Ebola as a market failure

[madd0ct0r]

http://www.independent.co.uk/life-style ... 16615.html

Asked why a fully tested and licensed vaccine had not been developed, Professor Hill said: "Well, who makes vaccines? Today, commercial vaccine supply is monopolised by four or five mega- companies – GSK, Sanofi, Merck, Pfizer – some of the biggest companies in the world.

"The problem with that is, even if you've got a way of making a vaccine, unless there's a big market, it's not worth the while of a mega-company …. There was no business case to make an Ebola vaccine for the people who needed it most: first because of the nature of the outbreak; second, the number of people likely to be affected was, until now, thought to be very small; and third, the fact that the people affected are in some of the poorest countries in the world and can't afford to pay for a new vaccine. It's a market failure."

He said that producing a vaccine for Ebola was "technically more doable" than making one for other challenging and more widespread diseases such as TB, HIV and malaria, which receive more funding. "There's a lesson here," he said. "If we had invested in an Ebola vaccine, had it sitting there as the outbreak comes, you could have nipped it in the bud, been able to vaccinate the region where it started. What happened in Guinea was that it got out of control and spread. If you invest in having a relatively small amount of vaccine, available in the right place, as soon as anything happens, you could save huge amounts of money, not to mention lives."

In the wake of the outbreak, governments should now work with the pharmaceutical industry to push through development of vaccines against "outbreak diseases" such as Ebola, as well as Sars, Marburg and Chikungunya, Professor Hill said, with the goal of establishing stockpiles in vulnerable countries.

In a trial in primates infected with Ebola, a single dose of ChAd3 protected all 16 animals. The human trials involve 60 healthy Britons and 80 healthy people in Mali and the Gambia. GSK is already fast-tracking development of the vaccine and hopes to have 10,000 doses available by the end of the year. If proved safe and effective, it would be given to health workers in the Ebola-hit countries. Hundreds have died in the current outbreak, and many are now refusing to come to work.

An Association of the British Pharmaceutical Industry spokesman said the industry "has a long-standing and continuing commitment to fighting infectious diseases. The Ebola outbreak is a global issue and requires a global multi-stakeholder response which needs to include the issue of infection control. Collaboration with stakeholders in government and academia from across the world continues to be an integral aspect of the industry's approach."

We may, just may, have a vaccine by January. I hope to fuck we then go to exterminate it.

[Starglider]

I hope to fuck we then go to exterminate it.

Alas that may not be possible due to several bat specieis acting as viral resevoirs. Although given blanket vaccination we could get close, if we could convice people to stop eating bush meat, or at least wild bats.

[Zixinus]

"The problem with that is, even if you've got a way of making a vaccine, unless there's a big market, it's not worth the while of a mega-company …. There was no business case to make an Ebola vaccine for the people who needed it most: first because of the nature of the outbreak; second, the number of people likely to be affected was, until now, thought to be very small; and third, the fact that the people affected are in some of the poorest countries in the world and can't afford to pay for a new vaccine. It's a market failure."

No, this is a spectacular example of how "supply&demand" can actually operate: there is a significant deal of people that demand most emphatically but will not be supplied. There is demand but it is not enough demand for the supplier to consider it profitable.

[madd0ct0r]

In economics, market failure is when the allocation of goods and services by a free market is not efficient. That is, there exists another conceivable outcome where a market participant may be made better-off without making someone else worse-off. (The outcome is not Pareto optimal.) Market failures can be viewed as scenarios where individuals' pursuit of pure self-interest leads to results that are not efficient – that can be improved upon from the societal point of view.

instead, rich countries will have to spend a huge amount to get this under control before it starts to damage them. they will also loose out the benefits of trade with the poor countries that are economically devastated. everyone is worse off. market failure

[Irbis]

instead, rich countries will have to spend a huge amount to get this under control before it starts to damage them. they will also loose out the benefits of trade with the poor countries that are economically devastated. everyone is worse off. market failure

What failure? That's what you get when you treat healthcare as any other market good - poor can't afford it? Why fuck them, we're not the ones paying bills for outbreaks, taxpayer is. Now, what trendy, harmless pet disease cure people in the 1st world would pay for we should develop?

