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

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

#131

Post by FireBeyond » Thu, Apr 11, 2013, 3:18 PM UTC

adventured wrote: post #37

adaml_623 wrote: post #26

Earlier quoted context omitted.

You say that US healthcare leads the way in innovation but in certain key measures like Infant Mortality and Life Expectancy it's not leading the field at all.

The US is within a small margin of error to being on par with both Japan (adjusting for their huge fraud in longevity) and South Korea on life expectancy. That sure sounds amazing considering our obesity / diet problems. I'd argue in fact that our advanced healthcare system and large investment is the only reason Americans aren't dying at 70 instead - we're able to keep people alive that would otherwise die much youn…

And for the average American, between 10 and 20 per cent of your lifetime healthcare costs accrue in the last 1-3 months of your life. Beyond healthcare, America has a problem with dying and death, and a willingness to spend vast amounts of money on someone who is at death's door, often in a manner that negatively affects the quality of the remainder of their life, and for what - other people? Sometimes even for no-one.

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

#132

Post by FireBeyond » Thu, Apr 11, 2013, 3:20 PM UTC

electromagnetic wrote: post #66

coldtea wrote: post #31

Earlier quoted context omitted.

> What if the European countries had to had to pay for their own defense? The European countries pay big bucks for their own defense, thank you very much. And the US doesn't provide any defense at all. It merely uses its pressure to get the European countries to participate in its inane crusades and wars, from Korea to Iraq, which are for it's own interests. Plus, defense against what? The only thing that brings any…

I think when the UK paid 1/20th of the cost to R&D Trident 2, but got 1/5 of the orders, I'd say yeah that was pretty heavily subsidized by the US to have an ally country with stealth-nuclear capabilities. I also think you have absolutely no clue who international politics works by your blatant naivety. There's a lot more at stake than "access to oil". FYI Iraq showed oil reserves far superior to that of Saudi Arabia…

"I think when the UK paid 1/20th of the cost to R&D Trident 2, but got 1/5 of the orders, I'd say yeah that was pretty heavily subsidized by the US to have an ally country with stealth-nuclear capabilities."

That's a little one-sided. You forgot to mention that the US got the ability to build military bases on UK soil for no rent / charge.

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

#133

Post by betterunix » Thu, Apr 11, 2013, 3:21 PM UTC

spartango wrote: post #122

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…

It sounds like the US might be better served if those research costs were funded by the government. If only we had an agency that gave researchers the money they needed for this sort of thing, some kind of national institutes of health that would be a medical counterpart to the NSF and DARPA...

The problem with market-based approaches to medical research and medicine distribution is that they force people to make economic decisions about their healthcare. Nobody, regardless of their income level, should have to sit down and ask themselves, "Do I want to treat my cancer now, or do I want to buy food for my children?" The same arguments for a universal healthcare system apply to federal funding for medical research. Yes, medical research is expensive; no, we do not want to fund it with a system that denies medicine to people who need it.

I do not want to be overly critical of your startup. Nobody says, "Man, there are too many ways to treat cancer!" On the other hand, your startup does need to bring in enough money to cover its costs, which means you cannot just give your drug to anyone who needs it -- you need to charge them for it. That is why the funding model needs to be overturned, so that the cost of developing the drug is not an issue in getting the drug to people who need it.

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

#134

Post by refurb » Thu, Apr 11, 2013, 3:21 PM UTC

snarfy wrote: post #75

Please tell me how charging $50,000/yr for 30 year old dimethyl fumarate (BG-12/tecfidera) for the treatment of multiple sclerosis is due to innovation. It shouldn't cost more than aspirin. The only reason they are charging that much is because that's how much all other MS medications cost. Oligopoly, it's like a monopoly, only legal.

Because someone has to pay for the phase 3 clinical trials to actually prove that it's safe and that it works? That doesn't come cheap.

