Who's to say that the EU/China/etc wouldn't cooperate fully. Right now only a few countries can launch satellites with these capabilities, and while they'll certainly use them against each other I'm sure a gentleman's agreement exists that they keep 3rd parties from getting access to sensitive stuff.
Besides, you can restrict satellite operation one way or another. If a 3rd-party balloon showed up over a civil-war battlefield offering imagery to the highest bidder it would simply be shot down. I'm sure any army with the capability would consider disabling or destroying 3rd party satellites if it were strategically necessary. It would be tolerated to some degree, but if a company didn't play ball when the time came to gather forces for some major sneak attack, I'm sure there would be "technical difficulties" - perhaps jamming of some sort, perhaps a spy planted in the operations center of the company operating the satellite, perhaps lasers, or perhaps an ASAT of some kind. Most likely it would just be the right amount of cash in the right hands and an appeal to "patriotism" of some kind. Unless we're talking about a major tension between superpowers whatever country the satellite owner is hosted in will just ask for a fine from the world court to save face and it would get paid or not a decade later long after the actual military conflict is decided.
Keep in mind we're talking dual-use technology. If the NRA showed up in an occupied nation issuing "hunting rifles" to anybody who wanted one I'm sure just about any nation with troops there would put a stop to it. Satellite imagery isn't as black-and-white as guns, but at particular moments I'm sure nations will want to make it scarce.
That's not really relevant to the question whether Big Pharma is especially innovative; it is scarcely a contestable issue. A huge amount of effort goes into 'me, too!' drugs of dubious utility that exist solely for the purpose of extending the effective lifetime of the effective monopoly on its production (notice the word "effective" before engaging in a legalistic argument.)
Me too drugs allow a company to sell an alternative treatment for a condition that already has a treatment. Often they're developed by companies other than the original innovator. They do not in any way extend the patent of the original drug, but the new drugs have their own patent lifetimes. A good example of a me-too drug is Lipitor - the original statin was Zocor and Pfizer came up with a molecue that did the same thing only better. Today you can buy generic simvastatin (the active ingredient in Zocor) for about the marginal cost of production. Or you can buy Lipitor for a lot more. Many people opt to pay more for Lipitor because it simply works better. However, they still have a choice and can buy the slightly older product for far less. Many insurers require that patients try the cheaper drug first and see how it works. If you got rid of me-too drugs then everybody would be buying the cheaper meds, but only because that was all that was available.
So, in some sense me-too drugs prolong patent lifetimes, but consumers still have a choice and can stick with the original product and obtain it cheaply. It is like saying that Intel props up computer prices by coming up with faster CPUs - if they didn't invent new CPUs all computers would be $300 or less. But of course they'd all have 486 processors. So it isn't like we're not getting anything for the extra money.
The other benefit of me-too drugs is that they give physicians choices. In a sense every antibiotic since penicillian has been a me-too drug, and yet doctors are lamenting the dearth of new antibiotics. The reason is simple - a particular drug doesn't always work in every case - either due to a problem with the disease (drug resistant bacteria in this case), or a problem with the patient (allergies). All drugs have side effects, but often patients can tolerate one drug to a greater degree than other me-too drugs with the same function. Having a choice means that doctors can find a therapy that works better for the patient, as opposed to a situation where exactly one molecule is available for one disease.
Finally, me-too drugs lower costs. They introduce competition. Zocor would have been a lot more expensive for the decade of its marketed patent life if it weren't for Lipitor competing for the same patients. Now, the costs don't drop to post-patent levels, but they can drop quite low compared to drugs with no competition whatsoever. How expensive would a 4-passenger sedan be if only one company sold them?
Reasonable profit margins take into account recoupment of fixed costs and risk, but Big Pharma's margins go way, way beyond that. And they are able to go beyond that because the barriers to entry into the Pharma market place are very high --->>> those very high fixed costs you spoke about distort the workings of the free market so that the governments that protect the market may have to step in to preserve it.
I'm all for trying to increase the amount of competition in the pharmaceutical industry. And I'm fine with government oversight. However, I think this needs to be a dynamic process, rather than a simple "well, lets just get rid of patents and the whole problem goes away". I'm not sure there is a cure for the tendency of large industries to drift towards monopoly - there is only the treatment of oversight. I think that a lot of people think that a few simply chances will make drugs plentiful and cheap, and I think that is oversimplified. Sure, getting rid of patents would make every drug now on the market very cheap, but I think you'd find very few new drugs entering the market. For every life
Let's imagine that only top-selling products are made. People die needlessly. Someone in the pharma industry figures that people do value their health and begins to sell the products at their natural capitalistic price : MARGINAL PRODUCTION COST.
Uh, I'll assume you're talking about a situation in the absence of patents. Just about everything more than a year old will be sold at marginal production cost, just as you suggest. However, very few products will be developed - only those that are likely to sell VERY well in their first year. And those products will be very expensive initially (having to recoup their costs in the first year).
You suggest that somebody will come along and find a way to develop other drugs more cheaply. Well, that is nice in theory, but in order for it to work you need to drasticly lower the cost of clinical trials, or eliminate them. Clinical trials involve thousands of patenties, with thousands of dollars. They would all need to volunteer without compensation, and some body would need to assume the costs of coordinating the trial. You can't just skip the trial - unless you change the laws of just about every nation on earth. If you want untested medication just go to your local pharmacy and buy some supplements. They're dirt cheap because they're untested - and as you would like they tend to be sold around marginal cost.
The drugs will go on being developed by universities, just like now. NO problem whatsoever.
I think you have a bit of a misconception about what universities actually do in the area of biomedical research. If universities were churning out marketable drugs left and right then we wouldn't have half the costs we do today...
Can you name one modern drug on the market developed by a university? I'm talking about a DRUG - not a biological mechanism, or a concept molecule. To my knowledge no drug has been developed from concept to optimized molecule to process development to formulation to safety testing to clinical testing to filing by a university, or by anybody other than a major pharmaceutical company in modern times (say post-1980 or so).
Sure, universities come up with models and ideas all the time. However, the process of coming up with workable drugs and testing them is very expensive. Most of the cost is in the clinical trials. Now, a clinical trial isn't necessarily the most innovative activity in developing a drug, but it is VERY expensive. And you can't simply skip them (if you want safe and effective drugs).
There is no question that universities could perform the full drug development process from soup to nuts, but it would require quite a bit of funding. I think the net costs of drugs to society wouldn't change much in the end - maybe a little, maybe not. The distribution of those costs might change if they were paid by taxes. And I think this is really where most of the societal problems lie.
Well, if you want to try publicly-funded medicine instead of voiding patents, why not just have the US/EU/whatever start supplying funds to perform full drug development, with the requirement that any molecules developed using such funding be freely licensed. Private capital could continue to develop patented drugs as they currently do. Consumers would have a choice of drugs as they currently exist, as well as very cheap publicly-funded drugs, and if the public model works well then it will become the dominant model naturally. Private capital would turn to subcontracting at a much lower profit level for the public firms, but this would be completely competitive.
