Home > Uncategorized > Patent monopolies, corruption, and the new Alzheimer’s drug

Patent monopolies, corruption, and the new Alzheimer’s drug

from Dean Baker

It seems that no one in policy circles believes that people respond to incentives. How else can we explain this lengthy piece in the New York Times on the process by which the Food and Drug Administration (FDA) approved Aduhelm, a drug for treating Alzheimer’s disease.

The piece details how the clinical trials designed to determine its effectiveness were aborted, since it did not appear to be helping patients. Nonetheless, the FDA worked close with Biogen, the drug’s manufacturer, to find evidence that it might be effective in slowing cognitive decline. The FDA ended up approving the drug over the unanimous objection of its advisory panel. (There was one abstention.)

Incredibly, the piece never once mentions the role of government-granted patent monopolies in this outcome. Biogen was very anxious to get the drug approved because it intends to take advantage of this monopoly and charge $56,000 for a year’s treatment. If the drug would be available as a generic, which anyone could manufacture, the price would be far lower and there would be much less incentive to pressure the FDA to approve a drug of questionable effectiveness.

Obviously, we need to pay drug companies to research and develop new drugs. But patent monopolies are only one mechanism, and because of the perverse incentives they create, often not a very good one. (The opioid crisis is another example of the harm resulting from the perverse incentives created by patent monopolies.) My preferred route is direct government contracting for research, as we did with Moderna in the development of a coronavirus vaccine. (We also let them get patent monopolies, since some folks feel you can never give drug companies too much money.)

In addition to getting lower priced drugs, and eliminating the perverse incentives created by patent monopolies, direct funding would also allow for open-source research. This means that all researchers could quickly learn from the successes and failures of others doing similar work. In the case of coronavirus vaccines, this might have prevented Pfizer from throwing out one sixth of its vaccines because it did not realize that its standard vial contained six doses rather than five. It may also have allowed it to realize more quickly that its vaccine did not need to be super-frozen but instead could stored in a normal freezer for up to two weeks. (I outline a mechanism for funding research in chapter 5 of Rigged [it’s free].)

Anyhow, it would be nice if we could one day have a serious discussion of alternative mechanisms for financing research  instead of acting as though the patent system came down to us from god. Apparently, the NYT is not even willing to acknowledge the corruption that results from the incentives it creates. That is not good.

  1. Ikonoclast
    July 25, 2021 at 2:11 am

    The first two issues of the tile and maybe even cognitive decline, if not Alzheimers per se, relate to COVID-19 of course.

    This is a reflection about “opening up” under COVID-19, especially now we have the delta variant a round the world.

    If anyone asks me rhetorically or otherwise “how many deaths should we accept” in relation to opening up, I am going to answer very sarcastically, “Oh, up until YOUR death. Does that sound reasonable?” But perhaps because I am in the middle of series of eye operations I had better not say that in person. I could scarcely afford a punch in the eye.

    There is a lot of nonsense written and spoken about “accepting deaths” by people who think they are not in the firing line of COVID-19. If they are correct, they are incredibly thoughtless, selfish or callous and incredibly poor at understanding the wider real issues. In addition, they may well be incorrect about their own assumed safety. The rate at which COVID-19 is mutating and some of the ultimate possibilities available to it, within the bounds of possibility, are seriously concerning.

    “… what happens when COVID-19 spreads through populations with minimal access to medicine and dramatically higher levels of poor nutrition, untended health problems and damaged immune systems? The age advantage will be worth far less to poor youth in African and South Asian slums.

    There’s also some possibility that mass infection in slums and poor cities could flip the switch on coronavirus’s mode of infection and reshape the nature of the disease. Before SARS emerged in 2003, highly pathogenic coronavirus epidemics were confined to domestic animals, above all pigs. Researchers soon recognized two different routes of infection: fecal-oral, which attacked the stomach and intestinal tissue, and respiratory, which attacked the lungs. In the first case, there was usually very high mortality, while the second generally resulted in milder cases. A small percentage of current positives, especially the cruise ship cases, report diarrhea and vomiting, and, to quote one report, “the possibility of SARS-CoV-2 transmission via sewage, waste, contaminated water, air conditioning systems and aerosols cannot be underestimated.

