The Best Fix for American Drug Prices Is Already on the Books • Hacker News Board

Re: The Best Fix for American Drug Prices Is Already on the Books

#131

Post by mikeash » Mon, May 14, 2018, 6:07 PM UTC

AnthonyMouse wrote: post #125

mikeash wrote: post #111

Earlier quoted context omitted.

I’m not sure how that’s related. My point is that pharma R&D is not a significant cause of high insurance premiums or high health care costs in general.

> My point is that pharma R&D is not a significant cause of high insurance premiums or high health care costs in general. It's the same issue across the industry. There are patents on medical devices, diagnostic tests, imaging equipment, etc. It's a major source of costs. And nobody is claiming that it's the only one.

Pharma R&D itself is not a major source of costs. It’s around 2-3%. Sure, you could potentially make an improvement there, but its role in our massive health care costs is vastly overstated.

Re: The Best Fix for American Drug Prices Is Already on the Books

#132

Post by mch82 » Mon, May 14, 2018, 7:59 PM UTC

ianai wrote: post #23

torpfactory wrote: post #7

Here’s the rub with developing something as important as a medicine. If it works, people often _need_ it to prolong their life or improve their health. What drug companies are selling... isn’t like what other companies are selling. We ought not look at it through our normal understanding of goods in a free market. Take, for example, Sovaldi, a drug which cures Hepatits C. After discovering this drug and confirming it…

One possible solution: have the government buy the rights for cost + some preset mark up. Then make it a government program to produce and transmit. Could earn some serious well wishing abroad by making it available for cost/free for developing nations. That’s how to lead the world.

Nice idea. Worth at least looking into the feasibility.

Re: The Best Fix for American Drug Prices Is Already on the Books

#133

Post by jhayward » Mon, May 14, 2018, 8:52 PM UTC

RcouF1uZ4gsC wrote: post #41

khazhoux wrote: post #19

Crazy idea: all pharmaceutical research should be publicly funded and publicly-owned. No private ownership of drug patents, period. "But this will disincentive research!" Maybe. Or, tax people more in order to fund the research. The tax revenue would go directly to researcher salary, equipment, expenses. Even a large tax increase can't be worse than today, where people have to pay huge $$$ anyway, of which a large cu…

You do that and in in a few decades, after a few rounds of negotiations, most of your research money will go to funding ex-researchers pensions. For an example, take a look at where California's tax revenues go. In addition, public funding tends to more risk averse. Private industry generously rewards innovation. Public funding tends to reward not rocking the boat.

> Private industry generously rewards innovation.

This is a unfounded assertion, not a fact.

A more correct statement would probably be: private industry sometimes generously rewards some innovation, as long as that innovation can be captured, monopolized, and monetized.

There are many innovations, both realized and that one can imagine, that would absolutely not be rewarded but would be nonetheless hugely significant in health and well-being.

As example, consider the whole “Is curing patients a sustainable business model?” question raised by a Goldman Sachs analyst. [1]

[1] https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie...

Re: The Best Fix for American Drug Prices Is Already on the Books

#134

Post by stinkbug » Tue, May 15, 2018, 12:13 PM UTC

disordinary wrote: post #52

AnthonyMouse wrote: post #17

Earlier quoted context omitted.

> the last numbers I saw, 2015, showed marketing budgets for medicine to be often times twice what was being spent on R&D in the US. The marketing expense isn't necessarily avoidable. Suppose it costs $50M to research a drug and patients will pay $1000 for a course of treatment. If you do no marketing then you get forty thousand customers and can't recover your R&D. If you spend $100M on marketing then you get two hu…

Surely though the best marketing is the effectiveness of the product, if it's a good product then doctors will prescribe it. I don't know if it's true or not, but looking at US movies/tv shows it seems like everyones taking medication which I doubt they actually need. Here I don't know very many people who actively take regular medication, I know that people who move here complain at how doctors are stingy with presc…

Why on Earth would this get down voted?

Re: The Best Fix for American Drug Prices Is Already on the Books

#135

Post by stinkbug » Tue, May 15, 2018, 12:18 PM UTC

AnthonyMouse wrote: post #96

disordinary wrote: post #93

Earlier quoted context omitted.

