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

#291

Post by YPCrumble » Mon, May 09, 2016, 1:49 PM UTC

Gilead has developed the first drug since penicillin to cure a major disease and people think the price tag is too expensive.

In the modern world, it's not ideal to create a drug to cure something. Once people are cured they no longer need your drug. That's why we have so many drugs like Lipitor and Viagra that treat symptoms but do not cure.

The "problem" with Sovaldi/Harvoni is that the patient only takes it for ~90 days, and then they're cured.

The drugs are cheaper than regular treatment of Hep C - which ends in liver transplant. Do people think the price tag was just random? No, it's because this is a price at which the taxpayer saves money by curing the disease vs. blood transfusions, liver transplants, lost economic value, etc.

Not to mention that the waitlist for a liver transplant is getting halved as we cure Hep C.

As we slam Gilead the other really evil pharma companies like Pfizer are taking notes and patting themselves on the back for creating drugs whose end goal is to addict the consumer.

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

#292

Post by maxerickson » Mon, May 09, 2016, 1:52 PM UTC

emn13 wrote: post #245

x5n1 wrote: post #147

Earlier quoted context omitted.

It should be priced according to ability to pay based on income. The same is the reasoning why the drug is so cheap in other countries, their people can't possibly afford the prices. So it makes no sense for citizens of wealthy countries to have to pay huge markups if they don't have the money. It makes no sense from an economic perspective to force people to go into bankruptcy just because they got sick.

That's only fair if you believe that the seller has the moral right to maximize their earnings. I think that's questionable across the board, but certainly in the pharmaceutical industry. As in: the idea behind capitalism (the reason we put up with it) is not that price-gouging is some fundamental right we should worship, but because capitalism works . What's that mean? It efficiently allocates resources. How does it…

One aspect of the patent system is that the government or non profits or whatever could do drug development, get patents and then give away licensing.

Would doing that put an end to commercial drug development? Or would commercial drug makers continue to seek treatments where they saw opportunities to profit?

Sofosbuvir is a really great test of how we reason about this stuff. The price is high and easy to balk at, but it's cheaper and better than the previous treatment. Cheaper and better are clearly compatible with the profit motive. So we are left with our intuition that the price is unfairly high. I think part of the answer is to look at how medical payments are structured.

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

#293

Post by rtkwe » Mon, May 09, 2016, 1:56 PM UTC

nickpsecurity wrote: post #172

rtkwe wrote: post #144

Earlier quoted context omitted.

I doubt it'll happen in the US because we don't really have workers dormitories for people to jump from and in the US very few people jump for suicides (~2%) vs guns (~56%), suffocation/hanging (~25%) or poisoning (~11%). source: http://lostallhope.com/suicide-statistics/us-methods-suicide

Ok, that makes more sense. So, I modify the question to be U.S. workers threatening mass suicide by gun or whatever with a good number at one plant over time. Then, the plant starts taking preventative measures against various suicide equipment instead of investing in working conditions. This actually has more odds of happening.

You'd probably have to go back a ways to at least the early 1900s I'd guess to get the right combination of horribleness to get that. These days workplace suicides are relatively rare 1-2 per million workers. Also being poor sucks but US workers are waaay more mobile than a rural Chinese person who move into a company town from their home town/village so before they'd get to 'I'll kill myself in protest' they'll probably get to 'I'll change jobs or quit' first.

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

#294

Post by zaroth » Mon, May 09, 2016, 1:56 PM UTC

adrianmacneil wrote: post #215

forrestthewoods wrote: post #109

Earlier quoted context omitted.

America subsidizes the health care of the entire world. Because such a large portion of health profit comes from the US. If the US ceased to exist then global prices would increase and global research would decrease.

I hear this line repeated a lot on HN (it appears multiple times in this thread even), yet I've never seen a study or any hard evidence for it. How do you know that the massive profits made by drug companies in the US are being reinvested into drug development, and not simply returned to their sharedholders? Do you have any sources for this claim?

Plenty of research on this topic and hard evidence abounds.

Regarding US share of research funding versus the rest of the world, this is well established... Public funding and private profits are the two big US sources of medical research dollars. The NE Journal of Medicine reports that the US funds about half of all global medical research spending, and that's split approximately evenly between public and private funding.

Here's [1] a CBO paper on the topic of pharma R&D spending / reinvestment which is also worth a look. R&D as a percentage of sales ("research intensity") is higher in pharma than almost any other industry, and increased significantly in the 80s and has held constant since then.

[1] - https://www.cbo.gov/sites/default/files/109th-congress-2005-...

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

#295

Post by Kristine1975 » Mon, May 09, 2016, 2:00 PM UTC

Ralfp wrote: post #263

irremediable wrote: post #248

Earlier quoted context omitted.

I'm fairly sure most drug companies now spend more on marketing than on R&D/testing.

Most drug companies sell generics because they don't want to enter costful R&D game.

Or they try to prolong their patents or very slightly change the formula of an existing drug so they can patent it again: https://en.wikipedia.org/wiki/Generic_drug#Prolongation

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

#296

Post by coredog64 » Mon, May 09, 2016, 2:08 PM UTC

irremediable wrote: post #248

halviti wrote: post #243

Earlier quoted context omitted.

