The Gutting of America's Medical Research (opens in new tab)

Never take anyone serious who says “The government is not making enough money/losing money on this.”

It’s not a business. Its job is clearly outlined in the preamble of the constitution.

> The leadership of this country seems to believe it can in fact influence biology to take its positions.

That or they would rather simply ignore biology in service of this or that politically-motivated special interest, and put off any problems for the next generation to deal with.

There will be follow-on effects, too. Like "wellness" ending up on the same tier as "medicine". Without the research, who's to say? This will also compound the Qanon fascination with "medical freedom", where the patient gets to dictate to the doctor what to do (i.e. use ivermectin against COVID, or whatever other superstition rises to the top of the Qanon imagination cauldron).

It's impossible to discover a basic fact, such as "the mitochondria is the powerhouse of the cell," and monetize it fully within the same organization. A million scientists can take a look at that basic fact and involve it in their own research in ten million ways.

It's also not practical to keep those facts as trade secrets over the several decades over which their applications need to develop. Even if an industry consortium was willing to discover that clouds are made of water droplets, it would certainly leak before the science of meteorology had progressed far enough for that consortium to offer saleable rain forecasts.

Finally, companies are unwilling to train people about basic facts. Academia is the only system where "and then you tell everybody" is a part of the incentive structure. Privately, you have a strong incentive to reveal nothing and punish leakers.

Basic research creates foundation knowledge that can drive medical innovation, but rarely does academic research create final composition of matter. Private funded work is all the non-research components of drug discovery - optimization of molecules, regulatory work, commercialization, etc...

To imply that private companies reap the rewards of basic research without contribute much is ignoring the many other components of translational work.

To give a more financial answer, it’s because pharma products have a low probability of success and have long lag times. That means a high cost of capital: lenders and investors are going to expect good returns to make up for the risk.

Second, biotech/pharma actually already do invest quite a lot in R&D. But they tend to focus on translational work rather than speculative exploration, because it is less risky.

a lot of basic research is very risky and most of the time it’s not stuff that leads to immediate development of a new drug. it’s basically acquiring knowledge with the hope that some of it might turn out to be practically useful in the future, but in the short term, it just allows us to understand stuff. but it’s not directly profitable, so private companies aren’t motivated to invest so much money in that

In part because the expiry of patents puts a cap on the return on investment private research can get you.

Patents last for about 25 years, but important innovations have returns far into the future, hundreds of years. At that rate, you would very often be better off accumulating interest on capital anyways.

Notwithstanding the nature of scientific progress as an accumulation of smaller experiences (each individually harder to justify with a profit motive).

Indeed, even privately funded research is often openly published, such as the now-famous paper "attention is all you need". There's just not that much to gain from keeping every single thing under wraps. More to gain with openness.

A growing suspicion of mine is that maybe the govt is just more efficient at some things, like funding speculative research, which is part of the industrial policy of every prosperous nation.

While there is value from having the drug becoming available on the market, you would think there would need to be some form price controls in exchange for private production.

Why do you think reproducibility will improve if funding is cut significantly? That is less money for labor, instruments, and consumables, which means less money for experiments, particularly for follow up experiments that have no deliverable.

Sure. But which half? If half is legitimate, and half is fraudulent, who do you expect to still be in the game after you cut half, the legitimate researchers or the fraudsters?

Talking about rebuilding after just shifts this problem instead of solving it. When you start to spin things back up, who's at the front of the line looking for new grant money?

I’m conflicted about this as well. I’ve had a range of chronic illnesses my whole life. I’d love it if there was useful research into them. But after seeing decades with no progress, I have to conclude that most medical research into chronic illnesses is going in the wrong direction.

Most research is still following a medical model that worked for infectious diseases in the 1950s but does not yield any meaningful information or treatments for chronic, complex disorders that have multiple interrelated factors.

And since doctors are trained primarily in the treatment of acute diseases, even the useful information that’s found by research is largely ignored in practice. The ignorance of the average MD about chronic illnesses is astounding.

I’ve been sick for the last two years and I’ve given up going to doctors. They are a waste of my time. I’ve done much better by doing my own research and treating myself. Much of what’s helped has been stuff that I’ve seen described as pseudoscience, even though it’s empirically based, because there aren’t enough RCTs for it to qualify as “evidence”. This makes me incredibly angry.

The system is utterly broken. I’d like to scrap the whole thing and start over. Hopefully, we’ll find a way to start over when the smoke clears.

> For decades we've been told that our healthcare prices were due to medical research

That was a lie to justify insurance price gouging.

Hahaha, prices come down?! In this economy? That's not very pro-shareholder of you.

Honestly; the exact opposite. Removing funding for research means either research is canceled, or funded private.

Funding the research privately increases costs to end user as private ensurer is directly accruing more cost. Research stopping increases costs to end user as new/novel cures/treatments aren't found.

Cost for consumer goes up because of lost opportunity cost of 1) learning to diagnose earlier 2) finding new or cheaper cures/treatments.

You can make the argument 'But other countries will pick up the slack!' - but that doesn't necessarily help either, why would they give us the results of their research cheaper? US already jacked up pricing via an executive order on drug pricing just this year to knock that.

Publicly funded medical research is an absolute positive for the US general public health and wallets. We're all losing here on both ends of the spectrum ($$ and actual general public health).