5 ms·

Drugs for the People: Rethinking the global pharmaceutical supply chain

23 points by benbreen 6y ago

swiley 6y ago
I'm constantly surprised at how rare clandestine pharmaceuticals are. Insulin for example is just worked up GMO yeast metabolites. That's not a particularly new or complex idea.
- SpicyLemonZest 6y ago
  People just don't end up using clandestine pharmaceuticals. For example, fish oil as a dietary supplement is widely available and cheap at supermarkets, but people with a medical need for fish oil instead get Lovaza at many times the price. (https://slatestarcodex.com/2014/06/15/fish-now-by-prescription/ https://slatestarcodex.com/2014/06/15/fish-now-by-prescripti...)
- DoreenMichele 6y ago
  Sometimes people in the US mail order drugs from other countries without a prescription. People sometimes also turn to non drug alternatives while getting called quacks and lumped in with antivaxxers, so a lot of them keep that kind of on the down low to protect themselves.
Vaslo 6y ago
For a tl;dr, an article by a left leaning magazine saying that drug companies should make drugs and not be allowed to charge exorbitant prices or the government should get involved. Between that and the Trump bashing, shockingly original.
- GiorgioG 6y ago
  I don't care what side of the political aisle you side with: It's insane that pharma companies and the healthcare system in general can hold people hostage. A friend of mine has Leukemia and takes Gleevec. Thankfully he has a good job because it costs something like $14,000/month. Yep, you read that right, $14,000. Yes it's covered by insurance. But that's not some magical money tree paying for it, we're collectively paying for it. My son's a type 1 diabetic and we hit our out of pocket max of about $9,200 every single year to pay for his insulin pump & glucose monitor supplies. An older family member of mine had cancer surgery - in the hospital for 5 days total and came out with a $150k bill. America's great as long as you're not sick. I lean left and right on many different issues, but holy shit America's healthcare system is ass-backwards compared to the rest of the world, which has figured out how to keep people alive if some unfortunate event happens without making them worry about deciding to pay for groceries or pay for medicine/healthcare. Anyone that thinks otherwise is brainwashed. Yes there are horror stories in other countries, but they don't include bankrupting people who were grossly overcharged for their care, or people rationing their medication because they can't pay for it. Fuck the current US healthcare system. A single-payer system makes sense and it works everywhere else on the planet. The American people's refusal to get it reminds me of the not-invented-here syndrome we see in tech everyday.
  - ineedasername 6y ago
    It's difficult to say whether other countries are just dealing with the financial side of this better or if the US is basically subsidizing the low prices elsewhere by paying the exorbitant prices here.
    - henrikschroder 6y ago
      > or if the US is basically subsidizing the low prices elsewhere by paying the exorbitant prices here. Nope, you're just being taken for a ride because they can. Remember that the biggest line item for pharmaceutical companies is their advertising budget, not their research budget. Also, this kind of thinking is some weird sort of Stockholm Syndrome, you're basically trying to frame being taken advantage of as some sort of altruism.
      - roenxi 6y ago
        > the biggest line item for pharmaceutical companies is their advertising budget There seems to be some tension between that and a $14,000/month leukemia drug. The drug companies shouldn't really need to advertise life saving medication. The world is full of surprises, but I assume the advertising budget is more for the less important medications where people have to be more active in seeking them out.
      - jandrewrogers 6y ago
        The reason their advertising budget is so high is that they have a small number of years within which to recover a billion dollars in development costs. They have to find customers fast for new drugs, they have no time to waste, and that requires aggressive marketing. Companies don’t advertise for laughs since it costs money, it has a concrete ROI. It is a matter of incentives. If you want them to spend less on advertising, you’d have to provide them with a much longer time to recover development costs. Which also has significant downsides.
        GiorgioG 6y ago
        I'm just going to leave this here: http://www.drugood.com/2018/07/15/gleevecs-cost-and-price/ http://www.drugood.com/2018/07/15/gleevecs-cost-and-price/ Gleevec did not take many years at all for Novartis to recover its trivial relative costs and generate billions of dollars of profit for nearly 2 decades. The problem is when you have a disease and there's only one treatment around, you'll literally pay whatever it costs - because not having it means you're dead. These companies then turn around and extract as much money as they possibly can. They're monopolies, pure and simple. I've seen this with my son's diabetes as well. The costs continue to rise (insulin, Dexcom sensors/transmitters, etc.) I've turned down jobs because their health benefits only covered a lousier insulin pump / glucose monitor due to an exclusive agreement with their chosen health insurer. The problem is if you or a loved one isn't sick, this doesn't affect you one damn bit. My dad (an italian-born immigrant) has always complained to me about our healthcare system (and he had a great healthcare plan as a GM employee.) I didn't really paid it much attention because I was young and healthy. Now, quite a bit older and with family members with a variety of health issues, I realized that he (in my opinion) was right.
