7 ms·

"it’s the same damn molecule with a few cosmetic changes" pretty much tells you everything you need to know about this article. As any chemist worth their salt

"it’s the same damn molecule with a few cosmetic changes" pretty much tells you everything you need to know about this article. As any chemist worth their salt will tell you, small differences to molecules doesn't necessarily make them just as easily produced. And similarly any biochemist worth their salt will be able to tell you that small differences can indeed matter a lot! Reading the wikipedia article for the more expensive drug (http://en.wikipedia.org/wiki/Ranibizumab http://en.wikipedia.org/wiki/Ranibizumab), it does appear that there are therapeutic differences between the two drugs in terms of associated infections. The real thing, however, to check when talking about medicines is the Specific Product Characteristics sheet. This is, in essence, what doctors refer to when looking up medicines. http://www.medicines.org.uk/emc/medicine/19409/SPC/Lucentis+10+mg+ml+solution+for+injection/ http://www.medicines.org.uk/emc/medicine/19409/SPC/Lucentis+... and http://www.medicines.org.uk/emc/medicine/15748/SPC/Avastin+25mg+ml+concentrate+for+solution+for+infusion/ http://www.medicines.org.uk/emc/medicine/15748/SPC/Avastin+2... . Avastin is used for a lot more than just eye conditions, it seems, and has shall we say a number of issues. Something most people fail to realise is exactly how expensive new drug development actually is. You've got experimental labs doing in-vivo tests of thousands of molecules (at least), animal studies to ensure the human trials will be safe, multiple stages of clinical trials in humans with associated insurance, etc. The sole means of recuperating the cost of all of this is through product sales. There are very few actual grants awarded for developing medicines all the way through to production. No tie-in marketing of lunch boxes. No crowdfunding from patient groups. I do wholeheartedly agree, however, that there are perverse incentives on doctors to prescribe more expensive medication, and the modern pharmaceutical industry is messed up in so many ways. Most doctors too don't even understand properly what it is they are prescribing[1], and the 21st century medical representative system has more in common with jingles and home appliance sales than the clinical educators of the 20th century. Disclosure: I have family and friends working in this field [1] Reasons why people become doctors: money, power and helping people. Good doctors get to chose two of out of three. And to be fair to doctors, they have to remember a hell of a lot of academic material in a constantly changing field, and /then/ have social skills and physical skills to master

ams6110 13y ago
Several of the "perverse incentives" are possible because of insurance/medicare hiding the true cost of medications from the consumer, so there is very little rational price-signaling back to the manufacturers. Other perversions are made possible by the very regulatory agencies that originally had the good purpose of ensuring drug safety and preventing snake-oil remedies but which have become complex, ever-expanding nightmares of bureaucracy with vast opportunities for corruption and political favor-trading.
georgewfraser 13y ago
> "it’s the same damn molecule with a few cosmetic changes" pretty much tells you everything you need to know about this article. This is not like a small molecule where a little change makes a huge difference; Avastin is a giant antibody and Lucentis is a part if the same antibody. It's a hack of the FDA process to allow Genentech to sell an equivalent drug at a very different price.
silencio 13y ago
If the pharmaceutical industry didn't already turn me into a jaded person, I would still be feeling a bit of "so what" at what you're suggesting - and coming from an almost-biochem-but-CS major studying for the MCAT right now, I can probably appreciate what you are trying to say a bit more than the average layman. Genentech have no problem at all whatsoever with most off-label uses of Avastin (e.g. ovarian cancer) and have subsequently added them to the label (and in some cases, like breast cancer, they had to be dropped from the label afterwards), but they actively refuse to do so for ophthalmic use presumably because it would chew into Lucentis profits which are practically an order of magnitude larger. Imagine if Avastin were wildly different from Lucentis - would this fingers-in-ears "lalalala" singing attitude (to be generous) to keeping the use off-label seem reasonable to you in the face of massive amounts of evidence supporting the idea that it is just fine? Literally their only excuse for doing so is that Lucentis exists, nothing else. Both drugs have a number of issues, both drugs could be used for a lot more than ophthalmic use, and both drugs are still kind of expensive ($50 vs $2000 in the US). Avastin is still a blockbuster for Genentech, don't forget - it is one of the best selling drugs in the US. And yes, I appreciate that drug development is expensive and I know companies have to work for their stockholders, but it's really hard to watch patients trying to make a decision about Avastin vs Lucentis at the end of the day. Maybe I'm wanting to be a mediocre doctor that just wants to help people, haha. But my father has retina issues and I have spent way too much time in waiting rooms overhearing his specialist convincing other patients that he has had an excellent track record with Avastin use as well as Lucentis and he wants to prescribe whichever costs the least out of pocket first. When some of his patients decide not to go with either drug because off label use is too scary for them and they can't afford Lucentis even though he tries to reason with them - those are people giving up their fucking _sight_ and a practically miraculously effective treatment for want of money and a successful scare campaign. And he is a specialist that (I did my research before we went to him) has a good background in research and clinical practice, as well as participating in some studies for Avastin and Lucentis alike, so I hope he has appreciated your argument before doing what he does, too. Perverse is an understatement here in my (not so honest) opinion.

