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Goldman Sachs questions whether curing patients is a sustainable business model

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Re: Goldman Sachs questions whether curing patients is a sustainable business model

#331

Post by cage433 »

neuromantik8086 wrote: post #284
cage433 wrote: post #200

Earlier quoted context omitted.

Nope - that's not true. https://en.wikipedia.org/wiki/Medical_research#Privately_(in... Private R&D is around 60% - however a large part of that is making minor changes to existing molecules in order to obtain fresh patents.The bigger, riskier research is done by the NIH and other publicly funded bodies. See https://marianamazzucato.com/entrepreneurial-state/ Also - the quality of privately funded research is much wo…

Intriguing. I've often speculated about how private sector research compared with public research, especially in the context of the reproducibility crisis since I assumed that a lot of pharma companies knew that some research couldn't be replicated behind closed doors. I wonder what the quality of proprietary / unreleased studies is- do the links you provide take that into account?

It compares badly. Unfortunately too much private research is allowed to be kept secret - but what is known indicates it's of poorer quality - judged by the kind of metrics the Cochrane Institute use.

Goldacre's book (he also has a blog) is well worth reading - describing _many_ ways in which drug companies can cheat.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#332

Post by rectang »

GiorgioG wrote: post #203
rectang wrote: post #167

Earlier quoted context omitted.

The US military is spectacularly inefficient, and the US military-industrial complex is a parasitical behemoth per Eisenhower's critique. It's not like the problem is unknown; the issue is that the state has to have a monopoly on violence, so we live with the inefficiency. Encouraging a marketplace of competing militia would not a viable approach. :)

> The issue is that the state has to have a monopoly on violence A monopoly on violence in what context? The planet? That doesn't seem to be necessary for most countries. Within the country itself? That's the job of local law enforcement.

"Monopoly on violence" is a term with a lot of history. I'm using it in the same sense as Max Weber, where the state is defined as the "human community that (successfully) claims the monopoly of the legitimate use of violence within a given territory."

https://en.wikipedia.org/wiki/Monopoly_on_violence#Max_Weber...

All the critiques on this thread about competing authorities such as local law enforcement, the second amendment, and so on, none of them invalidate the idea of legitimate use of force defining the state. Weber accounts for all those points.

The closest thing we have to an actual marketplace among authorities wielding violence is the competition between jurisdictions (one municipal police department against the one the next town over, the state police in one US state vs another US state) -- but that's not the same as a commercial marketplace.

The only critique I think is relevant is the idea of mercenaries, a.k.a. private military contractors. But there again, those mercenaries are part of the military-industrial complex, which is an extremely stunted marketplace as it's largely a government monopsony.

We don't use economic competition to determine who holds authority on the legitimate use of violence. As a consequence, we don't get the full benefit of marketplace competition in maximizing the efficiency of our armed forces -- but we also don't have perpetual civil war.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#333

Post by fjsolwmv »

fsloth wrote: post #126
ramblerman wrote: post #78

Earlier quoted context omitted.

You are jumping from one extreme to the other. Creating a public institution with no pressure to make profit is a disaster waiting to happen. You can certainly keep a 'competitive' environment which is regulated with incentives. And I do agree healthcare needs this, and shouldn't live purely by the free market.

"Creating a public institution with no pressure to make profit is a disaster waiting to happen." Why? Schools are not for-profit institutions (well, not everywhere). Police don't make a profit. Nor does the fire brigade. Or the military, for that matter. Are all of these disasters waiting to happen?

Your examples are all local government with local accountability to a small group of local voters. At nation-scale the story is different

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#334

Post by fjsolwmv »

Chaebixi wrote: post #245
scottishfiction wrote: post #204

Earlier quoted context omitted.

The state doesn't have to have a monopoly on violence; as the use of private military contractors has proven.

> The state doesn't have to have a monopoly on violence; as the use of private military contractors has proven. I don't think you know what the "[state] monopoly on violence" means. It does not mean all people authorized to use force are directly on the government payroll.

Rectang misused it first, by claiming "encouraging a marketplace of competing militia would not a viable approach. " Even though mercenary corporations are in fact competing militia.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#335

Post by fjsolwmv »

ddingus wrote: post #223
ramblerman wrote: post #78

Earlier quoted context omitted.

