I also thought that Scott fell into the fallacy of thinking something can't happen because he can't imagine the details. Markets solve lots of problems that individuals cannot or do not.
I'm not sure that's a fallacy. Markets solve lots of problems that individuals cannot or do not, but hardly perfectly in every case. You still need a plausible story for how it could work, in my opinion, or else you're going on blind faith in the infallibility of the free market which seems highly imprudent with respect to such high stakes issues.
Governments can also often solve problems that individuals don't. The FDA regime is better than what came before it. Perhaps there are better ways of regulating medicine than how the FDA does things today, but governments can be the right tool for some jobs.
The problem with abolishing the efficacy requirement is that you remove the main incentive for drug companies to demonstrate that their drugs have a positive risk-benefit profile. Patients may have more choice, but they'll be making those choices on the basis of minimal (or nonexistent) data about whether drugs work. The arguments about abolishing the FDA tend to focus on patients and doctors, when I think the more relevant impact is how it changes the incentives and behaviour of the drug industry.
The FDA can go out and do efficacy testing without forcing the rest of us to wait on them. They can produce data as a public good rather than producing data at the cost of billions in compliance costs and thousands of lives in delay.
Most drugs that go into clinical trials (90%) are less effective or safe than existing options. If you release everything onto the market you'll get many times more drugs that are net toxic (biologically or financially) than the good drugs you'd get faster. You will almost surely do net harm, especially when you consider that companies will be less rigorous about selecting compounds for development than today.
Companies don't want to release products that are worse than their competitors.
Companies test lots of cars or computers or ovens which are less effective or safe than existing options but they only release the ones that are competitive. This isn't because most consumers could tell whether their car was less efficient or that their computer is less secure, and it's not because making a less efficient car or less secure computer is against the law.
Pharmaceutical companies won't go and release hundreds of dud or dangerous drugs just because they can. That would ruin their brand and shut down their business. They have to sell products that people want.
The FDA's delay of the Pfizer vaccine alone was so deadly that I think it is difficult for this to do net harm.
Consumer products like ovens and cars aren't comparable to drugs. The former are engineered products that can be tested according to defined performance and safety standards before they are sold to the public. The characteristics of drugs are more discovered than engineered. You can't determine their performance characteristics in a lab, they can only be determined through human testing (currently).
I agree that many (not all) pharma companies wouldn't want to release unsafe drugs, but the problem is that many drugs we expect to work in good faith end up net harmful. The sick consumer is highly motivated but relatively poorly informed, so there's a power and information imbalance too that can lead an extreme market for lemons to emerge.
I agree that the time from phase 3 results to approval could have been faster for the Pfizer vaccine, but before then it wasn't clear the vaccines would be effective - and they are not completely benign (like any drug).
"Pharmaceutical companies won't go and release hundreds of dud or dangerous drugs just because they can." No, but if they can profit from doing so, they will. Note Oxycotin in the dangerous category, and the supplements industry for the dud one.
Medicines are too potentially dangerous for there not to be much strong research into their dangers. The opportunity cost of not treating serious disease effectively is too high for there not to be much strong research into their efficacy.
While consumers choose doctors to be their medical decision-makers, is is highly important that doctors make good decisions. The FDA serves to make it possible for individual doctors to make good decisions on drug prescribing. Doctors could never dream of doing all the research themselves. Even large hospital trusts and insurance providers would baulk at overseeing the research required to replace that directed by the FDA.
If the FDA were abolished, doctors would seek a body that provides the same services. They might choose the European Medicines Agency. They might choose a new body established by Google or Harvard or the Mayo Clinic. Such a new body would be very powerful, and would likely not limit it's scope in the way the FDA does.
Abolishing the FDA could easily lead to a bigger, bolder monopoly with a grip over the lives of nearly everyone in the world. I don't think this is ideal from a libertarian perspective.
It could also lead to two or three health advice agencies, with market forces keeping them serving the consumer well to an extent. But one need only look at the social media market and it's relationship to suicides and deaths-by-eating-disorder to see a similar market's balancing of profit and customer welfare.
The motor industry is an even better example. Few cars followed Volvo's seat belt innovation until governments forced them to. Car manufactures in a highly competitive market knew that if people died using their product, other people would blame factors other than the car. Why not focus innovation on the shape of a car's fins, or it's colour, or it's top speed? That's what the consumer was focused on.
This is not to say the FDA is ideal. But a democratic government is probably the best kind of organisation to own and oversee a body of it's type.
