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Conversation has been slow here. I feel like the standards have increased to the point where people are afraid to post (except of course for bad faith posters who don't care).
So, let me try a post that's more of a conversation starter and less of a PhD thesis.
According to Bernie Sanders, it costs about $5 to make a monthly dose of Ozempic, the blockbuster-weight loss drug. Americans pay about $1000/month. Canadians pay $155. Germans pay $59.
The stock of the company which makes the drug, Novo Nordisk, has doubled since the beginning of 2023. (I considered buying in 2022 but didn't because I thought I was already too late 💀) It now has a market cap of nearly $600 billion, making it the most valuable company in Europe.
I assume that if companies were forced to charge the same price in U.S. as they do in Europe, the global pharma industry would become insolvent.
So why is the United States paying for > 100% of global pharma research? And how can we fix the glitch?
To fix the overall problem requires burning the whole system to the ground. But to fix this particular issue -- European governments putting price controls on drugs -- it "only" requires a trade war. Allowing re-importation is a start, but those countries would ban re-export. So by law, refuse to allow US drug companies to sell in foreign countries (or at least some selected set of wealthy foreign countries) for less than they sell here. Refuse to allow non-US drug companies to sell here for more than they sell in other countries. And if the Europeans respond by abrogating patent rights, go nuclear (figuratively) on them -- remove them from normal trade relations, start abrogating THEIR patent rights, etc.
Agree it's what it would require.
It'd be interesting because I think the result would actually be to bring America to EU style price controls. I imagine the intelligensia is more in favour of the socialist price controlled system than the US one. The big loser would be pharma RnD (and stock prices). It is crazy the extent to which the US subsidises pharma RnD for the rest of the world. I saw a graph showing pharma investment returns slowly projecting down over time, reaching 0% around 2020 then going negative. I think this is based off a low-hanging-fruit theory and the data supports it.
On Ozempic I am rather bearish. There are very few buttons in the body which can be pushed for gain without many side effects. It sort of violates a no-free-lunch theorem (which I do believe in) regarding pharmacology. I think over time many people will decide the side effects aren't worth the benefits for them and the positive effects are actually quite modest when viewed in their totality.
I have actually seen some things which violate this no-free-lunch recently. Follistatin gene therapies appear to boost muscle mass, QoL and maybe longevity (30% boost in mice). This counts for me; even though it's not a drug it's a single protein and it's impressive you can get so many positives boosting one thing. There will likely be others along this line, but I don't imagine too many being available.
That seems too strong. A no-free-lunch theorem for pharmacology might make sense for things that we expect to have been already optimized by evolution. Maintaining a good weight in an environment of caloric abundance and whatever else is causing the obesity crisis (corn syrup? microplastics? the chemicals they put in the water to turn the frogs gay?) is probably not one of those things.
It's more that there aren't buttons you can push in without affecting everything else. The signalling systems aren't anything like a computer where there is one variable for each discrete thing. If a molecule has one major effect you can ride off and only a few other minor effects you are very lucky. Often molecules have different major effects in different parts of the body because their release is isolated. But they usually also just regulate multiple important things simultaneously, so with GLP-1's you see a lot of GI side effects. You're not pushing a button that decreases appetite, you're pushing a button that greatly upsets the entire downstream digestive process.
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