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Dutch join backlash at expensive drugs by making their own

reuters.com

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Re: Dutch join backlash at expensive drugs by making their own

#111

Post by toomuchtodo »

ams6110 wrote: post #76
JKCalhoun wrote: post #74

Earlier quoted context omitted.

You mention problems, and to be sure there would be problems, but we're also awash in the problems of the current system as well. I am ignorant of these things so I have to ask if it is assumed that your assertions are common knowledge. For example: "the US can't get anything done over a 20 year time horizon". If international trade is a larger sticking point then I would suggest an international consortium? Like a W…

Lately, with respect to the government, I think it's fair to shorten the statement to simply "the US can't get anything done."

Disagree. We get daily weather reports from Mars [1]. SpaceX can still get approval to lift to ISS. Social Security checks still get cut and clear every month. I'm able to get into national parks daily.

Legislation is stuck in the mud, but government is very much still getting things done.

[1] https://mars.nasa.gov/insight/weather/

Re: Dutch join backlash at expensive drugs by making their own

#112

Post by wpasc »

sametmax wrote: post #98
Thriptic wrote: post #57

One thing that is typically not mentioned in these debates is the fundamental structure of the industry. Let's say someone finds a research compound which looks to be promising, and they start a new company to try to commercialize it. Often, they are looking at at least 1-2 decades to get that product to market. Assuming they don't sell out to a big company, they almost certainly have to go public before starting tri…

It's true for new drugs, but insuline price have been multiplied by 5 during the last decade ( https://www.ontrackdiabetes.com/type-1-diabetes/insulin-pric... ), which is a drug that should actually cost less to make, since we know it very well, and have a lot of demand now with the obesity epidemic.

What troubles me about insulin prices is that raising prices can simultaneously be used to satisfy shareholders with growing profits AND be used to fund new drugs (revenue from existing drugs obviously must fund the creation of new drugs). I am a little worried that if strict financial controls are put in place, then the companies will just turn into cash cows for existing drugs because a limit has been put on the profitability of new ones.

I believe we need to trudge further and further because even though we are creating new therapies that are wildly expensive, we are moving closer to truly cost effective therapies and best-in-class therapies. Though, we are certainly not there yet.

If someone can explain to me that my fears are unjustified about price controls diminishing capital invested into new treatments, I'd happily join the chorus of people calling for price controls in medicine (US citizen here with a chronic disease treated by TNF inhibitor which can cost 30K+ a year but through employer insurance, I pay nothing except for a copay which the manufacturer pays for).

Re: Dutch join backlash at expensive drugs by making their own

#113

Post by wpasc »

JKCalhoun wrote: post #60
Thriptic wrote: post #57

One thing that is typically not mentioned in these debates is the fundamental structure of the industry. Let's say someone finds a research compound which looks to be promising, and they start a new company to try to commercialize it. Often, they are looking at at least 1-2 decades to get that product to market. Assuming they don't sell out to a big company, they almost certainly have to go public before starting tri…

Maybe drug "companies" should be government entities then and not for-profit at all.

NIH funding has been highly stagnant for sometime as well as NSF funding. Drug development and research timelines are much longer than any single politician's term. What successful government projects inspire your confidence that they would do a good job innovating for future medicines? Moon Landing? Look at NASA's budget changes to see the rewards for their efforts.

Has this been successful anywhere? What purely run state enterprises that are charged with creating new and innovate things have been success stories?

I think that while private enterprise has had a jaded role in healthcare, I'm not sure what the better alternative is.

Re: Dutch join backlash at expensive drugs by making their own

#114

Post by dragonwriter »

wpasc wrote: post #112
sametmax wrote: post #98

Earlier quoted context omitted.

It's true for new drugs, but insuline price have been multiplied by 5 during the last decade ( https://www.ontrackdiabetes.com/type-1-diabetes/insulin-pric... ), which is a drug that should actually cost less to make, since we know it very well, and have a lot of demand now with the obesity epidemic.

