Friday, April 01, 2011

See It's All Big Pharma's Fault

Yesterday morning at 4 am (why is it always 4 am?), my son started throwing up, exhibiting all the classic symptoms of stomach flu. My wife wanted to take him to the doctor but I convinced her to hold off till the afternoon and by then the symptoms seemed to have abated. Then they stopped abating, so we were driving to the hospital at 11 pm in the rain, where they ended up giving him Motilium which worked like magic. He was able to hold down water and slept peacefully all night long.

Motilium is a brand name of domperidone an antiemetic that is available by prescription, or over the counter, in most countries. A notable exception is the United States. This 20+ year old drug which has a long worldwide track record of safety has never been approved by the FDA.

Land of the free, home of the brave and all that. Protect us (well, not me) almighty FDA from anti-puking medicine. After all, it was developed in Belgium and that's not even a real country, right?

Big Pharma's motivation is to sell patented drugs, not to make people as healthy as possible. These two things would be highly convergent in a society of perfect information. They are currently pretty divergent. But whose fault is that? Isn't it your doctor's job to make you as healthy as possible? Or all these government regulatory agencies? Or your own?

Everyone responds to incentives: corporations, doctors, government agencies, politicians, etc. 

Let's start with doctors. Why is there a disconnect between the patient's best interests and doctors' treatments such as prescribing all these statins and other useless or harmful medicines and dishing out harmful advice like low-fat diet dogma. Is that the fault of Big Pharma? Are doctors purposefully damaging their patients health because they in a giant conspiracy with Big Pharma? No, of course not.

What about Big Pharma, are they purposely trying to damage people's health just to make money? Again, no, I don't believe that. They are responding to incentives, incentives created by the alphabet soup of regulatory agencies in charge of government health. Private industry has to nimbly respond to market incentives or they will soon get bounced out of the market.

Which leads us to the final player in this quagmire, government intervention. Patients have a very high incentive to increase their health. Doctors have a high incentive to care for their patients health, but they also have an incentive to cover their ass which can conflict with the first. Pharmaceutical firms have an incentive to discover, patent and sell as many drugs as possible. But what is the incentive of a government bureaucrat?

In short, to increase the power and scope of the bureaucracy. Also, to cover their ass. And because of regulatory capture, the bureaucrat's incentive soon becomes aligned with the deepest pockets of the industry they are supposed to be regulating. This means that smaller and less influential players are forced out of the market and we end up with a situation where the best interests of the consumers have become wildly divergent with that of the market.

How is an unelected bureaucrat at the FDA who wants to regulate home genetic testing kits interest's aligned with the consumer? Not at all. And what about the interests of all the government officials who keep shoveling coal into the boiler of the runaway train that is the diet-heart hypothesis? How much incentive do they have to worry about the misguided science behind the cholesterol myth?

Next time you hear a more enlightened member of the paleosphere complain about statins and Big Pharma, explain that it is Big Gov, not Big Pharma that is the real culprit.

I've been banging this drum for a while, here and here. But despite the paleosphere being full of libertarians of some stripe or other, I seem to be the only one who doesn't want to cast Big Pharma as the easy villain in all of this.

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