DoreenMichele 6y ago
Evergreening props up pharmaceutical profits but prevents lower-income populations from ever benefitting from the drugs. It keeps enormous swaths of the global population, without insurance or financial resources, from accessing lifesaving treatments. It seems the pharmaceutical industry has largely forgotten why it makes drugs in the first place: to save lives. No, not really. They are in it to make money. We used to think of medication as something you took occasionally during a crisis. Now we take it as a given that a large percentage of the population will be on maintenance drugs for life. Then we act all shocked at the fragility of the global pharmaceutical industry and the growing issue of antibiotic resistance. But if you make some prosaic observation about this overall pattern, you can expect to be basically booed, not taken seriously as trying to talk about the problem in some sensible fashion.
- Nbox9 6y ago
  > But if you make some prosaic observation about this overall pattern If you outlined a pattern in your comment I failed to deduce it. Something about negative externalities of increased drug consumption? I’m sure there is a point there that deserves a better argument.
  - DoreenMichele 6y ago
    These days, we conflate medical care and health care. Basic health care is stuff like eating right, exercising, good hygiene, etc. We overprescribe drugs in part because things have swung too far in a commercial direction. A drug is a solution we can sell. A walk for your health is not. And then we wring our hands when this leads to the kind of situation described in the article. But I know from long experience that no one will take you seriously if you try to talk about non drug solutions.
- baumandm 6y ago
  > We used to think of medication as something you took occasionally during a crisis. Now we take it as a given that a large percentage of the population will be on maintenance drugs for life. Not disputing this, and it certainly supports your point about the pharmaceutical industry making money. But is there evidence that we are actually worse off for it? Did previous generations benefit from better mental and physical health than we do now. My instinct is that we're healthier than ever before. We're treating conditions that weren't even identified a generation ago. Now that might not be due to our pharmaceutical intake, but I'd be surprised if it wasn't partially responsible. Of course it's possible we've gone farther towards drugs than needed, which perhaps was your original point.
Nbox9 6y ago
Is it viable for every country to produce all of it’s own basic necessities — food, medicine, energy, fresh water, building materials? Is it desirable? I believe that the US being a net exporter of food, and a net importer of medicine is an acceptable situation. I think that to frame out ‘reliance’ on India and China for medicine ignores China’s ‘reliance’ on the US for soybeans, or India’s reliance on US warships in the Indian Ocean for strategic defense. We are codependent, and that codependency is going to keep us all from killing each other again.
- solstice 6y ago
  I fully agree with your last sentence. But I think that nobody is seriously arguing that the US or European countries should become autarchies and produce _everything_ themselves again. (That whole "decoupling from China" is considered unfeasible and highly disruptive/dangerous at least by EU officials that I have personally heard from.) Instead, certain products and production capacities should be preserved at a minimum level. This is economically unprofitable but can save your country's collective butt in an emergency if it's properly managed and production can be ramped up quickly by getting a network of companies to switch their production (eg masks). I would expect my government to think about these long-odds, high risk events and take measures to prevent them or at least mitigate them. More traditional examples of this kind of thinking are strategic stockpiles of oil, food etc. If the covid-19 pandemic has shown one thing, it's that just in time manufacturing and globalized highly-optimized supply chains can fail spectacularly.
  - Nbox9 6y ago
    It seems to me to be too large of a correction against ‘highly-optimized supply chains’ to assume that at any time we’ll suddenly need a 100x supply of any medicine in the WHO List of Essential Medicines and that we’ll need this emergency supply of medicine while the world supply chain is disrupted. This is essentially the ask of the article, when it references the sudden need for Hydroxychloroquine. Should we have emergency stockpiles of food, water, medical equipment, energy, and shelters? Absolutely. Let’s remember that any inefficiencies in our manufacturing base serve to make us less competitive internationally and raise the prices that consumers spend. There’s only so much emergency preparedness we can reasonably expect.
bigdogc 6y ago
big pharma does not equal generic drug manufacture. HCQ is available by at least 8 different manufacturers in America. As a drug wholesaler, this drug increased from ~20$ for a 100ct bottle to ~$100 for a 100ct bottle. At its height of popularity in late April, all supply chain went to McKesson/Cardinal/Amerisource with daily allocations to smaller independent/regional wholesalers. State boards of Pharmacy specifically changed law to make sure this drug was given to those that actually needed it for RA. The author does make great points on big pharma and absurdity of patents/costs, but HCQ is not a great way to illustrate that point. Lastly, HCQ was so overproduced that by the end of July 100ct bottles were selling to smaller regional wholesalers off contract at $3-5 per 100 ct bottle. Patients can probably buy this cash pay from an independent pharmacy for $10 now.

