13 ms·

2,000% price hike for infant seizure drug called 'absurd'

66 points by cordite 11y ago

rm_-rf_slash 11y ago
I don't know much about pharmaceutical policy, but I have an idea. I would like to have it torn to shreds if it means we can have an idea of a more equitable process of creating medicine. What if, in a single payer model, a resesrching entity that creates a new treatment which is in turn approved by the government, automatically forfeits any rights to the drug, but is guaranteed royalties for 20 years or so? Manufacturers don't have any limits on what they may or may not create, but there is a minimum price at which the government will pay for it, similar to the "cost+profit" model seen in the defense industry. Likewise, the obscure cheap drugs that get abandoned then have the rights purchased by sociopathic hedge fund managers would instead be manufactured by the state and sold at cost. Is that so crazy?
- deleted 11y ago
  [deleted]
- whistlecrackers 11y ago
  Yes. A free market is a solution. Naturally regulated markets satisfy customer demands at the lowest cost when compared to the results any other system.
  - eropple 11y ago
    And people die needlessly because they can't pay. Are we not better than that?
    - bravo 11y ago
      You could apply that to so many things. It's just an appeal to emotion. People also needlessly lack education because they can't pay, but we'd be fucked if the government jumped to guarantee more loans and grants.
      - eropple 11y ago
        If you were begging the question any harder, you'd be one of the people tech guys hate on in the Tenderloin. And at the same time you're teetering on the edge of an epiphany that strikes at the heart of techno-fetishistic free-market worship. Because the government guaranteeing loans and grants isn't a good way to provide education, no--but plenty of countries make education a state function and charge a very manageable amount, if anything at all, to students, while making the total cost of operation remarkably reasonable.
        bravo 11y ago
        I don't understand - are you saying I was wrong? If so please tell me why or recommend me some reading. I do know that other countries are able state-fund education, but I don't concretely know why they're different. I just assumed that "jumping to guarantee more loans" is an obviously bad idea.
  - Oletros 11y ago
    > Naturally regulated markets satisfy customer demands at the lowest cost when compared to the results any other system Do we have any study about that claim?
  - wamatt 11y ago
    Comcast and Ticketmaster execs would heartily agree with that opinion
    - mumumuyou2 11y ago
      You think Comcast likes the competition from a slew of telecoms, Google, and DirecTV?
  - beagle3 11y ago
    Free markets are good a at lot of things, but staying free is not one of them. (Similarly for a democracy, by the way). A "naturally" regulated market eventually converges into one all-powerful monopoly player - it's a stable configuration that maximizes the profit for the owners of that monopoly. So you have to regulate this "freedom" away from disappearing - in the same way that GPL regulates BSD freedom away from disappearing.
    - mumumuyou2 11y ago
      Coca Cola has been around for 129 years. How many centuries does this process take?
      - beagle3 11y ago
        Coca Cola is a luxury item. If they raise the price too much, no one will buy it, and that puts an upper limit to the price (and makes consolidation less profitable). And it still may happen if not for antitrust - I'm sure a combined RCPepsiCoca Cola company will be more profitable than three independent ones. The only reason DataPrim price could be hiked was that the people who need it will actually pay for it. Same with ACTH. A captive audience is a wonderful thing -- something Coca Cola would love but doesn't have. There were ~100 car manufacturers 100 years ago, how many are there now? (And cars are not as essential as ACTH) There were tens to hundreds of media companies up until the 1980's. Now, there are essentially six[0]. And if antitrust didn't matter, there would probably be less. Similar things are happening in pharma[0]. It is one aspect of capitalism that's to blame: "free market". If you monopolies are legal (and in a totally free market, they are), then you will get monopolies because they are more effective at extracting rent than competition. we've just seen this happen twice in the pharma market. [0] https://en.wikipedia.org/wiki/Media_cross-ownership_in_the_United_States https://en.wikipedia.org/wiki/Media_cross-ownership_in_the_U... [1] http://www.ft.com/cms/s/0/6aad8ebe-e9c0-11e4-b863-00144feab7de.html http://www.ft.com/cms/s/0/6aad8ebe-e9c0-11e4-b863-00144feab7...
