FDA drug approval processes and insurance regulations.

> FDA drug approval processes

What, specifically? Just abolish them all, and return to the pre-1938 status quo (e.g. marketing radium water to cure what ails ya)? Or specific reforms to make the drug approval processes more effective?

https://en.wikipedia.org/wiki/Radithor

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jamil7 2 days ago | parent | next [-]

> (e.g. marketing radium water to cure what ails ya)?

Sounds like something the current US health secretary might actually like.

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cogman10 2 days ago | parent | prev [-]

Best way to make the entire process more efficient would be centralizing R&D and approval and nationalizing the manufacturing of drugs. MAYBE you could license out the rights to produce drugs on 10 or 20 year license agreements.

Turn it into a pure R&D effort and not one driven by profit.

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ajmurmann 2 days ago | parent [-]

Who is gonna decide how the R&D money gets spent? What's their skin in the game and their feedback mechanism? Why will they do a better job picking what to research than current pharmaceutical companies?

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cogman10 2 days ago | parent | next [-]

> Who is gonna decide how the R&D money gets spent?

Same way the NHS previously funded medical research. Grants and grant review. You can expand that department and effort.

> What's their skin in the game and their feedback mechanism?

Believe it or not, some people just want to research and look into cures for diseases. Shocking I know. Feedback can be reviews of their work and blackballing bad actors that consistently kick out bad research.

> Why will they do a better job picking what to research than current pharmaceutical companies?

Because they already are. Pharmaceuticals aren't doing the majority of research, they are taking NHS funded research and running it through FDA approval.

Ozempic, for example, didn't come from pharmaceutical research, it came from grant research into lizard spit.

	▲	ajmurmann 2 days ago \| parent [-]
		I used to believe in the efficiency of publicly funded research, especially for things that have no direct path to economic returns. My canonical example used to be particle physics. It promises incredible breakthroughs but commercial application is faaar down the road and the risk profile is crazy. The Sabine Hossenfelder convinced me otherwise: https://youtu.be/htb_n7ok9AU?si=fJ7B8QALLm3Vy-_W I don't think we should cut all public funding for research, but we also need private research. While semaglutides were discovered in Gila Monsters a long time ago it was Novo Nordisk that put in many years of leg work to actually turn it into something useful for humans. The more interesting argument might be that Novo is controlled by a non-profit org.

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palmotea 2 days ago | parent | prev [-]

> Who is gonna decide how the R&D money gets spent? What's their skin in the game and their feedback mechanism? Why will they do a better job picking what to research than current pharmaceutical companies?

Pharma companies are pretty terrible (e.g. pricing a cure for a kind of hepatitis just under a liver transplant, not because it costs that much, but because they can make the most money that way even though access is severely restricted). Getting rid of that market-driven terribleness may be a enough gain to justify the reform.

Personally, I'm so sick of the business-all-the-things approach and its well-known failure modes that I think society needs to put some effort into making other models work. Either straight up nationalization (with perhaps internal competition between research centers), or stricter oversight (e.g. putting government officials, patients, etc. on pharma company boards with enough power that the shareholders have to take a back seat).

	▲	ajmurmann 2 days ago \| parent [-]
		Somehow the pharma industry still doesn't bring in that much money. There is a reason we aren't all in pharma funds.