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Varitek 06-27-2007 11:57 AM

Quote:

Originally posted by Irvine511
at this point, what seems to make sense to me is what Romney (!!!) proposed in Mass, where health insurance is required of all citizens, in a manner similar to car insurance.
Don't be fooled, Irvine, it wasn't Romney but the legislature that came up with the proposal. Don't let him take credit for it when he tried to undercut it in several ways while it was being passed. He wants to take credit because of his presidential ambitions - just another case of him using and abusing Mass for his run.

anitram 06-27-2007 12:11 PM

Quote:

Originally posted by Irvine511

so what do we do, assuming the above is (generally) correct?

I don't really think it is totally correct. Because what you don't consider is that the governments of a lot of nations are subsidizing drug costs to make up the difference. And considering that the US pretty much has the lowest taxes of anyone, then the conclusion to be drawn is that from the grossly higher tax rates the rest of the western world is paying, a part goes to drug subsidy costs. The US citizens spend enormous amounts on prescription drugs because the government fails to regulate and fails to subsidize. The reason many other people pay less is because their government covers part of the cost. This could, of course be doable in the US, but you'd have to substantially raise taxes, which probably wouldn't fly.

Also, let's not forget that Americans are on average more medicated than other Western nations. If you have one patient in France and one in California, with the same conditions but the one in France is on 3 medications and the one in California is on 15...that is a fact you have to consider in looking at exactly why Americans are a cash cow for pharmaceutical companies.

We are not as "medicated" in Canada, but we are more medicated than Europeans. At one point I had a grandmother in Europe and one in Canada, both of whom suffered from the same stage of Alzheimer's. One also had diabetes, the other had cholesterol problems. The one in Europe was on 4 medications per day, the one in Canada was on 11. The difference was that the one in Europe wasn't prescribed sleeping pills, wasn't prescribed pills to keep her bowels regular, wasn't prescribed a pain killer in addition to an anti-inflammtory for her arthritis, etc. So in that sense, is it fair to say that one is subsidizng costs for another? Or is it a difference in how the medical system treats patients?

corianderstem 06-27-2007 12:27 PM

We're dealing with the Massachusetts situation in my department at work. Interesting stuff.

Irvine511 06-27-2007 12:40 PM

Quote:

Originally posted by anitram
[B]

I don't really think it is totally correct. Because what you don't consider is that the governments of a lot of nations are subsidizing drug costs to make up the difference. And considering that the US pretty much has the lowest taxes of anyone, then the conclusion to be drawn is that from the grossly higher tax rates the rest of the western world is paying, a part goes to drug subsidy costs. The US citizens spend enormous amounts on prescription drugs because the government fails to regulate and fails to subsidize. The reason many other people pay less is because their government covers part of the cost. This could, of course be doable in the US, but you'd have to substantially raise taxes, which probably wouldn't fly.

but how much farther could European countries continue to subsidize if the profit generated by the American market were to begin to shrink? would they somehow pick up the slack? does government subsidization have the overall effect of depressing the incentive to innovate?

i really don't know -- i'm new to much of this, just curious.



[q]Also, let's not forget that Americans are on average more medicated than other Western nations. If you have one patient in France and one in California, with the same conditions but the one in France is on 3 medications and the one in California is on 15...that is a fact you have to consider in looking at exactly why Americans are a cash cow for pharmaceutical companies.[/q]


but isn't the end result the same?

i'd agree that americans tend to be overmedicated as there's tremendous pressure on doctors to perscribe more and more medications for every possible ailment by drug companies. my father, a doctor, can testify to this.

but, to take a market view of this, perhaps this functions much in the way a movie studio might function. they need their big block buster $300m grossing movies to feed the studio so that a smaller, artier, better movie can be made with the cash that was generated. so maybe your pain can be managed as well with Tylenol, or almost as well, but it's the purchasing of the non-generic that generates the revenue that can then be invested into better, more expansive cancer research?

i suppose i'm just wondering if it's the lucrative American market -- no matter how it becomes lucrative, whether that is good or bad -- that has built an industry that is, down the line, keeping Africans with AIDS alive.

i think it's not so much that one is subsidizing the other, and more that we're all reaping the benefits from the American pharmecutical market, and the one's picking up the tab are Americans themselves.

anitram 06-27-2007 01:26 PM

Quote:

Originally posted by Irvine511


i suppose i'm just wondering if it's the lucrative American market -- no matter how it becomes lucrative, whether that is good or bad -- that has built an industry that is, down the line, keeping Africans with AIDS alive.

i think it's not so much that one is subsidizing the other, and more that we're all reaping the benefits from the American pharmecutical market, and the one's picking up the tab are Americans themselves.