Besides, you seem to think on the 'business' side of things, why would a company want to make a drug that will permanently cure a disease? The individual takes the dose and they are well. In fact drug companies love chronic non-fatal diseases. They are like a virus if you will, they want the host (customer) to be bring them profit so if they either kill them or cure them, they won't get a profit.
You're assuming some vast conspiracy where none exists. Why do people sell drinks that DON'T make you thirstier - like pure water? Shouldn't people who sell bottled water just sell drinks that don't satisfy thirst so that people buy more? Well, it only takes one person selling what the consumer wants to take over the market. Drugs are no different - if somebody invented a cure for diabetes and sold it for $5000 for a course of treatment, insurance companies would be lining up to pay it, and even private individuals would probably save up as best as they could. Sure, that company would eliminate its own market, but drugs only make a profit for 10 years anyway, and I'm sure there will be enough diabetics to pay a handsome profit in that time. Not every drug company sells products that treat every disease - if you come up with a cure for high cholesterol there is a decent chance are you don't even have a product that treats it at all, so this is your market entry product. And when you're doing R&D, it isn't like you set out to only find expensive treatments - you look for anything that works and take what you can get. And do you think that any CEO is thinking about a 20-year horizon when making choices of what to market?
And companies still come out with vaccines - which are generally cures. If you have a cure you run with it - you don't just sit on it, since it is probably still profitable to some extent. And if you've looked at Pharma stock prices lately you'll realize they can hardly afford to be throwing away potential products...
And where would the government take that money from? Or you are one of those people who thinks that governments can just print money...
As others have pointed out, the amount Brazil spends on AIDS medications is a very small drop in their total budget. It is kind of like listening to Americans whine about spending $2.50/gallon for gas while buying an SUV - it is still very cheap and people would still be complaining if it cost $0.25/gallon. And AIDS medications save money - less money spent on hospitalization and unproductive citizens (which is what you'd have if the medications were never invented).
Yes, some (you) are worried about golden geese and some (me) are worried about sick, dying people, it's kind of (but not really) the same.
My concern is that pricing current drugs at marginal cost results in lots of sick, dying people 10 years from now when the diseases they have AREN'T cured/treated/whatever. 10 years from now the drugs that everybody is all worked up about will be dirt cheap no matter what happens. The question is whether we want new drugs to treat new diseases available. When the current crop of AIDS medications stops working, do we want Pharma companies to have learned their lesson and stopped developing them? A life saved is a life saved, whether it is somebody who could be saved today with a pill that now exists, or a person who could be saved 10 years from now with a pill that does not yet exist. The question isn't just how to make drugs cheap, but how to give the overall human population the best bang for the buck. What people seem to object to most is the concept that rich people get better care than poor people, but I wonder if it weren't for rich people funding R&D that poor people wouldn't be worse off overall. There might be other more equitable ways of distributing the costs, but you can't just pretend those huge up-front development costs don't exist.
I'm fine with having the US/EU/whatever spend more on full drug development to create license-free drugs, and seeing how it works
In Elbonia the costs are cheapest of all. Practicing medicine is illegal.:)
I don't measure the success of a healthcare system based on how cheap it is per-capita. I want to know how well I'll be cared for if I need medical attention. In every society you get what you pay for.
And half of the costs associated with the US medical system is the result of medical liability. If Canada had court systems like the US things would not be nearly as cheap there (either that or nobody would practice medicine).
Big Pharma then takes that and performs the final step, in a lot of cases, but that's in no way necessary, and could be done if the excess and waste were put directly into research and research alone.
Uh, then why don't Universities just outsource the manufacturing to India and market the drugs on their own?
The answer - because that "final step" is clinical trials - and they cost a FORTUNE. Most of the time they end up leading to cancellation of the drug candidate (with no return on investment). The drugs that make it are expensive since they must recoup these costs.
University research is important, but it is a drop in the bucket compared to the costs of developing a drug.
I'm fine with publicly-funded drug development, but I'm not under any illusions that it will result in cheaper drugs (except from the standpoint that the costs get shifted to taxpayers instead of patients).
Most university research departments couldn't be bothered with clinical trials - they usually aren't all that interesting. Kind of like putting up a building - sure, the engineering is the foundation of everything, but it probably represents 1% of the cost...
The patent was assigned to Burroughs-Wellcome who paid for drug trials and promptly began selling it two years later. Selling it at a price that made it the most expensive drugs ever marketed ($8,000+ a year per patient) - despite the fact it was developed with public money and was the only treatment available for a rapidly-spreading disease with a 100% mortality rate.
Uh, it was only partially developed using public money. As you state the cost of the drug trials was carried by Burroughs-Wellcome. They would have carried that cost even if the drug were proven unsafe (which happens more often than not). The costs of a clinical trial are probably 90% of the cost of developing a drug - so the public paid around 10% of the cost. It really isn't all that different from many of the drugs on the market. Virtually all of the cost is in the trials, and companies bear those costs whether drugs get approved or not.
If you want to see cheap drugs (and higher taxes), fund the clinical trials. You'd see many more drugs tested, and as a result more competition and cheaper prices. For every major pharma there are probably 40 biotech companies that can't afford to fund clinical trials - if you take away that cost you'd have tons more competition and much cheaper prices...
Let's turn that around: Merck did not pay one single dime for the education of those scientists. The US taxpayers did. Merck did not pay one single dime for all the basic research needed to develop the drug. The US taxpayers did. Why should Merck be allowed to steal money from the US taxpayers?
So, why not make your own drugs in your garage? Apparently it doesn't cost a single dime, and you can make a fortune from them!:)
The money a drug company invests into R&D is an investment. You assume some of the risks granted by such an investment: whether the patents will be granted or rejected, unforeseen long-term side effects, class action lawsuits, etc. Moreover, since patents are granted by the government in the first place, it is the government's right to take them away as it sees fit.
Why have patents at all if you're just going to yank them at whim? The goal of patents is to spur private investment. If you threaten to pull them at will, nobody will bother to invest despite the patent being available.
It is kind of like saying that because corprate charters are granted by the government the government should be able to just dissolve corporations at whim. Sure, I guess that sounds fair, but if actually exercised it would tremendously decrease investment in corporations. That will have a much larger negative effect on the economy than whatever was hoped to be reaped in the case where the charter was revoked...
The first is that AIDS research has received significant public funding, and second is that antiretroviral drugs have the shortest time to approval of any class of drugs, approximately half the time of normal clinical trials (the mean time for antiretrovirals is 44.6 months, compared to an industry average of 87.4 months).
