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His repetition of "no collusion" throughout the interview sounds like the guilty tic that hack screenwriters create for their villains in the third act. She hopes to delay that hit by pre-paying next year's taxes before December 31 so she can deduct them on her taxes. It is important to ensure your family is covered no matter what. Which may very well be a valid concern for the Times -- except it hasn't been one for the Washington Post, who have gone after Trump with claws out and teeth bared for at least a year. The former explains high prices well, but only the latter explains massive price variations within the US.

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The Problems With Generic Medications Go Deeper Than One Company | Slate Star Codex

If so, imagine somebody more attractive buying the rights. If you like, suppose the buyer is an effective altruist who will use all his profits on bed nets. Maybe another way to ask my question is: Why was this opportunity even available? Why are we mad at Shkreli rather than at CorePharma aside from the fact that Shkreli acts like an ass? Some guy comes along and notices that there is some money to be made resurrecting it, so he tracks down who owns the rights and buys them, selling this previously unavailable drug at Market Price i.

If not, what exactly distinguishes him from Shkreli? I wonder if there is anybody like that? Selling the drug at hundreds of dollars only makes money because of government interference, namely, the requirement that competing versions are tested against your version which you refuse to sell to them. Someone who does not do this government-mandated and impossible testing cannot make money by competing.

The ANDA is even worse than it sounds. It requires the second company to procure drugs from the first company to conduct the bioequivlence study. But under the pretext of complying with recent FDA regulations to encourage drug companies to prevent diversion, the first company can tightly control distribution to try to prevent the second company from getting any to test with.

Hedgie is try to do. Not technically legal but in small numbers unlikely to be seized by customs. Which in turn points out one good solution to this mess — reciprocity with other developed world regulators, at least for generics. A more comprehensive solution is to publicly fund a generic manufacturer of last resort.

Given that so much of the cost of these stunts including related stunts with so-called orphan drugs falls on medicare and medicaid, it would probably save money. And no one could accuse the government of stiffing the production of new drugs since it would only manufacturer drugs in the public domain. This reminds me of a Breaking Bad fanfiction idea I once had, inspired by a friend who compared the war on drugs to anti-piracy efforts, which actively drive people to piracy. The basic idea is that Walter White branches out from being a meth kingpin and eventually delivers higher-quality prescription drugs than you would get at a pharmacy at a lower price, such that, regular, otherwise law-abiding citizens whose primary goal was to get their medication would buy from him instead of from whatever had FDA approval.

This testing for medicinal and, I suppose, nootropic drugs is heavily subsidized by profits from recreational drugs, which are sold in high quality with fact sheets containing information about side-effects and risk of dependency and stuff.

Have you seen the Dallas Buyers Club? The movie is similar to your premise except that what they do is more of a legal grey zone than a black market. Also reminded me a little of Better Living Through Chemistry: Now we only need someone to write it. I think Scott should help with the parts describing effects of psychoactive substances on story characters.

Universal love, transcendent joy…. Libertarian-leaning people seem to blame the entire situation on evil FDA regulations. Meanwhile people on the left like me can equally say that the problem is continued Republican blocking of letting government agencies set and monitor the price of drugs and also note that most if not all other Western nations treat drugs like a regulated utility with strict price controls. The drug companies say that high prices are because of how expensive it is to market and research new drugs but a lot of this is already done with government money in one way or another.

There is an implied threat that there will be no more new drugs if the U. But the only way to test this is for the U. My guess is that there would still be new drugs coming to market. The guy is only three years my junior and he mainly tweets about spending 5 figures on rare bottles of wines, helicopter rides, and other conspicuous consumption choices.

The dude might be operating in the world of the perfectly legal if not morally defensible but his brazen consumption bragging could not have helped his case. And I am not opposed to spending money on quality product or the profit motive. Well should we institute the price controls based on your hunch and then 15 years later try to figure out how many life-saving blockbuster drugs were NOT developed because of artificial price controls imposed by the government?

There seems to be an argument that the rest of the world can have a welfare state at the expense of the United States not having one. I am not sure that this is true.

Capitalists being capitalists will find ways to develop products even in countries with strong price controls. Thalidomide and Acutane were both developed in Europe and both have horrible side-effects. FDA regulations stopped Tahlidomide from being approved for use in the United States and it seems to be credited to one pesky regulator who died recently. Accutane is available in generic form in the United States.

I see no evidence to suggest that drug development would stop if the U. The truth is that it was the person, not the rules that blocked it.

Kelsey discovered that after six months of stalling. It is these lost opportunities, decisions to not investigate a drug where society loses. You would never find evidence of this after the fact either from your point of view. There are more examples in Bad Pharma. Legally drug companies in the US have the freedom to pull this kind of stunt but we can see from the fact that the company which previously owned the rights not doing so, not every executive acts like a sociopath and charging as much or more than the market will bear.

Many countries deal with these problems by making the action illegal in both cases above due to the impact on others. The weird thing is that in the US there seems to be this belief that things are by default morally OK if someone is doing it to make money or that we should expect no better of corporations than to be exactly as evil as the absolute legal limits imposed upon them. It both improves scale and makes it more likely that one of the more socialist systems will fund things if the total cost is too high.

