Greed in the medical industry doesn't "kill people." There is a difference between not saving someone's life and taking it. That moral distinction undergirds our whole economy.
Corruption is bad, no doubt. But the double standard applied to medical companies makes no sense. If not saving lives is the same as taking ones, then many of the things developed by Silicon Valley are morally abhorrent. How many lives could be saved if the billions of dollars flowing into Facebook, Twitter, Tindr, YouTube, Netflix, etc. were used to buy or develop medicine? I could save the life of a kid in Africa suffering from malaria, but instead I chose to purchase a new Apple Watch. If people actually applied your moral principle in a non-hypocritical way, we'd have almost nothing to talk about on HN.
There's a difference between not saving someone's life and bribing an official to stop someone else from saving lives. This is no different than if I got a law passed saying that nobody was allowed to sell or give food to you. When you starve to death, would you say you weren't killed?
I agree with you about the specific example. But this thread is about the EpiPen, where no officials were bribed and where there was an FDA-approved alternative on the market until it was voluntarily withdrawn. The outrage is over Mylan taking advantage of transient market conditions to jack up the price on their product.
The overall thread was about the EpiPen, but you replied to a comment describing a pretty clear-cut case where bribery was getting people killed, and you wrote a completely general comment saying that greed in this industry wasn't killing people.
If you only meant that to apply to the EpiPen, and not to Russians being killed by their own government because of corruption related to cardiac stents, you chose a really weird way to go about it.
The comment I replied to led with a general point about greed in the medical industry getting people killed, and was in a thread about EpiPen. If it wasn't meant to be a comment on the medical industry generally, not just a specific case in Russia, that's pretty weird.
Except that "greed in the industry is killing people" is true even if it's rare. "Greed in the medical industry doesn't 'kill people.'" is false if there's just one instance to the contrary. So trying to reverse my argument, while witty, doesn't really work.
I do think that there was some bribery and game-riggery involved with the EpiPen. The Intercept had an article enumerating the various laws that the company had lobbied for or even had a hand in writing, almost all concentrated on either minimizing other manufacturers or encouraging the purchase of more EpiPens. The interesting bits are in the second half of the piece.
Nothing in that article says anything about bribery. Nothing says Mylan made any campaign contributions to anyone to keep competing products from being approved.
It gives three examples:
1) Lobbying to not let Medicare negotiate with drug manufacturers. Which is a perfectly reasonable policy to avoid a creating a monosopny buyer of drugs.
2) Lobbying for the Generic Drug User Fee Act. That law imposed fees on the industry to beef up FDA resources for reviewing applications of generics. It also imposed testing requirements on foreign production facilities equal to the testing requirements imposed on domestic facilities. Again, seems reasonable, and the Act was supported by public interest organizations.
3) Lobbying for federal funding to be used to purchase EpiPens for schools. Somewhat shady, but how does that kill anybody?
Actually I think point #1 reduces competition and encourages monosopnies, at least under our current situation where there are only a few major insurers. B2B market competition is probably even more important for prescription drugs than consumer market competition given the nature of medicine. That law effectively eliminates the government from engaging in competitive market practices (in other words, this gives pharmaceuticals a very large source of funds from a major purchaser of pharmaceuticals whose hands are effectively tied when it comes to both price and choice). IMHO this probably has done a lot to increase the price of prescriptions over the years. If private insurance was a highly competitive market, perhaps things would be different, but it's not.
The problem with #2 is that it creates artificial scarcity. In this case, there is plenty of justification as you don't want shady medicine on the market. The question is whether the FDA is being overcautious with generics and imports. As of now there's certainly plenty of people illegally importing prescription medicine from offshore pharmacies in an unregulated manner, because prescription prices are so inflated compared to most countries.
Lobbying does not produce some of the outright corruption that bribery does, but I've seen more than my fair share of lobbying encouraged laws in the US over the years where a subtext of the law was to eliminate competition. I'm not sure how much of current drug law is pharmaceutical industry influence (my gut feel is some but not all) but some of it definitely, for good reasons or not, blocks up the "invisible hand" of competitive forces.
