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Drug Goes from $13.50 a Tablet to $750, Overnight

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Re: Drug Goes from $13.50 a Tablet to $750, Overnight

#181

Post by ssmoot »

danmaz74 wrote: post #138
bedhead wrote: post #96

Earlier quoted context omitted.

That's the loophole though, the quantities are so small that realistically, no pharmaceutical company has the incentive to make their version of the drug, even at $750 per dose. There are still costs to making a drug that's off-patent, and sometimes the number of patients being treated is only in the double digits. Additionally, a competing drug released at say, $500 per dose would still be considered predatory anywa…

They should just allow importing drugs from other markets that have good enough quality standards - like the EU or Canada I guess. Problem solved.

But who provides the quality standards oversight? The drug is apparently produced in India. What if pills were shipped to the US and it was found after the fact that many batches contained unacceptable levels of iron? Who to blame?

I'm sure Canada has decent oversight, but who wants to say that the solution is no direct US agency oversight, and that we want a "Pharmaceuticals-NAFTA"? It seems funding oversight with a "homeland" agency is one issue you could get bipartisan support on.

While sure, I doubt many have a problem with medical tourism, I'm not sure bringing drugs across the border intended for distribution without FDA approval is the answer.

On the other hand maybe countries working together at the agency level to ensure their oversight measures are in compliance with some agreed upon standard is a sane way to move forward. But then who maintains the list of approved drugs? Is that power given to some international body? Or does the FDA still have to approve drugs for distribution and only alternatives are brought in? And then what about drugs that are patented in the US (like this one), but freely available in other markets from other manufacturers?

It seems a worthy enough goal in general, but I don't think a fully libertarian approach to the problem comes close to being the right answer either.

Re: Drug Goes from $13.50 a Tablet to $750, Overnight

#182

Post by emodendroket »

Brakenshire wrote: post #154
ams6110 wrote: post #58

Earlier quoted context omitted.

No, this will just make a bad problem worse. Overreaction in the extreme. There may be a need to look at enforcing some more openness to formulas and manufacturing process so that after patents expire it's less possible to maintain an exclusive on a generic. That is consistent with the intent of patent protection and encourages open markets and competition.

The Pharma industry does need to be relatively strictly regulated - for instance see the issues over withholding and bias in clinical research: https://en.wikipedia.org/wiki/AllTrials But, nationalizing the industry is impossible. We don't spend anywhere near enough on medical research for it to be possible. The UK government for instance spends about £500m a year on all medical research, even if you redirected all t…

Why would you assume that in a situation where the entire pharmaceutical industry was nationalized there would not be any more revenue going to those programs? Presumably 1) a government who chose to nationalize them would also direct more tax dollars toward them 2) at least some of the revenue pharmaceutical companies are seeing now would go to government manufacturers instead.

This is academic, perhaps, given the likelihood of it happening.

Re: Drug Goes from $13.50 a Tablet to $750, Overnight

#183

Post by gnoway »

ZenoArrow wrote: post #53
gnoway wrote: post #40

Earlier quoted context omitted.

Do you really want Congress arguing over which drug research to fund?

Why would Congress be micromanaging it? They don't do that for NASA.

Any nationalized program would have to be funded, meaning there would be yearly appropriations bills. Maybe I'm just cynical, but I think this could become a circus every year.

As for the NASA comparison... I don't really want drug research to be chronically underfunded.

Re: Drug Goes from $13.50 a Tablet to $750, Overnight

#184

Post by caseysoftware »

bedhead wrote: post #96
cmiles74 wrote: post #85

Earlier quoted context omitted.

It seems to me that the overall result would be other companies start manufacturing the generic and sell the drug for maybe 20% less than Martin and over time the price drops back down towards where it once started. In the meantime, this company either goes bankrupt or is sold off. Or the government passes a law capping how much you can raise the price of a generic drug over so many years.

That's the loophole though, the quantities are so small that realistically, no pharmaceutical company has the incentive to make their version of the drug, even at $750 per dose. There are still costs to making a drug that's off-patent, and sometimes the number of patients being treated is only in the double digits. Additionally, a competing drug released at say, $500 per dose would still be considered predatory anywa…

Even though it's $750 per dose now, since they have exclusive control over the market they could decrease it to whatever whenever they wanted to starve competitors.. probably after said competitors have invested in doing it.

