A decade ago, citing sources in an online debate was considered normal. I think we should bring that back. If you cite sources, it's harder to lie, and you have to do at least a little bit of research before posting. It leads to much better discourse, IMO.
People rely on their paycheck to pay bills! If anyone stops getting their paycheck, that's not "keeping the lights on". Do you agree that any "review" mustn't prevent anyone from receiving their paycheck?
Rather than thinking in terms of "left vs. right", I think in terms of "extreme left vs. moderate left vs. moderate right vs. extreme right". I support moderates over extremists. I support democracy and rule of law. I care about this more than I care about left vs. right.
> Rather than thinking in terms of "left vs. right", I think in terms of "extreme left vs. moderate left vs. moderate right vs. extreme right". I support moderates over extremists. I support democracy and rule of law. I care about this more than I care about left vs. right.
This is a great position. I wish more people adopted it.
The problem I have seen over the past few years is that those who are on the extremes are not aware that they are on the fringe. They believe that their ideology is widely shared and common amongst everyone.
> Protesting [police] brutality is right and necessary. It’s an utterly American response. But burning down communities and needless destruction is not. Violence that endangers lives is not. Violence that guts and shutters businesses that serve the community is not.
We need more of that from our politicians. When Republicans are willing to criticize Trump, I respect them enormously for it; but few Republicans are willing to publicly disagree with Trump.
Agreed - I think we say similar things. I am mostly suggesting that authoritarians currently live in all sides of the aisle in our government right now. And they’ve all been ratcheting up in intensity, getting us used to “their” version of it. This latest jump being by far the most severe and scary.
> Ok, so all payments are paused while funding is reviewed? ... This is taxpayers money ... A shocker that government agencies might need account for spending.
Reviewed for what?
Reviewed for whether the spending was authorized by Congress? If Musk finds that money is being spent in ways that are not authorized by Congress, and cuts that spending, great.
Reviewed for whether the money is being used efficiently to accomplish the goals set by Congress? Again, if Musk finds ways to stretch the same amount of money to accomplish more, that's great. For example, if Musk makes USAID more efficient so it delivers more aid for the same amount of money, that would be wonderful.
Or "reviewed" for whether Trump/Musk agree with them? It's illegal for the President to unilaterally cut programs just because he doesn't like them.
The idea that the President, the head of the Executive branch, has zero power over Executive branch spending down to the agency level, because Congress said X must be spent and dammit they must spend it, makes no sense.
By that logic and taken to an extreme, Congress could pass a budget law (overriding the executive’s veto) to set executive spending for specific agencies to only be spent on computers, say the FBI, and the executive is powerless to Congresses control over the executive function to carry out the laws that the Congress has passed?
So clearly the intention is one of checks and balances, for example the President can’t spend money Congress does appropriate but also has some power over how that money is spent as such to exercise the power of the Executive.
So let’s see what the Constituion says as per Congress.gov!
“The constitutional dimensions of impoundment disputes have been confined to the political branches. The Supreme Court has not directly considered the extent of the President’s constitutional authority, if any, to impound funds.16 However, a case decided in 1838, United States v. Kendall,17 has been cited as standing for the proposition that the President may not direct the withholding of certain appropriations that, by their terms, mandate spending.18”
Congress quite literally has the power to pass laws. According to the Constitution, the President "shall take Care that the Laws be faithfully executed"; the President's oath of office requires that he execute the laws set by Congress. So for example, if Congress were to pass a silly law saying "the FBI shall spend exactly $X on computers, down to the cent", then the President would be required to make sure the FBI spent exactly $X on computers, down to the cent. The President has many powers, but "deciding not to execute the laws passed by Congress" is not one of them.
Quoting from the page you linked:
> Impoundments usually proceeded on the view that an appropriation sets a ceiling on spending for a particular purpose but typically did not mandate that all such sums be spent. According to this view, if that purpose could be accomplished by spending less than the appropriation’s total amount, there would be no impediment in law to realizing savings. Impoundments were also justified on the ground that a statute, other than the appropriation itself, authorized the withholding.
In other words, if Congress appropriates $X for the FBI to buy computers, then Congress didn't necessarily mean "the FBI shall spend exactly $X on computers, down to the cent". It could be interpreted to mean "the FBI may spend up to $X on computers". But Congress has clarified this ambiguity: https://en.wikipedia.org/wiki/Congressional_Budget_and_Impou...
