19 ms·

Drugmakers are abandoning cheap generics

175 points by JPLeRouzic 3y ago

Solvency 3y ago
Wait, 4 days ago we were on the cusp of a golden age of medicine: https://news.ycombinator.com/item?id=36458515 https://news.ycombinator.com/item?id=36458515 I must have blinked and missed it!
- throwawaylinux 3y ago
  It's the New York Times. They're like the Cramer or Krugman of newspapers.
Terr_ 3y ago
> The causes of shortages are well established. Everyone wants to pay less, and the middlemen who procure and distribute generics keep driving down wholesale prices. The average net price of generic drugs fell by more than half between 2016 and 2022, according to research by Anthony Sardella, a business professor at Washington University in St. Louis. > As generics manufacturers compete to win sales contracts with the big negotiators of such purchases, such as Vizient and Premier, their profits sink. Some are going out of business. I'm confused, how is it that the prices are being driven so low that the supply dries up despite continued demand?
- warent 3y ago
  I think this is one of those "race to the bottom" things where businesses endlessly undercut each other until everyone loses
  - sacnoradhq 3y ago
    "Race to the bottom" is bullshit because there is a floor equilibrium of difficulty of manufacturing and regulatory administration, and there is relatively constant demand. People never stop getting sick. Generics need more social ventures to keep critical medications supplied on the market. One recent example is the shortage of amphetamine stimulant medications.
- foota 3y ago
  It's unclear whether the demand would support a higher price I guess. Alternatively, another way of looking at this is perhaps that the distributors are seeking a profit, and so are demanding low prices from the manufacturer, meaning that high cost manufacturers go out of business, reducing supply. However, this may be inefficient, in that demand may exist at higher prices, that could support more manufacturers if not for the distributor.
  - Terr_ 3y ago
    Hm, so in other words perhaps there's a distributor/middleman layer without enough competition, one whose most-profitable situation comes from focusing on high-margin drugs.
  - lsaferite 3y ago
    Sounds like it's a lot of things, but one thing mentioned in the article is pricing pressure from plan administrators. Large plans have outsized influence on pricing. Mix that with unscrupulous manufactures that cut corners to lower costs and you have a mess. Those bad manufactures can agree to go lower than legit manufactures and they then let the plan administrators force pricing lower for everyone. At some point the legit manufacturers are priced out, leaving only the bad ones. Then when a bad one implodes, the market isn't there anymore. By this point plan administrators have anchored pricing too low and are likely going to be slow to adjust (if they adjust at all). NB: I'm not involved in the medical field or in economics, so take my statements as what they are, conjecture.
- sacnoradhq 3y ago
  Relative profits are "drying up" because they can't charge $10k per dose and throw away half and quarter doses.
  - bozhark 3y ago
    moving into biologics
    - ackbar03 3y ago
      are they actually? The generic companies are making biologics now? Biologic generics, or technically biosimilars, are supposedly much harder to make, which is why a lot of them remain expensive even when the patents expired for a long time (e.g. insulin)
- bandrami 3y ago
  Cancer drugs in particular have this exceedingly weird market where oncologists buy drugs from distributers and resell them to their patients. Everybody agrees it's a bad way to do it, and nobody would have deliberately designed it that way, but it's a system that's hard to disassemble now that it's in action.
- ars 3y ago
  > I'm confused, how is it that the prices are being driven so low that the supply dries up despite continued demand? The incremental cost of an additional dose is low, so as long as the production line is operating all is well. But then the line shuts down for whatever reason - and reopening it (or a new company starting one) costs way way too much. i.e. it's not worth it for them to do that at current prices. They would have to charge far more than the existing companies charge, and no one would buy the drug. It's basically a timing issue, long term contracts mean that prices can not rapidly adjust for market disruption, combined with very very long lead time for additional production, means that the market can stay disrupted for extended periods of time. Years even. It will eventually adjust, but it will take so long that current patients are in trouble. The solution is a buffer, keep production in a strategic reserve.