What percentage of the cost of Elfavirenz R&D was publicly funded? My guess is probably around 0.1% or so. The same applies to almost all other drugs. At best the public funds some basic blue-sky research and maybe expedites the approval review. The public still requires clinical trials - which alone probably constitute 90% of the cost of drug R&D. If clinical trials were publicly funded that would probably cut drug prices tremendously. Sure, the blue-sky R&D is essential to finding drugs, but it is one of the cheapest parts of the whole process. Even if the trials are half as expensive (due to being half as long), the costs are still huge - instead of charging $5/pill maybe you can charge $2-3 - Brazil wanted to pay a few tens of cents.
The marginal cost of an Intel CPU might be $10, and the cost to design the CPU production plant was probably $300k, but building that plant probably cost hundreds of millions of dollars. In this case, the plant design is the NIH, the plant construction is Pharma, and the $10 CPU selling for $500 is the drug. Just because building the plant didn't require as much innovation as the design, doesn't make it cheap...
The NIH doesn't discover drugs. They discover enzymes, mechanisms, etc. Sometimes they come up with lead molecules as well. Most of the time if you gave those molecules to people it would end up killing them, or not working well. Pharma companies spend most of the R&D money figuring out how to make the lead compounds work better, and figuring out if they work at all and are safe. Answering that question costs literally hundreds of millions of dollars, and most of the time the answer is no.
With the method you propose you don't need to ban patents at all. Just fund the public R&D as you propose, and license the resulting compounds freely to anybody who wants to make them. The pills will be VERY cheap. If the model works everybody will buy those pills, and private pharma can continue to patent and sell products that are innovative (assuming they can find markets not dominated by new cheap drugs). It would be the best of both worlds.
My concern with just banning patents entirely is that it forces ALL drug R&D to be public. That means that if a particular disease has a social stigma associated with it, there will probably be disproportionately less spending on R&D for it. If a drug tends to affect the constituents of those in power then it will get disproportionately more funding. And you potentially have all the mess associated with government bureaucracy as well.
So, let public and private R&D compete, and then everybody can see which is working better. If public R&D just turns out to be a boondoggle then we will still have the status quo. If public R&D works out great then private pharma will probably turn to the public body to be an outsource partner (they give up the huge profits, but on the other hand they get paid the same whether a drug works out or not). Everybody wins.
Right now the extent of public pharma R&D is just blue-sky basic reasearch. The problem is that this type of R&D, while essential, represents only the tiniest fraction of the costs associated with drug R&D. The loss of public basic research probably wouldn't affect drug costs much at all despite private R&D having to pick up the tab - but what it would do is lower the number of fresh ideas leading to new drugs. I'm not knocking the NIH or anything like that - it is just that they're taking on the intellectually hard part of the problem, and not the expensive part of the problem.
A good analogy might be an architect/engineer designing a skyscraper - in one sense theirs is the hardest and most critical part of the job, but it is also much cheaper than putting up the building. The most expensive part of Pharma R&D is also the most routine - clinical trials. Short of getting rid of the humans not much can be done to make it cheaper (although much effort is directed at this goal).
If that cost can be offset in the time it takes for a product to begin to get copied, then the Holy Necessary Incentive is met!
Uh, just how long do you think it takes to copy a pharmaceutical product? I doubt it takes more than six months - considering the hundreds of government workers who have access to all kinds of details regarding how the product is made (any one of which can leak the info). And if all you had was a sample of the drug you could probably make copies within a year - it isn't the chemistry that makes drug R&D hard (most of the time).
So, people want all kinds of clinical testing to ensure drugs are safe before we allow them on the market (cost $500M*(1/SuccessRate) per drug marketed). Now you want all that money recouped in a year. Just how much are you willing to pay for pills? The only drugs that make that kind of money in their first year are the VERY top-selling products.
That is the big problem with pharmaceuticals - they cost a LOT of money to develop (measured in billions of dollars if you factor in the failure rate), and they cost fairly little money to copy. And it isn't like there is a low-cost "indie" market like there is in music. You can mix a decent album with maybe a few thousand dollars worth of equipment total - much of which can be found in every home (a computer). Drug R&D requires litterally millions of dollars in capital, a huge number of specialists, and the collaboration of hundreds of MDs in the clinical trials. There simply aren't any modern examples of drugs developed inexpensively.
I'm all for finding ways to reduce the costs of medicines on the poor, but it is simplistic to simply say that drugs shouldn't cost more than a few cents per pill and expect anybody to bother doing R&D.
So in fact they have to chose between letting these people die or making a profit, seems like a clear cut issue.
You present a false dichotomy - the government could have just paid a little more for each pill and nobody would have died.
If it was a pill to cure "athlete's foot" it would be unacceptable to override the patents but in this case it makes sense.
Ok, by this logic only drugs that aren't terribly important should be profitable. Therefore, companies will only bother to do R&D on non-life-saving medications. Is that what you really want?
Investors will fire any manager that doesn't aim for share growth, and that requires profits. Managers as a result direct R&D money to the most profitable areas. Governments that want to leverage private investment should make the most important products the most profitable - not the least.
Sure, there are lots of ways to do this other than patents, but nobody is talking about that. Everybody seems like they're just interested in killing the goose that layed the golden egg...
Granted, companies need to make back their investment in new drugs. I do not believe that new drugs would be stifled if we put in cost controls here in the United States, at least $7 billion worth of cost controls.
There is no question that the Lipitors and Viagras of the world wouldn't be stifled one bit by moderate cost controls. The problem is the drug that makes $75 million annually. Those would just get dropped altogether.
And drugs wouldn't be marketed if the marketing didn't increase profits. If you cap the cost of the product, the R&D budget would probably be slashed right along with marketing. No company will reduce their marketing budget to zero - because that would result in an even bigger loss than the price controls.
The big problem is - how do you decide what is a good price? The free market awards price based on value. Nobody will pay $10/day for a pill that slightly reduces allergies, but they will gladly pay $5000 for a series of pills that dissolves blood clots and eliminates the need for open heart surgery. On the one hand you can call that profit excessive, but on the other hand you could look at that as a $35k savings on surgery bills and potential complications. And in 10 years those same pills will cost 75 cents each.
It simply isn't fair to make companies spend on R&D and then decide how much they can charge for their products. It would be more fair if the prices were decided before anybody discovered anything. If medicare set a price for the cure for AIDS/cancer/etc now then companies could decide whether to bother trying to discover them.
It all depends on what you want. If you want the best medicine then you should allow prices to float. If you want cheap drugs then you can fix prices, but then you won't get as much innovation. The US system makes you pay lots of cash for new drugs, and little cash for old ones. It seems like a fair balance and it results in lots of cheap drugs for the entire planet - after 10 years.
1. Organization releases new drug with no patents whatsoever.
2. Big Pharma corp. creates similar drug and covers it with broad patent.
3. Big Pharma corp. uses patent to remove unpatented drug from shelves.
If the original drug was out before the new drug was patented, there would be no case. And there is TREMENDOUS public pressure to stop patent creep - a few companies were trying to play patent games a while ago, but the courts don't tolerate it much now. If you discover something it is yours for 17 years, and then it isn't yours. Drugs aren't covered by broad patents these days - typically your patent is good for one molecule only (just look at all the cases of multiple-drugs-in-class out there).