People like Shkreli are the reason why so much regulation exists in the first place. Their determination to screw other people over to the maximum possible extent imposes both short-term costs on whoever ends up paying, and long-term costs on the whole society.

Well, it depends on whether your fantasy system relies on all human beings to be perfect, compassionate and altruistic at all times, forever, or whether you deal with the real world in any form. The former explains high prices well, but only the latter explains massive price variations within the US. European-style government-run healthcare seems to do better on both at the moment. In such a system, the government internalises the costs that result from its standards. Internal politics and inappropriate levels of screaming make the tradeoffs European health systems strike still excessively cautious possibly less excessively cautious?

Price controls would probably do a little worse there than the fully government run system, because in the latter the government is at least on the hook for additional healthcare expenses incurred as a result of poorly treated diseases.

So, this makes me think about the underlying roots of which direction I run on this and similar issues. I get this idea that regulation X causes problem A; one side wants to remove X, they other side wants to patch X with regulation Y.

Definitely a bias I need to make myself aware of any time a discussion on this sort of topic is taking place. Big corporations tend to LOVE complex regulations, because only they have the army of lawyers necessary to game the regulations to maximum benefit.

Which has obvious conflict of interest issues. My admittedly cynical-libertarian slant is that the more power you give the government, the more detailed and complex you make their purview, the more opportunity for abuse you have.

This is standard Regulatory Capture Too late, not going to change, anything that looks like a change will just be cleverly arranged to produce the same end result. The Longecity-type hack is a neat idea, and might be a way for clever and exceptionally well-informed people to deal with the problem. If it ever comes close to being a real solution for everyone, the FDA actually does have SWAT teams and they can get the records of your payment to the Chinese lab.

Take a look at the supplement and cosmetics industry. If you want to buy resveratrol, for example, there are different vendors to choose from, and many of them are highly trustworthy. And resveratrol, as a raw material in powder form, costs twice as much as pyrimethamine.

It beats buying bulk powders from China, and it beats a drug black market. Onerous regulations may make things marginally safer — at huge, one might say disproportionate, social cost — but it certainly does not eliminate risk. Did troglitazone and rosiglitazone have any unexpected side effects? Or did they just have bad luck to get a few adverse events and were pulled from the market due to pure noise?

Also, Consumer Labs and some of the other big testing places charge to read their reports — I think the current burden in research, knowledge and money in order to try to make a good vitamin purchase is fairly non-ideal.

Surely not as terrifying as ordering chemicals from underground chemists in China and taking them on faith?

As far as that particular article is concerned, the testing methods that the NY attorney general used were wholly inappropriate.

Well, I have some health conditions that make certain vitamins and supplements desirable for me to take. Also, it is certainly not an isolated incident:. And it beats the Longecity model by a country mile, as well — both in terms of scope and in terms of risk. Yeah, this is a poor example. There are useful ingredients and useless ingredients.

Educated consumers are healthy and safe consumers. Cheaper than paying for a single dose of some generic drugs, which cost pennies to actually manufacture. The cream will rise to the top, and the scum will sink to the bottom; there will be trustworthy and untrustworthy vendors. My argument is basically that if regulations were loosened to near-nothing — to late 19th century levels — things would be a lot better than they are today.

The industry would police itself, consumers and consumer associations would actively test product, we have the internet, and so on….

So far they are not being super well treated by the supplement industry but it doesn't matter much because supplements have small effect. Extending the same lack of regulation of advertising and of quality to medicine in general seems likely to have a very negative impact on them. The world does not have an underlying design which would make things great and fair for everyone so long as everyone does What They Are Supposed To, so making things more fair for the educated and intelligent consumer can make things less fair to other people, and there isn't going to be an easy fix for that in the form of someone else who just needs to start doing What They Are Supposed To to sort it out.

You have to make compromises, not just focus on one group and optimise for them and assume that it should be possible for other groups to deal with the results of that because if they couldn't it wouldn't be fair. I live in Hong Kong. Medicines are wholly unregulated here and pharmacists are held in the same regard as shop-keepers. Antibiotics and antivirals cost pennies. In fact, they are very well-served by this unregulated market, as they can actually afford to pay out of pocket for the drugs they need, when they need them.

Hong Kong also has an extremely high life expectancy, which would seem to indicate that its laissez faire attitude towards pharmaceuticals leads to positive outcomes. My objection was to the case built around solely how a market built on reviews and consumers doing their own testing keeps an educated consumer healthy and safe without addressing what it does for the rest. If there was a cheap way to do almost as well then companies would use it to avoid advancing drugs which were going to fail into FDA trials and avoid ever having expensive failed trials, and while they do some of that they still have a huge failure rate in clinical trials.

No, in fact, there are not. Unless you are a pregnant woman, a Zambian child, or afflicted by one of a handful of rare diseases, there is no medical need for you to take vitamins or supplements. And what happens if the second bottle but not the first is tainted?

