Treat Medicines Like Netflix Treats Shows • Hacker News Board

Re: Treat Medicines Like Netflix Treats Shows

#51

Post by fwip » Thu, Mar 07, 2019, 4:34 PM UTC

Anon84 wrote: post #30

lkbm wrote: post #10

Earlier quoted context omitted.

> Maybe I’m missing something, but discussions on the cost of medicine never seem to question whether using prescription drugs is the right choice to begin with. Because it's pretty darn obvious that once you have Hep C, yes, prescription drugs are the right choice. No one's pumping Hep C drugs into people who don't have Hep C. > Surely the solution to this epidemic is to address the underlying drug problems first? I…

> No one's pumping Hep C drugs into people who don't have Hep C However, that is what is being done with HIV drugs under the guise of PrEP https://en.wikipedia.org/wiki/Pre-exposure_prophylaxis So I wouldn't be so quick to rule it out, specially if Pharma companies see a way to profit out of it.

> Under the guise of

I thought y'all were all about prevention? Now you're acting like preventing acquisition of a lifetime disease is a bad thing.

Re: Treat Medicines Like Netflix Treats Shows

#52

Post by ummonk » Thu, Mar 07, 2019, 4:39 PM UTC

bencoder wrote: post #27

pyedpiper wrote: post #17

I'll just leave this here: https://en.m.wikipedia.org/wiki/Cost_of_drug_development#Res...

Not sure if you're posting this as a disagreement with the suggested model, or agreeing. From the link, it looks like it costs ~$10bn per successful drug, at the top end of that list. Australia paid $750m for 5 years access. Australia has ~1/10th the population of the United States. and ~1/3rd the population of the UK. If just the UK, USA and Australia paid at that same rate (per capita) then they would cover that 10…

I imagine the Hep C drugs are some of the more monetizable drugs though and will need to rake in more money to subsidize the development of niche drugs.

Re: Treat Medicines Like Netflix Treats Shows

#53

Post by kakaorka » Thu, Mar 07, 2019, 4:39 PM UTC

VikingCoder wrote: post #34

jedberg wrote: post #31

A great theory but one major flaw. The utility value of most tv and movies comes when they are brand new with quickly diminishing returns afterwards. Drugs on the other hand have equal utility for their lifetimes (until replaced by something better, which can in some cases take centuries). In fact sometimes a secondary use for a drug is found and its utility goes up. Entertainment rarely has increasing utility. Even…

I don't understand how you're measuring. Hep C medicine has zero utility value for me right now. And I'm enjoying watching Brooklyn 99 from the beginning right now, because I'd never seen it. My wife is watching series after series on Netflix that are all old. My daughter is enjoying the entire archive of Disney movies. Snow White is what, 82 years old? When Incredibles 2 is coming out, you can bet the utility of Inc…

Maybe because that’s just you, a unique individual.

For a different unique case, such as someone who has Hep C, the utility value for the medicine could literally be everything for the person.

So, if we average the utility value for a whole population, the utility value would actually be pretty high, especially if a lot of people have Hep C.

Re: Treat Medicines Like Netflix Treats Shows

#54

Post by nabla9 » Thu, Mar 07, 2019, 4:45 PM UTC

pyedpiper wrote: post #17

I'll just leave this here: https://en.m.wikipedia.org/wiki/Cost_of_drug_development#Res...

Those numbers are sign of incredible waste and wrong incentives.

The incentives in drug industry are towards developing patentable molecules and techniques, not for discovering new ways to cure things. There is too much overlapping development, not actual drug discoveries that provide net benefits for the society in exchange for patent monopoly. When some discovers a new chemical entity (NCE) and gets it approved, competitors spend massive amount of money developing new molecular entities (NME) that do the same thing with slightly different molecule.

Then those srug companies use evergreening and pay-for-delay that adds several billions annually.

Governments should look very critically to drug patents start paying only for actual discoveries.

