A cancer trial’s unexpected result: Remission in every patient • Hacker News Board

Re: A cancer trial’s unexpected result: Remission in every patient

#231

Post by jlarocco » Tue, Jun 07, 2022, 1:36 AM UTC

brigandish wrote: post #229

jlarocco wrote: post #117

Earlier quoted context omitted.

> Should the government have not helped fund this drug because now it's expensive? If he wants to charge "what the market will bear," then he should fund the research through the market. If he wants government handouts to do the research then the public deserves to get the benefit that it's paying for - we're not funding it to make some guy rich. I'm not saying it should be free, but he's already opted out of the mar…

I'm all for cutting subsidies, but the problem is that if you want risky things then investors might decide it's better not to invest and the drugs never appear. The government (which is really a government of and for the people, right?;) gets what it wants - a new drug - and jobs are created, trade happens, taxes are levied, health improves leading to (theoretical) money saved, more hours worked, more taxes… There's…

> I'm all for cutting subsidies, but the problem is that if you want risky things then investors might decide it's better not to invest and the drugs never appear.

So? Nobody has a right to free money. If investors don't want to fund the research, and the researcher doesn't want to share the results with the public, then no money for them. They can go off and work on something else.

> There's no need to punish the creator by not letting them make money off of their creation just because the government was involved, the government is getting plenty out of their investment.

You're putting words in my mouth. I said the cost of government funded drugs should be the cost of manufacturing plus a percentage for the inventor.

Second, that's not how government funding works. If the public funds a thing, then the public has a right to use that thing. If the inventor doesn't like it, then they shouldn't take funding from the government.

Funny to see a pro-corporate welfare argument on HN.

Re: A cancer trial’s unexpected result: Remission in every patient

#232

Post by horsawlarway » Tue, Jun 07, 2022, 12:16 PM UTC

greedo wrote: post #119

horsawlarway wrote: post #27

Earlier quoted context omitted.

Yes - that's not unreasonable for a full time care facility for something like dementia or Alzheimer's in the US (it's below what we paid for my grandmothers). If you're lucky - they have long term care insurance, and that covers most of the expenses for approx 2 to 10 years (depending on how old the insurance is - it's getting harder to find long plans, and they're all getting significantly more expensive as it turn…

"Otherwise... you spend everything, and then your kids pay." That's incorrect. With Medicaid, the recipient is require to spend down their assets to a small amount, then Medicaid will pick up the remainder. The recipient's children aren't on the hook for anything. Of course, they won't receive any inheritance since the estate of the recipient has been drained prior to Medicaid.

This is wrong. Or rather, correct, but only in certain states, and for certain facilities.

IMD over 65 is only offered in some states, and have strict requirements for facilities that accept medicaid (not all that many do near us).

In our case, the waiting time was about 3 years for a room in the facility closest to us. Alternatively, there was an option about 4 hours away.

Worse, both medicaid facilities we looked at were... bad. Frequent complaints about abuse, very high rates of staff turnover, very little stimulation for residents (one was basically a single old tv on the wall in a cinderblock room - it looked basically like prison).

So yes - Medicaid will cover some costs in some cases, but really - the kids end up paying.

Re: A cancer trial’s unexpected result: Remission in every patient

#233

Post by genkiman » Tue, Jun 07, 2022, 2:52 PM UTC

epmaybe wrote: post #123

I got to spend a couple of weeks as an internal medicine intern with a medical oncologist who incidentally worked at memorial sloan prior to coming to my university. You could tell how excited he was about the current state of cancer research and new treatments, especially with immunotherapy. Wonder if docs will start off-label treating earlier with immunotherapy. There's tons of immune checkpoint inhibitors meant fo…

No post body was provided.

Re: A cancer trial’s unexpected result: Remission in every patient

#234

Post by brigandish » Tue, Jun 07, 2022, 4:28 PM UTC

jlarocco wrote: post #231

brigandish wrote: post #229

Earlier quoted context omitted.

