that at the end of the day, you can simply not pay it, and the worst that will happen to you is a black mark on your credit report.

    In a market that didn't give away drugs for free, Zosyn and Vanc would be hot commodities. People would pay a lot of money for a new drug that could cure a cancer or prevent a second MI. In today's market however, these prices are controlled, either by those that won't pay or an insurance market that devalues them with government backing.

    ED drugs on the other hand usually hit the market as a cash business. When they do make it onto insurance plans, they are high tier and still make a lot. No one demands that people get Cialis as some sort of moral assertion.

    The result of the politically correct government backed R&D that has occurred has led to a million drugs to prolong the lives of HIV patients (doing nothing to stop the spread of the disease might I add), which make up a microscopic portion of the total US population. I live in the AIDS capital of the US, and we still have an HIV rate of less than 2% in the highest risk populations.

    Drug companies on the other hand have pushed millions into drugs to control cholesterol, HTN, various cancers, and DM. These are the scourges that actually kill most people in our country. Everyone is talking about Cialis, but no one is saying anything about Byetta, the ARBs, or any other drug developed in large part by private money.
     
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