Dutch join backlash at expensive drugs by making their own • Hacker News Board

Re: Dutch join backlash at expensive drugs by making their own

#51

Post by Retric » Sat, Mar 09, 2019, 4:23 PM UTC

sonnyblarney wrote: post #44

eecc wrote: post #30

Earlier quoted context omitted.

Please provide conclusive proof this process is not consequence of neoliberal policies, aimed at defunding public spending and encouraging for-profit spinoffs, aligning the research process to its ideology

If you're going to make such a conspiratorial claim, then the onus is on you to provide the proof. I think the answer is probably a little bit more grey FYI.

Seems likely either drugs would end up being used, or government would stop funding drug R&D research.

Saying funding would continue without any benifits seems to be the least likely outcome. Personally, I would be fine stopping all public drug research, but I suspect more people would want to continue...

Re: Dutch join backlash at expensive drugs by making their own

#52

Post by ls612 » Sat, Mar 09, 2019, 4:28 PM UTC

eecc wrote: post #30

aaavl2821 wrote: post #16

Earlier quoted context omitted.

without for profit companies, all that taxpayer funded research would be sitting on a shelf, never becoming medicines to treat patients. In the last 2 years I think every drug that got approved by FDA was developed by a for profit company. Drugs don't emerge fully formed from academia, just waiting for pharma to patent them and jack up the price. Pharma spends more on r&d than academia

Please provide conclusive proof this process is not consequence of neoliberal policies, aimed at defunding public spending and encouraging for-profit spinoffs, aligning the research process to its ideology

A very large portion of R&D costs for drugs are in doing phase 3 clinical trials. These will always be expensive because you have to recruit and closely monitor several thousand people with a relevant condition to determine if a treatment is better than existing alternatives and what sort of side effects a medication has. Many drugs which were developed by academia using federal dollars and which passed phase 1 and 2 trials fail phase 3. Pretty much every phase 3 trial is paid for by private industry.

Re: Dutch join backlash at expensive drugs by making their own

#53

Post by pault » Sat, Mar 09, 2019, 4:31 PM UTC

Freak_NL wrote: post #10

rocqua wrote: post #3

Yes, less payout on rare disease drugs is less of an incentive to research them. But: * Drug companies have profit margins of 15% on average indicating there is room. * many recent 'orphan drugs' were not newly developed, but off-label uses registered with the FDA for a whole new patent. * these drugs rely heavily on research done by universities through public funding. It stands to reason the public should get to be…

The blackmail part is literally by-design. They call it value-based pricing, where the price of the medicine is not related to its cost plus a profit margin plus a margin for research and development of new or improved medicines, but on what each nation (pricing is adjusted per country) is willing and able to bear to keep a small group of people alive (or at least comfortable). It puts quite a dent in public health c…

This model is perfectly fine for most of the economy, but is a perfect example that for-profit medicine is inherently flawed.

Re: Dutch join backlash at expensive drugs by making their own

#54

Post by cedex12 » Sat, Mar 09, 2019, 4:32 PM UTC

Are there countries where drug research and production isn't privatized? I would naively consider it ideal if research and “recipes” were made in the open, shared between countries and the production wouldn't be the job of for-profits… what am I missing?

Re: Dutch join backlash at expensive drugs by making their own

#55

Post by AndrewGaspar » Sat, Mar 09, 2019, 4:41 PM UTC

jknz wrote: post #50

simonsaidit wrote: post #46

In Denmark I recently saw a discussion between politicians and the just resigned head doctor of a major hospital where he said he no longer could bear the responsibility of “optimizing” and that there was not enough money in the coming years no mattter how much money the politicians were promising in their soon to be election campaigning.. and his belief was we had to decide what we can afford as a country in regard…

I am wondering if any cost-analysis studies have been done to assess the trade-off between lengthy end-of-life terminal care and the corresponding cost. Doctors seem to make such decisions all the time; but we may have at some point to discuss collectively how much of the public money involved in end-of-life terminal care (last two months, say) for elderly should be used instead for better care earlier in life. In co…

For better or worse, people don't apply purely rational thinking about trade-offs to healthcare. I think it would make a lot of people squeamish to hear this argument about why somebody, where somebody might be mom or dad, isn't going to receive certain care because they didn't pay for it earlier in their life.

