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The Hollywood Analogy

Yesterday’s drug-research-is-hard screed brought a lot of responses, and I wanted to address some particular points that came up. On Twitter, Alex Tabarrok of Marginal Revolution advanced the Hollywood Analogy. I’ve used this one myself; it leads off a talk that I put together a few years ago. The model for a movie studio is that not all your films are going to be hits, or even make money. You can make and release a certain number of them per year, with fairly long lead times, and you try to arrange those to give you the best chance of success. No one’s really sure what makes a bit hit, though, so there’s a lot of uncertainty.

So far, so pretty good. That really does sound like the drug industry. The biggest difference (as I said in that talk of mine) is that Hollywood has no FDA. No one’s going to sue you if they weren’t entertained by your movie; the government isn’t going to make you withdraw it from distribution if it wasn’t funny or exciting enough. (Neither is the government going to examine your movie in detail before release, asking you to substantiate its billing as “The Feel-Good Hit of the Summer!” or change the labeling).

This current response, then, is to take that objection and run with it. Instead of imagining the movie industry as if it had the regulatory environment of pharma, what if pharma had the regulatory oversight of Hollywood? What if companies just released their proposed therapies (after, one presumes, some safety work) and the consumers just decided where to spend their own money, the same way that they do at the theater?

I think that the best way that I can deal with this analogy is to take on the various ways in which it breaks down. These are not necessarily in order of importance – not everyone will agree on that order – but here we go. First, we have a big one: we know a lot more about movie-making than we know about drug-making. And by movie-making, I don’t mean only cinematography, acting, set design and all the physical processes that go into the process. I mean narrative structure and the forms of entertainment. I won’t go into all those lists of the basic plots, or into a discussion of common screenplay structures (and how they’re tweaked or played against for effect). I just want to note that these things exist, even those the great majority of people watching the movies don’t notice them much.

That’s why movies can be pitched in single lines to people who know a lot about them: “Star Wars, but underwater”. “Treasure of the Sierra Madre, in Vietnam”. “Rom-Com, with a twist in the third act”. These days, they’re most pitched in terms of sequels and prequels, making the explanations even more telegraphic. My point is that narrative entertainment is a very well worked out area. Heroes go on journeys, plucky young outcasts fight against the odds, lovers discover after misunderstandings and mistakes that they were actually right for each other all along. An outsider travels along observing the ways of the natives through fresh eyes, a trusted friend and partner turns out to have betrayed the team, a sudden tragedy changes everyone’s lives. Do any of these sound familiar at all? These are tropes, and if you want to see them elaborated at the wholesale level, read one of the books that are pitched at people who want to write novels or screenplays. For the retail experience, go to tvtropes.org, a notorious time sink whose community of obsessives has broken these things down into insanely small granules, copiously annotated.

The equivalent in drug research is the idea of looking for agonists, antagonists, or allosteric modulators at receptors, or inhibitors of enzymes. These are our well-worn plots, but there’s a big difference, in that we’re not trying to please humans by doing what humans have liked before. We can’t pitch a new enzyme inhibitor project by saying “This is like captopril, but without the sulfur”, because those lessons just don’t carry over. Every project is new. We learn some general lessons, but the number of exceptions and idiosyncracies always threaten to swamp them. Fundamentally, the problem is that we don’t have control over the story in the way that movie-makers do. We have to adapt to the reality of what’s taking place inside the human body, which was not designed for humans to tinker with. This is another variant of what I’ve called the Andy Grove fallacy, where Silicon Valley/computer science types see drug research through their own experiences in coding and hardware development. In both cases, people are confusing the relative ease of working in a human-produced environment for the difficulties of working in one that has no regard for us at all.

That’s a big one. A second big difference is that the stakes are higher. If you blow $10 on a movie that you didn’t like, that’s not a fun way to spend a couple of hours. But if your new drug doesn’t help your disease, you may well be far more upset – and even more so if it turns out to make you even sicker. I’ve talked about how health changes people’s opinions about their economic behavior here, and many other people have gone into this topic at greater depth. Basically, your own health is the biggest ace in the deck – without it, little else can seem worthwhile. Comparing it with a choice in movies gets stranger and stranger the harder you look it it.