What troubles me about insulin prices is that raising prices can simultaneously be used to satisfy shareholders with growing profits AND be used to fund new drugs (revenue from existing drugs obviously must fund the creation of new drugs). I am a little worried that if strict financial controls are put in place, then the companies will just turn into cash cows for existing drugs because a limit has been put on the pr…

> What troubles me about insulin prices is that raising prices can simultaneously be used to satisfy shareholders with growing profits AND be used to fund new drugs (revenue from existing drugs obviously must fund the creation of new drugs).

That's not obvious at all; there's no reason creation of new drugs couldn't be financed by raising capital through either debt or equity issues, which are then paid back, in effect, by the profits from the drug itself; in fact, a fair amount of drug development is funded that way, because it's done by startups which are acquired by major firms, if at all, only after doing much of the development work; obviously, that's how every firm’s first drug is financed.

It may be that firms want to eventually shift business models, so at some point they take their existing stake of drugs and body prices so instead of paying off their own development, they are doing that and paying forward development, and after that switch to internal financing, but there is no reason that is obviously a necessity.

Re: Dutch join backlash at expensive drugs by making their own

#115

Post by wpasc »

dragonwriter wrote: post #114
wpasc wrote: post #112

Earlier quoted context omitted.

What troubles me about insulin prices is that raising prices can simultaneously be used to satisfy shareholders with growing profits AND be used to fund new drugs (revenue from existing drugs obviously must fund the creation of new drugs). I am a little worried that if strict financial controls are put in place, then the companies will just turn into cash cows for existing drugs because a limit has been put on the pr…

> What troubles me about insulin prices is that raising prices can simultaneously be used to satisfy shareholders with growing profits AND be used to fund new drugs (revenue from existing drugs obviously must fund the creation of new drugs). That's not obvious at all; there's no reason creation of new drugs couldn't be financed by raising capital through either debt or equity issues, which are then paid back, in effe…

Fair reply, and thank you for replying. While I agree the funding mechanisms you mentioned certainly must exist, I imagine things like unexpected delays for a given therapy or complications with a clinical trial (not with the medicine but with some procedural stuff) must happen. Times where existing room in revenue streams is vital for the development.

Secondly, if a publicly traded company already has a significant amount of equity in the hands of the public, issuing too much debt can mess with the balance sheet, right?

I hear you though, I still worry that price controls is attacking the issue in the wrong way. I don't know all the specifics, but I feel like protections to competition would be a better way to ensure the competitive market?

This is an area I'd really like to understand more from a non-partisan perspective, especially understanding the current nature of which countries actually do develop the most drugs. But every piece of information I find on this subject has a partisan bent. Anyone got a source they'd recommend?

Re: Dutch join backlash at expensive drugs by making their own

#116

Post by dmitriid »

aaavl2821 wrote: post #110
dmitriid wrote: post #95

Earlier quoted context omitted.

R&D spending has been relatively stagnant. While industry revenue increased by 45 percent, or $241 billion from 2008 to 2014, industry spending on R&D increased just 8.5 percent in that same period, from $82 billion to $89 billion (GAO 2017). By some measures, R&D expenditures are actually falling, as more firms are outsourcing R&D to third parties. In that seven-year period, purchased R&D increased from $20.5 billio…

That links a 404 for me but I'd want to investigate the methodologies. The r&d numbers for the industry seem low as do the revenues, I don't know what sample of companies they used Also don't know what criteria Bentley used to determine how much NIH research contributed to new drugs This report provides another perspective and highlights the role of industry http://www.hbmpartners.com/media/docs/industry-reports/Anal…

Sorry, copy-pasted from anotger comment without checking the link. Here’s the proper link: http://rooseveltinstitute.org/wp-content/uploads/2019/02/RI_...

The HBM partner report seems to somewhat confirm some of the findings in the report I linked and quoted:

- 50% of drugs come from outside “Big Pharma”

- Less than 50% drugs developed in-house (mostly coming from licensing and acquisition)

Also:

- 58% approved drugs are orphan drugs.

Orphan drugs may mean government incentives, funding, public policy.

Re: Dutch join backlash at expensive drugs by making their own

#117

Post by username223 »

tomcam wrote: post #17
username223 wrote: post #13

Earlier quoted context omitted.

