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Why Snakebites Are About to Get a Lot More Deadly
- NathanKP 17y agoIt seems ridiculous to me that the FDA prevents scientists and doctors from getting known, proven anti-venom products back in the market, whereas the rich corporations can get drugs on the market that still aren't proven to be much more effective than a placebo, but with worse side effects.
- deleted 17y ago[deleted]
- pyre 17y agoIt seems like this would be an instance where the government should provide the funding. It's in the public's best interest to have at least one anti-venom product available. It makes no sense to tell people "tough luck" when they get bitten just because it's too expensive to pay for the studies to get government approval.
- earl 17y agoWell, until it has been tested, it is neither tried nor proven. And here is but a single reason http://en.wikipedia.org/wiki/Thalidomide http://en.wikipedia.org/wiki/Thalidomide for such testing requirements. Edit: to be clear, I was attempting to respond to the parent's parent post. I apparently suck at internet.
- barrkel 17y agoThe use case for an antivenom based on known working precedents, where the untreated alternative is death, is somewhat different to sedatives used generally to treat colds, coughs, morning sickness, etc.
- earl 17y agoNo. Read the article -- in the example used, the alternative is weeks on a ventilator. Which we know works. Until these drugs are known to be efficacious with tolerable side effects, they are still a second best treatment.
- pyre 17y agoWhat if you are too far away from a facility that can provide that for you? Having a syringe of anti-venom with you can be the difference between life and death.
- evgen 17y agoThere is no facility you will encounter that has the anti-venom but does not have a ventilator. This is not like an epi-pen or some other OTC med that a backpacker will carry with them, it is a hospital-dispensed, fucking expensive dose of medicine (e.g. rattlesnake anti-venom is around $4K/bottle.) But why let reality get in the way of a good rant I guess...
- pyre 17y agoHow could you classify my comment as a rant? I realize that 'tone' doesn't really translate well through text and you might read my comment as an attack (which it wasn't), but how can a couple of sentences be a 'rant?' I would think that a rant would have to be at least a few sentences or more (or some sort of absolute character/word limit in the case of large run-on sentences). If you felt it was made in anger or hate, I would think it would classify as a retort or something similar.
- pyre 17y ago> Edit: to be clear, I was attempting to respond to the parent's parent post. I apparently suck at internet. Something weird happened. When I originally posted, your comment was a sibling post to mine (and was already a child of the root of this thread after the page reload from submitting my comment). I was surprised when I came back to this thread to see your comment a child to my comment.
- Gormo 17y agoOr simply revoke the patent for these antivenoms so that companies that don't have the same opportunity costs can enter the niche. I think it would solve a lot of other problems (e.g. submarine patents) if patent holders were required (within defined bounds) to offer their patented products for sale on the open market in order to retain the patent.
- brg 17y agoAs much as you may be against software patents, there can be no current patent restriction on the production of coral-snake antivenom if it was approved in 1967. The problem described in the article is simply that so few bites occur, the effort to make antivenom is not interesting to anyone with the skills or equipment to make it. This includes individual pharmacists, university scientists, and corporations; all of who can but do not provide antivenom.
- Gormo 17y agoThat's a good point; I didn't make the connection with the 1967 date and focused on the article referencing that one company as the only source of antivenom. Is it possible for pharmacists to synthesize anti-venom on demand? Coral snake bites may be rare, but if you were, for example, the operator of an Everglades tour group, your probability of encountering a bite might be a bit higher, and the antivenom would be good to keep around.
- sigstoat 17y agoyou'd probably want an organic synthesis chemist, not a pharmacist. and you wouldn't have time for him to have the appropriate glassware fabricated, and synthesis equipment setup. so he'd have to leave a room with it all step up properly. ...which sounds like the sort of thing you might do if you were just manufacturing it.
- brg 17y agoPerhaps originally I should have said pharmacologist, but even in retrospect your term of a specialized chemist seems more correct.
