5 ms·

Here’s the rub with developing something as important as a medicine. If it works, people often _need_ it to prolong their life or improve their health. What dru

Here’s the rub with developing something as important as a medicine. If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. We ought not look at it through our normal understanding of goods in a free market. Take, for example, Sovaldi, a drug which cures Hepatits C. After discovering this drug and confirming its efficacy and safety, the next question should be, IMO: how fast can we possible scale production to quickly stop liver damage and cure those suffering. Instead we have Medicaid setting absurd rules (https://www.chlpi.org/wp-content/uploads/2013/12/Annals-of-Internal-Medicine-HCV_July_2015.pdf https://www.chlpi.org/wp-content/uploads/2013/12/Annals-of-I...) whereby sufferers must get sicker before they are eligible to be cured. That is seriously fucked up. Edit: to be clear on why states must do this: Gilead Sciences is charging $84,000 for a course of treatment and there isn’t enough money to treat every patient. Gilead offers the same treatment in Egypt for $900. (https://www.reuters.com/article/us-hepatitis-egypt-gilead-sciences/gilead-offers-egypt-new-hepatitis-c-drug-at-99-percent-discount-idUSBREA2K1VF20140321 https://www.reuters.com/article/us-hepatitis-egypt-gilead-sc...)

koolba 8y ago
Medicaid should consider medical tourism. Sure it’s absurd to have to ship patients halfway around the world to literally take some medicine but it would be cost effective... https://en.m.wikipedia.org/wiki/Medical_tourism https://en.m.wikipedia.org/wiki/Medical_tourism
- TomK32 8y ago
  English patients in the south-west are already taking the trip across the channel for much quicker operation appointments that they'd get with the NHS. For the near future that won't come at an extra cost for the patients.
ianai 8y ago
One possible solution: have the government buy the rights for cost + some preset mark up. Then make it a government program to produce and transmit. Could earn some serious well wishing abroad by making it available for cost/free for developing nations. That’s how to lead the world.
- mch82 8y ago
  Nice idea. Worth at least looking into the feasibility.
kemiller2002 8y ago
My coworker's dad had this happen to him. He got Hep C through a blood transfusion for a routine surgery. The insurance company waited until he was almost dead before starting the treatment. Now his liver is in such bad shape that if he has any alcohol it will kill him. Ridiculous, especially since they were going to pay for it anyway.
- booleandilemma 8y ago
  Doctors should be the ones making the medical decisions, not the faceless employees working with spreadsheets at insurance companies. Our system is backwards and needs to be overhauled.
  - throwaway84742 8y ago
    Seems like you wouldn’t like universal healthcare then, where such things happen to _everybody_.
    - aaronbrethorst 8y ago
      Stephen Hawking would have disagreed vehemently with you. https://www.theguardian.com/science/2018/mar/14/i-would-not-have-survived-nhs-enabled-stephen-hawking-to-live-long-life https://www.theguardian.com/science/2018/mar/14/i-would-not-...
      - throwaway84742 8y ago
        And Charlie Gard would have disagreed with Stephen had the court not decided that he should die. There is another high profile ALS sufferer in the US: Jason Becker, a super virtuoso guitarist popular in the 80s, tragically afflicted at the very peak of his ability. Still alive, still writing music, but can’t move anything but his eyes or breathe. No one sentenced him to death or anything. https://en.m.wikipedia.org/wiki/Jason_Becker https://en.m.wikipedia.org/wiki/Jason_Becker
    - jadedhacker 8y ago
selimthegrim 8y ago
https://endpts.com/pharmas-broken-business-model-an-industry-on-the-brink-of-terminal-decline/ https://endpts.com/pharmas-broken-business-model-an-industry...
AnthonyMouse 8y ago
> If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. It is very much like many other products. If you don't have food you will die of starvation, if you don't have shelter you will die of exposure, etc. The real issue is drug patents. Nobody is complaining about the price of ibuprofen any more than they complain about the price of eggs. But the patent system is doing what it's supposed to here -- twenty years ago any patented drug didn't exist, and it nominally only exists now because the inventors judged it to be sufficiently profitable to conduct the research. If you make it less profitable, you'll get less research. There is no drug research fairy. If you don't want the money to come from high insurance premiums that pay for high drug costs, it has to come from somewhere else. And just devising some other method (like taxes) of extracting the same money from the same general public isn't really going to change much.
- mikeash 8y ago
  Pharmaceutical R&D spending isn’t all that high. It’s around $300 per capita in the US. The money is not coming from high insurance premiums.
  - pg_bot 8y ago
    That is around 90 Billion dollars. I'm not sure where you got that number exactly, but phrma member companies list their combined 2016 R&D expenditures at 65.3 billion[0] so it seems plausible. For context that is around the GDP of Slovakia or Sri Lanka. (65th and 66th biggest world economies)[1] [0] https://www.phrma.org/press-release/randd-investment-by-u-s-biopharmaceutical-companies-remains-strong-despite-ongoing-economic-challenges https://www.phrma.org/press-release/randd-investment-by-u-s-... [1] https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nominal) https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nomi...
    - mikeash 8y ago
      I don’t understand how comparing it to the GDP of small foreign countries adds context. The important context is what I stated: it’s about $300 per person. That means that it’s a very small portion of our ~$10,000/year per capita health care expenditures. Anyone who knows how much their health insurance costs per year can immediately see how much of that funds their share of pharma R&D. The answer will almost always be “not very much.”
rayiner 8y ago
> We ought not look at it through our normal understanding of goods in a free market. This is the biggest flaw in how we think about many important issues. Market economics isn’t something you decide to apply or not based on public policy. Instead, its the framework of actions and consequences against which you must determine public policy. If your policy is to have private companies develop and commercialize medicines, then you need to ensure functioning markets from drugs. That means avoiding antitrust issues, but also avoiding free-rider problems that result for drugs being easy to copy. You can, of course, do something else, such as having the government pay to commercialize drugs. What you can’t do is eat your cake and have it too, by deciding that you can somehow “opt out” of market dynamics for industries you deem to be of public importance. It’s like saying that “supersonic flight is important, so we ought not to look at it through our normal understanding of aerodynamics.”
- torpfactory 8y ago
  We most certainly do get out of market economics for some things we deem important. Think defense, water and electric utilities, and law enforcement.
  - rayiner 8y ago
    We don’t “get out of market economics.” We choose to find those things through government. But we’re still slaves to market forces. E.g. the government prices water too low and thus encourages waste of water resources.
carlmr 8y ago
>Gilead Sciences is charging $84,000 for a course of treatment and there isn’t enough money to treat every patient. Gilead offers the same treatment in Egypt for $900. (https://www.reuters.com/article/us-hepatitis-egypt-gilead-sc... https://www.reuters.com/article/us-hepatitis-egypt-gilead-sc...) The free market solution would be to send your patients to Egypt to get treated. Ecnonomy class flight + drugs = $2000 (maybe $3000 from Hawaii). The biggest issue with American health care is if you have something acute that needs immediate treatment. Then you're f*ed. But for 95% of non-acute cases, travel to Latin America, travel to Europe, travel to North Africa, or Asia and get the drugs + plane ticket at out of pocket prices lower than your co-pay. I know this is ecologically terrible in terms of CO2, but it's what I would be doing in that case.
- dagw 8y ago
  Of course the only reason Gilead feels comfortable charging $900 to Egypt is that they believe they have the market fairly well segmented. If that market segmentation where to disintegrate then the prices in Egypt would rapidly rise (and prices in the US would no doubt fall).
- omegaham 8y ago
  I spent several years stationed in Yuma, AZ, and a lot of people would come to Yuma to do just that. They can't afford a procedure in the US, or they're waitlisted to oblivion in Canada, so they fly into Yuma, take a shuttle across the border, and have it done in Algodones. As always, you need to be smart, but people are willing to take the risk of complications if it means the difference between a modest expense and facing a medical bankruptcy. The same thing applies with dental work. All of my wife's root canals were done in Mexico.

