# Profit Motive in Health Care - Essential, Immoral, or ???



## Makalakumu (Sep 12, 2009)

With the health care reform debate raging in the US, I'd like to start a discussion about for-profit health care systems.  Is the profit motive essential for new technologies?  Is charging money to save lives and/or treat sick people immoral?  Or are there some other reasons we should consider or not consider for-profit health care systems?


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## elder999 (Sep 12, 2009)

maunakumu said:


> With the health care reform debate raging in the US, I'd like to start a discussion about for-profit health care systems. Is the profit motive essential for new technologies? Is charging money to save lives and/or treat sick people immoral? Or are there some other reasons we should consider or not consider for-profit health care systems?


 
The profit motive is no more essential for new technologies than it is for new artwork, or novels, or anything creative. It does help grease the tracks in the form of devlopmental funding, but it's not essential: devlopmental funding can and does come from a variety of sources. more to the point, in the area of medicine we often see the "profit motive" leading to less than desirable outcomes, as in the rushing of "bad drugs" to market.

Charging money is the medium of exchange for our society-there is nothing immoral in charging money for services. The usurious profits of the health industy are almost wholly the result of corporate gouging: by the pharmeceutical industry and, most especially, by the insurance industry. It's especially interesting when one considers the insurance industry, which not only is responsible for health care payments for the majority of Americans, but for the cost of malpractice insurance-an additional financial strain on the system. Couple this with corporate control of medical facilities-very often by insurance providers-and you have a defacto _shared _monopoly of monstrous proportions.


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## Bill Mattocks (Sep 12, 2009)

With regard to R&D, I completely agree with Elder on this.

Profit can indeed bring huge sums of money to bear on problems, which often stand a good chance of then being solved.

Government funding can do the same thing, with the same result.

The problem for both is what gets funded.

Private industry would fund that which it believes it can get the best return on.  That means low-cost, common, or non-patentable cures are of no interest to them.  Rare conditions which few people have are of no interest to them.  What they want to invest in are cures and treatments for problems many people have, which can be dealt with by use of new and expensive drugs or treatments, which can be patented and profit extracted from.  Diabetes research is a case in point.

Government funding funds that which politicians, lobbyists, and moneyed constituents find important, which means that politically-charged areas get more funding, and those which are not politically 'sexy' get less. There is no system of putting money where the problems are without regard to politics, because politicians control the funds.  AIDS is a case in point.

No good answers.


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## Steve (Sep 12, 2009)

Here in Seattle, the Fred Hutchinson Cancer Research Center operates as a non-profit organization largely on private donations and public grants from the NIH, if I'm not mistaken.   Their work is cutting edge.


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## CoryKS (Sep 12, 2009)

Neither essential or immoral, really.  If someone has a product, they can give it to you or they can sell it to you.  Their choice.  If they sell it, they need to price it at a level where people will actually buy it, otherwise they've accomplished nothing.

But here's the thing - you can't force someone to produce something if they don't want to.  So it's irrelevant to ask whether profit _should_ be a motive.  Either it is or it isn't.  The important thing is to identify what it is you want, who has the ability to provide you with it, and what do they want in exchange for their service?  If they want money, that's what you give them.  If they want more money than you're willing/able to spend, you do without or find a way to allocate funds toward the purchase.  Or you can use the government to take the money from other people, which is the increasingly popular approach.


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## Steve (Sep 12, 2009)

CoryKS said:


> Neither essential or immoral, really. If someone has a product, they can give it to you or they can sell it to you. Their choice. If they sell it, they need to price it at a level where people will actually buy it, otherwise they've accomplished nothing.


This is a very different argument then the one made in another thread that, without profit, there would be no innovation.


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## CoryKS (Sep 12, 2009)

stevebjj said:


> This is a very different argument then the one made in another thread that, without profit, there would be no innovation.


 
There can be some, but not nearly to the same degree that you would have when profit is a motive.  Even non-profit organizations derive their success from the profit motive.  The organizations themselves may not be making money, but the people they employ do.


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## elder999 (Sep 12, 2009)

CoryKS said:


> There can be some, but not nearly to the same degree that you would have when profit is a motive. Even non-profit organizations derive their success from the profit motive. The organizations themselves may not be making money, but the people they employ do.


 

As I said, money is the medium of exchange for our society. The people they employ make money to live, generally-this is not a "profit" motive, which is more about _gain_

From the usually excellent _Merriam Webster's English Language Technical Manual_ (that's _engineerspeak_ for *dictionary*):





> *Main Entry: 1prof·it*
> Pronunciation: \&#712;prä-f&#601;t\
> Function: noun
> Usage: often attributive
> ...