If Biogen charged only the price of aspirin, they would never recoup their R&D costs, let alone make a profit.

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

#135

Post by refurb » Thu, Apr 11, 2013, 3:23 PM UTC

spartango wrote: post #122

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…

Is your biotech startup in the Bay area? Would love to chat. Email in profile.

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

#136

Post by danielweber » Thu, Apr 11, 2013, 3:24 PM UTC

npsimons wrote: post #115

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.

Haven't seen Goldacre's stuff, but I had heard (can't find a source right now) that it's actually closer to 80-85% of pharma companies costs are advertising and marketing. Can't think of a better place to cut costs, really.

They spend money on marketing because it makes them money.

Say you spend $1 billion to develop a drug. That $1 billion number is a sunk cost; it is irrelevant to figuring out how much to spend on advertising and marketing.

Limiting marketing to less than that $1 billion that was spend on research makes no sense.

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

#137

Post by calibraxis » Thu, Apr 11, 2013, 3:26 PM UTC

melling wrote: post #126

calibraxis wrote: post #69

Earlier quoted context omitted.

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.

I try to spend the time to support my claims with evidence, as such arguments are more intellectually convincing. Once you depart from views frequently repeated in the media, you no longer have the luxury of soundbites, so providing evidence is best.

It takes more effort (particularly since you don't want to cite bad evidence), but is necessary.

And the issue is, people who want truth gotta dig. Otherwise they'll be doomed to live the rest of their lives believing lies written by some PR flack. (I've known some PR flacks. They eloquently phrase what their bosses want communicated. And even being careful, I'm sure I believe many serious lies and falsehoods, at least to some extent.)

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

#138

Post by betterunix » Thu, Apr 11, 2013, 3:27 PM UTC

amalag wrote: post #104

DennisP wrote: post #93

Earlier quoted context omitted.

So the problem is that healthcare innovation is a public good, which like all public goods is underprovisioned if you don't take steps. We approached this one by converting it to a private good within the U.S. But that's not the only solution. A natural entity to pay for drug development is health insurance companies, who would save a lot of money if drugs were patent-free. But they don't in fact fund patent-free dru…

Having the government fund patent-free drug development is a very interesting approach. Is the idea to do through proposals like Darpa?

I would support such a system. In my ideal world, things look like this:

NIH pays for the research and development of new drugs, and we do not give out patents for any of it. Pharmaceutical companies are free to produce whatever drugs they want, and cannot prevent anyone else from producing those drugs; they must only meet the quality control standards set by the FDA. All drugs would be sold like today's "generics," in a competitive market that keeps prices down.

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

#139

Post by refurb » Thu, Apr 11, 2013, 3:29 PM UTC

rdl wrote: post #20

objclxt wrote: post #10

Earlier quoted context omitted.

> In the US, you have no monopoly on the healthcare side, but the drug companies have a monopoly on the drugs they produce. In a way there is a monopoly on the healthcare side in the US, but it only impacts a certain segment of the population. Medicare is able to negotiate significant discounts on the cost of healthcare compared to private insurers precisely because for so many people it is the de facto provider. The…

Medicare/Medicaid are specifically not allowed to bargain on drug prices, though. They are a monopsony for hospital/doctor services, with full pricing power, for the old and poor, but pay market prices for drugs by law.

More accurately, Medicare is not allowed to negotiate for drug prices, however, the don't pay more than the average selling price for a drug (ASP).

Medicaid is certainly allowed to negotiate over drug prices. Medicaid gets an automatic 23% off the drug price and if the states can get an even bigger discount, they often get to keep it.

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

#140

Post by Retric » Thu, Apr 11, 2013, 3:30 PM UTC

refurb wrote: post #127

jellicle wrote: post #98

Earlier quoted context omitted.

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.

It costs tens of millions of dollars in large part because US healthcare is so expensive. The actual handing out of drugs is fairly low effort, it's everything else that makes trials so expensive.