What can you tell us Yanks about Healthcare in the UK

I agree that there is a problem with drug prices - though I accept fully that the companies who have researched and developed those drugs with all that that costs should be able to reap the benefits of that effort and make a fair profit. Perhaps some kind of time limit on that exclusivity should be globally imposed - say 15 years or so, after which time the formulas must be made public domain - call it a fair price for having public money buy those drugs in the first 15 years.

This already exists - generic drugs are ones that have gone off-patent and can be made by anyone. Big Pharma pushes drugs as strongly as possible (eg Pfizer's suggestion that women can benefit from Viagra too) while they are still protected by patent as this is when they make the bulk of their money, recoup their development costs and make a profit on top. Bear in mind that this is a relatively short space of time - they need to patent the drug before seeking FDA approval, which takes a long time - and the costs they need to recoup are unbelievably huge. That's why they market them so aggressively, particularly in the US.

The reason Big Pharma is struggling at the moment is because the "conceptual space" for small molecules is limited. Drugs need to treat a condition, be orally bioavailable (so you can take them in a pill) and have side effects that are less harmful than the condition they're treating. [If you're interested in this, Google "Lipinski's rule of five".] Most of the possible candidates have now been investigated. Barring major breakthroughs on the peptide front, Big Pharma will continue to suffer and will churn out fewer and fewer "blockbusters" each year.

But this misses the point. The real problem with privatised drug development isn't the cost for consumers in developed countries, it's the fact that these consumers are the only market. Drug companies got badly burned developing HIV treatments that they had to give away for peanuts in the developing world, after consumer / international pressure. All the money they spent developing and producing them was wasted. That's why you don't see any money going into HIV or Malaria treatments any more - it's recognised in the industry as a quick way to make a giant loss. Hence the focus on "lifestyle drugs" for conditions like insomnia, pain, erectile dysfunction, dementia, etc, and also the proliferation of "me too" drugs that are just there to compete and don't provide anything useful to clinicians when they're prescribing.

Instead, we need an international, socialised drug development program to treat these conditions. Hopefully as Big Pharma disintegrates we'll see this happen.