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Cancer Doctor Leading the Attack on Astronomical Drug Prices

162 points by datashovel 11y ago

Neil44 11y ago
Prices are high because of long and expensive development times, massive amounts of regulation, very high risk and relatively short patents to recoup these costs. Not to mention the costs of the other 5 drugs that failed final trials. Demand is also understandably very high. I do think there should be harder discussion of cost/benefit though to bring some sanity into the system. What else could be done with that money, rather than a marginal outcome for one person? It's a hard conversation. This is especially relevant in something like the NHS where direct tradeoffs must be made.
- sdoering 11y ago
  R&D are surely contributing to the high price. But as can be seen in the yearly financial statements of these companies, they are not that high, as they want us to believe. Take Europe for example. As far, as I know in Germany the producers can pretty much dictate the price (ok, the have to discuss with the insurance companies, but they just can raise their fees so they have no real interest in saving money). After the German price is decided neighboring countries (Belgium for example) take these, cut of about half of that and dictate this as the maximum price for the drug. Looking at the financial statements, the regarding companies still make a lot of money in Belgium of these drugs. But way more in Germany. So I really do not believe the story being told, that the R&D costs and the risk are the reasons for these astronomically high prices. And - when your life is at stake, your are more then willing to pay every price necessary - so your bargaining position is not quite great and your market power is drastically lowered.
  - bayesianhorse 11y ago
    Actually no, in Germany the drug companies can't take any price, because the insurers are negotiating as one party with the drug companies. But yes, drug prices in Germany are relatively high. Why would private companies leave money on the table unless forced by regulation? They have to squeeze every profit they can out of the health care system. The situation in Germany is way better than in the US, where these negotiations are a lot more favorable to the companies, because they can "negotiate" with individual insurance companies and even patients. But especially in the latter case, there's not a lot of "negotiation"...
    - sdoering 11y ago
      Had also mentioned the negotiating part - but the history shows, that there isnÄt that much interest from the insurance companies to really keep prices low, as they are able to always get more money from their "clients" via our regulators. So even here, where the system is probably better then in the US, it could be improved massively via regulation, without killing all profits or even the investments on R&D by the companies. But the political will seems to be missing.
    - taki1 11y ago
      this is because of over-regulation. Destroy regulation, i.e. patents, and then then tell me drugs aren't cheap.
      - bayesianhorse 11y ago
        I think the argument for patents, as incentive for development, is quite strong. There is no alternative system in place yet. Also you probably underestimate the value and purpose of pharmaceutical regulation. Most rules revolve around production quality, scientific soundness, safety monitoring and so on. Come to think of it, the degree of safety in pretty much any drug on the legal market is quite astounding, despite exceptions and accidents.
      - sdoering 11y ago
        Sorry, but there is imho to little regulation going on here. The market seems rigged against patients - esp. patients with terminal (or at least grave) illnesses that are pretty wide spread. These people are hey are prone to be exploited and there are enough of them. Mostly pharma does not dev drugs for wide spread illnesses that mostly occur in poor countries for example. Or grave illnesses, that only affect very, very few people. But dev a "new" cancer drug and you got your license to print money (lot of people get cancer, a lot is payed by insurance, and people and their loved ones want healing).
        JoeAltmaier 11y ago
        I'm missing your point. Most diseases is characterized that way - lots of people get them, healthcare paid by insurance, people want healing. Cancer is not special.
- bayesianhorse 11y ago
  That's simply not true. Yes, development costs are high, but not that high. The real reason the drugs are priced so high is that people/insurers pay it. I wouldn't even call it a free market, since the patent protection is involved. Essentially it is extortion. Eventually we might get a situation where drug companies raise costs for patented drugs, not only cancer ones, slowly to the breaking point where even less people can afford insurance anymore. Why wouldn't they? The insurers are very disinclined to refuse life saving treatments to their patients. With biologicals the cost of actually producing the drugs can be high. The only way to bring that down is to drive forward the necessary technology.
  - m_mueller 11y ago
    > Eventually we might get a situation where drug companies raise costs for patented drugs, not only cancer ones, slowly to the breaking point where even less people can afford insurance anymore. Aren't American drug prices already optimized around that breaking point?
