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

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#331

Post by WalterBright » Tue, Aug 23, 2016, 8:15 PM UTC

Ironchefpython wrote: post #303

WalterBright wrote: post #203

Earlier quoted context omitted.

You're making quite a vast assumption that service contracts mean the software is unusable without them. Red Hat Linux is just one counterexample. A further vast assumption is that your arguments are so compelling that anyone not convinced must be a paid shill. There are many software consultants who charge over $10,000/day for doing training. Many companies find them worthwhile when amortized over a roomful of engin…

>> it's unusable (to the customers that buy a service contract) without a service contract > You're making quite a vast assumption that service contracts mean the software is unusable without them. Red Hat Linux is just one counterexample. No. I'm not. I'm basing that on the tautology that consumers of "free" software who purchase expensive service contracts spend their money purchasing expensive service contracts. S…

> To frame this as a simple dichotomy

Except it's not so simple. Peltzman showed with statistics in "Regulation of Pharmaceutical Innovation" that the 1962 FDA amendments resulted in an increase in human suffering and death. (The 1962 amendments added "and effective" to the FDA's mandate.)

While some ineffective drugs were prevented from reaching the market, this was overshadowed by good drugs being delayed, and a sharp reduction in new drugs being developed due to huge cost increases from the regulations.

Markets are very dynamic systems, and unintended side effects always happen even with regulations that have the best of intentions.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#332

Post by Apocryphon » Tue, Aug 23, 2016, 8:15 PM UTC

Tiksi wrote: post #169

rdtsc wrote: post #133

Earlier quoted context omitted.

Why is it protecting a monopoly? Why doesn't it say "this EpiPen can't cost more than $30"?

Because then no one will manufacture it. You can't just will things into existence with unrealistic feel good rhetoric.

If the pen cost less than $30 to manufacture, there's no reason that no one would manufacture it.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#333

Post by clarkmoody » Tue, Aug 23, 2016, 8:22 PM UTC

clavalle wrote: post #323

clarkmoody wrote: post #313

Earlier quoted context omitted.

Let's talk about a free market. > every incentive to cut corners Do you continue to patronize businesses that cut corners when you expect good customer service or a good product? The free market ruthlessly punishes businesses that do not meet consumer demands. Only through government interference are substandard businesses sustained. Profits are the signal that a business is doing something right. Ok, but the EpiPen…

>The free market ruthlessly punishes businesses that do not meet consumer demands. True. But only as ruthlessly as the market approaches the free market ideal (readily available and accurate information on products, other users, choice at time of purchase etc). And we know there are no true free markets and that markets can drift far from the ideal even absent of government interference. Who is the first to try out a…

> markets can drift far from the ideal even absent of government interference

But only government interference can lock the market in that state in perpetuity, eliminating the corrective forces of price and competition.

> Are we to believe that information asymmetry is all rooted in government interference?

Of course not. But businesses that are able to satisfy more consumers through better transparency are going to win market share and increase profits.

Asymmetry exists in most business situations though. That's the whole point of specialization in the economy: some people have greater knowledge, skill, or training in a certain area and are able to provide more value to the consumer. It is worthwhile for the consumer to trade money in exchange for the specialized service rather than spending years to learn that craft to perform the service herself.

The cornerstone of the free market is satisfying consumer demand. Firms that fail to do so are destroyed quickly and effectively when the consumer stops purchasing their product.

> abundance of sustained profits is also a signal that the business is doing something wrong

What? Please explain.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#334

Post by curiousgeorgio » Tue, Aug 23, 2016, 8:46 PM UTC

mikeash wrote: post #328

curiousgeorgio wrote: post #306

Earlier quoted context omitted.

