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With no prospects for profits, big pharma neglects new infectious diseases

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Re: With no prospects for profits, big pharma neglects new infectious diseases

#31
post #17

Earlier quoted context omitted.

There are several cancer (lymphomas) that were literal death sentences a decade or two ago, but how have a very high cure rate. It's not fair to say we don't develop cancer drugs because some, very difficult to treat cancers, haven't seen as much progress as others.

Testicular cancer is now very treatable, but before Cisplatin, the prognosis was pretty grim. I guess to grandparent's comment, we absolutely do develop chemotherapy drugs, and many don't just buy you six months, they're life-saving.

I unfortunately can't find it, but there was an interesting chart that showed overall survival in metastatic colorectal cancer.

It covered the last 30 years. Each new therapy improved survival by only 6-12 months, but each new drug was more effective than the last. Over those 30 years, the median survival went from 6 months to over 5 years.

People shouldn't discount incremental improvements because that's often how medicine progresses.

Re: With no prospects for profits, big pharma neglects new infectious diseases

#33
post #15

Earlier quoted context omitted.

Sure you could do that, but manufacturing drugs isn't as simple as hitting a switch - the infrastructure needed along with the scientific expertise is sometimes hard to replicate.

The infrastructure and expertise exists in India, and they'll gladly manufacture drugs at a cost that the developing world can afford.

Depends on the drug. Small molecules, sure? Complex biologics? Even other large pharma companies can have challenges making those.

Re: With no prospects for profits, big pharma neglects new infectious diseases

#34
post #2

Perhaps they’re behaving entirely rationally. Infectious diseases do not kill that many people compared to cancer in America. We may have a bad “flu” year this year, with a spike of elderly deaths, but we have a bad cancer year every year.

Perhaps what's "rational" in a purely economic sense isn't whats best for the nation or for society. In an economic sense, you could make an argument that slavery is "rational" as far as profits for slaveholders are concerned, but we don't allow slavery because its wrong and immoral despite the potential economic benefits to certain vested interests. Similarly, perhaps its time that we as a society reevaluated our re…

>but we don't allow slavery because its wrong and immoral

No, slavery is not allowed because the pro slavery people lost, they are forced to stop the practice. It certainly ain't wrong or immoral according to the pro slavery people.

Re: With no prospects for profits, big pharma neglects new infectious diseases

#35
post #2

Perhaps they’re behaving entirely rationally. Infectious diseases do not kill that many people compared to cancer in America. We may have a bad “flu” year this year, with a spike of elderly deaths, but we have a bad cancer year every year.

But we don't really develop "cancer" drugs. We develop a drug that treats certain type of pancreatic cancer that give the individuals another 3-6 months to live. But curing an infectious disease can give someone another 40 years.

This recent drug does better than 3-6 months: Nivolumab . One-Third of Patients With Advanced Melanoma Survive at Least 5 Years After Nivolumab Treatment. (https://www.ascopost.com/issues/may-10-2016/one-third-of-pat...

Here's another recent success : https://hcp.lutathera.com/ --- https://www.nejm.org/doi/full/10.1056/NEJMoa1607427 At the data-cutoff date for the primary analysis, the estimated rate of progression-free survival at month 20 was 65.2% (95% confidence interval [CI], 50.0 to 76.8) in the 177Lu-Dotatate group and 10.8% (95% CI, 3.5 to 23.0) in the control group.

Lutathera delivers a radioactive molecule to the tumor.

Re: With no prospects for profits, big pharma neglects new infectious diseases

#36
post #28

I thought the "party line" was that private industry doesn't accomplish much if anything, so isn't "big pharma" irrelevant? It makes more sense to demand higher taxes and more basic research.

The problem is that regulation is so expensive there isn't any financial motivation in researching does that are unlikely to generate massive revenue. The reason for this is FDA is fundamentally extremely conservative. The people that run the regulatory system are just faceless bureaucrats and are risk adverse. Their pay is based on seniority and there isn't any financial motivation for them to take risks or stand ou…

I think people who talk about "over regulation" should be excluded from serious discussion. "More" or "less" or "no" regulation is never the answer.

I don't think we have ultra safe drugs. I could be just paranoid, but I don't think the FDA is that good at monitoring the manufacturing of drugs. And I know I've read about how sometimes they approved a new dosage without actual testing and it turned out in at least one case the delivery mechanics didn't work properly.

Deregulation is like reform. Enough people think it's automatically good, that it's completely meaningless, and because it's meaningless the worst people pick it up as a slogan and run with it.