Are you seriously drawing a causal inference from a single data point? All of the developed East Asian countries have high life expectancies regardless of how stringent their drug controls are Asian-Americans have a higher life expectancy still. The point is more that huge sums of money are wasted on vitamins and supplements with a small risk of grave harm and no upshot. I rather like CoQ10 and experimenting with nootropics, and lots of folks obviously feel the same way.

Whether or not the supplement industry is a sham is irrelevant. And I feel that this problem is simply that there is no free market for generics. Testing chemicals is not magic. How can you possible know that? There are lots of things which some well informed people believe might be good for you which nobody can be certain are good for you. You are failing to factor in the amount of money which will be squandered on nostrums and patent medicines in an unregulated market. Certainty is an unreasonably high bar— what we really want is a reasonable degree of confidence that the supplement or vitamin in question will significantly increase your lifespan or improve your quality of life without also carrying an undue risk of harm.

As far as I know, no supplements or vitamins exist at present which can make this claim, and indeed if there were any they could in due course secure FDA approval and sell like gangbusters.

The product you mention has a batch of endorsements by high-flyers cf. And what exactly is being repaired in the body? And is the outcome the same for everyone? In other words, we do not have even a glimmer of the mechanism by which the supplement could work. Good luck trying to sue them through a Chinese court from your hospital bed in America! Well, either this supplier is reputable or they are not. If they are currently reputable, they will no longer be and they will lose customers.

If they are not currently reputable, then buying their stuff was a bad idea to start with. Now you may point out quite rightly that if the reputable producer poisons their pills, that will cause a lot of suffering before their reputation is updated.

But then again, if a company with FDA approval to sell their drug starts cutting it with fertilizer, that will also cause a lot of suffering before their approval is revoked. Also, the problem today is that the very thing that makes a producer able to satisfy your demand for a cheap drug is what makes them able to deliver a bad product with no legal consequences.

If medicine was deregulated, it is likely that there would be many US manufacturers to choose from who you could sue if they start delivering fertilizer instead of modafinil. Patent medicines often contained heroin or cocaine no surprise about their appeal there and ionizing radiation sterilizes things.

Rich people in our day believe stuff just as stupid. But the 19th century was also about The Triumph Of Science.

So much industrial and technological progress was being made, people were living richer, easier lives than in the past, new products and labour-saving devices were coming out all the time sound familiar? Now you can get better from a disease that previously would have been a sure death sentence — why, this same drug will surely knock that cold on the head in no time flat!

And look at the unexpected side-effects when you start testing drugs — Viagra started off as a candidate for treating angina and hypertension before the other benefits turned up.

Cue a whole new market when finally a working aphrodisiac had been discovered! Yes, that is an over the top and snarky summation. The more the truth of claims about benefits and harms of a product are not readily apparent to the consumer, the more important it is that a third party which is hard to coerce or bribe be responsible for validating the product in some manner.

I agree with that. Hard to coerce but possible to bribe, and, in the regulatory context, it has a monopoly position. I agree with this statement. Since basically all government bureaucracies are easy to bribe on an industrial scale, it is particularly important that government bureaucracies be kept out of the product-validation business.

Nobody has yet found a way to make a government bureaucracy immune or even highly resistant to industrial-scale bribery, aka regulatory capture. What about strict campaign finance laws? These seem like they have the potential to thwart regulatory capture, even if they are objectionable for independent reasons. Campaign finance laws would do very little to thwart regulatory capture. At least in the First World, most of it comes out of lobbying and information and staffing asymmetries, not favor-trading.

Information asymmetries are not trivial, but there is generally a pool of academics to draw on and consumer or environmental groups happy to suggest candidates.

But I can offer an even tidier fix for this problem. Sorry, if I was incorrectly ascribing views to your avatar. I mean, the completely independent bond rating agencies seem to have had a far worse problem in terms of corruption and capture. And the more arcane the instrument, the worse it was. I contend, this is just inherent tension in these types of systems.

The best way to minimize it is via cultural mores. Regulatory capture works primarily at the level of unelected bureaucrats, because it is the bureaucrats who write and implement the regulations. Even if an issue rises to the level where a congressman introduces a bill saying that e. Those pages of text will be written by unelected bureaucrats, and it will be unelected bureaucrats who explain to the congressmen that yes, these pages of legalese do in fact close all the loopholes.

For reasons that I think have been explained here repeatedly, those bureaucrats will be very nearly de facto employees of the pharmaceutical industry. Even the ones that are specifically hired by individual congressmen to give them sound advice on pharma legislation.

And if you still think strict campaign finance laws will be any use at all, those also will have to be complex tomes of legalese to close all the obvious loopholes, and will be written by, oh, you know the rest. And most regulatory issues never rise to that level in the first place.

This is a complicated problem, deeply rooted in the structure of a civil service more than two centuries old, and lots of smart people have spent a lot of time trying to solve it. They are hired by people who are hired by people who… are elected politicians. There are literally hundreds of thousands of doctors, biochemists, and pharmacists who have nothing good to say about the pharmaceutical industry. There is little need to advert to institutional causes when there are actual flesh-and-blood legislators who will cheerfully tell you what a great idea it is to have Pfizer reps draw up bills for them.