Unfortunately the trade-offs don't go away, and we haven't figured out a way of making these trade offs that doesn't feel horribly statist (so called "death panels") or callous (private insurance denying care).

Re: Dutch join backlash at expensive drugs by making their own

#56

Post by pault » Sat, Mar 09, 2019, 4:41 PM UTC

It's really depressing knowing that no matter what policies other countries adopt to bring drug prices down it will never happen here in the US because there's too much money to be made from bribes^H^H^H^H^H^H donations from the pharmaceutical companies.

Re: Dutch join backlash at expensive drugs by making their own

#57

Post by Thriptic » Sat, Mar 09, 2019, 4:46 PM UTC

One thing that is typically not mentioned in these debates is the fundamental structure of the industry. Let's say someone finds a research compound which looks to be promising, and they start a new company to try to commercialize it. Often, they are looking at at least 1-2 decades to get that product to market. Assuming they don't sell out to a big company, they almost certainly have to go public before starting trials in order to amass the required funds. Normally, a public company is expected to show regular profits and growth. This is impossible for a new pharma company because they don't have a product yet, so they are expecting investors to foot the bill for years and years of development and trials. During this time, if the compound fails a major trial, the entire company can go under because it may be prohibitively expensive to start over again if there is a problem. Therefore, not only is there a massively delayed ROI but a lot of risk. As such, when a company gets something to market, investors expect massive profits for shouldering that risk and delay. It is simply not feasible for companies to charge small amounts of money because no investor could justify locking up capital / taking those risks for something other than a huge return.

Re: Dutch join backlash at expensive drugs by making their own

#58

Post by Retric » Sat, Mar 09, 2019, 4:52 PM UTC

ls612 wrote: post #52

eecc wrote: post #30

Earlier quoted context omitted.

Please provide conclusive proof this process is not consequence of neoliberal policies, aimed at defunding public spending and encouraging for-profit spinoffs, aligning the research process to its ideology

A very large portion of R&D costs for drugs are in doing phase 3 clinical trials. These will always be expensive because you have to recruit and closely monitor several thousand people with a relevant condition to determine if a treatment is better than existing alternatives and what sort of side effects a medication has. Many drugs which were developed by academia using federal dollars and which passed phase 1 and 2…

I don’t agree that phase 3 trials must be that expensive.

Currently they cost ~19 million each which is frankly not that big of a deal. A larger issue is only ~15% of drugs make it through the process. With ~20 new drugs a year this only adds up to 2.5 billion per year which a frankly a drop in the bucket compared to drug costs.

Re: Dutch join backlash at expensive drugs by making their own

#59

Post by Ericson2314 » Sat, Mar 09, 2019, 4:55 PM UTC

Thriptic wrote: post #57

One thing that is typically not mentioned in these debates is the fundamental structure of the industry. Let's say someone finds a research compound which looks to be promising, and they start a new company to try to commercialize it. Often, they are looking at at least 1-2 decades to get that product to market. Assuming they don't sell out to a big company, they almost certainly have to go public before starting tri…

That's why drug bounties, or even "promising compound bounties", can be good for researchers too.

Re: Dutch join backlash at expensive drugs by making their own

#60

Post by JKCalhoun » Sat, Mar 09, 2019, 5:37 PM UTC

Thriptic wrote: post #57

One thing that is typically not mentioned in these debates is the fundamental structure of the industry. Let's say someone finds a research compound which looks to be promising, and they start a new company to try to commercialize it. Often, they are looking at at least 1-2 decades to get that product to market. Assuming they don't sell out to a big company, they almost certainly have to go public before starting tri…

Maybe drug "companies" should be government entities then and not for-profit at all.