> the Impoundment Control Act of 1974 specifies that the president may request that Congress rescind appropriated funds. If both the Senate and the House of Representatives have not approved a rescission proposal (by passing legislation) within forty-five days of continuous session, any funds being withheld must be made available for obligation.
In other words, if Congress appropriates $X for the FBI to buy computers, but the President thinks $X is excessive, then the President may ask Congress for permission to spend less than $X. If Congress doesn't grant the permission within 45 days, then the President must go ahead and spend the full $X. Again, Congress literally has the power to set the laws, and the President is required by his oath of office to execute those laws.
> President Richard Nixon was of the view that the administration was not obligated to disburse all funds allocated by Congress to states seeking federal monetary assistance under the Federal Water Pollution Control Act Amendments of 1972 and ordered the impoundment of substantial amounts of environmental protection funds for a program he vetoed, and which had been overridden by Congress.
That case seems directly analogous to what Musk is currently trying to do. Nixon lost that case in the Supreme Court.
Even if the Supreme Court did rule that the President had impoundment powers, it would probably be on the condition that "[the purpose of the law] could be accomplished by spending less than the appropriation’s total amount" (quoting from the page you linked). For example, the President would still be required to buy sufficient computers for the FBI, even if he spent less than $X on them. The President still wouldn't be able to just unilaterally decide "no, the FBI doesn't need computers, this is a waste of money".
So, I think it's already quite clear that Trump/Musk do not have the constitutional authority to just start cutting government programs. Do you agree? If not, which part do you want further clarity on?
No, it’s not “quite clear” as the link provided described.
Any impoundment authority and how it has been curtailed is purely a political solution, not a constitutional one.
If the Democrats think they are right they can go to the Supreme Court to force him to spend money with no say in the matter.
And while the President is mandated to execute the law you’re forgetting how much of the government is not described in law. USAID “to further the mission of the US in foreign countries” would give the President a lot of latitude in how that money is spent. A lot.
Then layer on the immense agency structure written all through “interpretation” of the law that the agencies no longer can rely on Chevron to defend and things get really interesting.
And while the Supreme Court did rule on Empoundment law curtailing Nixon, it did not rule specifically on the constitutionality of it and a lot has changed on the Supreme Court since Nixon.
So please don’t respond with “doesnt have the constitutional authority” when that is most definitely not the case.
> If the Democrats think they are right they can go to the Supreme Court to force him to spend money with no say in the matter.
They did sue, and a federal judge temporarily blocked the "federal spending freeze".
> you’re forgetting how much of the government is not described in law
It's true that many aspects of the government are not described in law. But the major federal expenditures are definitely described in law. That's why Republicans in Congress are currently debating the budget! https://www.yahoo.com/news/trump-spending-bill-stalls-congre...
> They did sue, and a federal judge temporarily blocked the "federal spending freeze".
Last I saw the judge blocked the mechanism, and needed time to decide on other issues.
Hence the confusing email (only if you don’t know how the government works) that rescinded the original mechanism and replaced it with another.
> They then returned with a proposal of $700 billion in spending cuts, but that failed to convince some of those in the right flank.
It’s going to be a knockdown drag out fight over this. Trump will win some, but lose others. That’s just how it goes.
But unlike last time where he got there day 1 with “ok, what’s next”, he went in this time with a laundry list and an actual strategy.
Which is just smart. I’ve worked for big corps and it’s impossible to turn that ship. I can’t imagine the federal government. The only people I’ve seen be successful are the ones that get creative.
> It’s going to be a knockdown drag out fight over this. Trump will win some, but lose others. That’s just how it goes.
Yes, that's how spending cuts are supposed to be decided: Congress.
> it’s impossible to turn that ship. I can’t imagine the federal government. The only people I’ve seen be successful are the ones that get creative.
Trump has every right to "get creative" within his constitutional power; he doesn't have the right to "creatively" violate the constitution by refusing to faithfully execute the law.
Let's return to the original question. Suppose that Congress passed a law fifty years ago saying that "there shall be an agency to do ABC, with a budget of $X/year, and the President can figure out the details". I agree that the President has wide latitude to decide how the agency does ABC. But he cannot just decide "ABC is a waste of money, let's abolish the agency and use that $X/year to pay off the debt instead". Do you agree? Or are you claiming that the President could unilaterally abolish the ABC agency and stop doing ABC? (Setting aside the question of whether Trump is currently doing that; do you agree that he would not be allowed to do that?)