And a company could defensively patent their drug and then license it freely. The reason this doesn't happen is as you pointed out - even non-profit labs have to cover their costs, and that essentially requires a patent...
And yet looking at political manipulation of the health care situation: right-wing protection of drug patents MAY drive innovation, but definitely drives up drug costs.
I can't think of any modern drugs that weren't created by an organization funded by drug patents. If patents didn't drive innovation, shouldn't we see organizations offering patent-free drugs (and not simply drugs whose patents have expired)?
For all the people who complain about drug patents, I don't see anybody doing drug R&D without them. There isn't anything stopping a non-profit or government lab from coming up with a compound, patenting it, developing it, and then offering free licenses to manufacturers - there would be lots of takers as even patent-free drugs can be profitable once you eliminate R&D costs.
The solution isn't to ban patents - it is to offer an alternative. If the alternatives (possibly tax-funded) generate good value, then expand them. Otherwise, just keep refining them until they do generate value.
Most painkillers save precisely zero lives every year. And most painkillers kill LOTS of people every year. So, should we ban them?
Sure, I can feel like I'm starving 24 hours a day and maybe be a little healthier, but why would I want to live an extra 10 years if I feel like I'm suffering through them? If a pill will buy me those 10 years with no sacrifice on my part other than a little cash, but a 0.1% chance of dropping dead in one year, maybe it is worth it.
Lots of people are overweight, and lots of people aren't. Usually the people who aren't don't work hard to stay that way (though many do). Them's just the breaks. When I see some guy hauling trash who never got beyond middle school math, I don't belittle him for not spending enough time studying his calculus and linear algebra - maybe those things were easy for me to learn and no so easy for him...
Basically, we're all different, and no matter how you slice it some of us are going to be far more successful in life than others, and some of us will drop dead before we turn 20. I don't think that either unbridled captialism or socialism really solve those problems - the goal shouldn't be to achieve equality, but rather to achieve the best quality of life on average for everyone. I think that in general that is best accomplished with a market-based solution, for the most part...
And how much do you pay for a liter of petrol or milk?:)
The funds come from somewhere...
Also - does the Swiss government control prices charged by health care providers? If I'm the best heart surgeon in the country can I charge more as a result? Or do I have to get by on the same wage as some guy who kills half his patients?
In the US, the best doctors treat the people with the most money.
In many other countries the best doctors treat the people with the best political connections.
Any way you slice it - not all people get the same care. All that varies is whether you acknowledge whether this is true, and how you decide who gets preferential treatment. At least in the US anybody can potentially become rich...
The problem with pills is that they cost $2/pill for R&D, and $0.05/pill for manufacture. As long as a company can recoup its development costs somewhere, it makes sense to sell pills for $0.20 in Europe - it is still a profit on a marginal level, and if the European country is threatening to just buy pills from India they don't have much choice anyway.
The problem is that if the US insisted on $0.20 pills nobody would do drug development any longer. You'd just never make a profit. I don't know of any non-profit organizations anywhere developing drugs all the way to market. Sure, lots of non-profits do basic research, but if they were turning out actual pills then drug prices wouldn't be so high in the first place... Keep in mind that the actual cost of developing a drug is very high - those clinical trials costs hundreds of millions of dollars (mostly due to the need to pay doctors, who command high paychecks).
I'm all for non-profit drugs. However, instead of putting a gun to the head of companies and telling them that they're not allowed to make profits, why not just let people fund non-profits or government agencies to make their own drugs, which can compete on the open market. This way for-profit companies can still make lots of new drugs, and there will also be lower-cost options available as well. Then everybody can look at the true cost of both routes and decide whether to expand the public programs. No need to abolish patents and fix prices - just compete with them fairly. Nobody had to ban Windows to get Linux to take off - if you offer a good product at a good price people will buy it.
Actually, unless the wormhole is very new there, or unless matter is spit out with tremendous velocity, or unless the output of the black hole moves quite a bit over time would be a black hole there regardless. A really big ball of gas will sooner or later end up being a black hole - there are just so many stars you can dump into the same place...
BTW, lots of government money goes into research, though perhaps you haven't heard of the NIH, WHO, etc?
Sure, and they should patent any drugs they develop and license them royalty free. I don't think anybody objects to that. However, I don't know of any major drugs on the market that were developed from basic research to marketed product by a government organization. At best they discover an enzyme which can potentially be inhibited, and maybe some proof-of-concept molecules that might or might not kill dogs after being taken by IV. Most of the drug R&D money gets spent after this point - there are tons of targets out there that lack drugs - because finding a target is only one piece of the puzzle.
Put it this way - the concept of fire is in the public domain. Does that mean we shouldn't allow patents on engine designs? Sure, without fire/turbines/etc you wouldn't have scramjets, but that doesn't make a practical scramjet a minor obvious next step.
But I'm all for publicly-funded medicine - as long as there are no bans on the private sector doing its own thing. If the NIH can come up with a better and cheaper cure for the common cold, then everybody will be in line to buy it (or maybe get it for free). There is no need to abolish medical patents for this to work. Those with money will have more options, but the private sector will still enlarge the public domain (granted a decade later). Drugs like statins used to cost a fortune but you can get them on the cheap now, and they're still pretty modern. If you want last year's statin you'll pay more than a 10-year old one, just like if you want a luxury car you'll pay more than you would for a Honda Civic. That doesn't make the Civic useless.
No matter how you slice it, those with power will be treated better than those without power. At least money is reasonably obtainable by most people. If the only way to get access to the best medicine is having political connections your society will be less egalitarian. Even when doctors are all free it doesn't make them all equal...
Well, you could also view it as rich decision-makers supply lots of cash to fund R&D, and then the benefits trickle down to everyone else. That's more or less how it works for health care (although it works better for drugs than stuff like surgery where the cost doesn't drop as much with time) - I wonder if it would work with internet access. I'm generally a fan of net neutrality though.
The rich will always be better off than the poor - if they weren't why would anybody bother to work hard? Even in "communist" nations the rich were better off than the poor, although wealth was often measured in political connections rather than dollars. I'm sure that no matter how you slice it if you and a congressman are in the hospital at the same time needing a heart, and there is only one to go around, you're not going to get it. And if your heart is fine but you're in marginal shape with an organ donor card, I wouldn't count on keeping that heart either...
The key is to find a practical solution that will work in the real world (where everybody is selfish), that will get the best product to EVERYBODY in the least amount of time, and which will work indefinitely. If you pass a law saying that anybody can steal cars from a dealer then the poor benefit for a few weeks until nobody bothers making cares any more. Ditto for health care advances. And I wonder if the same will apply in the online world.
I do think we need safeguards against the restraint of trade. But the person paying $9.99 for internet access need not get the same product as somebody paying $99.99.
