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Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India

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Re: Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India

#121

Post by LekkoscPiwa »

nhashem wrote: post #4

This is basically the paradox of US healthcare innovation. Canada can tell its pharmaceutical companies, "yeah, that cool drug you just invented, we're not gonna pay you what you want for that." And what option does the pharmaceutical company have? Convince healthcare providers to charge retail prices to their patients as an out-of-pocket expense, or... reduce prices accordingly. Because healthcare payments are not f…

No, No, No. It is exactly opposite. It is the rest of the world subsidizing the US. The dollar is the world currency. It means that if any other country in the world wants to buy energy (i.e. oil or natural gas), or to trade internationally, it can do that only and only in the US dollars. About 90% of all dollars in circulation, circulate outside of the US borders. Think about it for a second. Your "genius" central banker Ben Bernanke may print and print and print and who gets hit by inflation? China does. Europe does. Japan does. You get just 10% of it and 100% of its benefit. So, yeah, with the whole world subsidizing you any, each and every time that a barrel of oil is bought, or m3 of gas is bought, or international trading deal done -- you can waste as much as you want, bragging how great you are, sure. But I tell you this: given unlimited and unrestricted credit any nation could innovate and create google's, healthcare and military equipment it wanted. It is just function of free credit. Someone else pays your bills. Clowns like Trump can go bankrupt every second year (as he does!) and still get even more borrowed money from a bank overflowing with it from the FED that gets it with only 10% downside, exporting 90% of the cost.

There are no miracles in this world and US is not an exception. Wait and see world turning back on the dollar, and we'll have a level playing field. Then we'll see how much the USA is really worth. Without subsidies.

Re: Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India

#122

Post by spartango »

nhashem wrote: post #4

This is basically the paradox of US healthcare innovation. Canada can tell its pharmaceutical companies, "yeah, that cool drug you just invented, we're not gonna pay you what you want for that." And what option does the pharmaceutical company have? Convince healthcare providers to charge retail prices to their patients as an out-of-pocket expense, or... reduce prices accordingly. Because healthcare payments are not f…

> ...it's likely to be tough to control costs and yet maintain R&D and innovation

I'm running a biotech/healthcare startup, and this point is rather interesting for me.

Most of these arguments against "crazy high" drug pricing in the US work to vilify the large pharma and biotech companies. I don't seek to defend them, but perhaps we can look at some of these conundrums through a startup's lens:

Getting my product to market is incredibly challenging. There's a good amount of novel technology development and research around it, and we're not even developing a therapeutic. We're working in a scientifically challenging space (cancer pathology), so things aren't easy.

Even if we can build what we are trying to, that's not the sum total of our costs. We have to invest a huge amount of energy into validating that what we've built is scientifically accurate, and then medically appropriate. This isn't for regulatory approval, this is simply to convince our customers (and basic ethics/QA, I suppose).

The standards to which our product will be held are quite high because we influence peoples' lives. That's the curse and the blessing of healthcare.

Given all the work we're putting into this and the nontrivial cost of the project, we'll need to generate significant revenue to make it work out. It doesn't come cheaply, but in the US we think there's room in budgets for us. We don't seek to price exorbitantly, but there's a fine line between that and barely surviving.

Re: Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India

#124

Post by snambi »

Nice post. In USA employers pay the medical bills through insurance companies. In india either government pays the bill or the patient. So, they cannot afford $70,000 bill. So the government takes the decision that is beneficial to itself and patients. In US the pharma companies and insurance companies decide what is the price.

Re: Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India

#125

Post by spartango »

inDigiNeous wrote: post #24
mansigandhi wrote: post #17

Earlier quoted context omitted.

Huh? Do you have an idea of how science and medicine works?

Just wondering what this has to do with Hacker News. But anyway, check out: http://www.cancer-research-awareness.com/why-chemotherapy-ne... http://www.smashcancer.com/2010/08/22/cancer-lies-and-the-me... http://current.com/green/89138817_cancer-is-not-a-disease-ch... Just a few writings and articles speaking about the lie that is chemotherapy. I have an idea how medicine works, let me spell it out here for you: 1. Po…

I'm sorry. None of this is legitimate, validated science of any kind. Not even close to that. This falls into the domain of homeopathy, conspiracy theories, and old-wives tales.

Science doesn't work by conspiracy theories, nor without data, nor by opinions. The data points to this "idea" being absolutely wrong.

Unlike politics or art, opinions don't count.

Please, let's engage with the real science that has been done, studying the mechanisms by which cell growth control goes awry and chemotherapy targets proliferative growth. Yes, let's talk about how chemotherapy is poorly targeted, and ways we can improve it to really only kill cancer cells.

But let's stay away from pseudoscience. We can do better.

Re: Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India

#126

Post by melling »

calibraxis wrote: post #69
melling wrote: post #27

Earlier quoted context omitted.

Please provide some data to back that up because it is a common belief that the high cost of producing a new drug is offset by the US consumer.

Consider googling it, just as you'd investigate how to fix a bug in software you use. "Common beliefs" should be viewed with suspicion. ( http://www.citizen.org/publications/publicationredirect.cfm?... ) Just as with the development of computers and the internet, we can thank the US taxpayer and government for subsidizing pharmaceutical innovations. Which is then sold back to us at hilarious rates. Pharmas reap wonde…

Consider that when you are making a statement to tens of thousands of people that it would be best to provide supporting evidence so that exercise of "googling" doesn't have to repeated by everyone.