You can try the social pressure route every time this happens (and if you haven't noticed, this seems to be a recurring issue in health care), but unfortunately that's going to take more effort in the long run with fewer results. Many companies - whether morally justified or not - just won't respond to social pressure. Or, redirect those efforts into fixing the issue through legislation (either to open up the market…

How am I, an average citizen, supposed to fix this issue through legislation? Write to my representative? He'll just throw my letter on the pile, and our useless legislators will continue being useless. The only way to get any legislative action on this is to get the electorate to care about it so that legislators get convinced that they need to act on this in order to keep their constituency returning to the polls a…

> The only way to get any legislative action on this is to get the electorate to care about it so that legislators get convinced that they need to act on this in order to keep their constituency returning to the polls and checking off their name.

> And in order to do that, you need to talk about how problematic and reprehensible these moves are, so people actually care about it.

It sounds like we're in agreement there. The only difference is, you've expressed an unrealistic expectation with regard to the effectiveness of social pressure directly aimed at the company involved. If history is any guide, we can only expect systemic improvement in this scenario through legislation and/or deregulation. Otherwise, you're merely treating symptoms of the problem, not the cause (and no, the cause isn't capitalism or profit-seeking companies as many may have you believe).

Now, if trying to fix problems in our country through the use of a system of rules and regulations (aka, laws) that has been established for that very purpose is nonsensical, then so be it. I suppose that view is indeed nonsensical in the context of today's prevailing social attitudes.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#335

Post by seanp2k2 » Tue, Aug 23, 2016, 8:52 PM UTC

grandalf wrote: post #320

clavalle wrote: post #305

Earlier quoted context omitted.

So, what is the market solution? All I see is a restatement of the problem.

It's not necessarily an all-or-nothing solution. Consumers value accurate information about drug safety, so there is abundant incentive for a wide variety of different groups to offer a list of safe drugs. Since most Americans also interface with a private health insurance company and often private medical groups or hospitals, it's not just the individual who determines which safe list to trust. For example: Ronald's…

Do we really expect every person to conduct such personal research for every single treatment to every single ailment they have? I don't consider that a reasonable solution.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#336

Post by hackuser » Tue, Aug 23, 2016, 8:58 PM UTC

ancap wrote: post #302

hackuser wrote: post #175

Earlier quoted context omitted.

> 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…

I would first like to point out that in the context of this conversation the definition for shortage I am using is that there is a shortage of a good or service where it once was readily available. Sure I could, say, take a rocket ship, to mars and denounce the absence of internet connectivity, but that's not what I'm referring to here. >unregulated electrical, communication (including Internet service) and transport…

You make many claims in strong langauge, but that's not itself meaningful. They are at odds with what I learned from economists, and from what I believe is the very widely accepted consensus in the field (though I might have a few details wrong). Regulation is a normal, effective response to market failures, which sometimes result in shortages.

Of course, I'm not providing any citations myself!

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#337

Post by clarkmoody » Tue, Aug 23, 2016, 9:09 PM UTC

Apocryphon wrote: post #330

clarkmoody wrote: post #313

Earlier quoted context omitted.

Let's talk about a free market. > every incentive to cut corners Do you continue to patronize businesses that cut corners when you expect good customer service or a good product? The free market ruthlessly punishes businesses that do not meet consumer demands. Only through government interference are substandard businesses sustained. Profits are the signal that a business is doing something right. Ok, but the EpiPen…

> Do you continue to patronize businesses that cut corners when you expect good customer service or a good product? Do you have cable and/or phone service? Would we be using Comcast or AT&T if monopolies or regional monopolies didn't make them the only choices? Monopolies that were enabled through government inaction, by the way, not through government enabling. [1] > The free market ruthlessly punishes businesses th…

> Do you have cable and/or phone service?

The terrible state of internet service providers is not a free-market phenomenon. Those industries matured over a long period of time hand-in-hand with governments and regulators. Through bidding processes, licenses, and overt monopolies, government has heavily influenced the shape of those industries today. Taking a broken system and "deregulating" it doesn't magically get you awesome results, if the very fabric of that system was built on government privilege and control.

