From: allens@yang.earlham.edu (Allen Smith)
Newsgroups: comp.society.futures
Subject: Re: Suppressing innovations (was Mander and Telev
Date: 13 Apr 92 04:16:05 GMT
Organization: Earlham College, Richmond, Indiana

In article <1992Apr7.211401.21952@leland.Stanford.EDU>, whynot@leland.Stanford.EDU (William Shepherd) writes:
> In article <1992Apr04.013822.23814@norton.com> brian@norton.com (Brian Yoder) writes:
>>In comp.society.futures article <1992Apr2.054515.20041@leland.Stanford.EDU> 
>>William Shepherd (whynot@leland.Stanford.EDU) wrote:
> 
>>> Dead bodies?  I've got two words for you:  DDT and thalidomide.  
>>
>>OK, thalidomide did cause a number of birth defects, but as far as I am aware,
>>there was no indication that one could expect this.  Compare those birth
>>defects to the enormous numbers of people who die and suffer because of
>>strict FDA rules.
>>It's no contest, we'd be FAR better without the FDA restrictions.
>>
>>As for DDT, I don't know of a single case of DDT killing ANYONE.  On the
>>other hand, since it has been banned, the number of deaths from malaria
>>have exploded from a few thousand when DDT was widely used to (if memory
>>serves) about a million per year (almost as high asblem that comes 
>>along.  That it is more often than not "something bad" doesn't seem to 
>>concern either the politicians or the pundits much.
>>
>>Now, there IS a legitimate role for government to play in attacking fraud
>>in the drug industry (and any other case where it crops up), but that's
>>not what the government is up to.  It's trying to run the companies that
>>it's worried about, not trying to prosecute fraudulent companies.
>>
> I strongly disagree with your assesment of the need for the FDA.  What
> conditions are necessary for efficient market transactions?  Free trade
> between _fully informed, rational_ decision makers, with the parties to
> the transaction bearing the _full costs_ of the transaction.  I view the
> governments major role in this situation to be correcting the inefficiencies
> of the market.  My contention, based on the above premise, is that your
> average consumer does not have the necessary information to make proper
> judgements about the drug market.  (i.e. doesn't have access to labs to
> conduct his own test and doesn't have access to information regarding any
> tests.)  Second, I argue that consumers are very rarely completely rational
> in this area (witness the incredible success of all sorts of quack cures
> whenever not stamped on by the government).  Finally, in many situations
> (and this is why I brought up DDT), the parties to the transaction do not
> bear the full costs of the transaction (i.e. there are externalities).
> The bald eagle is not an endangered species just by chance.  The same goes
> for many other species.  

	The FDA's proper role is to make sure the consumer is informed. As 
long as competent consumers are informed, then believing in quack cures is 
their own fault, and they should pay the consequences.
	I can see the point on DDT- environmental protection does need 
some degree of enforcement.
> 
> In terms of drug regulation, there are two other kinds of externalities.  One,
> given the fact that most (and it should be more...) Americans have health
> insurance, they rarely bear the full costs of treatment.  Secondly, in terms
> of the long range detrimental health effects of some drugs, without regulation,
> many marginal companies would not be around to bear the costs of their earlier
> sales.

	If the government/FDA advises against a drug and the consumer uses 
it anyway, then the government shouldn't have to pay for it. Insurance 
companies should be able to not pay for drugs they don't think will help, 
or not pay for long-term treatment of side effects the consumer chose to 
accept when taking the drug. Marginal companies wouldn't be around long 
enough to bear such costs in any event. Generally, the FDA can't find out 
long term detrimental effects in time to stop them anyway.
> 
> 2 questions to consider:
> (1)  There are countries without the equivalent of an FDA.  If we would be
> _so_ much better off without one, why don't we see more cross border traffic
> looking for "forbidden" treatments?  An the cost of travel doesn't work
> as an excuse.  If it was really a life or death situation, people would
> find a way to get overseas.
	This does occur, especially before the FDA started allowing 
life-saving drugs to go through faster.
> (2)  Where does the millions dying of malaria come from?  (Not doubting, 
> just wondering...)  Is that a number for the entire world?  I believe DDT
> is still used in some parts of the world.  And should the increase be 
> written off to a decrease in DDT usage, or an increase in mosquitos
> resistence to chemicals?  (Increase in pathogens or insects' resistance
> to drugs/chemicals is another _very_ important case of an externality that
> justifies government intervention.)

	I'd agree with that bacterial resistance to antibiotics justifies 
the prescription status of antibiotics. But it doesn't justify the 
prescription status of, for instance, Seldane.
> 
>>> Given, bureaucracy often goes too far, but there are many circumstances
>>> where caution is more than justified.  
>>
>>So who should decide how much caution is justified?  If a drug comapny has a
>>new and questionable drug and a patient is considering buying it (knowing full
>>well the risks involved) what business does the government have in jumping in
>>and calling a halt to the transaction?
> 
> My whole point is that there aren't really any patients who know "full well"
> the risks involved in a given drug.

	That's the fault of the patient. If someone decides to take a drug 
without full knowledge of side effects, etc. when they could have that 
knowledge (and I support forcing companies to disclose all such 
information), then any side effects are their problem.
	I can see, however, making exceptions for non-competent 
individuals (children, for instance). If a drug is evaluated by the 
government as unsafe, it shouldn't be allowed to be given to children.
> 
> 
>>> It's big and ugly, chews up money and makes mistakes by the bushel basket, 
>>> but it's there because it needs to be.
>>
>>I don't dispute that a government is necessary.  What I dispute is that it
>>needs to be big, ugly, expensive, or abusive.  If it just stuck to it's
>>proper role as policeman, rather than also taking on the role on "mommy",
>>it wouldn't be so big, ugly, and expensive.
> 
> I've never encountered a bureacracy that wasn't big, ugly, and expensive.
> Even the police.  I agree in that it definitely could be better, though.
> 
Newsgroups: comp.society.futures,alt.fax