6 ms·

The failure at every level here is astounding. 1. The pharma company selling Unisom+B6 for $800, with the FDA apparently not batting an eye. I mean, these are

The failure at every level here is astounding. 1. The pharma company selling Unisom+B6 for $800, with the FDA apparently not batting an eye. I mean, these are OTC substances, so it's probably safe for consumption, but still. 2. The doctor prescribing an $800 drug with two known, cheap, OTC ingredients. Probably receiving kickbacks. 3. The pharmacy accepting the prescription and billing insurance for a bullshit drug without informing the patient of an OTC alternative, when anyone who is licensed as a pharmacist knows the drug is Bullshit with a capital B and would save the customer $777.50 in needless expense. 4. The insurance company denying coverage, presumably with a form letter, without telling their customer about the OTC alternative. What's to stop me from creating a pharma startup marketing a combination Vitamin D and acetaminophen as a treatment for back pain, selling it for $1000, and blasting doctors' offices with cold calls? Not our government(s), apparently.

teclordphrack2 4y ago
ekianjo 4y ago
Agree with some of your points but you are missing something essential here. You don't pay for the cost of the ingredients in pharmaceutical products (otherwise the cost of most drugs would be 1/10th of what they are or even less), but for the IP behind it. You need clinical trials to demonstrate that something works for a specific condition, and this is what gets an approved stamp by the FDA and integration with the reimbursement system, along with a negotiation on pricing. If there were no such incentives, then nobody would do any kind of clinical trial for compounds that are already widely available in OTC form, and the only thing you would have is anecdotal evidence (i.e. noise) to know what works or not. Whether this is the right way to incentivize research and development is a valid topic to discuss, however.
- asdff 4y ago
  To be fair its not so simple. You fund the clinical trial perhaps, but you also fund shareholder profits. This incentive model is actually pretty perverse because there are diseases that aren't seeing drugs developed because they are so rare that a treatment will never be given to enough patients to turn a profit. A better incentive model is to have the government identify diseases that lack a solid treatment option and fund clinical trials through direct taxation versus profiting off of the sick or abusing the for profit insurance process to cover these huge fees.
  - ekianjo 4y ago
    > A better incentive model is to have the government identify diseases that lack a solid treatment option and fund clinical trials through direct taxation The government is the worst tool for this job, because they would need to hire external experts to assess which disease should be studied, and those experts would be already in bed with the industry for a long time. You would just be diverting tax-payer money in a different way.
    - asdff 4y ago
      How do you think government research money is currently directed? Sure you get people from industry but you also get people from academia and government as well filling these positions. That's basically anyone with domain knowledge. Sure people can be corrupt and evil or whatever, but that's why you have other checks in your system to deal with it. If you think it can't be done just because 'government', that's not a strong argument because literally any sort of person in any position in any org, public or private, could be corrupted, and the race to the bottom of this logic is to trust nothing and no one.
    - coldtea 4y ago
      >The government is the worst tool for this job, because they would need to hire external experts to assess which disease should be studied, and those experts would be already in bed with the industry for a long time. There's no need to "hire external experts". They could have their own pool.
      - ekianjo 4y ago
