Fed Up with Drug Companies, Hospitals Decide to Start Their Own • Hacker News Board

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#231

Post by yequalsx » Fri, Jan 19, 2018, 7:20 PM UTC

roadnottaken wrote: post #216

yequalsx wrote: post #214

Earlier quoted context omitted.

What about government funding research? It doesn’t have to be just rich people or corporations. It could be all of us in the form of government. I believe that most of a drug’s overall cost is marketing. I might be wrong on this but it is a significant, useless expense. Remove filthy rich profit motive and we might get drug companies that don’t resort to shenanigans.

You are simply wrong on this. It costs hundreds of millions of dollars to develop a new drug, prior to approval and marketing. What percent of a companies budget is spend on marketing versus R&D at a given time is kind of irrelevant because (1) the development costs occur before market and (2) often drugs are in-licensed or acquired after significant expense towards R&D has been expended. They don’t buy all the compa…

Developing drugs costs money. Marketing them does too. Which one has more money spent on it?

https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#232

Post by mullen » Fri, Jan 19, 2018, 7:38 PM UTC

Maarten88 wrote: post #172

manmal wrote: post #154

Earlier quoted context omitted.

Why not just go on a 2 week holiday :)

I was in San Diego some time ago, and went for a walk to Tijuana, Mexico. I noticed a flourishing pharma business there ;-). Not only Viagra but also seemingly normal pharmaceuticals and services like dentists and doctors. They seem to have found a market there... Getting through the border and back on foot was a bit of a hassle, and it's probably not a good idea to "bring" too much stuff, but it was a fun experience…

> I was in San Diego some time ago, and went for a walk to Tijuana, Mexico. I noticed a flourishing pharma business there ;-). Not only Viagra but also seemingly normal pharmaceuticals and services like dentists and doctors. They seem to have found a market there...

And many, if not most, of these medicines are fake. Especially Viagra.

If you get medicine in Mexico, you have to bring your old prescriptions and compare the two. Luck for me, my regular medicine is a cream for my psoriasis that comes in a box that I can take down there and compare the two. If the boxes look too different, I pass on it.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#233

Post by WalterBright » Fri, Jan 19, 2018, 8:38 PM UTC

SAI_Peregrinus wrote: post #209

WalterBright wrote: post #137

Earlier quoted context omitted.

Is the food in your local supermarket certified to not harm people to eat it? It's regulated, and the FDA can inspect to verify compliance with regulations, but suppliers do not have to get approval from the FDA to ship.

Actually quite a lot of food is inspected by the USDA.

That's right. But the point is you do not have to send food products to the USDA for approval prior to selling them.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#234

Post by DanBC » Fri, Jan 19, 2018, 8:51 PM UTC

cjalmeida wrote: post #223

DanBC wrote: post #153

Earlier quoted context omitted.

> You can do the NHS way and forbid paying for unwarranted procedures for life extension. Please cite which of these procedures are forbidden. > NHS adopts this measures in the so called death panels The US has these too, in the form of insurance companies. I think if you're going to have them it's better to ahve them be publically owned not for profit organisations under intense government regulation, rather than pr…

NHS guidelines is to not extend a terminal patient's life indefinitely. Not sure the explicitly reason is costs but having people months on intensive care is pretty darn expensive http://www.telegraph.co.uk/news/health/news/6127514/Sentence... Also, it had a policy of not funding what they call "procedures of limited clinical value" http://www.miltonkeynesccg.nhs.uk/referrals-and-priorities-p...

Your first link refers to the Liverpool Care Pathway. This was only for people with end stage terminal illness. It doesn't happen anymore -- the Liverpool Care Pathway has been stopped in all hospitals in England.

https://www.compassionindying.org.uk/wp-content/uploads/2015...

https://www.theguardian.com/society/2013/jul/15/liverpool-ca...

Your second link is even weirder. Firstly you've linked to a local organisation that covers a population of 250,000 people. Milton Keynes CCG is not a national organisaton. Secondly, you've said this is about not funding some treatments, but you've linked to the page where people can request funding for those treatments. Thirdly, You think US insurance companies fund anything and everything?

Some treatments are very expensive and also do not work. We see this most commonly with cancer drugs. To ease the burden for CCGs there's a national "Cancer Drugs Fund", set up to provide access to the latest cancer drugs.

They do not work. They do not work, and they cause harm, and they are very expensive.

https://www.theguardian.com/science/2017/apr/28/cancer-drugs...

> The Cancer Drugs Fund, set up by the government to pay for expensive medicines that the NHS would not normally finance, failed to benefit patients and may have resulted in some of them suffering unnecessarily from toxic side-effects, experts say.

> An analysis in a leading cancer journal has found that the fund paid out £1.27bn from 2010 to 2016 – an amount that would have paid for an entire year of mainstream cancer drugs for the NHS.