I also thought that Scott fell into the fallacy of thinking something can't happen because he can't imagine the details. Markets solve lots of problems that individuals cannot or do not.
I'm not sure that's a fallacy. Markets solve lots of problems that individuals cannot or do not, but hardly perfectly in every case. You still need a plausible story for how it could work, in my opinion, or else you're going on blind faith in the infallibility of the free market which seems highly imprudent with respect to such high stakes issues.
Governments can also often solve problems that individuals don't. The FDA regime is better than what came before it. Perhaps there are better ways of regulating medicine than how the FDA does things today, but governments can be the right tool for some jobs.
The problem with abolishing the efficacy requirement is that you remove the main incentive for drug companies to demonstrate that their drugs have a positive risk-benefit profile. Patients may have more choice, but they'll be making those choices on the basis of minimal (or nonexistent) data about whether drugs work. The arguments about abolishing the FDA tend to focus on patients and doctors, when I think the more relevant impact is how it changes the incentives and behaviour of the drug industry.
The FDA can go out and do efficacy testing without forcing the rest of us to wait on them. They can produce data as a public good rather than producing data at the cost of billions in compliance costs and thousands of lives in delay.
Most drugs that go into clinical trials (90%) are less effective or safe than existing options. If you release everything onto the market you'll get many times more drugs that are net toxic (biologically or financially) than the good drugs you'd get faster. You will almost surely do net harm, especially when you consider that companies will be less rigorous about selecting compounds for development than today.
Companies don't want to release products that are worse than their competitors.
Companies test lots of cars or computers or ovens which are less effective or safe than existing options but they only release the ones that are competitive. This isn't because most consumers could tell whether their car was less efficient or that their computer is less secure, and it's not because making a less efficient car or less secure computer is against the law.
Pharmaceutical companies won't go and release hundreds of dud or dangerous drugs just because they can. That would ruin their brand and shut down their business. They have to sell products that people want.
The FDA's delay of the Pfizer vaccine alone was so deadly that I think it is difficult for this to do net harm.
Consumer products like ovens and cars aren't comparable to drugs. The former are engineered products that can be tested according to defined performance and safety standards before they are sold to the public. The characteristics of drugs are more discovered than engineered. You can't determine their performance characteristics in a lab, they can only be determined through human testing (currently).
I agree that many (not all) pharma companies wouldn't want to release unsafe drugs, but the problem is that many drugs we expect to work in good faith end up net harmful. The sick consumer is highly motivated but relatively poorly informed, so there's a power and information imbalance too that can lead an extreme market for lemons to emerge.
I agree that the time from phase 3 results to approval could have been faster for the Pfizer vaccine, but before then it wasn't clear the vaccines would be effective - and they are not completely benign (like any drug).
"Pharmaceutical companies won't go and release hundreds of dud or dangerous drugs just because they can." No, but if they can profit from doing so, they will. Note Oxycotin in the dangerous category, and the supplements industry for the dud one.
Medicines are too potentially dangerous for there not to be much strong research into their dangers. The opportunity cost of not treating serious disease effectively is too high for there not to be much strong research into their efficacy.
While consumers choose doctors to be their medical decision-makers, is is highly important that doctors make good decisions. The FDA serves to make it possible for individual doctors to make good decisions on drug prescribing. Doctors could never dream of doing all the research themselves. Even large hospital trusts and insurance providers would baulk at overseeing the research required to replace that directed by the FDA.
If the FDA were abolished, doctors would seek a body that provides the same services. They might choose the European Medicines Agency. They might choose a new body established by Google or Harvard or the Mayo Clinic. Such a new body would be very powerful, and would likely not limit it's scope in the way the FDA does.
Abolishing the FDA could easily lead to a bigger, bolder monopoly with a grip over the lives of nearly everyone in the world. I don't think this is ideal from a libertarian perspective.
It could also lead to two or three health advice agencies, with market forces keeping them serving the consumer well to an extent. But one need only look at the social media market and it's relationship to suicides and deaths-by-eating-disorder to see a similar market's balancing of profit and customer welfare.
The motor industry is an even better example. Few cars followed Volvo's seat belt innovation until governments forced them to. Car manufactures in a highly competitive market knew that if people died using their product, other people would blame factors other than the car. Why not focus innovation on the shape of a car's fins, or it's colour, or it's top speed? That's what the consumer was focused on.
This is not to say the FDA is ideal. But a democratic government is probably the best kind of organisation to own and oversee a body of it's type.