To be honest, I think this is so overly simplistic that it ends up being inaccurate. For example, if you pay $40 for a medication in the US and I pay $10 for it but the government pays the other $30 our of my twice-as-high taxes...are you more of a cash cow? That's why I think that yes, your market is lucrative in terms of exploiting the people who are paying for the drugs and overmedicating them, but it's not necessarily more lucrative per drug. Does that make sense?

As for who is keeping Africans alive, probably nobody is doing it well. The drug companies will not do anything for free so they do have to make up the difference somewhere. But whether that drug company sells it to an American who is paying for 100% of the costs or to a Frenchman who is paying 25% but his government pays the other 75%....does it really matter to them from a business perspective?

I just think that once you adjust for all the quirks of the different systems, you'll find that we may not be reaping the benefits of an American market the way you think we are.

As far as innovation goes - I don't feel bad for big pharma at all because I'm very familiar with how they operate. And for all their whining and moaning about costs of R&D and decreased innovation, they behave the same way as Nike et al in outsourcing their work and making ridiculous profit margins. But for some reason, the media doesn't report on it and most people have no idea so they've been able to construct this narrative of "we must make billions of dollars of profit or everyone will die because we won't be able to make any new drugs." What a load of crock, honestly.

Irvine511 06-27-2007 02:32 PM

why are all the European big pharma companies doing their R&D in the US? sure, their headquarters might be in Geneva, but the work is done in the US. what blockbuster drugs have been created by European pharma?

i'm also wondering if your assertion -- that the government picks up the tab in Europe -- is correct. my understanding (and i could very well be wrong, and thank you for your insights, i'm just trying to learn more) would be that a drug in the US market could be sold at market value. i'm wondering if a pill in France costs the same as a pill in the US, only the government gives you a 90% co-pay, say, in France. so if all that needs to happen is the US government simply pays more of the cost to the consumer, then everything stays about the same? i had thought that governments themselves bargained with big pharma? that government, and not the market, sets pharmaceutical prices in European countries, and the negotiated costs per pill is significantly less than in the US market, and thus the US market is what big pharma relies on to make up the difference.

i agree with not feeling bad for big pharma, but i think the profit motive has an overall positive affect on the potential of the latest breakthrough, and some would argue that pharma must raise capital in the market, just like Nike, and their risk-adjusted returns on equity aren't egregious in comparison to other products.

i suppose a question would be whether or not innovation -- however that might be defined -- in pharmaceuticals could be purchased at a much lower cost, whether it is just as lucrative to deal with the US government rather than the US drug market.

my biggest beef, however, with big pharma, is the marketing. marketing should be allowed to doctors only, and not directly to the consumers.

again, more thoughts than assertions.

randhail 06-27-2007 03:57 PM

Another major problem with pharma is that these new drugs often are only marginally better than previous generation drugs. One company invents a drug and then all the other ones create a very similar drug that is always "better" than the competition. Just look at how many drugs are out there for ED. Pfizer made a killing on Viagra, then Bayer came out with Levitra, Lilly came out with Cialis, etc. They talk about the new drug being 10 or 15% more effective and yet the price increase does not reflect the marginal improvement.

Irvine511 06-27-2007 04:05 PM

^ sounds like iPods.

randhail 06-27-2007 04:18 PM

Quote:

Originally posted by Irvine511

my biggest beef, however, with big pharma, is the marketing. marketing should be allowed to doctors only, and not directly to the consumers.

That's what pharma has done best. They have such an efficient marketing machine. It would rival the world's best. How many drug ads did you see on tv 15 years ago? Close to zero. But that all changed in the 80's when medicine became viewed as just another business and a lot of the older views of medicine no longer applied. It was supposed to empower the patient and makes things better, but that's not really the case. I'm sure pharma would agrue that marketing is part of empowering the patient to have an active role in their treatment, but it certainly wasn't a bad thing that it would drum up business as well.

anitram 06-27-2007 05:24 PM

Quote:

Originally posted by Irvine511


my biggest beef, however, with big pharma, is the marketing. marketing should be allowed to doctors only, and not directly to the consumers.

A large reason for why they started doing this is because doctors got out of control in the 80s and were essentially bought by big pharma. It was standard practice to fly them out to Hawaii for 5 day "conferences" following which they essentially became shills for the pharmaceuticals. Civil liberties unions specifically, and newly emerging pharmaceutical companies became very opposed to this because doctors would regularly not provide options to their patients. If your back pocket is being (indirectly or directly) padded by a certain pharmaceutical corporation, how likely are you to make other recommendations? Doctors are not any more ethical than other professionals.