I saw the graph of tropical disease cures being developed in one of Ebola articles. It was telling - we hit the peak in 1950s, then it was all the way down to alternating 0/1. Back then, there was demand from colonial military units, and while army paid little you didn't refuse your own government. Of course, this was too commie approach to continue even in this limited form, just ask any free market televangelist and their 'private allocation of funds is 10.000% more efficient' gospel.

[Simon_Jester]

Well, there's another issue- the diseases that were successfully cured back then were mostly "low-hanging fruit." Most of the diseases that haven't already been cured are the ones that are harder to figure out, and require more investment of time and resources.

But, yes, this is a lovely example of how not bothering to spend money on things a corporation deems unprofitable can bite you in the ass down the line.

[PainRack]

There are how many diseases out there? And prior to this, just how important was Ebola as a epidemic?


If the argument was against Lassa fever, that might make more sense but it isn't, is it? The arguments was against TB, HIV and malaria......

Let's recap shall we?

in 2012, TB had 8.6 million people infected, and over 1 million died. The disease is increasingly antibiotic resistant, most especially in poor countries such as India. Over 95% of deaths occur in low to middle income country.
http://www.who.int/mediacentre/factsheets/fs104/en/

Is targeting a vaccine for this disease somehow pandering to the rich?

Malaria! Disease that's ravaging AFRICA as well. Estimated death toll, 600 thousand in 2012.
http://www.who.int/features/factfiles/malaria/en/

HIV is even more idiotic. Right now, the only effective treatment for HIV is only available to the rich. To the poor in Thailand, they rely on 'cheaper' generics, but emphasis on the word CHEAPER. And in Africia? They rely heavily on foreign aid to support HIV treatment programs.

Just how on earth is this stupid in the form of market economics AND morality?

Professor Hill has a point, that if we, read, the world had invested in an Ebola vaccine, they could had a stockpile able to target and stop outbreaks. That sounds like a good funding project and worthy of both private and government support. But moaning the failure of market economics in healthcare sounds like whining to me.

[Simon_Jester]

Well, Ebola and the lack of a vaccine stockpile for it is a market failure, one that has the potential to kill tens of thousands in Africa, maybe millions- with a slight chance of global pandemic if the disease spreads faster than vaccine production can ramp up.

But it is not purely a failure of EVIL BIG PHARMA, it also represents a failure by governments to adequately fund any kind of properly organized international body devoted to preventing international plague outbreaks, and so on.

[PainRack]

Simon, in a world of scarcity, we can't possibly be able to invest in every potential healthcare problem.

In this scenario, throwing more dollars and scarce biological science expertise into Ebola will mean a reduced capability elsewhere. It's not as if biology expertise is easily translatable. What a person knows about Ebola might.not know enough about Lassa

[Irbis]

Simon, in a world of scarcity, we can't possibly be able to invest in every potential healthcare problem.

And that's why much poorer world economy managed in 1950 to have 3 orders of magnitude more medicine research programs of equatorial diseases than today?

Equatorial, found only in poor countries, not things like Tuberculosis, found in rich countries, too.

In this scenario, throwing more dollars and scarce biological science expertise into Ebola will mean a reduced capability elsewhere.

Sure, cut pet diseases funding, for example. That's, what, hundreds to thousands of times more than spent on above?

No, seriously, EU and USA spend 22 billion dollars on pet healthcare in 2012. Entire Africa, with population larger than both of above combined, spends 2 to 3 digit million dollar sums on R&D of medicine, and that with big outside assistance. I guess Malaria victims aren't as marketable as kittens with cold or fever.

Here's a link of how we spent even R&D earmarked to human diseases. According to invisible hand of market, baldness in USA is more serious than all haemorrhagic fevers combined, globally, even including military funding:

http://www.vox.com/2014/8/4/5963751/the ... -you-think

[PainRack]

Except Professor Hill was comparing the difficulty of producing an Ebola vaccine vs HIV, TB and Malaria...all problems that plague the poor.

Right now, the complaint is that we lack a vaccine to a disease that was rare, affected relatively few people and didn't factor as a blip in most countries healthcare systems. It's definitely a good idea to allocate more resources into treating the unexpectedb outbreaks but this is a systematic failure of private and public funding .

[madd0ct0r]

It may not have been common, but we've all been sitting around for years saying how scary it is. An outbreak was inevitable.

Painrack, how is a systematic failure not a market failure?

[Zixinus]

Painrack, how is a systematic failure not a market failure?

