Drugs for the People: Rethinking the global pharmaceutical supply chain • Hacker News Board

Re: Drugs for the People: Rethinking the global pharmaceutical supply chain

#21

Post by freeone3000 » Mon, Nov 23, 2020, 10:23 AM UTC

jandrewrogers wrote: post #19

GiorgioG wrote: post #18

Earlier quoted context omitted.

I'm just going to leave this here: http://www.drugood.com/2018/07/15/gleevecs-cost-and-price/ Gleevec did not take many years at all for Novartis to recover its trivial relative costs and generate billions of dollars of profit for nearly 2 decades. The problem is when you have a disease and there's only one treatment around, you'll literally pay whatever it costs - because not having it means you're dead. These compa…

Yet Novartis only has 15% margins. Not shabby but not exactly living large, and much worse than tech companies. You aren’t going to move the needle on drug costs by making those margins 0%, and no amount of wishing will change that. That’s math. I guess you could pay people less at Novartis but it probably won’t have the desired effect. These things cost a certain amount of money to produce. What you are complaining…

>the implications of redistributing that cost are not particularly palatable either

Perhaps not to you, but socialized healthcare is being advocated for by several elected officials, so it's not completely off-the-table.

Re: Drugs for the People: Rethinking the global pharmaceutical supply chain

#22

Post by redis_mlc » Mon, Nov 23, 2020, 10:30 AM UTC

Nbox9 wrote: post #12

Is it viable for every country to produce all of it’s own basic necessities — food, medicine, energy, fresh water, building materials? Is it desirable? I believe that the US being a net exporter of food, and a net importer of medicine is an acceptable situation. I think that to frame out ‘reliance’ on India and China for medicine ignores China’s ‘reliance’ on the US for soybeans, or India’s reliance on US warships in…

> Is it viable for every country to produce all of it’s own basic necessities — food, medicine, energy, fresh water, building materials? Is it desirable?

In most cases, yes.

> I believe that the US being a net exporter of food, and a net importer of medicine is an acceptable situation.

China already denied exports of PPE to the US in the early days of corona, so no. In addition, during war, the US military has to be self-sufficient.

> We are codependent, and that codependency is going to keep us all from killing each other again.

That's what people said before WW2.

Everything you said is nonsense when the historical record is examined.

Re: Drugs for the People: Rethinking the global pharmaceutical supply chain

#23

Post by ineedasername » Mon, Nov 23, 2020, 2:48 PM UTC

henrikschroder wrote: post #10

ineedasername wrote: post #7

Earlier quoted context omitted.

It's difficult to say whether other countries are just dealing with the financial side of this better or if the US is basically subsidizing the low prices elsewhere by paying the exorbitant prices here.

> or if the US is basically subsidizing the low prices elsewhere by paying the exorbitant prices here. Nope, you're just being taken for a ride because they can. Remember that the biggest line item for pharmaceutical companies is their advertising budget, not their research budget. Also, this kind of thinking is some weird sort of Stockholm Syndrome, you're basically trying to frame being taken advantage of as some s…

I wouldn't exactly frame paying for other countries' healthcare costs as a sort of altruism, not when it puts many people in the US in crippling debt and causes thousands upon thousands of medical-debt bankruptcies every year.

This isn't me speculating there's some benevolent reason for high costs. This is me speculating on whether or not the US, if it dealt with these issues head on, would inadvertently cause prices to rise elsewhere. And if it did, that would simply mean the world, and not just the US, would have to deal with the systemic issue at hand.

