A million-dollar drug

News flash!

Emotion, character and reason are all valid in this discussion.

Let me put it to you just a bit more directly:

An aggrieved mother and father are there, facing you and their dead child.

Now, having made this call to let their kid die, what do you say to them?

I will wait...

Actually, I won't. It is one thing to speak of optimal choices when one is seperated from, or above, disassociated.

Real life, where the actual humans are plays out much differently.

Above, when I asked, "Seriously?" it was this I was getting at.

The claim of strange morals, based on some 100 to one, as if!

I found the whole thing deeply disturbing. Not a negative to the participants. Not my intent.

No, what I found disturbing was the detached nature of the whole thing.

Maybe Liberal Arts education remains more relevant than I realize.

Again, not a negative toward anyone. Context matters, that's all.

I very seriously question the general wisdom in having some percentage of us so far isolated from people overall, and any sort of meaningful policy, moral debate being beneficial.

You completely failed to make a meaningful rebuttal. Correct... ?

Like I said, seriously?

> I see you arguing that things went just the way they should have all over this thread.

Actually, I never said that anywhere. I think what happened is basically a no-op. Without a profit motive, the drug would never have been developed, and therefore not available to anyone, and we'd be in the same boat we're in anyway.

What I do think is one of two things should happen: Either (1) we decide that the drug is worth it, in which case health systems should pay the owner of this drug fairly for their investment. Or (2) it's not worth it, in which case we're no worse off than we would have been without this company, other than the fact that they wasted a bunch of their money.

(As an aside, note that I said we should pay the owner, fairly for their invention, not the original developer who voluntarily gave up the rights. This is an important distinction as the ability to voluntarily transfer property rights is pretty central to the whole concept. Imagine if after you bought a car, anyone could take it, because you're not the original manufacturer. It's not hard to see the path from this society to one where nobody bothers making cars.)

> The two doctors who made the drug do not even hold the patent and basically gave it away for free to the company trying to distribute it.

Those two doctors did the least expensive part of the whole operation. The more expensive part was funded privately. If you want to fix this you can either have the government fund that expensive part, or you can have it done privately and pay the owners what they want.

> if not for the patent this drug would definitely still exist, and probably be available to people who actually freaking need it

Sure, maybe the doctors still would have done the research, but there would be no money either for the clinical trials, and so manufacturing and distributing the drug would be illegal.

> Let's say your drug's price of $1m compares favourably to $100k/year for 40 years to manage the disease. How can a company who might only be covering the employees for 1-3 years be expected to cover that higher cost?

Yes, it's essentially a Prisoner's Dilemma. If every insurance company agreed to pay for this drug, the total cost of treatment overall would be lower (and the patients would be healthier and happier). If my company decides to pay it and no other insurance company does, then when the patient leaves our network (in less than 10 years) and joins another insurance network, my company will have paid the cost but can't reap the financial benefits.

There's two major differences between this scenario and classic PD, though.

First, companies are allowed to communicate. We could conceivably get everybody in a room together and come up with some agreement by which everybody agrees to pay for this drug, even if patients switch insurers. Everybody wins. Patients are healthier, and insurers save money.

Second, it's not a one-time decision. An insurer can change their mind from "no" to "yes" at any time. So it's more like "iterated PD", with an indefinite number of rounds. In that game, interestingly, there is no strictly dominant strategy, and altruism tends to do better in practice! So maybe you don't even need an agreement.

> To be clear, this is further evidence of how stupid the US model is. In a single payer model this particular concern goes away.

How do you figure? The article points out that they also had trouble convincing European governments to pay for it. You can't get Glybera anywhere in Europe or Canada today, either.

The US model is arguably a poor one, but this isn't a good example of that, because every other country in the world failed at Glybera, too.

As you can see from the lack of biosimilars in the US, manufacturing a biological is a hell of a lot more complex and expensive than doing it for a small molecule.

And in fact, since this is version 1.0, I’ll bet a better version comes out before any generic company launches.

This article brings up a thought experiment I've been pondering for a good while now...

So what would you charge for a drug that guaranteed you would live 30 extra years after you spent 20 million to develop it?

For an added twist, let's say it's NOT FDA approved but you have solid clinical evidence that it's efficacy was solid and can your "street cred" (whatever that means in biotech) allows you access to the world's most successful (ie richest) people.

I have my answer...what's yours?