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Who's to say that the EU/China/etc wouldn't cooperate fully. Right now only a few countries can launch satellites with these capabilities, and while they'll certainly use them against each other I'm sure a gentleman's agreement exists that they keep 3rd parties from getting access to sensitive stuff.
Besides, you can restrict satellite operation one way or another. If a 3rd-party balloon showed up over a civil-war battlefield offering imagery to the highest bidder it would simply be shot down. I'm sure any army with the capability would consider disabling or destroying 3rd party satellites if it were strategically necessary. It would be tolerated to some degree, but if a company didn't play ball when the time came to gather forces for some major sneak attack, I'm sure there would be "technical difficulties" - perhaps jamming of some sort, perhaps a spy planted in the operations center of the company operating the satellite, perhaps lasers, or perhaps an ASAT of some kind. Most likely it would just be the right amount of cash in the right hands and an appeal to "patriotism" of some kind. Unless we're talking about a major tension between superpowers whatever country the satellite owner is hosted in will just ask for a fine from the world court to save face and it would get paid or not a decade later long after the actual military conflict is decided.
Keep in mind we're talking dual-use technology. If the NRA showed up in an occupied nation issuing "hunting rifles" to anybody who wanted one I'm sure just about any nation with troops there would put a stop to it. Satellite imagery isn't as black-and-white as guns, but at particular moments I'm sure nations will want to make it scarce.
That's not really relevant to the question whether Big Pharma is especially innovative; it is scarcely a contestable issue. A huge amount of effort goes into 'me, too!' drugs of dubious utility that exist solely for the purpose of extending the effective lifetime of the effective monopoly on its production (notice the word "effective" before engaging in a legalistic argument.)
Me too drugs allow a company to sell an alternative treatment for a condition that already has a treatment. Often they're developed by companies other than the original innovator. They do not in any way extend the patent of the original drug, but the new drugs have their own patent lifetimes. A good example of a me-too drug is Lipitor - the original statin was Zocor and Pfizer came up with a molecue that did the same thing only better. Today you can buy generic simvastatin (the active ingredient in Zocor) for about the marginal cost of production. Or you can buy Lipitor for a lot more. Many people opt to pay more for Lipitor because it simply works better. However, they still have a choice and can buy the slightly older product for far less. Many insurers require that patients try the cheaper drug first and see how it works. If you got rid of me-too drugs then everybody would be buying the cheaper meds, but only because that was all that was available.
So, in some sense me-too drugs prolong patent lifetimes, but consumers still have a choice and can stick with the original product and obtain it cheaply. It is like saying that Intel props up computer prices by coming up with faster CPUs - if they didn't invent new CPUs all computers would be $300 or less. But of course they'd all have 486 processors. So it isn't like we're not getting anything for the extra money.
The other benefit of me-too drugs is that they give physicians choices. In a sense every antibiotic since penicillian has been a me-too drug, and yet doctors are lamenting the dearth of new antibiotics. The reason is simple - a particular drug doesn't always work in every case - either due to a problem with the disease (drug resistant bacteria in this case), or a problem with the patient (allergies). All drugs have side effects, but often patients can tolerate one drug to a greater degree than other me-too drugs with the same function. Having a choice means that doctors can find a therapy that works better for the patient, as opposed to a situation where exactly one molecule is available for one disease.
Finally, me-too drugs lower costs. They introduce competition. Zocor would have been a lot more expensive for the decade of its marketed patent life if it weren't for Lipitor competing for the same patients. Now, the costs don't drop to post-patent levels, but they can drop quite low compared to drugs with no competition whatsoever. How expensive would a 4-passenger sedan be if only one company sold them?
Reasonable profit margins take into account recoupment of fixed costs and risk, but Big Pharma's margins go way, way beyond that. And they are able to go beyond that because the barriers to entry into the Pharma market place are very high --->>> those very high fixed costs you spoke about distort the workings of the free market so that the governments that protect the market may have to step in to preserve it.
I'm all for trying to increase the amount of competition in the pharmaceutical industry. And I'm fine with government oversight. However, I think this needs to be a dynamic process, rather than a simple "well, lets just get rid of patents and the whole problem goes away". I'm not sure there is a cure for the tendency of large industries to drift towards monopoly - there is only the treatment of oversight. I think that a lot of people think that a few simply chances will make drugs plentiful and cheap, and I think that is oversimplified. Sure, getting rid of patents would make every drug now on the market very cheap, but I think you'd find very few new drugs entering the market. For every life
Let's imagine that only top-selling products are made. People die needlessly. Someone in the pharma industry figures that people do value their health and begins to sell the products at their natural capitalistic price : MARGINAL PRODUCTION COST.
Uh, I'll assume you're talking about a situation in the absence of patents. Just about everything more than a year old will be sold at marginal production cost, just as you suggest. However, very few products will be developed - only those that are likely to sell VERY well in their first year. And those products will be very expensive initially (having to recoup their costs in the first year).
You suggest that somebody will come along and find a way to develop other drugs more cheaply. Well, that is nice in theory, but in order for it to work you need to drasticly lower the cost of clinical trials, or eliminate them. Clinical trials involve thousands of patenties, with thousands of dollars. They would all need to volunteer without compensation, and some body would need to assume the costs of coordinating the trial. You can't just skip the trial - unless you change the laws of just about every nation on earth. If you want untested medication just go to your local pharmacy and buy some supplements. They're dirt cheap because they're untested - and as you would like they tend to be sold around marginal cost.
The drugs will go on being developed by universities, just like now. NO problem whatsoever.
I think you have a bit of a misconception about what universities actually do in the area of biomedical research. If universities were churning out marketable drugs left and right then we wouldn't have half the costs we do today...
Can you name one modern drug on the market developed by a university? I'm talking about a DRUG - not a biological mechanism, or a concept molecule. To my knowledge no drug has been developed from concept to optimized molecule to process development to formulation to safety testing to clinical testing to filing by a university, or by anybody other than a major pharmaceutical company in modern times (say post-1980 or so).
Sure, universities come up with models and ideas all the time. However, the process of coming up with workable drugs and testing them is very expensive. Most of the cost is in the clinical trials. Now, a clinical trial isn't necessarily the most innovative activity in developing a drug, but it is VERY expensive. And you can't simply skip them (if you want safe and effective drugs).
There is no question that universities could perform the full drug development process from soup to nuts, but it would require quite a bit of funding. I think the net costs of drugs to society wouldn't change much in the end - maybe a little, maybe not. The distribution of those costs might change if they were paid by taxes. And I think this is really where most of the societal problems lie.
Well, if you want to try publicly-funded medicine instead of voiding patents, why not just have the US/EU/whatever start supplying funds to perform full drug development, with the requirement that any molecules developed using such funding be freely licensed. Private capital could continue to develop patented drugs as they currently do. Consumers would have a choice of drugs as they currently exist, as well as very cheap publicly-funded drugs, and if the public model works well then it will become the dominant model naturally. Private capital would turn to subcontracting at a much lower profit level for the public firms, but this would be completely competitive.