 
Indeed, many "non-profits" do, in fact, make a "profit"-these excesses are simply reinvested in their endownment. An example would be the Santa Fe Opera. Many other non-profits in the arts are in the same position-though not lately, of course.....


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## CoryKS (Sep 12, 2009)

elder999 said:


> As I said, money is the medium of exchange for our society. The people they employ make money to live, generally-this is not a "profit" motive, which is more about _gain_
> 
> From the usually excellent _Merriam Webster's English Language Technical Manual_ (that's _engineerspeak_ for *dictionary*):
> 
> ...


 
Making money to live _is_ a profit motive.


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## elder999 (Sep 12, 2009)

CoryKS said:


> Making money to live _is_ a profit motive.


 

Simply living is not a _gain_. While it is a motive, it is not a _profit_ in the strictest sense of the word. 

Otherwise, why are so many _in debt_ to do so?


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## CoryKS (Sep 12, 2009)

elder999 said:


> Simply living is not a _gain_. While it is a motive, it is not a _profit_ in the strictest sense of the word.
> 
> Otherwise, why are so many _in debt_ to do so?


 
Of course it is.  Unless you're suicidal, every day you manage to keep yourself alive is a gain.


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## elder999 (Sep 12, 2009)

CoryKS said:


> Of course it is. Unless you're suicidal, every day you manage to keep yourself alive is a gain.


 
There is no _gain_ in collecting welfare, or social security, or disability-though some might mistakenly equate it with getting something for nothing, and see it that way. There is no _gain _in working for Walmart. There is no _gain_ in being homeless-where many, many, many people (200,000 schoolchildren alone) are _managing to keep themselves alive_.


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## CoryKS (Sep 12, 2009)

elder999 said:


> There is no _gain_ in collecting welfare, or social security, or disability-though some might mistakenly equate it with getting something for nothing, and see it that way. There is no _gain _in working for Walmart. There is no _gain_ in being homeless-where many, many, many people (200,000 schoolchildren alone) are _managing to keep themselves alive_.


 
That's what I'm saying, there _is_ a gain.  It's called keeping your *** alive.  Gain is relative, and I'm sure they'd all love to have money in the bank, but the bare minimum is to have not died.  If you have accomplished that task one day further, you have gained.  To say otherwise is to take _way_ too many things for granted.


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## crushing (Sep 12, 2009)

elder999 said:


> Simply living is not a _gain_. While it is a motive, it is not a _profit_ in the strictest sense of the word.
> 
> Otherwise, why are so many _in debt_ to do so?



People making a living often use their 'profits' to purchase a few TVs, maybe two gaming consoles, cable or satellite TV, a couple computers, cell phones, internet access, MP3 players, a couple cars, leisure activities such as golf or maybe MA, restaurant dinners, wine, beer, and more.  Sometimes they even put some of the 'extra' money away for a rainy day or into an emergency fund.


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## elder999 (Sep 12, 2009)

CoryKS said:


> That's what I'm saying, there _is_ a gain. It's called keeping your *** alive. Gain is relative, and I'm sure they'd all love to have money in the bank, but the bare minimum is to have not died. If you have accomplished that task one day further, you have gained. To say otherwise is to take _way_ too many things for granted.


 
To call simply staying alive under the most mundane of circumstances a "net gain", is taking _credit_ for *way *too much. 



crushing said:


> People making a living often use their 'profits' to purchase a few TVs, maybe two gaming consoles, cable or satellite TV, a couple computers, cell phones, internet access, MP3 players, a couple cars, leisure activities such as golf or maybe MA, restaurant dinners, wine, beer, and more. Sometimes they even put some of the 'extra' money away for a rainy day or into an emergency fund.


 
Or a boat, or extra vehicles, or a second home,(or a plane!!!) and *that*, provided they aren't making those purchases on credit, *is* profit. 

Simple sustenance or subsistence, the basics: food, clothing, shelter-should not be considered "profit" or "gain," but basic *needs*.


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## CoryKS (Sep 12, 2009)

elder999 said:


> To call simply staying alive under the most mundane of circumstances a "net gain", is taking _credit_ for *way *too much.


 
It is if someone else is footing the bill.


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## elder999 (Sep 12, 2009)

CoryKS said:


> It is if someone else is footing the bill.


 
And I said that _some_ might see it that way....