      - pixl97 11y ago
        Are you saying Coca Cola is not attempting to get a soft drink monopoly? You should be a convenience store owner and see both the battle between them and Pepsi and the demands they put on their customers for preferred pricing.
  - JamesBarney 11y ago
    Healthcare and pharmaceuticals are not even in the ball park of a normal free market. 1. Monopolies - We give monopolies to pharmaceutical companies to incentivize R&D. 2. Principal-Agent problem - Doctors guide, and make decisions about care for consumers. But However consumers of health care have different incentives than doctors. 3. Insurance - Most individuals are relatively shielded from the costs of their healthcare. 4. Public Good - Many people want to live in a society where people do not die from easily treatable conditions. So yes a free markets is always the optimal solution given a certain set of assumptions. Unfortunately very few of these assumptions are true in healthcare.
  - collyw 11y ago
    Disproven by privatisation of the UK rail industry. I think it's the most expensive in Europe, certainly close. Oh, and the European healthcare systems.
  - dragonwriter 11y ago
    > Naturally regulated markets There is no such thing. "Free markets" presume both particular context (which is not present in any real state, though it can sometimes be approximated) and particular artificial regulation (particular, particular constructions of property rights.) The idea that "naturally regulated markets" is a meaningful concept (much less a meaningful concept with some correspondence with "free markets") is absurd on its face.
  - jbssm 11y ago
    All nice and dandy in theory, clearly disproven by practice. Heath costs and medicine costs in Europe and Canada are lower than in the USA.
josteink 11y ago
Hopefully more incidents like this will prompt people to question whether granting patents are actually useful to society or not. Patents are after all an artificial (and supposedly temporary) monopoly enforced by society on behalf of a private entity, because society deems the value of this protection will create something beneficial to society as large. Using patents to bump prices of existing, already profitable medicines hardly seems what patents were made for.
- danielahn 11y ago
  There is no patent on the drug.
  - blucoat 11y ago
    This is what confuses me, so maybe someone with a better understanding of this market works can elaborate. How is it that the drug is not patented but the manufacturer has the exclusive right to sell it? It blows my mind that one company can overnight make such a huge change and there is no competitor to turn to.
    - danielahn 11y ago
      I am several steps removed from the industry but to my knowledge - There is still a regulatory approval process to be able to manufacture the drug - so the cost and time required to receive this approval, then to market the drug as a generic alternative to the existing drug to a market that often doesn't see itself as the ultimate payor (ie. the consumer thinks the insurance companies / government are paying) and may prefer known names, and the original manufacturer's ability to then lower the price of the drug all combine to push away competition on low volume drugs like this one.
    - dzeanah 11y ago
      According to a CNBC interview last week the product is protected via trade secrets. People know what's in it, but not how to make it. And it's some weird stuff (I think pituitary glands from pigs or something equally weird are key components - not sure there's a lot of open-source knowledge on how to deal with that ingredient pipeline.) The CEO's pitch was that they believe the drug is useful in more roles than it's currently used for, so they're taking the increased money to perform the studies required to allow the drug to be used to treat more diseases for which there is no alternative. And right now this is a last-ditch drug - it's used once all other therapies have failed. So they're trying to increase marketshare by doing expensive studies, which is why this drug is still produced and where the money is going. At least according to the CEO, and my memory.
rtl49 11y ago
