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Hospitals and universities repurposing drugs at lower cost

kcl.ac.uk

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Re: Hospitals and universities repurposing drugs at lower cost

#41

Post by none2585 »

wk_end wrote: post #25
shevy-java wrote: post #20

The prices of drugs in the USA are especially high. This is interesting because the USA claims to pursue a maximum capitalistic society - but if this were the case, you'd have competition in a free market. But you don't have that. You have a cartel (or rather more than one). A pure capitalistic society works on assumptions that are not real. People are often cheaters. This would have to be taken into account. But whe…

> This is interesting because the USA claims to pursue a maximum capitalistic society No it doesn't. This is silly. Drug prices in the US are high for non-generic drugs because patent law gives the patent holder an artificial government-granted monopoly, which is blatantly not "pure" or "maximum capitalistic". Generic drugs - where the free market does apply - in the US are as cheap or cheaper than in other countries…

I believe you two are arguing the same thing. Maybe the poster could have better worded it "general thought among most people is that the USA ..."

Because you are both absolutely right.

Re: Hospitals and universities repurposing drugs at lower cost

#43

Post by petesergeant »

jawns wrote: post #8

I have been a supporter of Cures Within Reach, a nonprofit that focuses on repurposing drugs, especially for rare diseases. https://www.cureswithinreach.org They have funded some important repurposed-drug studies for Huntingtons Disease, which runs in my family. For a disease like this, it's never going to make sense for major pharmaceutical companies to invest the effort to develop entirely new drugs, but by repurpo…

> For a disease like [Huntingtons], it's never going to make sense for major pharmaceutical companies to invest the effort to develop entirely new drugs

This is ... not correct.

Roche, Regeneron, and Novartis all have novel HD drugs under development in tandem with smaller labs (Ionis, Alnylam, and PTC respectively), and then smaller labs like uniQure and Wave Life Sciences do too. Novartis have already dropped $1bn on the partnership with a committed $2b more. In addition, there are a bunch of incentive schemes for diseases like HD: both the FDA and EMA have offered orphan-drug designation to therapies for HD, the FDA does expedited programmes and can offer RMAT designation for drugs like AMT-130.

With some luck (which is always in short supply for HD treatments, sadly), people with the disease might be able to get a single-injection treatment in the next 12 months[0].

0: https://en.hdbuzz.net/the-other-shoe-drops-uniqure-shares-pl...

Re: Hospitals and universities repurposing drugs at lower cost

#44

Post by jpk2f2 »

amanaplanacanal wrote: post #13
boxed wrote: post #5

Earlier quoted context omitted.

That seems wild. Do you have a citation to back that up? And in what country/countries?

I'm in the US, and there are a couple of wrinkles to this: insurance typically won't cover off label use, so patients end up paying the full cost of the medication, and if there is a big enough market, I believe companies can patent the new use even if the patents for the original use have run out. Doctors here are allowed to prescribe them though.

Insurance absolutely covers off label use. And depending on the area of medicine, off label use can be incredibly common (see cardiac pediatrics).

Re: Hospitals and universities repurposing drugs at lower cost

#45

Post by mothballed »

Aurornis wrote: post #33
oezi wrote: post #18

Earlier quoted context omitted.

The doctors are assuming liability or let the patient sign waivers, which I guess is fine. But the lack of a pathway prevents a lot of commercial possibilities. For instance it is almost impossible to build a business around supporting off-label use cases (for instance selling necessary accessories).

Off label prescribing is extremely common. This isn’t a new or novel concept. Doctors manage patients with off-label prescriptions all day long.

To get a drug approved you have to go through regulatory approval for a particular use. If the fuck-fuck game is you can just off-label for whatever but only if first approved by the FDA to solve some other problem, why not just bypass the bullshit and get straight to the point of approving the drug without any approved use? Oh yes, because that assures the barriers to entry are arbitrarily higher, and Pfizer and other ilk can insulate themselves from competition. Thanks FDA!

