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Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

mattstoller.substack.com

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Re: Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

#441

Post by nr3msd »

DoreenMichele wrote: post #321

Well, I hope this does some good, but I'm a bit skeptical. I think we need more focus on how to help freelancers, gig workers and microbusiness actually succeed as a counterpart to preventing big business from preying upon small business. It's something I personally try to promote but I feel I have little in the way of success. I still struggle to make it through the month myself and my various projects intended to h…

> I don't get enough feedback affirming that the lives of others suck less thanks to me.

I have always liked your posts a lot over the years here.

I'm in the same boat, I have created a few things that are used by actual people but I have not yet thought about trying to make a living that way. Ideally I would open source everything and go the Patreon / donation route, but I want to get some of my work in order and nail at least one of my bigger ideas... then it might be feasible, but for now money is absolutely the limiting factor and I don't even need much relative to some :(

Re: Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

#442

Post by dtech »

hug wrote: post #362
AnthonyMouse wrote: post #319

Earlier quoted context omitted.

It isn't a 100 year old drug. There are newer formulations that are faster acting, longer lasting, easier to administer, etc. They're newer so they're still under patent so they're a lot more expensive (because the rest of the world makes the US pay to develop the newer formulations). When insurance is paying for it, people prefer the newer formulations. Then, since most people have insurance, there wasn't enough of…

This doesn't pass the smell test. Anyone making the decade-old version of insulin and selling it for 1% of the price would corner a large portion of the market immediately. Anyone without good health insurance, which is a large and increasing part of the population, would immediately jump on the lower priced version. And since when are insurance companies excited to pay for the more expensive drug with limited extra…

> Anyone without good health insurance, which is a large and increasing part of the population, would immediately jump on the lower priced version.

Medicine isn't like a supermarket, people usually just take what their doctor/hospital prescribes. In addition, I think it's likely that those with no/worse health insurance are on average less informed.

Re: Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

#443

Post by koheripbal »

KirillPanov wrote: post #431
iso1210 wrote: post #410

Earlier quoted context omitted.

> You can buy prescription drugs online from India without a prescription for super cheap. They arrive in your mail. And what guarantee do you have of their contents?

Gas chromatography-mass spectrometry (GC/MS [1]) by an independent third-party lab [2]. For unscheduled substances they'll even email you the mass plot. Nearly all of our (US) pharmaceuticals already come from India anyways. Manufactured there from Chinese bulk precursors. I trust a third-party GC/MS plot way more than any brand slapped on a package. [1] https://en.m.wikipedia.org/wiki/Gas_chromatography–mass_spec...…

I'm confused. Are you saying that every time you receive a package of medications from India, you send a sample off to for spectrometry?

That seems extremely arduous.

The point is that you don't trust this specific supply chain/manufacturer, which is part of the approval process.

"India/China" is not some monolithic entity that is either good or bad, there are some manufacturers that you can trust, and some you cannot.

Quality control in drug manufacturing is what ensures that every single pill has the correct dose, and not some random batch accidentally having 100x the active drug you need - or 0.01%.

Re: Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

#444

Post by roenxi »

mft_ wrote: post #440
andyferris wrote: post #349

Earlier quoted context omitted.

Europe does drug R&D and still manages to sell their drugs at a reasonable price to sick people (generally because their governments utilize their buying power for the good of their citizens). It seems to me that US people have been sold FUD by there own pharma companies, if I’m honest.

In the context of this discussion, ‘Europe’ doesn’t do ‘R&D’. Biotech/Pharma are international. Irrespective of the home location of the organisation, virtually every drug trial from phase I onwards will be run in multiple countries. Further, virtually every drug found to work and filed with regulators for a license, will be filed internationally: Europe (EMA), US (FDA), and a whole host of smaller independent countr…

> Drugs are more expensive in the US simply because there aren’t any pricing controls...

There aren't any other markets where "pricing controls" are needed. Drugs are more expensive in the US simply because it is illegal for a 3rd party to sell them.