> But medicine it paid for was not worth the money, the report concluded. The analysis in the Annals of Oncology journal looked at 29 cancer drugs approved for 47 different types of treatment (known as indications), some of which were approved to treat more than one cancer. They found that only 18 of the 47 treatments prolonged the patient’s life, and then only by an average of three months.

But assuming someone still wants it, and they apply for individual funding and don't get it, they're now in the same position as many Americans: they can crowd-fund and go private.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#235

Post by avogadro » Fri, Jan 19, 2018, 9:00 PM UTC

wetpaws wrote: post #230

roadnottaken wrote: post #188

Earlier quoted context omitted.

Why is that cool? Intellectual property law is necessary for industries like Pharma. No IP, no new drugs.

If you study the subject of drugs R&D carefully, in most of the cases companies break even in 1 or 2 years after the release of the drug.

...for drugs that they release.

They take a bath on drugs that don't get released.

I'm not trying to claim Pfizer isn't profiteering, but it's not quite that black & white.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#236

Post by prklmn » Fri, Jan 19, 2018, 9:04 PM UTC

hibikir wrote: post #74

vkou wrote: post #43

Earlier quoted context omitted.

In Canada, developing an accidental MRSA infection after a routine surgery will trivially turn a $5000 procedure into a $25,000 package of life-saving treatment and associated hospital stay. When things go bad in medicine, your bill grows really, really, really fast. Also, unlike a mechanic with a car, your doctor can't stop working on you after they blow through their quoted budget and ask if you still want to pay f…

Ah, but your chances of an MRSA infection aren't the same everywhere. Some hospitals are far better than others at preventing infection, while others are far worse. In a bill per procedure world, like in US medical billing, while I'd not expect anyone to do it badly on purpose, lax procedures that lead to more care are paid by the patient's insurance. In a government owned hospital, or if billing is done up front, it…

I couldn't agree more. I've heard talks that the US is heading toward a capitation style payment system.

https://en.wikipedia.org/wiki/Capitation_(healthcare)

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#237

Post by danvoell » Fri, Jan 19, 2018, 9:15 PM UTC

shykes wrote: post #86

This article makes it seem like drug companies alone are responsible for predatory pricing in US healthcare, with hospitals being somehow on the consumer's side of the issue. In reality US hospitals are just as guilty of predatory behavior. If they do achieve lower costs through a new generics company, I do not trust them one bit to pass on the savings to patients. Why would they?

Medical Devices use the exact same play book. Small improvements + patents and new FDA approvals. You can use the old design, but there may be a flaw. Not to mention distribution strongholds and salespeople in the operating room with doctors.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#238

Post by thatcat » Fri, Jan 19, 2018, 9:29 PM UTC

refurb wrote: post #174

thatcat wrote: post #110

Earlier quoted context omitted.

This is common, the US is alone in its legislation against negotiating as a group for prescription prices.

That's an over simplification. Sure Medicare and Medicaid don't negotiate directly. Instead they impose discounts by fiat (no discount, no gov't business). Look up the 340B program and mandatory Medicaid rebates. They add up to huge discounts. In most cases Medicaid pays the lowest price of any customer and Medicare often pays the same as private insurers. It's a fallacy to say the gov't is getting screwed over by no…

To show that it is a fallacy you would need to compare the final drug costs after rebate with an average of foriegn govs that do negotiate rather than private insurers.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#239

Post by jenkstom » Fri, Jan 19, 2018, 11:09 PM UTC

roadnottaken wrote: post #188

steiger wrote: post #182

Earlier quoted context omitted.

I live in Brazil and generics for drugs which patents are expired are widely available, accounting for 30~40% of all drug market. If I'm not mistaken, we even broke patents in some cases (HIV drugs), which is cool.

Why is that cool? Intellectual property law is necessary for industries like Pharma. No IP, no new drugs.

That is a bit naive. There are other ways to fund drug research, such as government grants.

Re: Fed Up with Drug Companies, Hospitals Decide to Start Their Own

#240

Post by darkerside » Sat, Jan 20, 2018, 1:01 AM UTC

mirimir wrote: post #120

brucephillips wrote: post #106

Earlier quoted context omitted.

The same reason any industry benefits from being privatized: to incentive innovation. The antibiotics revolution would never have happened, at least not in America, had there not been a profit incentive. The other services you listed are less dependent on innovation.

OK, I get the dogma. But reality is more complicated. See https://www.pharmaceutical-journal.com/news-and-analysis/fea...

You can call it dogma. I think of it as a fundamental principle of human nature. Balancing creativity and efficiency effectively is quite the trick, and capitalism actually pulls it off. People and companies who take risks are the ones that thrive. Those that don't "fade away". It uses survivorship bias to our advantage.

Fading away used to mean dying in the streets. Sometimes it still does, but much more rarely. It's a dearly paid price for the innovation that brought us the world as it is today.