FDA approves first monthly injectable to treat HIV infection

From all my research, I've come to the conclusion that while there are things that are broken about the US system, it's not as fundamentally broken as people make it out to be.

Let's say there are two variables you can optimize for, X and Y, and that there are tradeoffs between optimizations such as optimizing for X often reduces Y and optimizing for Y often reduces X.

The problem with the popular discussion today is that no one ever acknowledges what the US system does well. They only talk about what it does poorly. If you don't acknowledge what it does well, it's trivially easy to come up with solutions that address the things it does poorly, but often at the expense of creating a new replacement that now does poorly at the thing that the previous system did well.

In the US, the system is remarkably effective at optimizing for financial incentives. The replacement system many people argue for will likely lay waste to optimizing for financial incentives. This doesn't come without a cost however. Eliminate the financial incentives and you will at minimum get less of two very important things: (1) investment by companies and capital markets in R&D, and (2) investment in a career in the field of drug R&D by individuals deciding what career to pursue. The loss of one or both would be devastating to the development of novel treatments in perpetuity.

As a general heuristic, I've found it valuable to figure out what a system does well before I propose a solution to replace it. If I can't articulate what a system does well, it's typically a sign that I don't yet understand the system well enough and don't understand what that system's designers were optimizing for when it was first implemented. This heuristic is applicable to all pretty much all systems, not just health care.

I think the issue people have is the public spends about 1.4 trillion on patented prescription drugs per year globally which is more than 10x what drug companies are spending on R&D. Especially when manufacturing and distribution is such a small fraction of this cost.

While time value of memory explains some of that it’s still a huge discrepancy. Advertising etc make up the difference and while cost effective for the company, their harder to justify as a fraction of drug prices. Especially when over prescription is so harmful due to side effects and adverse drug interactions.

There is a substantial percent of the population whose yearly medical care costs exceed their income.

For example, about 7% of the world’s population collectively has some sort of a rare disease, which is theoretically treated with orphan drugs. There are also people who chronically live with cancer who end up living quite a long time. Diabetes, (type 1 or type 2) with or without complications, is quite expensive in the US.

I personally have 2 rare immune mediated neurological diseases affecting my peripheral nervous system. The only medication that has kept me in pharmaceutical remission is subcutaneous immunoglobulin (intravenous immunoglobulin did not work), and I have tried 10 different treatments plus combinations of them. When I was living in the US, my private commercial insurance paid, under contract (not the amount that was being billed which was much higher!), $100 per gram. In other words, they were paying $23,500/month for my blood product or $282,000/year.

In Europe, where I live now, the price goes for 40 Euro (about $50/gram).

Anyways, you should watch this, “The World’s Most Expensive Drug” (which it no longer is), which is quite revealing: https://youtu.be/0uYCw5EDX8U

Alexion (a pharma company) started the trend and now the have drugs that cost millions per year over, that are required over the course of a lifetime: https://www.nytimes.com/2019/08/25/health/drug-prices-rare-d...

There is a good documentary on it (requires a Hulu subscription): https://www.nytimes.com/2019/08/23/the-weekly/rare-diseases-...

Anyways, the prices of these drugs are an insult to the intelligence of a lot of scientists and (formal) engineers.

I also have type 1 diabetes, and because of my training in electrical engineering, I could tell by reading patents on analog insulin patents that a 10 mL bottle of insulin cost somewhere between $1-$10 to produce. Turns out that it costs between $3-$6 to produce. At its worse, in the US, it cost $350 per 10 mL vial for analog insulin.

Anyways, the best way of dealing with this situation is by having even the most disabled people working to offset these prices, along with having universal healthcare with price controls. Unfortunately worker protection against discrimination in the US is very poor and when your health benefits are tied to work then it just does not work. Patent law also needs to be reformed, and if the prices are obscene and unjustifiable, then they should be seized.

Well, thanks to the US government, the very rare immune mediated neurological disease I have was discovered in the early 2000s, at the Mayo Clinic, via NIH grant funds.

Because of the disease, I had uncontrollable orthostatic hypotension (low blood pressure when sitting/standing up), and I was passing out multiple times a day. I also was diagnosed with multiple types of arrhythmia.

If it were not for the US government, I would not be alive. I am a dual US|EU citizen, and while being American is naturally a huge part of my identity, I would not be afraid to renounce my US citizenship. The only reason why I do not is because the US literally saved my life and others with the disease I have, worldwide.

I'm not quite sure what your point is. Mine was that millions of people choose from a variety of treatment options and that there's no clear evidence that a pill is vastly preferred to an injection or even some more invasive delivery method. I think my link about birth control usage just shows that the more options, the better. Presumably we'll cover the at-risk population better if there are more good options.

I think this is a wonderful thing and that we should spread the word when these new treatments are available so that more people know they have options if they like the sound of occasional injections but don't like daily pills or vice versa.