4 ms·

I don't think that's a very good point. In order for people to be willing to pay the ever-rising costs for the best drugs they are going to have to work, drug c

I don't think that's a very good point. In order for people to be willing to pay the ever-rising costs for the best drugs they are going to have to work, drug companies aren't going to make much money once they've lost the trust of their customers. Perhaps the funding is problematic in one way or another but I doubt it's in drug companies' best interest to keep us sick.

deleted 10y ago
[deleted]
reddytowns 10y ago
If it takes 5 to 10 years before a drug makes you sick, no one will care. It's all about next quarter
Retric 10y ago
The increasing cost relates to drug companies running out of useful simple molecules. If you count the number of new drugs that treat common problems aka more than 100,000 people per year in the US and are not closely related to another drug you get a very tiny number of new drugs per year. Sure we have a lot of drugs related to Morphine, but most of them are not significantly different from Morphine as to be worth high prices. When viagra goes generic at the end of the year the hurdle for the next male 'enhancement' drug ratchets up.
akiselev 10y ago
This isn't a hypothetical problem but a well known issue within the pharmaceutical industry. The drug companies don't purposefully make drugs that cause harm in order to sell more of their other products but the economic incentives in the United States healthcare market are extremely misaligned. The end result is, essentially, an industry that "keeps us sick" to maximize profit not because of malice, but because of a market failure. Market size and total profit over the lifetime of the patent is the primary factor that is considered at every step from random screening to clinical trials. Spinning up a clinical trial requires many tens or hundreds of man-years of work by very specialized and hard to find scientists/doctors before you even sign up your first human subject so even the biggest pharma companies have limited bandwidth. This forces them to be very selective, even when they have multiple high-potential targets, and that means choosing to run the clinical trials for drugs with the highest potential ROI and lowest regulatory approval risk. For a variety of reasons, cures are usually much more complex and difficult to develop and get approved than simple drugs that treat symptoms and since the US has a complex, opaque network of insurance companies instead of a single payer, no one is in a position to negotiate prices that maximize healthcare ROI at scale. There is little incentive for pharmaceutical companies to develop cures for diseases when they can provide a "good enough" quality of life boost for the entire lifetime of the patient and sell it for the exact same price. This means that often times cures won't even be researched past animal testing because the pharma company has a large pipeline of less risky, more profitable drugs to get through the FDA
- refurb 10y ago
  This is wrong on a number of levels. I've worked for a couple biotech companies and typically the commercial viability of a drug isn't examined until about phase 1. And even then it's a very rough estimate. I highly doubt any company is calculating an ROI at the screening stage. Second, it's typically the science that limits the effectiveness of therapy, not the potential ROI. The reason why many drugs only treat symptoms is because that's the best science can do right now. Third, curing a disease can often have a much better ROI than just treating symptoms forever. Look at Gilead's hepatitis C cure. Before it came to market the drug revenue for that disease was maybe $2 billion. The first year that Gilead's drugs were on the market, they sold $12 billion. The cure was way more profitable.
  - Noseshine 10y ago
    I think you are both right, both forces (and more) are at work. Market effects are not about what individuals plan or want, it's about system outcomes. If, just as a thought experiment, it was possible to treat a disease quickly with a cheap drug or intervention, for example a cheap herbal drug that is available patent-free and for mere cents per liter, there would be no business in it, so no company could viably pursue this. The market selects for treatments that give a lot of profit. That always or even merely "usually" automatically somehow translates into the best option from a public health point of view only if you close your eyes and make lots of assumptions about how great the market magic works - in a market with extremely unequal information and very high pressure on customers (when you are sick). On the other hand you are right that symptom treatment usually is the best we can do. The body is built during the early years and from then on it's maintenance, also what the body itself does and not just the doctors (it does not regenerate most structures, only repair). Just more and more ever more horrible hacks, workarounds and kludges and patches delaying the long decline more or less well. Or as most drugs do, don't even repair anything, just push levers and buttons in the body, but it doesn't do anything structural unless the body does it on its own. So if the structures don't regenerate the button-pushing drug has to be take lifelong. That is so fundamental to complex life forms that current medicine simply cannot work against it. Maybe never, because replacing a structure in the grown body is much more difficult than growing it with everything else. For example, the difficulty of finding the path for new axons after a spinal injury is much greater than building everything together during very early development. Medicine would not just have to achieve what nature already does (when the body is assembled) - it would have to become far better! Repairing something often is much more difficult than starting from scratch.