- Hermitian909 3y ago
  - Patients can only buy cancer medication from their healthcare providers, and expect it to be covered by health insurance. - Healthcare providers will only buy cancer medication whose prices are low enough to be covered by insurance. - Insurance scours the market for the lowest cost providers and states it will only cover that cost, no higher. - If the cost of drugs goes up, insurance does not immediately renegotiate prices. Healthcare providers stop buying the drugs while waiting for low cost capacity to re-appear so they don't take a loss on the care. - Drug companies go out of business because they can't sell their inventory, driving up prices further while reducing supply. We really ought to have a government funded drug manufacturer...
- akiselev 3y ago
  Premier and Vizient are group purchasing organizations which handle all the supply for a ton of hospitals - 800k or so hospital beds between the two out of about a million total in the US. They started out as hospital purchasing groups which were created by hospitals who banded together to get better deals so they usually monopolize purchasing for an entire hospital. Now they’ve grown so big they’ve got monopolistic pricing power as consumers (I don’t know the right economic term) since there are so few organizations buying for all the hospitals. When buying syringes, bandages, and most of the things hospitals need, that’s not a big deal but the way many oncology drugs are administered these organizations end up handling all of the negotiations instead of pharmacies and insurance companies. Patients and even their healthcare providers have basically zero say in the purchasing because it’s all rolled in. Since the US is the most profitable market in an already low margin business, the generic manufacturers can’t justify the production lines for cancer drugs without at least one of these clients so they‘re driven to extreme price wars. In good times, they eek out a profit, but in bad times when variable costs go up, they’re no longer viable.
  - worldsayshi 3y ago
    I wonder if premier and vizient have a vested interest in some of the suppliers going out of business, like if they have indirect ownership in competing suppliers.
  - Arkanum 3y ago
    I think the word you might be looking for is "Monopsony" https://en.wikipedia.org/wiki/Monopsony https://en.wikipedia.org/wiki/Monopsony
  - deleted 3y ago
    [deleted]
Aleklart 3y ago
Who needs drugs, when AI develop cancer treatment in just 30 days (according to https://nypost.com/2023/03/20/ai-develops-cancer-treatment-in-30-days-predicts-survival-rate/ https://nypost.com/2023/03/20/ai-develops-cancer-treatment-i...).
- Spastche 3y ago
  [flagged]
submeta 3y ago
Applying my rudimentary knowledge of microeconomics, the situation with the shortage of cancer drugs seems to be a case of a race to the bottom, as one commenter noted. Here, multiple generic drug manufacturers are competing to win sales contracts by offering the lowest possible price. This can be seen as an example of perfect competition, where firms are price takers and compete mainly on price, driving prices down to the point where they equal the marginal cost of production. However, the problem arises when these prices are driven so low that they no longer cover the firms' average total costs (including both variable and fixed costs), making it unprofitable for them to continue production. Some firms may choose to exit the market, leading to a reduction in supply. This is where the theory of "shutdown point" comes in: firms will choose to shut down production (at least temporarily) when price falls below the minimum point of the average variable cost curve. The complication in this case is that the reduction in supply is occurring for a product (cancer drugs) that is still in demand. However, as one commenter suggested, it's unclear whether the demand would support a higher price. There might be external forces (like regulatory environments, health insurance dynamics, and negotiations by large scale buyers) that are keeping the prices artificially low, preventing the price from rising to a level where it would be profitable for more firms to produce the drugs.
- LastTrain 3y ago
  Where is the consumer - the sick cancer patient - represented in your analysis?
  - submeta 3y ago
    I am not saying that this is the way it should be.
    - LastTrain 3y ago
      Understood, I was actually wondering where they fit in your analysis. It seems they are locked out of direct participation in a transaction that is ultimately harmful to them, with no regulatory protections for /them/.