> But he cannot just decide "ABC is a waste of money, let's abolish the agency and use that $X/year to pay off the debt instead". Do you agree? Or are you claiming that the President could unilaterally abolish the ABC agency and stop doing ABC?
Oh I agree, if the law Congress passed was explicit in the funding and the purpose of it.
My comment was more around the multitude of spending in the federal government that is not tied to a specific purpose approved by Congress.
Which is why USAID is likely being targeted.
I would argue that the room to maneuver is where the courts will need to decide - if the President is still following the law but not spending all the money, what happens? Or if the money spent is shifted significantly but still represents a “good faith” effort to follow the law, is that allowed?
> a lot has changed on the Supreme Court since Nixon
Both legislation and Supreme Court precedent say that the President cannot impound funds. You seem to be arguing that it's OK for him to impound funds because the Supreme Court decision was fifty years ago and they might rule differently today.
Couldn't that argument be used to justify breaking any law? I think Trump must follow the law. Do you agree that Trump must follow the law even if the Supreme Court hasn't specifically reaffirmed that particular law recently?
(I'd feel differently if Trump illegally impounded some trivial amount of money just to get a case before the Supreme Court; but that's not what he's doing here.)
I think it would be great for the federal government to be more efficient and less corrupt. For example, let's talk about USAID. It would be great if DOGE could make USAID more efficient, to accomplish the most possible good with the money allocated by Congress.
So far, that's not what DOGE appears to be doing. Rather than "rooting out corruption and inefficiency", DOGE appears to be cutting government spending that Musk disagrees with.
And that's unconstitutional! The executive branch doesn't have the constitutional authority to unilaterally cut a program established by Congress. If Congress allocated $X billion for foreign aid to country Y, the executive branch must disburse that aid.
Furthermore, speaking of corruption: Both Trump and Musk have major conflicts of interest. Prior to Trump, presidents were expected to divest business interests and put their assets in a blind trust; but Trump refused to do so. And SpaceX is a major federal contractor; if the head of a major federal contractor is _also_ the biggest supporter of the incoming president, the conflict of interest is obvious.
As you said, anyone who has an issue with rooting out corruption isn't in the right. So surely you're alarmed by these conflicts of interest, right? Don't you agree that Musk should either fully divest from SpaceX, or step away from politics?
Everyone deserves a presumption of good faith by default. But Trump has a long history of dishonesty and lawbreaking, culminating in an attempted self-coup in 2020. At some point, he doesn't deserve a presumption of good faith anymore. And he passed that point a long, long time ago.
This is perhaps the single biggest disconnect I see between Democrats and Republicans right now. To Democrats, Trump is "the man who attempted a self-coup", and everything he does is viewed in that light. Whereas Republicans seem to think that it just wasn't a big deal that Trump tried to overturn the 2020 election.
How exactly did Trump attempt a self-coup? What words or actions (on his part) would you say qualify for that description?
There were all sorts of bad intentions on the part of the rioters/coupers/whatever on January 6th, but AFAIK there is very little evidence to indicate these people were directed by Trump in any meaningful way.
The fundamental definition of a democracy is that the candidate who wins the election, gets to be in power. Trump lost the 2020 election, yet tried to stay in power. If Trump had succeeded at staying in power despite losing the election, then America would no longer have met the definition of a democracy. Therefore, Trump tried to overturn American democracy.
Do you recognize that Trump tried to overturn American democracy? If not: which part of the above paragraph do you disagree with?
In your comment, you seem to be referring to the fact that Trump didn't specifically call for violence on Jan 6. Depending on how exactly you define "coup", you could argue that Trump didn't personally attempt a coup, but rather Trump's supporters attempted a coup on his behalf while he cheered them on (and subsequently pardoned them). I think this is an irrelevant technicality; if Trump's supporters' attempted coup had succeeded, then American democracy would be just as dead as if Trump personally committed the coup.
Returning to the original topic: If you consider Trump's entire conduct around the 2020 election (as well as his extensive history of other dishonesty and lawbreaking) do you genuinely believe that the Democrats still owe Trump a presumption of good faith?
Because of Trump's history. Trump attempted a self-coup in 2020 by trying to overturn the election. This attempt was foiled because many judges, public officials, etc. resisted it, including many Republicans. Now Trump is back in power, and Democrats are very nervous about anything that looks like "Trump packing the government with loyalists" or "Trump trying to gain more power over public officials", because that would make it easier for Trump to attempt a future self-coup.