Third, there’s also a time-and-choice problem that does not occur in entertainment. Many diseases (acute and chronic) are easier to treat when caught early, which makes an incorrect diagnosis or therapy matter a lot. There may well not be a chance to make it right – you can’t go back next weekend and see a better movie or rent a version of the story that you’d like better. That window has closed.

Fourth, that time-and-choice difference applies on the production end as well. Few movies have their principal photography schedule last for four, six, or ten years (well, maybe Orson Welles’ last movie, but you know what I mean). Drug project routinely go on for just those spans, tying up greater and greater amounts of capital along the way. A movie has to be cast, shot, edited, and distributed, but the risk profile through that process is much different than it is in drug research. The latter stages of a drug development effort are by far the most expensive (Phase II and especially Phase III trials); it’s as if getting the final edit of a movie consumed 70% of the total budget, and as if the editing technology would (in a majority of cases) suddenly and randomly zap your entire film into unrecoverable waste products. Hollywood would look a bit different under those conditions.

Fifth, another reason that Hollywood differs greatly from drug research is copyright versus patent law. This is so obvious that it shouldn’t need belaboring, but in the US, such works of art are protected for at least 95 years after release. Drug patents are for 20 years after filing, and the drug itself will not appear for some years after that filing date, if it ever does. Huge best-selling drugs go generic all the time, but movies? In 2019, US films made in 1923 will start to enter the public domain. Hollywood, again, would run rather differently if cheap copies of (say) all the Disney movies and characters could be sold after twenty years.

A sixth difference is in the ways that art and science march along. Aspirin was first synthesized in 1853, and first sold in the late 1890s. Nitroglycerine was first used as a drug in 1878. Ibuprofen’s patent was filed in 1961. These are all still perfectly good drugs, and in everyday use. At the same time, an older drug or treatment can be totally wiped off the medical map by something definitively better – no one revisits them by taking them out of nostalgia or historical interest, as someone would watch an old film. Plenty of drugs from the 1970s, 1980s, and 1990s fall into these categories – while some have been superseded, others are going to be with us for a long time to come. They don’t look out of fashion; their colors have not faded, they don’t have odd slang in their dialog, and their special effects are not dated. We’re on a far different time scale in the drug and medical world, because it’s again not a human one. The English language will change long before the cyclooxygenase enzymes do.

So while the Hollywood analogy is still one of the closer ones to drug research, on the absolute scale, it’s not all that close at all. The superficial resemblances are actually a bit of a trap, leading people to extend lines of reasoning further than can be supported. I hate to keep banging away on this theme, but drug discovery is different, different, different. No other industry works this way.

48 comments on “The Hollywood Analogy”

  1. SPQR says:

    I heard theyre making a reboot of Thalidomid.

  2. Sanjay says:

    I’m fond of the very bright Professor Tabarrok but his views on the FDA drive me completely nuts; this morning he was praising self-administration of gene-therapy ideas without experimental support as being beyond needing an IND– yeah, make that idea widely known and many many very bad things are going to be happening all over the country as nutcases get syringes.

    On which lines, I think Dr. Lowe’s _second_ point is, far and away, the _first_ one. It’s not even that your drug may make you sicker — Lowe is thinking here from his experience in pharma of the number of times phase II or III work shows the drug is statistically worse than a placebo. But in the absence of tight FDA regulation that’s not what we’ll be talking about; we’ll be talking about endless crap that hasn’t even been through the minimal study necessary for an IND and the vast majority of it will have horrible health effects. Because of difficulties keeping even medical professionals — let alone the hoi polloi — aware of the science, the free market will no more forestall that problem than it did the use of say radium as a cure-all before the FDA, or than it contains anti-vaccine nonsense now. It’s that second point that makes the movie analogy a howler: with very, very few exceptions a movie can’t flop so badly it actually kills you (although, for example, I haven’t yet met anyone who saw, say, the Conan remake so I figure the lethality was 100%).

    1. Hap says:

      I think some people are talking not about the FDA not having safety authority, but not having efficacy authority (not caring whether a given drug is known to do something). The health effect of those drugs wouldn’t (probably) be catastrophic.