If it were legal, anyone could buy the drugs where they are cheapest and ship them to America. The problem is obviously that competition is banned. If that isn't the problem, the entire population of the world is remarkably indifferent to a really easy opportunity to make lots of money.

And, I suppose almost to obviously to add, if competition is illegal then prices go up.

Re: Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

#445

Post by the_third_wave »

pkaye wrote: post #332
the_third_wave wrote: post #175

Earlier quoted context omitted.

Being European I think they will pay even less attention to me than they would to their constituents. Hearing aids are expensive on this side of the Atlantic as well though - although less expensive than in the USA - so it is still worth finding a way to open up this market. Just like intrepid hackers managed to turn routing appliances into versatile network components by creating OpenWRT, DD-WRT and similar "hacks"…

The high price for hearing aids in the US is due to that independent providers need to mark up their hearing aids to pay for their overhead. So a $4k/pair hearing aid might have cost $2k/pair for them. Here Costco also sells hearing aids so they private label the same top end hearing aids for $1.4k/pair. They are a lot cheaper because they make profits through their overall membership base. Also they can negotiate a…

>

Yes, a hearing aid is not the same as a noise-cancelling earbud, they use different algorithms and the former needs to be more configurable than the latter. Then again, this functionality is implemented in firmware and uses common audio processing algorithms on off-the-shelf low-power DSPs, just like those noise-cancelling earbuds. The IndieGogo example I mentioned seems to be able to sell a pair of multi-purpose buds for around $250 a pair, $600 for 3 pairs. Assuming they are actually making a profit on these sales - and I don't see why they wouldn't, the hardware seems quite standard for noise-cancelling earbuds - this is proof of what I stated before and gives lie to the "overhead" excuse for the high mark-up, especially given the small size of the company behind the things. Of course I do not know whether the buds sold through IndieGogo are as capable hearing aids as "regular, overpriced" ones and I do notice that the stated running time (18 hours) is that of the buds and the charging case together - the buds themselves last for 7 hours between charges. They're specified for "mild ~ moderately-severe hearing loss" and seem to have the required amplification and equalizing capabilities [1]. Maybe give them a try? I don't need hearing aids myself but my mother does use them so I'm thinking about getting her a pair of these once her current pair is in need of replacement.

[1] https://c1.iggcdn.com/indiegogo-media-prod-cld/image/upload/...

Re: Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

#446

Post by dmitriid »

l33t2328 wrote: post #337
dmitriid wrote: post #330

Earlier quoted context omitted.

What you're literally saying is: instead of ending predatory pricing, enforce it for the rest of the world. Here's a novel idea: cut military spending in half, and you can provide all the free medicine to all Americans for the rest of their lives. All the while making the world a safer place.

Are you aware that the US government already spends far more on health care than it does on the military? Half the US defense budget is no where near the amount spent on healthcare in the private sector.

> Are you aware that the US government already spends far more on health care than it does on the military

At least 34% of that is spent on admin alone: https://time.com/5759972/health-care-administrative-costs/ and most of that is on privately insurers overhead.

> Half the US defense budget is no where near the amount spent on healthcare in the private sector

It would be way more than enough if there was some political will behind it.

Re: Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

#447

Post by mft_ »

roenxi wrote: post #444
mft_ wrote: post #440

Earlier quoted context omitted.

In the context of this discussion, ‘Europe’ doesn’t do ‘R&D’. Biotech/Pharma are international. Irrespective of the home location of the organisation, virtually every drug trial from phase I onwards will be run in multiple countries. Further, virtually every drug found to work and filed with regulators for a license, will be filed internationally: Europe (EMA), US (FDA), and a whole host of smaller independent countr…

> Drugs are more expensive in the US simply because there aren’t any pricing controls... There aren't any other markets where "pricing controls" are needed. Drugs are more expensive in the US simply because it is illegal for a 3rd party to sell them. If it were legal, anyone could buy the drugs where they are cheapest and ship them to America. The problem is obviously that competition is banned. If that isn't the pro…

I’m not an expert on the import/export side.