Without more information, I think the indignant tone and format of this article are unwarranted. Before we learn anything, we hear about the human toll: innocent babies will die, parents are distraught, and doctors are furious. But we're provided with no clear information on the reason for the price increase. "When Mallinckrodt acquired Questcor in 2014, Synacthen Depot was one of the products in the portfolio. It was losing money then and still is. Moreover, in the spring of 2014, Mallinckrodt was told by the existing supplier of the product that they would cease production in early 2016," a Mallinckrodt spokesman said in an email to CBC News. So the company faced an unexpected reduction in supply, and the drug might have been unprofitable at the previous price. One can object to the fact that the means of pharmaceutical production are privately owned, but given that these are not currently non-profit institutions, the outrage seems misplaced. There's nothing "absurd" about it. Edit: I'd like to address some of the commenters, who seem to have misinterpreted my comment as a defense of this company, or the pharmaceutical industry in general. This comment is an objection to the style of journalism in this article: light on information, heavy on emotion. I've said nothing in defense of the corporation. Some have suggested that these corporations should not increase prices in order to uphold some set of moral principles. I take it for granted that corporations are only answerable to power, and any limitations you might wish to impose upon them must either take the form of collective action (boycotts/protests) or regulation. Perhaps motivating either of these was the intent of the article, but if so the author went about expressing this wish in a way that I find objectionable, by appealing to emotion rather than reason and disguising an ideological belief as factual reporting.
- ubersync 11y ago
  Yes, but the fact that Martin Shkreli wanted to buy the rights for this drug makes me think there is somewhere a list of potential drugs that can be exploited in this way, and multiple companies are bidding for them.
  - rtl49 11y ago
    Well, I certainly wouldn't expect a business executive to invest in a drug he suspects will be unprofitable. That aside, if the drug is unprofitable, and society has established as a general principle that the private sector is the appropriate venue for drug manufacturing, then I don't understand the objection to a price increase in principle. Without more information, we just don't know that this is an instance of price gouging. I'm open to that possibility, but I suggest waiting for actual evidence before taking your pitchfork out of the shed.
trhway 11y ago
>The price was so high that Alberta delisted it in July, and government chickens out and fails to protect its citizens. The government has the power to treat it for example as public utility and negotiate the price based on that premise.
jostmey 11y ago
Quote: "The drug is long off patent." So why not order the drug from China or India? Is the drug expensive to manufacture? Or is it that the Canadian government will only order the drug from select countries? I wish the article dug a little deeper.
- imgabe 11y ago
  There may be requirements to purchase the drug from manufacturers that comply with government regulated quality controls. Not that someone who really needs the drug couldn't seek out an online source to get it cheaply from overseas, but doctors may not be able to legally prescribe it from those places. I don't have any knowledge on the subject though, just speculating. At least in the US buying directly from overseas pharmacies seems to be more or less illegal.
  - mgkimsal 11y ago
    "doctors may not be able to legally prescribe it from those places." We just get a prescription and have it filled wherever's cheapest. It's not up to the doctor to say where it can be filled...
    - imgabe 11y ago
      It may be illegal for pharmacies operating in Canada to buy from those manufacturers then, I don't know. I'm just saying there are possible additional risks with buying drugs of unknown provenance. It's not necessarily as simple as "just buy it from China or India".
- mumumuyou2 11y ago
  http://slatestarcodex.com/2015/09/24/the-problems-with-generic-medications-go-deeper-than-one-company/ http://slatestarcodex.com/2015/09/24/the-problems-with-gener...
- Cass 11y ago
  A coworker who worked as a doctor in Afghanistan and Myanmar for about a year told me that a third of the medications they had in the hospital, and two thirds of the medications you could purchase in pharmacies contained no active ingredient. People kept dying on him because an antibiotic would randomly do nothing, or lysis medication turned out to consist of colored NaCl. He said that most of those medications were delivered from China and India because of the low prices in those countries. This is anecdata, obviously, but I'd be very careful purchasing drugs from countries with low oversight. Fake drugs are an enormously profitable market. I also like this quote from a New York Times article: “If I have to follow U.S. standards in inspecting facilities supplying to the Indian market,” G. N. Singh, India’s top drug regulator, said in a recent interview with an Indian newspaper, “we will have to shut almost all of those.” The unease culminated Tuesday when a top executive at Ranbaxy — which has repeatedly been caught lying to the F.D.A. and found to have conditions such as flies “too numerous to count” in critical plant areas — pleaded with Dr. Hamburg at a private meeting with other drug executives to allow his products into the United States so that the company could more easily pay for fixes. She politely declined. http://www.nytimes.com/2014/02/15/world/asia/medicines-made-in-india-set-off-safety-worries.html?_r=1 http://www.nytimes.com/2014/02/15/world/asia/medicines-made-...