Besides, you seem to think on the 'business' side of things, why would a company want to make a drug that will permanently cure a disease? The individual takes the dose and they are well. In fact drug companies love chronic non-fatal diseases. They are like a virus if you will, they want the host (customer) to be bring them profit so if they either kill them or cure them, they won't get a profit.
You're assuming some vast conspiracy where none exists. Why do people sell drinks that DON'T make you thirstier - like pure water? Shouldn't people who sell bottled water just sell drinks that don't satisfy thirst so that people buy more? Well, it only takes one person selling what the consumer wants to take over the market. Drugs are no different - if somebody invented a cure for diabetes and sold it for $5000 for a course of treatment, insurance companies would be lining up to pay it, and even private individuals would probably save up as best as they could. Sure, that company would eliminate its own market, but drugs only make a profit for 10 years anyway, and I'm sure there will be enough diabetics to pay a handsome profit in that time. Not every drug company sells products that treat every disease - if you come up with a cure for high cholesterol there is a decent chance are you don't even have a product that treats it at all, so this is your market entry product. And when you're doing R&D, it isn't like you set out to only find expensive treatments - you look for anything that works and take what you can get. And do you think that any CEO is thinking about a 20-year horizon when making choices of what to market?
And companies still come out with vaccines - which are generally cures. If you have a cure you run with it - you don't just sit on it, since it is probably still profitable to some extent. And if you've looked at Pharma stock prices lately you'll realize they can hardly afford to be throwing away potential products...
And where would the government take that money from? Or you are one of those people who thinks that governments can just print money...
As others have pointed out, the amount Brazil spends on AIDS medications is a very small drop in their total budget. It is kind of like listening to Americans whine about spending $2.50/gallon for gas while buying an SUV - it is still very cheap and people would still be complaining if it cost $0.25/gallon. And AIDS medications save money - less money spent on hospitalization and unproductive citizens (which is what you'd have if the medications were never invented).
Yes, some (you) are worried about golden geese and some (me) are worried about sick, dying people, it's kind of (but not really) the same.
My concern is that pricing current drugs at marginal cost results in lots of sick, dying people 10 years from now when the diseases they have AREN'T cured/treated/whatever. 10 years from now the drugs that everybody is all worked up about will be dirt cheap no matter what happens. The question is whether we want new drugs to treat new diseases available. When the current crop of AIDS medications stops working, do we want Pharma companies to have learned their lesson and stopped developing them? A life saved is a life saved, whether it is somebody who could be saved today with a pill that now exists, or a person who could be saved 10 years from now with a pill that does not yet exist. The question isn't just how to make drugs cheap, but how to give the overall human population the best bang for the buck. What people seem to object to most is the concept that rich people get better care than poor people, but I wonder if it weren't for rich people funding R&D that poor people wouldn't be worse off overall. There might be other more equitable ways of distributing the costs, but you can't just pretend those huge up-front development costs don't exist.
I'm fine with having the US/EU/whatever spend more on full drug development to create license-free drugs, and seeing how it works
In Elbonia the costs are cheapest of all. Practicing medicine is illegal. :)
I don't measure the success of a healthcare system based on how cheap it is per-capita. I want to know how well I'll be cared for if I need medical attention. In every society you get what you pay for.
And half of the costs associated with the US medical system is the result of medical liability. If Canada had court systems like the US things would not be nearly as cheap there (either that or nobody would practice medicine).
Big Pharma then takes that and performs the final step, in a lot of cases, but that's in no way necessary, and could be done if the excess and waste were put directly into research and research alone.
Uh, then why don't Universities just outsource the manufacturing to India and market the drugs on their own?
The answer - because that "final step" is clinical trials - and they cost a FORTUNE. Most of the time they end up leading to cancellation of the drug candidate (with no return on investment). The drugs that make it are expensive since they must recoup these costs.
University research is important, but it is a drop in the bucket compared to the costs of developing a drug.
I'm fine with publicly-funded drug development, but I'm not under any illusions that it will result in cheaper drugs (except from the standpoint that the costs get shifted to taxpayers instead of patients).
Most university research departments couldn't be bothered with clinical trials - they usually aren't all that interesting. Kind of like putting up a building - sure, the engineering is the foundation of everything, but it probably represents 1% of the cost...
The patent was assigned to Burroughs-Wellcome who paid for drug trials and promptly began selling it two years later. Selling it at a price that made it the most expensive drugs ever marketed ($8,000+ a year per patient) - despite the fact it was developed with public money and was the only treatment available for a rapidly-spreading disease with a 100% mortality rate.
Uh, it was only partially developed using public money. As you state the cost of the drug trials was carried by Burroughs-Wellcome. They would have carried that cost even if the drug were proven unsafe (which happens more often than not). The costs of a clinical trial are probably 90% of the cost of developing a drug - so the public paid around 10% of the cost. It really isn't all that different from many of the drugs on the market. Virtually all of the cost is in the trials, and companies bear those costs whether drugs get approved or not.
If you want to see cheap drugs (and higher taxes), fund the clinical trials. You'd see many more drugs tested, and as a result more competition and cheaper prices. For every major pharma there are probably 40 biotech companies that can't afford to fund clinical trials - if you take away that cost you'd have tons more competition and much cheaper prices...
Let's turn that around: Merck did not pay one single dime for the education of those scientists. The US taxpayers did. Merck did not pay one single dime for all the basic research needed to develop the drug. The US taxpayers did. Why should Merck be allowed to steal money from the US taxpayers?
:)
So, why not make your own drugs in your garage? Apparently it doesn't cost a single dime, and you can make a fortune from them!
The money a drug company invests into R&D is an investment. You assume some of the risks granted by such an investment: whether the patents will be granted or rejected, unforeseen long-term side effects, class action lawsuits, etc. Moreover, since patents are granted by the government in the first place, it is the government's right to take them away as it sees fit.
Why have patents at all if you're just going to yank them at whim? The goal of patents is to spur private investment. If you threaten to pull them at will, nobody will bother to invest despite the patent being available.
It is kind of like saying that because corprate charters are granted by the government the government should be able to just dissolve corporations at whim. Sure, I guess that sounds fair, but if actually exercised it would tremendously decrease investment in corporations. That will have a much larger negative effect on the economy than whatever was hoped to be reaped in the case where the charter was revoked...
The first is that AIDS research has received significant public funding, and second is that antiretroviral drugs have the shortest time to approval of any class of drugs, approximately half the time of normal clinical trials (the mean time for antiretrovirals is 44.6 months, compared to an industry average of 87.4 months).