    - bayesianhorse 11y ago
      considering that the cost of healthcare in the US is increasing rapidly, but also the ratio of insured citizens, no, I wouldn't say a breaking point has been reached.
  - NeutronBoy 11y ago
    > since the patent protection is involved While I'm no fan of software patents, why would I spend billions developing a new drug when I can wait for somebody else to do it, then just copy it?
    - robbiep 11y ago
      Because these drugs are mostly monoclonal antibodies, you have to actually develop your own. You can work out what the target is, but because the antibody has extremely high specificity for a specific target, and is high molecular weight, you can't just synthesise it, you need to grow it (An absolutely fascinating process in and of itself) There have been examples of other drug companies targeting the same target as an existing high value monoclonal antibody drug, however I am aware of at least one example where the 'knockoff' monoclonal antibody actually had harmful effects compared with the original. The only way you can actually copy the drug is to steal a cell from their lineage and produce your own
- peteretep 11y ago
  > This is especially relevant in something like the NHS > where direct tradeoffs must be made You say this like you're unaware of NICE and the guidelines they publish.
  - Neil44 11y ago
    That's a whole extra discussion - the pressure they get put under by families and groups to approve very expensive and relatively ineffective drugs is immense. Meanwhile people are having to take charity collections to pay for MRI machines.
rodgerd 11y ago
New Zealand's Pharmac has generally been quite successful in keeping costs down, which is of course why it's under constant attack by the US State Department and is likely to be required to be effectively destroyed when New Zealand signs up to the TPPA.
- srean 11y ago
  The same used to be true for India, till it folded. pretty sure both pressurization tactics and bribery were at play.
- jordanthoms 11y ago
  Pharmac works fairly well in NZ - although it's not nirvana, there still are issues around what drugs they fund (Pharmac provides the drugs they select at cheap prices, but if they choose not to fund a drug because they don't consider it cost effective enough, you have to pay full price yourself). However, I'm not so sure it's a good model for the world or for the US market, because it's actually quite selfish. NZ is able to get drugs cheap because the US consumers are paying extremely high prices which cover the development costs. If everyone was buying drugs at the price we pay in NZ, there would be far less incentive to develop new drugs. With NZ being such a small market we can get away with it without having any impact on the development of drugs, but we're lucky that the Americans are picking up the development tab for us and we would have a problem if they stopped doing that.
  - taki1 11y ago
    If it would be such a big problem for Big Pharma they would stop selling drugs in NZ. Just to set an example for other countries if not for anything else.
    - jessriedel 11y ago
      "Big Pharma" isn't a monolithic entity with greater coordination powers than New Zealand. (The very largest pharmaceutical company, Johnson & Johnson, has $70B in revenue compared to NZ's $180B GDP.) Furthermore, NZ can make a credible commitment to act irrationally for a long time through the democratic process, while individual pharmaceutical companies are driven by shareholders to maximize profits with a time horizon set by interest rates.
Toine 11y ago
Starts with a culture shift : society should care about its citizens health. It's just not the case in many countries, especially in the US. I guess the maths are simple : keeping more people alive and healthy is less profitable for the people involved..
- Fuxy 11y ago
  Keeping it's citizens alive, healthy and able to work is very profitable for a country since more able bodied citizens means a better economy. Most companies only care about how much insurance they have to pay and their bottom line they have no reason to keep an eye on the big picture. If an employee gets sick for too long or dies they will just fire him/her and get someone else to replace them. The citizens health is a big picture thing that only a government has the incentive of maintaining.
  - arethuza 11y ago
    In the UK at least, universal healthcare through the NHS was created largely because it was seen to be the morally right thing to do: The collective principle asserts that... no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means. I think it is worth noting that the book by Aneurin Bevan, the founder of the NHS, from which that quote comes was called "In place of fear" - that's what we had before socialized medicine (NB not claiming that the NHS is perfect, it clearly isn't - but compared to a lot of the alternatives it's fantastic). Of course, we do deny some care because the NHS can't pay for every treatment for everyone - but at least they try to decide this in a fairly sensible evidence based manner.
  - _yosefk 11y ago