pazimzadeh 3y ago
This is ridiculous. Shouldn't it be the government's job to step in in these situations and mass produce these basic compounds. Does anyone measure the cost of not saving lives, and who pays that cost?
- monsecchris 3y ago
  [flagged]
  - tfourb 3y ago
    The demand for these kind of drugs is quite predictable. It would be trivial for the government (assuming it has the political will to do it) to make mid or long term contracts with suppliers to provide these drugs so that the risk of shortages is drastically reduced. I.e. many governments store enough anti-radiation drugs to supply their population in case of a major fallout event. Governments were also the main customers for the various COVID-vaccines and where the political will was available to make it work, this system worked quite well.
    - monsecchris 3y ago
      That sounds wonderful and is nothing at all to do with what the parent comment was suggesting.
- danielschonfeld 3y ago
  Nah in the US we only save businesses. The bigger they are the better.
raincom 3y ago
Few days ago, 'US doctors are rationing lifesaving cancer drugs amid dire shortage': https://news.ycombinator.com/item?id=36447371 https://news.ycombinator.com/item?id=36447371
oefrha 3y ago
It’s mind boggling that with close to 20% of GDP poured into the medical industrial complex, the government can’t subsidize or straight up take over the production of some life saving drugs.
- fifteen1506 3y ago
  I'm strongly against subsidies. It sounds like the worst of both sides. Either the government owns the plants or not. Plants can be privatized later if deemed necessary, or kept on government hands to allow the government to have the know-how about the industries it needs to supervise. That being said, I'm just a peasant.
refurb 3y ago
If you note, most of these drugs are parenteral (injected IV). It’s a bitch to manufacturer because standards are so high. So what happens is profits get squeezed, someone runs a bad batch and throws it out, while another company is like “nah, we don’t want to make this any more” and poof, shortage. Of course someone will step in eventually, charge 10x the price, and get bad press for “cost of lifesaving cancer drug increases by 1000% percent”.
mrweasel 3y ago
There's basically a shortage of every conceivable type of drug. While not in the US, my partner works in a pharmacy, and it happens on an almost daily basis that they are unable to fulfill prescriptions do to a shortage. It's everything, certain types of pain kills, ADHD medication, vaccines, insulin (because the resources goes to weight lose medication), weight lose medication (because more people are getting it, compared to expectations), drugs for hearth problems, blood pressure, you name it and there is or have been a shortage. Everything seemed to breakdown during COVID and just never fully recovered.
sologoub 3y ago
Seems like similar story is playing out around the world: https://amp.dw.com/en/health-ministry-confronts-germanys-dire-medicine-shortage/a-64733080 https://amp.dw.com/en/health-ministry-confronts-germanys-dir...
KnuthIsGod 3y ago
"MEDICINE SHORTAGE REPORTS DATABASE The medicine shortage reports database includes information about shortages of reportable medicines in Australia https://apps.tga.gov.au/Prod/msi/search?shortagetype=All https://apps.tga.gov.au/Prod/msi/search?shortagetype=All" Here in Australia, 414 medications are in short supply. I regularly get pharmacists ringing me to inform me that the medication I prescribed for a patient is unavailable. That is the result of American middleman companies like Premier and Vizient squeezing every last paisa out of Indian generic manufacturers. Some of them decide to close their production lines and switch to manufacturing more profitable medications.
chucklenorris 3y ago
here's an idea that will never be implemented because of the paranoia of communism but that i think would be the most beneficial for society. why not create a government controlled non profit for producing out-of-patent drugs? it wouldn't hurt big pharma, it will substantially improve the life of the poor and chronically ill, reduce overall cost of healthcare, create strategic production in case of emergencies, can be a stepping stone to the healthcare as a human right.
- bawolff 3y ago
  Googling i found this proposal https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134734/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134734/
thesaintlives 3y ago