- elidourado 17y agoMy view is that people should be allowed to opt out of FDA regulation if they wish to do so. It's my body; I should be allowed to put anything I want into it. It took 10 years for the first beta blockers to be approved in the US after they were in use in Europe. In that amount of time, thousands of Americans died for lack of the drugs. It's hard to distinguish this from mass murder, or at least mass manslaughter.
- earl 17y agoAnd Thalidomide wasn't approved in the US whereas it was approved in Europe and Canada. So... your point is stupid.
- deleted 17y ago[deleted]
- jsn 17y agoNo, it's not, but your point definitely is irrelevant. You see, it's my body, so I can put whatever I want in it, be it aspirin, heroin, thalidomide or cyanide. And yeah, I may wish to make an educated choice about that, but then again, I don't have to.
- pyre 17y agoTrue, but when you're talking medicines, you may not have a choice in the matter. e.g. You come into the emergency room unconscious, what medicines should the doctors be allowed to use?
- jsn 17y agoBasically, if someone is going to make a decision affecting my body while I'm unconscious, I'd rather have someone I picked for that job to do it (like, I don't know, my doctor or my wife or my dad or my friend or even my insurance company) than some bureaucrat in FDA. But that's not quite the issue in question, eh? My understanding is, you can't get the unapproved anti-venom even if you are conscious and you are about to die without it anyway, by doctors opinion.
- Tichy 17y agoThere might be a connection, rich corporations benefit from costly approval procedures. Keeps the small competition at bay.
- Jun8 17y agoWhew, this article was a real eye-opener. I didn't know we had anti-venom shortages, my assumption being that you can go to a hospital after a bite in time you'll be easily cured.
- imajes 17y agowhereas in reality, "The cost of ... antivenom is $2000 – $3000 per bottle" [1] and you should hope that your health insurance covers it. I've heard of anti-venom which is more like $10k per bottle, but can't find a link. oh, and you'll hope that there's a location in-state, otherwise you're going to rely on the fastest courier to get one to you, once you've been approved. [1] http://www.biochem.arizona.edu/CatalystWebsite/Fall04/Feature2.html http://www.biochem.arizona.edu/CatalystWebsite/Fall04/Featur...
- pyre 17y ago> you should hope that your health insurance covers it. I don't think that the choice between thousands of dollars of debt and death is a hard one to make... Even in this case where without the anti-venom you could 'wait out' the venom on breathing apparatus, it will cost your $100K+ (according to the article). You don't really have many choices. It basically comes down to: death or debt. I know which one I choose.
- kgermino 17y agoThat leads into a whole other debate. Death vs. Debt is straightforward when you're 30 or 40 and looking at $100k to cure a snakebite. It's an entirely different issue when you're 70 and looking at a $2m cancer treatment, the only problem is then you know that your debt will be payed for by the government.
- pyre 17y ago> Death vs. Debt is straightforward when you're 30 or 40 and looking at $100k to cure a snakebite. It's an entirely different issue when you're 70 and looking at a $2m cancer treatment, the only problem is then you know that your debt will be payed for by the government. That may be, but this entire discussion is around snakebites and anti-venom which is a lot different than a (possibly) terminal condition like cancer. You're completely changing the frame of reference when you compare 2 different types of health issue and two different age brackets at the same time...
- deleted 17y ago[deleted]
- gcv 17y agoFascinating. I had no idea that anti-venoms make for such a great example of regulatory failure: a completely strangled market and the resulting dangerous shortages.
- yalurker 17y agoMy read of the article makes this sound more like a natural failure than a regulatory one. The anti-venoms are very expensive to make and very rarely needed. I see no reason that these drugs should get a pass on FDA testing that other drugs are held to, so it doesn't seem like a regulatory failure. It seems like some body acting for the general good (ie, government or nonprofit, maybe some life/health insurance?) should pay for the FDA trials to help get the alternative drugs to market.
- ubernostrum 17y agoFascinating. I had no idea that government regulation is the force which drives companies to stop manufacturing products which are expensive to manufacture and for which there's little demand in the market. You've truly opened my eyes to this hitherto-unseen lurking evil.
- gcv 17y agoThe article clearly states that Coralmyn would have been on the market, except for FDA approval. The demand is low, I agree, but regulatory overhead made the difference between producing something and producing nothing.
