rowyn | Hope and Politics.

One of my leftist friends was talking to a conservative, and one of the things the conservative said was 'Liberals live in a very different world from me. I don't think I'd like it there; it seems like a very bleak and depressing place'.

My friend defended herself ably from this contention, but it run a chord with me nonetheless. My liberal friends do have a very bleak outlook on the direction the world is going in.

On reflection, I don't think it has anything to do with liberals being particularly pessimistic, or conservatives being optimistic. I think it's more about empowerment. American liberals are living under a Republican Congress and Republican president, and they quite naturally feel that this government doesn't reflect their political ideals. We're on the wrong track; of course things -- politically, at least -- are bound to get worse instead of better. I see the same pessimism in many conservatives, for that matter, because a lot of them aren't getting what they want either. Y'know, like some people on the left are ticked because we don't spend enough money on schools and we have a patchwork hash of a healthcare system, while some on the right hate the national gov't is still spending hand-over-fist and digging us deeper into debt. Which is funding, among other things, a hugely expensive drug benefit for Medicare. I don't actually know anyone on any side who's actually voiced approval for that drug benefit. You'd think it'd make someone happy but I don't know that it has.

Anyway, part of my point is that political orientation is so much more complex than our "two party" system represents. A lot of my friends are so far from identifying with either that it doesn't much matter which party is in power: they're still going to feel disenfranchised. They know how they want the government to work, and neither mainstream Republicans nor mainstream Democrats agree with them, so they're not going to win no matter which side comes out on top.

Funny thing is, that last describes me pretty well, too. I still vaguely consider myself small-L libertarian: fiscal conservative, social liberal. The Libertarian party is never going to go any where, and Republicans have been doing at least as much tax-and-spend as Democrats do, just on different issues. (Sometimes.) "Family values" and "war against terror" gets a lot more lip service than "civil liberties" nowadays (has it always? Are civil liberties just not sexy, in the same way that small government and untargetted tax cuts are not sexy?)

And yet I'm basically optimistic about the state of America and the world. I don't know why that is, exactly. I just have this peculiar faith that things are going to be OK, that the police and the military are not going to be overwhelmed by corruption and powerlust, that we're not going to lose our prized freedoms, that the economy is not going to face-plant into the ground. This isn't a factor of "my guys" being in power. I felt just the same when the Republicans took Congress in my liberal days in the 90s, or when I'd switched to libertarian leanings and Clinton was still president. "It'll be all right."

Maybe it's that I think the nation is resilient, that there are enough good people in the country that it doesn't matter which monkeys you put in Washington.

Or maybe I'm just not that convinced that my politics are right. Hey, it's the way I think the country should be run -- but I could be wrong. Maybe it's just as well that my side isn't in charge. Who knows what hash we might make of things?

Flat | Top-Level Comments Only

From:

zaimoni.livejournal.com

Forcing negative gross margin is extortion.

This particular extortion is legal because it's the government doing it. That doesn't make it ethical. Without the U.S., the world (including the EU and Canada) would be hosed because there would be no replacement antibiotics for vancomycin in research.

To be fair:

Classically socialized healthcare works better than the U.S. model for predictable illnesses with relatively inexpensive treatments. Specific examples I have researched include psychiatric care, and preparing for Avian flu. On conventional vaccinations for diseases of childhood, the two appear to be comparable.
The U.S. model works better for superheroic treatments. We don't have waiting lines for medically necessary surgery, except as limited by organ donation. The EU and Canadian waiting lines are often at least a year long.

So, it's a matter of which needs of citizens the various governments put first.

From:

gleef.livejournal.com

Forcing negative gross margin is extortion.

Perhaps, but nobody is forcing negative gross margin here. The pharmaceutical companies have very high gross margins (sales - cost of goods sold). However, then they, of course, have to adjust their figures to account for their R&D costs (high) and Marketing/Lobbying costs (even higher) and other fixed expenses that aren't covered by cost of goods sold. They have, by their reconing, a negative adjusted margin that they like to pretend is their gross margin. I think it's reasonable to disagree about how such fees are accounted without resorting to accusations of extortion.

This particular extortion is legal because it's the government doing it.

It's only extortion if there's a threat of violence if you don't hand over something of value. I see no threat of violence here. I'm just trying to picture Canada invading New York City to lay siege to the Bristol-Myers Squibb headquarters on Park Avenue.

Without the U.S., the world (including the EU and Canada) would be hosed because there would be no replacement antibiotics for vancomycin in research.

