11 ms·

How many people will this price hike kill? I'm sure that's estimable. What would be morally justified, to stop it?

rdtsc 10y ago
Nah because it would upset the free market. I mentioned in another comment when someone from Europe or Canada asked something to the effect of "how come everything has to be free market in US even healthcare and such". And I think the answer is we treat free market as a religion. We don't evaluate what is better, healthier, more rational answer for a problem. Like say, "How do we keep people from dying from anaphylaxis?" We don't answer that. We always answer first, what would free market want? Will it want us to do this? If not, we don't proceed. We treat it as if it is deity of sorts and if we disobey we'll be punished. Someone replied and said this idea isn't so outrageous because a similar concept has been defined already in politics: American Civil Religion (https://en.wikipedia.org/wiki/American_civil_religion https://en.wikipedia.org/wiki/American_civil_religion) I am just proposing there is a similar religion in respect to free market. It is often sold in propaganda terms of course -- we are not communists here, we just want efficiency, we want progress, don't worry stuff will trickle down eventually and so on. So we make it palatable but the main incentive is worshiping the deity. It sounds crazy but evaluating a lot of things we do as a society through that perspective can be interesting.
- schmidty 10y ago
  How is government protecting a monopoly free market exactly?
  - MarkPNeyer 10y ago
    EXACTLY A free market would mean anyone who wanted to to create one of these.
  - rdtsc 10y ago
    Why is it protecting a monopoly? Why doesn't it say "this EpiPen can't cost more than $30"?
    - gwright 10y ago
      Perhaps because it actually costs more than $30 and so an edict such of this would guarantee that there are no EpiPens at all? In any case, the current high price is the result of regulatory/legislative actions and so the current price is evidence of regulatory failure, not market failure.
      - maxerickson 10y ago
        I don't think it is a massive regulatory failure to have the pharmacy dispense a product with matching use instructions to the product that is prescribed. So it's the market that has doctors prescribing $600 Epipens instead of the $150 alternative (that has different use instructions and thus cannot be used to fill a prescription for an Epipen).
        gwright 10y ago
        Isn't this just another example of a problem created by the rules/regulations? A pharmacist is forbidden from providing the $150 alternative even if the customer specifically requests it (because of the prescription requirement and rules). For those who need epinephrine injectors, can't they just ask their doctors to prescribe Adrenaclick? What prevents that from happening? I'm guessing it is insurance guidelines that are also stuck in the EpiPen-only world but perhaps it is also doctors being too conservative?
        maxerickson 10y ago
        It's marketing. I saw some discussion on social media, people expressed a preference for the Epipen because they expected other people to be more aware of how to use it. Same with parents, they expect the school nurse to be more familiar with the Epipen (and I guess the other way around, the nurses prefer Epipen because they are familiar with it). If asking the pharmacist for a specific type of injector isn't onerous then neither is asking the doctor. I'm willing to concede that US medical regulation has lots of problems, but there is also clearly some problems with the way people in this market are behaving. Patients should care about saving $1000-$1500. Doctors should care about saving their patients $1000-1500.
- jdpedrie 10y ago
  That's silly. How do you propose to "evaluate what is better, healthier, more rational"? I suppose some panel of experts could give you their best approximation, but it will always be sub-optimal. Markets exist in order to answer these questions, and they answer them by delegating the decision to every person involved in the decision, not by hoping a designated person can make a guess that's close enough. It appears that the problem in this case is that there is a single producer who is able to engage in monopolistic pricing, which is certainly not something a market-oriented person would condone. And the market for healthcare is not a free market. Not anything resembling a free market.
  - rdtsc 10y ago
    > Markets exist in order to answer these questions, Well in this case it answered that the price should be $600. This means people, kids, astamatics are going to die at some point in higher numbers because of that. I say the market is drunk or evil and should not be allowed to make medical decisions. But because it has a religious following, we don't want to make it angry so we can't say "we mandate EpiPen cost to be $25". Instead we dance around it and say "oh we'll create this health insurance thing, and then that will pay for it". But only if you work. Or ... if you don't you have to buy it anyway, or you have to pay a penalty. But unless you are old, then we kind a let you off the hook a bit and you sign up for this other thing. All of that is done in paper and in how it is presented to the public because we don't want to upset the free market gods.
    - gwright 10y ago
      Setting prices via administrative fiat doesn't eliminate problems. If the price is set to low, there will be shortages or no product at all. If the price is set to high, then the blame for the high price is shifted to the legislature rather than the supplier. In any case, it is the government that is creating the conditions that allow the price to be set so high in this case. Blaming the 'market' for adjusting to the conditions created by government is confusing cause and effect.
