Hospitals and universities repurposing drugs at lower cost • Hacker News Board

Re: Hospitals and universities repurposing drugs at lower cost

#181

Post by ItsMonkk » Sat, Jun 20, 2026, 3:11 PM UTC

simiones wrote: post #148

ItsMonkk wrote: post #97

Earlier quoted context omitted.

Prizes pay for working results. Grants pay for possibilities. Grants are therefore riskier, and thus we allocate less resources to them. Since the people with the money don't understand the science, these possibilities must then be assessed by bureaucrats, and this causes our best to spend half of their time writing proposals instead of working and researching. A complete waste of time. Let the people who know the mo…

> Since the people with the money don't understand the science, these possibilities must then be assessed by bureaucrats, and this causes our best to spend half of their time writing proposals instead of working and researching. A complete waste of time. What part of this changes when a company is paying for the research, and why can't that same part be used in a government office? It's not like drug company CEOs and…

Yes, businesses have the same flaw with a bit of better incentives.

With a prize based approach, what you want is for researchers to make small targetted gambles early in their career, earn their prize profits from those gambles, and work their way up into bigger gambles. There's nothing crazy about this scheme, it's how businesses have formed for hundreds of years. If a company wants to buy equity in the prizes of an independent researcher, I see no issue with this.

> then why would this model not be possible in a government office

I see no issue with governmental workers, or those from a university medial research center, or any other persons who can achieve the results from receiving this prize.

> someone needs to pay for all of the trials that don't work

The researchers. They are the one taking the risk. They are the one who would get the rewards. Skin in the game.

> With a public funding scheme, the benefit analysis could be based on public health interests.

Yes, we should directly pay the organization, or persons, based on the value they generate from their own. The bigger the public health interest, the more they should be paid. Right now we give a tiny piece to these people, and thus harm our incentives. Fully fund the results. It's risk-free.

Re: Hospitals and universities repurposing drugs at lower cost

#182

Post by benj111 » Sat, Jun 20, 2026, 4:12 PM UTC

peterbecich wrote: post #176

benj111 wrote: post #141

Earlier quoted context omitted.

How does that justify a 30 fold increase? If an individual Dr can get a batch checked while saving the patient money, it obviously isn't justified.

In my opinion this is an unfair risk to the doctor's career in assuming responsibility for the quality of the compounded drug. In the absence of any other evidence, I assume the 30-fold increase is the cost to the manufacturer of preparing the drug for eye injection "according to Hoyle."

So why isn't the batch checker taking on that responsibility?

Doctors aren't responsible for anything and everything that happens. If they've had a drug tested to check it's safe, after informing the patient, what else is there for them to do? You're creating a hypothetical to enforce the status quo. That's why we end up with this bs to start with.

Re: Hospitals and universities repurposing drugs at lower cost

#183

Post by parineum » Sun, Jun 21, 2026, 1:47 AM UTC

yndoendo wrote: post #179

parineum wrote: post #172

Earlier quoted context omitted.

> Billionaires are not created by being supporters of the common good. Yes they are. Name a billionaire who didn't make their money providing a service people voluntarily paid for.

Common good != making money! Exploitation of working class != common good! Replacing product quality indigence with poor quality and substitutions != common good! Hording money != common good. Friedman doctrine != common good. Power to harm the producer and consumer based on product and service provider != common good. Didn't know price fixing is now classified as common good. Billionaires exist by the exploitation o…

> Common good != making money!

Providing valuable goods and services for people who voluntarily exchange their money is very good for everyone.

> Exploitation of working class

Paying your employees mutually agreed upon salaries seems good though, right?

> Hording money != common good

Who's hoarding money?

> How many billionaires push against living wages vs support them for all their employees for all their businesses?

Setting government policy isn't the job of billionaires. People speak with their wallets and would rather have the prices for goods go down (something that historically and consistently happens) rather than see their own wages rise. Which is the tradeoff. You can't suddenly raise wages without seeing a commensurate price rise and then your back to square one. Most businesses run on very thin margins due to intense competition.

Re: Hospitals and universities repurposing drugs at lower cost

#184

Post by pas » Sun, Jun 21, 2026, 2:20 PM UTC

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?

we don't know.

https://lorienpsych.com/2021/11/02/ketamine/#11_How_does_ket...

the opiate receptor interaction might be important, but it seems that the antidepressant effect persists even if the opiate pathway is blocked (via naltrexone)

https://pmc.ncbi.nlm.nih.gov/articles/PMC6439824/ (though it's an open-label super small study ... n=4)

Re: Hospitals and universities repurposing drugs at lower cost

#185

Post by simiones » Mon, Jun 22, 2026, 8:47 AM UTC

bit-anarchist wrote: post #157

simiones wrote: post #147

Earlier quoted context omitted.

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…

My point is this: assume a world where free market maximalists win and patents (for drugs) get abolished, in the hope of reduced prices from increased competition. Since the reasoning is free market maximalism, this society will almost certainly not force companies to publish their drug formulas, it will allow them to keep these formulae a secret.

My contention is that in this case, the hoped for market competition would not materialize, drug prices would stay roughly the same for novel medicine normally covered by patents today. I admit that this may only be true for some drugs, not for all - some drugs may indeed be very easy to reverse engineer, and those would benefit from such a change. For example, the use of lithium to treat bipolar disorder would probably be easily reverse engineered and transformed and generic alternatives would quickly appear.

What I was pointing out with the generics part is that the formula publication requirement of patents is in practice having a significant positive impact today - all drugs that are off patent are being successfully synthesized and sold much more cheaply by generics drug manufacturers. This only happens for drugs that are far too old, so I'm not a fan of this system, but I think there is a real risk that even this small thing will get lost if we replaced patents with trade secrets.