      Approving drugs on safety data only still has lots of problems. They might make a disease worse, or delay an effective treatment (making a disease deadlier than it should be). No one is likely to get data showing their drug doesn’t do what they claim, so unless the FDA mandates its collection (in which case patients would be getting drugs as Phase 3 participants and insurance companies would be paying for the trials) it won’t exist. Finally, there is always a risk with a drug – it’s the benefit/risk ratio that determines whether someone should use it or not, and with no benefit data, you don’t have any idea whether a drug is a good idea or not, only that its risk is less than a certain threshold.

      1. Dan says:

        If I read this comment right Hap is mainly agreeing with Sanjay. With the FDA monitoring safety only you could get baking soda approved and market it as a cancer drug. If patients choose baking soda injections over a real cancer therapy with a significant overall survival benefit then even if there is no direct harm, the baking soda is killing people.

        It is weird seeing normally smart, or at least smarter-than-this, people advocate such a terrible idea. Markets are indispensable for many parts of the economy, but they have not given us conclusive data on the health effects of eggs, MSG, salt, low-fat diets, low-carb diets or 1000 different dietary supplements. Markets are not going to tell us which IO combinations work without the FDA requiring trials. Bernard Munos’ article in Forbes was, predictably, much better.

        For science I will go see the Conan reboot. If you do not hear from me it was as deadly as you feared.

        PS Not to say there are no data on eggs, MSG etc., just not the conclusive data it takes to approve a drug.

        1. Hap says:

          I was assuming that Sanjay meant the FDA wasn’t gating for safety at all rather than testing for safety and not efficacy. Sorry if I was confused.

          1. Sanjay says:

            Dan’s right but I think Hap’s wrong about nonsafety issues too. Look, first let’s be clear on what we mean by “safety.” It’s not just, “this drug doesn’t kill you on its own.” Licensing things like biologics got a lot harder because stuff got contaminated by fungi, people died, and now FDA is very very hard on manufacturing and standardized processes in a way that _almost_ doesn’t happen in other industries — seriously, cGMP/GLP has _similarly strict_ analogies in some other high-tech manufacturing, but, nothing is harder, and there’s a reason for that — and that’s beyond all the stuff Lowe is talking about here but it is wrapped up with it because it talks back and forth with how the science is done. So it’s not just “your drug is good” and “the adjuvant you’re mixing it with is good” but “you’re doing it in very very much the same reproducible way every time and it’s how you did it in the studies and if things _are_ changing you have a way to show that they’re changing for the better.”

            But also it’s a bizarre comment to make about efficacy — the idea seems to be that, well, if it’s safe and doesn’t do anything then it should be not a concern of the FDAs. What universe does that idea come from? In this one you can be dying of say cancer — to pick something Lowe has talked about — and there can be some possible treatment option, but a thousand shysters will jump up to sell you something that does absolutely nothing and you die horribly. Yes, the FDA should protect you against that. No, if there’s no FDA than nothing will.

            But also in an era of trying to regulate and control costs note that FDA wants to know the drug is _worth it_ — that it provides some benefit of some kind not just in absolute but _relative to other existing treatments_ — again, that seems worth it, and we haven’t even started worrying about effects in different populations, or cross-reactivity, or…

  3. Something to write to your congresscritters, a draft. Feel free to criticize it, suggest edits and so on! But if you’re in the USA, write something out and mail it to someone in congress. Railing about these things on the internet doesn’t accomplish anything, unfortunately.

    —-

    The Scientific Method is the best approach we humans have devised for determining what does, and does not, work in a variety of areas from rocketry to medicine. It is imperfect, and as new knowledge is discovered, the answers it produces may change, occasionally radically. However, it consistently produces our best guess at the right answer, and that answer is usually a pretty good one. We did, after all, put men on the moon, and antibiotics do work.

    Experts in drug discovery agree that the FDA’s current drug approval process, while lengthy, expensive, and highly politicized, is a good approximation of the best we can do. The Scientific Method has been, and continues to be applied with a fair degree of rigor.

    Substantial changes to the FDA’s process to permit more drugs to be approved more quickly would result, experts agree, largely in more ineffective drugs being available. In theory, from time to time, an effective drug would make it to market more quickly, but these would be at best rare cases. There would be no way to know a priori which of the many new therapies are the effective ones. The result, in the end, would be more expensive, less effective health care.

