8 ms·

Something to keep in mind is the population that typically has chronic Hep C requiring this drug. It's IV drug users who share needles. Think they have $84K? No

Something to keep in mind is the population that typically has chronic Hep C requiring this drug. It's IV drug users who share needles. Think they have $84K? Nope. Think they have insurance? Nope. Guess who pays for it. Oh that's right, it's Medicaid! It's you, the taxpayers. Where is there a large concentration of people that have Hep C? Prisons. Guess who pays for it then? Still you! The prison systems are obligated to provide health care and treatments in accordance with community standards of care, which they do. They have treated many people already who meet the criteria of disease progression to qualify for it. Still think Gilead should be charging this much for it here and not elsewhere?

mgiannopoulos 10y ago
So India does not have prisons or similar laws for treatment of prisoners?
- cheiVia0 10y ago
  Incarceration rate (Prisoners per 100,000 population): United States: 698 India: 33 https://en.wikipedia.org/wiki/List_of_countries_by_incarceration_rate https://en.wikipedia.org/wiki/List_of_countries_by_incarcera...
refurb 10y ago
You don't think it's fair to price a product relative to the wealth in a given country? I think it's quite fair to be honest.
- x5n1 10y ago
  It should be priced according to ability to pay based on income. The same is the reasoning why the drug is so cheap in other countries, their people can't possibly afford the prices. So it makes no sense for citizens of wealthy countries to have to pay huge markups if they don't have the money. It makes no sense from an economic perspective to force people to go into bankruptcy just because they got sick.
  - emn13 10y ago
    That's only fair if you believe that the seller has the moral right to maximize their earnings. I think that's questionable across the board, but certainly in the pharmaceutical industry. As in: the idea behind capitalism (the reason we put up with it) is not that price-gouging is some fundamental right we should worship, but because capitalism works. What's that mean? It efficiently allocates resources. How does it efficiently allocate resources? By letting a fluid market with many competing buyers and sellers figure out an appropriate price. Notably, patents of life-sustaining medicines utterly destroy that cornerstone of capitalism. People can and will pay almost anything to get that drug, so the seller can charge what it wants - that's not capitalism as it's supposed to work, that's a hostage scenario. I don't know what the best alternative is, but I'm convinced that there are many trivially better solutions to allocating resources to medical research, efficacy testing and production than what we're doing now. Every social network, things like google's pagerank, scientific journal impact ratings - all represent alternative means to determine worth in a competitive fashion; and even competition isn't strictly necessary - for some scenarios plain old raw computation to solve for the optimal solution may be possible nowadays. We're not even trying to improve the status quo.
    - chongli 10y ago
      The best alternative is really quite simple: public funding for lifesaving medicines. This model also works for the provision of medical care and is used throughout the entire developed world, with one exception.
      - greeneggs 10y ago
        As far as I know, this is not true anywhere in the world. What drugs out there have had their development and trials fully (or majority) funded by governments, either in Europe or---apropos here---India?
        chongli 10y ago
        Huge, huge amounts of drug discovery is funded by governments[0] around the world. Pharmaceutical companies step in to fund the trials after the promising results come out. A lot of the trials take place in India under ethically concerning conditions[1]. [0] http://www.ncbi.nlm.nih.gov/books/NBK50972/ http://www.ncbi.nlm.nih.gov/books/NBK50972/ [1] http://www.who.int/bulletin/volumes/86/8/08-010808/en/ http://www.who.int/bulletin/volumes/86/8/08-010808/en/
- m_mueller 10y ago
  Certainly. And it should be just as fair to allow parallel imports of everything. Want to charge more than [retail price B + transport cost B->A + import tax A]? Guess what, the market is going to take care of this for you.
  - icebraining 10y ago
    Of course, that just means they'll sell at the expensive price everywhere.
    - m_mueller 10y ago
      See the import tax that I included in the calculation? IMO this should be the way to solve this from a humanitarian standpoint. If a government wants to solve medical issues of poor countries, it can work together with drug corporations, dictate the price points (i.e. manufacturing+logistics without R&D) for offering these supplies and then protect the own market through import taxes on these products. But the point here is: It needs to be a transparent, i.e. democratic, process. The way it works now is just shady and anti free market.
necessity 10y ago
The drug from the original company is expensive everywhere, what India has is generics, which in their turn might lower the price of the original drug because of the competition. It also lowers the incentive of selling the original drug there at all (and consequently allowing the government to press for agreements). I have some unpopular opinions regarding the subject...
- chris_wot 10y ago
