EpiPen Price Rise Sparks Concern for Allergy Sufferers • Hacker News Board

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#171

Post by curiousgeorgio » Tue, Aug 23, 2016, 3:51 AM UTC

mikeash wrote: post #170

curiousgeorgio wrote: post #165

Earlier quoted context omitted.

If not for laws and government-mandated standards, how would you go about making sure companies put the "correct" value on lives vs profits? I can hope my neighbor is a decent human being and that he'll be a good neighbor when people around him are in need, but I personally won't blame him if he doesn't. Similarly, if he's being a nuisance - without breaking any laws - I still can't really expect him to stop (just be…

Making a company's customers upset tends to have teeth. There's a reason companies spend money on PR instead of just keeping that money as additional profit, after all. If your neighbor is being a nuisance, it may be more effective to gather up some of the other neighbors and all go over to the fellow and tell him to knock it off. I don't have any actual solutions to propose here. Maybe it merits legislation, maybe i…

Gathering a group of neighbors and telling him to knock it off doesn't have any teeth either, I'm afraid. He can still say "screw you, I'm not breaking any laws, so you can't do anything to stop me."

I do agree about upset customers having teeth. That's exactly how a free market operates. If they're upset enough, they'll stop buying the product and look for alternatives. Except there aren't any suitable alternatives to EpiPen on the market, and it's a potentially life-saving product, so those teeth don't have anything to bite in this case. I'm sure many, many other companies would love to seize that opportunity. So what's stopping them from competing? Answer: unnecessarily complex government regulation.

Or, if that approach doesn't resonate with your worldview, then go out and put pressure on the government to regulate the prices of things like EpiPen.

Either way, the answer lies in the government, not the corporation. The company hasn't broken any laws. We can wish they'd lower prices, but we might as well wish for pink unicorns. The answer for your neighbor is the same - you can't expect him to be reasonable just because you gave him a stern word.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#172

Post by hackuser » Tue, Aug 23, 2016, 3:52 AM UTC

gwright wrote: post #128

Ironchefpython wrote: post #110

Earlier quoted context omitted.

> The price hikes would immediately attract lower-cost competitors if this were truly a free market. Any participants in a free market for a product with inelastic demand (e.g. something you need to stay alive) and non-trivial entry costs immediately implements price fixing in the absence of regulation. When life-saving devices that require a significant supply chain to manufacture capture the bulk of consumer surplu…

The non-trivial entry costs are there because of regulations and the legal environment regarding liability. You can view the high price as the free-market finding the intersection of supply and demand given the regulatory and legal constraints but that seems like a less than useful way of understanding 'free-market'.

> The non-trivial entry costs are there because of regulations and the legal environment regarding liability

I think that misplaces the cause. The requirement for safety and the high cost of failure is what creates those regulations and liabilities.

Theoretically, we could eliminate the regulations and liabilities and just let people die, but 1) that's a really bad idea, and 2) it would be excluding from the market mechanism (i.e., externalizing) the most important aspect of the product, its safety.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#173

Post by yoohoocthulhu » Tue, Aug 23, 2016, 3:55 AM UTC

smu3l wrote: post #141

Terr_ wrote: post #72

Earlier quoted context omitted.

So a "used" epi-pen's internal syringe might contain 4-5x more epinephrine than actually goes into a standard dose? I assume this means most of the expense of making it comes from the housing/mechanics. (And recouping whatever cost of QA/approvals.)

The drug itself is very cheap. With an Rx you can purchase an ampule with about 3 doses for I worked at a summer camp where we would carry 1 or 2 pens plus a bunch of ampules if we were in a wilderness situation where we couldn't get to emergency care and needed more than one dose. [1] http://www.buyemp.com/product/epinephrine-ampule

The drug is cheap...because it's unpatentable (as a molecule anyway) and is old enough that any patents would be expired anyway.

The marketing of autoinjectors has some legitimate public health value, but it's also a clear business strategy to get new drug prices for an ancient drug

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#174

Post by malz » Tue, Aug 23, 2016, 3:57 AM UTC

sevenless wrote: post #30

How many people will this price hike kill? I'm sure that's estimable. What would be morally justified, to stop it?

How many people would die if the only manufacturer of the device goes out of business?

It's not a flippant question; their only competitor pulled their product off the market, because the cost of fixing bugs was too great. How would it have helped to force them to charge less?

http://www.fiercepharma.com/marketing/sanofi-s-auvi-q-recall...

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#175

Post by hackuser » Tue, Aug 23, 2016, 4:00 AM UTC

ancap wrote: post #140

Ironchefpython wrote: post #110

Earlier quoted context omitted.

> The price hikes would immediately attract lower-cost competitors if this were truly a free market. Any participants in a free market for a product with inelastic demand (e.g. something you need to stay alive) and non-trivial entry costs immediately implements price fixing in the absence of regulation. When life-saving devices that require a significant supply chain to manufacture capture the bulk of consumer surplu…

I can think of many products which are life-saving which are readily available from countless producers for relatively cheap. The difference here is just as gwright has pointed out and you have a corpus of regulation which makes this particular product more expensive and/or chokes out competition. The only sectors of the economy where significant, lasting shortages occur are the ones most heavily regulated.