pja 11y ago
Scott Alexander wrote a whole article on the difficulties in bringing competitors to out of patent drugs to the US market: http://slatestarcodex.com/2015/09/24/the-problems-with-generic-medications-go-deeper-than-one-company/ http://slatestarcodex.com/2015/09/24/the-problems-with-gener...
forrestthewoods 11y ago
What's the answer here? Should the government pay for manufacturing of generic drugs that are non-profitable but "essential"? Let the tax payers eat the cost of such drugs? There's more than a few like that. I believe snake venom antidotes are often on such lists. (note: I did specify generic drugs. Not drugs still under patent exclusivity windows. Which is a valid but separate discussion.)
beagle3 11y ago
This is pure capitalism in action, and an important datum about what happens in free markets. [see edit below] Questcor is cornering the market - this has nothing to do with research or availability. In 2012, they acquired the manufacturing of the pig-pituary-gland version of this drug, called "HP Acthar Gel"[0], and hiked the price from $50 to $28,000 per vial. In June 2014, they acquired the synthetic version called "Synacthen Depot" and modestly hiked it by just 2000%. The generic term naming both is ACTH, which is cleverly (?) disguised inside both names. This is greed, plain and simple - now that Questcor owns the market, they can name any price they want, or the infantile spasm kids suffer greatly (die, or suffer developmental problems of all sorts including retardation). There are other diseases treated with ACTH, and dropping treatment due to cost has effects almost as severe. Show me the parent who would let their baby die or become retarded because the price was hiked. That's an example of what any completely free market will converge to. [0] http://www.nytimes.com/2012/12/30/business/questcor-finds-profit-for-acthar-drug-at-28000-a-vial.html http://www.nytimes.com/2012/12/30/business/questcor-finds-pr... edit: I stand corrected in my use of "pure capitalism" - government regulation makes it very much not pure capitalism. But the monopolizing of production that we see here is a real-world result of capitalism (pure or impure) - the assumption that "if there's money to be made, some other entity will rise to the challenge" is not supported by evidence in small markets (such as ACTH). If it weren't, there would be no need for antitrust laws.
- narrator 11y ago
  This isn't pure capitalism. This is a result of what Mises called "license monopoly". See "The Monopolized Commodity" under https://mises.org/library/monopoly-prices https://mises.org/library/monopoly-prices for more discussion of this. "Under monopoly, a greater part of the specific factors of production concerned will remain unused. The common feature of all instances of monopoly prices is that part of the supply, which under competitive conditions would have been offered on the market, is withheld from the market. The most spectacular and objectionable instance of this withholding is the purposeful destruction of the commodities concerned. It happened mostly with consumers’ goods (e.g., coffee) but sometimes also with factors of production." There are other sources of this drug, notably foreign production, but they don't have the proper licensing. Thus you get a license monopoly. There are a lot of drugs developed overseas that are effective but they are unknown in the U.S market because they are not approved by the proper license monopoly granter. Under pure capitalism, these products would be allowed on the market and independent rating agencies would ensure their quality.
deleted 11y ago
[deleted]
scoot 11y ago
"2,000% price hike" is a link-bait headline. Not to excuse the hike, but lets call it what it is - a 20 times increase. Any use of percentages over double-digits is asking for confusion. And using a four-digit percentage is intentionally misrepresenting the scale of the increase.
T3RMINATED 11y ago
American Medicine is worse than ISIS Terrorism
emergentcypher 11y ago
I'd like to know why people would consider giving their children a drug named Absurd in the first place!