Vancomycin? I don't understand. Vancomycin was discovered by in 1953. It was discovered by Eli Lilly, in Indiana, but I see no reason why it would have been impossible to discover by other people later, Lilly just found it first. The 1950s pharmaceutical industry was also very different then, not as bad in the ways I'm griping about them now.

All patents for Vancomycin and any fancy processing needed to keep it from killing people (it gathered dust for almost two decades because of toxicity problems with early formulations) expired by the '80s. It's now a generic medication made by multiple companies in multiple locations. I believe China has been making it for a while, as well as Xechem who outsources much of their production to India. What about the US would hose the world regarding Vancomycin?

So, it's a matter of which needs of citizens the various governments put first.

I wasn't even getting into the difference between our health care system and other countries'. I was getting into the question of who should, for example, France put first, Eli Lilly or the French people? That sort of question is illuminating regardless of health care model.

From:

zaimoni.livejournal.com

For reference: vancomycin happens to be the "master antibiotic". Any bacterium that ignores vancomycin, by definition ignores all other antibiotics based on persuading bacteria to commit suicide.

If nothing is researched in time, we fall back to 1920's healthcare for bacterial diseases. Staph and strep (the two major bacteria killers pre-penicillin) will return at full force, completely untreatable.

Preventing that is an example of what the U.S. is bankrolling, because the EU and Canada won't pay their way.

From:

gleef.livejournal.com

I'm ok with deleting advertising costs from the calculation. However, the R&D costs to be amortized include all failures and orphan drugs covered by the blockbuster (at a rate of 15 failures to each good pharmaceutical). So the EU and Canada are still forcing gross negative margin: the price reductions in question are well over the 20%-30% of the costs attributed to advertising.

I have no specifics figures, and I wasn't even saying that they don't have a right to charge for R&D of failed drugs. I was, however saying that there's no sane way that they can claim that R&D on a failed or commercially unsuccessful drug counts towards the gross margin of another drug.

To my knowledge, nobody is forcing any company to sell drugs at a loss. Those occasions where countries asked the pharmaceutical companies to sell at a loss, (eg. drugs used in AIDS treatments), the companies just refused to sell there (which is justifiable), and in some cases the countries decided to develop their own generic alternative. No force, no extortion, just two entities with different goals doing what they needed to do in a bad situation.

I was thinking of EU-based corporations like Astra-Zeneca, Glaxo-SmithKline, and Roche, more than U.S.-based ones.... If nothing is researched in time, we fall back to 1920's healthcare for bacterial diseases. Staph and strep (the two major bacteria killers pre-penicillin) will return at full force, completely untreatable. Preventing that is an example of what the U.S. is bankrolling, because the EU and Canada won't pay their way.

I'm confused, you list three enormous European pharmaceutical companies, and then go on to imply that Europe isn't researching antibiotics? I find that hard to believe. First off most new categories of antibiotics were developed in Europe: Penicillin was British R&D, Sulfonamides was German R&D, Cephalosporin was Italian research and British development. Many new individual antibiotics were developed in Europe as well, Cipro, Rocephin and Zinnat, among others. If by some freak tragedy of economics, the US pharmaceutical companies all go bankrupt from long-overdue corporate reform, there is still plenty of research and development being done outside the country to keep us from all dying of strep while we fix whatever went wrong here.

From:

zaimoni.livejournal.com

Nobody is forcing the companies to see at a marginal loss. But the physical cost of manufacuturing currently runs at about 10% of the U.S. retail price of a pharmaceutical. So it is quite possible to force companies to sell at a negative gross margin because of the R&D costs.

And the R&D for the failures and orphan drugs has to be covered from somewhere. It's either covered by the blockbusters, or...you shut down research to what can be sustained by annuities, endowments, and government grants (the last of which is too unstable to be relied on).

I'm implying that Europe is not paying its way for the researching of antibiotics. Rather, the U.S. is subsidizing research by European companies.

The European companies, in general, are in comparable fiscal shape to the U.S. ones. The weak ones were merged out in a wave of mergers from 1999-2001. I'm not seeing any going under from anything less than Great Depression II.

From:

zaimoni.livejournal.com

Ok, I see some hyperbole in my last reply.

Reduce U.S. prices to EU-controlled levels, and researsh (both U.S.-based, EU, and other) has to be cut back dramatically. I'd have to do some work to see how much of this is a negative spiral. But what stops this spiral is trust and government funding. With the long time scales, government funding is not reliable.

Note: an orphan drug is defined as a drug that works, but that doesn't pay for its own research. In practice for a chronic disease, about 10,000 patients/year is the threshold.

What I'd like is for a research core to be funded out of a corporate trust, rather than be subject to market and government whims.