Following Philip’s suggestion I use a different heading.
Dear Joe,
Thank you for your thoughtful response. And of course it is a very complex issue. At this point I just want to give more precision to my “problem statement” so we communicate better. When I say that we cannot afford to treat everybody at the very high prices set by big pharma I am not referring to the drugs already existing and whether we should ration them (we should not). I mean the invention of new drugs, not yet existing, for as yet unknown disease. Essentially, I am talking about the pace of discovery.
Increasing the pace of new discoveries is generally considered to be an absolute good. But I question it. If given a choice of whether to make the existing drugs available and affordable to all, or introducing new drugs that will be affordable to only a few, I would choose the former. Since we as a society are increasingly looking at the latter situation in the foreseeable future, I would not be so concerned with the prospect of a slower pace of discovery under the conditions of publically owned pharmaceutical industry, as long as it can dramatically reduce social costs. A utilitarian view.
Unfortunately, the incentives for the big pharma to introduce new drugs, including the role of venture capital, are pushing in the opposite direction.
Halina
From: Joe Zammit-Lucia [mailto:jo...@me.com]
Sent: Saturday, September 14, 2019 7:14 PM
To: Halina Brown <HBr...@clarku.edu>
Cc: Philip Vergragt <pver...@outlook.com>; sco...@googlegroups.com
Subject: RE: [EXT] RE: [SCORAI] public amenities instead of basic income
Dear Halina,
You are right to question what we can afford or not afford.
That’s a complex question in terms of how society wishes to spend its money. Do we want to spend more on education, healthcare, UBI, unemployment benefit, defense, culture and the arts, and the endless other things that we could spend money on.
And how does ‘society’ make those decisions?
And what is the best method for financing all of these things - public through the tax system? Private? Some kind of combination?
And knowing that we cannot afford to make all these innovations available to everyone all the time, what mechanism of rationing should we use? And how do we justify it to those people whose child, for instance, could be cured of a severe disease but someone somewhere decides the treatment is not affordable?
I would suggest that reducing these complicated questions for which no easy answers exist to equating pharmaceutical innovation with bankrupting the economy or that it’s all due to investors wanting easy returns may not do justice to the issues involved.
Maybe I read different things than you do, but in my world these questions are constantly being discussed and argued over - and not just by moral philosophers.
Best
Joe
Dr Joe Zammit-Lucia
+31 646 86 21 76
On Sep 14, 2019, at 9:31 PM, Halina Brown <hbr...@clarku.edu> wrote:
Thank you Philip, for these comments. I would go a step further with my critique of innovation in the pharmaceutical industry. We all take the concept of innovation as an absolute good. But is it really an absolute good if it bankrupts the economy? Do we really have enough money as a society to pay a million or two dollars per person for the future yet unknown cures to some yet unidentified diseases? This is not a new question among moral philosophers but I do not hear it being discussed at all in the public forum. There is a reason why most of the costs of bringing new pharmaceuticals to the market is covered by venture capital: the expectation of quick and huge returns to the investors and shareholders.
Halina
From: Philip Vergragt [mailto:pver...@outlook.com]
Sent: Saturday, September 14, 2019 10:09 AM
To: jo...@me.com; Halina Brown <HBr...@clarku.edu>
Cc: 'sco...@googlegroups.com' <sco...@googlegroups.com>
Subject: [EXT] RE: [SCORAI] public amenities instead of basic income
Dear Joe, and all,
With the danger of being labeled as a retro 60s or 70s adept, I’d like to discuss the drive for more and more innovation. First, I think that it would be useful to consider public-private partnerships with strong and clear rules as to profits and ethical research. Next, biomedical research takes us with the speed of light towards cloning humans and gene-editing and whatever these new technologies are being called, without a viable discussion about the desirability of that all, and about possible negative side effects. That takes me straight to Joe’s point about innovation. While I see the benefits of biomedical innovation and we all benefit from it in our personal lives, I would like to propose that we do not take “more innovation is better” for granted; just like we are questioning economic growth and unbridled consumerism. Innovation should be led by social consensus, not by profit making.
I agree that most innovation comes from smalls start-ups; and it is not easy to regulate that; but the implementation comes through buying up of small start-ups by large corporations; and there is the possibility for public intervention and regulation.
Warm regards,
Philip
From: 'Joe Zammit-Lucia' via SCORAI [mailto:sco...@googlegroups.com]
Sent: Friday, September 13, 2019 12:45 PM
To: Halina Szejnwald Brown
Cc: sco...@googlegroups.com
Subject: Re: [SCORAI] public amenities instead of basic income
Dear Halina,
With respect, I find the paper circulated to be well off base.
Public ownership of pharmaceutical research and development was tried in the 60s and 70s in some countries. It was an absolute disaster. Innovation stalled amid the public bureaucracy and lack of real incentives to innovate. Bureaucracies don’t innovate, they mainly spend their time justifying why they should get bigger budgets.