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## crushing (Sep 12, 2009)

http://www.cnn.com/2007/US/Careers/05/16/cb.profit/index.html


> "The great majority of non-profit organization executives do not earn six-figure salaries with substantial fringe benefits," King writes. "Because the chief executive's salary establishes the top pay scale in the organization, most career positions in the non-profit sector cannot compete monetarily with those in the business sector."



I've heard it claimed that the best and brightest people don't get into politics, because it doesn't pay enough.  Could that also be the case for non-profits?

It seems to me, in healthcare anyway, one of the most noble causes would be to provide services to the war veterans that so bravely served our country and the place to do that would be the in the VA.  Based on the awful and chilling news that has come out from the VA in recent months, it doesn't appear that the VA is attracting those people.

Please don't take my question above as disparaging those that work hard and diligently for non-profits.  I know people that work hard trying to make a difference, also I am an unpaid elected officer of a non-profit organization.  While I do my best in my capacity, I probably wouldn't be hired into a for profit organization of a similar size doing what I do for the non-profit.  Fortunately for me, I also have a paying job at a Fortune 500 company for which feel that I am well qualified.


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## Dirty Dog (Sep 12, 2009)

Speaking as someone with roughly 30 years experience in healthcare (ER/flight nurse) let me just say that the idea that medical care should be non-profit is ludicrous.

On the hierarchy of needs, food, water and shelter are FAR more important than medical care. And yet, I don't see anybody suggesting that Wally World should be required to give away food free, or that they ought not make a profit, nor that the mortgage companies should stop making a profit.


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## Makalakumu (Sep 13, 2009)

I am a certified Wilderness First Responder.  Next time I'm on trail, if someone is in need of aid, should I demand that that they pay me first?  Lets say I come across someone who is going to die unless I provide some kind of aid.  Should I demand that this person enter into a contract with me to pay me before I help him?  Should this be a demand at anytime during this process?


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## Dirty Dog (Sep 13, 2009)

maunakumu said:


> I am a certified Wilderness First Responder. Next time I'm on trail, if someone is in need of aid, should I demand that that they pay me first? Lets say I come across someone who is going to die unless I provide some kind of aid. Should I demand that this person enter into a contract with me to pay me before I help him? Should this be a demand at anytime during this process?


 
Give me a break. There is a HUGE difference between "cash up front" and "you're not allowed to make a profit".
People die without food, water and shelter. When will you be lobbying to force grocery stores to give away food? The city to stop billing for water? The landlord to stop collecting the rents?

Despite your dramatic post, the reality is that at *least* 75% of the people in the average ED do not need to be there. They have no emergency. If medical care for visits like these is an entitlement, then pony up the tax money to pay for it.


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## Archangel M (Sep 13, 2009)

Except the cost and development of most new drugs is entirely on the shoulders of the "evil" pharma companies.

http://www.america.gov/st/econ-english/2008/April/20080429230904myleen0.5233981.html


> In the United States and most other countries with pharmaceutical industries, *private industry undertakes or funds virtually all discovery and development of new medicines*, often _building on basic medical hypotheses developed through university and publicly funded research_. Industry scientists searching for a new drug typically must sort through 5,000 to 10,000 new chemical inventions that look promising, in order to identify a pool of 250 compounds that then enter into preclinical laboratory and animal testing. Of those 250 unique compounds, fewer than 10, on average, will show enough potential to qualify for Phase I human testing to establish basic safety.


 
So while the hypothesis may be pubicly funded. "Making it work" needs companies (with investors) to spend the cash to "make something" and bring it to market. The same goes for most tech. Theory is different from R&D and manufacture.


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## Bruno@MT (Sep 13, 2009)

I think profit in healthcare is not bad. I jus think it should ONLY be made on medical materials and care though. Not to the gianormous administration of lawyers, accountants and executives the US healthcare system has in between.

Btw for full disclosure: I work for a big pharma company. Meds are ridiculously expensive to develop and make, following the long list of various international regulations and industry best practises.


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## Makalakumu (Sep 13, 2009)

Dirty Dog said:


> Give me a break. There is a HUGE difference between "cash up front" and "you're not allowed to make a profit".
> People die without food, water and shelter. When will you be lobbying to force grocery stores to give away food? The city to stop billing for water? The landlord to stop collecting the rents?



If people need water, they can get it for free.  If they need food, they can get that too, most of the time.  Housing?  That is something our country subsidizes and out right provides in many cases, but it something we could do better.  At any rate, very few people starve to death or die of thirst in our country, under normal circumstances.  The exception is on many Indian Reservations, of which I've lived, but at any rate, that's besides the point.

