Good jobs in pharma pay pretty well and are nearly competitive with SV (I've worked for Genentech, Google, and a small biotech startup). Pharma has no lack of smart people, but modern pharma is really just a rent-seeking entity (goal is to maximize profit on fairly small stable of well-defined drugs) while maintaining a portfolio of investments in smaller pharma and biotech companies who do most of the innovation, while pharma handles ads, sales, distribution, manufacturing, etc.

Creating cures for diseases is a systemically complex problem and it's not clear that "more smart people" really is the answer, versus "do a better job". In many ways, the smartest folks in the room are the least capable at moving drug discovery forward- smart people want to work on cool new problems, explore nifty theories, but don't want to deal with the day-to-day challenges of reliably identifying new drugs.

I left drug discovery because the systemic challenges were too great; it's not like you can be smart or work hard and solve a problem. You have to play a very long game, do a bunch of tedious and boring things, and master politics to get a drug to market.

One thing to note is that some drugs really do cost a lot to R&D and to manufacture, and I think those drugs should reflect those costs; but many companies overprice their drugs to maintain absurdly high profit margins. That doesnt' translate into larger investments in future drugs.

Gilead has been very good at this, but after working for a biotech startup that had a deal with Gilead to work on NASH, I've become extremely skeptical. This is a "disease" where nobody can agree that it's actually a disease, and worse, it could be far more easily treated using simple obesity reduction techniques, instead of spending billions to create a drug that helps people who are extremely sick.

There's a difference between ensuring companies creating beneficial products are financially rewarded and asking the customers to pay the full cost. The government can step in to pay for serious illnesses so we don't let people die from newly cured diseases. This already happens with Medicare/Medicaid, and it is tough to ask state governments to spend millions to cure a handful of people, but the alternative is capping drug margins or reducing the financial reward for developing drugs.

Also recall that in the current system not everyone who contributes to a new drug is rewarded. The basic research that scientists conduct using public money is not financially rewarded when its used by new drugs. Why do only people at the end of the pipeline get to profit?

What?

If the people who do the basic research patent their work, sure they get financially rewarded for it.

Go talk to the chemist at Northwestern who discovered Lyrica. Or the CF Foundation who made billions from Kalydeco.

It really depends on a lot of factors. Not every scientist who has their name on a patent that led to a billion dollar drug saw much money from it.

the university sees much of the upside.

That’s true, it all depends on the agreement with the university.

Or you know, we can determine that the cost of keeping people healthy is a social good and invest in that. I don't think we need market indicators to show that we don't want people to die. And we know that that market signal distorts the needs addressed so that chronic alleviation things get more attention than one-time cures...

There are smart people that want to earn more than a "social good" paycheck, whatever amount you peg that at.

That's the issue with your "social good" approach, is that by capping the upside, you're capping the control one can exercise over their own livelihoods.

The smart scientist wanted to send their kid to a more expensive Montessori preschool instead of a neighborhood preschool? Too bad. You are capped at the socially accepted able salary range.

No matter how much extra work, training, contributions, the smart person would inject into their career, they are forever capped at the socially good rate.

No one’s talking about pegging the salaries of the researchers who are in a completely different class than executive management. It’s a Straw Man argument.

The disdain for execs is apparent.

Most engineers can’t scale companies. Just take a look at the wasteland of personal projects demo’ed on HN. Great technical execution, but they don’t get off the ground as a profit generating company.

And a company scaled to to billions of dollars is even more of an outlier. It’s absolutely a skill.

Notice that I didn’t say anywhere that executives shouldn’t be paid more than workers. It’s a question of how much more. Right now executives make over 200 times more than an average worker, at a rate that’s increased more rapidly than workers wages. You can find a lot of economists who think this actually isn’t that great for the economy.

And yes, you can have a conversation of what value an exec brings vs the value generated by scientists inventing the products their selling. But the original point was that no one is coming after workers salaries — they’re not the ones making $15m a year.

That seems to suggest that somehow everyone's earnings is unlimited assuming they do extra work and train in whatever vocation they want, when we all know that isn't the case. Why is it that the markets cap is more virtuous than one that's good for society?

It actually is the case. Trick is that it's strongly modulated by randomness (luck).

There are no billionaire janitors, drycleaners, or chefs. I don't think there are even any billionaire software developers, doctors, or lawyers. There ARE billionaire business owners of all those things, but for the vocations themselves, it doesn't matter how good at that particular thing you are, you can't earn unlimited wealth strictly off those vocation specific skills and hard work unless you pivot and move your time and effort into something else.

> Or you know, we can determine that the cost of keeping people healthy is a social good and invest in that.

Social goods that we ostensibly invest in, often are crappy career paths in terms of pay. If you don't believe me, talk with a teacher. We know that few things contribute to the social good as much as a good education, but tell me honestly. If you knew a poor, smart, hard working kid, what career path would you suggest, teacher or software developer?

> what career path would you suggest, teacher or software developer?

Depends on what they like to do. There is a lot we can change so that people can do what they love without punishing careers that aren't directly tied to profit.

Or maybe extreme, frontier-inspired individualism went obsolete once the West was Won?

I’m all for smart people being paid well to work hard. But there has to be a better model. Perhaps something similar to the massive payouts we see lawyers getting in class action suits, except instead of law firms and defendants we have drug researchers and illnesses.

I mean, so you pay teachers more. Government jobs weren’t always vilified, nor heavily underfunded. The shift happened with Milton Friedman in the 60s and 70s.

If the free market doesn’t determine what diseases are targeted, then it’s just some govt official doing it. Which, undoubtedly, will succumb to political games.

There aren’t enough resources out there to tackle every disease.

The free market itself is the result of some govt officials' design, and plenty of polical games.

"Free market" isn't really the right term for this method of price discovery when life and limb is on the line. "Highway robbery" might be more appropriate.

I mean, sure, but if you turn on the TV the ads are for erectile disfunction drugs — that’s where the money is. When it comes to funding a vaccine that needs to go out to a few billion people who can’t afford it, I’d put my lot in with the government.

This is an interesting point that I hadn't considered. While I am resentful of pharmaceutical and insurance companies that prioritize profit over peoples' health, it does feel a little more just to tax companies creating frivolous social media ad platforms than companies doing drug research.

If 90% of the people in the world die because they cannot pay this vaccine, do you think they can keep making money with only the 10%?