    "Incentive"? Really? You mean a president looking to be reelected for another 4-year term has an incentive (as opposed to a moral imperative) to prevent future illness in people who're 20 today where the symptoms will become visible 30-50 years down the road? What is that incentive, and how is it stronger than the incentive to create jobs or lower prices right now for people who vote today by allowing some environment-destroying industry to expand, said expansion being the cause of future illness (a hypothetical or maybe not entirely hypothetical example)?
deleted 11y ago
[deleted]
unchocked 11y ago
It's an interesting plan from a game theoretic perspective to set an explicit upper price for drugs(in dollars per year of lfe or whatever). It certainly changes the price negotiation for drugs in the pipeline, and ultimately informs the incentives of drug development going forward.
blazespin 11y ago
The problem is not the high cost of drugs, the problem is the lack of R&D into processes and drugs that are not patentable. Like Stem Cells or Vitamin C. I'm not saying that these have any medical value, it's just no one is willing to invest because there is no ROI. What might be interesting is force everyone to buy life insurance and then have the life insurance industry underwrite the R&D.
- rjtavares 11y ago
  Or, you know, increase public funding for research...
  - Ntrails 11y ago
    It seems to me that plenty of publicly funded research ends up simply pushing ideas which are subsequently developed and patented by companies. Perhaps I misread the situation, but that doesn't seem like it's in our best interests
    - rjtavares 11y ago
      That's why public funding should be directed at under-funded areas, like "processes and drugs that are not patentable".
  - joeyspn 11y ago
    Or, improve the independence and targeting of the research. For instance, having medical groups, patients associations, etc of X disease invest in research for X through crowdfunding. Experiment [0] looks like a good example/PoC for this. [0] https://experiment.com/ https://experiment.com/
- rollthehard6 11y ago
  This also includes the interesting area of drugs which are already been patented and licensed but find new uses once out of patent for different conditions, Naltrexone being a prime example. google Dr Ian Zagon's work at Penn State if you are interested in his work on Naltrexone, OGF and opiod receptors generally.
Keyframe 11y ago
"Cancer Doctor" - really?
- drjohnkasanders 11y ago
  Oncologist. But 'cancer doctor' is a term more people would know instead of 'oncologist'
rollthehard6 11y ago
Personally I don't think we can truly call ourselves civilised whilst we persist in valuing our fellow humans' health and their very lives in terms of financial currency.
- imaginenore 11y ago
  If we want companies to keep making drugs, we either socialize them and pay them from our taxes, or we let them make profits. Drug research and production is extremely expensive. And so are the recalls and the lawsuits.
- IndianAstronaut 11y ago
  This routinely happens everywhere on the planet. We could protect our citizens from being in car accidents, getting murdered, etc. But those all cost money, and we have made a decision to not spend more money(to hire lots of police, to build lots of public transport) to prevent those deaths.
- cbd1984 11y ago
  Everything costs resources. Whether you account for that in terms of money or some other method is irrelevant.
gggggggg 11y ago
I might be wrong as I don't know how to in detail read financial statements, but at the end of the day if they were making too much money (and by to much I mean unproportional) it would be obvious there would it not? I work in the medical industry and can say I don't know any poor doctors. Even socialists. And maybe they are rich compared to their individual r&d in study, I am not saying I support $200k a year for drugs, but shouldn't this be part of a bigger question.
- _Wintermute 11y ago
  The researchers in R&D are making significantly less than your typical clinician. It's not a career path you take if you're prime motivation is money (or job security).
shiven 11y ago
Whenever something like this comes up, R&D is held up as the "cost center", whereas initial discovery (hit) or optimizing it into a "lead" molecule is a fraction of the cost of turning out a "drug", even manufacturing is a comparatively small expense. The majority of the cost lies in the clinical trials process. That is where a potential drug can fail and take everything down the drain. That is why the "fail-early, fail-fast" mantra has been ingrained into big pharmacy like gospel truth. However, there is no reliable predictor of "late stage" clinical trial failures for a candidate drug molecule. And trials can fail from a drug having statistically insignificant improvements in a group of target patients, all the way to, having a high (how high?) propensity for adverse effects in the patient group. So, the solution? More fundamental research to explore indicators of late stage failure, coupled with "cheaper" clinical trials to justify a lower development cost that is enforced by legislation to bypass greedy execs/shareholders. Now, those "cheaper" trials, that is whole 'nother can-o-worms for a different thread, because it involves our willingness, as a society, to accept such risks as are part of the discovery process.
- Sven7 11y ago