  Actually, India basically refuses to recognise patents for a wide variety of pharmaceutical products. For a long time they refused to recognise patents for drugs that combat AIDS and a thriving market for generics sprung up. There was a lot of posturing and complaining by pharmaceutical companies in the U.S. and the U.S. Government tried to heavy the Indian Government, but to no avail. When it became apparent that the Indians weren't going to budge, and with a growing realisation that other nations would ether do the same thing or import their drugs from India, the companies agreed to drastically reduce their prices on "humanitarian" grounds. Now they still make massive profits, just they are less massive than they once were. This is now happening with academic research. Nobody will shed any tears because greedy multinationals make a lower profit to ensure less people die from disease. Nobody will weep over Elsevier's reduced earning if it frees up necessary information and research findings so science can progress for the benefit of all mankind. The entrenched interests of rich, arrogant corporate executives and business owners in first world nations are finally being disrupted by poorer nations who don't care about this group of people. But that's what happens when you gain an attitude on I weaning entitlement - you eventually overreach so far you come undone, and nobody feels any sympathy when it happens.
  - halviti 10y ago
    While I tend to lean more to your side of the argument, the devil's advocate in me has to point out the fact that you leave out the massive costs of research, development, clinical trials / fda approval, etc. that go in to getting a drug to market. This not to mention all the extra capital needed to fund research into all of the drugs that never make it to market before a company finds something that works.
roywiggins 10y ago
It is expensive, but still cheaper than treating someone in the US with HepC for life, which Medicaid is already paying.
- danielweber 10y ago
  https://blog.jaibot.com/the-copenhagen-interpretation-of-ethics/ https://blog.jaibot.com/the-copenhagen-interpretation-of-eth... Copenhagen theory of ethics: If person A ignores a problem, but person B comes up with an expensive solution to the problem, person B is the monster because he should have come up with a cheap solution. Person A is completely innocent. (Obviously this is nuts.)
ubernostrum 10y ago
Actually a significant population in the US was infected by blood transfusion; the US didn't start properly/universally screening blood and taking precautions for hep C until 1992. This is why there's a spike in infection rate among older people, and why hep C is considered a looming cost crisis for Medicare -- we don't yet know the full extent of the infectious disaster that was unscreened blood, but it's ticking away inside anyone who received a transfusion prior to 1992.
- bunnymancer 10y ago
  There's something rather unsettling about the realization that Jehova's Witnesses had a point about something once..
  - stdbrouw 10y ago
    If you're getting a blood transfusion it's usually because you need it. I'd take hepatitis C over death any day.
  - gaur 10y ago
    A broken clock is right twice a day.
- 0bamacare 10y ago
  That's the 10% that the insurance companies have already treated.Most of those waiting now are the F1 and F2 variety.
PhasmaFelis 10y ago
Is there a way to take the taxpayer money being spent on medicine that's priced high to recoup the research investment, and shift it to directly funding the research in the first place? Obviously you'd have to spend a while funding both R&D and Medicaid/etc, while the new drugs are in development and the old ones are still under patent, and I'm sure there's other details I've missed, but it seems like there should be some way to make the system make more sense.
- mikekchar 10y ago
  I don't think you could get that to fly politically. While it is true that drugs require high prices to recoup research cost and that drug patents allow drug companies to charge those high prices, they don't just recoup prices. They charge as much as they can. From the point of view of trying to save as many people as possible for the money, that sucks, but from the point of view of encouraging investment in drug companies it is seen as a necessary evil. I won't try to rehash all of the permutations of ways that might work (just search HN for any discussion of drug companies and patents and you will be able to enumerate them). I suspect that there are ways to improve the present system substantially, but I concede that the problem is much harder than I can solve. Hopefully someone will be able to do it some day.
  - lucaspiller 10y ago
    > They charge as much as they can How does it work in European countries where health care is (mostly) paid for by the government? Do these companies still charge the same prices as in the US?
    - airless_bar 10y ago
      Of course not.
    - te_chris 10y ago
      Back in NZ, we have PHARMAC, which is basically a centralised drug buyer for the country. It works remarkably well at keeping drug prices low https://www.pharmac.govt.nz/ https://www.pharmac.govt.nz/ - though tends to miss some niche stuff.
herbst 10y ago
Not sure if this is ment against "free" health care or you are just noting how corrupt the U.S. health system is.
justsaysmthng 10y ago
My father is currently under treatment (for around 50,000 EUR) He's not an IV drug user, never was, most probably it was a dentist who infected him many years ago. Don't oversimplify things like this, there are lots of situations you aren't thinking about..
- dcposch 10y ago
  He's not oversimplifying. He's not saying that all Hep C patients are IV drug users. He's just staying that a lot of Hep C care is taxpayer funded, and that Gilead is therefore price gouging the American taxpayer. That your dad is also being price gouged, over in Europe, is just icing on the cake.
- dcposch 10y ago
  He's not oversimplifying. He's not saying that all Hep C patients are IV drug users. He's just staying that a lot of Hep C care is taxpayer funded, and that Gilead is therefore price gouging the American taxpayer. That your dad is also being price gouged, over in Europe, is just icing on the cake.