66 points by cordite 11y ago

I don't know much about pharmaceutical policy, but I have an idea. I would like to have it torn to shreds if it means we can have an idea of a more equitable process of creating medicine. What if, in a single payer model, a resesrching entity that creates a new treatment which is in turn approved by the government, automatically forfeits any rights to the drug, but is guaranteed royalties for 20 years or so? Manufacturers don't have any limits on what they may or may not create, but there is a minimum price at which the government will pay for it, similar to the "cost+profit" model seen in the defense industry. Likewise, the obscure cheap drugs that get abandoned then have the rights purchased by sociopathic hedge fund managers would instead be manufactured by the state and sold at cost. Is that so crazy?

deleted 11y ago
[deleted]
whistlecrackers 11y ago
Yes. A free market is a solution. Naturally regulated markets satisfy customer demands at the lowest cost when compared to the results any other system.
- eropple 11y ago
  And people die needlessly because they can't pay. Are we not better than that?
  - bravo 11y ago
    You could apply that to so many things. It's just an appeal to emotion. People also needlessly lack education because they can't pay, but we'd be fucked if the government jumped to guarantee more loans and grants.
    - eropple 11y ago
      If you were begging the question any harder, you'd be one of the people tech guys hate on in the Tenderloin. And at the same time you're teetering on the edge of an epiphany that strikes at the heart of techno-fetishistic free-market worship. Because the government guaranteeing loans and grants isn't a good way to provide education, no--but plenty of countries make education a state function and charge a very manageable amount, if anything at all, to students, while making the total cost of operation remarkably reasonable.
      - bravo 11y ago
        I don't understand - are you saying I was wrong? If so please tell me why or recommend me some reading. I do know that other countries are able state-fund education, but I don't concretely know why they're different. I just assumed that "jumping to guarantee more loans" is an obviously bad idea.
- Oletros 11y ago
  > Naturally regulated markets satisfy customer demands at the lowest cost when compared to the results any other system Do we have any study about that claim?
- wamatt 11y ago
  Comcast and Ticketmaster execs would heartily agree with that opinion
  - mumumuyou2 11y ago
    You think Comcast likes the competition from a slew of telecoms, Google, and DirecTV?
- beagle3 11y ago
  Free markets are good a at lot of things, but staying free is not one of them. (Similarly for a democracy, by the way). A "naturally" regulated market eventually converges into one all-powerful monopoly player - it's a stable configuration that maximizes the profit for the owners of that monopoly. So you have to regulate this "freedom" away from disappearing - in the same way that GPL regulates BSD freedom away from disappearing.
  - mumumuyou2 11y ago
    Coca Cola has been around for 129 years. How many centuries does this process take?
    - beagle3 11y ago
      Coca Cola is a luxury item. If they raise the price too much, no one will buy it, and that puts an upper limit to the price (and makes consolidation less profitable). And it still may happen if not for antitrust - I'm sure a combined RCPepsiCoca Cola company will be more profitable than three independent ones. The only reason DataPrim price could be hiked was that the people who need it will actually pay for it. Same with ACTH. A captive audience is a wonderful thing -- something Coca Cola would love but doesn't have. There were ~100 car manufacturers 100 years ago, how many are there now? (And cars are not as essential as ACTH) There were tens to hundreds of media companies up until the 1980's. Now, there are essentially six[0]. And if antitrust didn't matter, there would probably be less. Similar things are happening in pharma[0]. It is one aspect of capitalism that's to blame: "free market". If you monopolies are legal (and in a totally free market, they are), then you will get monopolies because they are more effective at extracting rent than competition. we've just seen this happen twice in the pharma market. [0] https://en.wikipedia.org/wiki/Media_cross-ownership_in_the_United_States https://en.wikipedia.org/wiki/Media_cross-ownership_in_the_U... [1] http://www.ft.com/cms/s/0/6aad8ebe-e9c0-11e4-b863-00144feab7de.html http://www.ft.com/cms/s/0/6aad8ebe-e9c0-11e4-b863-00144feab7...
    - pixl97 11y ago
      Are you saying Coca Cola is not attempting to get a soft drink monopoly? You should be a convenience store owner and see both the battle between them and Pepsi and the demands they put on their customers for preferred pricing.
- JamesBarney 11y ago
  Healthcare and pharmaceuticals are not even in the ball park of a normal free market. 1. Monopolies - We give monopolies to pharmaceutical companies to incentivize R&D. 2. Principal-Agent problem - Doctors guide, and make decisions about care for consumers. But However consumers of health care have different incentives than doctors. 3. Insurance - Most individuals are relatively shielded from the costs of their healthcare. 4. Public Good - Many people want to live in a society where people do not die from easily treatable conditions. So yes a free markets is always the optimal solution given a certain set of assumptions. Unfortunately very few of these assumptions are true in healthcare.
- collyw 11y ago
  Disproven by privatisation of the UK rail industry. I think it's the most expensive in Europe, certainly close. Oh, and the European healthcare systems.
- dragonwriter 11y ago
  > Naturally regulated markets There is no such thing. "Free markets" presume both particular context (which is not present in any real state, though it can sometimes be approximated) and particular artificial regulation (particular, particular constructions of property rights.) The idea that "naturally regulated markets" is a meaningful concept (much less a meaningful concept with some correspondence with "free markets") is absurd on its face.
- jbssm 11y ago
  All nice and dandy in theory, clearly disproven by practice. Heath costs and medicine costs in Europe and Canada are lower than in the USA.