But then those 160,000 other patients are either getting medication that they don't need or are getting medication which is inferior to something else which they should have gotten but has inferior advertising. I'd rather pay more and either only use the medication when I need it, or get the most effective medication. One of the reasons why the US spends so much more than the rest of the world is because of the share…

> But then those 160,000 other patients are either getting medication that they don't need or are getting medication which is inferior to something else which they should have gotten but has inferior advertising. Yes, if the advertising is total bullocks that is what happens. But getting rid of the advertising still doesn't make the price of the drug go down for the people who actually need it. And it's at least theo…

Yes of course the advertisements are total bollocks. That is the claim. You are making these very strident back-of-the-envelope "economics" arguments without realizing that the economic ideal for the health care industry is to provide therapies that make people sicker, thereby ensuring their return for more therapies.

Re: The Best Fix for American Drug Prices Is Already on the Books

#136

Post by stinkbug » Tue, May 15, 2018, 12:29 PM UTC

refurb wrote: post #117

disordinary wrote: post #81

Earlier quoted context omitted.

But, they all have access to knowledge bases and information and guidelines provided by the government.

That is true, but setting aside time to do research is a much bigger hurdle than taking 10-15 min to listen to someone give you the highlights. And in case anyone was wondering, doctors are very skeptical of drug reps and always verify anything they say before believing it. But it gives them a starting point.

"always verify". Well that's obviously not a true statement but (not singling you out) I wonder why there is such a compulsion to defend the honor, as it were, of medical doctors.

It's not exactly the same as pharma, but in the medical device field salespeople are commonly in operating theatres. Clearly the surgeons doing this do not have time to "verify" what they are being told. https://www.washingtonpost.com/national/health-science/why-i...

Americans would do well to stop idolizing doctors and realize that huge numbers of them are lazy, incompetent shills who routinely do a lot of preventable damage.

Re: The Best Fix for American Drug Prices Is Already on the Books

#137

Post by RcouF1uZ4gsC » Tue, May 15, 2018, 8:05 PM UTC

HarryHirsch wrote: post #55

RcouF1uZ4gsC wrote: post #41

Earlier quoted context omitted.

You do that and in in a few decades, after a few rounds of negotiations, most of your research money will go to funding ex-researchers pensions. For an example, take a look at where California's tax revenues go. In addition, public funding tends to more risk averse. Private industry generously rewards innovation. Public funding tends to reward not rocking the boat.

Private industry generously rewards innovation The drug industry is generally happier to develop new drugs against targets that are well established and for conditions that physicians are trained to prescribe for. That's why we are now at fifth-generation statins, and also why "first-in-class" compounds are so rare. For something really new you need to find the target, devise an assay and make a case for use. It's a…

That is why I am so glad that Solvadi the Hepatitis C cure is making so much money.

Re: The Best Fix for American Drug Prices Is Already on the Books

#138

Post by danShumway » Wed, May 16, 2018, 12:35 AM UTC

rayiner wrote: post #127

danShumway wrote: post #122

Earlier quoted context omitted.

> There is no correlation between brilliance and altruism. That's not really relevant to what was being discussed above. The question isn't whether smart people are altruistic, it's whether there's a correlation between altruism and effectiveness. The question is whether charitable individuals are capable of building better products than profit-driven individuals. And given that depending on who you ask anywhere from…

Most open source development is done by for profit companies. Not through altruism, because software just happens to be an input into more profitable businsss activities. If Google licenses Android to smart phone manufacturers, maybe it gets $5-10 once every two years. But by giving it away for free and creating an Android user, Google makes that much every month.

The fact that many companies incorporate Open Source into their profit models does not diminish or remove the enormous number of unpaid, volunteer hours that have gone into those projects.

It's simplistic to the point of insulting to claim that the Free Software movement can be completely encapsulated by Capitalism. You have to ignore vast swaths of the history of the Internet, Linux, and the origins of Copyleft itself. You have to either ignore efforts by organizations like Mozilla or the Internet Archive, or claim that those efforts aren't important.

Richard Stallman's original announcement of GNU included the following message: "I consider that the golden rule requires that if I like a program I must share it with other people who like it. I cannot in good conscience sign a nondisclosure agreement or a software license agreement. So that I can continue to use computers without violating my principles, I have decided to put together a sufficient body of free software so that I will be able to get along without any software that is not free.

If I get donations of money, I may be able to hire a few people full or part time. The salary won't be high, but I'm looking for people for whom knowing they are helping humanity is as important as money."

This is the environment that Linux came out of - people who decided they cared about something more than they cared about money. You don't have to be an absolutist like Stallman, but you also can't pretend that absolutists like Stallman haven't played important roles in building our modern computing world.