13 ms·

Hepatitis C is a nasty disease that primarily affects people on the fringe of society. Many of these people don't have money, they don't have insurance, they of

• mentat 12y ago
  They are also making efforts to make it available in other countries where healthcare is hard to acquire and the disease is widespread for significant discounts.
• svsaraf 12y ago
  The most amazing thing is the simplicity of the drug in its chemical structure. Anyone with a chemistry background would recognize it as a modification of the RNA nucleotide that you learn in a undergraduate biochemistry course. Every few years people seem to think we've found all of the significant small molecules for human disease - they keep getting proven wrong.
  • prlin 12y ago
    Can you give any background on how they typically discover the chemical structure of new drugs? Or provide a few good pointers?
    • lchengify 12y ago
      I wrote pharma software for a few years focusing on small molecule drug discovery, and did academic research on structural based drug discovery of allosterics. Different companies do it differently, but the customers I had went through a series of steps. I'll try to summarize them briefly here. 1. Target choice: Typically research focuses on a single "target". In small molecules, this is typically a protein that you want to activate somehow to change a biological pathway. For other sub-fields, such as biologics, "target" can mean other things. 2. Iteration / core choice: You start with a small organic molecule "core" that can be the backbone of your drug. Molecules with similar cores can "fit" into similar places, whereas active groups that branch off of the core affect their efficacy. 3. Screening / lead optimization: Pharma companies have libraries of chemical structures, their properties, and how they fit into certain proteins. The idea is to find a molecule with a core that will fit, and active groups that will make the drug 'plug' the active site of the protein. When doing drug discovery, there are all sorts properties you care about, ranging from pka to toxicity. - For many drugs, there is experimental data that is available. For other drugs, experiments must be performed to obtain data. At this stage it basically becomes a data problem for the chemist. Lots of time looking at pivot tables of raw experiment data, 2d molecule structures, 3d structures, computational predictive results, etc. The idea is to to find holes in the data where potential molecules with the right core and active groups could have matching properties, etc. - A lot of it is data based, but a lot of it is also intuitive. - There are other sources of data other than assays (experiments). One of the most useful is X-Ray crystallography images, which are 3D images of molecules in active sites. 4. Discovery Candidate: At some point (hopefully) you reach the stage where you're pretty sure a drug has good properties. This is when you lock down the IP, not just by patenting that molecule, but all other molecules that are similar. Basically "putting it in a box" to start the more expensive animal / human testing. 5. POST-IND FDA approval process. You can read about this here [1], but basically this is where the expensive / time consuming fun begins. Animal tests, efficacy tests on humans, etc. This is pretty expensive but also well defined by the FDA Note that I am far from an expert, some of the people I worked with had done this for decades and would probably correct me and / or point out steps I'm missing. [1] http://www.fda.gov/drugs/resourcesforyou/consumers/ucm143534.htm http://www.fda.gov/drugs/resourcesforyou/consumers/ucm143534...
    • lngtmelistener 12y ago
      Derek Lowe's blog does cover that subject. You can find it at http://pipeline.corante.com/ http://pipeline.corante.com/ including a sovaldi related post http://pipeline.corante.com/archives/2014/07/21/the_hep_c_field_gets_nastier_by_the_minute.php http://pipeline.corante.com/archives/2014/07/21/the_hep_c_fi...
• gordjw 12y ago
  So if these people have no money or insurance, how does this benefit them at all?
  • copperx 12y ago
    It's easier to get ahold of $1000 to cure your disease than get ahold of a permanent stream of income that will enable you to live.
    • michaelbuckbee 12y ago
      Small but important note, it's $1000 / pill and $80,000 for the curative course of treatment.
      • visarga 12y ago
        They probably don't want or expect too many people to be cured with it, at this price.
  • ef4 12y ago
    People with no money in the US go on Medicaid, and Medicaid is legally obligated to pay for any medically necessarily FDA-approved drug. Much of the article above is essentially about state Medicaid programs freaking out for exactly this reason.
    • waps 12y ago
      This is probably one of the rules that makes it so easy for pharma companies to make medicine so expensive. Most European welfare states refuse certain treatments based on costs. This can, obviously, really suck because there are (sometimes) no private options, or they're unrealistic. And of course, every few years an expensive option is made available for a year or so because some politician's daughter happens to have it. This has been a criticism of Europe. Drugs get developed because Americans will pay for them, then when the cost is mostly recouped (ie. a decade later), it finally becomes available in Europe. This is freeloading, but you can't really blame them.