  "Cheaper" trials are already par for the course in the developing world. And there are, as you mention, all kinds of down sides. But don't worry Big Pharma is not going to be sitting forever in the west. The rest of the world's governments, have had enough of their BS while trying to keep their populations alive. The consequences can be seen in IP law in the developing world and the rise of serious local competition. Bottom line - if you need access to medication\treatments that's costing a bomb, check out the options available in the developing world. You will be amazed.
  - athenot 11y ago
    Some of the trials from big western pharmaceutical companies are actually being outsourced to smaller labs in Asian countries with less restrictive laws, especially when testing with large mammals.
- MagicWishMonkey 11y ago
  Isn't marketing/advertising a huge cost center as well?
bcoates 11y ago
Headline doesn't match article: Saltz's beef is with the US spending too much on the very sick, which is getting in the way of truly universal health care coverage for the generally healthy. He wants the US government to use its market power to discourage the progress of ever more expensive treatments until we solve the problem of getting everyone access to affordable health care.
- kefka 11y ago
  We all have "access", as in I can potentially drive a car down to the upper end cancer facility in Indianapolis or the Mayo clinic in Chicago. "Is it affordable?" is a whole different question. And simply put; No.
  - jfoutz 11y ago
    Access usually means obtain. For example, if i hand a person a calculus book, have i given them access to knowledge of calculus? If they can read, yes. If i hand another copy to a blind person, have i given them access to the knowledge of calculus? Not really, no. If my intention is access to knowledge of calculus, i need to take extra steps. Maybe a brail version, maybe just read to them. I think you might be fuzzy because of login prompts. Technically you're using computer resources. clearly i have access to the machine in some way. Similarly, i have access to the Mayo clinic. I can walk in and talk to people. But, with the computer i can't get to the good parts, i can't open files. Also, with the hospital, i can't get to the good parts, i can't get healthcare without extra stuff. This isn't a slight against the clinic, I know they do charitable work. I think they charge so much, in part, to offset the costs to those who can't pay.
    - kefka 11y ago
      However, access can be compared to areas that which do not have it. For example, if I was in northern India and get injured, I do not have access to emergency room care. Nor do I have access to a hospital. I may have access to a local doctor, but (s)he may have very limited tools and even less amount of drugs to work with. If I am injured in this country, I do have a reasonable access to emergent care. But the costs are exorbitant to the point that many people default on those bills. And then I would also go to the argument that there is no informed consent on the bills for treatments. We, as a public, are supposed to go in for a problem and choose the appropriate solution with no regard for cost. Our solution is that we then get the "bill we deserve". There is no breakdown for "issue X is average cost Y". In choosing what treatments can potentially cause harm, we have the idea of informed consent. We cannot make a choice, medically speaking, unless we know both the pros and cons of said argument. This somehow, does not transfer over to harms of money and reduction on standard of life. That's criminal. (And yes, I chose the Mayo clinic because they are a top of the line medical center. And they charge for it as well, when the client can bear it or has good insurance. I also know they do a great deal of charity work.)
erbo 11y ago
The problem is not just with cancer drugs, it's with drugs of all types. There's a scorpion antivenom that routinely costs $12,000 or more per vial in the United States. That same antivenom, with the same level of purity, is available over the counter in Mexico for $100/vial. [1] Yet, if you were to go there, fill your trunk with scorpion antivenom, then bring it back to the U.S. and try to sell it at a 100% markup (which would be a pretty sweet profit for you, but would also drive the cost way down), the Feds would confiscate it and likely throw you in prison. The drug Sovaldi, a treatment for hepatitis C, costs $85,000 for a course of treatment in the U.S., and only $1,500 in India. This has one executive coming up with insane plans like docking a cruise ship carrying the drug in international waters off Miami, and ferrying U.S. patients to the boat to be treated. [2] Of course, there are laws on the books that allow pharmaceutical companies to get away with these prices...because, if there weren't, these would be felony violations of the Sherman and Clayton Acts. Real health care reform would involve wiping those special protection laws off the books and taking legal action against the companies engaging in these practices, with prison sentences for the people involved. Unfortunately, what we've wound up with is a "Patient Protection and Affordable Care Act" that neither protects patients nor makes care affordable. [1] http://www.nydailynews.com/news/national/arizona-woman-feeling-pain-83-046-bill-anti-venom-drug-seeking-medical-treatment-scorpion-sting-article-1.1152754 http://www.nydailynews.com/news/national/arizona-woman-feeli... [2] http://www.bloomberg.com/news/articles/2015-06-01/hepatitis-cruise-india-trips-among-plans-to-save-on-1-000-pill http://www.bloomberg.com/news/articles/2015-06-01/hepatitis-...