What percentage of the cost of Elfavirenz R&D was publicly funded? My guess is probably around 0.1% or so. The same applies to almost all other drugs. At best the public funds some basic blue-sky research and maybe expedites the approval review. The public still requires clinical trials - which alone probably constitute 90% of the cost of drug R&D. If clinical trials were publicly funded that would probably cut drug prices tremendously. Sure, the blue-sky R&D is essential to finding drugs, but it is one of the cheapest parts of the whole process. Even if the trials are half as expensive (due to being half as long), the costs are still huge - instead of charging $5/pill maybe you can charge $2-3 - Brazil wanted to pay a few tens of cents.
The marginal cost of an Intel CPU might be $10, and the cost to design the CPU production plant was probably $300k, but building that plant probably cost hundreds of millions of dollars. In this case, the plant design is the NIH, the plant construction is Pharma, and the $10 CPU selling for $500 is the drug. Just because building the plant didn't require as much innovation as the design, doesn't make it cheap...
The NIH doesn't discover drugs. They discover enzymes, mechanisms, etc. Sometimes they come up with lead molecules as well. Most of the time if you gave those molecules to people it would end up killing them, or not working well. Pharma companies spend most of the R&D money figuring out how to make the lead compounds work better, and figuring out if they work at all and are safe. Answering that question costs literally hundreds of millions of dollars, and most of the time the answer is no.
With the method you propose you don't need to ban patents at all. Just fund the public R&D as you propose, and license the resulting compounds freely to anybody who wants to make them. The pills will be VERY cheap. If the model works everybody will buy those pills, and private pharma can continue to patent and sell products that are innovative (assuming they can find markets not dominated by new cheap drugs). It would be the best of both worlds.
My concern with just banning patents entirely is that it forces ALL drug R&D to be public. That means that if a particular disease has a social stigma associated with it, there will probably be disproportionately less spending on R&D for it. If a drug tends to affect the constituents of those in power then it will get disproportionately more funding. And you potentially have all the mess associated with government bureaucracy as well.
So, let public and private R&D compete, and then everybody can see which is working better. If public R&D just turns out to be a boondoggle then we will still have the status quo. If public R&D works out great then private pharma will probably turn to the public body to be an outsource partner (they give up the huge profits, but on the other hand they get paid the same whether a drug works out or not). Everybody wins.
Right now the extent of public pharma R&D is just blue-sky basic reasearch. The problem is that this type of R&D, while essential, represents only the tiniest fraction of the costs associated with drug R&D. The loss of public basic research probably wouldn't affect drug costs much at all despite private R&D having to pick up the tab - but what it would do is lower the number of fresh ideas leading to new drugs. I'm not knocking the NIH or anything like that - it is just that they're taking on the intellectually hard part of the problem, and not the expensive part of the problem.
A good analogy might be an architect/engineer designing a skyscraper - in one sense theirs is the hardest and most critical part of the job, but it is also much cheaper than putting up the building. The most expensive part of Pharma R&D is also the most routine - clinical trials. Short of getting rid of the humans not much can be done to make it cheaper (although much effort is directed at this goal).
If that cost can be offset in the time it takes for a product to begin to get copied, then the Holy Necessary Incentive is met!
Uh, just how long do you think it takes to copy a pharmaceutical product? I doubt it takes more than six months - considering the hundreds of government workers who have access to all kinds of details regarding how the product is made (any one of which can leak the info). And if all you had was a sample of the drug you could probably make copies within a year - it isn't the chemistry that makes drug R&D hard (most of the time).
So, people want all kinds of clinical testing to ensure drugs are safe before we allow them on the market (cost $500M*(1/SuccessRate) per drug marketed). Now you want all that money recouped in a year. Just how much are you willing to pay for pills? The only drugs that make that kind of money in their first year are the VERY top-selling products.
That is the big problem with pharmaceuticals - they cost a LOT of money to develop (measured in billions of dollars if you factor in the failure rate), and they cost fairly little money to copy. And it isn't like there is a low-cost "indie" market like there is in music. You can mix a decent album with maybe a few thousand dollars worth of equipment total - much of which can be found in every home (a computer). Drug R&D requires litterally millions of dollars in capital, a huge number of specialists, and the collaboration of hundreds of MDs in the clinical trials. There simply aren't any modern examples of drugs developed inexpensively.
I'm all for finding ways to reduce the costs of medicines on the poor, but it is simplistic to simply say that drugs shouldn't cost more than a few cents per pill and expect anybody to bother doing R&D.
So in fact they have to chose between letting these people die or making a profit, seems like a clear cut issue.
You present a false dichotomy - the government could have just paid a little more for each pill and nobody would have died.
If it was a pill to cure "athlete's foot" it would be unacceptable to override the patents but in this case it makes sense.
Ok, by this logic only drugs that aren't terribly important should be profitable. Therefore, companies will only bother to do R&D on non-life-saving medications. Is that what you really want?
Investors will fire any manager that doesn't aim for share growth, and that requires profits. Managers as a result direct R&D money to the most profitable areas. Governments that want to leverage private investment should make the most important products the most profitable - not the least.
Sure, there are lots of ways to do this other than patents, but nobody is talking about that. Everybody seems like they're just interested in killing the goose that layed the golden egg...
Granted, companies need to make back their investment in new drugs. I do not believe that new drugs would be stifled if we put in cost controls here in the United States, at least $7 billion worth of cost controls.
There is no question that the Lipitors and Viagras of the world wouldn't be stifled one bit by moderate cost controls. The problem is the drug that makes $75 million annually. Those would just get dropped altogether.
And drugs wouldn't be marketed if the marketing didn't increase profits. If you cap the cost of the product, the R&D budget would probably be slashed right along with marketing. No company will reduce their marketing budget to zero - because that would result in an even bigger loss than the price controls.
The big problem is - how do you decide what is a good price? The free market awards price based on value. Nobody will pay $10/day for a pill that slightly reduces allergies, but they will gladly pay $5000 for a series of pills that dissolves blood clots and eliminates the need for open heart surgery. On the one hand you can call that profit excessive, but on the other hand you could look at that as a $35k savings on surgery bills and potential complications. And in 10 years those same pills will cost 75 cents each.
It simply isn't fair to make companies spend on R&D and then decide how much they can charge for their products. It would be more fair if the prices were decided before anybody discovered anything. If medicare set a price for the cure for AIDS/cancer/etc now then companies could decide whether to bother trying to discover them.
It all depends on what you want. If you want the best medicine then you should allow prices to float. If you want cheap drugs then you can fix prices, but then you won't get as much innovation. The US system makes you pay lots of cash for new drugs, and little cash for old ones. It seems like a fair balance and it results in lots of cheap drugs for the entire planet - after 10 years.
If the original drug was out before the new drug was patented, there would be no case. And there is TREMENDOUS public pressure to stop patent creep - a few companies were trying to play patent games a while ago, but the courts don't tolerate it much now. If you discover something it is yours for 17 years, and then it isn't yours. Drugs aren't covered by broad patents these days - typically your patent is good for one molecule only (just look at all the cases of multiple-drugs-in-class out there).