While I tend to lean more to your side of the argument, the devil's advocate in me has to point out the fact that you leave out the massive costs of research, development, clinical trials / fda approval, etc. that go in to getting a drug to market. This not to mention all the extra capital needed to fund research into all of the drugs that never make it to market before a company finds something that works.

I'm fairly sure most drug companies now spend more on marketing than on R&D/testing.

If you're going to parrot Marcia Angell, at least get the substance right: They spend more on marketing and administration than they do on R&D. Where "administration" is stuff like IT, HR, etc.

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

#297

Post by coredog64 » Mon, May 09, 2016, 2:12 PM UTC

rev_null wrote: post #282

halviti wrote: post #243

Earlier quoted context omitted.

While I tend to lean more to your side of the argument, the devil's advocate in me has to point out the fact that you leave out the massive costs of research, development, clinical trials / fda approval, etc. that go in to getting a drug to market. This not to mention all the extra capital needed to fund research into all of the drugs that never make it to market before a company finds something that works.

This ignores the fact that the expensive, risky research is often funded by public money instead of by the pharmaceutical companies. So, the taxpayers pay for the research until it shows progress. Then it gets patented and sold to a large company which sells it back to the public for $1000/pill. It's a pretty gross abuse of the original idea of patents.

The expensive, risky part of drug development is not the portion that is publically funded. Yay! You've found a compound that appears to shrink tumors when directly applied to them on glass slides.

Now, figure out what the correct dose is, how to get it into a mammal so that it's not metabolized into uselessness, how much you can safely give the mammal.

Now, start again with humans and hope you don't get to the final stage only to find out that it's not as effective as existing treatments or has side effects that will open you up to lawsuits.

Finally, once you've done all that, scale out the production of your compound such that you can prove that every dose meets FDA quality requirements.

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

#298

Post by stdbrouw » Mon, May 09, 2016, 2:13 PM UTC

bunnymancer wrote: post #286

ubernostrum wrote: post #193

Earlier quoted context omitted.

Actually a significant population in the US was infected by blood transfusion; the US didn't start properly/universally screening blood and taking precautions for hep C until 1992. This is why there's a spike in infection rate among older people, and why hep C is considered a looming cost crisis for Medicare -- we don't yet know the full extent of the infectious disaster that was unscreened blood, but it's ticking aw…

There's something rather unsettling about the realization that Jehova's Witnesses had a point about something once..

If you're getting a blood transfusion it's usually because you need it. I'd take hepatitis C over death any day.

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

#299

Post by swalsh » Mon, May 09, 2016, 2:14 PM UTC

YPCrumble wrote: post #291

Gilead has developed the first drug since penicillin to cure a major disease and people think the price tag is too expensive. In the modern world, it's not ideal to create a drug to cure something. Once people are cured they no longer need your drug. That's why we have so many drugs like Lipitor and Viagra that treat symptoms but do not cure. The "problem" with Sovaldi/Harvoni is that the patient only takes it for ~9…

I worked for a company that developed some PA criteria for these drugs, I can assure you a lot of debate went into this criteria.. these two specific drugs are probably the most hotly contested drugs. If we sold them at the 84k price tag to anyone that COULD use it, the entire insurance industry would go bankrupt, literally. Not even an exaggeration. While your logic is sound, the drug is cheaper than a liver transplat... not everyone who has Hep C ends up getting a liver transplant. There's a huge gap between the number of people who COULD use the drug (and have a MUCH better quality of life), and the people who are most qualified for it. The drug companies are not doing the government a favor here... sorry.

Another side conversation that's interesting, is who takes the $84k hit. There's sound logic that it's cheaper to give the drug NOW vs paying for surgery LATER... but what if i'm not your insurer when you need it. With obamacare, you can't be denied because of pre-existing conditions... so it's interesting math.

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

#300

Post by jhall1468 » Mon, May 09, 2016, 2:14 PM UTC

YPCrumble wrote: post #291

Gilead has developed the first drug since penicillin to cure a major disease and people think the price tag is too expensive. In the modern world, it's not ideal to create a drug to cure something. Once people are cured they no longer need your drug. That's why we have so many drugs like Lipitor and Viagra that treat symptoms but do not cure. The "problem" with Sovaldi/Harvoni is that the patient only takes it for ~9…

> In the modern world, it's not ideal to create a drug to cure something. Once people are cured they no longer need your drug. That's why we have so many drugs like Lipitor and Viagra that treat symptoms but do not cure.

I don't think that's a reasonable conclusion at all. One of the main reasons we have so many drugs that treat symptoms is because cures are absurdly difficult to find while treatments can be found accidentally (Viagra was originally intended to treat hypertension).

Funding research into cures is funding your own bankruptcy. Pfizer execs would jump a the opportunity for "Pfizer" to be the name of the company that cured cancer. But the reality is, hunting for cures is expensive with little chance of payoff. That's not how you stay in business.