The authors clearly have no idea of the dynamics of pharmaceutical innovation most of which now comes from agile startups funded by the financial markets rather than big pharma. This is emerging as the only way in which the high risk nature of pharmaceutical research and the need for global availability of innovation can be sustained. The idea that government monopoly (with all the inevitable political shenanigans that it involves) can carry this sort of risk profile is laughable.
I also personally find the retrograde discussion of pitting private vs public a tiresome throwback to the 1970s. I thought we were done with all that and that most people had moved on to an understanding that a mixed economy works best provided we keep working towards refining the incentive structures - which are currently out of whack - and can get better but will never be perfect.
The issue of healthcare funding and access is a very valid one but one that is proving to be highly intractable in most countries. Would be great if there were some magic bullet but there isn’t.
And it’s not just the difficulty of trying to work out appropriate pricing for drugs (an impossibility) but also gets one into what should doctors, nurses and everyone else get paid? What is the right price for an MRI scanner? Should governments be building those too? And everything else?
I have no easy answers I’m afraid. And, sadly, neither does anyone else.
Beware those selling snake oil.
Best
Joe
Dr Joe Zammit-Lucia
+31 646 86 21 76
On Sep 13, 2019, at 2:20 AM, Halina Brown <hbr...@clarku.edu> wrote:Dear SCORAI’ers,
Some of you may find the attached document about the public alternative to Big Pharma interesting. It is a fine report issued by the Next System Project in the US. The proposal in it focuses on the US but it can be just as well applied in other advanced economies with a strong research sector.
https://thenextsystem.org/medicineforall?mc_cid=9bc87732e4&mc_eid=e81c2d3d7d
I find this proposal to be an important alternative to guaranteed basic income proposals. I have always been uncomfortable with the idea of guaranteed basic income because I see it as a massive indirect subsidy for the private sector that wants people to spend money on more and bigger stuff. This sector will surely devise the cleverest of ways to extract that extra income from citizens.
At the risk of sounding awfully patronizing, I believe that many people will spend that extra income not on better housing, live necessities, education for their children or other such “wise” choices, but on other things.
A better solution, other than distributing cash, is to create access to affordable high-quality housing, high quality free education, low cost or free healthcare, and low cost or free medicines, etc. This is why I find this report interesting.
Halina S. Brown
Professor Emerita of Environmental Science and Policy
Clark University
Worcester, MA 01610
http://halinasbrown.comAssociate Fellow
Tellus Institute
2 Garden Street, Cambridge MA 02438
Co-founder and Member of Executive Committee
Sustainable Consumption Research and Action Initiative, SCORAI
www.scorai.org
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Following Philip’s suggestion I use a different heading.
Dear Joe,
Thank you for your thoughtful response. And of course it is a very complex issue. At this point I just want to give more precision to my “problem statement” so we communicate better. When I say that we cannot afford to treat everybody at the very high prices set by big pharma I am not referring to the drugs already existing and whether we should ration them (we should not). I mean the invention of new drugs, not yet existing, for as yet unknown disease. Essentially, I am talking about the pace of discovery.
Increasing the pace of new discoveries is generally considered to be an absolute good. But I question it. If given a choice of whether to make the existing drugs available and affordable to all, or introducing new drugs that will be affordable to only a few, I would choose the former. Since we as a society are increasingly looking at the latter situation in the foreseeable future, I would not be so concerned with the prospect of a slower pace of discovery under the conditions of publically owned pharmaceutical industry, as long as it can dramatically reduce social costs. A utilitarian view.
Unfortunately, the incentives for the big pharma to introduce new drugs, including the role of venture capital, are pushing in the opposite direction.
Halina
From: Joe Zammit-Lucia [mailto:jo...@me.com]
Sent: Saturday, September 14, 2019 7:14 PM
To: Halina Brown <HBr...@clarku.edu>
Cc: Philip Vergragt <pver...@outlook.com>; sco...@googlegroups.com
Subject: RE: [EXT] RE: [SCORAI] public amenities instead of basic income
Dear Halina,
You are right to question what we can afford or not afford.
That’s a complex question in terms of how society wishes to spend its money. Do we want to spend more on education, healthcare, UBI, unemployment benefit, defense, culture and the arts, and the endless other things that we could spend money on.
And how does ‘society’ make those decisions?
And what is the best method for financing all of these things - public through the tax system? Private? Some kind of combination?
And knowing that we cannot afford to make all these innovations available to everyone all the time, what mechanism of rationing should we use? And how do we justify it to those people whose child, for instance, could be cured of a severe disease but someone somewhere decides the treatment is not affordable?
I would suggest that reducing these complicated questions for which no easy answers exist to equating pharmaceutical innovation with bankrupting the economy or that it’s all due to investors wanting easy returns may not do justice to the issues involved.
Maybe I read different things than you do, but in my world these questions are constantly being discussed and argued over - and not just by moral philosophers.
Best
Joe
Dr Joe Zammit-Lucia
To view this discussion on the web visit https://groups.google.com/d/msgid/scorai/BN3PR03MB214722C5F70D7116F3B2F704AC8D0%40BN3PR03MB2147.namprd03.prod.outlook.com.
- Submit an item to the monthly newsletter: lizb...@gmail.com
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