- fjabre 17y agoWhile it's done a lot of good for making things safe to eat and is a necessary public service I'm going to have to say that currently: ...The FDA sucks... You need millions in legal/preparation fees just to get your foot in the door and the level of bureaucratic bullshit you have to deal with still blows my mind. My company has had a lot of experience in this sorry to say. Again. Going to reiterate here: The FDA sucks and needs to be completely overhauled. Lots of PhDs and government bureaucrats spending too much time behind a desk with no real world experience and dictating arcane rules to the rest of us - that's the FDA I know.
- Retric 17y agoI don't think the FDA is the real problem on this one. There is a known treatment whose patents have expired, however for now nobody is willing to manufacture it.
- atlbeer 17y agoIt's just not profitable to manufacture the currently known solutions. If someone discovers a new, better antivenin you would still have to spend millions of dollars and wait years to pass the FDA guidelines. That alone probably destroys the profitability margins of most discoverable solutions due to the small demand.
- deleted 17y ago[deleted]
- fnid2 17y agoYou know, when you boil it all down, most things in life are about the approval process. Money has become the defacto standard for approval. If the FDA requires millions of dollars to be approved, then the people, law, and pharmacies believe that organization getting approval must be approve worthy. If you are a guy in a shed with a couple thousand bucks and a cancer cure, ... hmm... you're just a guy in a shed. If you were smart enough to cure cancer, obviously you'd have more than a couple thousand bucks -- right? So that's how society works. A series of gate keepers who have become persuasive enough to acquire "convincing wealth". Wealth is all you need to convince others that whatever you have and whatever you may have in the future is worth buying into, either in thought, or as a product. Many times, this convincing is as easy as an advertisement on television or some clever lawyers who can figure out that all you have to do is change the name of your product and market it to another segment to extend your patent.
- yalurker 17y agoMy first thought reading the article: Could something like the Bill & Melinda Gates Foundation step in to make life-saving but unprofitable drugs available? This seems like a very legitimate problem that might be worthy of attention from some non-profit, but maybe it just effects too few people?
- megablast 17y agoMaybe it is just too expensive to keep producing these drugs, when they are not needed. As horrible as it is to say, there is a price on a human life. If those millions can be better spent elsewhere, surely we should be doing that.
- boyter 17y agoInteresting. Being an Aussie it makes me wonder what the situation regarding anti-venoms are here, because lets face it everything over here is either poisonous or venomous which with the small population and the large distances makes it potentially a worse problem.
- thisrod 17y agoGoing by rumours I've heard from snake fanciers, Australian doctors don't like anti-venom as much as they used to. Besides being expensive, it's quite dangerous. They've gotten so good at keeping people alive that it's often safer to let the victim recover naturally. The large distances don't matter as much as you'd think, because first aid management of snakebite is very effective. If you're bitten by a snake, and there are country people or bushwalkers around, you can spend many hours getting to hospital, or even days.
- boyter 17y agoI can belive that. What worries me is if you do need it that they cant get at it quickly enough. As for distances though im not sure if I would care to be waiting hours following a Taipan bite considering how neurotoxic the venom is and how much they can inject.
- jheriko 17y agoThey say you can't put a price on human life... piffle.
- ars 17y agoI think the US should fund the NiH to do drug studies for potentially good, but uneconomic (usually because no patent is possible, but also if they isn't a high demand) drugs. Give it say 40 million a year, and they should do as many studies as they have money for. I think that's enough for about 4-10 per year.
- matwood 17y agoJust make it part of the science research grants they give out. I'm sure there are some scientists out there who love to work with venom and anti-venom :)
- old-gregg 17y ago..intubate coral snake bite victims on ventilators for weeks until the effects of the toxin wear off--potentially costing hundreds of thousands of dollars per bite.. Granted, the antivenom situation is ridiculous, but the quote above exposes yet another, much larger ridiculous issue: why is it OK to charge "hundreds of thousands of dollars" for a few weeks of hospital stay? Is it because lung vent. machines are $1 billions apiece, or what? How do they come up with those ridiculous bills? Are they really riding 1000% profit margins there or what's going on?