When I used the term ‘pricing control’, I was referring to the systems that some countries (eg UK, Germany) have in place for determining the price they’ll pay for a drug based on (roughly) the value it brings to patients. (The best known of these is probably NICE in the UK; it’s not a perfect system, but it’s a pretty good attempt.) Other countries in turn ‘reference’ their price from a number of similar countries including those with formal processes.

Broadly, this is why drug prices are controlled and lower in Europe vs. the US.

In the US, even where there are competing drugs in the same disease, there’s no pressure on prices - manufacturers can just keep on racking up their prices almost without a concern.

Re: Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

#448

Post by IfOnlyYouKnew »

hellbannedguy wrote: post #426
JumpCrisscross wrote: post #361

Earlier quoted context omitted.

> Europe does drug R&D and still manages to sell their drugs at a reasonable price to sick people Most novel R&D, in America and Europe, happens in biotech. (“Big” pharma does trials, manufacturing scaling and distribution.) The investment thesis for most of this research does not work without the American market. This doesn’t mean high drug prices are a necessity. Just that the funding needs to be replaced if we wan…

China, and Russia, and other countries, are making big breakthroughs in biotech, but we are hesitant on believing their results--now. They have the advantage of pushing through Clinical trials without much oversight. I am all for strict Clinical trial protocols, but our biotech companies are testing their drugs in countries that don't have strict protocols on safety. I don't get the price increase argument anymore. T…

To get approval in US and Europe, the trials need to be of the same quality no matter where they are run. Sometimes it may be cheaper in poorer countries because you don't have to pay your volunteers as much. You still need to check all the appropriate boxes regarding informed consent as anywhere else. And, of course, western companies are entirely capable to run trials anywhere in the world. The COVID vaccine trials were run in Europe, the US, South Africa, Israel, and really any place where the incidence was high enough.

And China and Russia are not "making big breakthroughs": just look at the vaccines again: BioNTech/Moderna/J&J/AZ all work extremely well, all things considered. The Russian and Chinese vaccines don't. Just ask/look at the charts of Chile. Or any Russian.

Re: Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

#449

Post by IfOnlyYouKnew »

jeeeb wrote: post #374
AnthonyMouse wrote: post #301

Earlier quoted context omitted.

This one is particularly prickly because the high cost paid in the US funds medical R&D and extremely expensive clinical trials which other countries are free riding on by imposing price controls. We still need to fund the R&D and clinical trials (unless they could be made less expensive somehow), so the most obvious solution would be to have other countries pay their fair share so the US could stop subsidizing every…

I’ve seen this claim made a few times. If this is true then surely it would be in the US’s interest to stop doing it! Stop us freeloaders from mooching off your drug development! Personally I’m doubtful that this claim is broadly true though. I think it should at least be backed by some decent analysis.

The US does pay about twice as much per capita for healthcare, while getting rather mediocre results. No, it's not in the country's best interest as any normal person would understand it.

But there's a large segment of the US population that has very strange priorities. They are willing to pay a bit extra to avoid the possibility of, say, poor people getting healthcare.

(They also pay 5x as much for their military, compared to their NATO peers. It's the export version of their particular brand of sadism.)

Re: Biden launches action on "Big Tech, Big Pharma, and Big Ag" – can it be real?

#450

Post by giantg2 »

renewiltord wrote: post #282
giantg2 wrote: post #249

Earlier quoted context omitted.

"Limit medical care to being provided by these people" Who else would provide this care? This licensure is similar to other professions, like lawyers, and really doesn't take very much lobbying since the majority of the public want oversight of these sorts of professionals. Residencies simply haven't kept pace with medical student numbers. They have gone up though. The main question is "where does the funding come fr…

You find it hard to believe a thing that the AMA made an overt aim of. Fascinating. Well, I’m out of this conversation.

Then show me a source.
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