In short: Framing this as "cutting waste, fraud, and abuse" is assuming good faith, but given Trump's history, he doesn't deserve a presumption of good faith.
(Secondary to that: There's a difference between "cutting waste, fraud, and abuse" versus "shutting down entire functions of government without a replacement". Look at Musk trying to shut down USAID, for example. If Musk wanted to "cut waste, fraud, and abuse", that would mean "reforming USAID to achieve the same outcomes while spending less money". Instead, Musk is proposing to eliminate USAID entirely. Even if not for the self-coup angle, that's clearly not just "cutting waste, fraud, and abuse". Foreign aid is established by Congress, and only Congress has the constitutional authority to eliminate that aid.)
I tried searching for "#democrats" on my own Instagram account, and I can confirm it's returning no results. Meta issued a statement saying this was a bug, and some people are saying it's fixed, but it's still broken for me at the time of posting this comment.
My Facebook account is not following Trump or Vance. The article mentioned a theory that some people were following the "POTUS" account, which changed hands; I was never following the "POTUS" account. That seems plausible to me.
But presumably the advertising department pays for itself, right? So if they cut the advertising department, wouldn't they have less total money in the end? The advertising supports the R&D, not competes with it.
(The one exception is when two pharma companies have competing drugs that are basically equivalent. So they get trapped in a "Red Queen's race" where they both spend money on advertising to try to gain market share. In the end they've both spent a bunch of money on ads and ended up back where they started. For those cases, I think government regulation would be valuable.)
They want the "ask your doctor about..." bits to be heard and followed, I'm guessing. People who thought they just had to live with it will now go in and ask for Bimzelx.
As someone with psoriasis, I seriously doubt anyone with severe plaque psoriasis is going to go from no treatment to monoclonal antibodies. In fact, your insurance won't even pay for it no matter how good it is unless you try other courses of treatment first. The effect is going to be changing from one course of treatment to the next, asking your doctor about it is a call to action.
I don't think this article's analysis makes sense.
If pharma companies lose revenue, they have to cut something. Presumably the intention is to force them to cut profits. I found this analysis of global pharma industry profitability: https://www.ispor.org/docs/default-source/euro2023/poster-is... They found that the average profit margin across the pharma industry was around 20%. So even if pharma companies cut their profits to zero, prices would only drop 20%, right?
And even the idea of cutting profits to zero isn't realistic. Pharma investment is similar to venture capital; investors make risky bets in the hopes that a few of them will pay off big. Why would investors agree to take that risk if they get zero profit in return?
Some people propose things like "the government should fund drug development". OK, that's a fine proposal; it has pros and cons. But that's a very different proposal than "the government should institute price caps on privately-developed drugs". Don't try to justify the latter proposal by conflating it with the former.
Pharma spends more on marketing drugs than developing them. If marketing drugs is prohibited, especially through dubious kickback schemes with doctors and hospitals, there'd be a lot more room for lowering prices.
The profit motive really doesn't deliver great outcomes in medicine, between the enormous information asymmetry between patient and doctor (and even other doctors), doctors with perverse financial incentives, and believing (whether it's true or not) that your life or wellbeing are on the line if you're wrong, it's ideal for all sorts of chicanery. (/rant)
I do agree there would be a benefit from removing the marketing. But the benefit would be little more than what is spent on said marketing.
It comes back to the same thing--where is the money going to come from? Few medicines actually have a high per-unit production cost. The cost is usually mostly amortizing R&D and the production equipment. (And looking at R&D overall--you have to count the spending on the failures as well as on the successes.) Sell fewer pills and you don't cut that R&D cost, you just distribute it across fewer pills.
Hmmm, the marketing question is complicated and I'm not sure what to think.
From a profit point of view, presumably the advertising department pays for itself; in other words, the advertising department generates money for the R&D department, rather than taking money from the R&D department.
But, the advertising presumably increases the number of people taking the drug. If it's teaching patients/doctors about a valuable new drug that will make peoples' lives better, then it's a social good. But if it's persuading patients/doctors to buy the drug unnecessarily, then it's a waste.
(Also, sometimes two pharma companies have competing drugs that are basically equivalent. So they get trapped in a "Red Queen's race" where they both spend money on advertising to try to gain market share. In the end they've both spent a bunch of money on ads and ended up back where they started. For those cases, banning marketing would be a clear win.)
