I'll talk more about "Sicko" after seeing it, but here was an interesting explosion on Wolf Blitzer's CNN program by Michael Moore yesterday. Moore reacted angrily to Dr. Sanjay Gupta's four minute long fact-check segment on "Sicko" that preceded Moore's interview.
I like Sanjay Gupta and his programs, as well as Wolf Blitzer who I think of as the-man-who-rarely-smiles. But I can see why Moore was angry because at least some (if not all) of Gupta's critique was shoddy and inaccurate.
For example, he needlessly contested Moore's assertion that per capita US healthcare expenditure is $7000 a year saying it is actually $6,098. Even the 2004 figure as reported by OECD is $6,102 and the US Health Department's (HHS) estimates for 2006 exceed $7,000. More seriously, Gupta misquoted the movie as claiming Cuba spent only $25 per capita on healthcare (10% of the actual figure) while Moore fumes that the movie said $251. I just saw Gupta on TV admitting at least to this mistake, while needlessly losing grace by asking why it wasn't $229. (Well, duh, the lower number would just strengthen Moore's claim that Cuban care is much cheaper, so what is Gupta's point?)
As promised by Moore on the CNN program, he posted a strong rebuttal to Gupta's critique on his own website. But even if they've been sloppy, you've got to give CNN credit. They had interviewed Moore live so that his comments and outburst could not be edited, and then have been reporting on the story and the exchange since then on their news channels. Tonight, they've called Moore to Larry King Live for a full interview, with Sanjay Gupta in attendance. This should be interesting.
In a broader context CNN strengthens its centrist credentials with both the left and the right wings complaining that it leans towards the opposite side.
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I saw "Larry King Live" this evening - Sanjay Gupta admitted that he had made an error regarding the $251 per capita spending in Cuba, but pointed out that all the rest of his numbers were based on WHO figures. In the end I felt that Gupta's polish and the refined manner in which he countered all allegations levelled against him subdued Moore.
Reminds me of my son's ex-boss who said the reason he preferred employing immigrants from India over the other rising economy is because they were more polished and not as crude/blunt(?).
Rene.
I saw this program as well. Too bad Moore is such a weak debater. A lot of Sanjay Gupta's numbers and criticisms were misplaced and I had expected him to either own up and clear the record, or be exposed on all misstatements. Instead I saw Moore lapse into inane generalities.
Yes, Sanjay Gupta's was slick (or "polished", "refined" to use more generous adjectives) and saved himself, thanks also to Moore's inability to corner him. And you're probably right about us immigrants having good survival skills. :-)
Once again, Gupta and Moore know the price of everything and the value of nothing.
None of them account for the economic value of research in medicine. Both are just bean counters.
For example, the frontier of medicine today is "Gene Silencing".
That means if someone has a cancer gene we will be able to just "silence" it instead of present techniques of surgery or chemotherapy.
Companies like Sirna (bought by Merck), Alnylam, Isis, and Silence tech, are already attempting to get FDA approval for their drugs.
Let's say these pills will cost $10k. Yes, in a decade Canada will be able to make it for half that. But who came up with the idea in the first place?
And look at the economic costs. Today, chemo for cancer cost $40k. And the patient may be sick in bed for a year. With gene silencing there may be minimal side effects and the disease may be prevented in the first place. And the person can still work which is another $40k. Do you think Cuba can do that? (Sorry all my Cuban friends)
And who is this W.H.O that ranks the US with Cuba? Oh, I forgot they are a branch of the United Nothing, that front for all anti- American countries. They must have visited hospitals in the Bronx or San Francisco skid row.
Purely profit driven private drug research may not allocate funds where they are most needed. For all you know, pharma companies driven by shorter pay-off horizons and easy money may concentrate more on Levitra (Vardenafil), Cialis as Viagra competitors, or Celebrex raher than gene silencers.
The start-ups that often actually come up with cutting edge research and breakthroughs have horrendously high cost of capital (e.g., founder's own resources and VC money) so the small proportion that succeed look for huge valuations and pay-offs. Government funding of start-ups with a fraction of the funds saved through negotiations of drug prices may well lead to more innovations and more breakthroughs than our current system.
Besides, if a drug is that good, the government as a negotiating buyer will have to pay a higher price because of pressure to make it available to patients. If the government as a sole buyer can negotiate the price of defense equipment, why should it not do likewise as a major buyer of drugs?
About WHO rankings I agree they don't reflect quality of treatment. The drop in US ranking is largely due to its high price and the large number of uninsured. For the very rich unbothered by high bills the US is the best place for most treatments.
Sandip,
I've answered the question about why govt can negotiate the price of defense but not drugs. First, it is my belief that govt should only do things that citizens cannot do for itself. One of them is the military. I cannot have a private army and declare war on N. Korea or Iraq. I leave that to Congress. And therefore Congress should negotiate the price of submarines and tanks.
And they don't do a good job at that either. Only the govt will give you a $2 billion airplane. But that's the price we pay for allowing the Constitution to function.