> The only sectors of the economy where significant, lasting shortages occur are the ones most heavily regulated

That's not what economic theory (and practice) say, I'm pretty sure. For example, unregulated electrical, communication (including Internet service) and transportation markets have resulted in shortages in rural areas. Unregulated food and housing markets (and many other markets, including Internet service) result in shortages for poor people. Unregulated fishing creates shortages of fish - a 'tragedy of the commons'. Monopolies and oligopolies eliminate whole categories of products.

The free market is very good for some purposes, but it's not a benevolent God that finds solutions to all our problems. It's just a very useful tool in the toolkit.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#176

Post by ucaetano » Tue, Aug 23, 2016, 4:10 AM UTC

leereeves wrote: post #63

ucaetano wrote: post #52

Earlier quoted context omitted.

No it doesn't. Switzerland has one of the best healthcare systems in the world, which is completely private (although there are some public hospitals), but heavily regulated.

Heavily regulated to avoid the corrosive effect of the profit motive? You two might actually agree.

On that yes, in some industries a race to the bottom or winner-takes-it-all is actually bad for society, healthcare is one example.

My issue is not with the "profit" part, but the "health care systems should be nationalized" part.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#177

Post by Ironchefpython » Tue, Aug 23, 2016, 4:10 AM UTC

ancap wrote: post #140

Ironchefpython wrote: post #110

Earlier quoted context omitted.

> The price hikes would immediately attract lower-cost competitors if this were truly a free market. Any participants in a free market for a product with inelastic demand (e.g. something you need to stay alive) and non-trivial entry costs immediately implements price fixing in the absence of regulation. When life-saving devices that require a significant supply chain to manufacture capture the bulk of consumer surplu…

I can think of many products which are life-saving which are readily available from countless producers for relatively cheap. The difference here is just as gwright has pointed out and you have a corpus of regulation which makes this particular product more expensive and/or chokes out competition. The only sectors of the economy where significant, lasting shortages occur are the ones most heavily regulated.

> The only sectors of the economy where significant, lasting shortages occur are the ones most heavily regulated.

So you're saying that Petroleum Exporting Countries would never say... create an Organization intended to increase the price of oil?

Or the DeBeers wouldn't collude with diamond producers to limit the availability of diamonds to increase the price?

Or that manufacturers and distributors of light bulbs, lysine, copper, cleaning powder, vitamins, glass, milk and machinery would never, ever engage in price fixing?

I want to live on your planet, where capitalism is so nice and perfect that companies rush to give away all their profit by competing the marginal cost down to zero without any of those pesky regulations.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#178

Post by throwaway_xx9 » Tue, Aug 23, 2016, 4:15 AM UTC

Just something to investigate ... I heard when working with youth trainers that in an emergency when an Epipen is not available, caffeine (like coffee) can help, and even a glass of water is better than nothing.

I hope somebody who has investigated this can add more definitive info.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#179

Post by invaliddata » Tue, Aug 23, 2016, 4:16 AM UTC

jevinskie wrote: post #155

invaliddata wrote: post #146

The adrenaclick generic is much cheaper than the epipen, with or without insurance. Although technically different epinephrine auto injectors cannot be substituted (you can only be prescribed the one written by your doctor, or its generic equivalent), practically speaking the only difference between the epipen and the adrenaclick design is the instructions for use. I would hope there isn't a case of doctors being una…

My doctor/pharmacy was apparently unaware of the differences or neglected to inform me. At some point in the last 4 years I started getting generic Adrenaclicks instead of EpiPens. The difference between EpiPens and generic Andrenaclicks was never presented to me as a different choice in medications, just an "expensive brand name" vs "cheap generic" choice. I wonder who screwed that one up. I did notice the different…

It's your doctor's fault if you didn't get the substitute earlier. As adrenaclick and epipen are not actually equivalent (even though ultimately they deliver the same medicine, in the same dose, in the same manner), the pharmacist is not supposed to do anything but provide what was prescribed.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#180

Post by snowwrestler » Tue, Aug 23, 2016, 4:26 AM UTC

curiousgeorgio wrote: post #123

mikeash wrote: post #92

Earlier quoted context omitted.

(2) is a myth: http://www.nytimes.com/roomfordebate/2015/04/16/what-are-cor... (1) seems like a total cop-out to me. By that logic, you can blame everything on the government. Some guy murders his family in a fit of rage? Government should have done a better job preventing it. Also, part of the point of this kind of outrage is to punish these companies for their behavior so that the evil choice is not the most profit…

If corporations don't have an obligation to maximize profits for shareholders, then you'd better try and take that argument to shareholders rather than believe someone's opinion piece on the matter. I didn't say corporations are legally required to seek profits, but they do have profit-seeking obligations in most cases. Without investors' expectations of future profits, those companies wouldn't exist in the first pla…

Shareholders already know that companies don't have an obligation to maximize profits. Tim Cook among others has made this point forcefully fairly recently.

Shareholders make investment decisions based on their own opinions of which companies are most likely to generate the highest return over their preferred time span. That is not the same thing as believing in an obligation.