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Hospitals and universities repurposing drugs at lower cost

kcl.ac.uk

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Re: Hospitals and universities repurposing drugs at lower cost

#101

Post by bit-anarchist »

mrguyorama wrote: post #86
parineum wrote: post #76

Earlier quoted context omitted.

This all assumes that the government will do an equal or better job spending money than companies that rely on spending that money well to exist. What will actually happen is that the government department of repurposing drugs will be efficient once and then get their budget reduced and never be efficient again. Next time they'll make sure to spend every last cent and not worry about the over budget boondoggle that's…

>This all assumes that the government will do an equal or better job spending money than companies that rely on spending that money well to exist. We know they do because before the government took over the job, the nascent medicine industry would sell you literal poison. In fact, you can see today what an unregulated pharmaceutical industry looks like. It's the supplements aisle at your local supermarket. The place…

> We know they do because before the government took over the job, the nascent medicine industry would sell you literal poison.

We also know that some reports of poisoned industries in the past were exaggerated (and politically capitalized to lobby monopolistic regulations). This wasn't exclusive to medicine.

> The place where you can buy literal homeopathy sugar pills, and various completely unstudied compounds and other scams.

Presuming that these aren't actual cases of fraud - if they were, they'd already be illegal in a private market, regardless of the FDA - how many are actually buying these? Not many, I presume. For those that are, I think better informing them is much better solution, not only to combat innefective drugs, but also to strengthen trust on actually effective treatments. That said, homeopathy seems more like a yet-to-be cracked down case of fraud, regardless of regulations.

> If private industry was better than the government at managing drugs, the American supplements industry would mean we should have dramatically better health outcomes and dramatically cheaper healthcare.

Why? USA's healthcare system is an overly bureocratic, poorly regulated (not as in lacking in regulations, but that the regulations that exist are bad) goliath. It's closer to a government-funded system, except stupid. It's not an example of a government-free system, but how private actors do their best to exploit existing and lobbied soon-to-be regulations in their favor.

Re: Hospitals and universities repurposing drugs at lower cost

#102

Post by unacorner »

atourgates wrote: post #95

I have a little insight here from working with ophthalmologists. When the article mentions "using a cancer drug to treat a leading cause of blindness" it's talking about using Bevacizumab (brand name Avastin) to treat macular degeneration. Avastin and Lucentis are molecularly the same drug. The difference is that Avastin isn't packaged to be injected into eyeballs, and Lucentis is. Also, Avastin costs about $50/dose,…

Compounding pharmacies can get injectibles wrong in a deadly way. Many families are still waiting for justice after the MECC pharmacy caused the deaths of 64 people:

https://en.wikipedia.org/wiki/New_England_Compounding_Center...

Re: Hospitals and universities repurposing drugs at lower cost

#103

Post by g42gregory »

Yes, but it's really tough. I read that 50% of Stanford Medical School budget comes from Big Pharma. It's really hard to get the message out. I believe Pharma (the biggest advertiser on Google) is influencing Google search results, among other things.

Here is a site that focuses on COVID and Cancer: https://imahealth.org/

Re: Hospitals and universities repurposing drugs at lower cost

#105

Post by tehjoker »

bluGill wrote: post #26
shevy-java wrote: post #20

The prices of drugs in the USA are especially high. This is interesting because the USA claims to pursue a maximum capitalistic society - but if this were the case, you'd have competition in a free market. But you don't have that. You have a cartel (or rather more than one). A pure capitalistic society works on assumptions that are not real. People are often cheaters. This would have to be taken into account. But whe…

The US is not a capitalist society, it is a liberal society. Capitalism is a consequence of that but it isn't the reason.

This is completely backwards read Marx. Superstructure (culture, politics) flows from the economic base (there are some important exceptions, but that’s the dominant arrow).

Re: Hospitals and universities repurposing drugs at lower cost

#106

Post by digi59404 »

tyre wrote: post #83
dabinat wrote: post #77

I’m currently on Spravato, which is fully emblematic of how broken the incentives in the US healthcare system are. Spravato is esketamine - a modified version of ketamine. Ketamine is made up of mirror image molecules and esketamine is the right-handed molecule. They did this because ketamine is off-patent so they needed to modify it in order to patent it, however there is evidence that esketamine is a less effective…

> It would be in the insurance companies’ interests to band together to fund the research so they can save huge amounts of money in the long term but they do not do this. Insurance companies do not want cheaper care. In the US, insurance companies must spend 80% of premiums on care. So if you pay $1k/mo, they have to pay out at least $800/mo in care. (Not to you specifically, but averaged out across all subscribers.)…

It's worse than this. Their cap is 80% of the Insurer's profit. Not the Insurer's Parent company. So often the parent company will own the Insurer as a subsidiary and own the Pharmacy, Hospital, Healthcare etc under the parent company.

