Milton Friedman's Free to Choose Videos (1980)

[PSM]

Ten one-hour videos. The first half-hour is a film that sets up the debate followed by a round table discussion on what was presented.

Free to Choose

Looking back 35 years, it's interesting to see how things have changed...or not. Example: In the first hour, Michael Harrington, democratic Socialist Organizing Committee, argued that technology had become so complex that it was necessary for government to fund and direct future development. As he spoke these words, Steve Jobs, Steve Wozniak, Bill Gates, and other young wizards were hard at work in their respective garages piecing together one of the greatest revolutions in history without government guidance.

Pat

[PSM]

In episode 5, Frances Fox Piven, of Cloward-Piven Strategy fame, pissed off Thomas Sowell to the point that he yelled at her. When I first watched the program in the '80s, I had no idea who Sowell was. Now he's taken over Friedman's crusade. Sowell's 85 now; who's going to replace him?

Pat

[sinjefe]

Those videos are well worth watching. Brilliant man (Milton Friedman). Doesn't seem to ever not have a logical cogent answer to his critics.

[Trapper John]

A good example (IMO) of the effectiveness of government directed "innovation" is the "war on cancer" initially declared by Richard Nixon. The net effect has been 'nota'.

The NIH is the primary funding agency for basic medical research. This process has evolved to the NIH trying to pick winners and losers through the peer review process. To illustrate how this has changed, I had a conversation a few years ago with the late Baruch Bloomberg, MD (Nobel Prize for the discovery of the Hepatitis B virus). The comments he received in response to his initial grant application were scathing and the grant received a very poor score, but it was funded (this was in the '60s). Had that grant application been reviewed today, it would not have even been discussed and considered for funding.

The experts that review grant applications (I have sat on numerous review committees) by definition review the application in light of the current paradigm. Innovation, by definition, is outside of the current paradigm and cannot be predicted or mandated. My point is that by trying to pick winners and losers, the NIH is, in fact, suppressing real innovation.

Furthermore, the NIH needs to be accountable for how it spends it's money budgeted by Congress. This has led to false metrics, i.e. numbers of papers published or drugs approved or scientists employed. Now that may sound reasonable enough, but merely publishing a paper or hiring grad students and post-docs or junior faculty or having a drug approved by FDA does not translate to changes in disease progression in patients or reducing the cost of healthcare.

I would argue that a second and third order effect of the 'false metrics' from the picking winners and losers strategy has in part led directly to exponential rise in the cost of drug development. The net effect is that we have past the point of diminishing return for drug development, i.e. we can spend infinitely more dollars and get no new drugs that alter the course of disease.

What we are getting from this process is incremental increase in knowledge (not a bad thing) but I have likened this to extending the known decimal places of pi by one. Woopie!

Moreover, the hidden cost of killing innovations like the discovery of the Hepatitis B virus is incalculable in terms of healthcare costs and the loss of improvements in public health, patient suffering and deaths (lost opportunity cost).

Just my $0.02 worth

[PedOncoDoc]

Originally Posted by Trapper John

A good example (IMO) of the effectiveness of government directed "innovation" is the "war on cancer" initially declared by Richard Nixon. The net effect has been 'nota'.

The NIH is the primary funding agency for basic medical research. This process has evolved to the NIH trying to pick winners and losers through the peer review process. To illustrate how this has changed, I had a conversation a few years ago with the late Baruch Bloomberg, MD (Nobel Prize for the discovery of the Hepatitis B virus). The comments he received in response to his initial grant application were scathing and the grant received a very poor score, but it was funded (this was in the '60s). Had that grant application been reviewed today, it would not have even been discussed and considered for funding.

The experts that review grant applications (I have sat on numerous review committees) by definition review the application in light of the current paradigm. Innovation, by definition, is outside of the current paradigm and cannot be predicted or mandated. My point is that by trying to pick winners and losers, the NIH is, in fact, suppressing real innovation.

Furthermore, the NIH needs to be accountable for how it spends it's money budgeted by Congress. This has led to false metrics, i.e. numbers of papers published or drugs approved or scientists employed. Now that may sound reasonable enough, but merely publishing a paper or hiring grad students and post-docs or junior faculty or having a drug approved by FDA does not translate to changes in disease progression in patients or reducing the cost of healthcare.

I would argue that a second and third order effect of the 'false metrics' from the picking winners and losers strategy has in part led directly to exponential rise in the cost of drug development. The net effect is that we have past the point of diminishing return for drug development, i.e. we can spend infinitely more dollars and get no new drugs that alter the course of disease.

What we are getting from this process is incremental increase in knowledge (not a bad thing) but I have likened this to extending the known decimal places of pi by one. Woopie!

Moreover, the hidden cost of killing innovations like the discovery of the Hepatitis B virus is incalculable in terms of healthcare costs and the loss of improvements in public health, patient suffering and deaths.

Just my $0.02 worth

While there are several problems (of which you've mentioned the most pertinent) with the peer review process for grant applications, and with the NIH, there are additional checks for the researchers submitting the grants. I agree wholeheartely that the NIH needs to be held more accountable, just as every other aspect of the federal government.

If one has an extremely novel/innovative project supported by strong preliminary data (and possibly even a publication or two) it can be hard to turn away based upon the proposal. The bigger issue is the rating of the investigator and the institution in which he/she works - this leads to something akin to an old boys network that can be difficult to break into without the supporet of someone on the inside. Additionally and unfortunately, funding is needed to generate said preliminary data, and must come from other sources, such as philanthropy and institutional support...

What do you propose as an alternative to the review committees?

[Trapper John]

PedOncDoc-

The bigger issue is the rating of the investigator and the institution in which he/she works - this leads to something akin to an old boys network that can be difficult to break into without the support of someone on the inside.

Exactly!!

Government (NIH in this case) has a legitimate and important role in promoting the environment for innovation, IMO. One issue is risk mitigation in the risk averse environment that currently exists. Accountability with public money is absolutely necessary. Mitigating risk while providing accountability is the challenge but can be overcome.

I think the NIH is in the best position to set broad national priorities based upon unmet needs. Programs should be based primarily upon those unmet needs. this would probably result in fewer but more focused and well funded programs.

Funding of the programs via a public/private partnership would also be a good idea to not only promote innovation, but also provide follow-on funding based upon achieving key milestones. Eventually the funding of projects that are meeting the key milestones would be funded 100% by the private portion of the fund. No more 'valley of death'.

The fund should also be a 'green fund'. By that I mean, upon successful commercialization - a portion of revenue (royalty) should flow back to the fund to fund new projects.

Project review and approval (initial funding) should be primarily administrative, i.e are the project objectives addressed in the application, does the PI and the research team have the capability to conduct the research (facilities and personnel). Assessment or judgment about the probability of success should not enter into the approval/non-approval decision. Projects that outline key milestones to be accomplished would be a requirement for approval. Project reviews would be primary conducted by NIH Program Directors (subject matter experts) and their administrative support teams. The PDs can certainly seek outside opinion but this would not be governing the decision process.

I am not a fan of the peer-review process and the project scoring rubric as it currently exists. I am not sure it is even necessary at all (see the Bloomberg example).

I would certainly like to see preliminary data, but that should not be a requirement. Having a publication would automatically move the proposed project into one of the later stages.

Clinical trials should definitely be fundable and would come from the private sector of the fund.

Just a few thoughts.

[PSM]

Turns out that John Cleese, of Monty Python, was one of the Executive Producers on the series.

http://www.imdb.com/title/tt0852785/...f_=tt_ov_st_sm

Pat