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A million-dollar drug

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Re: A million-dollar drug

#151
post #60
post #29

Earlier quoted context omitted.

If a patent holder is not producing the patented thing, and not licensing it to someone else who is, the patent should expire. Kind of like a trademark that is not defended. Seems that would fix the problem?

It still wouldn't get the drug to the people who need it. Most of the cost involved is in getting it approved by the authorities for human use. There's nothing stopping people from manufacturing the drug for personal use, other than that it's likely extremely hard to make.

In this case it's already been approved for human use. So that's a non issue. But yes, I'm sure that is a hurdle for plenty of other pharmaceutical research

Re: A million-dollar drug

#152

Earlier quoted context omitted.

I don't understand how anyone can think patents are a good idea.

I don't have a problem with the idea of patents. I just think we could be a whole lot more pragmatic about them. They're supposed to incentivize useful behavior.

Who should decide what's a useful behavior? What's a fair price? What's a reasonable lroduction/distribution strategy?

I think the free market should decide, not the government and its enforced monopolies.

Re: A million-dollar drug

#153

> But it's the only way scientific discoveries ever get to patients, because universities don't make drugs. Why not? If there are so very few patients, a lab could easily produce enough for them.

Yeah, they had to make some quantity to run their trials. presumably it cost much less than $1mil/dose or they'd not have research funding at their level

Indeed. A lot less than $1million per dose, I bet.

I understand that there are regulatory issues.

But it seems pretty clear that the standard pharma industry model doesn't work for drugs like this.

Re: A million-dollar drug

#154

Earlier quoted context omitted.

I don't understand how anyone can think patents are a good idea.

Reading the article has convinced me that drug patents in particular are a great idea. Isn't it wonderful that we live in a world where futuristic new treatments like this can be developed? Yes it's true that people can't get the drug now, but at least someday it might be available. Without patents, who would you find to work for free developing something like this?

> Isn't it wonderful that we live in a world where futuristic new treatments like this can be developed?

This futuristic new treatment can no longer be developed or produced by ANYONE in the world, without the consent of this company. Before the patent, anyone could. Do you think that's not a problem?

We'll incentivize researchers the same way we'll do with musicians and writers in a post-copyright society. People who think this disease is important will crowdfund the research, and those who want to receive experimental and personalized treatment will pay for it.

How do you think we should incentivize things like environmental research? Is our knowledge about climate change patentable? What if someone found a cure?

Re: A million-dollar drug

#155

Earlier quoted context omitted.

The inherent cost of manufacturing the drug is relatively negligible. The problem is the cost of development and deployment, and the tiny customer (patient) population to spread that cost around to. A gene therapy for a more prevalent disorder would not have the same problems, or at least not as badly.

No, its only negligible for small molecules. Making proteins/biologics is much more expensive, and this is where many new drugs are headed. Plus the investment required to design the process and build facilities is far from negligible either.

Relatively negligible. I don’t know what the precise price point for biologics are, but equivalent techniques are routinely used in research; a bit of Googling found a lab services page pricing a an AAV (the kind of vector used in Glybera) batch at the neighborhood of $1k [1]. Would be much more for a medical-grade preparation, I’m sure, but not an appreciable fraction of a million.

[1] https://sites.duke.edu/dvvc/services/adeno-associated-vector...

Re: A million-dollar drug

#156
post #5

Earlier quoted context omitted.

I don't understand how anyone can think patents are a good idea.

Not a fan of it either, but how do we incentivize companies to research and create new drugs if they can't make back the huge cost of clinical trials?

How do you incentivize environmental research? How are we supposed to find solutions to climate change if they can't be patented?

Copyrights are just as bad as patents, and musicians/writers shouldn't make people pay for their music/books.

We should start giving money to causes we support, whether it's art, medical research, software projects, etc. It's a mistake to think we should only give money if we're forced to by law (through pricing something that's not scarce).

Re: A million-dollar drug

#157

Earlier quoted context omitted.

I don't understand how anyone can think patents are a good idea.

There should at the very least be a law that states that a patented technology should be made available in reasonable ways to make the patent valid.

We don't need more laws. The problem is caused by the government. They're the one that enforce patents and regulate clinical trials. You think they should decide what "made available in reasonable ways" means? What could go wrong...

