@Dangerous_beans The drug wouldn’t exist at all if Gilead hadn’t had an incentive to spend money on R&D, clinical trials, and the approvals process, and make at least some profit out the back end. And that would leave all of us worse off.

So where would you propose that money come from, or what alternative incentive structure are you proposing to ensure drug discovery continues to happen?

@valhalla @Dangerous_beans Yeah that’s a good model imho, in part because it allows for better cross-subsidisation of both failed and unprofitable drugs, based on drugs that are profitable. One issue is that it also tends to result in more unmet need in orphaned indications, since on a cost/benefit basis it isn’t rational to “waste” finite R&D on areas that have little need (which leaves folks with those conditions SOL). The TGA in Australia can be quite ruthless about this, for example.

And yes I believe OP was posting in the context of the US, where this kind of “socialist” model would be very difficult to deploy (which doesn’t make it any less of a good idea, ofc).

Referring to your first paragraph, that doesn’t match what I’ve seen. In the US the FDA provides accelerated approval pathways for orphan indications, for example, in part to reduce development costs and incentivise R&D by (for profit) biotechs who might otherwise ignore them and focus on the “big 3” indications (heart disease, diabetes, and cancer, which are where the biggest revenue opportunities are).

As an aside, it’s interesting to note that states/“taxpayers” also impose costs (with good reason - I fully support that role for regulations) on drug developers. The myth that it’s all one-way subsidy of drug developers falls apart when looked at like that too.