mgiannopoulos 10y ago

So India does not have prisons or similar laws for treatment of prisoners?

cheiVia0 10y ago
Incarceration rate (Prisoners per 100,000 population): United States: 698 India: 33 https://en.wikipedia.org/wiki/List_of_countries_by_incarceration_rate https://en.wikipedia.org/wiki/List_of_countries_by_incarcera...

refurb 10y ago

You don't think it's fair to price a product relative to the wealth in a given country? I think it's quite fair to be honest.

x5n1 10y ago
It should be priced according to ability to pay based on income. The same is the reasoning why the drug is so cheap in other countries, their people can't possibly afford the prices. So it makes no sense for citizens of wealthy countries to have to pay huge markups if they don't have the money. It makes no sense from an economic perspective to force people to go into bankruptcy just because they got sick.
- emn13 10y ago
  That's only fair if you believe that the seller has the moral right to maximize their earnings. I think that's questionable across the board, but certainly in the pharmaceutical industry. As in: the idea behind capitalism (the reason we put up with it) is not that price-gouging is some fundamental right we should worship, but because capitalism works. What's that mean? It efficiently allocates resources. How does it efficiently allocate resources? By letting a fluid market with many competing buyers and sellers figure out an appropriate price. Notably, patents of life-sustaining medicines utterly destroy that cornerstone of capitalism. People can and will pay almost anything to get that drug, so the seller can charge what it wants - that's not capitalism as it's supposed to work, that's a hostage scenario. I don't know what the best alternative is, but I'm convinced that there are many trivially better solutions to allocating resources to medical research, efficacy testing and production than what we're doing now. Every social network, things like google's pagerank, scientific journal impact ratings - all represent alternative means to determine worth in a competitive fashion; and even competition isn't strictly necessary - for some scenarios plain old raw computation to solve for the optimal solution may be possible nowadays. We're not even trying to improve the status quo.
  - chongli 10y ago
    The best alternative is really quite simple: public funding for lifesaving medicines. This model also works for the provision of medical care and is used throughout the entire developed world, with one exception.
    - greeneggs 10y ago
      As far as I know, this is not true anywhere in the world. What drugs out there have had their development and trials fully (or majority) funded by governments, either in Europe or---apropos here---India?
      - chongli 10y ago
        Huge, huge amounts of drug discovery is funded by governments[0] around the world. Pharmaceutical companies step in to fund the trials after the promising results come out. A lot of the trials take place in India under ethically concerning conditions[1]. [0] http://www.ncbi.nlm.nih.gov/books/NBK50972/ http://www.ncbi.nlm.nih.gov/books/NBK50972/ [1] http://www.who.int/bulletin/volumes/86/8/08-010808/en/ http://www.who.int/bulletin/volumes/86/8/08-010808/en/
m_mueller 10y ago
Certainly. And it should be just as fair to allow parallel imports of everything. Want to charge more than [retail price B + transport cost B->A + import tax A]? Guess what, the market is going to take care of this for you.
- icebraining 10y ago
  Of course, that just means they'll sell at the expensive price everywhere.
  - m_mueller 10y ago
    See the import tax that I included in the calculation? IMO this should be the way to solve this from a humanitarian standpoint. If a government wants to solve medical issues of poor countries, it can work together with drug corporations, dictate the price points (i.e. manufacturing+logistics without R&D) for offering these supplies and then protect the own market through import taxes on these products. But the point here is: It needs to be a transparent, i.e. democratic, process. The way it works now is just shady and anti free market.

necessity 10y ago

The drug from the original company is expensive everywhere, what India has is generics, which in their turn might lower the price of the original drug because of the competition. It also lowers the incentive of selling the original drug there at all (and consequently allowing the government to press for agreements). I have some unpopular opinions regarding the subject...