• jandrewrogers 12y ago
  I know someone who was part of a trial for an early (but highly unpleasant) Hepatitis C cure that was administered more than a decade ago. It was effective and he is still free of the disease today. He was on welfare at the time. Many people forget how difficult it is to produce a good, generalizable cure to any disease. It requires billions of dollars with a lot of dead ends. Occasionally it pans out. No one wants to spend the money for research that may never produce anything of value but they want the product of persistent and very expensive R&D for next to nothing. One of the biggest government investors in unpopular diseases is the US military, largely because they have a lot of veterans with them due to blood transfusions, environmental exposure, etc in the backwaters of the world. Organizations like the US Army are willing to put money toward relatively common diseases like multiple sclerosis, because it impacts their people, that the government at large is uninterested in because it is not politically sexy.
  • ArtDev 12y ago
    And yet, they spend much more on marketing gimmicks than actual research and development. (Big Pharma Spends More On Advertising Than Research And Development, Study Finds --- http://www.sciencedaily.com/releases/2008/01/080105140107.htm http://www.sciencedaily.com/releases/2008/01/080105140107.ht...)
    • com2kid 12y ago
      I've talked to multiple people who did not know that we've had HepC cures for around a decade now. I can sort of understand why marketing exists. Many people (most?) do not see their doctor on a regular basis, and even if they do, they might not bring up some chronic issue that they've learned to "live with". For people who do not see their doctor (or who do not have a good relationship with their doctor, or who have a poorly informed doctor) marketing from pharmaceutical companies may very well be the only way that they learn a cure or treatment exists for a problem that they have!
• foobarqux 12y ago
  What is the genesis of this drug? Was it started in a university? Acquired?
  • georgewfraser 12y ago
    It was created at a small pharma company called Pharmasset. The founders also worked on some of the AIDs drugs in the early 90s, and it's based on the same chemistry: nucleic acid analogues. They worked on a variety of drugs, this was their big winner. It was bought by Gilead for $11b at a time when only one phase 2 trial had completed and about 12 patients had been cured for a couple months. It's important to point out that it was by no means a sure thing, and indeed many of these patients relapsed. Only by combining it with an older drug were they able to get these high cure rates.
    • busyant 12y ago
      Back in 2012 (I think), I thought it was insane that they were willing to pay $11B for Pharmasset based on Phase 2 data. At the very least, it was a ballsy move that has generated about 6 billion in revenue in just the 1st 6 months on market in the U.S. Note that Bristol Myers Squibb paid about 2.5Billion to acquire a competing company (Inhibitex) and that drug had to be junked for safety issues shortly after the acquisition.
  • refurb 12y ago
    Gilead bought Pharmasset a few years back for $11B. Apparently it was discovored by Pharmasset, but I remember hearing they actually picked up the program from another small company.
• carbocation 12y ago
  I'm a doctor. The running theme up until a couple years ago among my colleagues was that, if forced to choose HIV or hepatitis C, we'd choose HIV (because there is effective suppressive therapy). With modern HCV therapeutics for genotype 1a, and, in particular, thanks to the non-interferon therapy widely expected to be approved this fall, I would say that there has been a dramatic reversal of views on that topic. Hepatitis C is a slow death sentence, and these drugs, based on studies to date, appear to be life saving.
  • liverman 12y ago
    I have a liver disease that hasn't been diagnosed yet, doctors have not been able to pin it down, (seems similar to Wilsons disease) but it is a chronic liver disease. Is there any chance this medicine could help cure it? Up till now the only course of action has really been to just try to avoid further damage and wait for cirrhosis, which doesn't sound particularly fun :( Sorry if this is a little like a stranger at a party asking about how to get rid of their warts :p
    • pja 12y ago
      Sofosbuvir (Solvadi is the brand name of the pill) acts by inhibiting the viral RNA polymerase enzyme used by the Hep C virus, so unless your liver disease has a viral cause where the virus relies on an affected RNA polymerase this drug probably isn't going to help.
    • Mz 12y ago
      There is probably a great deal more you can do than that, even without a diagnosis. A proper diagnosis would empower you to do yet more, even if doctors don't have the answers. You can do a lot to reduce the current load on your liver, to support the liver nutritionally, etc. That would improve your quality of life and extend your window for finding real solutions.