deleted 10y ago

[deleted]

reddytowns 10y ago

If it takes 5 to 10 years before a drug makes you sick, no one will care. It's all about next quarter

Retric 10y ago

The increasing cost relates to drug companies running out of useful simple molecules. If you count the number of new drugs that treat common problems aka more than 100,000 people per year in the US and are not closely related to another drug you get a very tiny number of new drugs per year. Sure we have a lot of drugs related to Morphine, but most of them are not significantly different from Morphine as to be worth high prices. When viagra goes generic at the end of the year the hurdle for the next male 'enhancement' drug ratchets up.

akiselev 10y ago

This isn't a hypothetical problem but a well known issue within the pharmaceutical industry. The drug companies don't purposefully make drugs that cause harm in order to sell more of their other products but the economic incentives in the United States healthcare market are extremely misaligned. The end result is, essentially, an industry that "keeps us sick" to maximize profit not because of malice, but because of a market failure. Market size and total profit over the lifetime of the patent is the primary factor that is considered at every step from random screening to clinical trials. Spinning up a clinical trial requires many tens or hundreds of man-years of work by very specialized and hard to find scientists/doctors before you even sign up your first human subject so even the biggest pharma companies have limited bandwidth. This forces them to be very selective, even when they have multiple high-potential targets, and that means choosing to run the clinical trials for drugs with the highest potential ROI and lowest regulatory approval risk. For a variety of reasons, cures are usually much more complex and difficult to develop and get approved than simple drugs that treat symptoms and since the US has a complex, opaque network of insurance companies instead of a single payer, no one is in a position to negotiate prices that maximize healthcare ROI at scale. There is little incentive for pharmaceutical companies to develop cures for diseases when they can provide a "good enough" quality of life boost for the entire lifetime of the patient and sell it for the exact same price. This means that often times cures won't even be researched past animal testing because the pharma company has a large pipeline of less risky, more profitable drugs to get through the FDA

refurb 10y ago
This is wrong on a number of levels. I've worked for a couple biotech companies and typically the commercial viability of a drug isn't examined until about phase 1. And even then it's a very rough estimate. I highly doubt any company is calculating an ROI at the screening stage. Second, it's typically the science that limits the effectiveness of therapy, not the potential ROI. The reason why many drugs only treat symptoms is because that's the best science can do right now. Third, curing a disease can often have a much better ROI than just treating symptoms forever. Look at Gilead's hepatitis C cure. Before it came to market the drug revenue for that disease was maybe $2 billion. The first year that Gilead's drugs were on the market, they sold $12 billion. The cure was way more profitable.
- Noseshine 10y ago
  I think you are both right, both forces (and more) are at work. Market effects are not about what individuals plan or want, it's about system outcomes. If, just as a thought experiment, it was possible to treat a disease quickly with a cheap drug or intervention, for example a cheap herbal drug that is available patent-free and for mere cents per liter, there would be no business in it, so no company could viably pursue this. The market selects for treatments that give a lot of profit. That always or even merely "usually" automatically somehow translates into the best option from a public health point of view only if you close your eyes and make lots of assumptions about how great the market magic works - in a market with extremely unequal information and very high pressure on customers (when you are sick). On the other hand you are right that symptom treatment usually is the best we can do. The body is built during the early years and from then on it's maintenance, also what the body itself does and not just the doctors (it does not regenerate most structures, only repair). Just more and more ever more horrible hacks, workarounds and kludges and patches delaying the long decline more or less well. Or as most drugs do, don't even repair anything, just push levers and buttons in the body, but it doesn't do anything structural unless the body does it on its own. So if the structures don't regenerate the button-pushing drug has to be take lifelong. That is so fundamental to complex life forms that current medicine simply cannot work against it. Maybe never, because replacing a structure in the grown body is much more difficult than growing it with everything else. For example, the difficulty of finding the path for new axons after a spinal injury is much greater than building everything together during very early development. Medicine would not just have to achieve what nature already does (when the body is assembled) - it would have to become far better! Repairing something often is much more difficult than starting from scratch.