Re: Treat Medicines Like Netflix Treats Shows

#55

Post by WhompingWindows » Thu, Mar 07, 2019, 4:54 PM UTC

VikingCoder wrote: post #34

jedberg wrote: post #31

A great theory but one major flaw. The utility value of most tv and movies comes when they are brand new with quickly diminishing returns afterwards. Drugs on the other hand have equal utility for their lifetimes (until replaced by something better, which can in some cases take centuries). In fact sometimes a secondary use for a drug is found and its utility goes up. Entertainment rarely has increasing utility. Even…

I don't understand how you're measuring. Hep C medicine has zero utility value for me right now. And I'm enjoying watching Brooklyn 99 from the beginning right now, because I'd never seen it. My wife is watching series after series on Netflix that are all old. My daughter is enjoying the entire archive of Disney movies. Snow White is what, 82 years old? When Incredibles 2 is coming out, you can bet the utility of Inc…

Yeah, you don't tear down his overall point with your anecdotal, n=1 case. It's the population average not N=1 average, that we care about in public health.

Re: Treat Medicines Like Netflix Treats Shows

#56

Post by alsadi » Thu, Mar 07, 2019, 4:57 PM UTC

We are big pharam, give us tons of money and hope that we cure you! We don't! we just treat you.

Re: Treat Medicines Like Netflix Treats Shows

#57

Post by Ericson2314 » Thu, Mar 07, 2019, 4:59 PM UTC

KaiserPro wrote: post #37

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, something odd has happened. For what ever reason, be it legal, cultural or other, copay, crippling buerocracy and down right greed has stopped the health system working properly. The problem with a "netflix" model, is that doctors can currently prescribe anything, re…

It's not quite insurance. Firstly, this is a relationship between the government/insurance companies and the drug companies. The people (however flawed) already have insurance. For those organizations, drugs aren't risk, and they are paying in bigger lumps, so this is closer to the opposite of insurance. It's constant price gouging mitigation.

There's a slight difference since nexflix entirely covers the marginal cost per item consumed. If we had drug bounties, the drug companies could become entirely R&D outfits, with boring old chemical companies doing the pill manufacturering. Over time, if the existing companies lose their manufacturing ability, they will need more dependent on this arrangement. Finally, it removes the perverse incentive against cures/innoculations and for rest-of-your-life migrations.

Re: Treat Medicines Like Netflix Treats Shows

#58

Post by VikingCoder » Thu, Mar 07, 2019, 5:01 PM UTC

kakaorka wrote: post #53

VikingCoder wrote: post #34

Earlier quoted context omitted.

I don't understand how you're measuring. Hep C medicine has zero utility value for me right now. And I'm enjoying watching Brooklyn 99 from the beginning right now, because I'd never seen it. My wife is watching series after series on Netflix that are all old. My daughter is enjoying the entire archive of Disney movies. Snow White is what, 82 years old? When Incredibles 2 is coming out, you can bet the utility of Inc…

Maybe because that’s just you, a unique individual. For a different unique case, such as someone who has Hep C, the utility value for the medicine could literally be everything for the person. So, if we average the utility value for a whole population, the utility value would actually be pretty high, especially if a lot of people have Hep C.

I'm sorry, can you explain how we "average" the utility?

For me, it has zero value.

For another person, it saves their life, and they would pay literally anything they could.

How do we average that?

My hot take: We can't. Buy medicine in bulk, give it to people for free, progressive taxes to pay for it.

Re: Treat Medicines Like Netflix Treats Shows

#59

Post by patmcc » Thu, Mar 07, 2019, 5:04 PM UTC

will_brown wrote: post #46

KaiserPro wrote: post #37

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, something odd has happened. For what ever reason, be it legal, cultural or other, copay, crippling buerocracy and down right greed has stopped the health system working properly. The problem with a "netflix" model, is that doctors can currently prescribe anything, re…

>The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy Unknown to almost everyone in the US is that if you are a Medicare patient, when you go to fill a Rx before the pharmacist fills the therapy, insurance software suggests cheaper generics to the pharmacist and requires the pharmacist to do the leg work of asking the doctor to change the Rx based on wha…

While I agree insurance companies do harm, encouraging generics is probably a net benefit. Doctors, just like anyone else, respond to marketing, so they remember 'viagra' more easily than 'sildenafil' and write prescriptions accordingly. There's often no medical reason a generic isn't 100% suitable.

Re: Treat Medicines Like Netflix Treats Shows

#60

Post by guelo » Thu, Mar 07, 2019, 5:14 PM UTC

We desperately need a socialist pharmaceutical industry: The same researchers that work for Gilead Science could work for the NIH. Instead of directing research at the most profitable niches it could be directed at the guidance of the CDC.