Via Unfogged via Jim Henley comes an extremely interesting feature in New York Magazine about how NYC businesses make their money. You can see the markup on fish at Nobu, how dollar stores stay in business and how to get into the fast-paced and exciting crystal meth industry.

But this is the most arresting of the slides. You know, I've been reading Derek Lowe's excellent blog for a while now — he's a chemist working in the pharmaceutical industry, and provides fascinating looks at how the industry works on a regular basis. Unsurprisingly, he's more sympathetic to the drug companies than the average American. And he does a good job of convincing readers that these corporations aren't the merciless profit engines that we all imagine them to be. He's got me at least partially convinced — I stand ready with Lowe-penned rebuttals to arguments about universities doing all the drug discovery work, and a sense of pity for those poor executives who are stuck with astoundingly large bills for clinical trials. What else can they do, though, but stalwartly defend the public's health?

But the NY Magazine graphic undercuts all that. Everyone knows that drug companies spend huge amounts of money on marketing. I hadn't realized that the amount dwarfs the cost of trials, though.

And, having just read Sunday's article about doctors continuing to receive payments for research, speaking and trials even after public disgraces, I'm left even less sympathetic. Lowe blogged about it and also didn't come away happy. I agree with him that it's unlikely that drug companies are selecting for incompetent doctors. But the fact that they're paying even the bad ones implies that a large proportion of that "marketing and sales" budget goes to shoveling money at every doctor in sight. Presumably this is done to generally shift prescribing habits toward particular companies' medications — or at least to avoid falling out of favor when some other company's busty new sales rep comes by with promotional scrip pads and promises of golf junkets.

After all, that immense promotional budget couldn't all go toward commercials of newly-continent men toasting each other with water, could it? The evening news/Wheel of Fortune block simply doesn't have that much ad inventory.

I wonder whether this is the sort of thing that universal health care is supposed to solve. Maybe my wiser friends can clue me in. I can imagine a plan with a formulary making these sorts of payouts pointless. But it seems like it'd have to be a pretty strict formulary — probably stricter than would be medically wise.

Anyway, I'm not entirely sure why I'm blogging this. My best guess is that Ezra emits some sort of electromagnetic field that makes people interested in healthcare. I'm sure it'll wear off soon.