Re: Hospitals and universities repurposing drugs at lower cost

#46

Post by vjvjvjvjghv »

wk_end wrote: post #25
shevy-java wrote: post #20

The prices of drugs in the USA are especially high. This is interesting because the USA claims to pursue a maximum capitalistic society - but if this were the case, you'd have competition in a free market. But you don't have that. You have a cartel (or rather more than one). A pure capitalistic society works on assumptions that are not real. People are often cheaters. This would have to be taken into account. But whe…

> This is interesting because the USA claims to pursue a maximum capitalistic society No it doesn't. This is silly. Drug prices in the US are high for non-generic drugs because patent law gives the patent holder an artificial government-granted monopoly, which is blatantly not "pure" or "maximum capitalistic". Generic drugs - where the free market does apply - in the US are as cheap or cheaper than in other countries…

"Drug prices in the US are high for non-generic drugs because patent law gives the patent holder an artificial government-granted monopoly, which is blatantly not "pure" or "maximum capitalistic"."

This is very much capitalistic. It's not competitive markets (which are good for consumers) but capitalists hate competition once they have made it to the top.

Re: Hospitals and universities repurposing drugs at lower cost

#47

Post by mothballed »

Geeek wrote: post #23
MrBuddyCasino wrote: post #22

Earlier quoted context omitted.

Look at the development of price and quality of something that is outside the regulated medical system, like eg Lasik, and everything within that system. Its like night and day. If we had proper competition and price discovery, things would be much better.

On the other hand, dental work, especially anything above basic filings, are prohibitively expensive. I'd say Lasik is the exception, not the rule.

Are you in the US? This is not my experience at all. I've paid in US <2000 for dental invasive surgery including general anesthesia straight cash. That's approaching prices for medical care in Mexico.

Re: Hospitals and universities repurposing drugs at lower cost

#48

Post by vjvjvjvjghv »

Aurornis wrote: post #37
shevy-java wrote: post #20

The prices of drugs in the USA are especially high. This is interesting because the USA claims to pursue a maximum capitalistic society - but if this were the case, you'd have competition in a free market. But you don't have that. You have a cartel (or rather more than one). A pure capitalistic society works on assumptions that are not real. People are often cheaters. This would have to be taken into account. But whe…

> This is interesting because the USA claims to pursue a maximum capitalistic society I don’t know why you think this. The US is not a maximally capitalist society. The reason drug prices are so high is due to regulations restriction who can manufacture them due to government-granted temporary monopolies through patent law. If the US was maximally capitalist it would be a free for all with no patent protection.

You are confusing capitalism with competitive markets. These are very different things.

Re: Hospitals and universities repurposing drugs at lower cost

#49

Post by _DeadFred_ »

mothballed wrote: post #45
Aurornis wrote: post #33

Earlier quoted context omitted.

Off label prescribing is extremely common. This isn’t a new or novel concept. Doctors manage patients with off-label prescriptions all day long.

To get a drug approved you have to go through regulatory approval for a particular use. If the fuck-fuck game is you can just off-label for whatever but only if first approved by the FDA to solve some other problem, why not just bypass the bullshit and get straight to the point of approving the drug without any approved use? Oh yes, because that assures the barriers to entry are arbitrarily higher, and Pfizer and oth…

Like a lot of the systems we have today, it grew from good intentions. We need to figure out a way to refresh our systems without throwing them away. The current system does provide new drugs and benefit. The question is is it limiting, and are the tradeoff of those limits worth while.

In other words it takes hard work, with politically risky outcomes and an upside that becomes invisible as far as political careers go. We need to figure out how to refresh our systems in an environment where that type of thing just stumbles along. Maybe a couple of politicians elected who have lost out because of the status quo, but that want to improve it not throw it away. Maybe working with them to motivate them to take it on as a pet project and move things.

Re: Hospitals and universities repurposing drugs at lower cost

#50

Post by fc417fc802 »

jnovek wrote: post #34
oezi wrote: post #18

Earlier quoted context omitted.

The doctors are assuming liability or let the patient sign waivers, which I guess is fine. But the lack of a pathway prevents a lot of commercial possibilities. For instance it is almost impossible to build a business around supporting off-label use cases (for instance selling necessary accessories).

I have some difficult-to-treat medical issues and about 1/3 of the handful of pills I take every day are off-label. I think when you get into less common medical concerns off-label use becomes much, much more frequent. E.g. gabapentin is an anti-seizure medication that has been found to reduce neuropathic pain as well. It has shot up to the 5th most prescribed medication in the last decade as it has replaced long-ter…

> I’ve never been asked to sign a waiver

That presumably has to do with the risk profile of the medications you've taken. If there was a high risk of devastating side effects and it was off label presumably the prescriber wouldn't be willing to take on the liability.

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