Re: Drugs for the People: Rethinking the global pharmaceutical supply chain

#24

Post by Nbox9 » Mon, Nov 23, 2020, 2:56 PM UTC

solstice wrote: post #20

Nbox9 wrote: post #12

Is it viable for every country to produce all of it’s own basic necessities — food, medicine, energy, fresh water, building materials? Is it desirable? I believe that the US being a net exporter of food, and a net importer of medicine is an acceptable situation. I think that to frame out ‘reliance’ on India and China for medicine ignores China’s ‘reliance’ on the US for soybeans, or India’s reliance on US warships in…

I fully agree with your last sentence. But I think that nobody is seriously arguing that the US or European countries should become autarchies and produce _everything_ themselves again. (That whole "decoupling from China" is considered unfeasible and highly disruptive/dangerous at least by EU officials that I have personally heard from.) Instead, certain products and production capacities should be preserved at a min…

It seems to me to be too large of a correction against ‘highly-optimized supply chains’ to assume that at any time we’ll suddenly need a 100x supply of any medicine in the WHO List of Essential Medicines and that we’ll need this emergency supply of medicine while the world supply chain is disrupted. This is essentially the ask of the article, when it references the sudden need for Hydroxychloroquine.

Should we have emergency stockpiles of food, water, medical equipment, energy, and shelters? Absolutely. Let’s remember that any inefficiencies in our manufacturing base serve to make us less competitive internationally and raise the prices that consumers spend. There’s only so much emergency preparedness we can reasonably expect.

Re: Drugs for the People: Rethinking the global pharmaceutical supply chain

#25

Post by baumandm » Mon, Nov 23, 2020, 3:16 PM UTC

DoreenMichele wrote: post #6

Evergreening props up pharmaceutical profits but prevents lower-income populations from ever benefitting from the drugs. It keeps enormous swaths of the global population, without insurance or financial resources, from accessing lifesaving treatments. It seems the pharmaceutical industry has largely forgotten why it makes drugs in the first place: to save lives. No, not really. They are in it to make money. We used t…

> We used to think of medication as something you took occasionally during a crisis. Now we take it as a given that a large percentage of the population will be on maintenance drugs for life.

Not disputing this, and it certainly supports your point about the pharmaceutical industry making money.

But is there evidence that we are actually worse off for it? Did previous generations benefit from better mental and physical health than we do now.

My instinct is that we're healthier than ever before. We're treating conditions that weren't even identified a generation ago. Now that might not be due to our pharmaceutical intake, but I'd be surprised if it wasn't partially responsible.

Of course it's possible we've gone farther towards drugs than needed, which perhaps was your original point.

Re: Drugs for the People: Rethinking the global pharmaceutical supply chain

#26

Post by DoreenMichele » Tue, Nov 24, 2020, 4:56 AM UTC

baumandm wrote: post #25

DoreenMichele wrote: post #6

Evergreening props up pharmaceutical profits but prevents lower-income populations from ever benefitting from the drugs. It keeps enormous swaths of the global population, without insurance or financial resources, from accessing lifesaving treatments. It seems the pharmaceutical industry has largely forgotten why it makes drugs in the first place: to save lives. No, not really. They are in it to make money. We used t…

> We used to think of medication as something you took occasionally during a crisis. Now we take it as a given that a large percentage of the population will be on maintenance drugs for life. Not disputing this, and it certainly supports your point about the pharmaceutical industry making money. But is there evidence that we are actually worse off for it? Did previous generations benefit from better mental and physic…

Did previous generations benefit from better mental and physical health than we do now.

There are a large number of differences between the past and the present. It's really hard to talk about comparisons between the past and present and try to boil it down to a single metric.

Many years ago, a friend and I were talking and I was making sort of the same argument you are making -- that things are better than they used to be. And she stopped and said something like "I'm not comparing it to the past. I'm comparing it to what I think is possible given present day knowledge and technology."

And she also said something about "low standards" or "low expectations" -- like "Why should we settle for this crap just because the past was worse?"

And that really stuck with me.

I have gotten off all drugs for a condition where that isn't supposed to be possible and that strongly shapes my views and opinions in ways that I can't back up with studies or the like to the satisfaction of other people. But I'm convinced we can raise the bar and do better than this and one path forward is to begin thinking more broadly about the fact that "life is chemistry" and stop acting like a pill is the most important and powerful means to interact with human biochemistry when it's really just one of the most convenient ways to manipulate biochemistry that is profitable in our current economic arrangements.