Re: A million-dollar drug

#158
I was recently one of the first recipients of gene therapy for my condition. I have Hemophilia A, which is a bleeding disorder that results in bleeding into joints, muscle and soft tissue due to lack of a naturally occurring clotting factor that my body can't produce due to a defective gene. I received my dose of 30 billion viral particles about 13 weeks ago as part of a phase II clinical trial at UCSF.

It is amazing to me that we can manufacture and program viral particles to target specific cells. In my case, my treatment is a non-nucleonic technique that didn't repair the actual chromosomal hereditary defect but inserted a working gene, additional and freely available genetic material into my liver cells. It's amazing that the body can just recognize this extra bit of code and just start producing the factor. The engineer in me is also impressed they can make so many copies of the engineered virus.

It appears to be working. My factor levels have steadily increased and I’m now no longer a severe or even moderate hemophiliac. I’m their first patient to have achieved these results for hemophilia A severe and it puts me well into the therapeutic range. It really feels like I have been given a new body, it’s indescribable. For the first time in my life, I’m pain free.

It’s a weird feeling. Pain, mostly from bleeds into my joints, has been my constant companion. I was never able to do sports as a kid and had to avoid many other activities that would put me at risk. I have mixed feelings about all of this. On one hand I’m extraordinarily grateful, and the other side I see what a huge disadvantage I’ve been at compared to others for all of my life. I thought this day would never come, I had resigned myself to my limitations but now they are gone in a matter of weeks through the miracle of a medical experiment.

My old medication, a replacement clotting factor that was synthetically produced in a lab, worked but not nearly as well as this. Not to mention the fact it cost over $100,000 per month and I had to give myself an IV every other day. It's truly been a life changing experience for me, and I hope that gene therapy becomes widely available to others.

Also, the thing that was a milestone in this case was that the Hemophilia A factor VIII gene has been notoriously difficult to create a genetic therapy for because of the complexity of the actual gene itself. On the scale of what the body produces, its one of the more complicated proteins. So it basically means many other genetic conditions will be able to be treated with and addressed with similar technology.

Such an exciting time to be alive, and yes there are amazing things happening right now despite all the bad news you may hear!

Re: A million-dollar drug

#159
post #49

Earlier quoted context omitted.

It just backs out to interest rates commensurate with the risk. Lack of collateral doesn't mean you can't get a loan. Perhaps the economics wouldn't work, but it sure sounds like nobody tried in this case. What it would boil down to is if the insurance company expected a larger net cost on a traditional drug regimen for the life of the patient, vs servicing a loan at the market rate over N years. Interest rates are s…

Insurance companies don't cover total health costs over the life of the patient. They cover the next month of health costs, and a certain percentage of their customers churn afterwards. For insurance companies, providing treatment that lasts a longer amount of time can often be a terrible business decision - if the customer switches insurance providers afterwards, then they're essentially subsidizing the insurance co…

Right, so what is necessary is for Gene therapy to have similar financial characteristics to an insurance company as a monthly perscription for a chronic illness. There is no reason this cant be securitized properly, unless a) the lifetime healthcare costs for a person are higher with the therapy than without (unlikely for most chronic illnesses) or b) the interest rate would need to be so high as to make it so. If gene therapy provides a more optimal use of resources and capital than continual therapy for chronic illness than the up-front high price tag nature of it being a problem is an opportunity for someone to come along and make the market more efficient.

Re: A million-dollar drug

#160
post #49

Earlier quoted context omitted.

It just backs out to interest rates commensurate with the risk. Lack of collateral doesn't mean you can't get a loan. Perhaps the economics wouldn't work, but it sure sounds like nobody tried in this case. What it would boil down to is if the insurance company expected a larger net cost on a traditional drug regimen for the life of the patient, vs servicing a loan at the market rate over N years. Interest rates are s…

Insurance companies don't cover total health costs over the life of the patient. They cover the next month of health costs, and a certain percentage of their customers churn afterwards. For insurance companies, providing treatment that lasts a longer amount of time can often be a terrible business decision - if the customer switches insurance providers afterwards, then they're essentially subsidizing the insurance co…

Insurance is how the US deals with health care. It isn't how all countries do it. There are other models and there's no reason we couldn't invent new ones if none of the existing ones work.
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