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Hospitals and universities repurposing drugs at lower cost

kcl.ac.uk

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Re: Hospitals and universities repurposing drugs at lower cost

#141

Post by benj111 »

peterbecich wrote: post #139
atourgates wrote: post #95

I have a little insight here from working with ophthalmologists. When the article mentions "using a cancer drug to treat a leading cause of blindness" it's talking about using Bevacizumab (brand name Avastin) to treat macular degeneration. Avastin and Lucentis are molecularly the same drug. The difference is that Avastin isn't packaged to be injected into eyeballs, and Lucentis is. Also, Avastin costs about $50/dose,…

The higher manufacturer price of the eyeball-safe formulation is clearly justified, then, i.m.o. Also, is it the doctor's responsibility to assume risk to save the patient money?

How does that justify a 30 fold increase?

If an individual Dr can get a batch checked while saving the patient money, it obviously isn't justified.

Re: Hospitals and universities repurposing drugs at lower cost

#142

Post by duskdozer »

pvaldes wrote: post #138
Buttons840 wrote: post #118

Earlier quoted context omitted.

How does a lowly pharmacy transform a drug that is not for eye injection into one that is?

> How does a lowly pharmacy transform a drug that is not for eye injection into one that is? New research probably discovered new applications for their product. Investors agree to diversify. Company developed a system to inject it. The system was approved by government agency at charge of this, and they give the green light to put it in the market. This is totally normal. See Ozempic history. The price of a treatmen…

The US government already was subsidizing the cost: https://www.nei.nih.gov/research-and-training/research-news/...

It subsidizing the cost of developing many drugs. The question is whether their pricing reflects that.

Re: Hospitals and universities repurposing drugs at lower cost

#143

Post by duskdozer »

lotsofpulp wrote: post #91
tyre wrote: post #83

Earlier quoted context omitted.

> It would be in the insurance companies’ interests to band together to fund the research so they can save huge amounts of money in the long term but they do not do this. Insurance companies do not want cheaper care. In the US, insurance companies must spend 80% of premiums on care. So if you pay $1k/mo, they have to pay out at least $800/mo in care. (Not to you specifically, but averaged out across all subscribers.)…

>Insurance companies do not want cheaper care. Why is there a continuous stream of healthcare providers threatening to or becoming out of network for various managed care organizations because they cannot come to an agreement on healthcare prices?

I suspect it's because the insurance companies are not in control. The idea would be to drive up costs when they profit on both sides (example: United and OptumRx) and push down reimbursements elsewhere.

Re: Hospitals and universities repurposing drugs at lower cost

#144

Post by thombat »

unacorner wrote: post #102
atourgates wrote: post #95

I have a little insight here from working with ophthalmologists. When the article mentions "using a cancer drug to treat a leading cause of blindness" it's talking about using Bevacizumab (brand name Avastin) to treat macular degeneration. Avastin and Lucentis are molecularly the same drug. The difference is that Avastin isn't packaged to be injected into eyeballs, and Lucentis is. Also, Avastin costs about $50/dose,…

Compounding pharmacies can get injectibles wrong in a deadly way. Many families are still waiting for justice after the MECC pharmacy caused the deaths of 64 people: https://en.wikipedia.org/wiki/New_England_Compounding_Center...

This note in that WP link is wild:

"On July 7, 2021, Barry Cadden's original 9-year sentence was increased to 14.5 years. An appeals court court decision required the trial judge to consider patients, and not only hospitals, as victims of the crime."

The law is always more complex than a layman like me thinks, questions of standing, etc. But I would have simply assumed that the patients hurt and killed would naturally be counted among the victims and not just the organisations left out-of-pocket.

Re: Hospitals and universities repurposing drugs at lower cost

#145

Post by epmaybe »

atourgates wrote: post #95

I have a little insight here from working with ophthalmologists. When the article mentions "using a cancer drug to treat a leading cause of blindness" it's talking about using Bevacizumab (brand name Avastin) to treat macular degeneration. Avastin and Lucentis are molecularly the same drug. The difference is that Avastin isn't packaged to be injected into eyeballs, and Lucentis is. Also, Avastin costs about $50/dose,…

The reason people get endophthalmitis is rarely due to a contaminated batch, but it certainly happens. But frankly it’s unsustainable to have all patients on branded drug, it would be too costly for patients and payers. Not to mention it is slightly unethical in the US due to drug rebates incentivizing branded drug use.

Endophthalmitis is bad, but we can treat it if caught promptly. Patient education, informed consent, good hygiene practices, and easy access to their ophthalmologist can make a tremendous difference.

Source: I do these injections for a living.