  - d4rti 10y ago
    NICE does a pretty good job in the UK. https://www.nice.org.uk/ https://www.nice.org.uk/
- gozur88 10y ago
  I'm pretty sure you could put together epinephrine and a syringe for a few bucks. And sell it for twenty or so with a healthy profit. But you can't, can you? Is that because of free market worship, or worship of the regulatory state?
  - rdtsc 10y ago
    > But you can't, can you? Yes you can! Believe it or not this completely unregulated free market utopia exists. It is not just a fantasy. Now don't get excited, I imagine after I tell you about you it, you probably won't be headed to the airport to go there -- that's because it is actually horrible. Unregulated market is what was (and is) happening in any of the post-Soviet republics, Russia, probably China, probably many other countries. Those countries are better at free market than America. Yes on paper they have their EPAs, FCCs, FDA and other nuisances, but in practice nobody cares. So you can buy some pills from the street corner shop that sells cigarettes. But chances are they are expired at best, made in a basement from chalk and sugar, or harmful at worst. Of course the claim is, "ah but market takes care of it, next time you won't buy from there and they'll go out of business". Nope, you might be dead next time and no they won't go out of business. You can go and buy unregulated vegetables from the market. And they look fresh and plump and nice, but they are chock full of horrible chemicals in them. How do I know? My relatives there grow and sell them. They have a separate plot of land for such things and wouldn't let their kids or themselves eat from there. Gun ownership there is restricted. Unless you are friends with the police. Then you can have a special permit for a gun. Oh but you have to pass a psych exam to make sure you are not crazy. But it so happens you are crazy. But, no worries, such regulations are bypassed with a quick $50 gift. And yes, I have seen them shoot their Dragunov sniper rifle, in a village, with houses right next to each other, and nobody cares. The list goes on. Now maybe I assumed too much that you won't like it. Who knows, maybe you would. Well you are welcome to visit and try it out.
    - gwright 10y ago
      I'm sure there are some people that truly want the unfettered, caveat emptor world that you describe, but I think that is a mischaracterization of what most free-market advocates are actually talking about. The type of regulations/laws are hugely important. Critical statements regarding existing regulations are not the same thing as advocating for no regulations whatsoever. I think it is more useful to view calls for a 'free market' to really be calls for a 'minimally regulated market'. For example, regulations and laws that penalize fraud and negligence are well within the scope of a 'minimally regulated market'.
- gwright 10y ago
  Why do you and many other characterize this as a free market failure? If anything this is a regulatory failure.
  - rdtsc 10y ago
    I am in the opposite camp. I characterize this as a free market success and as a failure of a civilized society to provide basic healthcare for its citizens.
    - forloop 10y ago
      Yeah sure. A free market success. Why not.
- cheald 10y ago
  The reason that EpiPens are expensive is because they're patent protected. In this case, regulatory protection that is the explicit issue. Demand for the product is clearly there; supply is not, not because there is nobody willing to provide it, but because the government prevents would-be competitors from doing so.
- sevenless 10y ago
  It's interesting how Americans act horrified at the word collectivism, when a market is nothing if not a collectivist decision making process.
harryh 10y ago
I dunno. I bet it's a pretty small number. Fewer than 100 people die per year in the US from anaphylaxis and it's hard to find evidence that this number has risen along with the price of the EpiPen. At the top end maybe the answer to your question is a dozen or so. About the same order of magnitude as the number of people that die due to dog bites. It's really small.
- sevenless 10y ago
  Fair enough. Maybe it's not such a big deal then.
malz 10y ago
How many people would die if the only manufacturer of the device goes out of business? It's not a flippant question; their only competitor pulled their product off the market, because the cost of fixing bugs was too great. How would it have helped to force them to charge less? http://www.fiercepharma.com/marketing/sanofi-s-auvi-q-recall-puts-mylan-s-rival-epipen-full-control-of-blockbuster-market http://www.fiercepharma.com/marketing/sanofi-s-auvi-q-recall...
dredmorbius 10y ago
There are from 30-950 cases per 100,000 people per year. Or an 0.03% to 0.9% incidence rate. That sets an upper bound on deaths. It corresponds to about 100,000 to 3 million exposures per year. If 10% of those were potentially fatal without treatment, you'd be looking at 10,000 to 300,000 deaths/year. Keep in mind I just pulled 10% out of my ass. You'd want to see how many people or cases would be untreated at the higher price level. But the information certainly supports the notion of thousands of deaths. At 1,000 deaths, that's about 1.6 million in profits per corpse for Mylan, based on $1.6 billion in additional profit. http://rnspeak.com/case-study/anaphylactic-shock-case-study-the-impending-doom/ http://rnspeak.com/case-study/anaphylactic-shock-case-study-...

