This is about medical drugs, not about recreational or illegal drugs.
There are two problems with drugs. Drugs cost too much. Drugs are not tested enough.
The obvious solution to either problem will make the other problem worse. More testing of drugs will make drugs cost even more. Reducing the prices of drugs will result in less testing.
Both problems can be solved by creating a universal drug testing program. Instead of having many small drug testing programs, there should be one large drug testing program. Drug companies should be required to sell drugs to the universal drug testing program at a very low price, maybe free. All people who cannot afford to pay the regular price for drugs should participate in the universal drug testing program.
When a patient is diagnosed with a disease, the patient can choose between a known drug or an unknown drug. If the patient chooses the known drug, the patient must pay whatever price the company asks. If the patient chooses the unknown drug, a computer will choose a drug or placebo for the patient, and the unknown drug will be free or very inexpensive.
When the patient chooses an unknown drug, the computer should not choose a drug at random. The universal drug testing program should be run by a committee of experts who assign probabilities to various drugs. More safe drugs should be more probable than less safe drugs. More effective drugs should be more probable than less effective drugs. More convenient drugs should be more probable than less convenient drugs. More expensive drugs should be less probable than less expensive drugs.
So if a patient has a disease which has a known, safe, effective, cheap, and convenient drug treatment; then most patients participating in the universal drug testing program should receive the standard drug. But if a patient has a disease for which there is not a good cure, then the patient should be more likely to receive an experimental drug.
In current drug studies, half of the patients receive the experimental drug and the other half receive the standard drug. In the universal drug testing program, most of the patients receive the standard drug.
Some patients should receive the standard drug, but in a larger or smaller dose than usual. Currently, not enough research is done to determine the optimum dosage of drugs.
Some patients should receive combinations of drugs. Currently, not enough research is done on combinations of drugs, especially when the drugs are made by different companies.
The patient and doctor will need to report on the results of the unknown drug. Ideally these reports should be in a standardized format which can be sorted by a computer. Ideally this data should be available to all researchers.
The committee of experts which sets the probabilities of the drugs will need to continously watch the results, and keep changing the probabilities as they learn more about the drugs.
Maybe all the data could be entered into a computer, and the computer could be programmed to calculate the probabilities, and to recalculate the probabilities as new data was entered.
There would need to be a list of diseases, and each drug would have a different probability for each disease. The doctor would say what disease the patient has, and the computer would select a drug using the probabilities for that disease.
Diseases should be split into as many seperate diseases as possible. If many people have the same disease, that disease should be divided into seperate diseases based on age, weight, gender, pregnancy, genes, presence or absence of other diseases or drugs, or other such criteria. For example, kidney failure in young people could be considered a seperate disease from kidney failure in old people, so that the universal drug testing program could determine if young people with kidney failure should receive different drugs than old people with kidney failure.
There would need to be a committee to add new diseases
to the list. The committee should be able to split old diseases into
multiple new diseases, and to merge multiple old diseases into a
single new disease. When a new disease is split off from an old
disease, the new disease should start with the same probabilities
of the old disease. Any drug company or researcher should be able
to propose new diseases. A
drug companies may propose splitting one old disease into multiple new diseases because the drug company thinks that its drug will work better in a subset of patients. The committee should accept most submissions without worrying about whether or not the proposed new disease is meaningful, because there is no way to determine if the proposed new disease is meaningful without trying it.
Neither the patient nor the doctor should know what the unknown drug is. The pharmacist who fills the prescription will have to know what the drug is. The pharmacist should not see or talk to either the doctor or patient. The prescription should be sent to the pharmacist using a computer, and the drug should be delivered to the patient by a delivery service.
When a drug company wants to make a new drug, the company should report the drug and what it might cure to the committe which sets the drug probabilities. The committee should immediately enter the new drug into the drug database, but should set the probability very low, so that very few patients will receive the new drug, because the safety and effectiveness of the new drug is unknown. Then if the drug appears to be safe or effective, the probability of that drug should be increased, so that more patients will receive the new drug, and so on.
Drug companies should not be allowed to test drugs. This
is the exact opposite of the current system, where
drug companies are required to test drugs. When a drug
company tests a drug, there is a conflict of interest because the
drug company wants the drug to be safe, effective, and profitable. If
the drug company hires an independent company to test the drug, the
independent company is not
really independent because the independent company was hired and could be fired by the drug company. Therefore the committe which adjusts drug probabilities should refuse any data provided by the drug company except the list of diseases which the new drug might cure. The drug company should not be expected to prove that the new drug is safe or effective or anything.