If memory serves, the solution I proposed has been tried before, but it was voided by unelected bureaucrats appointed by presidents beholden to mammoth corporations. It publishes model legislation and has enjoyed great success in prompting chiefly Republican legislators to introduce bills on its behalf.

Among its principal sponsors are Exxon Mobil, Pfizer, and the company formerly known as Philip Morris— so apparently its vision of individual liberty includes the liberty to enslave children to carcinogens. The Cato Institute is a member. Dollars to doughnuts that the Pauls, pere et fils, have also collaborated in the past. Even more so, the discovery of vitamins!

That terrible disease which cursed the mightiest navies in the world? That mysterious skin disease that cursed poor farmers for so long, maybe due to bad air or something insect-carried? Within a period of a few decades, diseases which had plagued us for centuries or longer vanished with the application of tiny quantities of nigh-magical substances, to the point where scurvy, rickets, and pellagra sound like weird, old-timey words to us now. People do take vitamins in useless ways just like they try to do for antibiotics.

Probably most vitamins taken in the US are taken for such useless reasons. You could add some currently illegal drugs to this too. But not all because a lot of them would make very effective weapons to use on people, e.

If I were the god of all drugs laws, I would try 10 other solutions before providing heroin. Solution number 2 would be to incentivize the development of more pleasurable but less horrifically destructive drugs. Solution number 3 would be setting up special areas very remote where addicts to the worst drugs could be sent, instead of prisons. Ideally these would be OK places to be, sort of gated communities for junkies.

It would need to be funded but you would probably save money overall because of fewer prisons. These places would have the drugs freely available. Most people who were there would volunteer to go because of the free and easy availability of the drugs, they would be free to leave if and only if they agreed to have an implant fitted that prevented the drug from working on them.

Having the option to exit society and spend the rest of your life doing heroin in a gated community, with the government footing the bill, seems pretty appealing! Sort of like a monastery, but for sin instead of prayer. Drug addicts volunteer to be sent there because the drugs are free and clean eliminates incentive to evade the police. Drug addicts can lead lives there, have sex with the opposite gender! You are probably not making it much easier to take these drugs for most people because you would have to make a commitment to go to the drug monastery.

It would not be a spontaneous decision you make at a party at 3am. Your opiate camp proposal sounds like it would have some potential negatives.

Given that, so far as we can tell, prescription heroin already reduces criminality in addict populations, having the treatment centre in the place where people actually live, where their friends and family are thus keeping them in touch with the social connections that I understand is a big help in overcoming addictions , rather than sending them miles away to a place where everyone is already a problematic opiate user, would still seem like a more sensible option.

I think this is probably a good idea in general — incentivising lower-concentration, or otherwise less risky forms of any drug beer over vodka, powder cocaine over crack, coca tea over cocaine, magic mushrooms over, say, LSD is worth trying.

Edited again to add: Does that actually happen often enough to be a serious strike against the benefits of ending the War on Drugs generally? Would spiking someone even be illegal? Drug addicts have extremely inelastic demand curves!!!

Having them injected under supervision, for free, at a government recreational drug centre would be better. Both options have the potential downside of increasing demand. With a drug centre in the community, people would go there in their lunch break because they thought they had the willpower to kick the habit… until they actually tried to. I remain skeptical that there is a significant of would-be heroin spikers just waiting for heroin to be legal to possess, who are not already happy to spike with alcohol.

Again, do you have any instances of this actually happening, or any good evidence that it would be so much of a problem as to outweigh the enormous social gains that stand to be made by making heroin safer by regulating purity and dosage, and taking almost all the profits of the heroin trade out of the hands of violent criminals?

Drug prohibition costs a hell of a lot of lives after all. Your premise seems to assume that even one dose is typically enough to create physical and psychological dependency, which seems pretty implausible to me. Taxing drugs would only work if the untaxed alternative basically had the same effect. If the heroin is available on prescription, that would pull the rug out from under the street dealers, and to the extent that the users themselves would otherwise become low-level dealers to fund their own habit, that would further prevent more people from being drawn in.

The word from Switzerland is that their heroin-assisted treatment model has seen a decline in the number of new users, so it seems to be working out for them. No need to send people off to gulags far from their friends, family, employment opportunities and other support network type things that can be vital in helping you overcome addiction unless you can demonstrate that keeping them in situ would be disastrous.

But what you are proposing is definitely better. But that would also mean treating adults like… adults. When eventually the drug turns out to in fact not work you lose your revenue stream, but can promptly start over with a new drug. Creating exceptions to rules can go awry as easily as the rules themselves can, after all. Not only is the amount of perverse incentive one is willing to tolerate to avoid being cruel and Orwellian variable between people, the size of this incentive and extent to which it is a problem is unclear to me.

I just thought it was worth describing the major reason I know of for opposition since it was mentioned as not being understood. If the drugs really are chasing smaller and smaller effect sizes, then who cares what the company charges for it? In the limit as the effect size tends to zero, drugs just become different brands of placebo. I suppose you could argue that they crowd out drugs that actually do work, but would people stick with a fancy placebo if someone came along with a real drug that actually works?

