How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India • Hacker News Board

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#201

Post by 1856294 » Mon, May 09, 2016, 6:44 AM UTC

rayiner wrote: post #139

pgodzin wrote: post #134

Earlier quoted context omitted.

Yes, the company that actively prevents people from obtaining life-saving medicine for billions extra in profit is more reprehensible than the company that makes no pretenses about having anything to do with life and death. Creating the cure was admirable, what it has done with it is reprehensible. It certainly has the right to make a significant profit. But a monopoly on medicine paid for by dying people with no oth…

> Yes, the company that actively prevents people from obtaining life-saving medicine for billions extra in profit is more reprehensible than the company that makes no pretenses about having anything to do with life and death. So the moral impact of a company's actions depends not on the net good done by that company, but on the "pretenses" it does or does not put on? It's morally better to waste natural resources on…

Why does everyone pretend that iPhones are a luxury? They are not. It's merely 800€. Even the drug in india still costs twice as much.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#202

Post by Daishiman » Mon, May 09, 2016, 6:46 AM UTC

rayiner wrote: post #96

Zigurd wrote: post #72

Earlier quoted context omitted.

Lots of research in the US is university and government lab-based. Even if private sector drug development were cut back, it would not end useful drug development. I suspect the way government and university research is monetized could be improved so that more competition would exist.

Let's say we shut down Silicon Valley and had the government do computer research. You think that would be efficient and effective? At the end of the day, you need to give smart people a reason to make their lives' work saving lives instead of selling financial products or advertising algorithms. That's not going to happen if going into drug development means topping out at GS-15 in a government lab.

How funny that you mention that, given that the Internet, the very backbone upon so much of the economy moves around, started and developmed mostly as... a military project. Supported by universities and public research.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#203

Post by mattdw » Mon, May 09, 2016, 6:55 AM UTC

refurb wrote: post #47

bogomipz wrote: post #42

Earlier quoted context omitted.

That's a strawman argument and you know it. A car is financed over 5 years. You can't get financing on pharmaceuticals. The "average" wedding is an equally bad comparison and your figure is wrong - average is actully 26K with majority of weddings under $10k: http://www.costofwedding.com/ It is absolutely reprehensible behavior. If $1,500 is a reasonable price point and profit margin for a company elsewhere in the wor…

If Gilead charged $1500 in every country it wouldn't have been worth to invest in the first place. Remember they paid $11B for the right to the drug and they still had to bring it through development.

Surely the right to the drug was only worth $11B in the first place because of $84k possibilities at the other end? If it was only ever going to be $1500, that $11B would have been adjusted accordingly.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#204

Post by cheriot » Mon, May 09, 2016, 6:58 AM UTC

Lazare wrote: post #186

cheriot wrote: post #114

Eminent domain is not just for land. In extreme cases like this where a profit motive is the only thing keeping us from curing huge numbers of people, the US government should write a single check, take the rights, and start handing out pills. As far as the company is concerned, that could even be a preferable outcome. Cash now and the marketing benefits to promote its other drugs. Edit: Just a reminder that eminent…

> In extreme cases like this where a profit motive is the only thing keeping us from curing huge numbers of people, the US government should write a single check, take the rights, and start handing out pills. Yeah, but, as your own link notes, courts (and the constitution) require fair market value for compensation. This doesn't save you any money at all; eminent domain can only have an impact when someone is refusin…

Yes, it amounts to single payer healthcare for drugs.

It's different from the government buying individual doses on the market because the current price is set to achieve the fair market value of the drug by treating a small subset of infected patients. Manufacturing costs are so small in comparison, we could treat everyone for nearly the same price.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#205

Post by adrianN » Mon, May 09, 2016, 7:02 AM UTC

markvdb wrote: post #198

This is yet another perverse collision of care and market regulation. Other examples abound. Why do we accept this? Do we even dare think of alternatives? What if western governments stop enforcing drug development intellectual rights? Not going to happen before hell freezes over, but let's have a short thought experiment. Quality health care for all would probably blossom thanks to more access to affordable drugs th…

I wouldn't call cancer, heart disease, alzheimer's, ageing etc "the rarest disease puzzles", yet I'm not satisfied with the status quo of medical care for these problems.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#206

Post by ptaipale » Mon, May 09, 2016, 7:03 AM UTC

dragonmum wrote: post #196

ptaipale wrote: post #142

I actually wouldn't expect that Indian prisons provide any effective medication against hepatitis C. You might get it if you buy it yourself, and bribe the prison staff to allow you to have it. Sorry: this is not based on any real experience or references, just the overall assessment of how India stands currently.