Since the drug companies are not expected to test drugs, it will not cost so much to develop new drugs, and the prices of drugs will decline.
Some people might think that since drug companies are not required to prove that drugs are safe and effective before submitting new drugs, the drug testing program will be overwelmed with poisons and random chemicals. I doubt this will happen.
The drug testing program will not be profitable for any drug company, because the drug companies will be paid very little for experimental drugs. The drug companies will not waste money submitting drugs to the drug testing program unless the drug companies think that the drug testing program will prove that the new drug is safe and effective enough to sell outside the drug testing program. Maybe the drug testing program should also charge a fee to submit new drugs to further discourage frivolous submissions.
It is true that some patients will receive and possible die from unsafe new drugs. This is unavoidable. The only way to determine if a drug is safe or not is to give the drug to people. The best we can do is to give a new drug to very few people at first; if the drug appears safe, we give it to more people; if the drug appears unsafe, we stop giving it to people. That is the way the current system works. The universal drug testing program would work the same way.
Currently new drugs must be proven safe and effective in rats before the new drugs can be tested in humans. This requirement could be included in the universal drug testing program. However, there are cases where drugs which were effective in rats were not effective in humans. So I think that there may be drugs which are effective in humans which are not effective in rats. So I think we should not require that new drugs be safe and effective in rats.
Some people might object to providing experimental drugs to the general public. But one of the problems with the current system is that drugs are not tested enough. Drugs need to be tested on large numbers of people, and that means that experimental drugs should be made available to the general public.
Another advantage of the universal drug testing program is that no drug is ever assumed to be safe. With the current system, when the FDA decides a drug is safe, we stop looking for risks and side effects. As a result, if some risk or side effect of a new drug was not discovered before FDA approval, it probably will not be discovered until after it has harmed many people. But with the universal drug testing program, all drugs are monitored. All drugs are assumed to be experimental.
Another advantage of the universal drug testing program is
that the universal drug testing program could determine long term benefits
and side effects of drugs. Currently, drug studies stop after a period
of time, and any effects which occur after the end
of the study are undectected. But the universal drug testing program would
never end. Any time a patient develops a new disease, it would
be entered into the database and could
be matched against any drugs the patient had ever taken anytime in the past.
Some people might object to the universal drug testing program because it forces poor people to take experimental drugs. But is the problem that poor people are forced to take experimental drugs, or that rich people are not forced to take experimental drugs? First of all, no one is forced to take experimental drugs. Everyone can choose to take no drugs at all. Secondly, most people in the universal drug testing program will receive the standard drug, not some unknown unsafe experimental drug.
Drugs need to be tested on large numbers of people. If we try to recruit volunteers, we will not find enough volunteers. So we need include everyone in the universal drug testing program, but allow people to choose not to participate. In the current system, people are not part of drug studies unless they choose to participate. With the universal drug testing program, people are part of the program unless they choose not to participate. So the problem is that rich people have more opportunity to choose not to participate because rich people have more opportunity to choose to pay for alternatives. The logical solution is to provide more and different opportunities to poor people, not to oppose the universal drug testing program.
Some people might object to the universal drug testing program because it means greater government control of health care. But the universal drug testing program does not have to be run by the government; the universal drug testing program could be run by a nonprofit organization, or by a cooperative of drug companies.
So would the universal drug testing program really reduce costs, or it would it merely shift and hide costs?
With the current system, every time a drug company wants to test a new drug, the drug company must prepare an application to do a study. This costs money. Then the FDA reviews the application. This costs money. Then the drug company recruits doctors and patients to participate in the study. This costs money. All these are eliminated by the universal drug testing program. The universal drug testing program would reduce costs by reducing the bureaucracy which oversees drug tests.
Many of the details of adminstering the universal drug testing program could be computerized. This would cost much less than having people administer drug studies as is done now.
The universal drug testing program could also include surgeries and other treatments.
I am in favor of competitive federalism and decentralization. I think the central government should not be involved in the universal drug testing program. The universal drug testing program should be administered by a consortium of local governments. Local governments should be free to choose to not participate in the universal drug testing program.
The universal drug testing program could be an international program.