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This is a great article. One correction: rDNA human insulin was the first product of biotechnology, introduced by Eli Lilly in the US in 1983 after 18 months of clinical testing and a five-month review of the company’s application for approval(at the time, median regulatory review times ranged between 28 and 34 months). These new insulin products pushed the price of insulin, which had been relatively stable for most its history, by up to 300% without a single bat of the FDA eye. There never was and to this day still isn’t any evidence that the products of biotechnology were safer or more effective. However, both Eli Lilly and Novo Nordisk (which also adopted the new technology for its insulin products) faced class action lawsuits in 3 countries after reports (to both regulators and the media) of serious harm including death. This iconic medicine was chosen by investors as a respected ambassador for a controversial technology. It now is super-cheap to produce and, if it’s not killing them, is bankrupting many poor, uninsured and low-income patients around the globe.

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Thank you for this fascinating examination of the many complexities of the R&D cycle of Big Pharma. It seems to have reached peak perfection of what it was designed to do: maximal wealth extraction while externalizing the human and societal costs. It also seems to have successfully insulated itself from any diminishment with its successful propaganda arm of academics and paid politicians and captured regulators. Their mind numbing advertising campaigns enrich the media and assure its compliance with the narrative handed them, while assuring an endless supply of brainwashed insured consumers to demand their insurance covers the drugs for them (never mind the copays, etc.). This system is pure genius and only dysfunctional for the humans and society which is harmed by it. In the scheme of things human needs and suffering do not count. Only stock buy-backs and CEO bonuses. Incidental health benefits to a few lucky patients is a collateral good, and needed for the propaganda of the value scam.

Americans are happy to look down upon and blame the less fortunate who are denied access by austerity budgets of prisons or who lack insurance or are underinsured. I now understand why there are fewer harpooners and whaling ships when it is so much easier and profitable and less dangerous to be the Remora suckerfish who attach themselves to sharks to feed off the bits that fall while cleaning the shark of parasites- symbiosis at its peak. Before we can address the capitalist health system, we must end Citizens United legal corruption. It is fascinating how such crushing inhumane cruelty can so easily be normalized.

I appreciate the thoughtful and practical proposed solutions that a very different society could enact. And the distant future of government negotiated drug prices for more than a handful of drugs for a handful of eligible patients. Again thank you for your insights and work.

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Hello Merrill - Hope all is well. I do not have your email. The macro issue, that someone needs to address, though I am not sure how we do it; The US is the only capitalist health care system on the planet. Ergo, the patients in the US are currently funding R&D for the global patient cohort, all diseases and all therapies. Perhaps you and some of your colleagues can offer a solution to this challenge? I have been trying to help solve for this as the economics are crippling for the sick people here, and as we all know that really means the poor people here in America. I do not have a back ground in public policy, or the correct level of influence to help solve for this. I can guarantee you that is the number one macro issue as I have been in the industry for many years. The vast majority of people stuck in the system as health care workers, investors, innovators, etc are not evil. That being said evil goes everywhere people go, par for the course. Thank you for all of your efforts to help us take care of the sick, forgotten, displaced, and suffering. We must continue to do better.

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