Edit: Also, keep in mind that "ban/regulate pharma advertising" is a different proposal than "medicare negotiation".
You're thinking at the level of one drug. But that's not the right level, it misses too many second order effects.
If someone is sick, they've likely been diagnosed by a doctor, who will treat them. This is how the consumer will know at all they might want to take the drug.
So the effect of the advertisement is to change the course of treatment as the consumer will ask their doctor for that drug ("ask your doctor if $drug is right for you"), and a doctor needs to prescribe it to begin with.
So the "Red Queen's Race" is not a sometimes. It's in fact almost always the situation at hand, generally between multiple courses of treatment.
We can observe from countries with no prescription drug advertising and similar levels of development that health outcomes are broadly similar. So we can be quite confident that this kind of advertising doesn't lead to significantly more appropriate treatment in aggregate, and it's therefore most likely to be a race to the bottom.
I'm not an expert on this stuff, so I'm not sure what's the answer. But this article says that about 90% of pharma marketing dollars are spent on marketing to doctors, not to consumers: https://www.pewtrusts.org/en/research-and-analysis/fact-shee... So it seems like pharma companies are mostly spending money on R&D and on advertising to doctors, not on direct-to-consumer advertising.
This is not true anymore, as advertising to patients has been the major driver of growth, perhaps due to Medicare and the rise of expensive biologics, leading to advertising to consumers becoming the predominant sink.
In 2016, pharma companies spent more on direct to consumer ads than they spend on marketing to doctors (excluding free samples, which are somewhere in between, though ultimately the drug being free is really of concern to the patient far more than the doctor), see: https://jamanetwork.com/journals/jama/fullarticle/2720029
In 2016, we have 9.6 billion in direct-to-consumer spending, 13.5 billion in free samples, and 6.8 billion in everything else. So clearly, advertising to consumers is the dominant venue.
That hasn't been true for awhile, mostly since it's now illegal to send doctors on expensive junkets or offer more than the smallest dollar amount inducements. So Big Pharma has intensified D2C marketing, where they can exercise much more leverage and prey on the relative ignorance of the average person.
In Australia, prescription drugs generally cannot be advertised to consumers. Additionally, prescriptions for all drugs are written in the generic drug name form and not the branded form.
That said, where this currently seems to fall apart is the pharamacies.. most only stock a single "brand" and pricepoint for many drugs, two at most. Most pharamcies aren't online so you can't easily compare prices. In practice, I have frequently observed over many different prescriptions a price different of 1-2x between pharamcies in the same area for the exact same thing and dosage. Additionally, the way we fill scripts here you don't even get the price until you go to pay and theyve already labelled your box with your script, etc.
There's also largely no pricing on the shelves, even if you can see the behind the counter ones.
The only thing that saves us, is that "many" but not all drugs are subsidised by our public health care and the government negotiates the price. But for any non-subsidised drug it's open season and also much of the pricing is "per dispense" and not at all related to the drug quantity.
e.g. 4x10mg or 28x5mg of the same drug has the same price.
Also recently the much-publicised Ozempic which is used for weightloss and diabetes which is $150/dose here, because the price is fixed by that government negotiated price for diabetic patients but off-label prescribers get the same price even when not subsised by the government and they actually have to pay the full $150. They launched the literal exact same drug for weight loss as "Wegovy" but they vary the recommended dosages a little so that in practice you can't cross-fulfill the prescription. The exact same 1mg is $150 when sold as Ozempic and $250 when sold as Wegovy :) And for some straight reason the weight loss dose is "2.8mg" but the diabetic doses are 1mg and 3mg.
Pharma companies spend about 2x on sales and administration as they do on R&D. However, this compares favorably to large tech companies where the ratio is closer to 2-8x.
So yes, the statement that "pharma companies spend more marketing drugs than developing them" seems strictly true, but lacks context. Therefor, I rate this claim: mostly true. :-)
I think the main difference there is that tech companies don't spend 67% of their marketing money schmoozing your doctor.
Of the $30 billion that Pharmas spends marketing in the US, $20bn is aimed at doctors.
There's about a million doctors in the US.
That's ~$20,000 per doctor, each of whom has a significant degree of implicit trust and authority.
Even if a doctor believes they are not swayed by marketing, studies have shown that these efforts can subconsciously affect their decisions.
And $20k/year/doctor just seems awfully high. There must be a more efficient way to help doctors make those sorts of decisions...
