5 ms·

Slightly off-topic but one thing that I've always been honestly curious about is that literally billions of dollars are donated to cancer research each year...b

Slightly off-topic but one thing that I've always been honestly curious about is that literally billions of dollars are donated to cancer research each year...but then the practical results of the research are sold to oncology patients at bankrupting sums. So my question is when we donate to cancer research, are we donating to public research or are we handing our money to a for-profit corporation. What is the path from donation to six figure cancer treatments? I would be very interested in how that works.

Uberphallus 8y ago
> the practical results of the research are sold to oncology patients at bankrupting sums. In the US. [0] [0] https://www.healthsystemtracker.org/chart-collection/how-do-healthcare-prices-and-use-in-the-u-s-compare-to-other-countries/#item-on-average-other-wealthy-countries-spend-half-as-much-per-person-on-healthcare-than-the-u-s https://www.healthsystemtracker.org/chart-collection/how-do-...
- kokey 8y ago
  The rest of the world can thank people in the US for spending rather large sums on certain treatments. In the UK the treatments are covered by the state at no cost to the patient, but it's only a limited set of available treatments which are considered cost effective. In the US there are plenty more options, if you can pay for it. People may decide to bankrupt themselves or sell their house for these treatments that could enable them to survive or not, but either way they are contributing to real world data that informs the rest of the world of the efficiency and cost effectiveness of a particular treatment.
refurb 8y ago
Donations likely contribute to the body of knowledge about cancer. Then someone takes that and develops a new drug, charging a high price along with it. An interesting approach is the cystic fibrosis association in the US that directly invested in a new CF drug. They made a ton of money and rolled it back into research.
barry-cotter 8y ago
The research part of research and development is primarily done by publicly funded researchers. The development part is primarily done by private ones, who expend huge sums of money on trying many different candidate therapies and shepherding them through safety and efficacy trials, which almost all of them fail, at huge expense. If we want to increase the rate of return on investment the big, easy win would be dropping the efficacy test. If we want to reform the system of funding altogether buy out patents for their market value or give massive prizes and then have the drugs freely available for anyone to manufacture.
WhompingWindows 8y ago
There's a lot of grants for cancer research coming from donation dollars. For the Leukemia and Lymphoma society, which I've contributed to numerous times, they fund early-stage research going on at academic institutions mostly, though trials and patients are also supported. A number of their early-stage funded research projects have advanced to official FDA trials. The overall issue you're speaking of is the healthcare system in the US, which is not present in other countries where drugs and treatments may be present, albeit slightly delayed, for much cheaper. Some of the most expensive options are biologic drugs, which cost a lot but that's because they are more difficult to manufacture and are often tailored to the individual patient level. Still, the US healthcare system is supporting the main engine of biotechnological research in the world. Look at Cambridge, MA and you will see huge brain drain and financial investment into pharma and biotech companies.
aaavl2821 8y ago
For-profit companies actually fund more R&D than public research does (globally the biopharma industry spends $200B+ on R&D a year; NIH budget is $34B; not sure about other countries' public medical research budgets but doubt international public drug R&D approaches $200B tho i could be wrong). Typically the way it works today is that an academic group, startup or big pharma company will have a "seed" of an idea for a drug. Some of the early drug discovery work happens in academia, some in startups, some at big pharma. But by the time that a potential drug enters preclinical development it is almost always owned by a for-profit company because they have the budget and resources for this work. At this stage fewer than 0.01%-5% of candidate drugs end up working and getting approved by FDA, and it costs tens or hundreds of millions to get a drug approved (and it can cost multiples of that if you include cost of failed drugs). So these companies take a tremendous amount of risk. These days startups do most of the late stage discovery / early stage development work. They often take the drugs through the riskiest phases of development, generally up to Phase 1/2 or Phase 2 where effectiveness is first tested in humans. Phase 2 failure is the single largest driver of the cost of drug development. Phase 2 failure rates are as high as 60-70%, and it can cost $100M+ to get a drug to Phase 2. In many cases a startup will try to sell their drug to big pharma after good Phase 2 data. At this point the risk is much lower (drugs have a better than 50% chance of getting approved), but they require significant funding to do the large Phase 3 studies needed for approval and to fund commercialization (can need 9 figures just for Phase 3 work and submission to FDA). So at this point it is a lower risk / lower return bet, but an expensive one, and big pharma companies are structured to take those bets. However big pharma companies also spend a lot on early stage R&D. From looking at SEC filings, it seems roughly half of big pharma R&D is early stage and half late stage. The problem is that big pharma typically does not do well at early R&D. The return on investment in R&D at big pharma companies is approaching 0%. Much of the high price of drugs is simply a function of the high risk and high cost of drug development. Very few drugs that pharma invests in actually become profitable drugs. So they try to milk all they can out of the few winners. It isn't the case that pharma's business model is buying fully derisked products from academia and then jacking up the price. And while at some point publicly funded research could replace for-profit research, the reality today is that if we didnt have for-profit drug research then we would not have new drugs. in 2017 the FDA approved 49 new drugs. None of those were owned by non-profits at approval (one was owned by a public-private JV). There is not enough non-profit money to take drugs through the development process to FDA approval And when high prices do exist, in many cases it is because the drugs literally save lives. If you value a QALY at $50K / year (a common estimate), and your drug enables a child to live a full life who otherwise would have died at age 2 due to a rare genetic disease, it doesn't seem absolutely crazy to charge $1M for that drug. The issue to me seems to be more 1) what happens if you pay $1M for a drug and it doesn't work or 2) what if the patient cannot afford to pay $1M upfront for the drug even if it is guaranteed to add 20 healthy years to your life.

