How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India • Hacker News Board

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#341

Post by tomc1985 » Mon, May 09, 2016, 7:56 PM UTC

greeneggs wrote: post #337

tomc1985 wrote: post #327

Earlier quoted context omitted.

I'm not in that industry, I'm sure my ideas aren't very good. * massive step up in grant funding to front-load R&D costs so they're paid by the time the drug is out, or * worldwide medical R&D fund, bounties for individual re-searchable issues, or * move private R&D to universities, have profits gained pay back R&D, send any extras to researchers, and shutter R&D aspect of private medicine At least I'm trying to thin…

I don't have a problem with your ideas. I think the vast majority of drug development costs are being borne by industry right now. So when you say "massive step up in grant funding," that might have to be something like a 100x funding increase. And the NIH budget has been flat (when adjusted for inflation) since 2002 [1], so there doesn't seem to be much political will for your suggestions. (And that's bad! Even if y…

Indeed, lack of political will kills many things :/

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#342

Post by greeneggs » Mon, May 09, 2016, 8:23 PM UTC

tomc1985 wrote: post #326

greeneggs wrote: post #316

Earlier quoted context omitted.

But isn't it worth two or three years of income to save your life? It seems absolutely worth it to me, frankly a much better value than almost anything I spend money on (I mean, Netflix?).

Not if people who can't afford it have their lives ruined simply because they can't afford it

How is someone's life ruined by the existence of a treatment option that didn't exist before?

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#343

Post by WalterBright » Mon, May 09, 2016, 10:06 PM UTC

cheriot wrote: post #332

WalterBright wrote: post #197

Earlier quoted context omitted.

The investors and the courts may have very different notions of the fair market value. If it's much less than the investors expect, expect no more cures. Consider that the whole point of the government taking it is the idea that the fair market price is too high. Also, there are many, many ways the government can take things without just compensation. For example, civil asset forfeiture. They could get the patent dec…

The point of the government taking it is that when there's only one seller people get greedy. That's why both sides have recourse of the courts. Considering the lives at stake, intentionally paying 20% more than the estimated value would be a better deal than the current system.

Price controls have a very long history of unintended negative consequences. Keep in mind that the cure was developed with the expectation of high profits, and with no cure all the lives at stake would have died.

Suppose a cure for Alzheimer's never happens because price controls were put on the Hep C cure? Are you willing to risk it?

The price will come down after the patent expires. People are better off with a high priced cure than no cure.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#344

Post by dcposch » Mon, May 09, 2016, 11:51 PM UTC

justsaysmthng wrote: post #309

corvallis wrote: post #122

Something to keep in mind is the population that typically has chronic Hep C requiring this drug. It's IV drug users who share needles. Think they have $84K? Nope. Think they have insurance? Nope. Guess who pays for it. Oh that's right, it's Medicaid! It's you, the taxpayers. Where is there a large concentration of people that have Hep C? Prisons. Guess who pays for it then? Still you! The prison systems are obligate…

My father is currently under treatment (for around 50,000 EUR) He's not an IV drug user, never was, most probably it was a dentist who infected him many years ago. Don't oversimplify things like this, there are lots of situations you aren't thinking about..

He's not oversimplifying. He's not saying that all Hep C patients are IV drug users.

He's just staying that a lot of Hep C care is taxpayer funded, and that Gilead is therefore price gouging the American taxpayer. That your dad is also being price gouged, over in Europe, is just icing on the cake.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#345

Post by dcposch » Mon, May 09, 2016, 11:51 PM UTC

justsaysmthng wrote: post #309

corvallis wrote: post #122

Something to keep in mind is the population that typically has chronic Hep C requiring this drug. It's IV drug users who share needles. Think they have $84K? Nope. Think they have insurance? Nope. Guess who pays for it. Oh that's right, it's Medicaid! It's you, the taxpayers. Where is there a large concentration of people that have Hep C? Prisons. Guess who pays for it then? Still you! The prison systems are obligate…

My father is currently under treatment (for around 50,000 EUR) He's not an IV drug user, never was, most probably it was a dentist who infected him many years ago. Don't oversimplify things like this, there are lots of situations you aren't thinking about..

He's not oversimplifying. He's not saying that all Hep C patients are IV drug users.