Re: Hospitals and universities repurposing drugs at lower cost

#146

Post by rcxdude »

refurb wrote: post #100
dabinat wrote: post #77

I’m currently on Spravato, which is fully emblematic of how broken the incentives in the US healthcare system are. Spravato is esketamine - a modified version of ketamine. Ketamine is made up of mirror image molecules and esketamine is the right-handed molecule. They did this because ketamine is off-patent so they needed to modify it in order to patent it, however there is evidence that esketamine is a less effective…

Blame the FDA on that one. The FDA's policy for the last couple of decades is that mixtures of mirror images will not get FDA approval unless there is a strong rationale for it. Racemic mixture of ketamine was approved decades ago. If you want a new indication for ketamine, you will need to get approval for a single mirror image, as the FDA won't approve the old drug. They did this because there are numerous examples…

Thalidomide being one of the more notable ones (though apparently neither chirality is truly safe)

Re: Hospitals and universities repurposing drugs at lower cost

#147

Post by simiones »

bit-anarchist wrote: post #94
simiones wrote: post #64

Earlier quoted context omitted.

> If the US was maximally capitalist it would be a free for all with no patent protection. The much more likely alternative in a maximally capitalist / free market maximalist society would be keeping all drug formulas as trade secrets, and thereby having all drugs as branded, no generics whatsoever (or few - perhaps some substances could be reverse engineered). In such a society, having the state force companies to p…

I'm not convinced about trade secrets being the capitalistic route here, specially since, as pointed out somewhere else, the current system is basically like trade-secrets already, which suggest inverted causality. In a pure free market, someone could try to keep the formulas secret, but others can just reverse engineer it into being public, which is basically guaranteed to happen if there's sufficient demand. Given…

The recipe for Coca Cola, the most popular soft drink in the world by far, has been a trade secret for over 100 years. And I'd wager a guess that it's slightly simpler to make then most medicines. So I don't see any reason whatsoever to assume that drugs would be easily reverse engineered.

Instead, I'd say that the assertion that today's drug making is hard to reverse engineer is hard even knowing the exact formula, substance, and dosage of every drug is unlikely to be true - is there any example of any drug that generics companies are not producing more cheaply than the original inventor, once the patent has expired?

Re: Hospitals and universities repurposing drugs at lower cost

#148

Post by simiones »

ItsMonkk wrote: post #97
lotsofpulp wrote: post #93

Earlier quoted context omitted.

That is just an inefficient way to spend taxpayer money than straight up paying researchers from the government’s accounts. The US has an enormously large higher education system with all the expertise and manpower to facilitate large trials of novel medicines. The only thing missing is political will to spend the money, so instead, Eli Lilly or Novartis or Pfizer etc spend investor’s money to do it. And then taxpaye…

Prizes pay for working results. Grants pay for possibilities. Grants are therefore riskier, and thus we allocate less resources to them. Since the people with the money don't understand the science, these possibilities must then be assessed by bureaucrats, and this causes our best to spend half of their time writing proposals instead of working and researching. A complete waste of time. Let the people who know the mo…

> Since the people with the money don't understand the science, these possibilities must then be assessed by bureaucrats, and this causes our best to spend half of their time writing proposals instead of working and researching. A complete waste of time.

What part of this changes when a company is paying for the research, and why can't that same part be used in a government office? It's not like drug company CEOs and CFOs are also world class medical researchers. And if the funding decisions are entirely done by a CTO who is, then why would this model not be possible in a government office?

Ultimately someone needs to pay for all of the trials that don't work, and someone needs to do a cost/benefit/likelihood analysis on any research to decide whether it will be funded or not. With a public funding scheme, the benefit analysis could be based on public health interests. With a private company funding scheme, it has to be based on profitability. In healthcare, there is usually a huge gap between these two, unlike other more traditional markets.

Re: Hospitals and universities repurposing drugs at lower cost

#149

Post by RobotToaster »

rcxdude wrote: post #146
refurb wrote: post #100

Earlier quoted context omitted.

Blame the FDA on that one. The FDA's policy for the last couple of decades is that mixtures of mirror images will not get FDA approval unless there is a strong rationale for it. Racemic mixture of ketamine was approved decades ago. If you want a new indication for ketamine, you will need to get approval for a single mirror image, as the FDA won't approve the old drug. They did this because there are numerous examples…

Thalidomide being one of the more notable ones (though apparently neither chirality is truly safe)

It's worth noting that thalidomide is still approved, but only for leprosy and certain types of cancer.

Re: Hospitals and universities repurposing drugs at lower cost

#150

Post by yndoendo »

parineum wrote: post #136
yndoendo wrote: post #124

Earlier quoted context omitted.

I hate to break it to you. Private Equity does not care about the common good, only profits. They only bow to increase price and out side of medicine, reduce the qualifying of the product. Want common good, start creating disdain for the wealths in societies.

> Private Equity does not care about the common good, only profits. Go back and read what I wrote. The point of capitalism is to align the profit motive of capitalists with the common good. It's not to give free reign to capitalists to do whatever they want at all costs.

Not according to the Friedman doctrine, which more and more companies are latching onto under capitalism [0].

I would also add that rejecting PE as not being apart of capitalism is rejecting reality. It is here and unfortunately to stay. Wealthy prefer to extract as much wealth from a brand, product, or service versus keep it around in good condition. Billionaires are not created by being supporters of the common good.

[0] https://en.wikipedia.org/wiki/Friedman_doctrine

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