162 points by datashovel 11y ago

Prices are high because of long and expensive development times, massive amounts of regulation, very high risk and relatively short patents to recoup these costs. Not to mention the costs of the other 5 drugs that failed final trials. Demand is also understandably very high. I do think there should be harder discussion of cost/benefit though to bring some sanity into the system. What else could be done with that money, rather than a marginal outcome for one person? It's a hard conversation. This is especially relevant in something like the NHS where direct tradeoffs must be made.

sdoering 11y ago
R&D are surely contributing to the high price. But as can be seen in the yearly financial statements of these companies, they are not that high, as they want us to believe. Take Europe for example. As far, as I know in Germany the producers can pretty much dictate the price (ok, the have to discuss with the insurance companies, but they just can raise their fees so they have no real interest in saving money). After the German price is decided neighboring countries (Belgium for example) take these, cut of about half of that and dictate this as the maximum price for the drug. Looking at the financial statements, the regarding companies still make a lot of money in Belgium of these drugs. But way more in Germany. So I really do not believe the story being told, that the R&D costs and the risk are the reasons for these astronomically high prices. And - when your life is at stake, your are more then willing to pay every price necessary - so your bargaining position is not quite great and your market power is drastically lowered.
- bayesianhorse 11y ago
  Actually no, in Germany the drug companies can't take any price, because the insurers are negotiating as one party with the drug companies. But yes, drug prices in Germany are relatively high. Why would private companies leave money on the table unless forced by regulation? They have to squeeze every profit they can out of the health care system. The situation in Germany is way better than in the US, where these negotiations are a lot more favorable to the companies, because they can "negotiate" with individual insurance companies and even patients. But especially in the latter case, there's not a lot of "negotiation"...
  - sdoering 11y ago
    Had also mentioned the negotiating part - but the history shows, that there isnÄt that much interest from the insurance companies to really keep prices low, as they are able to always get more money from their "clients" via our regulators. So even here, where the system is probably better then in the US, it could be improved massively via regulation, without killing all profits or even the investments on R&D by the companies. But the political will seems to be missing.
  - taki1 11y ago
    this is because of over-regulation. Destroy regulation, i.e. patents, and then then tell me drugs aren't cheap.
    - bayesianhorse 11y ago
      I think the argument for patents, as incentive for development, is quite strong. There is no alternative system in place yet. Also you probably underestimate the value and purpose of pharmaceutical regulation. Most rules revolve around production quality, scientific soundness, safety monitoring and so on. Come to think of it, the degree of safety in pretty much any drug on the legal market is quite astounding, despite exceptions and accidents.
    - sdoering 11y ago
      Sorry, but there is imho to little regulation going on here. The market seems rigged against patients - esp. patients with terminal (or at least grave) illnesses that are pretty wide spread. These people are hey are prone to be exploited and there are enough of them. Mostly pharma does not dev drugs for wide spread illnesses that mostly occur in poor countries for example. Or grave illnesses, that only affect very, very few people. But dev a "new" cancer drug and you got your license to print money (lot of people get cancer, a lot is payed by insurance, and people and their loved ones want healing).
      - JoeAltmaier 11y ago
        I'm missing your point. Most diseases is characterized that way - lots of people get them, healthcare paid by insurance, people want healing. Cancer is not special.
bayesianhorse 11y ago
That's simply not true. Yes, development costs are high, but not that high. The real reason the drugs are priced so high is that people/insurers pay it. I wouldn't even call it a free market, since the patent protection is involved. Essentially it is extortion. Eventually we might get a situation where drug companies raise costs for patented drugs, not only cancer ones, slowly to the breaking point where even less people can afford insurance anymore. Why wouldn't they? The insurers are very disinclined to refuse life saving treatments to their patients. With biologicals the cost of actually producing the drugs can be high. The only way to bring that down is to drive forward the necessary technology.
- m_mueller 11y ago
  > Eventually we might get a situation where drug companies raise costs for patented drugs, not only cancer ones, slowly to the breaking point where even less people can afford insurance anymore. Aren't American drug prices already optimized around that breaking point?
  - bayesianhorse 11y ago
    considering that the cost of healthcare in the US is increasing rapidly, but also the ratio of insured citizens, no, I wouldn't say a breaking point has been reached.
- NeutronBoy 11y ago
  > since the patent protection is involved While I'm no fan of software patents, why would I spend billions developing a new drug when I can wait for somebody else to do it, then just copy it?
  - robbiep 11y ago
    Because these drugs are mostly monoclonal antibodies, you have to actually develop your own. You can work out what the target is, but because the antibody has extremely high specificity for a specific target, and is high molecular weight, you can't just synthesise it, you need to grow it (An absolutely fascinating process in and of itself) There have been examples of other drug companies targeting the same target as an existing high value monoclonal antibody drug, however I am aware of at least one example where the 'knockoff' monoclonal antibody actually had harmful effects compared with the original. The only way you can actually copy the drug is to steal a cell from their lineage and produce your own
peteretep 11y ago
> This is especially relevant in something like the NHS > where direct tradeoffs must be made You say this like you're unaware of NICE and the guidelines they publish.
- Neil44 11y ago
  That's a whole extra discussion - the pressure they get put under by families and groups to approve very expensive and relatively ineffective drugs is immense. Meanwhile people are having to take charity collections to pay for MRI machines.