Unfortunately now people are in the business of Google diagnosing themselves and showing up to doctors' offices demanding certain drugs regardless of whether they are appropriate for them.

You have to somehow strike a balance between the two, but I'm not sure exactly what the best form of marketing would be.

anitram 06-27-2007 05:32 PM

Quote:

Originally posted by Irvine511
what blockbuster drugs have been created by European pharma?

LOTS. I don't know why there is a perception in the US that this type of work isn't being done.

I don't really feel like doing a ton of research but I can tell you right off the bat that Plavix (the 2nd biggest prescription drug seller in the world, by the way) was developed by Sanofi, which is French, which merged with Aventis (also European). In the US it's sold by BristolMyersSquibb, but it's most definitely a European patent.

Pravachol and Taxol are another two blockbusters, developed in Japan, and marketed/patented in the US by Bristol-Myers.

diamond 06-27-2007 05:59 PM

Does the Health Care system really suck that bad in Canada?

That's all we hear in the states and that Canadian women are both beautiful and unscrupulous.

Is any of this truth?

dbs

VintagePunk 06-27-2007 07:44 PM

Quote:

Originally posted by diamond
Does the Health Care system really suck that bad in Canada?

No, it doesn't, not at all.

In the past five years, I've spent more time in doctors offices, ERs and hospitals than I care to remember, due to the health of elderly relatives. The experiences have been overwhelmingly positive. In many cases, wait times for specialists, tests, surgeries and treatments are grossly exaggerated, and I've been pleasantly surprised by the speed with which treatment was carried out. Best of all, it's free and available to everyone.

I saw Sicko last night, and can't imagine living with the stress that many Americans do over their health care costs. I'm well aware of Moore's tactics, and the argument that he's taking the most extreme cases and highlighting them as the norm. But the fact remains that in the US, countless lives are ruined over medical costs, and that's a shameful state for a rich nation to be in.


ETA - I'm not sure if this has been addressed in this thread, but the focus of the documentary isn't the lack of universal health care in the US, it's focuses more on people who are covered by private medical insurance, and the difficulties they have in getting the coverage they're entitled to, when they actually do make a claim. Of course, the implication is that if circumstances are this dire for them, how must it be for those who have no insurance.

Irvine511 06-27-2007 10:35 PM

Quote:

Originally posted by anitram


LOTS. I don't know why there is a perception in the US that this type of work isn't being done.



i don't have time for the research either, but to flesh out the perception, it's that these companie might be European, and have headquarters in Europe, but the work itself is mostly done in the US.

that's just the perception.

diamond 06-27-2007 10:35 PM

Thank you for your clarifying response Ms V-Punk.

:)

dbs

anitram 06-27-2007 11:31 PM

Quote:

Originally posted by Irvine511

i don't have time for the research either, but to flesh out the perception, it's that these companie might be European, and have headquarters in Europe, but the work itself is mostly done in the US.

that's just the perception.

Are you familiar with Arthur Kornberg? He won the Nobel some 4 decades ago for his work in medicine (more accurately genetics - DNA transfer). Interestingly his son won the Nobel in chemistry last year or the year before, I believe. Anyway, Kornberg was an American researcher at Stanford who ended up spending his sabbaticals in the UK and collaborating a lot with UK scientists. And there is a very, very famous quote by him which says roughly, "I went to England and I realized then the difference. The English were doing brilliant things. The Americans were doing lots of things."

So I think the public perception exists because of who knows what - media, some weird sense of patriotism or whatever. It's certainly not the perception in the scientific community. Plenty of drugs are developed and patented in Europe, and a huge number in Japan.

shart1780 06-28-2007 01:37 AM

Wow, I actually agree wth Michael Moore here.

Still, I wouldn't trust this film. I don't think I could ever take anything this guy says seriously. He's a liar.