    Please allow science to proceed, and support updates to the FDA’s process that are driven by science, with solid research supported by experts. Please reject updates to the FDA’s processes that are driven by political expediency, and by profit-seeking.

  4. anon says:

    Nitroglycerin should be 1878.

    1. Derek Lowe says:

      Dang. Fixing that now – thanks!

  5. Isidore says:

    Playing devil’s advocate here, but it is my understanding (I am sure someone will correct me if this is not the case) that the Japanese FDA requires only safety data and not efficacy to approve drugs to be sold to the public. Yet the Japanese are not dying in droves, in fact last I checked they have among the highest life expectancies in the world and as far as I know they are not particularly sickly either. I will say that even though I believe it will benefit from some efficiency tweaks I am personally happy (not that it matters) with the way the US FDA operates, but I am curious about the Japanese model and I am hoping that someone knows more about it.

    1. tnr says:

      Isidore:

      That is not quite true. For some compounds which have been approved elsewhere (with efficacy data), Japan does allow for what is called a bridging strategy which allows companies to use the argument that Japanese people are similar enough to the rest of the world in regards to this compound/disease so that efficacy data obtained elsewhere can be assumed to be true for Japanese people also. However, the requirements of the bridging strategy are not trivial and many companies just decide its easier to try and redo efficacy studies completely in Japan. There is no way that Japan would allow a bridging strategy for a compound which has not been shown efficacious somewhere else in the world.

      1. Isodore says:

        Thank you. I had heard/read, but I have been unable to verify, that it is possible to obtain approval to sell drugs in Japan based on safety alone. I guess I was mistaken.

    2. RM says:

      The counterpoint to that is that Japanese doctors *do* have efficacy information: from the US FDA. They can just pick the drugs which have passed US FDA approval to make sure they get ones which are efficacious. (It might not even be conscious: literature and manufacturing will focus on FDA-approved medicines. Non-FDA approved medicines will be a much more niche thing.)

      Europe may pick up some of the slack, but without US FDA requirements many of the tests just wouldn’t get done. The US pharmaceutical market has such an outsized influence on the world drug market that you can’t necessarily use results from other (smaller) markets to predict what would happen if the US FDA changed policies.

    3. Dylan says:

      I do not know a lot about the Ministry of Health and Welfare in Japan, but I do not believe this is correct. I think there is something along the lines of only requiring a small supporting study in Japanese patients if a drug has already been approved somewhere else. But for drugs that are approved first (or only) in Japan I do believe they require efficacy data similar to the FDA or EMA. I have friends who work for the ministry, so I’ll have to ask them for the details the next time we talk.

  6. Thaddeus says:

    I think one could call the MPAA the FDA of the cinema, if one were committed to trying to make the analogy work. An NC-17 rating is scarcely less of a death knell than an FDA rejection, even if it’s a lot easier to avoid. It’s not a perfect equivalent (the FDA is a lot more transparent and professional, and it’s a lot easier to cut a movie than rework an NDA, the MPAA doesn’t follow movies after they’ve been rated, and it’s not a government body), but it’s no worse than the rest of the analogy, which isn’t great.

  7. DCRogers says:

    If the FDA regulated only safety and not efficacy, there would be other unmentioned shifts:

    1) Companies would move research resources from efficacy studies to safety studies, leading to more “safe” drugs but much less knowledge about “efficacious” drugs.

    2) Companies would move marketing resources from efficacious drugs to safe drugs, actively pushing more people towards unproven treatments, and crowding out effective ones.

    3) Insurance companies would push people from (presumably expensive) effective drugs to the (presumably cheaper) “safe” drugs for the same indication. You may not be able to even try the real thing until you had proven all the “safe” drugs failed to work in your case.

    All of these forces would lead to poorer treatment of patients, fewer effective drugs, and less access to effective drugs.

    The plus side of such a shift (earlier access to “safe” drugs that would have been later proven effective) seems like small beer in the face of these YUGE effects.

    1. Hap says:

      1) An estimate of the ratio of effective drugs that would be approved early to ineffective ones might be the success/failure ratio of Phase III trials.