    The pandemic has now reached the slums of Africa and South Asia, where fecal contamination is everywhere: in the water, in the home-grown vegetables, and as windblown dust. (Yes, shit storms are real.) Will this favor the enteric route? Will, as in the case of animals, this lead to more lethal infections, possibly across all age groups?” – Mike Davis.

    We can NEVER open up internationally again, and maybe not nationally again, in the way we were open before, IF COVID-19 remains pandemic and endemic throughout the globe. In such a situation COVID-19 becomes a scourge equal to, nay far greater than, the combined effects of malaria, TB, HIV, dengue, zika and the more serious influenzas. Would we accept TB, HIV, dengue, zika and bird flu in dangerous variants running rampant through our society non-stop? Of course not, unless we wanted to collapse our society. Why then would we accept COVID-19 when we see how dangerous and dangerously mutable it is? Such a decision is the height of idiocy.

    The first chance to eradicate this virus was lost around about February-March 2020 by not putting in place global national border lock-downs. Now we are committed to the incredibly difficult path of having let it run rampant globally and in future killing many, many more millions of people and maybe even 100s of millions of people (the deaths have only just started) AND then having to eradicate it globally: for eradicate it we must unless it fortuitously evolves into a benign form. The likelihood of this happening in the next 10 or even 20 years is quite low.

    There is currently little to no selection pressure for COVID-19 to evolve into a more benign form. The selection pressures are, and will be for a long time to come, to evolve into forms;

    (a) more transmissible;
    (b) more able to transmit in asymptomatic stage;
    (c) more able to effect immune escape;
    (d) more able to effect vaccine escape; and
    (e) more able to infect young people and children to a degree that generates more asymptomatic-stage infections passed on to others.

    This last selection pressure will be at best “indifferent” or un-selected one way or the other with regard to whether it affects the young person or child host by serious illness, Long COVID or death. Indeed, higher infectivity may go with higher harm to the young person or child. There is also the possibility of evolution of the enteric infection route, though this just might be precluded by the virus’s total conformation and infective attributes. Does any researcher even one know yet, on this score? I doubt it.

    These are all terrifying and real possibilities because near-idiots (correct term) from Donald Trump and Boris Johnson down to libertarians and neoliberals of all ages in many countries have unleashed this scourge upon us and all humanity when it was actually stoppable by best available epidemiological and preventive science and good-enough political economy.

    I will have no truck with the position that capitalism is reformable or that any elements of conventional economics are usable without radical transformation. Capitalism is systemically, emergently and evolutionarily, unsustainable and unreformable. It has proven itself so by its empirical outcomes to date. Its trajectory to collapse is undeniable. Discard it or collapse. Those are the choices. By the same token I do not recommend the state capitalism of China as it to turns into a just another system of crony, oligarchic, one-party and corporate capitalism. It simply demonstrates the Marxian insight that capitalism ineluctably, by its axioms its intolerance of alternatives and its total exploitation of other systems must first conquer the world before socialism or the return to barbarism become the only possibilities. Capitalism’s autocatalytic sprawl (search for the terms Ulf Martin and auto-catalytic sprawl) is of a prion disease form if we may use a disease analogy. Just as the prion is a protein folded the deleterious way and just as it catalyses proteins folded the right way to fold to that deleterious way, so do the axioms and operations of capitalism when contacting other, multi-variate economic systems, even state capitalism seeking socialism, fold those systems into the capitalist conformation. I am well that Nietzsche critiqued metaphor and metonomy but it seems to me capitalism is autocatalytic in the prion disease sense. I would be interested if Jonathan Nitzan or Ulf Martin cared to comment.


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