Even without breathing problems, you need to watch out when your area gets an air quality warning. The AQI in my area went over 400 last summer because of the fires and you could feel it when you breathed outside.
Yeah a placebo trial would be evil. I think widening the trials is important too, but there’s probably a huge medical difference between a puberty-blocker trans puberty for an adolescent and an adult trans second puberty. While estradiol is a basic easy one, none of these meds are all that great for you - its just the medical need to transition is greater than most (not all) of the health risks.
Did US health insurance end up deciding to cover the new COVID boosters?
There was a lot of mixed messaging there for a while about how the prices were going to be like 10x as much and coverage was uncertain. That uncertainty can't have helped getting people in to get that and their other seasonal vaccines, even if it ended up getting resolved.
There is still a profit incentive to have something on the market, the disincentive is only if the value difference between the small market and bigger market is greater than the value of having something on the market vs nothing. And with the smaller market items they tend to be higher profit because they may be the only option available for that small market.
Plus there is uncertainty on whether the bigger market drug will make it through trials.
This is a potential distortion that will happen sometimes, or heck there’s a distortion where maybe negotiated prices might make the returns for some drugs not good enough to attempt.
But the alternative is higher prices on all the negotiated drugs, with impacts like people dying of diseases we have treatments for because they can’t afford it, and medical bankruptcies. We have elected leaders to decide between trade offs like these, and I think they decided rightly in favor of lower costs for everyone with the potential impact of some new small market drugs being delayed.
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