- ojbyrne 17y agohttp://blogs.law.harvard.edu/philg/2010/05/10/americas-efficient-health-care-system-my-15-bill-for-a-checkup/ http://blogs.law.harvard.edu/philg/2010/05/10/americas-effic... "So… in terms of the real economy, this was an $83 transaction, equivalent to what you might spend on dinner for two. But instead of being paid with a credit card swipe, there were apparently multiple clerks involved at the doctor’s office and the insurer. Negotiations happened behind the scenes. A paper invoice was printed and put into an envelope by hand. A check was mailed through the U.S. mail"
- matwood 17y agoExactly. The effort required to meet insurance and then government regulations for a doctor or hospital to get paid is through the roof. I was at the doctor not long ago and noticed a sign at the desk that if you paid in full with cash or credit he would give you a price that was close to or below many people's rising co-pays.
- RyanMcGreal 17y agoKnow what would fix that? Universal, single payer health insurance.
- walkon 17y agoThen move to the UK, where their debt is about to eclipse that of Greece.
- 10ren 17y agoAdam Smith showed that some regulations lead to smuggling (he spoke of gold and silver mainly). Doesn't this antidote situation == instant black market, via internet-based mail-order from countries where it isn't banned? Though it probably wouldn't be delivered fast enough for when you need it; and organizations that would sensibly keep a stock of it (hospitals, zoos) are not in a position to buy from a black market; and if you're going to pay thousands for something and inject it, you probably want more assurance than a dodgey website can give. Unless you're dying.
- ddustin 17y agoThe FDA is here to protect you. If they didn't regulate testing of the anti-venom, how would you know it wouldn't kill you?
- natmaster 17y agoBut without regulation there would be chaos! All corporations are evil and want to kill you and the government is perfect and only has your best interests at heart!
- necubi 17y agoActually, that's exactly true. Without regulation there _would_ be chaos. It's not hard to look back a hundred years[1], before there was an FDA. Instead of real, effective cures the market was dominated by patent medicine, most of which was harmless (aside from not curing you) but much of which was actually dangerous. The FDA was set up not as a silly, unnecessary regulatory layer but to solve a very real problem that was actually killing and sickening people. It's easy to decry regulation today, when we have never personally seen the world before that regulation. But if you read your history, you would realize today's world is much more pleasant to live in. [1] OK, technically 104 years
- InclinedPlane 17y agoI see your point and I think I mostly agree with you. However, I don't think crediting the FDA with all of the benefits of the rise of medicine as a scientific discipline through the late 19th and early 20th century is entirely warranted. Were snake oil salesmen sidelined because of the FDA or because doctor's started developing medicines that actually, and obviously, worked (such as aspirin, sulfa drugs, etc)?
- necubi 17y agoThe point is, without the FDA there would be no way to tell the difference between actually effective medicines and snake oil. Since snake oil is a lot cheaper to research and make, economics would dictate that it would come to dominate the market. And ordinary people, left to their own devices, are spectacularly bad at differentiating between the two. This is clearly demonstrated by the contemporary anti-vax movement (with its attendent "alternative" cures) and the alternative medicine movement, which is almost entirely snake oil.
- roboneal 17y agoLost in all these borderline hysterical comments is that very few people get bitten by coral snakes - so few - that the remaining stock is expiring on the shelves. No Demand = No Supply.
- Goladus 17y agoTechnically, it's small demand about to become no supply. If bureaucracy is the only thing standing between a victim and treatment, a certain passion is understandable. People have a tendency to recognize injustice whether, rationally or statistically speaking, they shouldn't care about it.
- giardini 17y agoIt appears that anyone who could quickly provide the Mexican variant of the coral snake antivenin would be in a position to profit. Isn't there some room here for an entrepreneur/arbitrageur ("your money or your life!")?
- rsheridan6 17y agoI guess you could life-flight the patient out of reach of the FDA, if they could afford it.
- Yaa101 16y agoall for the big buck...