Uberphallus 8y ago

> the practical results of the research are sold to oncology patients at bankrupting sums. In the US. [0] [0] https://www.healthsystemtracker.org/chart-collection/how-do-healthcare-prices-and-use-in-the-u-s-compare-to-other-countries/#item-on-average-other-wealthy-countries-spend-half-as-much-per-person-on-healthcare-than-the-u-s https://www.healthsystemtracker.org/chart-collection/how-do-...

kokey 8y ago
The rest of the world can thank people in the US for spending rather large sums on certain treatments. In the UK the treatments are covered by the state at no cost to the patient, but it's only a limited set of available treatments which are considered cost effective. In the US there are plenty more options, if you can pay for it. People may decide to bankrupt themselves or sell their house for these treatments that could enable them to survive or not, but either way they are contributing to real world data that informs the rest of the world of the efficiency and cost effectiveness of a particular treatment.

refurb 8y ago

Donations likely contribute to the body of knowledge about cancer. Then someone takes that and develops a new drug, charging a high price along with it. An interesting approach is the cystic fibrosis association in the US that directly invested in a new CF drug. They made a ton of money and rolled it back into research.

barry-cotter 8y ago

The research part of research and development is primarily done by publicly funded researchers. The development part is primarily done by private ones, who expend huge sums of money on trying many different candidate therapies and shepherding them through safety and efficacy trials, which almost all of them fail, at huge expense. If we want to increase the rate of return on investment the big, easy win would be dropping the efficacy test. If we want to reform the system of funding altogether buy out patents for their market value or give massive prizes and then have the drugs freely available for anyone to manufacture.

WhompingWindows 8y ago

There's a lot of grants for cancer research coming from donation dollars. For the Leukemia and Lymphoma society, which I've contributed to numerous times, they fund early-stage research going on at academic institutions mostly, though trials and patients are also supported. A number of their early-stage funded research projects have advanced to official FDA trials. The overall issue you're speaking of is the healthcare system in the US, which is not present in other countries where drugs and treatments may be present, albeit slightly delayed, for much cheaper. Some of the most expensive options are biologic drugs, which cost a lot but that's because they are more difficult to manufacture and are often tailored to the individual patient level. Still, the US healthcare system is supporting the main engine of biotechnological research in the world. Look at Cambridge, MA and you will see huge brain drain and financial investment into pharma and biotech companies.

aaavl2821 8y ago

For-profit companies actually fund more R&D than public research does (globally the biopharma industry spends $200B+ on R&D a year; NIH budget is $34B; not sure about other countries' public medical research budgets but doubt international public drug R&D approaches $200B tho i could be wrong). Typically the way it works today is that an academic group, startup or big pharma company will have a "seed" of an idea for a drug. Some of the early drug discovery work happens in academia, some in startups, some at big pharma. But by the time that a potential drug enters preclinical development it is almost always owned by a for-profit company because they have the budget and resources for this work. At this stage fewer than 0.01%-5% of candidate drugs end up working and getting approved by FDA, and it costs tens or hundreds of millions to get a drug approved (and it can cost multiples of that if you include cost of failed drugs). So these companies take a tremendous amount of risk. These days startups do most of the late stage discovery / early stage development work. They often take the drugs through the riskiest phases of development, generally up to Phase 1/2 or Phase 2 where effectiveness is first tested in humans. Phase 2 failure is the single largest driver of the cost of drug development. Phase 2 failure rates are as high as 60-70%, and it can cost $100M+ to get a drug to Phase 2. In many cases a startup will try to sell their drug to big pharma after good Phase 2 data. At this point the risk is much lower (drugs have a better than 50% chance of getting approved), but they require significant funding to do the large Phase 3 studies needed for approval and to fund commercialization (can need 9 figures just for Phase 3 work and submission to FDA). So at this point it is a lower risk / lower return bet, but an expensive one, and big pharma companies are structured to take those bets. However big pharma companies also spend a lot on early stage R&D. From looking at SEC filings, it seems roughly half of big pharma R&D is early stage and half late stage. The problem is that big pharma typically does not do well at early R&D. The return on investment in R&D at big pharma companies is approaching 0%. Much of the high price of drugs is simply a function of the high risk and high cost of drug development. Very few drugs that pharma invests in actually become profitable drugs. So they try to milk all they can out of the few winners. It isn't the case that pharma's business model is buying fully derisked products from academia and then jacking up the price. And while at some point publicly funded research could replace for-profit research, the reality today is that if we didnt have for-profit drug research then we would not have new drugs. in 2017 the FDA approved 49 new drugs. None of those were owned by non-profits at approval (one was owned by a public-private JV). There is not enough non-profit money to take drugs through the development process to FDA approval And when high prices do exist, in many cases it is because the drugs literally save lives. If you value a QALY at $50K / year (a common estimate), and your drug enables a child to live a full life who otherwise would have died at age 2 due to a rare genetic disease, it doesn't seem absolutely crazy to charge $1M for that drug. The issue to me seems to be more 1) what happens if you pay $1M for a drug and it doesn't work or 2) what if the patient cannot afford to pay $1M upfront for the drug even if it is guaranteed to add 20 healthy years to your life.