This way as costs go up, it's really just bypassing the 80%. Because the hospital can charge the insurance subsidary X amount, and then the hospital profits to the parent company.

There needs to be a law in the US that health insurance organizations cannot be owned by anyone who owns a healthcare provider. Nor can the insurance company own healthcare providers.

We've allows the Ma Bell of healthcare to exist.

Re: Hospitals and universities repurposing drugs at lower cost

#107

Post by bluGill »

tehjoker wrote: post #105
bluGill wrote: post #26

Earlier quoted context omitted.

The US is not a capitalist society, it is a liberal society. Capitalism is a consequence of that but it isn't the reason.

This is completely backwards read Marx. Superstructure (culture, politics) flows from the economic base (there are some important exceptions, but that’s the dominant arrow).

Marx can say what he wants but history itself disagrees.

Re: Hospitals and universities repurposing drugs at lower cost

#108

Post by bonsai_spool »

amanaplanacanal wrote: post #88
bonsai_spool wrote: post #38

Earlier quoted context omitted.

This is clearly made by an LLM and thus not a credible resource. From: https://pmc.ncbi.nlm.nih.gov/articles/PMC9336118/ "COM claims can be difficult to gain for repurposed compounds, as the patentee must somehow differentiate their patent claims over what is in the public domain and present data that the drug is a credible candidate for the new indication [41, 42]." citing 41 https://pubmed.ncbi.nlm.nih.gov/32241561…

Do you like this source better? https://synapse.patsnap.com/blog/what-are-the-types-of-pharm... ?

It’s somebody’s random blog instead of three published, peer reviewed articles. I’m not sure what you expect to hear

Re: Hospitals and universities repurposing drugs at lower cost

#109

Post by radicalbyte »

tyre wrote: post #83
dabinat wrote: post #77

I’m currently on Spravato, which is fully emblematic of how broken the incentives in the US healthcare system are. Spravato is esketamine - a modified version of ketamine. Ketamine is made up of mirror image molecules and esketamine is the right-handed molecule. They did this because ketamine is off-patent so they needed to modify it in order to patent it, however there is evidence that esketamine is a less effective…

> It would be in the insurance companies’ interests to band together to fund the research so they can save huge amounts of money in the long term but they do not do this. Insurance companies do not want cheaper care. In the US, insurance companies must spend 80% of premiums on care. So if you pay $1k/mo, they have to pay out at least $800/mo in care. (Not to you specifically, but averaged out across all subscribers.)…

I tried to explain to people in The Netherlands this exact problem when they were thinking about switching from single-player to a commercial insurance company model.

Insurance companies always have an incentive to make healthcare services expensive. They have even more incentive to make healthcare expensive and do deals on the backside where their suppliers give them a kickback. Even better if said kickback comes via a side door.

So we went for the commercial insurance companies. It took them 4 years before they change the drug choice from decentralised (Pharmacies deal with drugs companies, received small discounts which funded a good quality of care) to centralised (Insurance deal with drug companies, receives kickbacks) and the Pharmacies funding was drastically cut leading to worse quality of care and more drugs being used. Double-whammy because in the previous system the Pharmacy did medication reviews which almost always result in a reduction in drugs (the thing with drugs is that quite a lot of them are given to reduce side effects of other drugs, the original drug gets cancelled but the side effect reducer gets forgotten and just continues ad infinitum).

Health insurance has been super inflationary since then when controlled for quality of care.

Re: Hospitals and universities repurposing drugs at lower cost

#110

Post by oezi »

dpark wrote: post #54
oezi wrote: post #4

Such studies are great but there is no regulatory pathway to extend the use of existing drugs for new indications of use without the consent of the manufacturer (or becoming a manufacturer yourself). This means such studies can give more clarity on which off-label use is beneficial but it can't be an officially allowed usage.

This is all untrue so far as I understand. A research group can file for a new drug application (or abbreviated new drug application) for an existing drug. There is no mandate that an NDA sponsor be a manufacturer or the existing manufacturer. Only the entity holding an approved NDA can file a supplemental NDA but that’s not the only path. The real reason no one files for off label use is that there’s high cost and l…

On paper you are right. You can file an NDA. But in reality you can't prove that the product on the market (the drug you are adding an NDA to) is sufficiently under your control to enable you to claim that it is safe and effective. Only a manufacturer can control the product. If you want to piggyback on top of an existing product in the market, you have to become a manufacturer or sign a contract with an existing one.

You are absolutely right about the incentives. There are absolutely none except to help humanity which is why only hospitals and universities are doing these off label studies.

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