He's just staying that a lot of Hep C care is taxpayer funded, and that Gilead is therefore price gouging the American taxpayer. That your dad is also being price gouged, over in Europe, is just icing on the cake.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#346

Post by 0bamacare » Tue, May 10, 2016, 12:46 AM UTC

ubernostrum wrote: post #193

corvallis wrote: post #122

Something to keep in mind is the population that typically has chronic Hep C requiring this drug. It's IV drug users who share needles. Think they have $84K? Nope. Think they have insurance? Nope. Guess who pays for it. Oh that's right, it's Medicaid! It's you, the taxpayers. Where is there a large concentration of people that have Hep C? Prisons. Guess who pays for it then? Still you! The prison systems are obligate…

Actually a significant population in the US was infected by blood transfusion; the US didn't start properly/universally screening blood and taking precautions for hep C until 1992. This is why there's a spike in infection rate among older people, and why hep C is considered a looming cost crisis for Medicare -- we don't yet know the full extent of the infectious disaster that was unscreened blood, but it's ticking aw…

That's the 10% that the insurance companies have already treated.Most of those waiting now are the F1 and F2 variety.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#347

Post by chongli » Tue, May 10, 2016, 1:34 AM UTC

greeneggs wrote: post #318

chongli wrote: post #271

Earlier quoted context omitted.

The best alternative is really quite simple: public funding for lifesaving medicines. This model also works for the provision of medical care and is used throughout the entire developed world, with one exception.

As far as I know, this is not true anywhere in the world. What drugs out there have had their development and trials fully (or majority) funded by governments, either in Europe or---apropos here---India?

Huge, huge amounts of drug discovery is funded by governments[0] around the world. Pharmaceutical companies step in to fund the trials after the promising results come out. A lot of the trials take place in India under ethically concerning conditions[1].

[0] http://www.ncbi.nlm.nih.gov/books/NBK50972/

[1] http://www.who.int/bulletin/volumes/86/8/08-010808/en/

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#348

Post by ChrisLTD » Tue, May 10, 2016, 3:08 AM UTC

icebraining wrote: post #269

ChrisLTD wrote: post #257

Earlier quoted context omitted.

Bingo. The private profit motive isn't the only way to get things done. Two of the greatest scientific and engineering feats of the 20th century, the atom bomb and landing on the moon, were both government run and funded.

Not sure if the war motive is much better than the profit motive, though.

To stretch the analogy, lives are being threatened in war as they are also threatened by medical illness.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#349

Post by rushabh » Tue, May 10, 2016, 7:43 AM UTC

halviti wrote: post #243

chris_wot wrote: post #237

Earlier quoted context omitted.

Actually, India basically refuses to recognise patents for a wide variety of pharmaceutical products. For a long time they refused to recognise patents for drugs that combat AIDS and a thriving market for generics sprung up. There was a lot of posturing and complaining by pharmaceutical companies in the U.S. and the U.S. Government tried to heavy the Indian Government, but to no avail. When it became apparent that th…

While I tend to lean more to your side of the argument, the devil's advocate in me has to point out the fact that you leave out the massive costs of research, development, clinical trials / fda approval, etc. that go in to getting a drug to market. This not to mention all the extra capital needed to fund research into all of the drugs that never make it to market before a company finds something that works.

There still needs to be incentive to lower the cost. For example, to lower costs of clinical trials, companies can invest more in computer simulations and find other ways to reduce those costs. Also this might also force big pharma companies to collaborate more with each other rather than re creating the wheel.

Re: How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India

#350

Post by emn13 » Tue, May 10, 2016, 12:28 PM UTC

greeneggs wrote: post #317

emn13 wrote: post #245

Earlier quoted context omitted.

That's only fair if you believe that the seller has the moral right to maximize their earnings. I think that's questionable across the board, but certainly in the pharmaceutical industry. As in: the idea behind capitalism (the reason we put up with it) is not that price-gouging is some fundamental right we should worship, but because capitalism works . What's that mean? It efficiently allocates resources. How does it…

> Notably, patents of life-sustaining medicines utterly destroy that cornerstone of capitalism. People can and will pay almost anything to get that drug, so the seller can charge what it wants - that's not capitalism as it's supposed to work, that's a hostage scenario. I don't think it is appropriate to compare a drug company that created a life-saving drug to a hostage taker. And in this scenario it is particularly…

Right, so in this case there was a tiny modicum of competition, and the smart company selling the drug priced their product appropriately.

However, that does not mean that they (or some other organization) couldn't have developed this drug for less.

The question isn't whether it's better that what came before, the question is whether it's efficient. If there were many buyers and sellers, you'd have some faith that is at least approximately efficient.

But with just one seller, they could recoup their costs many, many times over. That's terribly inefficient - those resources could be better used elsewhere.

And it's quite a bit worse than that - by being so inefficient, you're creating all kinds of perverse incentives. Instead of trying to find and create a worthwhile drug, the aim is to find those drugs with captive audiences. The Martin Shkreli saga illustrates that quite blatantly.

The appropriate benchmark is efficiency, not whether the drug at the offered price is better than nothing.