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

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

#141

Post by twoodfin »

venomsnake wrote: post #89
twoodfin wrote: post #82

Earlier quoted context omitted.

No problems? Why wouldn't your genius idea work in every sector of the economy? Surely Apple and Samsung could sell more, better phones if they didn't conduct market research or run ads...

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 every medicine that might help me out, but why should consumers be force to depend on that?

The idea that there are hordes of people making doctor's appointments to demand brand name drugs they heard about on TV, and doctors are "forced" to write what they consider useless or overpriced prescriptions for these drugs seems silly to me.

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

#142

Post by melvinmt »

mikestew wrote: post #117
gambiting wrote: post #60

Earlier quoted context omitted.

As far as I know, companies are supposed to make profit,they are not charities. 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(unless you can show that selling your product cheaper is going to bring more money to the company in the long run). This is not "evil" - this is just how th…

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.

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

#143

Post by danielweber »

venomsnake wrote: post #89
twoodfin wrote: post #82

Earlier quoted context omitted.

No problems? Why wouldn't your genius idea work in every sector of the economy? Surely Apple and Samsung could sell more, better phones if they didn't conduct market research or run ads...

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…

To get the drugs past the FDA you only need to show it behaves better than placebo

Not really. You need to show how it works compared to the current regimen.

If someone suffering from a disease currently takes drugs A, B, and C, and you have what you think is a better C (let's call it C++), then the study would compare people on (A,B,C) to people on (A,B,C++).

Unless there is no treatment at all for the disease, in which case, go for the placebo.

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

#144

Post by danielweber »

jellicle wrote: post #98
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…

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…

There are so many weasel words in "basic research to discover new drugs" that I can't even begin to evaluate it.

Or, you can look at the actual drugs that get approved, and back-trace them to their sources. Hey, someone already did that. Here: http://pipeline.corante.com/archives/2010/11/04/where_drugs_...

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

#145

Post by 3am »

The first comment after the article ends the discussion:

"This article is misleading from the beginning. India did not refuse to issue a patent for Gleevec, it refused to extend the patent Gleevec already had, based on merely superficial changes to the formula, a practice known as "evergreening", which pharmaceutical companies use to extend the monopoly on their medications as long as possible."

That is completely accurate, and more informative that the article in fewer words.

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

#146

Post by refurb »

Retric wrote: post #140
refurb wrote: post #127

Earlier quoted context omitted.

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.

It costs 10s of millions of dollars because that is how you prove a drug is safe. That isn't unique to the US. If you want to launch a new drug in the EU, it's not going to cost you any less.

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

#147

Post by criley »

kingkawn wrote: post #129
belorn wrote: post #113

Earlier quoted context omitted.

One can read the data in different ways, and I don't think anyone doubt that pharma companies do contribute to the investments into new medical innovations. One interpretation that I listen/read about is that NiH and pharma operate on different levels, and thus sadly, NiH's contribution tend to be forgotten because they aren't the people with that pop out the pills bought in the store, even if the pills would not hav…

"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 amounts of money so that they can recoup their investment.

Low hanging fruit has been taken and newer methods of discovering safe and effective drugs are needed.

You might find this shocking, but pharma is a dying business. Companies are divorcing their drug development departments into separate businesses so they can fail gracefully. The blockbuster drugs that can recoup the investment of looking for a needle in a haystack aren't coming any more.

>If, as these statistics imply, you can show that the drugs and other changes in medical care that provide positive changes to quality of life and mortality are coming from government research significantly more so than other sources then why subsidize private research, why protect the private drug development system that results in outrageously priced drugs, why waste 2/3rds of research money to produce such a disproportionately small portion of the advancements in medical knowledge?

This is absolutely, 100% totally and COMPLETELY false.

The government IS NOT INVOLVED IN DRUG RESEARCH. Honestly, period. They can't afford it! It costs a billion dollars to whittle 10,000 drug candidates into 1 FDA approved drugs. NIH grants aren't even 1% of that cost.

The government is not responsible for very much actual drug development at all. They don't own or fund the labs. They fund the schools that do the work on the lower level theory, on the tools and concepts that will one day be commercially viable.

Private labs handle the vast majority of all new molecular entity discovery, pre-trial, trial, etc. They have the money, labs and teams capable of handling it -- NIH funded labs often don't!

Here's a list of NME's for 2013 so far: http://www.fda.gov/drugs/developmentapprovalprocess/druginno...

Remember, the FDA is the gatekeeper and these companies research thousands and thousands of candidates looking for something that they can statistically prove safety and efficacy of to the FDA, and the FDA gets to decide.

As you can see from that list, the FDA doesn't allow new molecules out very often.

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

#148

Post by visarga »

refurb wrote: post #134
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.

Then maybe we should find a way to make trials cheaper. Why does it cost one billion dollars to bring a new drug to market? That could drastically limit the innovation.

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

#149

Post by solistice »

coldtea wrote: post #31
mansigandhi wrote: post #18

Earlier quoted context omitted.

> The US is effectively subsidizing advanced healthcare for every other country in the world. That's a very misinformed statement.

> 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…

The sum of European defense spending is about as high as that of the US, but it's defense efficiency is at about 10% of that of the US due to duplicate hardware and parallel organisational structures.(I went to a Model UN Conference a couple of years ago, and our comitee wrote a resolution on establishing an Unified European Defense Force, and those numbers came up somewhere in my preliminary research, but I'm too lazy to dig them up again). What's intresting is that there are Community Medical Centers in the US, which offer the same medical procedures as regular hospitals, by the same doctors which are paid the same wage ,for 2,5k $ instead of 25k$ afaik. But then they don't charge 25$ for a disposable syringe that cost 50 cent to buy and 5 cent to produce.

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

#150

Post by anuraj »

replicatorblog wrote: post #65

One point I haven't seen explained is why the Indian companies don't manufacture the drug based on the molecule described in the expired patent. If what the courts are saying is true and the new patent covering crystallization is trivial, the expired patent should be just as effective and free to use? If it's not as effective, that seems to make the case for the new Novartis patent.

Many Indian companies including Cipla,Natco and Sun Pharma has been manufacturing generic versions for the last 10 years or so and are selling at a fraction of the price. For your information, India is the largest generic drug producer globally. http://www.indiamart.com/moderntimes/imatinib-mesylate-capsu...
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