Because it was not the market that failed, perhaps? I think the problem is the assumption that the market is supposed to somehow act with foresight on a collective behalf to its participants. The market does not act on the non-financial well-being of its participants. It reacts to what people pay for, either as individuals or as governments. The market only has as much foresight as the people that make decisions in it do.

The governments did anticipate the outbreak but did not prepare for it by specializing to that eventuality. Or contain the disaster to prevent it from escalating. That is the government's failure, not the market's. It is not a failure of economic policy but that of healthcare policy (or enforcement of that policy) of the countries involved.

Plus, the market is already acting: there is a vaccine in the works. It will be (optimistically) developed within a year. How fast is that in vaccine development again?

[Darmalus]

It may not have been common, but we've all been sitting around for years saying how scary it is. An outbreak was inevitable.

Just because something is scary doesn't mean it's important. Ebola is a horrible, icky way to die, but looking at that blog of Irbis', Ebola is so far down on that list that I would question the priorities of a government that WAS spending lots of time and effort solving it.

[madd0ct0r]

I wonder how far up that list it'll be by Jan? Not very high, but it might enter at current rates and if the who's estimate of real cases being 4x reported.


The thing is, like deaths in an earthquake, the outbreak deaths were avoidable. Like the earthquake we couldn't guess the exact timing and again, like an earthquake the consequences scale rapidly with urban growth. This has been pretty predictable that an outbreak of xthousands would happen this decade, and will happen again, worse. What's the lives saved per dollar ratio I wonder?

[PainRack]

It may not have been common, but we've all been sitting around for years saying how scary it is. An outbreak was inevitable.

Painrack, how is a systematic failure not a market failure?

From google.
An economic term that encompasses a situation where, in any given market, the quantity of a product demanded by consumers does not equate to the quantity supplied by suppliers. This is a direct result of a lack of certain economically ideal factors, which prevents equilibrium.

Remember that before Ebola broke out, the entire world, including said countries affected by Ebola were more busy demanding resources for other medical conditions. Malaria. AIDS. TB. These were all important diseases that were badly hurting countries such as Nigeria.

Insisting that these countries divert scarce medical resources away from treating other diseases on the scope, to treat a POTENTIAL problem when NOBODY is demanding it....... how is that a market failure?

Are markets now prescient? The Free Hand of the market knows all?


Now, we elect experts and leaders to help prepare for potential problems. However, given the scope of other diseases, again, Malaria, TB, AIDs, just how is it justifiable, to put scarce public dollars into creating a vaccine for Ebola?
May I remind everyone of the public fracas that emerged after various governments bought too much H1N1 vaccine just a few years back? Now, said countries, like Nigeria, were facing a AIDS epidemic as well as severe disease burden from other diseases like Malaria. This was what THEIR government was focused on reducing. Existing diseases that were killing civilians NOW. Not a potential outbreak. They weren't wealthy enough to spend money on solving potential problems.


Ah, but the Western world certainly could............ But where would the money and demand come from? Where were the customers? The only customers were non profit organisations, which again, were heavily focused on EXISTING problems in Africa. Not potential outbreaks.



Now, Professor Hill idea does have merit. We should consider funding a subsidiary branch like say the WHO to increase resources into treating potential outbreak as opposed to the current mechanicism of monitoring and detecting outbreaks, a fire prevention service so as to speak as opposed to our current firefighting approach but that's not the fault of companies, because there simply were no buyers back THEN. If we had used public money to create what Professor Hill suggest, THEN we can start blaming the free market for not catering to said customer.

[Tanasinn]

This is tangential to why I fucking hate the "DON'T WORRY THE FREE MARKET WILL FIX IT" approach to manned space travel, as well. Unless it's profitable enough quickly enough, the free market never fixes it.

Vaccines in particular are a losing prospect if they're expensive enough to research and develop. Who the hell wants to CURE a disease, you can't make money like that.

[Bedlam]

This is tangential to why I fucking hate the "DON'T WORRY THE FREE MARKET WILL FIX IT" approach to manned space travel, as well. Unless it's profitable enough quickly enough, the free market never fixes it.

Vaccines in particular are a losing prospect if they're expensive enough to research and develop. Who the hell wants to CURE a disease, you can't make money like that.