josteink 11y ago

Hopefully more incidents like this will prompt people to question whether granting patents are actually useful to society or not. Patents are after all an artificial (and supposedly temporary) monopoly enforced by society on behalf of a private entity, because society deems the value of this protection will create something beneficial to society as large. Using patents to bump prices of existing, already profitable medicines hardly seems what patents were made for.

danielahn 11y ago
There is no patent on the drug.
- blucoat 11y ago
  This is what confuses me, so maybe someone with a better understanding of this market works can elaborate. How is it that the drug is not patented but the manufacturer has the exclusive right to sell it? It blows my mind that one company can overnight make such a huge change and there is no competitor to turn to.
  - danielahn 11y ago
    I am several steps removed from the industry but to my knowledge - There is still a regulatory approval process to be able to manufacture the drug - so the cost and time required to receive this approval, then to market the drug as a generic alternative to the existing drug to a market that often doesn't see itself as the ultimate payor (ie. the consumer thinks the insurance companies / government are paying) and may prefer known names, and the original manufacturer's ability to then lower the price of the drug all combine to push away competition on low volume drugs like this one.
  - dzeanah 11y ago
    According to a CNBC interview last week the product is protected via trade secrets. People know what's in it, but not how to make it. And it's some weird stuff (I think pituitary glands from pigs or something equally weird are key components - not sure there's a lot of open-source knowledge on how to deal with that ingredient pipeline.) The CEO's pitch was that they believe the drug is useful in more roles than it's currently used for, so they're taking the increased money to perform the studies required to allow the drug to be used to treat more diseases for which there is no alternative. And right now this is a last-ditch drug - it's used once all other therapies have failed. So they're trying to increase marketshare by doing expensive studies, which is why this drug is still produced and where the money is going. At least according to the CEO, and my memory.