IMO, you haven't really argued against the moral point I made above.  You say there is a huge difference between "cash up front" and "you are not allowed to make a profit" I don't really understand what that means.  

My point is pretty simple.  If I demanded that I enter into a contract with me before I saved their life, a contract that would bankrupt the individual that I would be saving, I would be performing an immoral action in the eyes of many people.  Yet, this is something the health care industry in the US does all of the time and people seem to have no problem with it.

Imagine if our police and firemen began demanding that we enter into contracts that were exhorebintly expensive before they rendered services.  Imagine if the law forced individuals into said contracts with these individuals after the service has been rendered.  A LEO could take the bad guy who was robbing your house and then slap you with a bill that would take your house as payment.

If you've got cancer and are going to die AND you want to live, you've got very few options but to lose everything you own in order to do that.  I don't see much difference between that and the other situations I wrote about above.


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## Makalakumu (Sep 13, 2009)

Archangel M said:


> Except the cost and development of most new drugs is entirely on the shoulders of the "evil" pharma companies.
> 
> http://www.america.gov/st/econ-english/2008/April/20080429230904myleen0.5233981.html
> 
> ...



America makes damn good weapon systems and the government pays for that.  R&D is already being done on the public dime there and it works great.  So, it can be done on a larger scale.

Also, we have places where good R&D is being done on drugs on the public dime.  What about expanding those?


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## Archangel M (Sep 13, 2009)

Paying for something and PRODUCING something are different things. The gvt pays private companies to R&D weapon systems..general dynamics, boeing, raytheon..they are all profit driven industries. The gvt. funding contracts is vastly different from thinking that the gvt can provide the quantity, quality and innovation that these companies can.

My father-in-law works FOR the military, on military bases, doing military R&D but he does it for a privately contracted company.


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## Makalakumu (Sep 13, 2009)

Archangel M said:


> Paying for something and PRODUCING something are different things. The gvt pays private companies to R&D weapon systems..general dynamics, boeing, raytheon..they are all profit driven industries. The gvt. funding contracts is vastly different from thinking that the gvt can provide the quantity, quality and innovation that these companies can.
> 
> My father-in-law works FOR the military, on military bases, doing military R&D but he does it for a privately contracted company.



Could a similar arrangement work for the health care industry?  Do we need to rely in companies producing drugs that will make lots of money rather then drugs that would benefit society the most?  Maybe a public health motive would reveals some solutions that may not be profitable, but they are highly valuable in terms of public health?


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## Bill Mattocks (Sep 13, 2009)

maunakumu said:


> Also, we have places where good R&D is being done on drugs on the public dime.  What about expanding those?



I already said why.

When the public dime is spent on R&D for health, it goes to the maladies that the politicians who control the purse strings demand.  That means companies who make big campaign contributions, companies that have a big presence in the home states of powerful chairmen of congressional committees.   It also goes to maladies that the public clamors for by way of special interest groups.

There is also a downside to private money spent on R&D.  Private companies will not invest research money on drugs that cannot be patented, or on maladies that not many people have.  They want to do R&D on the diseases everyone has, and drugs that can be patented and a profit made from them for as long as possible.

A mix is what we have now.  It does tend to level things out a bit.  However, the big winners are still AIDS research and Diabetes (which I have) because of the aforementioned.  Contract a disease that few get, and for which there are non-patentable treatments, and you'll discover that no one cares to do any research into that field.


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## Bill Mattocks (Sep 13, 2009)

maunakumu said:


> Could a similar arrangement work for the health care industry?  Do we need to rely in companies producing drugs that will make lots of money rather then drugs that would benefit society the most?  Maybe a public health motive would reveals some solutions that may not be profitable, but they are highly valuable in terms of public health?



Public R&D is not done for the public good but for the benefit of those who control the political committees that dispense the money.  There is no such thing as altruism.


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## Makalakumu (Sep 13, 2009)

Bill Mattocks said:


> There is no such thing as altruism.



A friend of mine back in MN works on MS drugs because he wants to help his father live longer.  When it comes to health care, I think there are other motivations rather then pure profit.  The desire the help others is not dead.


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## Bill Mattocks (Sep 13, 2009)

maunakumu said:


> A friend of mine back in MN works on MS drugs because he wants to help his father live longer.  When it comes to health care, I think there are other motivations rather then pure profit.  The desire the help others is not dead.