***
Responding by edit due to rate limit:
> Who else should they advertise to then?
No one. It's not a brand affiliation issue, it's a facts and awareness issue. Doctors can read journals and papers and peer reviews just fine!
There's no need for them to be told what to do on paid Hawaiian vacation weekends in 5 star hotels. You can see why they prefer things this way though.
> it is morally worse to advertise and influence people who don't know any better.
Who else should they advertise to then? The consumers aren't knowledgeable enough to make the decision on which drug they should take. Doctors are the only one qualified.
In fact, it is morally worse to advertise and influence people who don't know any better. At least, doctors are educated and it is their duty, both ethically and professionally, to learn about new drugs that best treat their patients. That is the whole point of a Medical Science Liaison. They are the "advertisers" for a pharma to make sure doctors know about the drug their companies make.
Mind you, at this level, advertising is a bit different. These MSLs are legally required to disclose both the indicators and the side effects and have strict rules in what they are allowed to give and say to doctors. There are hundreds of laws in place to prevent corruption/bribery. Of course there are bad actors everywhere, but at least, it is more regulated than Congress's "lobbying" and Supreme Court's "gifts".
The US and NZ are the only two countries in the world that allow direct-to-consumer advertising of prescription medications - and New Zealand is trying to get rid of it (and only allowed it following pressure from the US for a trade agreement).
You can't gift doctors a paid vacation, there are rules and laws already in place. Also, MSLs are not simply "salepeople". They often require a PhD so their job description is more about "spreading knowledge" than "advertising" a drug.
Like it or not, having an expert in the hospital who know everything there is about a specific drug is a lot more effective than requiring every doctor to read about every new drugs. By your argument, this type of job should be removed and doctors are responsible for finding out about new drug themselves.
Maybe that is better, maybe not. But the first thing that would happen is adoption rate of new treatment would drop and people who would otherwise recover may die because their doctors were too busy trying to treat people instead of reading journals.
They don't call it a vacation, they call it a conference.
An hour or two of "information sessions", with a big goody bag, and 2 or 3 days of fine dining, tours, and golf; all held in a plush 5 star hotel at $500 / night or more with all travel included.
> there are rules and laws already in place
What rules there are are not enforced. The regulatory office is flooded [0]:
"With the risks clear, Schwartz and Woloshin took a look at regulatory activity by the Food and Drug Administration and Federal Trade Commission and state attorneys general. They found a lackluster response to the skyrocketing medical marketing across the board. In fact, the FDA’s Office of Prescription Drug Promotion, which regulates consumer and professional promotional material, actually saw a decrease in regulatory activity. Though submissions increased from 34,182 in 1997 to *97,252* in 2016, violation letters dropped from 156 to *11* in those respective years. The finding “suggests the possibility of less oversight,” the authors conclude, possibly because FDA reviewers may be “overwhelmed by the massive increase in promotional submissions.”
Emphasis added.
> Like it or not, having an expert in the hospital who know everything there is about a specific drug is a lot more effective than requiring every doctor to read about every new drugs.
Do you think unbiased third party sources can't perform this role? And having an expert in every hospital is not what we're talking about [0].
If you think these companies are spending twenty thousand dollars per doctor per year just to better educate them and get better outcomes, I don't know what to tell you. That's a lil naive bud.
To take just one example of many: Remember Purdue? Remember how they told doctors that their new form of opiates (Oxycontin) was non-addictive and so much safer? ... Remember how few doctors made noise about this, compared to the massive number who swallowed it whole and prescribes the shit like candy? Remember how those brave doctors were ruthlessly and relentlessly smeared, and how Purdue got away with all this despite there being mountains of evidence for so, so long?
> the first thing that would happen is adoption rate of new treatment would drop and people who would otherwise recover may die
To me that just sounds like scare mongering and an imagination deficit. There's better ways of doing this, and no excuse for the current system.
At that price they might have teams dedicated to groups of a few dozen doctors, perfecting the company's manipulation to each of the doctors' personality. Somehow for-profit pharma always finds a way to be even more horrifying...
They identify thought leaders, analyze their data (who knows what data and how they analyze it?) to identify the best approaches, and have salesfolk and MSLs assigned to specific doctors, all to build relationships with tailored approaches and proven strategies. This is coupled with gifts disguised in various ways.
It bears repeating: submissions to the FDA’s Office of Prescription Drug Promotion, which regulates consumer and professional promotional material, hit 97,252 in 2016. This resulted in 11 violation letters.