rodgerd 11y ago

New Zealand's Pharmac has generally been quite successful in keeping costs down, which is of course why it's under constant attack by the US State Department and is likely to be required to be effectively destroyed when New Zealand signs up to the TPPA.

srean 11y ago
The same used to be true for India, till it folded. pretty sure both pressurization tactics and bribery were at play.
jordanthoms 11y ago
Pharmac works fairly well in NZ - although it's not nirvana, there still are issues around what drugs they fund (Pharmac provides the drugs they select at cheap prices, but if they choose not to fund a drug because they don't consider it cost effective enough, you have to pay full price yourself). However, I'm not so sure it's a good model for the world or for the US market, because it's actually quite selfish. NZ is able to get drugs cheap because the US consumers are paying extremely high prices which cover the development costs. If everyone was buying drugs at the price we pay in NZ, there would be far less incentive to develop new drugs. With NZ being such a small market we can get away with it without having any impact on the development of drugs, but we're lucky that the Americans are picking up the development tab for us and we would have a problem if they stopped doing that.
- taki1 11y ago
  If it would be such a big problem for Big Pharma they would stop selling drugs in NZ. Just to set an example for other countries if not for anything else.
  - jessriedel 11y ago
    "Big Pharma" isn't a monolithic entity with greater coordination powers than New Zealand. (The very largest pharmaceutical company, Johnson & Johnson, has $70B in revenue compared to NZ's $180B GDP.) Furthermore, NZ can make a credible commitment to act irrationally for a long time through the democratic process, while individual pharmaceutical companies are driven by shareholders to maximize profits with a time horizon set by interest rates.

Toine 11y ago

Starts with a culture shift : society should care about its citizens health. It's just not the case in many countries, especially in the US. I guess the maths are simple : keeping more people alive and healthy is less profitable for the people involved..

Fuxy 11y ago
Keeping it's citizens alive, healthy and able to work is very profitable for a country since more able bodied citizens means a better economy. Most companies only care about how much insurance they have to pay and their bottom line they have no reason to keep an eye on the big picture. If an employee gets sick for too long or dies they will just fire him/her and get someone else to replace them. The citizens health is a big picture thing that only a government has the incentive of maintaining.
- arethuza 11y ago
  In the UK at least, universal healthcare through the NHS was created largely because it was seen to be the morally right thing to do: The collective principle asserts that... no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means. I think it is worth noting that the book by Aneurin Bevan, the founder of the NHS, from which that quote comes was called "In place of fear" - that's what we had before socialized medicine (NB not claiming that the NHS is perfect, it clearly isn't - but compared to a lot of the alternatives it's fantastic). Of course, we do deny some care because the NHS can't pay for every treatment for everyone - but at least they try to decide this in a fairly sensible evidence based manner.
- _yosefk 11y ago
  "Incentive"? Really? You mean a president looking to be reelected for another 4-year term has an incentive (as opposed to a moral imperative) to prevent future illness in people who're 20 today where the symptoms will become visible 30-50 years down the road? What is that incentive, and how is it stronger than the incentive to create jobs or lower prices right now for people who vote today by allowing some environment-destroying industry to expand, said expansion being the cause of future illness (a hypothetical or maybe not entirely hypothetical example)?

