Thanks Carolyn. I had worked on a response earlier but your challenge has shaken my opinion loose. I share your cynicism about how the system really works.

In general my view is that capitalism, which works on the "greed" model of motivation and the law of supply and demand as a control on the greed with an "invisible hand" is closer to the truth on the motivation of people but is way off in its assumptions of perfect information and numerous buyers and sellers to set prices that clear the markets. When the assumptions are met, such as in commodities and equity shares in businesses, the market economies are highly efficient, but too often the imformation is lacking (no transparency) or there are few buyers and or sellers. As Kenneth Boulding (a British economist) said in a lecture that I attended may years ago, "Laisse faire, is pretty lazy, but not very fair."

But, no matter how flawed the capitalist model is at fair distribution of benefits gained from the organizational advantages and technological leverage of industry, it is still way better than the alternative of social value as a motivator for efficient deployment of assets. Instead of trying to fundamentally change the capitalist, industrial model for therapy development, we should try to balance the excesses with counter balancing forces, such as regulatory agencies and also through empowerment of PWP to have greater voices in the scientific, regulatory, and even business decisions. This will provide greater transparency in the pre approval design decisions, when our input can make a difference to the outcomes of studies.

I am working on a paper on the subject of business models and their impact on the PD pipeline that goes into more detail.

Perry