The Indian health care system is very interesting. Just imagine a big country with lots of poor people but not enough doctors and hospitals (or toilets for that matter). How do you stop everyone from dying of say a simple bacterial infection and give them access to medicine? The answer is the pharmacy. Every little village has one. It is fully stocked with most generic medicine and available over the counter at a very cheap price. The pharmacist decides what you need and you buy it. If you can afford it you find a doctor for further treatment. This system built itself through simple practicalities. No price gouging at any point. No vultures to regulate and feed. Capitalism in the USA is out of control..
dumpsterdiver 3y ago
From the article: > “It’s just insane,” said Mark Ratain, a cancer doctor and pharmacologist at the University of Chicago. “Your roof is caving in, but you want to build a basketball court in the backyard because your wife is pregnant with twin boys and you want them to be NBA stars when they grow up?” At that point the article "seamlessly" transitions into a statement from another person, at first making it seem as if the previous person had said it. A poor report, imo.
LatteLazy 3y ago
It seems like an opportunity for a single group to just offer these at a cost plus 20% basis and lock in some long term supply contracts...
CatWChainsaw 3y ago
Nobody who gets high off of libertarian laissez-faire idealism and the aphrodisiac of "move fast and break things" should feel they deserve to complain. There is no profit, and there is no one willing or able to take up their mantle. Obvious result is obvious.
tacon 3y ago
The problem of fraud in the generic drug industry is the topic of the book "Bottle of Lies" by Katherine Eban[0]. She joined Peter Attia for a fantastic episode of his podcast[1]. It isn't often I burst out laughing while listening to a healthcare podcast, but I did several times with that episode. Attia and Eban are imagining the situation as the naive new employee from the U.S. drug manufacturing industry is presenting a report to the board of his new Indian generic drug company how their fraud has been working, and how to fix it. All those patients who can't get their generic drugs: How many of them were getting fraudulent drugs before that had little or no effect on their disease? One U.S. startup tried to make a business model out of analyzing every batch of drugs they sold. [I'm sorry, did you think every batch of the drugs you take was verified as the real thing between you and the (foreign) manufacturer?] Valisure is a startup that bought drugs in bulk and actually tested samples, using mass spectroscopy, to verify they were the real thing, then sold them on to U.S. patients. Alas, their business model does not seem to be working out so far. But they did detect massive contamination in Zantac which lead to its recall five months later by the FDA.[2] [0] https://www.amazon.com/Bottle-Lies-Inside-Story-Generic/dp/0062338781 https://www.amazon.com/Bottle-Lies-Inside-Story-Generic/dp/0... [1] https://peterattiamd.com/katherineeban/ https://peterattiamd.com/katherineeban/ [2] https://peterattiamd.com/davidlight/ https://peterattiamd.com/davidlight/
jujube3 3y ago
Problem: the government (FDA) did a bad job at regulating drug production plants in India. HN Solution: the government should take over all drug production.
- dmvdoug 3y ago
  I mean, the FDA has been captured for a long time now, by design (see, e.g., the it’s reliance on funding by the entities it purportedly regulates in order to function at all). That’s not evidence that government in principle is the problem. It’s evidence that government in bed with the regulated parties is. Asking for stronger government intervention is asking not for more of the same—-just the opposite.
seamac3 3y ago
Seems like a new opportunity to me. Companies that could produce generics cheaply.
NoZebra120vClip 3y ago
About 18 years ago, a P.A. took me into her office and gravely informed me that I had a thyroid condition and that I would need to take pills. "It is tiny pill" she said in her Slavic accent as I mad-dog stared her down. Now, once upon a time, thyroid hormone was provided from slaughtered swine, and the natural substance was processed into a medication. This was too inconvenient and messy, and unprofitable, so the chemical manufacturers found a way to synthesize it. Now another thing about the thyroid is that it adjusts to the amount of hormone in the body and will gradually shut down, permanently, as more synthetic hormone is consumed. Therefore, the more your dose is increased, the less your own body produces, and the more dependent you become. So one blood test made me a Good Customer For Life(TM). I've been purchasing the generic synthetic from Wal*Mart for $4 per month. I am under no illusions that it is efficacious, pure, or contains anything but filler.