And a company could defensively patent their drug and then license it freely. The reason this doesn't happen is as you pointed out - even non-profit labs have to cover their costs, and that essentially requires a patent...
And yet looking at political manipulation of the health care situation: right-wing protection of drug patents MAY drive innovation, but definitely drives up drug costs.
I can't think of any modern drugs that weren't created by an organization funded by drug patents. If patents didn't drive innovation, shouldn't we see organizations offering patent-free drugs (and not simply drugs whose patents have expired)?
For all the people who complain about drug patents, I don't see anybody doing drug R&D without them. There isn't anything stopping a non-profit or government lab from coming up with a compound, patenting it, developing it, and then offering free licenses to manufacturers - there would be lots of takers as even patent-free drugs can be profitable once you eliminate R&D costs.
The solution isn't to ban patents - it is to offer an alternative. If the alternatives (possibly tax-funded) generate good value, then expand them. Otherwise, just keep refining them until they do generate value.
Keep in mind that you need to consider lifestyle.
Most painkillers save precisely zero lives every year. And most painkillers kill LOTS of people every year. So, should we ban them?
Sure, I can feel like I'm starving 24 hours a day and maybe be a little healthier, but why would I want to live an extra 10 years if I feel like I'm suffering through them? If a pill will buy me those 10 years with no sacrifice on my part other than a little cash, but a 0.1% chance of dropping dead in one year, maybe it is worth it.
Lots of people are overweight, and lots of people aren't. Usually the people who aren't don't work hard to stay that way (though many do). Them's just the breaks. When I see some guy hauling trash who never got beyond middle school math, I don't belittle him for not spending enough time studying his calculus and linear algebra - maybe those things were easy for me to learn and no so easy for him...
Basically, we're all different, and no matter how you slice it some of us are going to be far more successful in life than others, and some of us will drop dead before we turn 20. I don't think that either unbridled captialism or socialism really solve those problems - the goal shouldn't be to achieve equality, but rather to achieve the best quality of life on average for everyone. I think that in general that is best accomplished with a market-based solution, for the most part...
And how much do you pay for a liter of petrol or milk? :)
The funds come from somewhere...
Also - does the Swiss government control prices charged by health care providers? If I'm the best heart surgeon in the country can I charge more as a result? Or do I have to get by on the same wage as some guy who kills half his patients?
In the US, the best doctors treat the people with the most money.
In many other countries the best doctors treat the people with the best political connections.
Any way you slice it - not all people get the same care. All that varies is whether you acknowledge whether this is true, and how you decide who gets preferential treatment. At least in the US anybody can potentially become rich...
The problem with pills is that they cost $2/pill for R&D, and $0.05/pill for manufacture. As long as a company can recoup its development costs somewhere, it makes sense to sell pills for $0.20 in Europe - it is still a profit on a marginal level, and if the European country is threatening to just buy pills from India they don't have much choice anyway.
The problem is that if the US insisted on $0.20 pills nobody would do drug development any longer. You'd just never make a profit. I don't know of any non-profit organizations anywhere developing drugs all the way to market. Sure, lots of non-profits do basic research, but if they were turning out actual pills then drug prices wouldn't be so high in the first place... Keep in mind that the actual cost of developing a drug is very high - those clinical trials costs hundreds of millions of dollars (mostly due to the need to pay doctors, who command high paychecks).
I'm all for non-profit drugs. However, instead of putting a gun to the head of companies and telling them that they're not allowed to make profits, why not just let people fund non-profits or government agencies to make their own drugs, which can compete on the open market. This way for-profit companies can still make lots of new drugs, and there will also be lower-cost options available as well. Then everybody can look at the true cost of both routes and decide whether to expand the public programs. No need to abolish patents and fix prices - just compete with them fairly. Nobody had to ban Windows to get Linux to take off - if you offer a good product at a good price people will buy it.
Or you can just take pills and not worry about either...
Actually, unless the wormhole is very new there, or unless matter is spit out with tremendous velocity, or unless the output of the black hole moves quite a bit over time would be a black hole there regardless. A really big ball of gas will sooner or later end up being a black hole - there are just so many stars you can dump into the same place...
Those and incoming missiles - best line by a principal character sitting in the tailgun of some kind of aircraft:
"There are too many missiles! I can't shoot them all!"
BTW, lots of government money goes into research, though perhaps you haven't heard of the NIH, WHO, etc?
Sure, and they should patent any drugs they develop and license them royalty free. I don't think anybody objects to that. However, I don't know of any major drugs on the market that were developed from basic research to marketed product by a government organization. At best they discover an enzyme which can potentially be inhibited, and maybe some proof-of-concept molecules that might or might not kill dogs after being taken by IV. Most of the drug R&D money gets spent after this point - there are tons of targets out there that lack drugs - because finding a target is only one piece of the puzzle.
Put it this way - the concept of fire is in the public domain. Does that mean we shouldn't allow patents on engine designs? Sure, without fire/turbines/etc you wouldn't have scramjets, but that doesn't make a practical scramjet a minor obvious next step.
But I'm all for publicly-funded medicine - as long as there are no bans on the private sector doing its own thing. If the NIH can come up with a better and cheaper cure for the common cold, then everybody will be in line to buy it (or maybe get it for free). There is no need to abolish medical patents for this to work. Those with money will have more options, but the private sector will still enlarge the public domain (granted a decade later). Drugs like statins used to cost a fortune but you can get them on the cheap now, and they're still pretty modern. If you want last year's statin you'll pay more than a 10-year old one, just like if you want a luxury car you'll pay more than you would for a Honda Civic. That doesn't make the Civic useless.
No matter how you slice it, those with power will be treated better than those without power. At least money is reasonably obtainable by most people. If the only way to get access to the best medicine is having political connections your society will be less egalitarian. Even when doctors are all free it doesn't make them all equal...
Well, you could also view it as rich decision-makers supply lots of cash to fund R&D, and then the benefits trickle down to everyone else. That's more or less how it works for health care (although it works better for drugs than stuff like surgery where the cost doesn't drop as much with time) - I wonder if it would work with internet access. I'm generally a fan of net neutrality though.
The rich will always be better off than the poor - if they weren't why would anybody bother to work hard? Even in "communist" nations the rich were better off than the poor, although wealth was often measured in political connections rather than dollars. I'm sure that no matter how you slice it if you and a congressman are in the hospital at the same time needing a heart, and there is only one to go around, you're not going to get it. And if your heart is fine but you're in marginal shape with an organ donor card, I wouldn't count on keeping that heart either...
The key is to find a practical solution that will work in the real world (where everybody is selfish), that will get the best product to EVERYBODY in the least amount of time, and which will work indefinitely. If you pass a law saying that anybody can steal cars from a dealer then the poor benefit for a few weeks until nobody bothers making cares any more. Ditto for health care advances. And I wonder if the same will apply in the online world.
I do think we need safeguards against the restraint of trade. But the person paying $9.99 for internet access need not get the same product as somebody paying $99.99.