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Trust

Blog entry posted by anciendaze, May 22, 2012.

Three items in today's news prompted thoughts about trusting pharmaceuticals. The first is pretty obviously connected.

If one-third of drugs you obtain are not what they claim to be what confidence can you place in treatment with them? Of course one can say that this is not a problem in countries where drugs are well-regulated, though the costs this imposes are substantial.

(By the way, the paracetamol mentioned, whose mechanism of action is still not understood, is more widely known under the names acetaminophen and Tylenol.)

About the best you can say about introducing a new drug is that it costs less than introducing a brand-new design for a major airliner or developing a nuclear weapon. Still, if the cost is around $1,000,000,000 and the delay is 15 years, how much sense does it make to invest this money when the patent life is 17 years (or 20 years from date of priority)? With the current pace of litigation you can expect the struggle to obtain and enforce a patent to last as long as any potential benefits. Investing in Spanish banks would be more certain. Pharmaceutical companies have taken note, and the results are apparent in the reduced recent pace of new introductions.

At least one may say we are safer because of this. Let's check on how the most expensive procurement process on Earth is doing in avoiding counterfeits.

Apparently, there is no limit to how high costs may rise without conferring much in the way of certainty. Are U.S. pharmaceuticals in better shape? Are clinical studies free from similar problems?

For comparison I'm going to look at another kind of drug. In 1918, at the end of a devastating war, estimated world production of cocaine was put at 10 tons. Recent estimates of world production are over 100 times as high, and most of this is illicit. At an estimated $100 per gram this is a staggering number.

Where would a savvy investor put his/her money?
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anciendaze

About the Author

As the name suggests, I am old and dazed. The avatar illustrates my rule of thumb: "Hang on! This ride isn't over."
  1. alex3619
    I do not completely disagree with you, the report was only an indicator - its not prophecy carved in stone. In fact I can see ways out of the dilemma - quite a few in fact, aside from the solution offered by Club of Rome. Its just that we love to ignore issues until the crisis is fully upon us.

    One of the options for example is to embrace slower growth in terms of resource utilization, but be smarter in how those resources are applied. Bio-engineering will open up huge industrial possibilities. While there are limits on resource availability in a closed system, there is no similar fixed limit to information - science can produce solutions to questions we have not even asked yet. Also its not a closed system - we have a whole solar system full of resources. The issue really is cost - most solutions are much more expensive than we are used to. This in fact is one of the chief concerns from the Club of Rome. We have fossil fuels for centuries yet, but the cost of accessing them is going to rise, with that burden being added to mining, food production, manufacturing etc. Add that to our not really acting to fix problems arising out of the last four years of financial crises, and its just setting the stage for another one. When much of the world has governments operating at severe financial deficits, this just increases the concern. Given the aging population, plus increasing disability rates, then that is a further impact.

    These things can be solved, but first the problems need to be researched and nobody seems to think these issues are theirs. This is why I am concerned that we can't leave basic medical research to pharmaceutical companies - they are good at getting product to market but rely on discovery of mechanisms as targets - and such discovery tends to be in the public sector.
  2. anciendaze
    The Club of Rome model had serious defects, like using a single variable called pollution, and ignoring feedback from people learning in one location and applying knowledge elsewhere. You could test stability in that model by going back to a previous state and using data available at the date to predict what happened afterward. It turned out the model itself was unstable. Numbers had to be carefully tuned to get agreement with past changes.

    The robust reasoning behind the model is essentially the same as Malthus used in the 18th century. Freezing development at that level was not a good response then, and is not now. Better models and more careful reasoning are needed.
  3. alex3619
    Hi Anciendaze, yes water is one of the issues, but so is soil degradation, urban and industrial sprawl (leading to farming land loss) and persistent pollutants. The problem, taken to a highly simplistic form, is that growth is linear (which means supply), but population and economic requirements are exponential (which means demand). It is predicted to cost more to do less while the demand is for much more to happen. The model predicts that demand will exceed supply in about ten years and keep getting worse.

    This is not sustainable. Its also not inevitable - but based on difficulties with climate change issues I cannot see the world trying to deal with this until after the crisis hits. The current strategy is simply to hope its a bad computer model and not valid.
  4. anciendaze
    We have been dependent on technology ever since we domesticated animals and invented agriculture. Population densities for hunter/gatherer cultures are very low. Population is the driver of many of these problems.

    While you are worrying about food security you need to take a look at water. This is the limiting factor in a wide range of situations.
  5. alex3619
    http://www.csiro.au/files/files/plje.pdf

    This is an analysis of the Club of Rome report on collapse of world economy and the ability to sustain population. This was released in 2008. The world is on track for the start of serious economic collapse, according to the model, starting in a little over a decade. The model includes two bright and rosy assumption futures, one of which is sustainable, the other is dependent on ever increasing technological solutions. It is not certain that this represents the future, and its shown by the model that there is a solution, its just that the world is not on track for implementing a solution. Its not the end of the world if this model is right, but it is the end of the world as we know it. Some of the parameters are predicted to start collapsing in just over a decade, others to not collapse for another 30 years or more.