chris_wot 10y ago
Actually, India basically refuses to recognise patents for a wide variety of pharmaceutical products. For a long time they refused to recognise patents for drugs that combat AIDS and a thriving market for generics sprung up. There was a lot of posturing and complaining by pharmaceutical companies in the U.S. and the U.S. Government tried to heavy the Indian Government, but to no avail. When it became apparent that the Indians weren't going to budge, and with a growing realisation that other nations would ether do the same thing or import their drugs from India, the companies agreed to drastically reduce their prices on "humanitarian" grounds. Now they still make massive profits, just they are less massive than they once were. This is now happening with academic research. Nobody will shed any tears because greedy multinationals make a lower profit to ensure less people die from disease. Nobody will weep over Elsevier's reduced earning if it frees up necessary information and research findings so science can progress for the benefit of all mankind. The entrenched interests of rich, arrogant corporate executives and business owners in first world nations are finally being disrupted by poorer nations who don't care about this group of people. But that's what happens when you gain an attitude on I weaning entitlement - you eventually overreach so far you come undone, and nobody feels any sympathy when it happens.
- halviti 10y ago
  While I tend to lean more to your side of the argument, the devil's advocate in me has to point out the fact that you leave out the massive costs of research, development, clinical trials / fda approval, etc. that go in to getting a drug to market. This not to mention all the extra capital needed to fund research into all of the drugs that never make it to market before a company finds something that works.

roywiggins 10y ago

It is expensive, but still cheaper than treating someone in the US with HepC for life, which Medicaid is already paying.

danielweber 10y ago
https://blog.jaibot.com/the-copenhagen-interpretation-of-ethics/ https://blog.jaibot.com/the-copenhagen-interpretation-of-eth... Copenhagen theory of ethics: If person A ignores a problem, but person B comes up with an expensive solution to the problem, person B is the monster because he should have come up with a cheap solution. Person A is completely innocent. (Obviously this is nuts.)

ubernostrum 10y ago

Actually a significant population in the US was infected by blood transfusion; the US didn't start properly/universally screening blood and taking precautions for hep C until 1992. This is why there's a spike in infection rate among older people, and why hep C is considered a looming cost crisis for Medicare -- we don't yet know the full extent of the infectious disaster that was unscreened blood, but it's ticking away inside anyone who received a transfusion prior to 1992.

bunnymancer 10y ago
There's something rather unsettling about the realization that Jehova's Witnesses had a point about something once..
- stdbrouw 10y ago
  If you're getting a blood transfusion it's usually because you need it. I'd take hepatitis C over death any day.
- gaur 10y ago
  A broken clock is right twice a day.
0bamacare 10y ago
That's the 10% that the insurance companies have already treated.Most of those waiting now are the F1 and F2 variety.

PhasmaFelis 10y ago

Is there a way to take the taxpayer money being spent on medicine that's priced high to recoup the research investment, and shift it to directly funding the research in the first place? Obviously you'd have to spend a while funding both R&D and Medicaid/etc, while the new drugs are in development and the old ones are still under patent, and I'm sure there's other details I've missed, but it seems like there should be some way to make the system make more sense.

mikekchar 10y ago
I don't think you could get that to fly politically. While it is true that drugs require high prices to recoup research cost and that drug patents allow drug companies to charge those high prices, they don't just recoup prices. They charge as much as they can. From the point of view of trying to save as many people as possible for the money, that sucks, but from the point of view of encouraging investment in drug companies it is seen as a necessary evil. I won't try to rehash all of the permutations of ways that might work (just search HN for any discussion of drug companies and patents and you will be able to enumerate them). I suspect that there are ways to improve the present system substantially, but I concede that the problem is much harder than I can solve. Hopefully someone will be able to do it some day.
- lucaspiller 10y ago
  > They charge as much as they can How does it work in European countries where health care is (mostly) paid for by the government? Do these companies still charge the same prices as in the US?
  - airless_bar 10y ago
    Of course not.
  - te_chris 10y ago
    Back in NZ, we have PHARMAC, which is basically a centralised drug buyer for the country. It works remarkably well at keeping drug prices low https://www.pharmac.govt.nz/ https://www.pharmac.govt.nz/ - though tends to miss some niche stuff.

herbst 10y ago

Not sure if this is ment against "free" health care or you are just noting how corrupt the U.S. health system is.

justsaysmthng 10y ago

My father is currently under treatment (for around 50,000 EUR) He's not an IV drug user, never was, most probably it was a dentist who infected him many years ago. Don't oversimplify things like this, there are lots of situations you aren't thinking about..

dcposch 10y ago
He's not oversimplifying. He's not saying that all Hep C patients are IV drug users. He's just staying that a lot of Hep C care is taxpayer funded, and that Gilead is therefore price gouging the American taxpayer. That your dad is also being price gouged, over in Europe, is just icing on the cake.
dcposch 10y ago
He's not oversimplifying. He's not saying that all Hep C patients are IV drug users. He's just staying that a lot of Hep C care is taxpayer funded, and that Gilead is therefore price gouging the American taxpayer. That your dad is also being price gouged, over in Europe, is just icing on the cake.