The fact that people will pay more for the combination drugs if forced to is irrelevant because there are other companies that can undercut the company that payed for the trials. I can wait for you to do the trial, and then sell the drug at cut-price myself.

Another thought occurs to me, however, a question for which I don’t know the answer. What is the primary driver of cost in drug R&D? If it is the trials themselves then I think we both have valid points and are debating around the margins. If the primary driver of costs is the research and design of the drug itself and not the trials, then costs in the model we are discussing should be significantly lower as the drugs we’re talking about have already been discovered. As I said, I don’t know the answer, and as I’ve been out of my depth for the better part of our discussion I won’t speculate further.

One obvious thing you may be overlooking is that demand for medical X (services, drugs, etc.) is fairly inelastic. Gasoline is another example of this – it is a product which is necessary (right now) for many things in our daily lives. As a result, we’re willing to pay a relatively high price per gallon for it before we change our behavior to consume less of it. If combinations of existing drugs were shown to cure/alleviate/supress X better than anything else on the market, then those 1 million people would almost certainly pay $6 (or more) instead of $5.

Smarter and more experienced people than I would have to do a cost/benefit analysis, of course, but again given the fact that any number of bogus and completely ineffective treatments are currently sold for a profit I feel certain that someone would be willing to try. Which brings up another benefit of free markets – people are always willing to try new things…and fail spectacularly. These are almost always smaller or upstart companies – a big, established company has too much to lose.

And again – all of this assumes that the unknown unknowns described in the Lancet article actually exist, something I have trouble believing.

As for patents – Bayer still markets and sells branded aspirin even though the patent for it has long since expired and cheaper generic brands flood the market (and I’m not even sure who held the original patent). You do have a point that the start-up costs for an endeavor like the one we are debating could be high, but in a free market that values and encourages entrepreneurs I do have faith that someone would take the plunge. And if not, or if there is the political will to speed matters up a bit, government can always incentivize the behaviour through tax breaks or straight subsidies.

You have a faith in markets that not even Adam Smith would have had.

if there is a demand for something, anything, then it will be profitable for someone.

That’s just not true. Let’s just take a made up example to simplify matters. Let’s suppose that lots of people would like product X. Now, imagine that there are 1million people in the US willing to pay $5 for an X. But now suppose that developing X into something you can package and sell costs 5 million dollars. It is therefore not profitable for anyone to try to take X to market.

This is exactly the case with combination therapies of existing drugs. You cannot take a therapy to market unless you have the evidence showing a benefit. But gathering that evidence might cost half a billion dollars. For existing drugs for which there are many generics, the company that produces that evidence is not going to make their money back.

You could imagine lots of markets for which there is demand, but it would be crazy to try to bring the product to market because the costs will not be recouped through profits. I don’t know, I’m just making things up but imagine moon rocks. I’m sure there’s a market for rocks taken from the moon but nobody will pay enough for them to cover the costs of them being collected. Luckily, moon rocks are not important. But good combinations of current drugs could save a lot of lives — they just won’t be able to make a profit for the company that proves that.

I think we have found common ground, but it also seems that ground is a far cry from the rather paranoid comment from yogi-one, which you said you mostly agreed with.

And unless I’m mistaken, the FDA in the US only certifies the efficacy and safety of a drug that a company wishes to sell. I’m not an expert, but if they already control “everything” about drugs then that is news to me.

One final thing – something I haven’t articulated well in the last two comments – if there is a demand for something, anything, then it will be profitable for someone. With the exception of the air we breathe, I can’t think of another commodity that someone isn’t making a profit on somewhere. You and The Lancet is say there’s a possibility that there may be combinations of existing, low cost drugs to treat some sort of ailment. My point is, were there science-based medical evidence pointing to a treatment of that type, someone (maybe not a drug company) would have found a way to test it, package it, and make a profit from it. People make a profit selling homeopathy and acupuncture for God’s sake, and there is a booming market in generic drugs.

So I think we still have a little disagreement, but you’re right that there are many points upon which to agree.