What if we nationalized the drug industry? Just turned all of us into national research institutes, a public utility of the sort beloved by Martha Angell: like the post office, but with Erlenmeyer flasks?
I think something would be missing, and you might be surprised to hear what it is. It's fear. Oh, and greed, too - mustn't forget greed. Those two are the main movers of capitalism, which is why, aesthetically, the whole system drives some people nuts. Wouldn't it be nicer to let some finer feelings run things for a while? Well, who knows, because we're not going to find out as long as we're the species we are. Attempts to substitute allegedly higher-octane fuels haven't worked out as planned, to put it delicately.
Not that I have anything against altruism. I like the fact that the work I do could eventually help desperate people. But clinical success is so far away, off in the hazy distance, that it would be easy just to roll along at a comfortable pace. It looks about as close as it did last week, so what's the difference? But that doesn't cut it. To really keep things moving along in the drug industry, we need what every other industry needs, namely, the feeling of someone else's breath on our necks. Believe it, every time someone in my business makes a big discovery, the next thing they do is start wondering if someone else hasn't just done the same thing a week before at another company. Scooped! Aargh!
It happens. I've seen several photo finishes in my research career, and the order can be worth tens or hundreds of millions of dollars. The times are posted on the first page of the patent filings, which is where you can see the earliest priority date. (In the US, the date at the bottom of the lab notebook page is important, too.) Every day we haven't filed on a new drug series is a day that we wonder if someone else will, and the jitters continue even after the patent's been submitted. You won't see the applications publish for many months, and that lag time could be when you find out that someone beat you. The longer it takes to find out, the worse it feels when it happens.
So we race each other in the clinic, all the way through, trying to figure out what everyone else is up to, and then we fight it out in the market. And it's a mess! It's inefficient and it's wasteful! But the hellacious part is, it's the best way that anyone's found to do it. We chase the reward of a successful drug, and we fear failure - losing out to another company, or worse, losing out to hordes of swarming lawyers. What else would make us jump as high, what else would make us run as fast?
1. Klug on October 12, 2004 1:11 AM writes...
Undoubtedly, this pharmaceutical public utility would feature salaries that were similar to that of public service. (Good God!)
Who would work as an organic chemist (especially a PhD) in this utility? Why spend five years in graduate school (working night and day) and two years in a post-doc for that kind of salary? No thanks, really.
Permalink to Comment2. William Knight on October 12, 2004 1:14 AM writes...
First of all, let me say that I am not advocating that we nationalize the drug industry. Second, I think that there is a lot of history that attests to the success of our free market, capitalist system.
That being said, I have problem with the sentiment that says, "although free-market drug development may not be perfect, it's the best thing we've got".
The reason why is because I think it implicitly asserts that we have only a simplistic choice between our current economic system and something worse.
Of course, if we pursue the question, it can naturally grow into an extremely complicated and interminable one that is more in the realm of economists and historians than scientists.
So I will just throw out a little point that I think is not considered enough, especially in the current political debates.
I believe that there is very good evidence that a free market can only function in the right conditions. What those conditions are may depend on what you are trying to achieve, but we know for certain that in times and places of great violence and chaos (such as Iraq), the free market does not work very well at all for achieving complex goals, even though it may work just fine for buying chickens in the market place or something.
For complex goals, I assert that the free market requires various stable, long-term conditions in which the driving forces of fear and greed can express themselves in a more productive way.
For the very very complex goals related to drug development, the 'necessary' conditions for the functioning of a free market may not even be fully understood.
It is entirely possible that recent trends in the political process, corporate lobbying and intellectual property litigation may be creating conditions that are really incompatible with 'free market' drug development.
To say whether this is true or not requires a lot of really hard analysis. I belive that a lot of dedication and desire are needed in order to understand what the best economic choices would be.
I think saying that this is the best system we've got because fear and greed are powerful motivators is just way too simplistic.
Permalink to Comment3. Greg Hlatky on October 12, 2004 6:07 AM writes...
Q: "What else would make us jump as high, what else would make us run as fast?"
A: "Prisoner, you did not fulfil your daily norm of washing 2500 round-bottomed flasks. No gruel ration for you!"
Permalink to Comment4. jeet on October 12, 2004 4:42 PM writes...
The drug industry as a public utility is pretty bad idea as far as I'm concerned. Public utilities have almost no economic pressure to improve service levels or adopt new technologies.
Anyways we already have a national body kind-of capable of drug development, the NIH. Maybe the NIH could fund phase III studies of generic drugs in an attempt to expand their labels and supporting data. This way any benefit of the research handed to the general population.
Permalink to Comment5. CatCube on October 12, 2004 10:40 PM writes...
I thought that Zach at Jane Galt's site said it best, that having the government parceling out monies for hundred-million dollar projects that fail for reasons that laypeople don't understand is a recipe for massive abuse.
Go to the second to the last comment of the link in the post below this one.
Permalink to Comment