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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

#151

Post by bonsai_spool »

amanaplanacanal wrote: post #121
bonsai_spool wrote: post #108

Earlier quoted context omitted.

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

It's a matter of law, not science. Ask a patent attorney. If you like, here is a paper from the Vanderbilt law review: https://scholarship.law.vanderbilt.edu/cgi/viewcontent.cgi?a...

Did you actually read that article that spends many pages explaining how there is no good way for a firm to patent a repurposed drug that is working the same way as it worked in a prior indication, but is being used for a new indication where it has the same function - exactly what you’re asserting and what I said is not possible?

Thanks for the article, it is a good one.

Re: Hospitals and universities repurposing drugs at lower cost

#152

Post by owenmarshall »

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…

While I actually sympathize with your position, I think your argument has a significant flaw: the "unregulated pharmaceutical industry" you reference is actually quite regulated.

My company can put a GRAS compound like turmeric in a pill and sell it over the counter, but the moment I stop calling it a spice and make a treatment claim about it I face enforcement action. And I certainly can't put in an active ingredient that might actually /do something/ - like those gas station "sex enhancer" pills that, surprise, have sildenafil - because then I'm distributing an unapproved/mislabeled drug.

Re: Hospitals and universities repurposing drugs at lower cost

#153

Post by sowbug »

uberex wrote: post #17
intrasight wrote: post #14

Earlier quoted context omitted.

There tens of millions of people being treated off-label.

Can confirm. LDN user here.

I checked this thread for an expansion of that initialism, which I didn't recognize. It likely stands for "low-dose naltrexone." https://ldnresearchtrust.org/what-is-low-dose-naltrexone-ldn

"a prescription medication used primarily to treat alcohol use disorder and opioid use disorder" (in addition to the off-label uses discussed here)

Re: Hospitals and universities repurposing drugs at lower cost

#154

Post by kevinoid »

VladVladikoff wrote: post #125
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…

What’s so interesting about this that I just learned after googling about Spravato that ketamine is a treatment for serious depression. Why? That’s fascinating! Is it the dissociative effects?

A significant effect is through opioid receptor activation, as demonstrated by Williams et al. https://doi.org/10.1038/s41380-019-0503-4> by blocking the receptor with naltrexone, which attenuated the antisuicidality effects.

The Huberman Lab episode Ketamine: Benefits and Risks for Depression, PTSD & Neuroplasticity https://www.hubermanlab.com/episode/ketamine-benefits-and-ri...> and the referenced journal articles (including the above) have a lot of detail on it.

Re: Hospitals and universities repurposing drugs at lower cost

#155

Post by heathrow83829 »

universal health care can be offered even in 3rd world countries but they're really smart about keeping costs low. they drastically cut the costs of medical service by just offering one or two generic drugs bbought in bulk from china and india rather than all those custom expensive drugs that do the same thing. it does the same thing but at a much lower cost

Re: Hospitals and universities repurposing drugs at lower cost

#156

Post by Terr_ »

themafia wrote: post #129
tyre wrote: post #83

Earlier quoted context omitted.

> 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.)…

We baked the snake charmer problem into the law? Good lord.

> snake charmer problem

Perhaps you mean the "cobra effect" [0]? I think that's an apocryphal story about killing snakes, rather than using them in a performance.

[0] https://en.wikipedia.org/wiki/Perverse_incentive#Historicity...

Re: Hospitals and universities repurposing drugs at lower cost

#157

Post by bit-anarchist »

simiones wrote: post #147
bit-anarchist wrote: post #94

Earlier quoted context omitted.

I'm not convinced about trade secrets being the capitalistic route here, specially since, as pointed out somewhere else, the current system is basically like trade-secrets already, which suggest inverted causality. In a pure free market, someone could try to keep the formulas secret, but others can just reverse engineer it into being public, which is basically guaranteed to happen if there's sufficient demand. Given…

The recipe for Coca Cola, the most popular soft drink in the world by far, has been a trade secret for over 100 years. And I'd wager a guess that it's slightly simpler to make then most medicines. So I don't see any reason whatsoever to assume that drugs would be easily reverse engineered. Instead, I'd say that the assertion that today's drug making is hard to reverse engineer is hard even knowing the exact formula,…

I don't think Coca Cola is a good counterpoint due to a couple of reasons:

1) there was a recent attempt to find the formula [1], but the primary reason that was infeasible is that, allegedly by the ingredient list, they use coca extract and, IIRC, only one company provides that in the US, due to FDA regulations. Even if they were find the formula behind, it wouldn't help much, so they're are trying to replicate the flavor instead.

2) Coca Cola is, before anything, a brand. It's not comparable to generic medications because people in general don't buy it for the formula specifically, but the expectation of flavor and taste associated with the brand. Even if you were to find the current formula, the Coca Cola Company can just change it.

In regards to the last point, there probably is one (likely in heavily subsidized prices case), but, regardless, I don't see how your point shows patents are the reason anymore than a increase in competition, which we are proposing would happen if patents were abolished.

[1] https://www.youtube.com/watch?v=TDkH3EbWTYc

Re: Hospitals and universities repurposing drugs at lower cost

#158

Post by [deleted] »

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.)…

[deleted]

Re: Hospitals and universities repurposing drugs at lower cost

#159

Post by bonsai_spool »

doctorpangloss wrote: post #98
lesuorac wrote: post #92

Earlier quoted context omitted.

> So, no, paradoxically, it is not in the interest of people paying for the treatment to save money. Quite the opposite. I'll assume they're on company insurance. Which is often "self-insured" in that the company actually foots the bill as opposed to the insurance company. Why don't corporations just drop insurance companies that decide to not allow cheaper medicines?

UNH is so big because its customer Apple has its own pool. Apple deducts $24k/y for your healthcare. Healthy 29 year old male doesn't use anything. UNH denies the claims anyway. It gives that money back to Apple, which doesn't give it to you. The 80% rule has a lot of loopholes. It doesn't apply to employer funded plans. There's a reason UNH is so big!

Employer funded plans are not all the same. Large entities with a lot of money (like universities, big firms) self-insure. Thus the insurance company in those cases is simply managing all the administrative sides of insurance while the plan owner is the actual insurer of risk.

There’s an article about how a Wall St employee’s expensive care came up in C-suite meetings, as a real world consequence of this

Re: Hospitals and universities repurposing drugs at lower cost

#160

Post by photochemsyn »

parineum wrote: post #90
photochemsyn wrote: post #80

Earlier quoted context omitted.

Notice I was sure to include ‘revival of corporate R & D divisions’ in the argument? Bell Labs is the archetype - if corporations can do a better job of applied R & D, let them. If corporations are upset about publicly funded research generating open-source discoveries that upset the monopolistic apple cart, that’s not an argument about improving efficiency - that’s an argument about maximizing profits and investor r…

> The real question is, what is the metric of ‘success’ - improved public health for the entire population at low cost, or bloated returns for pharmaceutical investors? This is a false dichotomy and this kind of zero sum thinking is exactly the root of so much misunderstanding of economics that's all the rage these days (and probably forever). Wealth is created by innovation, not transfered. "Rent seeking" is wealth…

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