  • matt_morgan 12y ago
    > Hepatitis C is a slow death sentence I don't understand that statement. I had Hep C and it was cured with interferon/ribavirin. It was a nasty treatment and I guess there are people who don't complete it, hence (probably) its reputation for uncertain effectiveness. I absolutely would have preferred this new treatment, but if you had been able to tell me five years ago that I could take interferon & ribavirin now, or wait five years for a better treatment, I still would have completed the interferon/ribavirin treatment.
• teen 12y ago
  my ex girlfriend was born with hepatitis c and i'd been having unprotected sex with her for 2 years. you just scared me... i was last tested in october, time to get re tested :O
• SilasX 12y ago
  If so, that would make the title very misleading as this would be a case of one health care cost being high be used it's legitimately expensive to produce. It has nothing to do with the typical horror stories you hear about being charged $50 for an aspirin that characterize the problem with health care costs.
  • cbhl 12y ago
    Well, so the problem is that the "expensive to produce" part has already been done -- R&D, clinical trials, etc. The incremental cost of actually producing a pill now is probably far, far, lower than $1000, but the pharma companies will want to sell the drug for as much as they think people will pay for it so that they'll have money to produce new drugs.
    • SilasX 12y ago
      What I meant was, the cost, including amortization of fixed costs, is still legitimately high (and thus would be expensive for very different reasons from the typical "health care WTF" -- and most health care spending isn't in the form of pharmaceuticals). And expecting high-fixed-cost goods to be priced based on the marginal unit ... is the wrong heuristic to begin with.
      • makomk 12y ago
        Not sure it's legitimately that high - 3.2 million patients in the US alone times $84,000 per patient gives you a lot of amortization of fixed costs.
    • brazzy 12y ago
      > so that they'll have money to produce new drugs. That argument would be a whole lot more convincing if they didn't spend vastly more money on marketing than on R&D...
      • Ntrails 12y ago
        I have never got over my visits to North America and seeing endless adverts for prescription drugs - which never actually said what they were supposed to cure. Followed by, of course, a voice quickly firing off the list of side effects. "Ask your doctor if somthingodin is right for you." Just bizarre to me.
• hackerboos 12y ago
  If almost 1% of your population is the 'fringe of society' then that's another problem altogether.
  • deleted 12y ago
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• brazzy 12y ago
  > These drugs are a bargain Not when you learn that the company that actually created it planned to put the price 2 times lower before being bought out.
  • refurb 12y ago
    If Pharmasset had kept the drug for themselves, they would have launched at a similar price. Early on in a drug's development, companies will do market research to estimate the value of the drug. That research is pretty quick and dirty and the price you arrive at has a margin of error of +/- 50% easily. I have acquaintances who worked on the pricing of Gilead's drug. If anything, Gilead priced at the lower end of what they could have. No company, launching that drug today, would have priced it at the price Pharmasset estimated 2-3 years ago.
    • lotsofmangos 12y ago
      I suppose they must have a lot of extra costs. I bet you don't come cheap, for one thing.
• Fuxy 12y ago
  And this is why most companies would rather treat a disease then cure it. It has been so long since a disease has been cured that the current american system isn't designed to handle it. I have to say the European state sponsored medicare looks way superior from this point of view. They are not worried about the high upfront cost since every citizen is paying taxes for that. Plus they can drive prices down since if the government buys from you you make a lot of money if it doesn't you have to sell it a lot cheaper for regular people to buy it with their own money. It's not perfect it's open to manipulation however it's better that anything a dynamic corporate sector could offer.
  • Brakenshire 12y ago
    > They are not worried about the high upfront cost since every citizen is paying taxes for that. Not only that, but that they can look very clearly at cost vs benefit. With a citizen, who is unlikely to move anywhere else, you can look at lifetime care costs and reduced earning ability (at least in the average case), and say outright that it is sensible to pay $100,000 to save many times that on a lifetime of ineffective care and reduced potential. You can also look at the public health impacts - treating one patient might reduce the risk of wider infection in society, which can also be placed in the cost-benefit analysis. This is more difficult with American states (because people move between them much more- the payment comes from one state, but the benefit is spread out), and more difficult for insurers (because they are subject to much greater short term pressures, and can't look at wider benefits). From the article: “If it is cost-effective from a societal standpoint, it is not necessarily going to be cost-effective from a health plan standpoint,” said Dan Mendelson, chief executive of Avalere Health, a health care consulting company.