rtl49 11y ago

Without more information, I think the indignant tone and format of this article are unwarranted. Before we learn anything, we hear about the human toll: innocent babies will die, parents are distraught, and doctors are furious. But we're provided with no clear information on the reason for the price increase. "When Mallinckrodt acquired Questcor in 2014, Synacthen Depot was one of the products in the portfolio. It was losing money then and still is. Moreover, in the spring of 2014, Mallinckrodt was told by the existing supplier of the product that they would cease production in early 2016," a Mallinckrodt spokesman said in an email to CBC News. So the company faced an unexpected reduction in supply, and the drug might have been unprofitable at the previous price. One can object to the fact that the means of pharmaceutical production are privately owned, but given that these are not currently non-profit institutions, the outrage seems misplaced. There's nothing "absurd" about it. Edit: I'd like to address some of the commenters, who seem to have misinterpreted my comment as a defense of this company, or the pharmaceutical industry in general. This comment is an objection to the style of journalism in this article: light on information, heavy on emotion. I've said nothing in defense of the corporation. Some have suggested that these corporations should not increase prices in order to uphold some set of moral principles. I take it for granted that corporations are only answerable to power, and any limitations you might wish to impose upon them must either take the form of collective action (boycotts/protests) or regulation. Perhaps motivating either of these was the intent of the article, but if so the author went about expressing this wish in a way that I find objectionable, by appealing to emotion rather than reason and disguising an ideological belief as factual reporting.

ubersync 11y ago
Yes, but the fact that Martin Shkreli wanted to buy the rights for this drug makes me think there is somewhere a list of potential drugs that can be exploited in this way, and multiple companies are bidding for them.
- rtl49 11y ago
  Well, I certainly wouldn't expect a business executive to invest in a drug he suspects will be unprofitable. That aside, if the drug is unprofitable, and society has established as a general principle that the private sector is the appropriate venue for drug manufacturing, then I don't understand the objection to a price increase in principle. Without more information, we just don't know that this is an instance of price gouging. I'm open to that possibility, but I suggest waiting for actual evidence before taking your pitchfork out of the shed.

trhway 11y ago

>The price was so high that Alberta delisted it in July, and government chickens out and fails to protect its citizens. The government has the power to treat it for example as public utility and negotiate the price based on that premise.

jostmey 11y ago

Quote: "The drug is long off patent." So why not order the drug from China or India? Is the drug expensive to manufacture? Or is it that the Canadian government will only order the drug from select countries? I wish the article dug a little deeper.

imgabe 11y ago
There may be requirements to purchase the drug from manufacturers that comply with government regulated quality controls. Not that someone who really needs the drug couldn't seek out an online source to get it cheaply from overseas, but doctors may not be able to legally prescribe it from those places. I don't have any knowledge on the subject though, just speculating. At least in the US buying directly from overseas pharmacies seems to be more or less illegal.
- mgkimsal 11y ago
  "doctors may not be able to legally prescribe it from those places." We just get a prescription and have it filled wherever's cheapest. It's not up to the doctor to say where it can be filled...
  - imgabe 11y ago
    It may be illegal for pharmacies operating in Canada to buy from those manufacturers then, I don't know. I'm just saying there are possible additional risks with buying drugs of unknown provenance. It's not necessarily as simple as "just buy it from China or India".
mumumuyou2 11y ago
http://slatestarcodex.com/2015/09/24/the-problems-with-generic-medications-go-deeper-than-one-company/ http://slatestarcodex.com/2015/09/24/the-problems-with-gener...
Cass 11y ago
A coworker who worked as a doctor in Afghanistan and Myanmar for about a year told me that a third of the medications they had in the hospital, and two thirds of the medications you could purchase in pharmacies contained no active ingredient. People kept dying on him because an antibiotic would randomly do nothing, or lysis medication turned out to consist of colored NaCl. He said that most of those medications were delivered from China and India because of the low prices in those countries. This is anecdata, obviously, but I'd be very careful purchasing drugs from countries with low oversight. Fake drugs are an enormously profitable market. I also like this quote from a New York Times article: “If I have to follow U.S. standards in inspecting facilities supplying to the Indian market,” G. N. Singh, India’s top drug regulator, said in a recent interview with an Indian newspaper, “we will have to shut almost all of those.” The unease culminated Tuesday when a top executive at Ranbaxy — which has repeatedly been caught lying to the F.D.A. and found to have conditions such as flies “too numerous to count” in critical plant areas — pleaded with Dr. Hamburg at a private meeting with other drug executives to allow his products into the United States so that the company could more easily pay for fixes. She politely declined. http://www.nytimes.com/2014/02/15/world/asia/medicines-made-in-india-set-off-safety-worries.html?_r=1 http://www.nytimes.com/2014/02/15/world/asia/medicines-made-...