        Like the FDA? We see how well it works...
        coldtea 4y ago
        Well, other countries managed to solve it, as they've managed to have schools without shootings, cities with public transport, no gerrymandering, and so on. So it's not unsurmountable, just badly done...
- qwertyX99 4y ago
  The vast majority of new drugs in the US research was funded by the taxpayer. Innovation comes mostly from the public sector, not private sector. This applies equally to technology. Private-led innovation is hyped by these industries PR departments. DARPA, NASA, NIH don't have a PR department. References: 1/ Overall, NIH funding contributed to research associated with every new drug approved from 2010-2019, totaling $187 billion." (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3731819 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3731819) Search Mariana Mazzucato talks, books on innovation, example: https://www.noemamag.com/big-pharma-is-hurting-drug-innovation https://www.noemamag.com/big-pharma-is-hurting-drug-innovati... 2/ "Apple Didn’t Build Your iPhone; Your Taxes Did": https://www.pbs.org/newshour/economy/the-entrepreneurial-state-appl https://www.pbs.org/newshour/economy/the-entrepreneurial-sta... 3/ 97%-99% of Astrazenneca covid vaccine research was public+charity funded( ref https://pubmed.ncbi.nlm.nih.gov/34937701/ https://pubmed.ncbi.nlm.nih.gov/34937701/ )
ezoe 4y ago
Comparison with Japan: 1. The price of drugs are regulated. There is no chance such a bullshit drug just combining OTC ingredients are allowed to be sold with such a high price. 2. Since there is no bullshit expensive drugs, doctors don't need to worry about it. Rebate is prohibited, but even if it exists, you can't prescribe the drugs you can't use. 3. I'm not sure about the quality of pharmacy in Japan but they regularly call doctor when they have concerns about the prescription and they switch to generic drugs on default unless patient strongly object not to. 4. Universal Health Care. The govt regulate the insurance so it's either all covered by insurance or nothing.
- tomcam 4y ago
  How many new drugs is Japan developing? From what I can tell, a fraction of what we do. The free market is pretty damn good at that.
  - toomuchtodo 4y ago
    The US pays the most for healthcare for worse outcomes. Free market not doing so great. An expensive new drug is not necessarily an effective drug, nor is a free market required to innovate. The US imports a very effective lung cancer immunotherapy vaccine from Cuba, for example (CIMAvax EGF). https://khn.org/news/article/medicare-ruling-aduhelm-controversial-alzheimer-drug-critics/ https://khn.org/news/article/medicare-ruling-aduhelm-controv... https://hbr.org/2021/10/the-u-s-can-lower-drug-prices-without-sacrificing-innovation https://hbr.org/2021/10/the-u-s-can-lower-drug-prices-withou... https://en.wikipedia.org/wiki/CimaVax-EGF https://en.wikipedia.org/wiki/CimaVax-EGF
  - rentfree-media 4y ago
    If it's so good at it, why does it always need government funding? (As testified before a congressional committee by an FDA official, his response to the question of "how many drugs receive government research funding?" was "all of them.")
    - ekianjo 4y ago
wutwutwutwut 4y ago
Comparing to Sweden, 1 and 2 could happen here as well. But since government subsidies costs over 1200 SEK ($120), the pharmacy will always suggest the cheapest alternative (by law). If doctor prescribes something for $2 but an alternative exists which is only $1 then pharmacy will suggest the one for $1.
low_tech_love 4y ago
If we stopped scamming people and did things right the way you described, the system would collapse.
tpoacher 4y ago
> Probably receiving kickbacks. In the best case scenario. The more likely, and actually worse scenario, is that they have no idea either. Doctors get "free samples" all the time, and are so conditioned to receiving "freebies" by drug reps unquestionably that they aren't even aware of their biases after a while.