      2) Older drugs (that are actually known to work) might be old enough to be off-patent and cheaper and preferred to unevidenced drugs that are on-patent and so can only be sold by one company. In those cases, the default would be expected to be better than the “new” drugs available.

      No hope is probably better than false hope.

  8. MP says:

    In my mind, it would be completely unethical to remove the requirement to demonstrate clinical efficacy prior to drug approval. Someone who wanted to get rich quick could patent a lot of substances that would be safe but not efficacious, in a similar vein as the supplement industry. Maybe derivatives of substances naturally found in food? Or sell low-potency drugs at dosages that are far below what would be needed to show either an effect or significant toxicity. Instead of looking for tight binders in HTS, you could look for non-binders. You wouldn’t be killing anybody, but you would be robbing them of their time and money.

    1. tnr says:

      In my mind, its not a ‘don’t change anything/drop all efficacy requirement’ argument. Things that the FDA could do that they are reluctant now: 1) allow non-inferiority studies instead of placebo controlled in more disease areas, 2) allow alternative endpoints such as progression free survival instead of overall survival in oncology, 3) allow less stringent control of Type 1 error for rare, fatal diseases. The list goes on and on.

      1. flem says:

        I think as a rule of thumb:
        Japan focus is on safety and approves the lowest effective dose (as the “standard” dose)
        The West/US is focused on efficacy and approves the highest tolerated dose.

      2. M says:

        Not my main focus–I’m not involved directly with late stage development–but the FDA has allowed PFS or non-inferiority in many cases that I paid attention to. In fact, very rarely have I seen something I’ve worked on do a true placebo control, as in man cases it’s unethical to give a placebo when other treatments exist.

        Am I just getting a sampling error and my experience is not representative?

  9. Kent G. Budge says:

    “Hollywood, again, would run rather differently if cheap copies of (say) all the Disney movies and characters could be sold after twenty years.”

    I’m inclined to think it would be an improvement.

  10. Jeff says:

    On the other hand, the plethora of sequels in Hollywood (fast followers?) and the trend towards comic book hero movies (immuno-oncology?) seem pretty similar to how drug companies address risk.

  11. NHcentiPede says:

    Derek just wants to be a celebrity

    1. Huh? He’s already got 1.8million followers on instagram and a signature cologne. I hear there’s a clothing line in the works.

  12. Paul D. says:

    It seems to me insurance companies could take up the slack on efficacy. They could simply refuse to pay for drugs for which there is insufficient evidence of benefit.

    1. Anonymous says:

      Please clarify your statement: “[The insurance companies] could simply refuse to pay for drugs for which there is insufficient evidence of benefit.” Benefit to the patient or benefit to their bottom line?

      1. Paul D. says:

        Benefit to the patient. The insurance company could say “we will only pay for treatments that costs no more than $X per quality of life adjusted year of expected benefit”. Different insurance plans could be sold with different treatment thresholds.

        1. Anonymous says:

          Given the costs of some drugs (Glybera $1.2 M per year; … Kalydeco $300,000 per year …) and sometimes marginal or non-existent (eteplirsen $300,000 per year) benefit, the insurance companies don’t have to worry about setting that mystery X too high to avoid an increasing number of treatments.

          You also don’t say where the effectiveness data for making the decisions is supposed to come from if it isn’t required by the FDA. And there is much disagreement about effectiveness and quality of life measures anyway. Without that data, insurance companies can always argue that there is “insufficient evidence of benefit. Claim denied!”

          Drugs should be safe. Drugs should be effective. Drugs should be affordable. And there should be peace on earth, good will towards all. And free sprinkles on ice cream cones. You can’t always get what you want. But if you try sometimes, you just might find, you get what you need.

  13. milkshaken says:

    it should be noted that two big money-makers for Pfizer – Zoloft and Xalkori – were originally developed for wrong targets, their development was shelved and they were re-discovered after some time by screening through collections of synthesized compounds from abandoned projects. Also, the “blockbuster” Lipitor was almost terminated during its development because it was not clear it would have any advantage over the first generation of statins, and the clinical trials in cardiovascular area are extremely expensive.