rdtsc 10y ago

Nah because it would upset the free market. I mentioned in another comment when someone from Europe or Canada asked something to the effect of "how come everything has to be free market in US even healthcare and such". And I think the answer is we treat free market as a religion. We don't evaluate what is better, healthier, more rational answer for a problem. Like say, "How do we keep people from dying from anaphylaxis?" We don't answer that. We always answer first, what would free market want? Will it want us to do this? If not, we don't proceed. We treat it as if it is deity of sorts and if we disobey we'll be punished. Someone replied and said this idea isn't so outrageous because a similar concept has been defined already in politics: American Civil Religion (https://en.wikipedia.org/wiki/American_civil_religion https://en.wikipedia.org/wiki/American_civil_religion) I am just proposing there is a similar religion in respect to free market. It is often sold in propaganda terms of course -- we are not communists here, we just want efficiency, we want progress, don't worry stuff will trickle down eventually and so on. So we make it palatable but the main incentive is worshiping the deity. It sounds crazy but evaluating a lot of things we do as a society through that perspective can be interesting.

schmidty 10y ago
How is government protecting a monopoly free market exactly?
- MarkPNeyer 10y ago
  EXACTLY A free market would mean anyone who wanted to to create one of these.
- rdtsc 10y ago
  Why is it protecting a monopoly? Why doesn't it say "this EpiPen can't cost more than $30"?
  - gwright 10y ago
    Perhaps because it actually costs more than $30 and so an edict such of this would guarantee that there are no EpiPens at all? In any case, the current high price is the result of regulatory/legislative actions and so the current price is evidence of regulatory failure, not market failure.
    - maxerickson 10y ago
      I don't think it is a massive regulatory failure to have the pharmacy dispense a product with matching use instructions to the product that is prescribed. So it's the market that has doctors prescribing $600 Epipens instead of the $150 alternative (that has different use instructions and thus cannot be used to fill a prescription for an Epipen).
      - gwright 10y ago
        Isn't this just another example of a problem created by the rules/regulations? A pharmacist is forbidden from providing the $150 alternative even if the customer specifically requests it (because of the prescription requirement and rules). For those who need epinephrine injectors, can't they just ask their doctors to prescribe Adrenaclick? What prevents that from happening? I'm guessing it is insurance guidelines that are also stuck in the EpiPen-only world but perhaps it is also doctors being too conservative?
        maxerickson 10y ago
        It's marketing. I saw some discussion on social media, people expressed a preference for the Epipen because they expected other people to be more aware of how to use it. Same with parents, they expect the school nurse to be more familiar with the Epipen (and I guess the other way around, the nurses prefer Epipen because they are familiar with it). If asking the pharmacist for a specific type of injector isn't onerous then neither is asking the doctor. I'm willing to concede that US medical regulation has lots of problems, but there is also clearly some problems with the way people in this market are behaving. Patients should care about saving $1000-$1500. Doctors should care about saving their patients $1000-1500.
jdpedrie 10y ago
That's silly. How do you propose to "evaluate what is better, healthier, more rational"? I suppose some panel of experts could give you their best approximation, but it will always be sub-optimal. Markets exist in order to answer these questions, and they answer them by delegating the decision to every person involved in the decision, not by hoping a designated person can make a guess that's close enough. It appears that the problem in this case is that there is a single producer who is able to engage in monopolistic pricing, which is certainly not something a market-oriented person would condone. And the market for healthcare is not a free market. Not anything resembling a free market.
- rdtsc 10y ago
  > Markets exist in order to answer these questions, Well in this case it answered that the price should be $600. This means people, kids, astamatics are going to die at some point in higher numbers because of that. I say the market is drunk or evil and should not be allowed to make medical decisions. But because it has a religious following, we don't want to make it angry so we can't say "we mandate EpiPen cost to be $25". Instead we dance around it and say "oh we'll create this health insurance thing, and then that will pay for it". But only if you work. Or ... if you don't you have to buy it anyway, or you have to pay a penalty. But unless you are old, then we kind a let you off the hook a bit and you sign up for this other thing. All of that is done in paper and in how it is presented to the public because we don't want to upset the free market gods.
  - gwright 10y ago
    Setting prices via administrative fiat doesn't eliminate problems. If the price is set to low, there will be shortages or no product at all. If the price is set to high, then the blame for the high price is shifted to the legislature rather than the supplier. In any case, it is the government that is creating the conditions that allow the price to be set so high in this case. Blaming the 'market' for adjusting to the conditions created by government is confusing cause and effect.
- d4rti 10y ago
  NICE does a pretty good job in the UK. https://www.nice.org.uk/ https://www.nice.org.uk/
gozur88 10y ago
I'm pretty sure you could put together epinephrine and a syringe for a few bucks. And sell it for twenty or so with a healthy profit. But you can't, can you? Is that because of free market worship, or worship of the regulatory state?
- rdtsc 10y ago
  > But you can't, can you? Yes you can! Believe it or not this completely unregulated free market utopia exists. It is not just a fantasy. Now don't get excited, I imagine after I tell you about you it, you probably won't be headed to the airport to go there -- that's because it is actually horrible. Unregulated market is what was (and is) happening in any of the post-Soviet republics, Russia, probably China, probably many other countries. Those countries are better at free market than America. Yes on paper they have their EPAs, FCCs, FDA and other nuisances, but in practice nobody cares. So you can buy some pills from the street corner shop that sells cigarettes. But chances are they are expired at best, made in a basement from chalk and sugar, or harmful at worst. Of course the claim is, "ah but market takes care of it, next time you won't buy from there and they'll go out of business". Nope, you might be dead next time and no they won't go out of business. You can go and buy unregulated vegetables from the market. And they look fresh and plump and nice, but they are chock full of horrible chemicals in them. How do I know? My relatives there grow and sell them. They have a separate plot of land for such things and wouldn't let their kids or themselves eat from there. Gun ownership there is restricted. Unless you are friends with the police. Then you can have a special permit for a gun. Oh but you have to pass a psych exam to make sure you are not crazy. But it so happens you are crazy. But, no worries, such regulations are bypassed with a quick $50 gift. And yes, I have seen them shoot their Dragunov sniper rifle, in a village, with houses right next to each other, and nobody cares. The list goes on. Now maybe I assumed too much that you won't like it. Who knows, maybe you would. Well you are welcome to visit and try it out.
  - gwright 10y ago
    I'm sure there are some people that truly want the unfettered, caveat emptor world that you describe, but I think that is a mischaracterization of what most free-market advocates are actually talking about. The type of regulations/laws are hugely important. Critical statements regarding existing regulations are not the same thing as advocating for no regulations whatsoever. I think it is more useful to view calls for a 'free market' to really be calls for a 'minimally regulated market'. For example, regulations and laws that penalize fraud and negligence are well within the scope of a 'minimally regulated market'.
gwright 10y ago
Why do you and many other characterize this as a free market failure? If anything this is a regulatory failure.
- rdtsc 10y ago
  I am in the opposite camp. I characterize this as a free market success and as a failure of a civilized society to provide basic healthcare for its citizens.
  - forloop 10y ago
    Yeah sure. A free market success. Why not.
cheald 10y ago
The reason that EpiPens are expensive is because they're patent protected. In this case, regulatory protection that is the explicit issue. Demand for the product is clearly there; supply is not, not because there is nobody willing to provide it, but because the government prevents would-be competitors from doing so.
sevenless 10y ago
It's interesting how Americans act horrified at the word collectivism, when a market is nothing if not a collectivist decision making process.