23 points by benbreen 6y ago

I'm constantly surprised at how rare clandestine pharmaceuticals are. Insulin for example is just worked up GMO yeast metabolites. That's not a particularly new or complex idea.

SpicyLemonZest 6y ago
People just don't end up using clandestine pharmaceuticals. For example, fish oil as a dietary supplement is widely available and cheap at supermarkets, but people with a medical need for fish oil instead get Lovaza at many times the price. (https://slatestarcodex.com/2014/06/15/fish-now-by-prescription/ https://slatestarcodex.com/2014/06/15/fish-now-by-prescripti...)
DoreenMichele 6y ago
Sometimes people in the US mail order drugs from other countries without a prescription. People sometimes also turn to non drug alternatives while getting called quacks and lumped in with antivaxxers, so a lot of them keep that kind of on the down low to protect themselves.

Vaslo 6y ago

For a tl;dr, an article by a left leaning magazine saying that drug companies should make drugs and not be allowed to charge exorbitant prices or the government should get involved. Between that and the Trump bashing, shockingly original.

GiorgioG 6y ago
I don't care what side of the political aisle you side with: It's insane that pharma companies and the healthcare system in general can hold people hostage. A friend of mine has Leukemia and takes Gleevec. Thankfully he has a good job because it costs something like $14,000/month. Yep, you read that right, $14,000. Yes it's covered by insurance. But that's not some magical money tree paying for it, we're collectively paying for it. My son's a type 1 diabetic and we hit our out of pocket max of about $9,200 every single year to pay for his insulin pump & glucose monitor supplies. An older family member of mine had cancer surgery - in the hospital for 5 days total and came out with a $150k bill. America's great as long as you're not sick. I lean left and right on many different issues, but holy shit America's healthcare system is ass-backwards compared to the rest of the world, which has figured out how to keep people alive if some unfortunate event happens without making them worry about deciding to pay for groceries or pay for medicine/healthcare. Anyone that thinks otherwise is brainwashed. Yes there are horror stories in other countries, but they don't include bankrupting people who were grossly overcharged for their care, or people rationing their medication because they can't pay for it. Fuck the current US healthcare system. A single-payer system makes sense and it works everywhere else on the planet. The American people's refusal to get it reminds me of the not-invented-here syndrome we see in tech everyday.
- ineedasername 6y ago
  It's difficult to say whether other countries are just dealing with the financial side of this better or if the US is basically subsidizing the low prices elsewhere by paying the exorbitant prices here.
  - henrikschroder 6y ago
    > or if the US is basically subsidizing the low prices elsewhere by paying the exorbitant prices here. Nope, you're just being taken for a ride because they can. Remember that the biggest line item for pharmaceutical companies is their advertising budget, not their research budget. Also, this kind of thinking is some weird sort of Stockholm Syndrome, you're basically trying to frame being taken advantage of as some sort of altruism.
    - roenxi 6y ago
      > the biggest line item for pharmaceutical companies is their advertising budget There seems to be some tension between that and a $14,000/month leukemia drug. The drug companies shouldn't really need to advertise life saving medication. The world is full of surprises, but I assume the advertising budget is more for the less important medications where people have to be more active in seeking them out.
    - jandrewrogers 6y ago
      The reason their advertising budget is so high is that they have a small number of years within which to recover a billion dollars in development costs. They have to find customers fast for new drugs, they have no time to waste, and that requires aggressive marketing. Companies don’t advertise for laughs since it costs money, it has a concrete ROI. It is a matter of incentives. If you want them to spend less on advertising, you’d have to provide them with a much longer time to recover development costs. Which also has significant downsides.
      - GiorgioG 6y ago
        I'm just going to leave this here: http://www.drugood.com/2018/07/15/gleevecs-cost-and-price/ http://www.drugood.com/2018/07/15/gleevecs-cost-and-price/ Gleevec did not take many years at all for Novartis to recover its trivial relative costs and generate billions of dollars of profit for nearly 2 decades. The problem is when you have a disease and there's only one treatment around, you'll literally pay whatever it costs - because not having it means you're dead. These companies then turn around and extract as much money as they possibly can. They're monopolies, pure and simple. I've seen this with my son's diabetes as well. The costs continue to rise (insulin, Dexcom sensors/transmitters, etc.) I've turned down jobs because their health benefits only covered a lousier insulin pump / glucose monitor due to an exclusive agreement with their chosen health insurer. The problem is if you or a loved one isn't sick, this doesn't affect you one damn bit. My dad (an italian-born immigrant) has always complained to me about our healthcare system (and he had a great healthcare plan as a GM employee.) I didn't really paid it much attention because I was young and healthy. Now, quite a bit older and with family members with a variety of health issues, I realized that he (in my opinion) was right.