  14. Earl Boebert says:

    I find the Hollywood analogy to be wholly unconvincing. First, there is the uncertainty as to whether a given movie (or studio) is making money — google on “Hollywood accounting,” or, as a VC once told me “You should be careful reading the financials of an industry whose primary products are works of fiction.”

    Second, the model of movies as independent projects, some of which succeed and some of which don’t, is severely out of date. The majority of movies today are elements of a “franchise” (e.g., Star Wars, Harry Potter) which include sequels, amusement parks, and all manner of merchandise. These provide multiple associated revenue streams that do not exist in the drug business.

    If you want an analogy (and frankly, I don’t see what the value of one is) I would suggest offshore oil drilling. First you survey an area and on the basis of more or less iffy information you spend a bucket of money ($100 mil or so) drilling an exploration well. If what comes up looks promising you spend another bucket of money drilling one or more appraisal wells. If they look good you spend a third, larger bucket of money drilling production wells and laying in the infrastructure to get the oil to someplace where you can turn it into money — at a price over which you have little or no control.

    1. Kaleberg says:

      Offshore oil extraction is a good analogy. The steps are expensive, and just one little thing can halt the entire process.

      1. Earl Boebert says:

        Yes, and if you aren’t careful you can engineer a major disaster (Thalidomide, Deepwater Horizon). Plus great potential for predatory behavior, and the possibility we are approaching “Peak Pharma.”

        But since I believe that analogies exist to confuse us, for me this exercise has been “great fun, but it was just one of those things.” 🙂

  15. Bill too says:

    One area where an entertainment industry model could be applicable to the US pharma Industry is in importing successful programs, such as British or Japanese TV shows, into the US with only minor changes. A drug marketed outside the US with years of safety data should have lower regulatory hurdles for introduction in the US than a novel compound. In this regulatory environment, the development of repurposed drugs could focus on efficacy trials which would reduce the cost of development of a new therapy.

    1. passionlessDrone says:

      Or how about ‘Most Extreme Elimination Challenge – Roll Your Own Drug Version’? Instead of Japanese people trying to run over mud puddles while someone shoots rubber balls at them, they take random ‘safe’ drugs and see what happens.

  16. Pharmaceutical Actor says:

    I took a deep dive at that this many years ago and some of the comparisons are striking – for example the evolution the large studios or pharma from vertically integrated industries to distribution/financial consortia. Another striking similarity is the stage-gate nature of the decision making. But while these structural similarities are attractive, the breakdown occurs when one examines the options value of the decisions. The development timelines for movies are much shorter (about 2 – 5 years) relative to drugs (8 – 12 years) as you call out. The other major factor is that while it is difficult to call a major studio success, the equivalent of clinical trials, e.g., market testing of early versions of movies, is orders of magnitude more reliable. It’s as if one needs only to run a Phase I to get Phase III level feedback.

  17. dearieme says:

    “Silicon Valley/computer science types see drug research through their own experiences … confusing the relative ease of working in a human-produced environment for the difficulties of working in one that has no regard for us at all”: well said.

    Maybe we should stop calling it Computer “Science”.

  18. AQR says:

    One thing I haven’t seen addressed is how these studies which demonstrate safety are to be designed. Just for starters:
    – Presumably, it would have to be done in the appropriate patient population – it doesn’t do much good to show that an Alzheimer’s compound is safe in a bunch of college-aged adults.
    – How are you going to determine what dose to use? Currently, Phase 3 doses are set using biomarkers from Phase 1 studies or preliminary measures of efficacy in Phase 2 studies. If you don’t need to worry about efficacy, it would be pretty easy to demonstrate that a compound is safe at a 0.001 mg daily dose and then you just let the public figure out if it works and at what dose.
    – What comparator group are you going to use to demonstrate that your compound is “safe”? Do you compare your drug treated patients vs a set of untreated control patients, or do you use “historical” controls? How do you power these studies?
    It seems to me that a properly designed study to demonstrate that a compound is really safe would be pretty much indistinguishable from a classic Phase 3 study.

  19. Oblarg says:

    Another obvious problem is that there’s pretty quick development of consensus on the quality (or lack thereof) of a movie. Critics can tell immediately upon seeing a movie whether or not they like it, and critic opinion tends to be at least moderately predictive of that of other people. Moreover, people can see trailers, read in-depth reviews, and in general have a huge array of tools at their disposal to accurately pick which movies to spend their money on. In short, you have *informed demand,* and thus you have incentives for filmmakers to make good movies.