I'm all for cutting subsidies, but the problem is that if you want risky things then investors might decide it's better not to invest and the drugs never appear. The government (which is really a government of and for the people, right?;) gets what it wants - a new drug - and jobs are created, trade happens, taxes are levied, health improves leading to (theoretical) money saved, more hours worked, more taxes… There's…

> I'm all for cutting subsidies, but the problem is that if you want risky things then investors might decide it's better not to invest and the drugs never appear. So? Nobody has a right to free money. If investors don't want to fund the research, and the researcher doesn't want to share the results with the public, then no money for them. They can go off and work on something else. > There's no need to punish the cr…

> Funny to see a pro-corporate welfare argument on HN.

It's not so that's your mistake.

> > I'm all for cutting subsidies,

You see, I wrote that. However, as we can see when I continue I am able to see the benefits to a system I don't agree with. It's called being reasonable and not strawmanning your opponent.

> > but the problem is that if you want risky things then investors might decide it's better not to invest and the drugs never appear.

> So?

So… I gave that argument right there. "the problem is that if you want risky things then investors might decide it's better not to invest and the drugs never appear." If your response to this is "So?" then you've just said "So?" to "the drugs never appear". Strangely unappealing.

> Nobody has a right to free money.

Aside from having not made that argument and it not being relevant, you're arguing that people should get free drugs. Nobody has a right to free drugs. Now you're arguing against yourself.

> > There's no need to punish the creator by not letting them make money off of their creation just because the government was involved, the government is getting plenty out of their investment.

> You're putting words in my mouth.

Which words? Punishment? Ah, the percentage.

> I said the cost of government funded drugs should be the cost of manufacturing plus a percentage for the inventor.

How magnanimous of you. What would you set the percentage at? How would you get companies to manufacture things at cost for you? That's just not how a business survives, and the only people I've ever heard make this kind of argument are people who've never run a business and never will.

> Second, that's not how government funding works. If the public funds a thing, then the public has a right to use that thing.

No, that's not how government funding works, that's how you appear to think it should work in this fantasy you've constructed. Governments often provide funding to private companies that do not create some magical legal right to that company's products.

> If the inventor doesn't like it, then they shouldn't take funding from the government.

I'll repeat, that's not how government funding works. I'm against subsidies in general and in this case but I'd take this dysfunctional way over yours.

Re: A cancer trial’s unexpected result: Remission in every patient

#235

Post by isitmadeofglass » Wed, Jun 08, 2022, 12:33 PM UTC

gus_massa wrote: post #216

isitmadeofglass wrote: post #198

Earlier quoted context omitted.

If we allowed any type of experimentation on dying patients as long as there was consent, dying patients would end up getting used as a Guineapigs by companies trying to get a lucky indication. It would certainly benefit the families left behind financially, but it would not be pretty. “Here’s a million bucks, please take these 40 drugs that will certainly kill you, but we’ll learn which one we should continue with”.…

> It would certainly benefit the families left behind financially, but it would not be pretty. You are very optimistic. Medics will sell expensive snake oil treatment to desperate families. For example, from the bottom of https://en.wikipedia.org/wiki/Breast_cancer#History > In the 1980s and 1990s, thousands of women who had successfully completed standard treatment then demanded and received high-dose bone marrow tr…

> You are very optimistic. Medics will sell expensive snake oil treatment

I think you misunderstood. My point was that it would benefit the families because a company would gladly pay a million bucks to give a dying cancer patient the first human dose of 40 drugs they haven’t yet done any testing on, just to get quick human feedback.

The “patient” in that scenario won’t likely get any benefit from the money, but the family they leave behind would.

Obviously this is not something we want to actually see happening, but the cynic in me know that if a company can save billions by skipping all trials and going straight to “dying human” they will, and they’d be happy to pay the expendable subject a million or even more, they still come out net positive.

Re: A cancer trial’s unexpected result: Remission in every patient

#236

Post by goodpoint » Wed, Jun 08, 2022, 12:52 PM UTC

brigandish wrote: post #199

turtledove wrote: post #194

Earlier quoted context omitted.

Ah yes, a society with low cost medicines and a healthy research investment - definitely a recipe for low wealth and health. /s

I also dream of utopia but when I wake up I have to supply the logic that fills in the gaps else it remains a dream. If you remove the profit motive then investment falls, new medicines become less likely and lesser in number, and medicines remain higher in cost due to lack of pressure (competition from new drugs, competition from new entrants, new techniques etc). Altruism, necessary as it is, does not fill that voi…

> If you remove the profit motive then investment falls

The last 200 years proven otherwise. All basic research around airplanes, semiconductors, satellites, GPS, GSM, fiber optics, CD/DVD and much much more was almost entirely tax funded.