Re: Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India

#127

Post by refurb »

jellicle wrote: post #98
nhashem wrote: post #4

This is basically the paradox of US healthcare innovation. Canada can tell its pharmaceutical companies, "yeah, that cool drug you just invented, we're not gonna pay you what you want for that." And what option does the pharmaceutical company have? Convince healthcare providers to charge retail prices to their patients as an out-of-pocket expense, or... reduce prices accordingly. Because healthcare payments are not f…

Has nothing to do with "innovation", since nearly all healthcare research is paid for by the U.S. government anyway, and it's much less money than you think. The claimed expenses for "research" are mostly about bringing slight variations of drugs to market in order to extend patent protections - that is, they are rent-seeking. > "More than four fifths of all funds for basic research to discover new drugs and vaccines…

The key to your comment is "basic" research.

You can discover a new drug for a few tens of millions of dollars. Now to get that drug to market? You need to cough up a few hundred million dollars.

Discovering a drug doesn't save any patients, getting it to market does and THAT is paid for by private companies.

Re: Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India

#128

Post by FireBeyond »

takluyver wrote: post #77
venomsnake wrote: post #7

Earlier quoted context omitted.

According to Ben Goldcare (Bad Science, Bad Pharma) the companies spend around 12% of their budgets on R&D and 30% on marketing ... so the R&D is the easy part to be funded - just outlaw the direct marketing to consumers and doctors and the companies can spend 3 times as much on R&D with no problems.

Having heard Ben Goldacre speak, the problem isn't just direct-to-consumer marketing, which is already illegal in the UK for prescription drugs. Drug companies actually spend a lot of effort marketing to doctors, who think that they're smart enough to resist sales pitches. There's apparently evidence that they're not - doctors who see drug company reps prescribe those companies' drugs more often and have worse outcom…

"direct-to-consumer marketing, which is already illegal in the UK for prescription drugs".

No (well, yes), it's illegal in -every single country- in the world except for the US.

Only in America does your friendly pharmaceutical giant spend more money and energy on telling you what's wrong with you via non-individualized, vague 30 second spots - "Do you not get excited about anything? Cymbalta may help!" - than your healthcare providers.

As a healthcare professional -in the US-, this disturbs me hugely.

Re: Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India

#129

Post by kingkawn »

belorn wrote: post #113
criley wrote: post #94

Earlier quoted context omitted.

I'd be interested as well, because if he's trying to label all NIH-bound funds as imperative to this process, I think he's overstating his case. Yes, academic institutions do a lot of low level work that pharma companies build on top of, but you'd be surprised how often potential new molecular entities (truly new drugs) do not originate from government sponsored academic sources. (However, the tools, understanding an…

One can read the data in different ways, and I don't think anyone doubt that pharma companies do contribute to the investments into new medical innovations. One interpretation that I listen/read about is that NiH and pharma operate on different levels, and thus sadly, NiH's contribution tend to be forgotten because they aren't the people with that pop out the pills bought in the store, even if the pills would not hav…

"I don't think anyone doubt that pharma companies do contribute to the investments into new medical innovations."

Every aspect of this system has to be questioned relentlessly, because each of them requires huge investments of social and financial capital. I am happy to doubt the value of the private drug companies' contributions. Many of their discoveries are reformulations of older drugs meant to allow a repatenting and re-marketing of old ideas. Many of the new supposedly breakthrough drugs do not provide significant improvements in mortality, but do cost huge amounts of money so that they can recoup their investment.

There are of course important developments that come from everywhere, but the question is about signal to noise. If, as these statistics imply, you can show that the drugs and other changes in medical care that provide positive changes to quality of life and mortality are coming from government research significantly more so than other sources then why subsidize private research, why protect the private drug development system that results in outrageously priced drugs, why waste 2/3rds of research money to produce such a disproportionately small portion of the advancements in medical knowledge?

Again, I would like to see sources for the numbers, but regardless, there should be no assumptions made about the value of private or public investment because that's the way it has been.

Re: Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India

#130

Post by refurb »

nicktelford wrote: post #9
nhashem wrote: post #4

This is basically the paradox of US healthcare innovation. Canada can tell its pharmaceutical companies, "yeah, that cool drug you just invented, we're not gonna pay you what you want for that." And what option does the pharmaceutical company have? Convince healthcare providers to charge retail prices to their patients as an out-of-pocket expense, or... reduce prices accordingly. Because healthcare payments are not f…

You're forgetting an important factor. Competition. Pharmaceutical companies operate in an environment with very little competition. Obviously, the purpose of patents are to grant a limited monopoly in return for the innovation, but when that innovation is the only viable treatment for something, the manufacturer can just name a price and everyone has to live with it. The problem is that the US healthcare system isn'…

There isn't any competition? Ask Vertex about that! They just launched a new HCV drug that was expected to bring in several billion dollars per year of revenue at its peak. Now? It probably won't pass the $500M mark because other companies are bringing in competing therapies.
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