> Where would the money come from?

Same place it does now - the end user. But the money would cover research, development, trials, data mining, treatment, etc. It would not be used to mislead medical practitioners, patients, or government officials.

> Right now the NIH's budget is $30.1B. US pharmaceutical companies invest $48.5B in 2012. Note, that's only R&D expenditure, not all the capital costs ...

US-centric may not be the best way to come at a discussion about health costs (no disrespect - just it's not typical in the world stage, and you'd be hard pressed to find someone that considers it best practice).

How does that R&D component stack up against the industry's Sales and Marketing budget? (Hint - less than admirably.)

I think the US is a good example since most pharmaceutical R&D is done in the US. Also, the NIH has a pretty beefy budget. For other countries, the cost of running their on pharma companies would be much more burdensome.

To answer your first point, you're saying that the cost of R&D would still be born by the end-user (patient). What's the benefit then if it's not saving money?

If you think a gov't run company would not pull some of the same stuff the private ones do, I'd have you take a look at some of the corruption that goes on at public companies. A gov't run company might not be for-profit, but someone there has budgets and revenue numbers to meet. The motive to cut corners doesn't disappear when it's run by the gov't.

And why shouldn't a pharma company have a sales and marketing budget? Do you think your doctor has time to sit down and analyze all of the clinical trial data? Getting in front of a doctor and touting the benefits of your drug sounds like a good thing to me. Sure, some sales reps use slimy tactics, but overall educating physicians doesn't sound like a bad thing.

If it was not 'for-profit' and public. It could be shared more freely. Meaning you'd ideally have a global effort towards drug R&D. This would easily dwarf any number the current US pharmaceuticals invest, or the NIH budget. Advances would be shared and make the cost of an advance cheaper.

Also if it were open (globally) countries could be the checks and balances for each other.

And no, pharma don't need marketing. Marketing is always used to trick people into buying things, or to create brand awareness, it's never about the good of the recipient. Dr's could simply have a database where they look up drugs and supporting material (i.e pull information rather than push marketing).

How does one decide who to fund? You're going to have every half-baked 'researcher' getting in line for their free funding. A whole industry of lawyers and consultants will pop up specializing in gaming the system to get funding for their clients. I don't trust any system designed around spending other people's money. It inevitably leads to waste and corruption.

Marketing is solely about tricking people into buying things? What about informing people of goods and services they might want but didn’t know about?

> What about informing people of goods and services they might want but didn’t know about?

If marketing didn't exist, this need could easily be fulfilled by organizations acting on behalf of the buyers. Consumer buying guides and professional industry-specific journalists publishing reviews are examples.

Yeah, and we can replace capitalism with a more efficient centrally-planned economy. In theory.

> I think the US is a good example since most pharmaceutical R&D is done in the US. Also, the NIH has a pretty beefy budget. For other countries, the cost of running their on pharma companies would be much more burdensome.

Much R&D may be billed back to the US, or at least billed in USD, but I'd suggest it's been quite some years since even a sizeable minority of actual R&D work has been done within the borders of the US.

Quoting Ben Goldacre in "Bad Pharma" (2012)

"In the past, only 15 per cent of clinical trials were conducted outside the USA. Now it’s more than half. The average rate of growth in the number of trials in India is 20 per cent a year, in China 47 per cent, in Argentina 27 per cent, and so on, simply because they are better at attracting CRO business, at lower cost. At the same time, trials in the US are falling by 6 per cent a year (and in the UK by 10 per cent a year). As a result of these trends, many trials are now being conducted in developing countries, where regulatory oversight is poorer, as is the normal standard of clinical care."

* CRO = Clinical Research Organisation. Precisely as disarmingly harmless as it sounds.

> To answer your first point, you're saying that the cost of R&D would still be born by the end-user (patient). What's the benefit then if it's not saving money?

I wasn't suggesting that money won't be saved.

To the contrary - the cost of R&D is a relatively small component of the current pharma mechanism. Once you eradicate the need to (expensively) mislead and befuddle regulators, medicos, patients, there's a lot more to spend on actual R&D.

> If you think a gov't run company would not pull some of the same stuff the private ones do, I'd have you take a look at some of the corruption that goes on at public companies. A gov't run company might not be for-profit, but someone there has budgets and revenue numbers to meet. The motive to cut corners doesn't disappear when it's run by the gov't.

Rest assured my idealistic interpretation of this impossible world precludes this kind of corruption. :)

> And why shouldn't a pharma company have a sales and marketing budget? Do you think your doctor has time to sit down and analyze all of the clinical trial data? Getting in front of a doctor and touting the benefits of your drug sounds like a good thing to me. Sure, some sales reps use slimy tactics, but overall educating physicians doesn't sound like a bad thing.

Oh my. I'd strongly recommend you spend a few hours to read through Goldacre, B.'s book (ref above). The idea that the pharma industry is 'helping' doctors in their on-going education is ... worrisome, at best.

(Hint: overall .. it's a horrendously bad arrangement for everyone involved apart from the shareholders in the relevant big pharma org)

The money for drug development would come from the same budgets that currently pay for drug purchases - the manufacturing expenses are only a small fraction of what they pay now, and the remainder of those budgets should get shifted to R&D.

Medicare alone spends something like $50B per year on drugs, add also Medicaid and other agencies (VA and such), and there you have an ability to invest comparable numbers as the pharma companies do currently.

Taxes obviously. I'd be happy to live in a society where medication research is based on public need instead of profit margin. A drug such as this would save money for the NHS or any other western countries public health system ( bar the USA ) in the long term.

There is nothing stopping the gov't from doing that right now. Unfortunately, most of the drug development efforts by public entities have had a really poor track record.

>Unfortunately, most of the drug development efforts by public entities have had a really poor track record.

Could you quantify this? Is it because they're tackling the very difficult diseases and not the low-hanging (profitable) fruit?

The polio vaccine was developed with federal money and was provided for free as a result. There is no way the polio vaccine could have been done more efficiently if the private sector did it.

Oh yes I imagine the pharmaceutical industry wouldn't fight such a move at all, would breeze right in.

You talk about the gov't like it's powerless! You do realize that the US gov't extracted billions of dollars in concessions from the pharmaceutical industry during the Obamacare roll-out?