pja 11y ago

Scott Alexander wrote a whole article on the difficulties in bringing competitors to out of patent drugs to the US market: http://slatestarcodex.com/2015/09/24/the-problems-with-generic-medications-go-deeper-than-one-company/ http://slatestarcodex.com/2015/09/24/the-problems-with-gener...

forrestthewoods 11y ago

What's the answer here? Should the government pay for manufacturing of generic drugs that are non-profitable but "essential"? Let the tax payers eat the cost of such drugs? There's more than a few like that. I believe snake venom antidotes are often on such lists. (note: I did specify generic drugs. Not drugs still under patent exclusivity windows. Which is a valid but separate discussion.)

beagle3 11y ago

This is pure capitalism in action, and an important datum about what happens in free markets. [see edit below] Questcor is cornering the market - this has nothing to do with research or availability. In 2012, they acquired the manufacturing of the pig-pituary-gland version of this drug, called "HP Acthar Gel"[0], and hiked the price from $50 to $28,000 per vial. In June 2014, they acquired the synthetic version called "Synacthen Depot" and modestly hiked it by just 2000%. The generic term naming both is ACTH, which is cleverly (?) disguised inside both names. This is greed, plain and simple - now that Questcor owns the market, they can name any price they want, or the infantile spasm kids suffer greatly (die, or suffer developmental problems of all sorts including retardation). There are other diseases treated with ACTH, and dropping treatment due to cost has effects almost as severe. Show me the parent who would let their baby die or become retarded because the price was hiked. That's an example of what any completely free market will converge to. [0] http://www.nytimes.com/2012/12/30/business/questcor-finds-profit-for-acthar-drug-at-28000-a-vial.html http://www.nytimes.com/2012/12/30/business/questcor-finds-pr... edit: I stand corrected in my use of "pure capitalism" - government regulation makes it very much not pure capitalism. But the monopolizing of production that we see here is a real-world result of capitalism (pure or impure) - the assumption that "if there's money to be made, some other entity will rise to the challenge" is not supported by evidence in small markets (such as ACTH). If it weren't, there would be no need for antitrust laws.

narrator 11y ago
This isn't pure capitalism. This is a result of what Mises called "license monopoly". See "The Monopolized Commodity" under https://mises.org/library/monopoly-prices https://mises.org/library/monopoly-prices for more discussion of this. "Under monopoly, a greater part of the specific factors of production concerned will remain unused. The common feature of all instances of monopoly prices is that part of the supply, which under competitive conditions would have been offered on the market, is withheld from the market. The most spectacular and objectionable instance of this withholding is the purposeful destruction of the commodities concerned. It happened mostly with consumers’ goods (e.g., coffee) but sometimes also with factors of production." There are other sources of this drug, notably foreign production, but they don't have the proper licensing. Thus you get a license monopoly. There are a lot of drugs developed overseas that are effective but they are unknown in the U.S market because they are not approved by the proper license monopoly granter. Under pure capitalism, these products would be allowed on the market and independent rating agencies would ensure their quality.

deleted 11y ago

[deleted]

scoot 11y ago

"2,000% price hike" is a link-bait headline. Not to excuse the hike, but lets call it what it is - a 20 times increase. Any use of percentages over double-digits is asking for confusion. And using a four-digit percentage is intentionally misrepresenting the scale of the increase.

T3RMINATED 11y ago

American Medicine is worse than ISIS Terrorism

emergentcypher 11y ago

I'd like to know why people would consider giving their children a drug named Absurd in the first place!