koolba 8y ago

Medicaid should consider medical tourism. Sure it’s absurd to have to ship patients halfway around the world to literally take some medicine but it would be cost effective... https://en.m.wikipedia.org/wiki/Medical_tourism https://en.m.wikipedia.org/wiki/Medical_tourism

TomK32 8y ago
English patients in the south-west are already taking the trip across the channel for much quicker operation appointments that they'd get with the NHS. For the near future that won't come at an extra cost for the patients.

ianai 8y ago

One possible solution: have the government buy the rights for cost + some preset mark up. Then make it a government program to produce and transmit. Could earn some serious well wishing abroad by making it available for cost/free for developing nations. That’s how to lead the world.

mch82 8y ago
Nice idea. Worth at least looking into the feasibility.

kemiller2002 8y ago

My coworker's dad had this happen to him. He got Hep C through a blood transfusion for a routine surgery. The insurance company waited until he was almost dead before starting the treatment. Now his liver is in such bad shape that if he has any alcohol it will kill him. Ridiculous, especially since they were going to pay for it anyway.

booleandilemma 8y ago
Doctors should be the ones making the medical decisions, not the faceless employees working with spreadsheets at insurance companies. Our system is backwards and needs to be overhauled.
- throwaway84742 8y ago
  Seems like you wouldn’t like universal healthcare then, where such things happen to _everybody_.
  - aaronbrethorst 8y ago
    Stephen Hawking would have disagreed vehemently with you. https://www.theguardian.com/science/2018/mar/14/i-would-not-have-survived-nhs-enabled-stephen-hawking-to-live-long-life https://www.theguardian.com/science/2018/mar/14/i-would-not-...
    - throwaway84742 8y ago
      And Charlie Gard would have disagreed with Stephen had the court not decided that he should die. There is another high profile ALS sufferer in the US: Jason Becker, a super virtuoso guitarist popular in the 80s, tragically afflicted at the very peak of his ability. Still alive, still writing music, but can’t move anything but his eyes or breathe. No one sentenced him to death or anything. https://en.m.wikipedia.org/wiki/Jason_Becker https://en.m.wikipedia.org/wiki/Jason_Becker
  - jadedhacker 8y ago

selimthegrim 8y ago

https://endpts.com/pharmas-broken-business-model-an-industry-on-the-brink-of-terminal-decline/ https://endpts.com/pharmas-broken-business-model-an-industry...