You are jumping from one extreme to the other. Creating a public institution with no pressure to make profit is a disaster waiting to happen. You can certainly keep a 'competitive' environment which is regulated with incentives. And I do agree healthcare needs this, and shouldn't live purely by the free market.

Use the Post Office model. When profitable, it contributes to the general fund. See my other comment here. Political hobbling and fuckery related to post office operations done to marginalize otherwise exemplary performance aside, the model has merit.

The post office has a govenrment-granted monopoly on first class mail service, and does pretty poorly when it competes for non-first-class mail logistics.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#336

Post by kdelok »

dominotw wrote: post #70
kdelok wrote: post #67

Earlier quoted context omitted.

Flu vaccines aren't useless, but they also aren't 100% effective. The CDC reckoned they reduce the risk by about 40-60%. Flu is a variable pathogen, which means that it evolves to look different from an immune perspective over time. It follows clustered patterns, where the flu strain will look pretty similar (and vaccines will be more effective), then it "jumps" to a new cluster every few years or so (and the vaccine…

> CDC reckoned they reduce the risk by about 40-60%. curious, Do you have a link to this by any chance? According to this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693492/ After looking at "328 households with 1441 members, including 839 children," for an entire year (2011) these authors determined that there was a difference of 4/10ths of one percentage point between those who received flu vaccine and those who…

Yeah, I didn't look particularly critically at it, but this is where I got the figure from: https://www.cdc.gov/flu/about/qa/vaccineeffect.htm

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#337

Post by Zooper »

darawk wrote: post #305
andrepd wrote: post #285

Earlier quoted context omitted.

You can theorise all you want, but the world is rife with examples of what I said being true. As always, experiment must trump theory.

Name literally one example of that being true. I'll wait.

https://img.washingtonpost.com/blogs/wonkblog/files/2015/02/...

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#338

Post by Zooper »

fjsolwmv wrote: post #333
fsloth wrote: post #126

Earlier quoted context omitted.

"Creating a public institution with no pressure to make profit is a disaster waiting to happen." Why? Schools are not for-profit institutions (well, not everywhere). Police don't make a profit. Nor does the fire brigade. Or the military, for that matter. Are all of these disasters waiting to happen?

Your examples are all local government with local accountability to a small group of local voters. At nation-scale the story is different

Tell me the different national-scale story, and why if that's not working, it's not the fault of the nation's law or systems of governance?

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#339

Post by merb »

psergeant wrote: post #85
ramblerman wrote: post #78

Earlier quoted context omitted.

You are jumping from one extreme to the other. Creating a public institution with no pressure to make profit is a disaster waiting to happen. You can certainly keep a 'competitive' environment which is regulated with incentives. And I do agree healthcare needs this, and shouldn't live purely by the free market.

> Creating a public institution with no pressure to make profit is a disaster waiting to happen. This is the model many rich country healthcare runs on, and provides measurably better outcomes for less expenditure than the US.

> This is the model many rich country healthcare runs on, and provides measurably better outcomes for less expenditure than the US.

well I'm living in Germany and I agree with that it is cheaper, but "better outcomes"? I do not think so.

I mean in Germany treating Diabetes means taking Insulin for a life long. However newer studies, actually found out that a treatment where the patient should be dieting and starts to do more sport can actually reduce the needed insulin dose or patients can even completely dismiss insulin or are cured from it completely in rare cases. (not a lot of doctors would actually help the patient or even tell them that this would be beneficial to them, hell not even the public health care sector cares)

However the thing is if you can sell Insulin for a life long to somebody who will probably die earlier you make a profit. On multiple fronts. Treating it means that once the person is cured, he will probably live longer, will have less problems and will probably cost the overall system less (but that's not something that should happen).

So basically in "richer" countries the system is equal to the US, it's just more hidden. care system and government are systems that benefit from each other if patients take treatments over a long time and probably have a reduced life-time. i.e. treatment > healing, at least from a business perspective.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#340

Post by JoshuaRLi »

PeterStuer wrote: post #24

The 'ideal' drug from a business point of view not only not cures the patient long term, it offer a short term mitigation while increasing the risk on relapse and thus future recurring consumption of the treatment. At the same time it can be IP protected to block alternatives and has an insured third party collective payment coverage to guard against the treated running out of funds to afford the perpetual dependency…

Well said.
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