Your friend is noble.  I am referring to those who control the purse-strings of R&D for medical research.  In the public sector, that is the US Congress.  They do not devote money to R&D for fields they feel personally strongly about.


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## Makalakumu (Sep 13, 2009)

Bill Mattocks said:


> Your friend is noble.  I am referring to those who control the purse-strings of R&D for medical research.  In the public sector, that is the US Congress.  They do not devote money to R&D for fields they feel personally strongly about.



I think we may be touching on two separate issues here.  All of these points that you are bringing up aren't necessarily criticisms of public funding, but of Congress and of the process in which Congress operates.  For the sake of discussion, lets say that Congress worked perfectly and that the will of the people was always served.  Do you have any ideologic reasons for not supporting public funding of R&D?  Health care in general?


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## Knives (Sep 13, 2009)

immoral with the amount they price gouge


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## Bill Mattocks (Sep 13, 2009)

maunakumu said:


> For the sake of discussion, lets say that Congress worked perfectly and that the will of the people was always served.  Do you have any ideologic reasons for not supporting public funding of R&D?  Health care in general?



Ah, that's a different, and interesting, discussion.

Yes, I have an ideological reason to not support public funding of R&D for health care, and it is that it is not the proper role of the federal government.  I am, after all, a Jeffersonian and not a Hamiltonian.

However, I have changed some of my positions with regard to the role of the federal government, and I admit (gasp) that there are some things that the federal government can either do better than private industry or that it can do because private industry will not.  I get that.  I am not anti-all-regulations, for example.  So even though my fellow conservatives will skin me for it, I'm not a pure free-market capitalist any longer; I harbor some secret pro-regulation tendencies.

For the sake of argument, let's say that we could have a system of public funding for health care that was truly run for the benefit of the people and not for the contributors to some politician's reelection campaign or favorite PAC, or because their research facility happens to hire a lot of people in that Congressman's home state.

If that were the case, I would be a lot less opposed to the idea of publicly-funded health care R&D money, or even government-run R&D (universities and direct government labs, as the USDA does today).

I am sorry to say that I do not believe such a system is possible.  I am not being partisan in my condemnation - I have pointed out that the private sector has different, but just as serious problems with R&D for health care.


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## Bruno@MT (Sep 14, 2009)

The thing is, pharma companies already try to do that: find cures for the things that most benefit society, for the simple reason that that is where the most money is.

At the same time, it would be silly to suggest that we (pharma) have to abandon the meds we have and know how to make, just because they are not what the majority needs.


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## Bill Mattocks (Sep 14, 2009)

Bruno@MT said:


> The thing is, pharma companies already try to do that: find cures for the things that most benefit society, for the simple reason that that is where the most money is.



But that's not true.  The profit motive says that they put their money in R&D where they are most likely to make a profit.  That means researching drugs that are likely to be patentable (and thus expensive and not cheap) and researching maladies that are common and not unusual.

Thus, there is huge research money spent on developing new replacements for erection enhancing drugs and weight-loss pills, and very little spent on cures for diseases that few have.



> At the same time, it would be silly to suggest that we (pharma) have to abandon the meds we have and know how to make, just because they are not what the majority needs.



Developing a new drug often costs billions of dollars and years of effort on the part of the labs.  Like the movie industry, they find themselves only able to pursue the most promising drugs, so they put everything they have behind a few, quickly abandoning those that do not appear to be heading towards rapid success.  They also put major effort into getting those drugs approved, since their success as a company is so tied to them.

They routinely put technical writers to work writing glowing reviews and studies that they then farm out as 'ghost written' technical papers that they pay respected doctors to sign on to as if they had written them.  They lobby the government for approval intensely, and they send armies of salesmen into the field to convince doctors to prescribe on and off label with perks that would beggar the imagination and television commercials designed to get patients to beg their doctor for 'the purple pill' or whatever else they're selling.

http://www.nytimes.com/2009/09/11/business/11ghost.html?em



> Ghostwriting Is Called Rife in Medical Journals





> In the scientific literature, ghostwriting usually refers to medical writers, often sponsored by a drug or medical device company, who make major research or writing contributions to articles published under the names of academic authors.



http://www.ama-assn.org/amednews/2009/09/14/prl20914.htm



> Pfizer pays record $2.3 billion in off-label drug marketing settlement
> A drugmaker's subsidiary pleads guilty to misbranding Bextra.