Re: Drug Goes from $13.50 a Tablet to $750, Overnight

#185

Post by Bluestrike2 »

mvanvoorden wrote: post #162
mtgx wrote: post #103

Earlier quoted context omitted.

Yet people are still quick to say "...but what about Big Pharma?" when there's a discussion about abolishing patents. I don't know if patents should be abolished completely, but if there's a discussion about a serious patent reform, we should stop considering pharmaceuticals as some kind of exception, and apply the new reform equally to everyone, instead of allowing exceptions for Big Pharma, or worse, watering down…

Exactly. I don't understand why everybody's so afraid that without patents no medicine would be made anymore. On the contrary, it would force companies to work together and share the R&D, and would prevent the current inefficiency of multiple companies inventing the same wheel, doing the same studies, just because they all want to invent this medicine first. Even better: with all the money that would be saved from no…

That's a bit of a fantasy, isn't it? Pharma companies don't re-invent the same wheel: even in cases where they're pursuing similar avenues of research, the drugs being developed share sometimes significant differences (and in many cases, even insignificant differences can later be found to be more significant than first believed). Even if companies were somehow able to collaborate without any problem, the end result would be a decrease in the number of medications brought to market. Instead of multiple therapies that doctors can use to tailor to their individual patients, they'll get one that works for the majority of cases and woe be to anyone who falls outside the bell curve. The developing crisis with antibiotic-resistant strains is a perfect example of the sort of problems that arise from such short-sightedness.

But that's a scenario based on your idea being feasible. The far more likely scenario is an even more brutal and unethical market, where companies use controlled distribution (such as with Daraprim) to prevent generics from being tested, and thus, being brought to market. Why? Because without patents, even that limited initial window for drug companies to earn back R&D costs--along with supporting the sunk R&D costs wrapped up in the larger number of drugs the fail to bring to market--exists only so long as the manufacturer is able to use whatever force is available to it it to stop generics from being produced. Far from cooperating with one another, pharmaceutical companies would have every additional incentive to stab each other in the back. Instead of skirmishes like you have now, you'd have a war to the knife.

It's easy to look at problems with the current patent system and think that they'd all magically be fixed by getting rid of them. But unintended consequences are still consequences.

Re: Drug Goes from $13.50 a Tablet to $750, Overnight

#186

Post by logfromblammo »

andybak wrote: post #49
DanielBMarkham wrote: post #38

I'm a libertarian and completely in favor of private property and an open, informed marketplace. Having said that, this is out of control. If you know you're selling me a life-or-death product which has no peer, and the government protects your property such that others can't make it cheaper? It's not a market. It's rent-seeking, highway robbery. Bad actors are going to cause an overreaction that is going to seriousl…

> I'm a libertarian and completely in favor of private property and an open, informed marketplace. > Having said that, this is out of control. It sounds like you're well on your way to realising the flaw in straight-ahead libertarianism and joining those in the mainstream who want just enough market regulation to allow free markets without a huge social cost. I get the feel that most reasonable souls are in agreement…

You should be careful about suggesting that vanilla libertarians should abandon it. I'll explain why.

The problem with non-aggression principle libertarianism is sociopaths like Martin Shkreli. On one side of it, those guys are regulated to do less harm, and on the other, they get murdered for a bounty. But right there in the middle of NAP-libertarianism, a sociopathic rent-seeker can be as much of a selfish asshole as he wants, because one man's asshole is another's visionary leader, and NAP-libertarians judge all deviant behaviors by identifiable and measurable harm to victims. Shkreli is not actually causing harm here, so he's A-OK by NAP standards.

In this case, sick people are not able to compel the involuntary services of physicians and chemists, so they do not have the right to be provided with life-saving drugs. But nor does any other party have the right to prevent those people from acquiring them. So it would be inevitable for economic conditions to align on one drug or another such that the pricing rubs the median person's sense of justice the wrong way. The startup costs are just too high to be recovered, considering the marginal cost of production and the existing demand, so a natural monopoly forms. And there's the asshole in the middle of it, charging other people rent on their own health.

From one point of view, he is charging them less than what it would cost them to treat themselves. But from another, he is profiting from human misery.