> You might get it if you buy it yourself, and bribe the prison staff to allow you to have it. > Sorry: this is not based on any real experience or references, just the overall assessment of how India stands currently. Jeez, you didn't have time to search but had time to fantasize like a Hollywood script writer hashing out more 3rd world stereotypes? Perhaps we should look at the treatment and hepatitis morbidity rat…

Thank you for correction; grant me at least that I knew I'm commenting based on prejudices.

Note however that I don't view the American prison system as "our" ("mine") either (I'm not from the US).

And still, what I read of Indian prison is just way, way worse than what I read about the American system. Overcrowding, horrible delays in trials, abysmal hygiene. I doubt that the HCV treatment there is very good, despite there being a counseling centre.

"In India, overcrowding has aggravated the problem of hygiene. In many jails, conditions are appalling. At the tehsil level jails, even rudimentary conveniences are not provided. Prisoners in India are not even tested for specific infectious diseases, although all prisoners undergo a medical examination when they begin serving their sentence. No studies of the prevalence of viral infections among prison inmates have been done at a national level. India’s prison manuals provide for segregation of prisoners suspected of having contagious diseases. A few jails have established informal contacts with medical and social organizations for counseling of inmates to prevent the spread of infections."

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#207

Post by adrianN » Mon, May 09, 2016, 7:10 AM UTC

sandworm101 wrote: post #30

hueving wrote: post #9

Earlier quoted context omitted.

Right now US citizens are basically subsidizing other countries when it comes to drug revenue via price gouging. I would rather it be done via some other more explicit mechanism (e.g. India government subsidies) rather than at the expense of poor healthcare availability to people in the US.

Considering that Americans consume 75% of the world's prescription drugs, and I think it safe to assume an equivalent amount of non-prescription drugs, I don't think any of this makes much difference. The US is a very strange and unique drug market. Citation: "5 percent of the United States is the world's population and consumes 75 percent of the the world's prescription drugs." https://www.drugabuse.gov/related-topi…

That statistic seems a little misleading to me, because very large parts of the world don't consume any prescription drugs at all, because they're too poor to go to the doctor.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#208

Post by dba7dba » Mon, May 09, 2016, 7:14 AM UTC

evgen wrote: post #192

gruez wrote: post #61

Earlier quoted context omitted.

Sounds like a good decision by india

Yeah, until the US decides that it will retaliate by, for example, adding a 100% import duty to all goods produced in India and no longer supplying visas to Indian citizens.

I don't think such retaliation will ever happen. Many lobbyists will be waiting in the hallway of US Senate before ink of the signature dries.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#209

Post by MichaelBurge » Mon, May 09, 2016, 7:15 AM UTC

refurb wrote: post #165

MichaelBurge wrote: post #133

Earlier quoted context omitted.

That does seem like a public health concern. Normally you'd recover damages from a class action lawsuit or similar, but it sounds like it was common practice at the time so nobody was acting negligent. That's just a sad state of affairs. Gilead - or maybe even Congress/local states in cooperation with Gilead - could get a lot of goodwill by offering the cure for free in a one-time deal to people who: * Developed Hepa…

Don't have insurance that would cover it Gilead was doing that.[1] Hell, most drug companies give free drug for patients who are either uninsured or under-insured (their insurer won't pay for it). [1] http://www.gilead.com/responsibility/us-patient-access

That raises two questions:

* The article is about someone underinsured who went to India. Why couldn't he get free drugs from Gilead instead of needing to jump through some hoops in India?

* Wouldn't insurance companies just decline to pay for every expensive treatment? Probably customers won't want to go through prolonged legal battles fighting them for $84000 if they can get the treatment for free.

Then again, $1.3 billion in a quarter is only something like 15,500 full-price treatments. The CDC site[1] says there are 3.5 million sufferers. Maybe they expect most people not to pay, so millionaires and some insured will pay.

[1] http://www.cdc.gov/hepatitis/hcv/cfaq.htm#cFAQ21

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#210

Post by PhasmaFelis » Mon, May 09, 2016, 7:16 AM UTC

corvallis wrote: post #122

Something to keep in mind is the population that typically has chronic Hep C requiring this drug. It's IV drug users who share needles. Think they have $84K? Nope. Think they have insurance? Nope. Guess who pays for it. Oh that's right, it's Medicaid! It's you, the taxpayers. Where is there a large concentration of people that have Hep C? Prisons. Guess who pays for it then? Still you! The prison systems are obligate…

Is there a way to take the taxpayer money being spent on medicine that's priced high to recoup the research investment, and shift it to directly funding the research in the first place?

Obviously you'd have to spend a while funding both R&D and Medicaid/etc, while the new drugs are in development and the old ones are still under patent, and I'm sure there's other details I've missed, but it seems like there should be some way to make the system make more sense.