If you want to actually understand what would happen in such a case, it makes sense to look at empirical reality.
When it comes to nutritional supplements we frequently see independent labs testing supplements that are sold and finding that those supplements don’t contain what the manufacturer claims. Most people neither understand that this is the case nor are willing to pay for information about supplement testing.
People are much more likely to take a supplement because an influencer recommended it than because it had a good review on ConsumerLab.
Doctor review websites also seem to be currently ill-equipped to actually say more than whether or not a doctor is friendly to his patients. Patients generally don’t consume the available data about outcomes for medical interventions by different doctors.
Similarly, CVS currently sells homeopathic ‘medicine’, marketed exactly as if it were real medicine. https://www.cvs.com/shop/content/homeopathic-remedies If you didn’t know what “homeopathic” meant, could you tell that these were fake medicines? They say things like “The ONLY clinically proven cold shortening nasal swab” on them. I think some of these might also contain real medicine at normal doses, but I frankly can’t tell for certain. So why do we expect CVS to become more benevolent when all the regulations are gone than it currently is?
It makes sense to update on supplement actually containing what they claim they contain
The information landscape is very bad and reading newspaper articles does not allow a normal person to understand whether or not claims about what supplements contain are true or false. Marketing from the review companies further muddies the information landscape so that a lot of people who think they know what’s going on don’t
One very interesting tale of a regulation failure was the Ranbaxy saga. The FDA already was pretty bad at the case, but it shows the kind of problems that a regulatory agency is supposed to solve.
There is one other important difference between drugs (as currently regulated) and supplements: insurance doesn’t pay for supplements. Insurance companies today frequently refuse to pay for drugs they claim are ineffective or unnecessary. While they typically rely on FDA recommendations, privately controlled pharmacy benefit managers set criteria which can differ from the FDA’s. Insurance companies have an incentive to find reasons to refuse to pay for some, but not all, drugs, and deciding based on whether the drug is actually useful is a Schelling point. Big insurers and PBMs could conceivably afford to test new drugs, if sufficiently motivated.[1] To be sure, there are numerous opportunities for companies to profit by lying, colluding, and making decisions that are less than medically sound, but the market is still far from unregulated even without the FDA.
This isn’t to say unscrupulous drugmakers won’t market useless or dangerous products directly to consumers—of course they will. Nothing stops a manufacturer from releasing completely untested drugs onto the market and then waiting for someone else to study them. Any controls would have to move farther up the food chain. A big pharmaceutical company that doesn’t want to get its hands dirty could buy the rights to a new drug once it starts to gain acceptance.
Assuming drugs cannot be evaluated by some other reputable group. In the event the FDA is abolished, I expect regulatory requirements for drug approval would persist in other countries, and any interested party could benefit from the information, so most insurance companies likely would not do their own testing.
I think there are arguments you can make a system without the FDA would still work. This particular post however additionally makes predictions about how the resulting system would look like that I find unlikely.
If you want to actually understand what would happen in such a case, it makes sense to look at empirical reality.
When it comes to nutritional supplements we frequently see independent labs testing supplements that are sold and finding that those supplements don’t contain what the manufacturer claims. Most people neither understand that this is the case nor are willing to pay for information about supplement testing.
People are much more likely to take a supplement because an influencer recommended it than because it had a good review on ConsumerLab.
Doctor review websites also seem to be currently ill-equipped to actually say more than whether or not a doctor is friendly to his patients. Patients generally don’t consume the available data about outcomes for medical interventions by different doctors.
Similarly, CVS currently sells homeopathic ‘medicine’, marketed exactly as if it were real medicine. https://www.cvs.com/shop/content/homeopathic-remedies If you didn’t know what “homeopathic” meant, could you tell that these were fake medicines? They say things like “The ONLY clinically proven cold shortening nasal swab” on them. I think some of these might also contain real medicine at normal doses, but I frankly can’t tell for certain. So why do we expect CVS to become more benevolent when all the regulations are gone than it currently is?
https://astralcodexten.substack.com/p/how-trustworthy-are-supplements discusses supplements and concludes the issue is nowhere near as bad as claimed.
There are two main issues here:
It makes sense to update on supplement actually containing what they claim they contain
The information landscape is very bad and reading newspaper articles does not allow a normal person to understand whether or not claims about what supplements contain are true or false. Marketing from the review companies further muddies the information landscape so that a lot of people who think they know what’s going on don’t
One very interesting tale of a regulation failure was the Ranbaxy saga. The FDA already was pretty bad at the case, but it shows the kind of problems that a regulatory agency is supposed to solve.
There is one other important difference between drugs (as currently regulated) and supplements: insurance doesn’t pay for supplements. Insurance companies today frequently refuse to pay for drugs they claim are ineffective or unnecessary. While they typically rely on FDA recommendations, privately controlled pharmacy benefit managers set criteria which can differ from the FDA’s. Insurance companies have an incentive to find reasons to refuse to pay for some, but not all, drugs, and deciding based on whether the drug is actually useful is a Schelling point. Big insurers and PBMs could conceivably afford to test new drugs, if sufficiently motivated.[1] To be sure, there are numerous opportunities for companies to profit by lying, colluding, and making decisions that are less than medically sound, but the market is still far from unregulated even without the FDA.
This isn’t to say unscrupulous drugmakers won’t market useless or dangerous products directly to consumers—of course they will. Nothing stops a manufacturer from releasing completely untested drugs onto the market and then waiting for someone else to study them. Any controls would have to move farther up the food chain. A big pharmaceutical company that doesn’t want to get its hands dirty could buy the rights to a new drug once it starts to gain acceptance.
Assuming drugs cannot be evaluated by some other reputable group. In the event the FDA is abolished, I expect regulatory requirements for drug approval would persist in other countries, and any interested party could benefit from the information, so most insurance companies likely would not do their own testing.
I think there are arguments you can make a system without the FDA would still work. This particular post however additionally makes predictions about how the resulting system would look like that I find unlikely.