175 points by JPLeRouzic 3y ago

Wait, 4 days ago we were on the cusp of a golden age of medicine: https://news.ycombinator.com/item?id=36458515 https://news.ycombinator.com/item?id=36458515 I must have blinked and missed it!

throwawaylinux 3y ago
It's the New York Times. They're like the Cramer or Krugman of newspapers.

Terr_ 3y ago

> The causes of shortages are well established. Everyone wants to pay less, and the middlemen who procure and distribute generics keep driving down wholesale prices. The average net price of generic drugs fell by more than half between 2016 and 2022, according to research by Anthony Sardella, a business professor at Washington University in St. Louis. > As generics manufacturers compete to win sales contracts with the big negotiators of such purchases, such as Vizient and Premier, their profits sink. Some are going out of business. I'm confused, how is it that the prices are being driven so low that the supply dries up despite continued demand?

warent 3y ago
I think this is one of those "race to the bottom" things where businesses endlessly undercut each other until everyone loses
- sacnoradhq 3y ago
  "Race to the bottom" is bullshit because there is a floor equilibrium of difficulty of manufacturing and regulatory administration, and there is relatively constant demand. People never stop getting sick. Generics need more social ventures to keep critical medications supplied on the market. One recent example is the shortage of amphetamine stimulant medications.
foota 3y ago
It's unclear whether the demand would support a higher price I guess. Alternatively, another way of looking at this is perhaps that the distributors are seeking a profit, and so are demanding low prices from the manufacturer, meaning that high cost manufacturers go out of business, reducing supply. However, this may be inefficient, in that demand may exist at higher prices, that could support more manufacturers if not for the distributor.
- Terr_ 3y ago
  Hm, so in other words perhaps there's a distributor/middleman layer without enough competition, one whose most-profitable situation comes from focusing on high-margin drugs.
- lsaferite 3y ago
  Sounds like it's a lot of things, but one thing mentioned in the article is pricing pressure from plan administrators. Large plans have outsized influence on pricing. Mix that with unscrupulous manufactures that cut corners to lower costs and you have a mess. Those bad manufactures can agree to go lower than legit manufactures and they then let the plan administrators force pricing lower for everyone. At some point the legit manufacturers are priced out, leaving only the bad ones. Then when a bad one implodes, the market isn't there anymore. By this point plan administrators have anchored pricing too low and are likely going to be slow to adjust (if they adjust at all). NB: I'm not involved in the medical field or in economics, so take my statements as what they are, conjecture.
sacnoradhq 3y ago
Relative profits are "drying up" because they can't charge $10k per dose and throw away half and quarter doses.
- bozhark 3y ago
  moving into biologics
  - ackbar03 3y ago
    are they actually? The generic companies are making biologics now? Biologic generics, or technically biosimilars, are supposedly much harder to make, which is why a lot of them remain expensive even when the patents expired for a long time (e.g. insulin)
bandrami 3y ago
Cancer drugs in particular have this exceedingly weird market where oncologists buy drugs from distributers and resell them to their patients. Everybody agrees it's a bad way to do it, and nobody would have deliberately designed it that way, but it's a system that's hard to disassemble now that it's in action.
ars 3y ago
> I'm confused, how is it that the prices are being driven so low that the supply dries up despite continued demand? The incremental cost of an additional dose is low, so as long as the production line is operating all is well. But then the line shuts down for whatever reason - and reopening it (or a new company starting one) costs way way too much. i.e. it's not worth it for them to do that at current prices. They would have to charge far more than the existing companies charge, and no one would buy the drug. It's basically a timing issue, long term contracts mean that prices can not rapidly adjust for market disruption, combined with very very long lead time for additional production, means that the market can stay disrupted for extended periods of time. Years even. It will eventually adjust, but it will take so long that current patients are in trouble. The solution is a buffer, keep production in a strategic reserve.
Hermitian909 3y ago
- Patients can only buy cancer medication from their healthcare providers, and expect it to be covered by health insurance. - Healthcare providers will only buy cancer medication whose prices are low enough to be covered by insurance. - Insurance scours the market for the lowest cost providers and states it will only cover that cost, no higher. - If the cost of drugs goes up, insurance does not immediately renegotiate prices. Healthcare providers stop buying the drugs while waiting for low cost capacity to re-appear so they don't take a loss on the care. - Drug companies go out of business because they can't sell their inventory, driving up prices further while reducing supply. We really ought to have a government funded drug manufacturer...
akiselev 3y ago
Premier and Vizient are group purchasing organizations which handle all the supply for a ton of hospitals - 800k or so hospital beds between the two out of about a million total in the US. They started out as hospital purchasing groups which were created by hospitals who banded together to get better deals so they usually monopolize purchasing for an entire hospital. Now they’ve grown so big they’ve got monopolistic pricing power as consumers (I don’t know the right economic term) since there are so few organizations buying for all the hospitals. When buying syringes, bandages, and most of the things hospitals need, that’s not a big deal but the way many oncology drugs are administered these organizations end up handling all of the negotiations instead of pharmacies and insurance companies. Patients and even their healthcare providers have basically zero say in the purchasing because it’s all rolled in. Since the US is the most profitable market in an already low margin business, the generic manufacturers can’t justify the production lines for cancer drugs without at least one of these clients so they‘re driven to extreme price wars. In good times, they eek out a profit, but in bad times when variable costs go up, they’re no longer viable.
- worldsayshi 3y ago
  I wonder if premier and vizient have a vested interest in some of the suppliers going out of business, like if they have indirect ownership in competing suppliers.
- Arkanum 3y ago
  I think the word you might be looking for is "Monopsony" https://en.wikipedia.org/wiki/Monopsony https://en.wikipedia.org/wiki/Monopsony
- deleted 3y ago
  [deleted]