As long as the disease is wide spread enough and has a non human unimmunised vector then it can be very profitable. As long as everybody has to be vaccinated for ever you've got a captive market.

[madd0ct0r]

It may not have been common, but we've all been sitting around for years saying how scary it is. An outbreak was inevitable.

Painrack, how is a systematic failure not a market failure?

From google.
An economic term that encompasses a situation where, in any given market, the quantity of a product demanded by consumers does not equate to the quantity supplied by suppliers. This is a direct result of a lack of certain economically ideal factors, which prevents equilibrium.

Remember that before Ebola broke out, the entire world, including said countries affected by Ebola were more busy demanding resources for other medical conditions. Malaria. AIDS. TB. These were all important diseases that were badly hurting countries such as Nigeria.

Insisting that these countries divert scarce medical resources away from treating other diseases on the scope, to treat a POTENTIAL problem when NOBODY is demanding it....... how is that a market failure?

Are markets now prescient? The Free Hand of the market knows all?


Now, we elect experts and leaders to help prepare for potential problems. However, given the scope of other diseases, again, Malaria, TB, AIDs, just how is it justifiable, to put scarce public dollars into creating a vaccine for Ebola?
...
Now, Professor Hill idea does have merit. We should consider funding a subsidiary branch like say the WHO to increase resources into treating potential outbreak as opposed to the current mechanicism of monitoring and detecting outbreaks, a fire prevention service so as to speak as opposed to our current firefighting approach but that's not the fault of companies, because there simply were no buyers back THEN. If we had used public money to create what Professor Hill suggest, THEN we can start blaming the free market for not catering to said customer.

I think we're pretty close to agreement. The free market is just emergent behaviour. Agents participating in the free market can be prescient, it's why we tend to build power stations before the lights go out. As you said, that's the role of experts and leaders. In my previous posts I was pretty clear I blamed a lack of foresight on both sides. A drugs company, were they not beholden to short term shareholder interests could easily predict a large outbreak would create a market for a drug, and since the development speed is not quick, starting before the outbreak and having it on the books (or even better, being paid for vaccination work) would give them a huge lead on the competition. I also agree with you that funding a long horizon WHO department is probably the best way to create a stable market demand for such research.

At this very moment however, we have a huge unmet, yet reasonably predictable, market demand that the market cannot fulfil, and will be unable to fulfil for some time. By your own definition, that's a market failure.

[Irbis]

As long as the disease is wide spread enough and has a non human unimmunised vector then it can be very profitable. As long as everybody has to be vaccinated for ever you've got a captive market.

See, this is one utter failure of free market that should be obvious after a minute of reflection. A disease that either kills you horribly in 2 days or you're cured leaves no time for the patient to procure any significant funds. So, either you heal them for tiny amount of funds they have on hand, cure him for promise of later payment (which can argued to be duress and is very complicated from PR point of view) or let him die messily (even worse for PR). So, what you do?

What market would dictate as simplest and most efficient solution, do nothing, you might lose on some sales but don't waste money on R&D and don't lose sales to actually profitable people due to moral outrage. The infected die, who cares? You might even score extra PR points if you half-heartedly do half assed effort to produce some medicine, if someone dies after it, it was Ebola's fault and you're golden either way.

Remember that before Ebola broke out, the entire world, including said countries affected by Ebola were more busy demanding resources for other medical conditions. Malaria. AIDS. TB. These were all important diseases that were badly hurting countries such as Nigeria.

Tell me, do you think that if USA had rare, endemic disease striking only occasionally, but killing hundreds/thousands at each strike very messily, people would just shrug and focus on "more pressing issues"? Or would something be done with it, without waiting for benevolent market miracle?

They are more pressing issues only because funds that could solve the problem go instead on researching kitten butt balding - as kitten owners in first world can pay more than Africans do anyway. You might shift goalpost "but that's will of people" but that's bullshit. Someone choose to move resources from critical fields to trivial ones trying to chase limited purchasing money. They put an option frittering away funds on trivial matters on table, without which people could have spent it more responsibly, by choice their own or administrative one.

Call you what you want, progress, economic growth, choice, but if more common good could be made on not doing something, then system encouraging it is flawed by any sensible definition and should be changed. People found out that denying a few extra non-essential luxuries to improve lot of many was almost always better choice thousands of years ago, sadly through the eons people on receiving end of forced redistribution for the good of society had also the means to buy most skilled liars to try and convince the others the 1% hoarding all the goods is in fact proper way to go and there is nothing bad in it.