teclordphrack2 4y ago

ekianjo 4y ago

Agree with some of your points but you are missing something essential here. You don't pay for the cost of the ingredients in pharmaceutical products (otherwise the cost of most drugs would be 1/10th of what they are or even less), but for the IP behind it. You need clinical trials to demonstrate that something works for a specific condition, and this is what gets an approved stamp by the FDA and integration with the reimbursement system, along with a negotiation on pricing. If there were no such incentives, then nobody would do any kind of clinical trial for compounds that are already widely available in OTC form, and the only thing you would have is anecdotal evidence (i.e. noise) to know what works or not. Whether this is the right way to incentivize research and development is a valid topic to discuss, however.

asdff 4y ago
To be fair its not so simple. You fund the clinical trial perhaps, but you also fund shareholder profits. This incentive model is actually pretty perverse because there are diseases that aren't seeing drugs developed because they are so rare that a treatment will never be given to enough patients to turn a profit. A better incentive model is to have the government identify diseases that lack a solid treatment option and fund clinical trials through direct taxation versus profiting off of the sick or abusing the for profit insurance process to cover these huge fees.
- ekianjo 4y ago
  > A better incentive model is to have the government identify diseases that lack a solid treatment option and fund clinical trials through direct taxation The government is the worst tool for this job, because they would need to hire external experts to assess which disease should be studied, and those experts would be already in bed with the industry for a long time. You would just be diverting tax-payer money in a different way.
  - asdff 4y ago
    How do you think government research money is currently directed? Sure you get people from industry but you also get people from academia and government as well filling these positions. That's basically anyone with domain knowledge. Sure people can be corrupt and evil or whatever, but that's why you have other checks in your system to deal with it. If you think it can't be done just because 'government', that's not a strong argument because literally any sort of person in any position in any org, public or private, could be corrupted, and the race to the bottom of this logic is to trust nothing and no one.
  - coldtea 4y ago
    >The government is the worst tool for this job, because they would need to hire external experts to assess which disease should be studied, and those experts would be already in bed with the industry for a long time. There's no need to "hire external experts". They could have their own pool.
    - ekianjo 4y ago
      Like the FDA? We see how well it works...
      - coldtea 4y ago
        Well, other countries managed to solve it, as they've managed to have schools without shootings, cities with public transport, no gerrymandering, and so on. So it's not unsurmountable, just badly done...
qwertyX99 4y ago
The vast majority of new drugs in the US research was funded by the taxpayer. Innovation comes mostly from the public sector, not private sector. This applies equally to technology. Private-led innovation is hyped by these industries PR departments. DARPA, NASA, NIH don't have a PR department. References: 1/ Overall, NIH funding contributed to research associated with every new drug approved from 2010-2019, totaling $187 billion." (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3731819 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3731819) Search Mariana Mazzucato talks, books on innovation, example: https://www.noemamag.com/big-pharma-is-hurting-drug-innovation https://www.noemamag.com/big-pharma-is-hurting-drug-innovati... 2/ "Apple Didn’t Build Your iPhone; Your Taxes Did": https://www.pbs.org/newshour/economy/the-entrepreneurial-state-appl https://www.pbs.org/newshour/economy/the-entrepreneurial-sta... 3/ 97%-99% of Astrazenneca covid vaccine research was public+charity funded( ref https://pubmed.ncbi.nlm.nih.gov/34937701/ https://pubmed.ncbi.nlm.nih.gov/34937701/ )

ezoe 4y ago

Comparison with Japan: 1. The price of drugs are regulated. There is no chance such a bullshit drug just combining OTC ingredients are allowed to be sold with such a high price. 2. Since there is no bullshit expensive drugs, doctors don't need to worry about it. Rebate is prohibited, but even if it exists, you can't prescribe the drugs you can't use. 3. I'm not sure about the quality of pharmacy in Japan but they regularly call doctor when they have concerns about the prescription and they switch to generic drugs on default unless patient strongly object not to. 4. Universal Health Care. The govt regulate the insurance so it's either all covered by insurance or nothing.

tomcam 4y ago
How many new drugs is Japan developing? From what I can tell, a fraction of what we do. The free market is pretty damn good at that.
- toomuchtodo 4y ago
  The US pays the most for healthcare for worse outcomes. Free market not doing so great. An expensive new drug is not necessarily an effective drug, nor is a free market required to innovate. The US imports a very effective lung cancer immunotherapy vaccine from Cuba, for example (CIMAvax EGF). https://khn.org/news/article/medicare-ruling-aduhelm-controversial-alzheimer-drug-critics/ https://khn.org/news/article/medicare-ruling-aduhelm-controv... https://hbr.org/2021/10/the-u-s-can-lower-drug-prices-without-sacrificing-innovation https://hbr.org/2021/10/the-u-s-can-lower-drug-prices-withou... https://en.wikipedia.org/wiki/CimaVax-EGF https://en.wikipedia.org/wiki/CimaVax-EGF
- rentfree-media 4y ago
  If it's so good at it, why does it always need government funding? (As testified before a congressional committee by an FDA official, his response to the question of "how many drugs receive government research funding?" was "all of them.")
  - ekianjo 4y ago

wutwutwutwut 4y ago

Comparing to Sweden, 1 and 2 could happen here as well. But since government subsidies costs over 1200 SEK ($120), the pharmacy will always suggest the cheapest alternative (by law). If doctor prescribes something for $2 but an alternative exists which is only $1 then pharmacy will suggest the one for $1.

low_tech_love 4y ago

If we stopped scamming people and did things right the way you described, the system would collapse.

tpoacher 4y ago

> Probably receiving kickbacks. In the best case scenario. The more likely, and actually worse scenario, is that they have no idea either. Doctors get "free samples" all the time, and are so conditioned to receiving "freebies" by drug reps unquestionably that they aren't even aware of their biases after a while.