    Pay particular attention to one issue: food security.

    This is yet another reason why I think we possibly have a time limit on finding a solution to ME. Money is tight now, its going to be even more tight in twenty years.

    A rational world has a good future, the world of business as usual is predicted to collapse before the end of the century, even if we make super-optimistic assumptions. Of course, the model could be wrong ... but its still on track. There are also options that undermine these predictions, but we are not pursuing those either.
  6. alex3619
    If we can nix the patent strangleholds on genes (which is a violation of the principle of patents as genes are natural) and promote open publishing, together with better online journalism, we have a chance at creating a wonderful future. Otherwise its looking rather grim. I personally think that the drug companies could profit even more under this strategy, but it would require a change in strategic direction.

    In some ways what is happening with ME is similar. We have the psychologizer's stranglehold on a lot of the research funds, too much information is locked away in arcane libraries that require a dragonslayer to reach them (or oodles of cash for someone in the general public), and media reporting on ME issues is mostly of a very poor standard.

    I do believe these issues can be solved. They are not insurmountable - just very difficult.
  7. alex3619
    Advances in pharmacology and other fields of medicine require three things: availability of funding, availability of information, and a desire to act. Capitalist economies supply the first one, have limited supply on the second (due to patents and corporate secrecy), and mostly a profit motive on the third. Non-capitalist countries typically have none of the three. Its like the old saying about democracy - its the worst form of government there is, except for all the others. The same is true of capitalism. Unchecked capitalism may result in monopolies and mercantile aristocracy. Unchecked socialism usually results in broad mediocrity. China is an interesting case where they are both capitalist and non-democratic.

    Government is supposed to be the balancing force in society. If government becomes too partisan to big business, or the unions, or any other societal faction, then it will have a tendency to fail in its role as government. Good governance is a balancing act, but far too often it becomes secondary to good politics, an entirely different kind of balancing issues with different agendas.

    I believe it is possible to reconcile these things. However much I dislike current capitalist and democratic practices, it remains a system in which the problems could be solved - you simply could not do that in a fully totalitarian state. So we have the potential to do so, but it requires people with vision and long term committment to make a difference. Too few politicians in any country, and of any political leaning, have this kind of committment and vision. To me the key here is freedom of information. An educated and informed public, especially if they are taught to think for themselves, is an essential step to getting this done.
  8. anciendaze
    There is a problem with the description your have offered, Don. Non-capitalist countries, no matter how large, have not had a record of innovation in pharmacology, except possibly application of known drugs to dissidents. The operating principle of the societies which have fostered innovation is pluralism, not state monopolies cloaked by ideology and appeals to an amorphous force called "the People". Freedom of information is also essential. Every human social structure will constantly make errors, the question of how these are corrected is primary, not secondary. The chance that anyone is right from the get-go is negligible.
  9. Don Quichotte
    A large high-tech company prefers to hire young and healthy people,( who will be driven to work like slaves and will not last in the company for more than a few years), than older and disabled people who will work more slowly. Because this company will not survive if things don't move fast.
    Such a company can't be altruistic, unless they receive some funding or encouragement to hire disabled people. Even if the CEO of the company knows that the success of his company (and similar companies) is at the price of the crisis you are talking about. In fact, knowing that when he/she retires they can't count on a pension, will only make them work harder so they can save enough money for their old age.
    Capitalism gives people the illusion that if they only work hard enough, the sky is the limit. If you are not Bill Gates, than it is your own fault, you just didn't do enough to get there.
    Governments can't do much either, because they too depend on funding for their elections. See what happened when Obama tried to make changes in the american medical system.
    This kind of revolution can only come from the bottom up.
  10. Don Quichotte
    There is an inherent conflict between the individual and the society. As humans are social animals they have the ability to be altruistic, but they also have the ability to be egoistic.
    The capitalistic approach encourages egoism at the price of altruism. It clearly tells the individual that he/she has to be successful. Even in a profession which is basically altruistic (medicine, nursing) people are encouraged to be personally successful. A small drug company and a caring physician that is not interested in money or success, but just wants to develop a new medication for his patients will fail in this system. The drug they develop together may be very effective, but with a limited budget you can only check it on a limited number of patients, who have less chance of responding (because you have to first give each medication to patients who have no other treatment option and in whom the potential benefit will significantly outweigh a possible risk from an experimental agent).
    A large pharma company with a physician who is interested in personal success, is much more likely to succeed, even if their medication is not better (or even less good).
    There is no conspiracy here, just the forces of the market, which in many ways resemble those of the jungle-survival of the fittest.