DoreenMichele 6y ago

Evergreening props up pharmaceutical profits but prevents lower-income populations from ever benefitting from the drugs. It keeps enormous swaths of the global population, without insurance or financial resources, from accessing lifesaving treatments. It seems the pharmaceutical industry has largely forgotten why it makes drugs in the first place: to save lives. No, not really. They are in it to make money. We used to think of medication as something you took occasionally during a crisis. Now we take it as a given that a large percentage of the population will be on maintenance drugs for life. Then we act all shocked at the fragility of the global pharmaceutical industry and the growing issue of antibiotic resistance. But if you make some prosaic observation about this overall pattern, you can expect to be basically booed, not taken seriously as trying to talk about the problem in some sensible fashion.

Nbox9 6y ago
> But if you make some prosaic observation about this overall pattern If you outlined a pattern in your comment I failed to deduce it. Something about negative externalities of increased drug consumption? I’m sure there is a point there that deserves a better argument.
- DoreenMichele 6y ago
  These days, we conflate medical care and health care. Basic health care is stuff like eating right, exercising, good hygiene, etc. We overprescribe drugs in part because things have swung too far in a commercial direction. A drug is a solution we can sell. A walk for your health is not. And then we wring our hands when this leads to the kind of situation described in the article. But I know from long experience that no one will take you seriously if you try to talk about non drug solutions.
baumandm 6y ago
> We used to think of medication as something you took occasionally during a crisis. Now we take it as a given that a large percentage of the population will be on maintenance drugs for life. Not disputing this, and it certainly supports your point about the pharmaceutical industry making money. But is there evidence that we are actually worse off for it? Did previous generations benefit from better mental and physical health than we do now. My instinct is that we're healthier than ever before. We're treating conditions that weren't even identified a generation ago. Now that might not be due to our pharmaceutical intake, but I'd be surprised if it wasn't partially responsible. Of course it's possible we've gone farther towards drugs than needed, which perhaps was your original point.

Nbox9 6y ago

Is it viable for every country to produce all of it’s own basic necessities — food, medicine, energy, fresh water, building materials? Is it desirable? I believe that the US being a net exporter of food, and a net importer of medicine is an acceptable situation. I think that to frame out ‘reliance’ on India and China for medicine ignores China’s ‘reliance’ on the US for soybeans, or India’s reliance on US warships in the Indian Ocean for strategic defense. We are codependent, and that codependency is going to keep us all from killing each other again.

solstice 6y ago
I fully agree with your last sentence. But I think that nobody is seriously arguing that the US or European countries should become autarchies and produce _everything_ themselves again. (That whole "decoupling from China" is considered unfeasible and highly disruptive/dangerous at least by EU officials that I have personally heard from.) Instead, certain products and production capacities should be preserved at a minimum level. This is economically unprofitable but can save your country's collective butt in an emergency if it's properly managed and production can be ramped up quickly by getting a network of companies to switch their production (eg masks). I would expect my government to think about these long-odds, high risk events and take measures to prevent them or at least mitigate them. More traditional examples of this kind of thinking are strategic stockpiles of oil, food etc. If the covid-19 pandemic has shown one thing, it's that just in time manufacturing and globalized highly-optimized supply chains can fail spectacularly.
- Nbox9 6y ago
  It seems to me to be too large of a correction against ‘highly-optimized supply chains’ to assume that at any time we’ll suddenly need a 100x supply of any medicine in the WHO List of Essential Medicines and that we’ll need this emergency supply of medicine while the world supply chain is disrupted. This is essentially the ask of the article, when it references the sudden need for Hydroxychloroquine. Should we have emergency stockpiles of food, water, medical equipment, energy, and shelters? Absolutely. Let’s remember that any inefficiencies in our manufacturing base serve to make us less competitive internationally and raise the prices that consumers spend. There’s only so much emergency preparedness we can reasonably expect.

bigdogc 6y ago

big pharma does not equal generic drug manufacture. HCQ is available by at least 8 different manufacturers in America. As a drug wholesaler, this drug increased from ~20$ for a 100ct bottle to ~$100 for a 100ct bottle. At its height of popularity in late April, all supply chain went to McKesson/Cardinal/Amerisource with daily allocations to smaller independent/regional wholesalers. State boards of Pharmacy specifically changed law to make sure this drug was given to those that actually needed it for RA. The author does make great points on big pharma and absurdity of patents/costs, but HCQ is not a great way to illustrate that point. Lastly, HCQ was so overproduced that by the end of July 100ct bottles were selling to smaller regional wholesalers off contract at $3-5 per 100 ct bottle. Patients can probably buy this cash pay from an independent pharmacy for $10 now.