    Unfortunately, this is not the case for our imagined “Hollywood-esque Pharma” scenario. Figuring out which drugs work is difficult and expensive, and that’s even when carefully constructing trials. Trying to figure out what works and what doesn’t in such a situation would be nearly impossible, and there would be no informed demand – and thus, no incentive for anyone to make drugs that actually work.

  20. Pennpenn says:

    Technically the last movie Orson Wells worked on before his death was Transformers: The Movie, though I understand why he’d not want that as his epitaph (as much as I liked the movie…).

  21. Wavefunction says:

    Some of modern drug discovery reminds me of the exchange from “Argo”

    John Chambers: [after hearing of the plan to get the hostages out] So you want to come to Hollywood, act like a big shot…
    Tony Mendez: Yeah.
    John Chambers: …without actually doing anything?
    Tony Mendez: No.
    John Chambers: [smiles] You’ll fit right in!

  22. exGlaxoid says:

    If the FDA were just encouraged to allow more older drugs which are approved in other countries already (and already have established basic safety and efficacy studies) to be sold generically here, that would be a great first step, with almost no risk. That would also eliminate the Daraprim and Epipen type issues, as well as allow some inexpensive drugs, already widely used elsewhere, to be sold in the US. There are at least 5 sellers of Epipen type products in Europe that have never been approved in the US, even more companies that make Daraprim generics in the world.

    As well, the degree of efficacy proof required could be lowered some in rare and orphan diseases, I am aware of at least one drug that was in trials for years, but was never approved, mostly as there were not enough patients to recruit to make the FDA happy. There will never be “personalized medicines” if you need 10,000+ patients per study.

  23. gippgig says:

    A better analogy would be making documentary movies about ongoing events.

  24. Rumyana says:

    You make some great points here. I would want to add one I didn’t notice, but it matters a lot: Consumers not being able to recognize the quality of the end product.

    For movies, “people want to see it” and “good quality movie” is almost synonymous. For drugs, “people want to use it” and “good quality drug” is not. And this has consequences beyond the “a bad movie is 2 lost hours of your life” point you already mentioned. It has a consequence for the market.

    A market where people can recognize which product is the one they need can be self-regulating in the sense that good quality products will automatically get a lot of market share, and the market itself will punish bad quality products. If they hate downer movies, nobody will make downer movies. If a movie has a great pitch but the first moviegoers go out and say it was boring and illogical, the second wave of moviegoers will not buy the ticket at all. But in health, the reputation of a drug is usually made by what people want to believe about it, and not by how well it works. This means that buyers’ behavior will not be able to create an efficient market where everybody gets what he needs without the need for meddling regulators. (If you are interested in the theory behind it, look into models of markets under information asymmetry).

    As long as people are willing to pay thousands for the next exotic plant juice which is touted to cure diabetes, multiple sclerosis and toe bunions at once, the market needs regulators.

  25. Li Zhi says:

    I question the assertion that if movies went off-copyright in 20 years that there’d be any wholesale restructuring in the major (production/distribution) parts of Hollywood. Sure there’s a secondary business that buys rights to old movies (Bambi, Casablanca, Wizard of Oz,…) and makes money from them, but how significant is that? The movie analogy breaks down while you’re deciding which ticket (if any) to buy. It’s virtually certain that buying one won’t kill you, and that NOT buying one won’t mean you’ll be burying your kid next week (or next year). Seems to me that’s a pretty significant difference. It’s also virtually certain that buying a ticket won’t mean you’ll be unable to pay the mortgage. I’ve yet to be impressed with Tabarrok’s arguments against the FDA, but in general I approve of (some of) his libertarian views. With the FDA, he seems like a nutter, imho.

  26. steve says:

    So by this analogy is alternative medicine the porn industry?

  27. Andrew says:

    Dronedarone…like amiodarone, but without the iodine.

  28. Greg Hlatky says:

    The entertainment industry considers the ideal copyright length as eternity, minus one day. So if your blockbuster drug comes up to its patent expiration, you just lobby Congress to extend the term.

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