Illinois governor signs law capping insulin costs at $100 per month

Ah I see. So as long as we append the word "type", we're free to throw phrases into completely non-sensical contexts? How convenient.

Kidding aside, your use of the phrase here indicates a fundamental misunderstanding. This isn't "similar" to trickle-down. This has nothing to do with it whatsoever. You might as well call it "fascist" or "colonialist". It's jibberish.

Try this: You can find the Hopkins paper that Rayiner cited at https://sci-hub.tw/10.1056/nejmms1411398. It's a consice description of the causes of the ongoing dearth of generic biologic (non-small-molecule) medicines.

Read that. It's only five pages. Then tell me how the various possible ways to limit the monopoly position of incumbent insulin makers -- patent reform, lowered regulatory barriers for new competitors, whatever -- would constitute a "trickle down type" giveaway to said incumbents. Tell me how that makes any sense at all.

> Profit-driven drug companies will obviously focus on things that make money, e.g. superficial/vanity related things, not what's necessarily aligned with public interests.

Just for fun, give me some examples of drugs that are merely "superficial/vanity related". I think you're trying to construct a straw man.

It's certainly true that the free-market does not guarantee alignment with the public interest. It's also true that over-regulation is one of things that causes such misalignments.

In this case, a strong regulatory framework around biosimilars may be unavoidable due to their extreme complexity (again, read the paper). But if there are regulatory hurdles that can safely be removed, and thus allow generic drug makers to enter the market with cheaper alternatives, how exactly would that be unfair or unjust for anybody?

There is a fair amount of that. But I think the bigger problem is dogmatic ideology.

Many of those on the right are just ideologically opposed to government spending on anything (that isn't the military). It is often a win to get them to provisionally admit that, maybe, possibly, ANY government spending on research is useful. So "give more money to the FDA" is where they stop listening.

On the left, there is often a dogmatic refusal to even try to understand how markets and incentives work. They tend to inhabit a fantasy world where all humans are, or should be, pure altruists. If you think it is just pharma that responds to monetary incentives, you'd be dead wrong. Publicly-funded institutions LOVE this system as well because the typical endpoint is that when one of their researchers develops a candidate, the patent is sold to pharma...BUT the institute retains a right to, say, 5% of profits.

Why not just allow drug imports from Canada and India? It is because we -- meaning the American consumer and taxpayer -- are subsidizing drug development for the entire world. The current system in the USA, bad as it is for American consumers, develops the majority of new drugs for the whole world. I have no doubt that if you allow foreign drug imports without other reform in the system, you actually will see less drug development.

> When I get a chance to talk to politicians about how to fix this, I always make the same pitch. Step #1 should be to give a huge wad of money to the FDA. Say $1B/yr. Then you tell the FDA: every year, pick the 50 most promising drug candidates. Publicly fund the clinical trials, and the public will own the patent. Give some cash to the inventor and the institute to incentivize them to do this scheme and not sell to pharma.

This would be abused like any other slush fund. Plus there’s a natural adverse selection bias as all the “really good” patents will go the private route.

The real answer to all of this is to pass a law that drug prices in the USA have to be less than anywhere else on earth. Let that kick off a race to the bottom amongst the world’s countries. Let them eat the cost of constant marketing in the first world.

Some will argue that’s not fair to the millions in less affluent nations. I say who cares? A governments’s foremost job is to protect its own citizens.

The current pharma pricing system milks the American consumer so as to subsidize the rest of the planet. It’s long past time to end that.

To my knowledge -- keeping in mind this is not my area -- there are modest benefits for newer types of insulin. You have to dose less often. The variance in swings of blood glucose is lower -- newer types tend to be more "extended release". Some types can be inhaled instead of being injected, which is obviously preferable.

But in my understanding, in general, there are no major health risks from using plain insulin, and it is mostly about convenience. I do not know if that is true for all diabetics.

EDIT: kkreamer above says there are differences in long-term complication risks between insulin types. From my very brief literature review just now, that looks to be true. I guess I have become jaded because of the number of diabetics I have recently heard complaining that they are in danger of IMMINENT DEATH because they cannot afford their insulin. Long-term complication risks are important but it is not the same thing.

This is how pharma keeps the whole scheme going. They invent a drug that is marginally better in some way, refreshing the patent. Then, if the consumer cannot afford the product that is even 5% better, the consumer feels as if they might as well have been sent to a death panel.

You can't really blame an underfunded pension system on somebody who has been governor for a year. Illinois pensions are like many municipal pensions: they were unreasonable the day they were negotiated, and have only grown less reasonable over the many decades since.

There are lots of things wrong with Missouri. Our justice system is brutal to poor people and basically corrupt. Still, our cities are quite violent relative to other cities in USA. The "Department of Natural Resources" has rules to protect the environment, but very few of them are ever enforced against those who are willing to ignore them. (The one time I followed this trail all the way down the rabbit hole, the "Chief of Compliance and Enforcement" claimed that the courts always overrule him when he does choose to do his job, so this issue could be related to the first.) Important infrastructure is allowed to deteriorate while vanity projects get top priority. As a state, we'll vote for Trump again later this year, even though it's clear at this point that his previous anti-war rhetoric was nothing but lies. And so on...