Insisting that these countries divert scarce medical resources away from treating other diseases on the scope, to treat a POTENTIAL problem when NOBODY is demanding it....... how is that a market failure?

Ah. So, we're finally getting somewhere. And just why their medical resources are scarce? Are they lazy, unwilling to just work harder, flips some burgers, get extra degrees? Or maybe, just maybe it has something to do with faults in the system?

Are markets now prescient? The Free Hand of the market knows all?

If not, maybe it would be better to look for something that is more accurate? A bit more along this line, and you will admit yourself IHoFM actually sucks.

Now, we elect experts and leaders to help prepare for potential problems. However, given the scope of other diseases, again, Malaria, TB, AIDs, just how is it justifiable, to put scarce public dollars into creating a vaccine for Ebola?

If moving them off malaria research is not justifiable, then maybe, just maybe society can look for a field where it is and move it from there. And frankly, it doesn't matter if it is kitten butt grooming, or something else, there are thousands of completely superfluous services vaccuming money in, creating just excess fat, that don't add in any way to public good and could be axed for something that does.

May I remind everyone of the public fracas that emerged after various governments bought too much H1N1 vaccine just a few years back?

Poland did not. Here, have a link:

http://www.flu-treatments.com/h1n1_vaccine.html

You know why? Because our experts didn't listen to siren song of big pharma and actually did think on what would be most sensible resource allocation, axing useless, superfluous spending.

And guess what? It worked! Not our dear hand of market, but an expert telling salesmen to shove it and do something useful instead!

[cosmicalstorm]

Envisaging a World Without the FDA
Permalink | View Comments (20) | Post Comment | Share | Posted by Reason

Incentives matter in all areas of human endeavor. When people gather to develop and deploy new medicines, for example, they are more incentized by the prospect of personal gains - reputation, profit, feeling good by doing good, and so forth - than by the benefits brought to people they have never met. This is simple, hardwired human behavior. Exceptions are few and far between.

That we instinctively work to improve our own lot first is why progress for all happens so much faster in free, open marketplaces under the rule of law. There, everyone can trade to make themselves better off: specialization and comparative advantage means that trade benefits both sides. Trade is not zero-sum; we grow the whole pie by specializing and trading the results of our work. You go off and work to make the medicine I want, and many people like myself give some our our resources to purchase the end result. Both sides benefit, exchanging - what is for them - lesser value to receive greater value.

There is no open marketplace for medical technology in the developed world, however. Instead, we see a very different set of incentives dominating the state of research and development. Regulatory bodies like the FDA have every incentive to stop the release of new medicine: the government employees involved suffer far more from bad press for an approved medical technology than they do from the largely unexamined consequences of heavy regulation. These consequences go far beyond the obvious and announced disapproval of specific medical technologies: the far greater cost lies in all the research, innovation and development that was never undertaken because regulatory burdens ensure there would be no profit for the developer. Personal gain for the regulator is thus to destroy the gains of people they will never meet, the exact opposite of what occurs in an open marketplace.

An article that looks at one small part of the destruction caused by the FDA caught my attention, and particularly these snippets:

Quote:
Since 2005 the FDA has approved 18 new cancer drugs, many of them breakthrough products. But the pipeline contains hundreds more that will never get to market because corporate developers aren't able, or willing, to come up with the money, time, and patients necessary to establish acceptable data.

...

The clinical trial process now is a three-part, years-long effort that effectively kills off all but a handful of once-promising drugs.

...

It would have been the first new drug for prostate cancer in 20 years

Twenty years! Just stop a moment and think about how far and fast biotechnology and medical science has moved in the past twenty years. Think about what the far less regulated computing industry has achieved in the same timeframe. We live in the early years of the biotechnology revolution, with something amazing and new demonstrated in laboratories every week. Yet the dominant regulatory body for one of the most advanced regions of the world has managed to stop the clock at 1988 for a major disease, the subject of research in a hundred laboratories worldwide.

This sitation exists in every field of medicine, and all participants labor under the crushing burdens imposed by regulators incentivized to stop progress from happening. The same will be true of the future of longevity medicine, unless we do something about it.