At least the good thing about a system like the US (vs. the Russian example) is that there's some hope that public outrage over the most egregious examples (your Martin Shkrelis and whatnot) will cause some changes.
I agree that it doesn't specifically enumerate instances of bribery. It does, however, show Mylan engaged in the same sort of self-serving behavior that could, in my opinion, endanger lives.
I also agree that the case of Mylan is not as dramatic as that of the Russian heart stent company.
RE the killing vs. not saving, let's maybe put it more precisely - it's decisions that kill people vs. decisions that prevent someone else from saving people. Now in a way, the whole economy indeed runs on the second kind - as long as medical research and medical care aren't money-saturated (i.e. have more of it than know what to do with), all the money that flows somewhere else is preventing lives from being saved. One issue is, we can't just simply redirect all that money to medicine without the world (or at least the country trying) going straight to hell.
As for personal moral responsibility, I think it kind of depends on the "degrees of separation" from the issue. In the Russian stents case, I'd say that what happened is pretty close to mass murder. The separation between patients and the company is just one somewhat fixed legal system, that was about to save lives if it was not for the company. That's like if someone was jumping from a burning building, and last-second you pulled the life net away from where that person was landing. It's not you who killed them, it's the dv/dt...
Most of us, including Netflix, YouTube, et al. are much further separated from life-and-death issues. Like, if I work for a company automating some part of manufacturing in a factory, should I be responsible for a worker who got hit by downsizing? Don't know, I sometimes do feel that way. Should I be responsible for that worker not being able to pay his barberer, who had to start working overtime to compensate, and then didn't have time to go to the gym, and died of a heart condition? There's no way to do that in practice - there's too many variables in between me and that dying person to pin responsibility on one actor, or to even determine the casual chain.
Economy at large is kind of "causality laundering" - too many variables, too much things happening, for a single bad outcome to depend on a single actor if they're not directly connected. But the Russinan thing? Sounds as explicit and direct as one can get without pulling the trigger themselves.
> When you starve to death, would you say you weren't killed?
Being dead, he likely wouldn't.
Moral and logic (in the narrowest sense of the word) often don't go hand in hand. That having been said, your point is quite close to my own understanding.
> If not saving lives is the same as taking ones, then many of the things developed by Silicon Valley are morally abhorrent.
You're misrepresenting the issue by exaggerating in the opposite direction. It isn't "we built twitter instead of saving people". It's that some people have a life threatening problem, a company already has the solution to that problem but they charge a (perhaps unreasonably - depending on who you ask) large sum for it, they actively suppress competitors who provide it for much much cheaper (thus saving lives), and finally they do it for a profit motive (which is perhaps petty - depending on who you ask).
Yes, it's not murder, but on the scale, it's still closer to that part of the spectrum rather than the good side. The reason I say this is that I don't think it's unreasonable to conclude that this company chooses profits over saving lives, for whatever reason. If pharma companies truly valued saving lives over profits, they would reinvest some of those profits into actually saving lives instead of hoarding them. I don't envy those whose job it is to do that calculation.
In a very real sense, people did "build Twitter instead of saving lives." The money invested in Twitter's IPO alone could've saved more than half a million kids from malaria. And your first point basically reduces to: it's more immoral to develop a cure and make lots of money from it, than to spend billions on activities that don't even cure anything. That's absurd.
Your point about anti-competitive conduct is well-taken. But beyond that, it's government's obligation to make sure everyone who needs life-saving treatment has it. But going into the business of saving lives shouldn't entitle you to any less of a profit motive than going into businesses that don't even save lives at all.
> And your first point basically reduces to: it's more immoral to develop a cure and make lots of money from it, than to spend billions on activities that don't even cure anything. That's absurd.
Did the American company invent stents and was just protecting their R&D returns from evil Russian copycats? Also the "active suppression" issue is here - apparently the company bribed the government to prevent the competition. The point is more like "it's more immoral to be a life-saving cure provider who decides to make more money from it by shutting down competition that can provide that cure cheaper, than to not be in the life-saving business entirely".
> The money invested in Twitter's IPO alone could've saved more than half a million kids from malaria.
True only if taken out of context of the economy at large. There was no point in time where someone could make a business decision and whole money invested in Twitter's IPO would go directly to cure malaria. That money was not controlled by Twitter, but by many people who invested in it, each having a personal choice of what to do with their wealth.