> Universities and R&D companies have a codependent relationship and this is generally regarded as a good thing. Is it? At best, I'd say it's seen as a "necessary evil," where "evil" is much more certain than "necessary."

It stinks, I agree. What economic/social arrangement has done a better job in drug innovation?

Publicly-funded research universities, along with the March of Dimes, funded the polio vaccine, which has almost entirely eliminated the disease, and was not patented.

Re: Dutch join backlash at expensive drugs by making their own

#118

Post by Luc »

radicalbyte wrote: post #40
Luc wrote: post #28

Earlier quoted context omitted.

It's a 6 year study, but like the study for Medical Doctor, at the end you have a Masters diploma, not a Phd/Doctorate. Source: apotheek.nl e.a.

That's what I said :) A doctorate* (nl: doctorandus) which takes 6 years to earn (3-4 years BSc then 1-2 years MSc to use the English terms) followed by a 1 year specialization for public pharmacist. Exactly the same as the MDs (also doctorandus) have to do. It's not a PhD; although I assume that you'd want to go that route if you're more interested in the research (I'm assuming that a PhD in Pharmacology is a thing)…

Here's the correct usage of the terminology: https://en.wikipedia.org/wiki/Doctorate#Netherlands_and_Flan...

Re: Dutch join backlash at expensive drugs by making their own

#119

Post by Retric »

refurb wrote: post #108
Retric wrote: post #81

Earlier quoted context omitted.

I don’t know. Clinical trials can already be outsourced, so that’s not a major issue. And only two countries allow for direct to consumer drug marketing so that’s clearly unnecessary. Honestly, this is simply not going to happen in the US so it’s hard to say what’s realistic.

I wasn't referring to DTC marketing. DTC is a small percentage of the marketing companies do. Any yes, you can outsource running a trial, but you still need someone to design it, process the data, put together an NDA and submit for approval. I can only imagine the complete clusterfuck that would be if it was all done by public employees.

I understand you have some concerns, but it’s not like people doing cutting edge drug research don’t know how to do research.

Large drug companies are not bringing magic recipes to the mix here. Often it’s the same researchers who found the drug who end up starting drug a company to profit from their research.

As to advertising to doctors their is plenty of evidence this is harmful. It’s easy to for doctors to keep up with relevant drugs as so few are added each year and many are extremely specialized. Advertising results in over prescription which is known to be extremely harmful with opioids being an obvious example.

Re: Dutch join backlash at expensive drugs by making their own

#120

Post by dnautics »

nicoburns wrote: post #97
dnautics wrote: post #78

Earlier quoted context omitted.

And maybe that's not such a bad thing. There's a ton of space between "things companies" should do and "things government should do". In the US, the policy agenda is (still) broadly defined by tribalism along polarizing issues (e.g. abortion). In other countries, it's slightly less bad but the phenomenon is similar. If less social goods were coupled to politics the world might be a better place, but it also might tak…

I think the US needs a paradigm shift where it stops thinking of income taxation as taking something from someone. It's not, because under the rules of society, that person is never due that money in the first place. That money is the portion of the nominal sum that is "earned" that accrues to society for the support and conducive living environment that the provide to the individual. It's true that it is coercive: t…

who's suggesting that property laws are obvious? Property laws exist because property is rivalrous, and the commons are generally abused, for example how the #1 polluter in the US is the US government, how the soviet bloc and china were far worse per capita polluters than the US.

> But this is also true of all laws,

Yes, that's true for all laws. It's funny that no one says it's part of the "social contract" when someone gets choked out and killed by the police for selling bootleg cigarettes on the corner.

I'm also going to point out that the central problem with income tax is that we think it's great because it's "punishes" the wealthy, but the equilibrium state is that due to bracket creep, it winds up screwing over the poor and middle class while the wealthy find escapes. Of note: I remember a year when I paid more in income taxes (as a proportion of my income) having made 30k than Bernie Sanders did.

The general paradigm among the liberal left is that the poor are screwed over by the political power because they are poor. I think it might be worth rethinking that - the poor are and continue to be poor because they don't have political power. The problem is that political power is a zero-sum game, so any solution that gives those in power more power will only make matters worse.

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