Re: A cancer trial’s unexpected result: Remission in every patient

#237

Post by dekhn » Thu, Jun 09, 2022, 11:01 PM UTC

BurningFrog wrote: post #156

scoopertrooper wrote: post #141

Earlier quoted context omitted.

70% of Phase 2 trials fail and 50% of Phase 3 trials fail[1]. Why should the default to be to approve drugs in the early stage of human experimentation? Here are some interesting case studies of drugs graduating from Phase 2 trials only to fail Phase 3 trials on efficacy and safety grounds: https://www.fda.gov/media/102332/download [1] https://www.parexel.com/application/files_previous/5014/7274...

After Phase 2, the drug has been proven safe. In a sane and humane system, sick people would then be allowed to try it.

Except vioxx. One of the biggest mistaken approvals of all time.

https://en.wikipedia.org/wiki/Rofecoxib#Withdrawal

Re: A cancer trial’s unexpected result: Remission in every patient

#238

Post by dekhn » Thu, Jun 09, 2022, 11:17 PM UTC

ufo wrote: post #90

_Microft wrote: post #37

Earlier quoted context omitted.

The name of the drug ends in "-mab" [0] indicating that the drug is based on monoclonal antibodies [1,2]. Those antibodies are tweaked to bind to cancer cells which makes the immune system attack the cancer cells. [0] https://en.wikipedia.org/wiki/Drug_nomenclature#List_of_stem... [1] https://en.wikipedia.org/wiki/Monoclonal_antibody [2] https://en.wikipedia.org/wiki/Monoclonal_antibody_therapy

IIRC, in this particular case the antibodies bind to immune cells. Immune Checkpoints are a mechanism that keeps the immune system from attacking the own body but in cancer it can also stop the immune system from destroying the cancer. The checkpoint inhibitor antibodies remove these restrictions and allow the immune cells to attack the cancer. (The price is that they also become free to attack other things they shou…

Who the hell designed this computer?

Re: A cancer trial’s unexpected result: Remission in every patient

#239

Post by dekhn » Thu, Jun 09, 2022, 11:21 PM UTC

xiphias2 wrote: post #128

bsder wrote: post #116

Earlier quoted context omitted.

> I'm worried that it will take many years until that happens. For good reason. If we detect cancers early, surgery and radiation are often very good nowadays--often allowing you to skip chemotherapy. And these are far less likely to kill the patient than a checkpoint inhibitor (which can overload your kidneys if it works or give you autoimmune diseases even if it doesn't). The problem is that there are a lot of canc…

My ex girlfriend detected breast cancer early at age 28, but the doctors told her that she's ,,too young'' to have cancer. 1 year later on the checkup they said that it's too late (she has BRCA1 mutation). The last 10 years have been fighting with cancer, having about 10 operations on her, but the worst thing was chemotherapy (she said that she would rather die than go through it again, I think the dose had been too…

I sympathize. Cancer, especially in the young, is very tough. Patients really have to aggressively advocate for themselves, which itself comes with risks. And the treatments are devastating. The drug I worked on in grad school is really close to killing people to save them. https://en.wikipedia.org/wiki/Fluorouracil

But, recent work with immune treatments for cancer give me hope. I have not seen so many doctors and scientists say things like "the tumor just melted away" before.

Re: A cancer trial’s unexpected result: Remission in every patient

#240

Post by ajuc » Mon, Jun 13, 2022, 7:48 AM UTC

caddemon wrote: post #80

hughes wrote: post #60

Earlier quoted context omitted.

What's unethical is a system that completely drains a person's wealth for getting sick.

Certainly this happens for procedures that should be cheap, and nursing homes are also a huge issue. But in the current discussion it's not clear to me that something like a heart transplant should be cheap. Development of a novel treatment can be very expensive and sometimes involves scarce resources.

Heart transplant is free in countries with a tenth of USA GDP per Capita. And it's not a major cost in their health systems.

American healthcare system is absurdly inefficient.