Aleklart 3y ago

Who needs drugs, when AI develop cancer treatment in just 30 days (according to https://nypost.com/2023/03/20/ai-develops-cancer-treatment-in-30-days-predicts-survival-rate/ https://nypost.com/2023/03/20/ai-develops-cancer-treatment-i...).

Spastche 3y ago
[flagged]

submeta 3y ago

Applying my rudimentary knowledge of microeconomics, the situation with the shortage of cancer drugs seems to be a case of a race to the bottom, as one commenter noted. Here, multiple generic drug manufacturers are competing to win sales contracts by offering the lowest possible price. This can be seen as an example of perfect competition, where firms are price takers and compete mainly on price, driving prices down to the point where they equal the marginal cost of production. However, the problem arises when these prices are driven so low that they no longer cover the firms' average total costs (including both variable and fixed costs), making it unprofitable for them to continue production. Some firms may choose to exit the market, leading to a reduction in supply. This is where the theory of "shutdown point" comes in: firms will choose to shut down production (at least temporarily) when price falls below the minimum point of the average variable cost curve. The complication in this case is that the reduction in supply is occurring for a product (cancer drugs) that is still in demand. However, as one commenter suggested, it's unclear whether the demand would support a higher price. There might be external forces (like regulatory environments, health insurance dynamics, and negotiations by large scale buyers) that are keeping the prices artificially low, preventing the price from rising to a level where it would be profitable for more firms to produce the drugs.