Irvine511 06-28-2007 09:06 AM

Quote:

Originally posted by anitram


Are you familiar with Arthur Kornberg? He won the Nobel some 4 decades ago for his work in medicine (more accurately genetics - DNA transfer). Interestingly his son won the Nobel in chemistry last year or the year before, I believe. Anyway, Kornberg was an American researcher at Stanford who ended up spending his sabbaticals in the UK and collaborating a lot with UK scientists. And there is a very, very famous quote by him which says roughly, "I went to England and I realized then the difference. The English were doing brilliant things. The Americans were doing lots of things."




anecdotes are nice, but i don't think this is coming out of some form of patriotism -- i'm just asking some questions and trying to learn more, and most of this perception is built less from the media and more from my friends who are members of the scientific community, many of whom did 1-2 year programs in the UK (at Cambridge, no less) after undergraduate but were dead set on returning to the US for graduate work because of greater opportunities available.

it's less that Americans are the ones making all these scientific breakthroughs, whether in pharmecuticals or whatever, and more that such things happen in the United States where there is a tremendous amount of capital available for innovation. the reason why 13 of the top 15 universities in the world are in the US is because of the capital available that attracts top talent from across the globe. (and note that the other two are British universities, which augments Kornberg's quote). in the last 15 years, the United States has won 93 Nobel Prizes; in second place is the UK with 9. the rest of the world combined has only 36. why? the US has a system that attracts and retains international talent. this has been true since Einstein.

and just to float the idea, i wonder if there isn't an impulse to downplay just how much goes on in the US out of a weird sense of nationalism or, perhaps, subtle anti-Americanism, the rolling of eyes and muttering "they think they're so great." and while i understand that, and can even sympathize with it (and do it in here myself sometimes at the mere mention of Resolution 1441), i wonder if the facts actually support that attitude.

Quote:

Plenty of drugs are developed and patented in Europe, and a huge number in Japan.
of course -- it's not to say that everything that happens happens in the US. but that a disproportionate amount of innovation/research/development happens in the US compared to the rest of the world combined, and much of the capital available to do all this comes from the American consumer.

which, in many ways, is a negative commentary on US society. it furthers the sense of stratification of society, of the dividing into privileged/not privileged, where the top get absolutely everything imaginable and the bottom foot the bill and is generally neglected. while European countries in particular are good at providing a good education to all, the US provides an unparalleled education to a few, and so health care follows suit.

i suppose the big question is whether or not we'd see this "innovation" continue if the US were to adopt a more socialized way of paying for pharmecuticals for it's citizens.

anitram 06-28-2007 09:24 AM

Of course the US attracts more people - your scientific research (private) is much better funded than anyone else's. That's as plain as night and day. You also have far more universities which do research because you allow for private institutions, which many nations don't. The endowment of a place like Harvard is enormous - how can you expect a publicly funded university like one of the London colleges (say Imperial) or Melbourne or Toronto to compete? They will never be able to, that much is a fact of life.

Would this innovation continue if the US adopted a more socialized way of paying? Of course. It isn't as if the US patients account for 90% of the drug costs. If your government hiked up your taxes (and remember how much more the rest of us are paying around the world), and partially subsidized drug costs out of that and negotiated some flat-rate deals with pharmaceuticals, you'd have much decreased drug prices, Big Pharma would take a small or maybe moderate pay cut (which they can MORE than afford to), and life would go on as it does. It's the pharma lobby that's disgraceful and has convinced people that innovation and R&D would stop. I mean, consider yourself, you are clearly a far above average individual and you're wondering whether the innovation would stop. I've never met anyone in the scientific community who thought so. Ever. And I've met more than my fair share. Which kind of tells you that the perception you have is the one which has been created out of the narrative crafted by big pharma. It's inaccurate and it's akin to fearmongering.

Irvine511 06-28-2007 10:14 AM

Quote:

Originally posted by anitram
Big Pharma would take a small or maybe moderate pay cut (which they can MORE than afford to), and life would go on as it does. It's the pharma lobby that's disgraceful and has convinced people that innovation and R&D would stop.


this is the insight i'm looking for, but to play the devil's advocate, and to reiterate a discussion had between myself and a rabid free-market friend of mine, it's the same profit impulse that drives the iPod (or Nikes) that drives AIDS drugs. that of course thing wouldn't come to a complete stop, that of course life would go on, but it wouldn't be as robust and nimble an industry as it currently is (or perhaps that's debatable). if not for the profit motive, would we have had the major breakthroughs with anti-retrovirals that we had in 1996?

i suppose that's an unanswerable question, but the capitalistic amongst us would point to that as a direct result of the free market. that government policies in the form of price controls imposed by national health-care systems harm the private sector. if the profits from the American market go down, then there will be less $$$ available for drug research.

but then, people will pay less for the drugs we already have.

i suppose it's a trade-off -- do you want to risk losing whatever profit motive may (or may not) spur someone to the next discovery akin to the anti-retrovirals of 1996, or do you want to ease the financial burdens on everyday Americans?

i dunno. but i'm glad i've done some reading on this. it's quite a conundrum -- and it gets at a bigger question which is how do we measure the "value" of health? can/should/is health commodified? to what extent? is this a bad thing?


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