For everything else, the revenue stream from right-to-try would be much smaller than getting a drug through the FDA and for regular sale — and the drug company is losing potential patent years since the year patent timer starts ticking while the drug is still going through clinical trials.

Without an actual approved, useful drug, most pharmaceutical companies would go under, right-to-try sales or not. It would only slow down their folding a little.

Delay to capitalize on right-to-try seems like a losing strategy. And it might not be a clear cut case of spiking. They might get someone drunk, then persuade or overpower them and inhect heroin. They might use peer pressure to force someone young, vulnerable or frightened into taking it. How many times do you need to take heroin before you are physically addicted? Also, the existence of easily available heroin is a severe test of human rationality.

Rationally, there is absolutely no reason anyone would want to take it unless they were terminally ill. Adults are adults … but drugs with severe physical addiction potential are like landmines. The problem is that most of them end up relapsing at some point, because the underlying psychological reason for the addiction is still present.

Not to mention that the term assumes a non-existent distinction between neurochemistry and mental state. BTW I read a few tragic stories about people adults being peer pressured into starting either a heroin or crack habit and within a week being full-on addicts with addiction and physical dependence and having their lives ruined.

We have laws about food purity and adulteration because dairies and bakeries used to put everything from chalk to lead into their products.

Medicines and drugs are dangerous. There was a case recently in the news here of a woman who died from an accidental overdose of paracetamol she had been self-medicating. The modafinil you get from sketchy Internet sites works pretty well and I have heard of zero recorded cases of serious side effects.

The nootropics sold by the nootropics communtiy tend to be pure and safe effectiveness possibly limited by the science itself but not by the manufacturing process. There were a few cases where some people got bad batches of nootropics, sent them off for analysis, found they were indeed bad, posted about it, everyone heard, those companies went out of business, and the companies that the clued-in people buy from now are pretty legit.

Well, the nootropics consumers are likely to be smarter than average, no? Did they take them and have mild side effects? Here is this nice imported bottle of Chinese mineral water. Now, it may be from a legit manufacturing source that really does operate to the highest levels and draws its water from a 1, year old well that is monitored for trace contaminants, bacterial and viral levels, and mineral contents.

But to answer your question, as somebody who lived in a developing country without safety regulations for almost a decade, I can definitely say that you can find safe things. Sure, it means you need to do a bit more research though for common items such as bottled water you do your research once instead of grabbing just anything off the shelf, but you can definitely find trustworthy manufacturers. You can keep all the internal machinery exactly the same, the same inspections and personell, etc.

If your regulatory body finds that the water is made from raw sewage, that has to be written on the front of the bottle, in big red writing, with the actual name that the manufacturer chose in small font, and the package has to be plain apart from the manufacturer name, ingredients and FDA warning.

And furthermore, for the most egregiously unsafe products such as heroin or crack, I think they should still be banned because of their potential as a weapon to use against somebody.

BTW I am in the odd position of arguing the libertarian side in one thread and the nanny state side in another thread……!! Another thing to point out is that the dude got caught because he raised the price significantly in one swoop.

I suspect his style is what attracted the lightning. Had he been more conservative in his style, he probably would have not been targeted in such a hideous manner. Buy the rights to the drug. Short stocks in a variety of drug companies. Raise the price of the drug enormously and make sure the fact becomes public knowledge, resulting in lots of outraged commentary, proposals for drug price regulation and the like. Wait until step 3 has pushed down the stock prices of drug companies and close out your short sales at a large profit.

Potentially much more money to be made than from the drug itself, and it does seem to fit the background of the gentleman in question. I think that there might be legal bases for going after someone engaging in such behavior, such as tortious interference. Combining two legal actions need not produce a legal action. There are many things covered by your last paragraph that are illegal Market Manipulation. I think this example would easily count in Britain, but is more ambiguous in America.

There are three or four manufacturers of the pill, contract labs, basically, and all of them signed exclusivity agreements with the other companies which held the Daraprim brand.

Then Turing acquired the brand plus those contracts, becoming the new sole maker. They just paid off contract labs to become their sole customer for it. When a generic is introduced, oftentimes insurance will cover only the generic. If there are multiple generics, oftentimes the patient will receive a different generic every month depending what the pharmacy has that day. Might that not be a good argument for subsidizing the process of determining bioequivalency then?

So, does anyone want to explain the fold price difference for the generic cancer drug in different pharmacies? Of course, from a capitalist perspective, this is the market working as intended. The dumb losers here are the Costco CEO and small pharmacies, who apparently did not get the memo that cancer patients are desperate to live.

Pharmacies do not have identical business models. You cannot just walk into any pharmacy and have them accept your coverage: They also offer different services. They have direct billing to almost every major PBM in the country, not to mention the Medicaid clients. My major pharmacy notices that I am out of drugs and calls my doctor for me and then receives an electronic script and I can fill it anywhere in the nation and this process takes maybe an hour.