deleted 11y ago

[deleted]

unchocked 11y ago

It's an interesting plan from a game theoretic perspective to set an explicit upper price for drugs(in dollars per year of lfe or whatever). It certainly changes the price negotiation for drugs in the pipeline, and ultimately informs the incentives of drug development going forward.

blazespin 11y ago

The problem is not the high cost of drugs, the problem is the lack of R&D into processes and drugs that are not patentable. Like Stem Cells or Vitamin C. I'm not saying that these have any medical value, it's just no one is willing to invest because there is no ROI. What might be interesting is force everyone to buy life insurance and then have the life insurance industry underwrite the R&D.

rjtavares 11y ago
Or, you know, increase public funding for research...
- Ntrails 11y ago
  It seems to me that plenty of publicly funded research ends up simply pushing ideas which are subsequently developed and patented by companies. Perhaps I misread the situation, but that doesn't seem like it's in our best interests
  - rjtavares 11y ago
    That's why public funding should be directed at under-funded areas, like "processes and drugs that are not patentable".
- joeyspn 11y ago
  Or, improve the independence and targeting of the research. For instance, having medical groups, patients associations, etc of X disease invest in research for X through crowdfunding. Experiment [0] looks like a good example/PoC for this. [0] https://experiment.com/ https://experiment.com/
rollthehard6 11y ago
This also includes the interesting area of drugs which are already been patented and licensed but find new uses once out of patent for different conditions, Naltrexone being a prime example. google Dr Ian Zagon's work at Penn State if you are interested in his work on Naltrexone, OGF and opiod receptors generally.

Keyframe 11y ago

"Cancer Doctor" - really?

drjohnkasanders 11y ago
Oncologist. But 'cancer doctor' is a term more people would know instead of 'oncologist'

rollthehard6 11y ago

Personally I don't think we can truly call ourselves civilised whilst we persist in valuing our fellow humans' health and their very lives in terms of financial currency.

imaginenore 11y ago
If we want companies to keep making drugs, we either socialize them and pay them from our taxes, or we let them make profits. Drug research and production is extremely expensive. And so are the recalls and the lawsuits.
IndianAstronaut 11y ago
This routinely happens everywhere on the planet. We could protect our citizens from being in car accidents, getting murdered, etc. But those all cost money, and we have made a decision to not spend more money(to hire lots of police, to build lots of public transport) to prevent those deaths.
cbd1984 11y ago
Everything costs resources. Whether you account for that in terms of money or some other method is irrelevant.

gggggggg 11y ago

I might be wrong as I don't know how to in detail read financial statements, but at the end of the day if they were making too much money (and by to much I mean unproportional) it would be obvious there would it not? I work in the medical industry and can say I don't know any poor doctors. Even socialists. And maybe they are rich compared to their individual r&d in study, I am not saying I support $200k a year for drugs, but shouldn't this be part of a bigger question.

_Wintermute 11y ago
The researchers in R&D are making significantly less than your typical clinician. It's not a career path you take if you're prime motivation is money (or job security).

shiven 11y ago

Whenever something like this comes up, R&D is held up as the "cost center", whereas initial discovery (hit) or optimizing it into a "lead" molecule is a fraction of the cost of turning out a "drug", even manufacturing is a comparatively small expense. The majority of the cost lies in the clinical trials process. That is where a potential drug can fail and take everything down the drain. That is why the "fail-early, fail-fast" mantra has been ingrained into big pharmacy like gospel truth. However, there is no reliable predictor of "late stage" clinical trial failures for a candidate drug molecule. And trials can fail from a drug having statistically insignificant improvements in a group of target patients, all the way to, having a high (how high?) propensity for adverse effects in the patient group. So, the solution? More fundamental research to explore indicators of late stage failure, coupled with "cheaper" clinical trials to justify a lower development cost that is enforced by legislation to bypass greedy execs/shareholders. Now, those "cheaper" trials, that is whole 'nother can-o-worms for a different thread, because it involves our willingness, as a society, to accept such risks as are part of the discovery process.