Re: Hospitals and universities repurposing drugs at lower cost

#186

Post by simiones » Mon, Jun 22, 2026, 9:20 AM UTC

ItsMonkk wrote: post #181

simiones wrote: post #148

Earlier quoted context omitted.

> Since the people with the money don't understand the science, these possibilities must then be assessed by bureaucrats, and this causes our best to spend half of their time writing proposals instead of working and researching. A complete waste of time. What part of this changes when a company is paying for the research, and why can't that same part be used in a government office? It's not like drug company CEOs and…

Yes, businesses have the same flaw with a bit of better incentives. With a prize based approach, what you want is for researchers to make small targetted gambles early in their career, earn their prize profits from those gambles, and work their way up into bigger gambles. There's nothing crazy about this scheme, it's how businesses have formed for hundreds of years. If a company wants to buy equity in the prizes of a…

I'm still not getting how the funding of trials that don't succeed is supposed to happen. Individual researchers don't have the money to fund a serious drug trial on their own. So even if someone put a prize of 100 trillion dollars for curing pancreatic cancer, and you had an idea for a drug that you think can easily do that, but you'd need 10M dollars to actually synthesize and trial it, how do you go from here to there? Sure, you could sell equity in your prize, but how do you convince people to buy it?

Whatever you do, you can't get around the fact that the people with medical knowledge need to convince the people who have the money to invest in them before any research can take place. There is simply no way to get rid of the pitching to bureaucrats step here, not even in the most idealized societies - research just needs too many resources for any one individual to control.

Re: Hospitals and universities repurposing drugs at lower cost

#187

Post by yndoendo » Mon, Jun 22, 2026, 7:05 PM UTC

parineum wrote: post #183

yndoendo wrote: post #179

Earlier quoted context omitted.

Common good != making money! Exploitation of working class != common good! Replacing product quality indigence with poor quality and substitutions != common good! Hording money != common good. Friedman doctrine != common good. Power to harm the producer and consumer based on product and service provider != common good. Didn't know price fixing is now classified as common good. Billionaires exist by the exploitation o…

> Common good != making money! Providing valuable goods and services for people who voluntarily exchange their money is very good for everyone. > Exploitation of working class Paying your employees mutually agreed upon salaries seems good though, right? > Hording money != common good Who's hoarding money? > How many billionaires push against living wages vs support them for all their employees for all their businesse…

This is false assumption that billionaires are useful. You don't need billionaires for companies to provide common good. Billionaires are more likely to buy up existing companies to maximize their profits than create anything new.

Unions prove you need collective bargaining to prevent exploitation.

Billionaires are hoarding money, how else do they get that amount of wealth?

Billionaires exploit their monetary power to create and manipulate both the populous and government policy makers. Even when it goes against the common good.

Simple questions, how many of the products and services have you spent money on that are associated with billionaires? There is no way to answer that question when they use trust to hide their involvement. Saying a person has the ability to speak with their wallet is 100%. Corporate collect retirement funds also highlights this.

Re: Hospitals and universities repurposing drugs at lower cost

#188

Post by bit-anarchist » Tue, Jun 23, 2026, 5:38 PM UTC

simiones wrote: post #185

bit-anarchist wrote: post #157

Earlier quoted context omitted.

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…

My point is this: assume a world where free market maximalists win and patents (for drugs) get abolished, in the hope of reduced prices from increased competition. Since the reasoning is free market maximalism, this society will almost certainly not force companies to publish their drug formulas, it will allow them to keep these formulae a secret. My contention is that in this case, the hoped for market competition w…

I tried to show that that Coca Cola is an "exception" that proves the rule. With medications, people are really after the formula. If there's something preventing access to the source materials, like in Coca Cola, going after that particular formula isn't good either, as you won't be able to do much with it even after finding it out.

My contention with your position on patents is that, although they make companies publish the recipe, while in effect, they not only keep the formulas secret in practice, but also create a monopoly, preventing reverse engineering altogether. If you cut the duration of patents, the incentives of releasing as patents goes down as well, increasing the push for trade secrets. In the end, I posit that cutting the duration of patents will have similar practical effects to removing patents altogether.

Finally, I think your contention is exaggerated. Unless the drug is very niche, there's going to be a significant demand for them. This demand creates an incentive for better reverse engineering efforts. Patents make them illegal, almost nullifying this.

Re: Hospitals and universities repurposing drugs at lower cost

#189

Post by ItsMonkk » Sat, Jun 27, 2026, 8:32 PM UTC

simiones wrote: post #186

ItsMonkk wrote: post #181

Earlier quoted context omitted.

Yes, businesses have the same flaw with a bit of better incentives. With a prize based approach, what you want is for researchers to make small targetted gambles early in their career, earn their prize profits from those gambles, and work their way up into bigger gambles. There's nothing crazy about this scheme, it's how businesses have formed for hundreds of years. If a company wants to buy equity in the prizes of a…

I'm still not getting how the funding of trials that don't succeed is supposed to happen. Individual researchers don't have the money to fund a serious drug trial on their own. So even if someone put a prize of 100 trillion dollars for curing pancreatic cancer, and you had an idea for a drug that you think can easily do that, but you'd need 10M dollars to actually synthesize and trial it, how do you go from here to t…

You're not trying to get individuals to complete work that requires thousands of participants. You're trying to get it so that those one level below currently working on such projects can make it pencil out.

You're trying to give individual researchers, who believe they have a chance at a new strategy, to take their new strategy and sell equity to the prize they might win to a new firm.