ams6110 13y ago

Several of the "perverse incentives" are possible because of insurance/medicare hiding the true cost of medications from the consumer, so there is very little rational price-signaling back to the manufacturers. Other perversions are made possible by the very regulatory agencies that originally had the good purpose of ensuring drug safety and preventing snake-oil remedies but which have become complex, ever-expanding nightmares of bureaucracy with vast opportunities for corruption and political favor-trading.

georgewfraser 13y ago

> "it’s the same damn molecule with a few cosmetic changes" pretty much tells you everything you need to know about this article. This is not like a small molecule where a little change makes a huge difference; Avastin is a giant antibody and Lucentis is a part if the same antibody. It's a hack of the FDA process to allow Genentech to sell an equivalent drug at a very different price.

silencio 13y ago

If the pharmaceutical industry didn't already turn me into a jaded person, I would still be feeling a bit of "so what" at what you're suggesting - and coming from an almost-biochem-but-CS major studying for the MCAT right now, I can probably appreciate what you are trying to say a bit more than the average layman. Genentech have no problem at all whatsoever with most off-label uses of Avastin (e.g. ovarian cancer) and have subsequently added them to the label (and in some cases, like breast cancer, they had to be dropped from the label afterwards), but they actively refuse to do so for ophthalmic use presumably because it would chew into Lucentis profits which are practically an order of magnitude larger. Imagine if Avastin were wildly different from Lucentis - would this fingers-in-ears "lalalala" singing attitude (to be generous) to keeping the use off-label seem reasonable to you in the face of massive amounts of evidence supporting the idea that it is just fine? Literally their only excuse for doing so is that Lucentis exists, nothing else. Both drugs have a number of issues, both drugs could be used for a lot more than ophthalmic use, and both drugs are still kind of expensive ($50 vs $2000 in the US). Avastin is still a blockbuster for Genentech, don't forget - it is one of the best selling drugs in the US. And yes, I appreciate that drug development is expensive and I know companies have to work for their stockholders, but it's really hard to watch patients trying to make a decision about Avastin vs Lucentis at the end of the day. Maybe I'm wanting to be a mediocre doctor that just wants to help people, haha. But my father has retina issues and I have spent way too much time in waiting rooms overhearing his specialist convincing other patients that he has had an excellent track record with Avastin use as well as Lucentis and he wants to prescribe whichever costs the least out of pocket first. When some of his patients decide not to go with either drug because off label use is too scary for them and they can't afford Lucentis even though he tries to reason with them - those are people giving up their fucking _sight_ and a practically miraculously effective treatment for want of money and a successful scare campaign. And he is a specialist that (I did my research before we went to him) has a good background in research and clinical practice, as well as participating in some studies for Avastin and Lucentis alike, so I hope he has appreciated your argument before doing what he does, too. Perverse is an understatement here in my (not so honest) opinion.