I thought it was pretty clear the Turing CEO was trying to create political outrage against big pharma, driving down biotech share prices so he could sell their stock short. Given how biotech stock prices dropped after his performance, he would have made way more in a few days that way than by selling a low-demand pharmaceutical for years. That seems plausible at first glance — he is primarily a finance guy, after all. A rational munchkining genius who will soon be smiling at us from the top of a giant heap of utility!

This assumes, of course, that he was not exposed to nonpublic info in any such stock trades by virtue of being a biotech CEO. For instance, knowing unpublished third-party analyst predictions can under certain circumstances be insider trading. News coverage has a lot to do with that. Anyway, do you think he really could have predicted this backlash? A These price increases are not actually that unusual. B Negative press attention for one tiny company is FAR from guaranteed to torpedo the whole biotech index.

This is part of my point about capitalism i. Come back to me when you have a free market. What you say about the pharmacies charging various prices rings true to me, not just about nationwide chains of chemists and not just in America: My family, like everyone else in Ireland, was a customer of our national telecoms provider for years mainly because it was a monopoly until competitors finally entered the market in the 90s and we never got any offers on the pricing structure.

You want a landline and this was before mobiles became common , you pay our charges and put up with our crappy service. And it does sound like the court system in the US should have some guidance about cases where big companies sue pre-emptively on out-of-patent drugs or ones that have been in the public domain for decades in order to ward off potential competitors. The only good thing about Turing which apparently bought the rights from a company that bought the rights from a company that bought the American rights from GSK, the original manufacturers is that up to now, Daraprim had too small a market and was cheap as dirt so nobody was interested in coming up with an alternative.

So some real competition might ensue. Bob the Rational Actor makes jars of salsa in his home kitchen. In Lovely Theory Land, Bill is now in a dominant position as the customer with a greater choice, supply is outstripping demand and there is a glut of salsa, so prices must come down.

In the real world? And so you get firms like Turing being founded which took no risks, invested no money, did no work, and are merely creaming off the profit from the work of others. Obviously, there must be enough demand for the drug to enable profit to be made by hiking the price to such a degree: So possibly an answer is to licence small firms to make these kind of low-volume drugs for the big companies which created them and put a limit on the amount of price-hiking that can be done.

Or loosen up the law so generics can compete fairly. I trust Capitalism to deliver me a wide variety of consumer products. But I think certain goods like health care are human and social goods, not consumer goods.

Are consumers now inhuman or antisocial? The people that keep going on about how great the free market is are precisely the people that complain the loudest about companies abusing the legal system to create monopolies. I think Distributism would almost certainly underperform a more traditional capitalist economy: Can you imagine if the US government just one day banned interest rates?

The experiment has been done, although not in the U. Other ingenious people, at least in Judaism and probably the other two as well, devise rules intended to prevent such evasions. The first set of ingenious people …. It raises transaction costs and adds unnecessary uncertainty, since one way of not paying interest is a loan where the expected value of the amount paid back is larger than the amount lent but it takes a form, such as lending in one currency and repaying in another, where the actual value is uncertain, so no promise of interest.

I read that bit in the post as Scott expecting health insurance companies would be writing to the drug companies and pharmacies demanding lower prices, not Scott writing to the health insurance companies.

Is switching your health insurance easy enough for this to work? For example, Pfizer, maker of the biggest pill in the world, Lipitor, sued the one company that had the right to make a generic version.

It was pretty hush-hush, even though billions of dollars were on the line. Speaking as someone who is much more fond of regulation than most folks around here, this is my largest issue with regulated markets. In any event, it certainly has nothing to do with gated regulatory markets, which are made monopolies not because of intellectual property but at least in theory to ensure that all providers in a sector meet certain legal requirements in their provision of services.

That is to say, gated markets are supposed to address externalities. Entities entrenched within the system sue newcomers as a matter of course in order to increase the cost of establishing a new service and in the hopes of knocking out new competitors before they even exist.

I think the first should always happen, and the second should happen sometimes. Gated communities without patents tend to be much weaker. With patents one or a small number of producers get years of information, experience and brand building as well as regulatory connections which add to the barriers that potential competitors face when the patent expires.

The primary way to alliviate the current problems with gated communities is to lower the cost of entry for quality particicpants. The best way, IMO if we are keeping a regulatory structure is to allow any company that thinks it is competant to enter the marketplace. You could ask for a large bond that would cover damages if they were found to be of low quality but that would be returned to the company after they had cleared the outcome hurdles.

For people interested in a book arguing for the abolition of intellectual property, both patents and copyrights, I recommend Against Intellectual Monopoly by Boldrin and Levine. True to their principals, the authors have a version webbed where you can read it for free. One of the things I discovered teaching IP theory a few years back was that whether IP was a good or bad idea was a live issue well into the 19th century, with serious people on both sides.

And is it not possible in the US to order generic Daraprim from other countries, e. If not, would it be legal to go to Europe, buy a large stash and return home to US?