> A Pfizer subsidiary, Pharmacia & Upjohn Co., agreed to plead guilty in early September to a felony violation of the Food, Drug and Cosmetic Act for misbranding its COX-2 inhibitor, Bextra, for off-label uses. The company agreed to pay $1.3 billion in criminal fines for systematically promoting off-label Bextra use to physicians through marketing materials, drug rep talking points and more.



I do not blame the problems in the drug industry on 'greed' or whatever else.  The free-market system itself just doesn't work well in this environment, when so much is at stake for each drug introduced - failure of more than one or two new drugs is liable to bankrupt a drug maker completely, just due to the extreme costs involved in making and marketing a new drug.

As I've also said, there are also huge problems on the other side of the coin - when government itself does the R&D.  Then you have control over the purse strings held by politicians who have their own agendas, which seldom coincide with the 'public good'.

So the system is rotten to its core, and I do not know of a solution.  But private and public are both very very bad right now.


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## CanuckMA (Sep 14, 2009)

There are ways to reduce the immediate and future costs of drugs. The solution is obvious, but since it involves countries not protectting their turf, it will never happen. 

To reduce the consumer cost, lower the time limit on patents so that generics will be available faster.

To offset loss of revenues to the drug companies, have as many countries as possible agree on a mutual approval process. Same standards everywhere. A good portion of costs is the clinical trials and mass of regulations that must be duplicated from country to country.


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## Makalakumu (Sep 14, 2009)

For me, the moral issue trumps any government spending ideology I may harbor.

http://www.nytimes.com/2009/09/13/opinion/13kristof.html?_r=1



> After Al Qaeda killed nearly 3,000 Americans, eight years ago on Friday, we went to war and spent hundreds of billions of dollars ensuring that this would not happen again. Yet every two months, that many people die because of our failure to provide universal insurance  and yet many members of Congress want us to do nothing?



Priorities?



> Nikki was a slim and athletic college graduate who had health insurance, had worked in health care and knew the system. But she had systemic lupus erythematosus, a chronic inflammatory disease that was diagnosed when she was 21 and gradually left her too sick to work. And once she lost her job, she lost her health insurance.
> 
> 
> In any other rich country, Nikki probably would have been fine, notes T. R. Reid in his important and powerful new book, The Healing of America. Some 80 percent of lupus patients in the United States live a normal life span. Under a doctors care, lupus should be manageable. Indeed, if Nikki had been a felon, the problem could have been averted, because courts have ruled that prisoners are entitled to medical care.
> ...



When you consider the amount of people who will be getting sick from our terrible industrial food system (diabetes cough cough), we may be reviving the Megadeath from the Cold War era.  Reforming health care is a moral issue.  It has to be done.


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## Bill Mattocks (Sep 14, 2009)

maunakumu said:


> For me, the moral issue trumps any government spending ideology I may harbor.



I am not sure I disagree with you.  I'm getting there, slowly.

However, what I do not want is another patch.  ObamaCare is a political hack job, a patch, and it just takes more money out of my pockets (and yours) to throw to administrative types and bureaucrats to waste. 

If we're going to do it, let's face it head on and dismantle the whole stinking system and start from dot.



> When you consider the amount of people who will be getting sick from our terrible industrial food system (diabetes cough cough), we may be reviving the Megadeath from the Cold War era.  Reforming health care is a moral issue.  It has to be done.



If I can get past the constitutional issue, then I'm on board with you.

I am planning to see the movie "King Corn."

http://www.kingcorn.net/

[yt]
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[/yt]

There is room for this old conservative to learn a few things, my friend.

But I still have to wrestle with the better angels of my conscience about the whole constitutional thing.


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## Makalakumu (Sep 14, 2009)

I think the good news is that there is room for solutions by both ideologies.  For example, a driving cause of the mess of our food industry and the health care industries are the subsidies and regulations that actually FAVOR the most unhealthy options in terms of choices of both food and treatments for disease (In my mind, the issues of Food and Health Care are intimately twined because what we put into our bodies determines the ultimate shape they are in).  Good old fashioned conservatives can craft a populist argument that basically states that we need to get rid of these subsidies and these regulations they are provably bad for the people of this country.

This isn't the only solution because some Liberal ideas also have merit.  What we can't have is this one or the other approach.  That doesn't work.  Especially the idea drifted by our current crop of democrats that we can force everyone to have insurance and keep giving them stuff that will make them sick AND treating them with the same old inefficient mandated treatments.  That is a recipe for bankruptcy right there.  It's a measure of how strong these lobbyists are that not even Republicans are really serious about tackling the negative influence of government intervention in the system.


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