Sven7 11y ago
"Cheaper" trials are already par for the course in the developing world. And there are, as you mention, all kinds of down sides. But don't worry Big Pharma is not going to be sitting forever in the west. The rest of the world's governments, have had enough of their BS while trying to keep their populations alive. The consequences can be seen in IP law in the developing world and the rise of serious local competition. Bottom line - if you need access to medication\treatments that's costing a bomb, check out the options available in the developing world. You will be amazed.
- athenot 11y ago
  Some of the trials from big western pharmaceutical companies are actually being outsourced to smaller labs in Asian countries with less restrictive laws, especially when testing with large mammals.
MagicWishMonkey 11y ago
Isn't marketing/advertising a huge cost center as well?

bcoates 11y ago

Headline doesn't match article: Saltz's beef is with the US spending too much on the very sick, which is getting in the way of truly universal health care coverage for the generally healthy. He wants the US government to use its market power to discourage the progress of ever more expensive treatments until we solve the problem of getting everyone access to affordable health care.

kefka 11y ago
We all have "access", as in I can potentially drive a car down to the upper end cancer facility in Indianapolis or the Mayo clinic in Chicago. "Is it affordable?" is a whole different question. And simply put; No.
- jfoutz 11y ago
  Access usually means obtain. For example, if i hand a person a calculus book, have i given them access to knowledge of calculus? If they can read, yes. If i hand another copy to a blind person, have i given them access to the knowledge of calculus? Not really, no. If my intention is access to knowledge of calculus, i need to take extra steps. Maybe a brail version, maybe just read to them. I think you might be fuzzy because of login prompts. Technically you're using computer resources. clearly i have access to the machine in some way. Similarly, i have access to the Mayo clinic. I can walk in and talk to people. But, with the computer i can't get to the good parts, i can't open files. Also, with the hospital, i can't get to the good parts, i can't get healthcare without extra stuff. This isn't a slight against the clinic, I know they do charitable work. I think they charge so much, in part, to offset the costs to those who can't pay.
  - kefka 11y ago
    However, access can be compared to areas that which do not have it. For example, if I was in northern India and get injured, I do not have access to emergency room care. Nor do I have access to a hospital. I may have access to a local doctor, but (s)he may have very limited tools and even less amount of drugs to work with. If I am injured in this country, I do have a reasonable access to emergent care. But the costs are exorbitant to the point that many people default on those bills. And then I would also go to the argument that there is no informed consent on the bills for treatments. We, as a public, are supposed to go in for a problem and choose the appropriate solution with no regard for cost. Our solution is that we then get the "bill we deserve". There is no breakdown for "issue X is average cost Y". In choosing what treatments can potentially cause harm, we have the idea of informed consent. We cannot make a choice, medically speaking, unless we know both the pros and cons of said argument. This somehow, does not transfer over to harms of money and reduction on standard of life. That's criminal. (And yes, I chose the Mayo clinic because they are a top of the line medical center. And they charge for it as well, when the client can bear it or has good insurance. I also know they do a great deal of charity work.)

erbo 11y ago

The problem is not just with cancer drugs, it's with drugs of all types. There's a scorpion antivenom that routinely costs $12,000 or more per vial in the United States. That same antivenom, with the same level of purity, is available over the counter in Mexico for $100/vial. [1] Yet, if you were to go there, fill your trunk with scorpion antivenom, then bring it back to the U.S. and try to sell it at a 100% markup (which would be a pretty sweet profit for you, but would also drive the cost way down), the Feds would confiscate it and likely throw you in prison. The drug Sovaldi, a treatment for hepatitis C, costs $85,000 for a course of treatment in the U.S., and only $1,500 in India. This has one executive coming up with insane plans like docking a cruise ship carrying the drug in international waters off Miami, and ferrying U.S. patients to the boat to be treated. [2] Of course, there are laws on the books that allow pharmaceutical companies to get away with these prices...because, if there weren't, these would be felony violations of the Sherman and Clayton Acts. Real health care reform would involve wiping those special protection laws off the books and taking legal action against the companies engaging in these practices, with prison sentences for the people involved. Unfortunately, what we've wound up with is a "Patient Protection and Affordable Care Act" that neither protects patients nor makes care affordable. [1] http://www.nydailynews.com/news/national/arizona-woman-feeling-pain-83-046-bill-anti-venom-drug-seeking-medical-treatment-scorpion-sting-article-1.1152754 http://www.nydailynews.com/news/national/arizona-woman-feeli... [2] http://www.bloomberg.com/news/articles/2015-06-01/hepatitis-cruise-india-trips-among-plans-to-save-on-1-000-pill http://www.bloomberg.com/news/articles/2015-06-01/hepatitis-...