AnthonyMouse 8y ago

> If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. It is very much like many other products. If you don't have food you will die of starvation, if you don't have shelter you will die of exposure, etc. The real issue is drug patents. Nobody is complaining about the price of ibuprofen any more than they complain about the price of eggs. But the patent system is doing what it's supposed to here -- twenty years ago any patented drug didn't exist, and it nominally only exists now because the inventors judged it to be sufficiently profitable to conduct the research. If you make it less profitable, you'll get less research. There is no drug research fairy. If you don't want the money to come from high insurance premiums that pay for high drug costs, it has to come from somewhere else. And just devising some other method (like taxes) of extracting the same money from the same general public isn't really going to change much.

mikeash 8y ago
Pharmaceutical R&D spending isn’t all that high. It’s around $300 per capita in the US. The money is not coming from high insurance premiums.
- pg_bot 8y ago
  That is around 90 Billion dollars. I'm not sure where you got that number exactly, but phrma member companies list their combined 2016 R&D expenditures at 65.3 billion[0] so it seems plausible. For context that is around the GDP of Slovakia or Sri Lanka. (65th and 66th biggest world economies)[1] [0] https://www.phrma.org/press-release/randd-investment-by-u-s-biopharmaceutical-companies-remains-strong-despite-ongoing-economic-challenges https://www.phrma.org/press-release/randd-investment-by-u-s-... [1] https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nominal) https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(nomi...
  - mikeash 8y ago
    I don’t understand how comparing it to the GDP of small foreign countries adds context. The important context is what I stated: it’s about $300 per person. That means that it’s a very small portion of our ~$10,000/year per capita health care expenditures. Anyone who knows how much their health insurance costs per year can immediately see how much of that funds their share of pharma R&D. The answer will almost always be “not very much.”

rayiner 8y ago

> We ought not look at it through our normal understanding of goods in a free market. This is the biggest flaw in how we think about many important issues. Market economics isn’t something you decide to apply or not based on public policy. Instead, its the framework of actions and consequences against which you must determine public policy. If your policy is to have private companies develop and commercialize medicines, then you need to ensure functioning markets from drugs. That means avoiding antitrust issues, but also avoiding free-rider problems that result for drugs being easy to copy. You can, of course, do something else, such as having the government pay to commercialize drugs. What you can’t do is eat your cake and have it too, by deciding that you can somehow “opt out” of market dynamics for industries you deem to be of public importance. It’s like saying that “supersonic flight is important, so we ought not to look at it through our normal understanding of aerodynamics.”

torpfactory 8y ago
We most certainly do get out of market economics for some things we deem important. Think defense, water and electric utilities, and law enforcement.
- rayiner 8y ago
  We don’t “get out of market economics.” We choose to find those things through government. But we’re still slaves to market forces. E.g. the government prices water too low and thus encourages waste of water resources.

carlmr 8y ago

>Gilead Sciences is charging $84,000 for a course of treatment and there isn’t enough money to treat every patient. Gilead offers the same treatment in Egypt for $900. (https://www.reuters.com/article/us-hepatitis-egypt-gilead-sc... https://www.reuters.com/article/us-hepatitis-egypt-gilead-sc...) The free market solution would be to send your patients to Egypt to get treated. Ecnonomy class flight + drugs = $2000 (maybe $3000 from Hawaii). The biggest issue with American health care is if you have something acute that needs immediate treatment. Then you're f*ed. But for 95% of non-acute cases, travel to Latin America, travel to Europe, travel to North Africa, or Asia and get the drugs + plane ticket at out of pocket prices lower than your co-pay. I know this is ecologically terrible in terms of CO2, but it's what I would be doing in that case.

dagw 8y ago
Of course the only reason Gilead feels comfortable charging $900 to Egypt is that they believe they have the market fairly well segmented. If that market segmentation where to disintegrate then the prices in Egypt would rapidly rise (and prices in the US would no doubt fall).
omegaham 8y ago
I spent several years stationed in Yuma, AZ, and a lot of people would come to Yuma to do just that. They can't afford a procedure in the US, or they're waitlisted to oblivion in Canada, so they fly into Yuma, take a shuttle across the border, and have it done in Algodones. As always, you need to be smart, but people are willing to take the risk of complications if it means the difference between a modest expense and facing a medical bankruptcy. The same thing applies with dental work. All of my wife's root canals were done in Mexico.