    • rgoddard 12y ago
      In the US one way to help mitigate this problem is to start shifting some of the risk from the insurance plans on to the provider networks. As mentioned people can change insurance plans frequently so investing in their health can be difficult. While they change plans frequently, the providers they see would be slower change. There are times when a change in plans will cause in change in PCPs. But that should still be less frequent then the change in insurance. But we would need to reward provider networks for keeping people healthy, not just treating them when sick.
• ck2 12y ago
  See this map? http://www.advisory.com/~/media/Advisory-com/Daily-Briefing/2012/11/DB_medicaid_map_lg.jpg http://www.advisory.com/~/media/Advisory-com/Daily-Briefing/... If you live in any of the grey areas and don't make enough to get Obamacare, you cannot afford this drug, you will die. That is 50+ million people. Hopefully only a tiny fraction of those people have Hep C because I feel horrible for them. They didn't price it $5000, $10K, $20K or even $30k. They priced it $80k. Every 12 people is a million dollars for them. Then they turn around and will sell it overseas for $8000. The only hope for people in those states will be to buy a plane ticket to where it will be $8000 for the whole treatment, live there until cured and hopefully come back alive and not arrested for not giving the corporation $80k
  • peteretep 12y ago
    Could you explain to me like I'm stupid how you can not make enough to get Obamacare? I thought that if you didn't make enough, you got it subsidised.
    • ck2 12y ago
      You cannot get any subsidies unless you make a certain amount of money per year, and it is a significant amount. Then you cannot get medicaid unless you make below a certain amount, in some states it is like $3000 a year, which I imagine you'd have to be homeless or living under someone else's roof for free. All states were supposed to do medicaid "expansion" (raise the $3k minimum) to cover that big gap. Instead the supreme court ruled it was okay to let people be sick and/or die if they couldn't afford it. So either get two jobs (with hep c, good luck) to make enough to get obamacare, or become homeless to get under the $3000 mark in half the country. Yay America and million dollar profit for every 12 people dying.
      • CWuestefeld 12y ago
        Instead the supreme court ruled it was okay to let people be sick and/or die if they couldn't afford it. You mischaracterize the ruling. What the ruling said was the the federal government isn't allowed to coerce the states as it was trying to do. Moreover, you're making the mistake of working backwards. You're starting from what you want the outcome to be. With that baseline, you then determine what the court should rule. But surely you took enough classes in school about American history and civics to understand that this isn't how the American government works. There's a system of laws that determines what the government is allowed to do; if what it wants to do isn't permitted in that framework, then it's not allowed to do that. Your desire to see a particular outcome - even if that outcome is agreed on by all to be a morally superior one - does not enable our government to take actions it isn't given the authority to execute. (and apologies for wandering a bit astray into more concrete politics...) A belief that we ought to ignore the legal framework and instead focus on what is sold to us as "a practical view" is the way that we get to such governmental actions as Guantanamo Bay and prisoner torture.
• deleted 12y ago
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• allworknoplay 12y ago
  A bargain? The only reason the price is so high is because the company knows that insurers are generally mandated to provide it. Also, I love this: "Medicaid gets a mandatory discount of at least 23 percent on drugs." _Obviously_ the company just sets the price higher accordingly. It's pretty tough to evaluate the investments large pharmaceutical companies make in R&D because a lot of the expenditure is through acquisitions and a lot of failed efforts at private companies go uncounted. But do the math on this product: ($84K course of treatment times 3.2 million customers in the US alone) -- or just noting the $55bn total revenue estimate or the $3.5bn they sold last quarter. Compare that to the $2.1bn they spent on R&D last year (less in previous years) or the $11bn they paid for the company that developed the product. It's pretty clear that this is an absolutely monstrous windfall that they can get away with because of the way we've designed our healthcare system. It's not a bargain. Also: I don't have data to evaluate your statement that "they often aren't good at sticking to complex drug regimens", but it seems like a gross and extremely callous generalization. Also: it's 2014, we have smart pill bottles, automated alerts, and all sorts of other ways to solve that problem for nearly nothing. I'd refer to some of the other commenters who have noted that companies get richer through treatments than cures.