But I can start a pharmaceutical company if I can identify a need and a cure. And do that in competition with my fellow doctors and scientists. If the govt comes in to compete with me, it will have unlimited funds, alongside with the power to make laws that might be tilted in their favor.
If you look at the history of govt projects you get mixed reviews. Indeed, when a country is new govt may have a function because it can come up with financial capital where citizens have be devastated by war or mass destruction. \
Take the case of Japan after WW II. The country, with its infrastructure destroyed, formed M.I.T.I. They harnessed the finest college graduates and asked where capital could be deployed best. Indeed, they funded Sony and Honda. They thought steel and cars was something the govt should fund.
In 30 years, Japan's steel almost bankrupted US steel enterprises. Sony came up with the best consumer electronics. Toyota and Honda overtook GM and Ford.
But by 1990's MITI stopped coming up with good ideas and is virtually abandoned. They could not harness the forces of the markets which were always ahead of them.
That story rings true with all successful countries today. Nehru nationalized steel companies like Tata. But today Mittal steel has no govt funding. In my judgement, Nehru's socialistic policies set India back decades causing a brain drain of its best intellects. Only recently after India has denationalized its banks, tea and steel companies, has it emerged from its poverty stricken past.
Likewise with China. And Korea. And Russia.
And I am no foe of the govt. Indeed, I think there should be a greater funding of the FDA. But they should play a role of referee, not competitor.
The Dems are often called the mother party and the GOP, the father's. When a child is born it needs its mother's milk. By the time it's an adult, it needs its father's strength and discipline. We've grown up and don't need a nanny any more. That's the problem with govt programs. They insist they know what's best for us, though we should be making those decision ourselves.
The government shouldn't stay out of whatever the private sector can do - only what the private sector can do BETTER. There's no reason why the government can't compete fairly with the private sector. As far as fears about the lack of a level playing field go, the dice is probably loaded against the government. Unlike the government, the private sector reps and lobbyists can and do use favors to buy over lawmakers and government officials.
Besides, in the drug context we're mainly talking about government funding more start ups and universities where most of the breakthoughs happen even now. Big Pharma has a bad track record here - that's why most of them look at acquisitions to fill their new drugs pipeline.
I hadn't heard about this Dem / Repub mother / father analogy and it's matter of perspective. Some may think of the GOP as a selfish and bigoted step-uncle, while others have similarly unflattering notions about the Dems. :-)
Ha,ha, Sandip. I agree with your unflattering relatives analogy. In general, power corrupts.
To answer your your previous response about how govt may be a lower cost-of-funds for research. Start-ups do have an exceedingly high COF, but money is not the issue. Culture and environment is.
If you look at the best selling drugs of all the major big pharmas, they have come from takeover of small biotech companies. Take Pfizer's Lipitor. It came from a small biotech firm. Merck has just bought out Sirna even though they could have attempted to recreate a parallel.
So you're right that Big Pharma's record on innovation is pathetic. What makes you think the govt will fare better? Bureaucracy stifles innovation.
Innovation cannot be forced. Most of these guys are carefree, coming up with ideas on the beach or campgrounds. The very idea of putting on a pin strip suit will make them sick.
And this doesn't just stay in the pharma industry. IBM, in the 1980's, with all its might and capital, couldn't come up with an operating system for the PC. It took a start-up by the name of Bill Gates. But as his company, Microsoft has grown into a bureacracy, they are being out manuevered by other start-ups like Google. Gates is now wearing a suit.
Yes, govt can do some things right. But innovation is not one of them. And they shouldn't because they should stay with the tried and true.
May be I was not clear. I was suggesting that the government can use a part of the drug savings to fund those very start-ups that do all the innovating. California State has already raised a much publicised $3B for stem cell research, but a federal funding on a larger scale can go for more general purposes.
Yes, I am aware of the California proposition to lure biotech firms to the state. I opposed it because, once again, the govt has usurped the markets by trying to pick winners and losers. They tried that with Amtrak by forcing the public to use trains. It sounds like a good idea. But the markets wants cars. So we have these white elephants railtracks criss crossing the nation costing billions which few people use.
Besides, these taxes that get put in never get removed. It was only last year that our phone bill finally removed the tax for the Spanish American war a hundred years ago. Yes, ATT has been collecting this tax for the govt for a century. I'm sure this $3B tax will be substantially higher.
My city still collects street light improvement it imposed 2 decades ago even though we're lit up better than Las Vegas. So taxes are easy to impose but then it becomes a piggy bank and source of corruption for officials.
But I do support the govt trying to set the framework for stem cell research. They should be focusing on the laws that make the technology viable. For instance, we can make hearts and livers using the stem cells from a person. But is it ethical and legal? Govt should concentrate on these matters instead of trying to pick winners and losers. The markets, through Wall street, can raise its own financing if ideas are viable.
Yes, I too have heard of the well-founded concerns that a lot of CA's $3B stem cell fund may be wasted. It's quite possible - let's see. I can only hope they can be smart and good at execution.
Good point about stem cell research. Some have a religious dilemma though I'm all for it. :-)
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