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

theatlantic.com

161–170 of 176 posts

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

#161
post #62

Earlier quoted context omitted.

I'm not sure why it's useless. If you're going to account for value provided by external sources then account for all sources, not just the ones that support your argument.

For what are you accounting? Most mathematics has been known about for 100+ years... IMO, This comment was a reason for you to hear yourself "talk" or alternatively for you to take a (weak) shot at the U.S.

Lets see, mathematics[1], language[2], writing[3], the printing press[4], scientific method[5]. Each of these innovations are absolutely required for the innovation that pharma companies produce, and none originated in the US.

Your 100 year cut-off point is entirely arbitrary and chosen only because it supports your arguments.

[1] http://en.wikipedia.org/wiki/History_of_mathematics

[2] http://en.wikipedia.org/wiki/Origin_of_language

[3] http://en.wikipedia.org/wiki/History_of_writing

[4] http://en.wikipedia.org/wiki/Printing_press

[5] http://en.wikipedia.org/wiki/History_of_scientific_method

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

#162
post #147

Earlier quoted context omitted.

"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 repatentin…

> Many of their discoveries are reformulations of older drugs meant to allow a repatenting and re-marketing of old ideas. I think you're confusing evergreening, which is a real problem, with the number of NME's that are being generated. NME's are "new molecular entities", or totally new formulations. > Many of the new supposedly breakthrough drugs do not provide significant improvements in mortality, but do cost huge…

1/3 is the number, and while they do spend some on clinical trials, the vast majority goes to applied and basic research (their wording). That means 2/3 of the total R&D of medical innovation (US) need to go somewhere which is the drug development you are talking about.

Some people have argued that maybe those 2/3 should be tax money too. Its a bit weird situation where the state already pays for 1/3 of the R&D, and then on top of that give state enforced monopoly in 20 years periods for those who invest in the other 2/3 (additional monopoly period is also granted by the FDA after an successful drug trial). State enforced monopoly is often describe as tax raised outside congress control, and has its history and name (letters patent = royal decree) from that purpose.

One question we should ask is what the industry brings to the table if we took away all state funded involvement. Is it more efficient to bring competition through patent grants rather than direct research and development grants? Do we get larger and more spread out pool of investment that could not happen without a few blockbuster drugs to get gambling money? We should ask for data which prove that the current method (1/3 of the funding and granted state monopolies) is the best use of tax money. Maybe at least demand some kind of high standard when a company take research supported by the 1/3, and claim a new invention based on already known and disclosed techniques. The India model is to demand an increased efficiency, beyond showing that the modification of the old drug is novel.

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

#163
post #96

Earlier quoted context omitted.

> 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. "Subsidized to have an ally country" is completely different to "subsidized" (as in, "we did them a favor"). Plus, did they get those 1/5 of the orders for free? If not, I can't see how the fact that they paid 1/…

Thanks for the point by point there, but you basically just confirmed my initial opinion that you really have no clue beyond your own media-infused bias of the situation. I don't think we have to introduce your head to your ass, because I think they're well acquainted with each other. Boo hoo, US evil, blah blah.

>Thanks for the point by point there, but you basically just confirmed my initial opinion that you really have no clue beyond your own media-infused bias of the situation.

Ironic, coming from a citizen of the same country where 80% of the people believe in "miracles" ( http://www.npr.org/templates/story/story.php?storyId=1240075... ) and a large percentage cannot point their country on a map, much less a foreign country. Heck, it's the country the Presidents and political candidates are even know to do grave mistakes on international affairs, even confusing whole countries with others on camera.

>Boo hoo, US evil, blah blah.

I don't believe in "evil". I'm rational. US is just ruthlessly pursuing it's interests, and fuck everybody else (literally). Including fuck them with illegal and unethical means (from invading a sovereign country to drone murders). You can afford it when you are top dog. It's not like European colonial powers on their day behaved any better.

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

#164

Earlier quoted context omitted.

That's a complete non-answer, which is usually done by a person with the same issue you're accusing the parent of. Trident is a sore point for the UK for several reasons:- > It's not an independent nuclear deterrent, we're on a US leash even if we try to sell it otherwise. > They're based in Scotland, a country within the UK which has fairly low support for nuclear weapons, which the primary elected party are dead ag…

The prospect of getting rid of Trident is the #1 reason why I'm going to vote for independence next year.

Having politics done at the local level by people who live in and are invested in Scotland is the #1 reason I'm going to vote for independence.

Not being a viable target for nukes is just the icing on the cake.

It's a shame all polls suggest we're rather content being ignored by the status quo though.

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

#165

Earlier quoted context omitted.

Thanks for the point by point there, but you basically just confirmed my initial opinion that you really have no clue beyond your own media-infused bias of the situation. I don't think we have to introduce your head to your ass, because I think they're well acquainted with each other. Boo hoo, US evil, blah blah.

