Todays Taleb

Pharmaceutical companies are better at inventing diseases that match existing drugs, rather than inventing drugs to match existing diseases.

From The Bed of Procrustes
by Nassim Nicholas Taleb

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14 Comments

  1. Yes, thanks to all sorts of artificial government incentives. Incentives matter. Big Pharma isn't inventing diseases so much as following the money trail. If it didn't take millions or even billions of dollars to get drugs approved in the US (and let's face it Europe, and especially Sweden take their lead from the US), maybe these companies wouldn't be wasting so much time and energy inventing diseases to fit already approved drugs.

    Instead of bitching about Big Pharma, let's look at Big Gov's underlying involvement in the matter. Would there even be statins today without the McGovern committee and the institutional demonization of SFAs?

  2. Mario
    So true Sean! How about looking at everything the starts with "Big", but especially Big Gov!
  3. Sean: Good points! I've always wondered (and asked people when they talk about "big whatever") when the shift occurs to being evil.

    I own a couple of small companies, and I'm clear I'm a little guy. But one of my companies is getting quite large in its market. Perhaps I'll come to dominate that market in the next 4-5 years. At that point am I the evil big guy?

    It's so funny how BIG Pharma or BIG Tobacco or BIG Oil are derogatory terms. It's fun to point out that the only way to get big is to be successful, and then ask the person using the term if he would instead refer to them as Successful Oil, Successful Tobacco, etc. That usually spins out into a discussion that makes me realize how few critical thinkers exist in the world. :)

  4. Sean, Government is not blameless in this. I agree. I agree about the McGovern commission and the damage it has caused.

    I don't follow your logic that raising the cost to get drugs to market forces the drug companies to be evil.

    They're putting out worthless or dangerous drugs and making money on them by pumping doctors full of misinformation. They are falsifying research and in essence addicting people to their substances.

    Making the process cheaper and easier would likely have exactly the opposite effect. Government may or may not be the answer, letting the foxes guard the hen house is likely not.

  5. Kim
    Big Pharma and Big Gov. are the same thing. The doctors and researchers that work at the FDA end up working at the drug companies and vice versa. It's one big incestuous relationship designed to enrich all involved. There is so much corruption at every level. Bottom line: Big Pharma is not altruistic, developing drugs to save lives. They're in it to make money and lots of it regardless of how many get hurt or die. That's just the cost of doing business.
  6. It's not completely true that Big Pharma is the one spending all that research money. It depends on the individual drug in question. It is not uncommon for the United States government to fund the drug research, then hand off the license to produce that drug to Big Pharma. That has happened with AIDS drugs, for example.

    People do not understand how much research Uncle Sam actually pays for, nor how many of the things we use today came about through government funding. I say this not to be all "rah-rah-big-government" but it is not as clearcut as saying "business good, government evil." Y'all don't think the government is so evil when someone's just broken into your house and you have to call the police. The trouble with the demonization of saturated fats was an unwillingness on the part of the experts to take a nuanced view and follow the science rather than forcing the science to follow them. Libertarians make the same mistake when it comes to government and to social issues. Quit it.

  7. Dana writes:

    "Y'all don't think the government is so evil when someone's just broken into your house and you have to call the police."

    By Y'all I assume you are referring to us selfish libertarians. Thank God for nuanced views. If someone invades my home I'd prefer to defend myself with a gun rather than wait for local law officials who might simply arrest me for filming them. Or perhaps shoot my puppy by accident, uhm in the line of duty

    If only libertarians could understand nuance...

  8. Margaretrc
    An interesting book on the subject: "Selling Sickness: How The World's Biggest Pharmaceutical Companies are Turning us All into Patients", by Roy Moynihan In the end, though, I think there's enough blame to go around, including we the people. If we did our own critical thinking and research, we wouldn't fall for the ads Big Pharma throws at us with the government's permission and could discuss the issues with our doctors in a sane way, instead of just taking their word for it that we need this med or that. When my doctor wanted me to go on Boniva, I checked into it and decided it wasn't for me, and I explained to the doctor why. If he wanted to put me on Statins, I would do the same thing. But my sister and a friend are recovering from Breast cancer because of medical intervention, whereas a few decades ago, it might have been a death sentence. So I'm grateful for some of the advances Big Pharma and medical science have made, but that doesn't keep me from being realistic/skeptical and knowing that they are, indeed, in it for the money and don't necessarily have our best interests at heart. Now I have to research the cream that my husband's dermatologist wants him to put on the precancerous lesions on his forehead. The side effects look bloody awful...
  9. Funderaren
    Bill, a company gets evil by its action, not by its size. The problem usually is that to become big and stay big you often step on some toes along the way.
  10. Dr J
  11. Chris
    Whenever I hear folks profess a 'libertarian' point of view, the problem I have with it is that such a view seems to always imply that, as long as someone is seeking profit, they can do no wrong (or, at least, they cannot be blamed or held accountable for any wrong they do). As an individual, it is wrong for me to lie and manipulate others, but if I am engaged in the activity of maximizing my own material self-interest, it is OK? Even more so if I am a big successful corporation? Big companies, including big Pharma, are capable of 'making markets', and they use the government (and any other institutions they can engage) to help them do so. They do not make their transactions across free markets - they make them across various other governance structures where they control the information consumers use to make decisions about whether or not to buy their products. Do you really think that if the FDA did NOT make it so expensive to get a drug approved that the pharmaceutical companies would NOT be trying to squeeze every penny of profit out of a drug that they could? If all regulation were stripped away and people stopped criticizing them, they would suddenly become responsible corporate citizens and say, "Holy $#?*! These statin things are really dangerous, and they don't even provide a benefit for most people. We'd better stop trying to sell them to everyone"? Seems unlikely.

    I think the typical libertarian perspective (at least from what I hear from those who claim to be libertarians) is, economically speaking, very naive. It is rooted in idealized, small-scale, entrepreneurial capitalist free market system that does exist in our world, but which is not the dominant context for most (in terms of sheer dollars) transactions that take place. Pfizer and GSK may compete in the drugstore, but they are also co-members of big promotional and obligational networks that distort this idealized 'free' marketplace. There is no personal responsibility required in that system.

  12. Tom
    Andreas, the comments in this thread must seem utterly insane to you.

    They are common in the United States.

    (Just wait until Rupert Murdoch takes over several Swedish newspapers and a Swedish television network. You will start to see nonsense like this everywhere in Sweden.)

    It's like being trapped in a zombie movie that never ends.

    And wait until your mom starts talking this way. Yes, even your mother, sitting all day in front of a TV propaganda machine owned by Rupert Murdoch, will turn into someone you don't recognize. It can happen -- it happened to me.

  13. Meatsallad
  14. I've been a big fan of Taleb's writing for a few years now, since I first read The Black Swan. The Bed of Procrustes is a real treasure trove - it even has a chapter titled "Theseus, or living the paleo life". Here's one aphorism from the book that struck me as quite paleo-friendly:

    "Read nothing from the past one hundred years; eat no fruits from the past one thousand years; drink nothing from the past four thousand years (just wine and water); but talk to no ordinary man over forty. A man without a heroic bent starts dying at the age of thirty."

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