LastTrain 3y ago
Where is the consumer - the sick cancer patient - represented in your analysis?
- submeta 3y ago
  I am not saying that this is the way it should be.
  - LastTrain 3y ago
    Understood, I was actually wondering where they fit in your analysis. It seems they are locked out of direct participation in a transaction that is ultimately harmful to them, with no regulatory protections for /them/.

pazimzadeh 3y ago

This is ridiculous. Shouldn't it be the government's job to step in in these situations and mass produce these basic compounds. Does anyone measure the cost of not saving lives, and who pays that cost?

monsecchris 3y ago
[flagged]
- tfourb 3y ago
  The demand for these kind of drugs is quite predictable. It would be trivial for the government (assuming it has the political will to do it) to make mid or long term contracts with suppliers to provide these drugs so that the risk of shortages is drastically reduced. I.e. many governments store enough anti-radiation drugs to supply their population in case of a major fallout event. Governments were also the main customers for the various COVID-vaccines and where the political will was available to make it work, this system worked quite well.
  - monsecchris 3y ago
    That sounds wonderful and is nothing at all to do with what the parent comment was suggesting.
danielschonfeld 3y ago
Nah in the US we only save businesses. The bigger they are the better.

raincom 3y ago

Few days ago, 'US doctors are rationing lifesaving cancer drugs amid dire shortage': https://news.ycombinator.com/item?id=36447371 https://news.ycombinator.com/item?id=36447371

oefrha 3y ago

It’s mind boggling that with close to 20% of GDP poured into the medical industrial complex, the government can’t subsidize or straight up take over the production of some life saving drugs.

fifteen1506 3y ago
I'm strongly against subsidies. It sounds like the worst of both sides. Either the government owns the plants or not. Plants can be privatized later if deemed necessary, or kept on government hands to allow the government to have the know-how about the industries it needs to supervise. That being said, I'm just a peasant.

refurb 3y ago

If you note, most of these drugs are parenteral (injected IV). It’s a bitch to manufacturer because standards are so high. So what happens is profits get squeezed, someone runs a bad batch and throws it out, while another company is like “nah, we don’t want to make this any more” and poof, shortage. Of course someone will step in eventually, charge 10x the price, and get bad press for “cost of lifesaving cancer drug increases by 1000% percent”.

mrweasel 3y ago

There's basically a shortage of every conceivable type of drug. While not in the US, my partner works in a pharmacy, and it happens on an almost daily basis that they are unable to fulfill prescriptions do to a shortage. It's everything, certain types of pain kills, ADHD medication, vaccines, insulin (because the resources goes to weight lose medication), weight lose medication (because more people are getting it, compared to expectations), drugs for hearth problems, blood pressure, you name it and there is or have been a shortage. Everything seemed to breakdown during COVID and just never fully recovered.

sologoub 3y ago

Seems like similar story is playing out around the world: https://amp.dw.com/en/health-ministry-confronts-germanys-dire-medicine-shortage/a-64733080 https://amp.dw.com/en/health-ministry-confronts-germanys-dir...

KnuthIsGod 3y ago

"MEDICINE SHORTAGE REPORTS DATABASE The medicine shortage reports database includes information about shortages of reportable medicines in Australia https://apps.tga.gov.au/Prod/msi/search?shortagetype=All https://apps.tga.gov.au/Prod/msi/search?shortagetype=All" Here in Australia, 414 medications are in short supply. I regularly get pharmacists ringing me to inform me that the medication I prescribed for a patient is unavailable. That is the result of American middleman companies like Premier and Vizient squeezing every last paisa out of Indian generic manufacturers. Some of them decide to close their production lines and switch to manufacturing more profitable medications.

chucklenorris 3y ago

here's an idea that will never be implemented because of the paranoia of communism but that i think would be the most beneficial for society. why not create a government controlled non profit for producing out-of-patent drugs? it wouldn't hurt big pharma, it will substantially improve the life of the poor and chronically ill, reduce overall cost of healthcare, create strategic production in case of emergencies, can be a stepping stone to the healthcare as a human right.

bawolff 3y ago
Googling i found this proposal https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134734/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134734/

thesaintlives 3y ago

The Indian health care system is very interesting. Just imagine a big country with lots of poor people but not enough doctors and hospitals (or toilets for that matter). How do you stop everyone from dying of say a simple bacterial infection and give them access to medicine? The answer is the pharmacy. Every little village has one. It is fully stocked with most generic medicine and available over the counter at a very cheap price. The pharmacist decides what you need and you buy it. If you can afford it you find a doctor for further treatment. This system built itself through simple practicalities. No price gouging at any point. No vultures to regulate and feed. Capitalism in the USA is out of control..