Ninety-seven thousand submissions. Eleven violation letters. No typo.
$20k/doc/yr.
There may be more recent stats; I'm not finding them right now.
Here's a report from the Congressional Budget Office [1] that states that as of 2019 the Pharma industry in the US spent $83 Billion on R&D. And here's a Statista link with the total Pharma advertising in the US per month. About $1.1 BN, which would annualize to less than $15 BN per year.
So no, the Pharma industry does not spend more on advertising than on R&D, not even close.
You're not comparing the same numbers as Lowe did. So first thing, I was just summarizing what Derek Lowe wrote in 2013. If you click through, what he's comparing is SG&A to R&D. Quoting his post:
We're talking SG&A, "sales, general, and administrative". That's the accounting category where all advertising, promotion and marketing ends up. Executive salaries go there, too, in case you're wondering. Interestingly, R&D expenses technically go there as well, but companies almost always break that out as a separate subcategory, with the rest as "Other SG&A". What most companies don't do is break out the S part separately: just how much they spend on marketing (and how, and where) is considering more information than they're willing to share with the world, and with their competition.
That means that when you see people talking about how Big Pharma spends X zillion dollars on marketing, you're almost certainly seeing an argument based on the whole SG&A number. Anything past that is a guess - and would turn out to be a lower number than the SG&A, anyway, which has some other stuff rolled into it. Most of the people who talk about Pharma's marketing expenditures are not interested in lower numbers, anyway, from what I can see. So we'll use SG&A, because that's what we've got.
What he found is that SG&A spending was about twice R&D spending in 2013, then compared that ratio (2x) to large tech companies where the ratio was even worse (up to 8x).
For the pharma companies, SG&A was about 30% of revenue while R&D was anywhere from 12.5%-25% of revenue. (See his post I linked for the exact numbers he used.)
Now, looking at your CBO report, one thing I note is this tidbit:
The share of revenues that drug companies devote to R&D has also grown: On average, pharmaceutical companies spent about one-quarter of their revenues (net of expenses and buyer rebates) on R&D expenses in 2019, which is almost twice as large a share of revenues as they spent in 2000.
So R&D spending as a percent of revenue has increased to 25% industry wide since Lowe's post where it seemed to be a bit lower.
Search for SG&A spending in the pharma industry, I ended up like you did at statista:
The range is 38%-52%. So SG&A spending (50% of revenue) is still about 2x R&D spending (25% of revenue), with the numbers being a bit better than when Lowe wrote his post in 2013.
Now, whether SG&A is the right number to use as a stand-in for advertising, I don't know. I was just going by what Lowe wrote since he works in the pharma industry and is a well-respected name on this site.
> Now, whether SG&A is the right number to use as a stand-in for advertising, I don't know.
It is not. SG&E [1] includes a lot of things, including all labor costs (all the salaries for all the employees) and all rent.
As an example, Novo Nordisk, the maker of Ozempic, has annual operating expenses of about $20 billion and in 2023 launched an advertising campaign for Ozempic/Wegovy of a bit less than $0.5 billion/year.
> SG&E [1] includes a lot of things, including all labor costs (all the salaries for all the employees)
Lowe addresses that: Interestingly, R&D expenses technically go there [SG&A] as well, but companies almost always break that out as a separate subcategory, with the rest as "Other SG&A"
This is especially true since marketing drugs is essentially a negative sum game, it's banned in most developed countries with no discernible drawback.
> Some people propose things like "the government should fund drug development". OK, that's a fine proposal; it has pros and cons.
Not only that, it's complementary to private investment. Did public investment produce a valuable new drug? Great! Make sure the law doesn't allow anyone to patent drugs developed entirely with public funding so it immediately becomes a cheap generic.
But if a different drug is developed with private financing under the assumption that they'll get returns during the patent term to justify the cost and risk, well, that's why they're doing it. And paying a higher price for that drug is better than not having it all, or else why is anybody willing to pay the higher price for it?
Profit is revenue minus costs. How many of those “costs” are things like private planes for executives? How much for reps that visit doctors and give out free samples and swag and tickets to Cancun?
Famously some major tech companies aim to have zero profit as they want to reinvest everything back in the company. It doesn’t mean they don’t have any wiggle room to drop prices.
But doesn’t the high price come, largely from government blessed IP creating an artificial monopoly? Controlling prices in the context of a created monopoly makes some sense to me.