As someone that could really benefit from new drug approvals, I don't see deregulation as my savior because if it's executed by the worst people, then it will just lead to more snake oil and less ability to differentiate.

Re: With no prospects for profits, big pharma neglects new infectious diseases

#37
post #2

Perhaps they’re behaving entirely rationally. Infectious diseases do not kill that many people compared to cancer in America. We may have a bad “flu” year this year, with a spike of elderly deaths, but we have a bad cancer year every year.

But we don't really develop "cancer" drugs. We develop a drug that treats certain type of pancreatic cancer that give the individuals another 3-6 months to live. But curing an infectious disease can give someone another 40 years.

How much experience do you have in oncology? There are millions of breast cancer survivors that might disagree with you. There is also the false assumption that we haven’t made much progress in infectious diseases when, in fact, we have. Tamiflu was launched in 1999. AIDS drugs are light years ahead of where they were 25 years ago. We have effective vaccines for some of history’s worst killer diseases. Gilead has been working on remdesivir since 2016 for Coronaviruses. Hepatitis C is now curable (also thanks to Gilead.)

There is a lot of significant work happening in infectious diseases. However, curing cancer is the holy grail and a pursuit of that is on the same level as pursuing manned space flight. Flying people into space seemed frivolous at the time as well. After all, think of all of the hungry kids would could feed if we redirected Apollo money! However, space flight gave society countless advances that we didn’t foresee at the time. Perhaps we should argue that studying quantum physics is a waste of resources. Or studying astronomy. Or any number of fields where societally-useful breakthroughs are few and far between.

It’s ridiculous to imply that developing cancer drugs should be ditched in favor of developing more infectious disease drugs. We can walk and chew gum at the same time: this isn’t guns or butter.

If we want to apply pure rationality to drugs: let’s stop cancer drug expenditures so we can save more people from malaria, then we could apply that logic to social programs as well: why bother helping the mentally disabled when instead we could direct those funds towards something that provides more economic value to society? A kid with cerebral palsy isn’t going to contribute as much to society as a healthy kid — so why waste resources on that research? Of course it isn’t a waste when it’s your kid. Following that line of reasoning and we ultimately end up with eugenics and society would become a very nasty place indeed.

Re: With no prospects for profits, big pharma neglects new infectious diseases

#38

Earlier quoted context omitted.

But we don't really develop "cancer" drugs. We develop a drug that treats certain type of pancreatic cancer that give the individuals another 3-6 months to live. But curing an infectious disease can give someone another 40 years.

This recent drug does better than 3-6 months: Nivolumab . One-Third of Patients With Advanced Melanoma Survive at Least 5 Years After Nivolumab Treatment. ( https://www.ascopost.com/issues/may-10-2016/one-third-of-pat... Here's another recent success : https://hcp.lutathera.com/ --- https://www.nejm.org/doi/full/10.1056/NEJMoa1607427 At the data-cutoff date for the primary analysis, the estimated rate of progression-…

$150K+/yr. OOF. On the positive side, 20 years from now these drugs will be dollar a bucket as generics. Thank god for capitalism.

Re: With no prospects for profits, big pharma neglects new infectious diseases

#39
post #15

Earlier quoted context omitted.

> Great, here is $500M as long as you agree to produce as much drug as needed for free or some nominal cost Why not give $5bn (or whatever the NPV of the drug at a reasonable rate of return might be) in exchange for releasing the drug into the public domain? Then any number of generics manufacturers could be contracted to maintain a stockpile.

Sure you could do that, but manufacturing drugs isn't as simple as hitting a switch - the infrastructure needed along with the scientific expertise is sometimes hard to replicate.

> the infrastructure needed along with the scientific expertise is sometimes hard to replicate

Then the original developer can be the manufacturer. But no need to add hurdles.

Re: With no prospects for profits, big pharma neglects new infectious diseases

#40
post #25
post #18

Earlier quoted context omitted.

I wasn't using the word "artificial" in a negative sense; I was pointing out that this is a narrow example of socialized healthcare and why it's beneficial.

Gotcha. As an aside, the "netflix model" for drug payments is already a reality in Louisiana. Basically the drug maker and state government negotiated a payment for enough hepatitis C drugs to cure everyone in the state.[1] [1] http://ldh.la.gov/index.cfm/newsroom/detail/5181

Yeah, it's called single payer and it's pretty effective. We should try it on other diseases, all of them.
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