harryh 10y ago

I dunno. I bet it's a pretty small number. Fewer than 100 people die per year in the US from anaphylaxis and it's hard to find evidence that this number has risen along with the price of the EpiPen. At the top end maybe the answer to your question is a dozen or so. About the same order of magnitude as the number of people that die due to dog bites. It's really small.

sevenless 10y ago
Fair enough. Maybe it's not such a big deal then.

malz 10y ago

How many people would die if the only manufacturer of the device goes out of business? It's not a flippant question; their only competitor pulled their product off the market, because the cost of fixing bugs was too great. How would it have helped to force them to charge less? http://www.fiercepharma.com/marketing/sanofi-s-auvi-q-recall-puts-mylan-s-rival-epipen-full-control-of-blockbuster-market http://www.fiercepharma.com/marketing/sanofi-s-auvi-q-recall...

dredmorbius 10y ago

There are from 30-950 cases per 100,000 people per year. Or an 0.03% to 0.9% incidence rate. That sets an upper bound on deaths. It corresponds to about 100,000 to 3 million exposures per year. If 10% of those were potentially fatal without treatment, you'd be looking at 10,000 to 300,000 deaths/year. Keep in mind I just pulled 10% out of my ass. You'd want to see how many people or cases would be untreated at the higher price level. But the information certainly supports the notion of thousands of deaths. At 1,000 deaths, that's about 1.6 million in profits per corpse for Mylan, based on $1.6 billion in additional profit. http://rnspeak.com/case-study/anaphylactic-shock-case-study-the-impending-doom/ http://rnspeak.com/case-study/anaphylactic-shock-case-study-...