If government wants to take some action now that can undo what it has done in the past regarding the ISPs, then I'm all for it.

> There's always going to be the problem of information asymmetry.

Even if I grant you that point -- but see sibling comment -- wouldn't it be nice if that were the only problem in the market? Wouldn't it be nice if there were no government-granted monopolies? Uber vs the taxis is the perfect example of what's wrong with cronyism and government privilege.

> propping up the fast food industry

Consumers are propping it up, because it meets the need for cheap, tasty food. Sure it's bad for you, but people know that and don't care. Doing drugs is bad for you -- and illegal to boot -- and plenty of people use them. I don't prefer a government that dictates what sorts of things I put in my body of my own free will.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#338

Post by _archon_ » Tue, Aug 23, 2016, 9:19 PM UTC

CalRobert wrote: post #215

curiousgeorgio wrote: post #105

Earlier quoted context omitted.

True - the government's automobile safety standards are far from trivial, but there's no denying that the difference in safety between the cheapest smart car on the road and the safest car on the road is huge . In a head-on collision between the two, there's absolutely no contest. Asking why the government should allow an EpiPen competitor with a 0.1% higher failure rate is akin to asking why the government should al…

As a road user (walker, cyclist, occasional runner) I consider small vehicles that are easy to see around and above far safer than heavy, bulky vehicles. Cars aren't designed for the safety of anyone but their occupants, though.

> Cars aren't designed for the safety of anyone but their occupants, though.

This is not the case. Part of the reason that all new cars from large manufacturers are as bulky looking as they are is to conform with US pedestrian collision regulations.

While I applaud this initiative, I'd like to be able to buy a smaller, nimbler car and simply avoid hitting pedestrians.

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#339

Post by gwright » Tue, Aug 23, 2016, 9:22 PM UTC

maxerickson wrote: post #304

gwright wrote: post #161

Earlier quoted context omitted.

Perhaps because it actually costs more than $30 and so an edict such of this would guarantee that there are no EpiPens at all? In any case, the current high price is the result of regulatory/legislative actions and so the current price is evidence of regulatory failure, not market failure.

I don't think it is a massive regulatory failure to have the pharmacy dispense a product with matching use instructions to the product that is prescribed. So it's the market that has doctors prescribing $600 Epipens instead of the $150 alternative (that has different use instructions and thus cannot be used to fill a prescription for an Epipen).

Isn't this just another example of a problem created by the rules/regulations? A pharmacist is forbidden from providing the $150 alternative even if the customer specifically requests it (because of the prescription requirement and rules).

For those who need epinephrine injectors, can't they just ask their doctors to prescribe Adrenaclick? What prevents that from happening? I'm guessing it is insurance guidelines that are also stuck in the EpiPen-only world but perhaps it is also doctors being too conservative?

Re: EpiPen Price Rise Sparks Concern for Allergy Sufferers

#340

Post by grandalf » Tue, Aug 23, 2016, 9:59 PM UTC

seanp2k2 wrote: post #335

grandalf wrote: post #320

Earlier quoted context omitted.

It's not necessarily an all-or-nothing solution. Consumers value accurate information about drug safety, so there is abundant incentive for a wide variety of different groups to offer a list of safe drugs. Since most Americans also interface with a private health insurance company and often private medical groups or hospitals, it's not just the individual who determines which safe list to trust. For example: Ronald's…

Do we really expect every person to conduct such personal research for every single treatment to every single ailment they have? I don't consider that a reasonable solution.

It would be more of a checklist. Chances are there would not be much disagreement. Tylenol, for example, is likely to be whitelisted by nearly any list maker.

The scenarios where there was a mix of approval and disapproval probably do warrant taking some extra time, yet few of us are able to do it today because we assume (falsely) that just because something is approved by the FDA it is safe (or unsafe if not approved).

Effectiveness is a whole different question, and many drugs with significant side-effects do not do better than the placebo effect for some of their approved uses.