The insanity of this all is quite staggering - that people largely accept and defend the need for regulation that achieves this sort of result, that is. I have heard it said that the failure of libertarianism, of the urge to freedom and personal responsibility, is a failure of imagination on the part of those who have been brought up knowing nothing other than government and regulation on a massive scale. The majority cannot make the leap to see an unregulated marketplace for medical development that works in the same way as the unregulated marketplace for computers - enormous choice, low barriers to innovation, efficiency and low cost, competing review organizations, accountable sellers, rapid progress and responsiveness to customers driven by fierce competition, and so forth.

What is, is, and to propose another way is already an uphill battle regardless of merits. That is also hardwired into the human condition. But the present dismal state of affairs must be changed if we are to see the defeat of degenerative aging in our lifetime - nothing short of a revolution is called for, given just how far in the hole we find ourselves. The technologies needed to repair aging will take only a few decades to develop, and indeed some already exist in prototype, but the present regulatory burden placed upon medical technology will ensure we are all dead and buried, that wondrous potential squandered.

https://www.fightaging.org/archives/200 ... he-fda.php

[madd0ct0r]

corporate developers aren't able, or willing, to come up with the money, time, and patients necessary to establish acceptable data.

of course, without the need to establish acceptable data, it would be much much much cheaper to sell people sugar pills and invest in marketing instead. Take the current field of 'fitness aids' as an example.

[Simon_Jester]

Well, the real problem is that almost no one living today remembers thalidomide, or before that the days when "drugstores" carried cases upon cases of patent medicines that had zero effect on actual illnesses. Or did have an effect, but only because they were like 90% opium and cocaine by weight.

Basically, the problem is that the only way to make a corporation engage in meaningful research is to give them literally no other option if they want their product to function. Research is expensive, return on investment questionable, and you don't get the payoffs for decades, so it's like the exact opposite of what most modern corporate executives want to do if they get a choice.

[Welf]

An article that looks at one small part of the destruction caused by the FDA caught my attention, and particularly these snippets:

Quote:
Since 2005 the FDA has approved 18 new cancer drugs, many of them breakthrough products. But the pipeline contains hundreds more that will never get to market because corporate developers aren't able, or willing, to come up with the money, time, and patients necessary to establish acceptable data.

...

The clinical trial process now is a three-part, years-long effort that effectively kills off all but a handful of once-promising drugs.

Sometimes you just need to look at a few sentences and know something is crap. There's a reason there are so many promising drugs are not approved. First, because marketing hypes them up to keep shareholders happy. Second because they don't work. Also, if the companies are not able to produce satisfying data you have to wonder how they know it works.

[Irbis]

of course, without the need to establish acceptable data, it would be much much much cheaper to sell people sugar pills and invest in marketing instead. Take the current field of 'fitness aids' as an example.

Yes. Proposing to abolish tests if the medicine works is pure idiocy. Not only because it might not work, but also because most medicines can be harmful if not taken in correct way. Or, sometimes are harmful regardless:

http://healthimpactnews.com/2014/700-li ... st-pfizer/

That was first example from last 3 months. Pfizer knowingly sold something they knew to be harmful in long term, just because they profited massively on it. And it caused "just" diabetes, what about the company that released embryo damaging medicine then lobbied to keep it hush-hush?

http://www.drugwatch.com/depakote/

Only really brain dead libertarians would want to turn all of medicine into this, just because they think some poor billionaire might suffer due to his ability to sell potentially disastrous product being slightly limited

***

Also, upon thinking on PainRack post a bit more: the problem with saying free market works in healthcare is the same we had with environmental regulations 80 years ago - companies get to keep all the profits because pollution damage was "free" to them, no one was held accountable for damage they caused. This eventually got so bad that a host of regulations was passed, even if in some places they fall woefully short.

If you wanted to have free market system that doesn't push people off the wagon the moment they can't pay, how about doing the same to pharmaceutical companies? Sure, you get to keep all the profits, we will also give you nice fat subsidy from public funds (as everyone would agree keeping society healthy is worthy goal) but at the same time, companies would be fined for every possibly preventable death (not hopeless cases) to give them market impulse to actually improve. Not just come up with a ways like diet supplements and repackaged aspirin to increase profits, but actually focusing on worthwhile research.

Of course, that's just still putting a small plaster on a gaping wound, but at least conservatives would get to keep their holy cow and sometimes actual lives could be saved before increasing profits.