> Thanks for the point by point there, but you basically just confirmed my initial opinion that you really have no clue beyond your own media-infused bias of the situation. Ironic, coming from a citizen of the same country where 80% of the people believe in "miracles" ( http://www.npr.org/templates/story/story.php?storyId=1240075... ) and a large percentage cannot point their country on a map, much less a foreign cou…

No the irony here is you again completely proving my point by you assuming I'm American just by my "defending" them. I'm British, and I live in Canada. But again, your head has already met your own ass very intimately.

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

#166

Earlier quoted context omitted.

Especially if you are so large that you sell shares in company, then you have a LEGAL obligation to the shareholders to always take decisions that maximise profit over everything else I wish people would quit saying that. IANAL, but I never have found anything that definitively says that. It would seem that in the case of company sale or takeover, yes, the board has to "maximize shareholder value". But in day-to-day…

Simply put: if the board doesn't maximize the interests of the shareholders, the board will be replaced by a board who does. Because of this control mechanism a public company will always take care of the shareholders first before anything else.

It's not a given that the interestes of the shareholders are to "maximise profit over everything else".

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

#167

Earlier quoted context omitted.

The prospect of getting rid of Trident is the #1 reason why I'm going to vote for independence next year.

Having politics done at the local level by people who live in and are invested in Scotland is the #1 reason I'm going to vote for independence. Not being a viable target for nukes is just the icing on the cake. It's a shame all polls suggest we're rather content being ignored by the status quo though.

I'm actually less concerned about Scotland being targeted than having any support for weapons that I regard as fundamentally immoral.

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

#168
post #147

Earlier quoted context omitted.

"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 repatentin…

> Many of their discoveries are reformulations of older drugs meant to allow a repatenting and re-marketing of old ideas. I think you're confusing evergreening, which is a real problem, with the number of NME's that are being generated. NME's are "new molecular entities", or totally new formulations. > Many of the new supposedly breakthrough drugs do not provide significant improvements in mortality, but do cost huge…

And who said there was no need for caps lock?

We could get into a back and forth of yelling, but you are also it seems 100% wrong. Government funding underlies the vast majority of advances in basic science understanding, what you referred to as lower-level theory, that then is utilized by drug companies to direct their new drug development. A good example is the relatively recent isolation of the Angiotensin II receptor, which in turn is leading to drug development. The basic science and years of research underpinning that discovery is not a byproduct of private investment. Lower-level theory is not lower at all, and is of no less value or less important to the person who is at the receiving end of this entire system; the patient.

The FDA doesn't allow new molecules out very often because most of them are useless, harmful, or redundant. I think that their standards for redundancy should be tightened. Low hanging fruit have not all been taken, its just that pharma doesn't invest enough in basic research because they're trying to pick all the low-hanging fruit from other people's work.

Going back to my original reply; I objected to the unquestioned acceptance of the value of private research. I would also object to the unquestioned acceptance of government research as being inherently valuable. While I think it is fairly clear that I believe that the government funded research gives far more value per dollar for society as a whole, it doesn't mean that I will blindly accept either form as the right one. I asked for references to backup stats that reinforce what I believe, rather than just run with it as a bludgeon against your argument.

game recognize game, son.

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

#169

Earlier quoted context omitted.

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.

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

Perhaps; even if true, the fact is that drug companies claim they need patents (and other protections, both explicit and implied) to be able to recoup their R&D costs. If their R&D costs are swamped by their advertising costs, perhaps the problem isn't the cost of R&D, but mismanagement? I mean, honestly, it's not like they are producing luxury items. These companies are supposedly making a product that sells itself because their customers will die without it. To add to all that, arguments can (and have) been made that pharmaceutical advertising is a negative input to society by unduly influencing prescribers.

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

#170

Earlier quoted context omitted.

Healthcare is unlike the rest of the economy. Drugs don't need marketing and market research. Because in healthcare you don't give what patients want but what they need. If a drug is best in its class doctors will not need "seminars", "education" to use it - it will be self evident by the trials and outcomes. Oh but wait - you cannot compare drugs to other drugs. You only compare them to placebo thanks to the cuffs p…

Because in healthcare you don't give what patients want but what they need. Where's the line? Maybe I don't "need" a new prescription painkiller with substantially fewer gastrointestinal side effects than the OTC one I'm taking, but if it would greatly improve my quality of life, I certainly might want it. Maybe I'm lucky enough that I see my doctor regularly and he keeps up (without any pharmaceutical marketing?) on…

Maybe I'm lucky enough that I see my doctor regularly and he keeps up (without any pharmaceutical marketing?) on every medicine that might help me out, but why should consumers be force to depend on that?

You think that marketing helps? Maybe your doctor is unduly influenced by pharma marketing and prescribes you the worse drug that give you IBD; hell, maybe he prescribes you the wrong drug altogether because of marketing, and you die. It may sound beyond the pale, but borderline cases involving antidepressants (perhaps the most overmarketed drugs) have already happened.

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