dumpsterdiver 3y ago

From the article: > “It’s just insane,” said Mark Ratain, a cancer doctor and pharmacologist at the University of Chicago. “Your roof is caving in, but you want to build a basketball court in the backyard because your wife is pregnant with twin boys and you want them to be NBA stars when they grow up?” At that point the article "seamlessly" transitions into a statement from another person, at first making it seem as if the previous person had said it. A poor report, imo.

LatteLazy 3y ago

It seems like an opportunity for a single group to just offer these at a cost plus 20% basis and lock in some long term supply contracts...

CatWChainsaw 3y ago

Nobody who gets high off of libertarian laissez-faire idealism and the aphrodisiac of "move fast and break things" should feel they deserve to complain. There is no profit, and there is no one willing or able to take up their mantle. Obvious result is obvious.

tacon 3y ago

The problem of fraud in the generic drug industry is the topic of the book "Bottle of Lies" by Katherine Eban[0]. She joined Peter Attia for a fantastic episode of his podcast[1]. It isn't often I burst out laughing while listening to a healthcare podcast, but I did several times with that episode. Attia and Eban are imagining the situation as the naive new employee from the U.S. drug manufacturing industry is presenting a report to the board of his new Indian generic drug company how their fraud has been working, and how to fix it. All those patients who can't get their generic drugs: How many of them were getting fraudulent drugs before that had little or no effect on their disease? One U.S. startup tried to make a business model out of analyzing every batch of drugs they sold. [I'm sorry, did you think every batch of the drugs you take was verified as the real thing between you and the (foreign) manufacturer?] Valisure is a startup that bought drugs in bulk and actually tested samples, using mass spectroscopy, to verify they were the real thing, then sold them on to U.S. patients. Alas, their business model does not seem to be working out so far. But they did detect massive contamination in Zantac which lead to its recall five months later by the FDA.[2] [0] https://www.amazon.com/Bottle-Lies-Inside-Story-Generic/dp/0062338781 https://www.amazon.com/Bottle-Lies-Inside-Story-Generic/dp/0... [1] https://peterattiamd.com/katherineeban/ https://peterattiamd.com/katherineeban/ [2] https://peterattiamd.com/davidlight/ https://peterattiamd.com/davidlight/

jujube3 3y ago

Problem: the government (FDA) did a bad job at regulating drug production plants in India. HN Solution: the government should take over all drug production.

dmvdoug 3y ago
I mean, the FDA has been captured for a long time now, by design (see, e.g., the it’s reliance on funding by the entities it purportedly regulates in order to function at all). That’s not evidence that government in principle is the problem. It’s evidence that government in bed with the regulated parties is. Asking for stronger government intervention is asking not for more of the same—-just the opposite.

seamac3 3y ago

Seems like a new opportunity to me. Companies that could produce generics cheaply.

NoZebra120vClip 3y ago

About 18 years ago, a P.A. took me into her office and gravely informed me that I had a thyroid condition and that I would need to take pills. "It is tiny pill" she said in her Slavic accent as I mad-dog stared her down. Now, once upon a time, thyroid hormone was provided from slaughtered swine, and the natural substance was processed into a medication. This was too inconvenient and messy, and unprofitable, so the chemical manufacturers found a way to synthesize it. Now another thing about the thyroid is that it adjusts to the amount of hormone in the body and will gradually shut down, permanently, as more synthetic hormone is consumed. Therefore, the more your dose is increased, the less your own body produces, and the more dependent you become. So one blood test made me a Good Customer For Life(TM). I've been purchasing the generic synthetic from Wal*Mart for $4 per month. I am under no illusions that it is efficacious, pure, or contains anything but filler.