> it's more immoral to develop a cure and make lots of money from it, than to spend billions on activities that don't even cure anything
OK, when you put it this way, yeah, it's hard to argue against.
What I was going for was more about the after-the-fact of having developed a cure: there's something about the fact that they /have/ the cure and at that point choose not to make it more available that seems reprehensible. This to me seems analogous to the sad fact that people are dying of hunger all the time in the world but a lot of us are isolated from that fact by sheer distance and go about our lives ignoring that with no moral weight on our shoulders (analogy to twitter, not having developed a cure - and not to say that this is a good thing), but if we directly encounter a person dying of hunger one day and we have food (analogy to insert-pharma-here), I'd like to think most of us would feel obligated to help. The immediacy and ability to help seems a factor.
Lets hope those public companies will learn a lesson about enourmous public backlash, the wrath of consumer watchdogs etc sooner rather than later then?
Besides I thought (IANAL) this "maximize shareholder value" meaning short-term-economic-gain meme was massively misinterpreted and needs to die soon?
I understand that you're trying to make a division between the purposeful killing of people and the more passive, "just letting people die" by supporting the status quo. For sure, all of us are guilty of the latter and we become more guilty with every passing minute.
I disagree vehemently and fervently that the medical industry as whole should be lumped into the latter group: letting people die by passivity. In the poster's story, it's very clear that the US company is they very opposite of passive and worked quite hard to exclude the company with the less expensive product from the market. For sure, this isn't all on the US company and corruption in the state played a big role as well. Still, I don't think it's reasonable to excuse the US company as "just trying to make money".
A rational outlook on this is pretty simple, and yet not as black-and-white as you are suggesting the alternative to be.
We want to maximize human quality of life.
People dying of a heart attack does not fit that goal, and a few corrupt politicians and some medical company executives and stockholders making millions while thousands also does not fit. Devoting the whole economy to keeping people alive, but not letting them enjoy that life does not fit either.
A middle path of efficient markets in areas where that works, and of artificially supporting and regulating areas where market forces do not produce the desired outcome due to a lack of profitability or externalities, is not that hard to understand. It's just hard to implement.
I understand this is a thought experiment, but "if the billions of dollars flowing into Facebook, Twitter, Tindr, YouTube, Netflix, etc. were used to buy or develop medicine" is simply not how money works.
The baseline is that -- in the real world -- there are people with skills and equipment and they may or may not put those skills and equipment to use. You can maybe get them to agree to work on producing and developing medicine instead of software. But most of those people and equipment aren't really qualified for that. For the most part, it would just be a huge waste of talent.
However, in theory, this could still lead to some kind of progress in medicine (after all, those people are supposed to be smart), but that depends on whether the key to better medicine lies indeed within the field itself. Also, those gains would still have to outweight whatever benefits occur as a side effect of business as usual, for example when an AI that was developed so teens can better sext each other turns out to be useful in automated diagnostics (or something unexpected like that).
You're not wrong, but I don't think it's an all-or-nothing affair. We can choose to draw the line somewhere. Many people, including myself, think the line is to close to the "greed" side and not close enough to the "saving lives" side.
You're absolutely correct that if we chose to apply the standard of "how many lives could this money have saved" to everything we'd never get anything done. But we can be judicious where we choose to wield that standard.
We don't need to draw the line anywhere. Greed should not be any worse when it comes to saving lives than when it comes to entertainment. Any other standard screws up incentives. Otherwise you have the perverse result of incentivizing people to invest in the next Tindr instead of the next EpiPen.
Corruption is bad, no doubt. But the double standard applied to medical companies makes no sense. If not saving lives is the same as taking ones, then many of the things developed by Silicon Valley are morally abhorrent. How many lives could be saved if the billions of dollars flowing into Facebook, Twitter, Tindr, YouTube, Netflix, etc. were used to buy or develop medicine? I could save the life of a kid in Africa suffering from malaria, but instead I chose to purchase a new Apple Watch. If people actually applied your moral principle in a non-hypocritical way, we'd have almost nothing to talk about on HN.