You might have trouble getting a large stash past customs, though. Buy your drugs from Canada online. About ten years ago, generic manufacturers in Canada got together and formed a cartel related to the production of tricyclics. One would make amitriptyline under the ancient brand name of Elavil, one would get imipramine and so on. They would not cross-compete and all raised prices about ten times.

All because tricyclics in small doses made a big comeback for altering sleep architecture in chronic pain and there was an opportunity to profit. To be honest, I hate out generic companies far more than the brand name companies, especially since production has gone overseas and frequently large batches of staple drugs have to be condemned for safety reasons.

It would make sense tome to give the original inventors good patent protection and the right to recoup their development investment, but at the end for there to be a government generic plant that would sell the drugs at cost price to the provinces.

Lots of people died before they were required because manufacturers did things like making childrens cough medicine out of deadly substances. The company control lab tested the mixture for flavor, appearance, and fragrance and found it satisfactory. Immediately, the company compounded a quantity of the elixir and sent shipments— of them—all over the country.

The new formulation had not been tested for toxicity. At the time the food and drugs law did not require that safety studies be done on new drugs. Because no pharmacological studies had been done on the new sulfanilamide preparation, Watkins failed to note one characteristic of the solution. Diethylene glycol, a chemical normally used as an antifreeze, is a deadly poison.

Hence, the real question seems: Oh I agree, the current system in the US appears to be a mix of good sense combined with political interests and corruption. Yes, sure, the regulations cause all sorts of deviations from ideal markets, and this allows rent-seeking monopolists to extort money from people and cause all sorts of inefficiencies. Regulatory capture means that this is worse than it in some sense needs to be, OTOH regulatory capture is pretty much inevitable so in another sense things are exactly as bad as they need to be.

On the other hand, the regulations are necessary. Kicking the cruftball into the long grass and starting again with something completely different — even worse. Fell off the back of a lorry it did. Equivalency tests seem like a much higher bar. There are some drugs where bioequivalency is really important; for example, if you change your anticonvulsant dose even a little you might get a seizure.

For everything except warfarin, we just take this in stride. I think if generics had weaker bioequivalency testing, we would just have to worry a lot about the dose when switching people from brand names to generics, or among generics. So all we need to do to know which drugs can be cleared via Purity tests rather than Equivalency tests is to figure out which drugs are potentially dangerous to some fraction of people if taken with some different set of excipients.

Replicating the set of excipients seems like it would allay the concern. If that number is low enough, we could simply accept that as part of the risk of living in a world with cheap abundant medicine. We could also require disclosure. You cite a single example, which I think is the one example always cited for this argument. Do you have five more? During the course of the war, 1, Americans were killed in action with an additional 13, dying from other causes.

This high number of collateral casualties shocked the nation, and calls came from across America for an investigation. Although the high death rate had many contributing factors from compromised food provision and poor living conditions to infectious diseases, public outrage focused on the medical care given to soldiers.

It was concluded that adulterated drugs supplied to the Army had caused the large numbers of deaths among soldiers. This enraged the public, and the outcry led Congress to pass the Drug Importation Act of , the first federal drug law. Ten school children died as a result of the tainted serum. No national standards were as yet in place for purity or potency. Also prior to the FDA common food addatives included Formaldahyde and Borax because private industry had basically zero incentive to find out if their addatives were toxic or deadly.

Borax defeated, the poison squad moved on to test other common additives, including sulfuric acid, saltpeter and formaldehyde. One of their targets, copper sulfate, was especially disturbing: The food stuff is pretty easy to find examples for: If people died it was rare to be able to pin it on a batch of drugs even if it was straightforward poisoning.

Hm, and what if there were uncensorable websites that sold any pharmaceutical one could want, sending them stealthily, paid with magic internet money, that could even easily coordinate the crowdfunding of batches of medicines on enough demand? There was once a black market site that sold recreational drugs.

The market was opaque and lots of products were of shitty quality. Doing that raised the quality of all the drugs on the market, basically overnight. But that crowd-managed quality control was better, even when gameable, than no control at all. It was easier to sell good drugs than to cheat the quality control system just to go on selling shitty ones. There might well be some way to set up incentives to do the same thing on larger scales. But it seems really really weird that the obviously correct way to deliver needful things to people is the free market, EXCEPT if those things are medicines.

Like … if having the government run medicine was for some reason necessary or correct then surely for the same reason they ought to be handling the supply of bread? Less than 10 million EUR net worth. They are handling the supply of bread. US does it less directly than Rome, but even here we have food stamps and farm subsidies.

Aside police, one other example would be the third major emergency service: And your subsidising of the poor is going to get absurdly expensive as a result of the high prices people pay due to the state of the market.

Food is available from a whole bunch of different stores which all compete quite aggressively on price. Different markets work more or less effectively at settling the price at a stable minimum needed to motivate someone to do the job. The latter is a healthy, well-functioning market that works well. So we have the state take over the former but not the latter. Healthcare, it seems to me, sits closer to the fire example here. The above should be sufficient, but an additional reason is that government is also tampering with healthcare by setting safety standards and awarding patents.

This creates some particular kinds of dysfunction like the situation discussed in the article, where costs are distributed to parties not responsible for making the decisions which generate them and in a very haphazard, sometimes extremely painful or quality of life degrading manner.