Hard-core NAP-libertarians would probably suggest that other people should charge Shkreli $10000/night for hotel rooms, $100/gallon for gasoline, and $500/slice for pie, a solution that requires extensive reputation tracking systems and broad community support. After all, he has no more right to cheap food than others have a right to cheap drugs.

For a preview of how this would work, look at any social justice warriors' controversy of the last decade. Both actual assholes and those merely accused would be tried in the court of public opinion, then sentenced to a lifetime of petty reprisals from every angle. People get fired and blackballed for one ill-considered phrase or act that follows them for a long, long time. In this, jacking up pill prices by 1000% would be very much like refusing to marry homosexuals, or carelessly saying forbidden words.

You may not be aware of this, but NAP-libertarians are actually very reasonable moderates in the realm of libertarianism. Those who think it unworkable in practice have other options beyond a return to mainstream politics. They could sidestep into other moderate forms that better handle any one specific issue, or they could move on into the various forms of structured anarchism.

Every political philosophy has its weaknesses, but I'm not certain that this case is enough for a NAP-libertarian to justify altering any core values. Price gouging in very small niche markets just does not seem all that bad of a problem, in comparison to the related problems that could stem from the solutions that similar political philosophies would provide. I have to say that NAP-libertarianism produces better outcomes in this specific case than even my own politics. (That's not an endorsement.)

Re: Drug Goes from $13.50 a Tablet to $750, Overnight

#187

Post by [deleted] »

danmaz74 wrote: post #138
bedhead wrote: post #96

Earlier quoted context omitted.

That's the loophole though, the quantities are so small that realistically, no pharmaceutical company has the incentive to make their version of the drug, even at $750 per dose. There are still costs to making a drug that's off-patent, and sometimes the number of patients being treated is only in the double digits. Additionally, a competing drug released at say, $500 per dose would still be considered predatory anywa…

They should just allow importing drugs from other markets that have good enough quality standards - like the EU or Canada I guess. Problem solved.

[deleted]

Re: Drug Goes from $13.50 a Tablet to $750, Overnight

#188

Post by aianus »

paulmd wrote: post #149
drzaiusapelord wrote: post #140

Earlier quoted context omitted.

From an economic and policy perspective, unfortunately, Turing is doing everything right. Makena is probably not a great comparison as its used for prevent early birth, which is something of an edge case for certain pregnant women, versus Daraprim, which is a more common drug. It is the only FDA approved drug for Toxoplasmosis. According to wikipedia: Up to half of the world's population is infected with toxoplasmosi…

It's way down there in the article, but Turing's distributor (Impax) is tampering with the generic approval process. They use a controlled distribution strategy where you need to buy it directly from them, and they won't sell it to anyone who uses it for approval testing. Without the namebrand drug, there's no way to prove that your generic is equally efficacious, and thus no generic approvals and no competition.

Why can't you just go to a doctor or hospital and pay them a couple grand per pill and use that? Nobody has to know where you got it from...

Re: Drug Goes from $13.50 a Tablet to $750, Overnight

#189

Post by TD-Linux »

imdsm wrote: post #166
danmaz74 wrote: post #138

Earlier quoted context omitted.

They should just allow importing drugs from other markets that have good enough quality standards - like the EU or Canada I guess. Problem solved.

Can this drug be reproduced by others? Is it simply a licensing issue?

All of the drugs mentioned in the article have had their patents expire long ago.

Re: Drug Goes from $13.50 a Tablet to $750, Overnight

#190

Post by aianus »

jerf wrote: post #42
tammer wrote: post #27

I used to work for a generics manufacturer, and indeed this was their MO. Seek out old drugs that sill have a very viable market but are under the radar of the big guys, undersell until they're the only supplier left, then jack up the price when patients have no choice. It's despicable and seems inevitable with the current regulation model.

At least in the US, that actually sounds like it's already illegal from general business regulation. As in, no new laws needed, get the ones we have enforced. Wouldn't be surprised you can already pierce the corporate veil without new laws too. This is not specifically in reply to the parent, but the point fits here: I'd observe that calling for more regulation or even outright nationalization to fix this, when it's…

> undersell until they're the only supplier left

I don't think this is illegal unless they're selling the drug below cost (dumping).

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