Medicine — specifically prescription medication — is different than food, hygiene products, and most other necessities. Food is a relatively cheap business to get into and the regulations are far fewer and lighter than for pharmaceuticals.

If you hate them all, you can buy flour and yeast and make your own at home. Or just not eat bread, and eat something else instead. Whether more government regulation or more free-market solutions would lead to better outcomes, prescription pharmaceuticals ARE a different and possibly unique case. Well I trust my government to run healthcare yes.

The reason why I like it is because it means that whoever is pricing stuff has to bargain with the whole country. Individuals cannot always shop around so easily but governments can. In some circumstances a single company can decide to increase the price of medication by silly amounts.

Medication works differently though. If it is an FDA approved drug in the public domain, yes. If it is a new drug then no, you need million. Specifically Lymerix, the discontinued Lyme vaccine that is still approved by the FDA and is now off-patent. Recombinant proteins, like Lymerix, are in the middle. BUT, somehow Uber gets people to get into a car with a stranger all the time, without some fancy government stamp of approval.

What if you had a database that has user reviews of hundreds of labs around the world. A patient or doctor, or insurance company could put in a request for a particular drug, by a particular date, and when there are enough requests Groupon-like for the economies of scale to hit a certain point, then a batch is produced.

This is the whole reason that brand names and trademarks were invented. I would argue that the only real innovation that Uber did was to completely ignore [taxi] regulations. Of course, Uber managed to get young and hip West Coasters and Washingtonians as customers, and therefore on its side, to help shield it from the regulator blowback, while all that this hypothetical high profile, lots of advertising, Canadian shipping pharmacy would have going for it are a bunch of sick people who are too poor to pay for drugs.

The FDA puts really strict regulations on what you can and cannot advertise. Not so much with taxi regulations. And also that housing, education, and medical care are the three industries besides the financial industry in which the govmt is most heavily involved and also, by some strange coincidence, the industries where pricing is crazy and incomprehensible and getting more expensive all the time?

In the 50s it cost something like 2x the median annual salary to buy a house. Average sq footage of new homes has gone way up as have the extras in a house air conditioning etc. Costs of homeownership include interest rates for most buyers insurance, taxes, repairs etc. The education system is so government controlled that no one even dares think of privatizing it. The closest we can get is charter schools. I think in some ways the housing market is the worst. They are not an alternative in terms of your budget, because you are still paying the taxes to fund public k schools.

All the people without school age children have to pay those taxes too. Parents of children in private school presumably share in whatever positive externalities justify publicly funded education to begin with.

Vouchers are a little closer, and becoming gradually more common and closer to the full amount of the cost of the government schooling they replace. I agree with the broad sentiment here, but I would dispute the facts.

I work in the pharmaceutical industry myself, so I can confirm it is heavily regulated. However, I have some acquaintances who work at a nuclear power plant, and based on their reports, I think that nuclear energy is definitely more interfered with than pharmaceuticals and almost certainly more so than housing.

This is what effective altruism should be doing, right? Does it already exist? I think you have missed the point of the article. You sound like you are focusing on the recent headlines, where the problem is inadequate competition between drug companies. But the point of the article is that there are a lot of other ways in which generics are expensive. Why is generic modafinil so expensive? Is it the lack of competition between drug companies? Maybe, but large price differences between drug stores suggest that it is more complicated.

And there are examples of much more extreme price differences between drug stores. But even the recent headlines about high prices on monopolies might be a poor choice for charity because the market is so small. Orphan diseases are essentially natural monopolies due to high fixed costs of regulatory approval. Varying prices for other generics are price discrimination behavior. Price discrimination and natural monopolies are two different concepts.

Your electric company is a natural monopoly and your movie theater and grocery store engage in price discrimination. Of course, the answer can indeed be single-payer: After all, price discrimination can actually be a progressive force: Price discrimination certainly implies non-competitive markets, at least in the purest sense.

How big of a deal you make of this? I suggested some time back that what a large budget charitable organization, such as the Gates Foundation, should do was buy the patent rights to the second best AIDS drug or something similar , make it public domain, and then let anyone who wanted make it.

You buy the second best because it costs much less than the best, which is being sold at a high price to people to whom it is really important. And, unlike governmental solutions, you are increasing, not decreasing, the incentive to develop better drugs. I analyzed the economics of this, and came to the conclusion that the deadweight loss from profit-maximizing pricing is at most half of the consumer surplus from pricing the drug at marginal cost.

Beware Systemic Change notwithstanding, it might be even more productive to get the government to buy patents, although getting a fair process for determining purchase price might be problematic. It might be easier to get an initiative passed for a single state to buy a statewide license, rather than the national government buying a nationwide license.

Given the legal and practical limits on restricting trade between the states, how do you enforce a license that covers a single state? The price descrepancies between pharmacies can usually be explained fairly easily. Costco will have low prices because their clientel have already demonstrated that they are willing to put in the effort and expense to find lower prices and also have cars and can afford modest up front costs.

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