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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

#61

Post by datsci_est_2015 »

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…

And yet, the defense of the status quo often relies on the supposition that the US is a capitalist nation, perhaps even a “maximally capitalist” one.

I’ll have to keep this in mind the next time it comes up…

Re: Hospitals and universities repurposing drugs at lower cost

#62

Post by mothballed »

simiones wrote: post #60
wk_end wrote: post #25

Earlier quoted context omitted.

> 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…

The maximum libertarian alternative to patents isn't free-for-all copying, it's trade secret formulas - e.g. Coca Cola. Drug patents actually exist as a compromise given the clear need for the state to force companies to publish their drug formulas for research. Allowing companies to just keep their drugs secret would be even more capitalistic, and would increase drug prices even more.

They keep their processes secret instead under the current system, achieving a "trade-secret" like result for some drugs. For some drugs it achieves the same thing because finding a practical economic synthesis is the hard part rather than coming upon a small bit of chemical that is proven to be effective. For others it wouldn't matter whether you kept it secret or not, someone would isolate and characterize it and reverse engineer a practical synthesis.

The biggest value protector arguably of the patent-FDA approval process is on the FDA side, who create massive barriers to entry that mitigate close unpatented chemical competitors from outside the pharma oligopoly from competing.

Re: Hospitals and universities repurposing drugs at lower cost

#63

Post by cogman10 »

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…

Yup, I've seen this sort of off label prescription at least 3 times.

A lot of drugs require almost no evidence (especially if they are relatively cheap or common) to be given to the insurance company when they are prescribed. And if you are willing to pay for it, you can always pay out of pocket if insurance is being a pain.

Re: Hospitals and universities repurposing drugs at lower cost

#64

Post by simiones »

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.

> If the US was maximally capitalist it would be a free for all with no patent protection.

The much more likely alternative in a maximally capitalist / free market maximalist society would be keeping all drug formulas as trade secrets, and thereby having all drugs as branded, no generics whatsoever (or few - perhaps some substances could be reverse engineered). In such a society, having the state force companies to publish their formulas would be seen as unacceptable interference in the free market, almost certainly.

Re: Hospitals and universities repurposing drugs at lower cost

#65

Post by cogman10 »

mothballed wrote: post #55
_DeadFred_ wrote: post #49

Earlier quoted context omitted.

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 g…

If we're just letting doctors yolo* off-label, i have no problem with that, but that functionally relegates FDA protections to testing risk profile at some particular dose regimen, with a bunch of extra bullshit tacked on that is highly inefficient process for off-label use even if partially applicable. It's pretty clear if you're allowing off-label use you can just gate dose-risk profile at one gate and then just ad…

Doctors aren't yoloing it.

What's happening is further research on the medicines are being done which show medicinal benefits for off label use. In many cases, it's researchers seeing a drug has a known side effect and saying "Hmm, I wonder if that side effect can counter this symptom".

What's lacking is the final FDA approval for the drugs being used for these off label treatments. That's because these drugs have to go through all the same tests that are required to get FDA approval in the first place.

IMO, for already approved drugs there should be a faster secondary route to getting these drugs approved for current off label usages. Ideally, it'd be something the FDA itself spearheads in partnership with the likes of the NIH.

Re: Hospitals and universities repurposing drugs at lower cost

#67

Post by simiones »

mothballed wrote: post #62
simiones wrote: post #60

Earlier quoted context omitted.

The maximum libertarian alternative to patents isn't free-for-all copying, it's trade secret formulas - e.g. Coca Cola. Drug patents actually exist as a compromise given the clear need for the state to force companies to publish their drug formulas for research. Allowing companies to just keep their drugs secret would be even more capitalistic, and would increase drug prices even more.

They keep their processes secret instead under the current system, achieving a "trade-secret" like result for some drugs. For some drugs it achieves the same thing because finding a practical economic synthesis is the hard part rather than coming upon a small bit of chemical that is proven to be effective. For others it wouldn't matter whether you kept it secret or not, someone would isolate and characterize it and r…

I'm not really happy with the current system either - I tend to think that the state should just mandate that all medical research be fully published, and either have companies compete on research and manufacturing, or pay for it directly if it can't be made to work as a private business. My point was just that this is very much not a capitalist or libertarian position.

Re: Hospitals and universities repurposing drugs at lower cost

#68

Post by photochemsyn »

If every drug created with taxpayer dollars at government-funded research institutions was open-sourced, there would be a collapse in monopoly control of drug manufacturing and that would lower prices significantly.

The question is then, if corporations can no longer acquire IP rights to drugs created by taxpayer-funded research programs and transferred to their exclusive control (eg if Bayh-Dole is repealed in the USA), who will invest in clinical trial costs that need to be recouped via a period of inflated pricing?

The answer is government-funded, transparent, and statistically-robust clinical trials of drugs. Once a clinical trial is complete, private manufacturers can compete to produce the drugs at the lowest price by optimizing their manufacturing pipelines against a final product standard regulated by the FDA. If they want to run their own R & D divisions for drug development outside the taxpayer-financed university system to generate exclusive private patents, they certainly can - on their own dime. That’s an investment decision.

If you need to review why this government-linked, tightly regulated system is needed for drugs with clinical effects, just look up ‘patent medicine disasters of the early 20th century’.

Re: Hospitals and universities repurposing drugs at lower cost

#69

Post by ItsMonkk »

simiones wrote: post #60
wk_end wrote: post #25

Earlier quoted context omitted.

> 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…

The maximum libertarian alternative to patents isn't free-for-all copying, it's trade secret formulas - e.g. Coca Cola. Drug patents actually exist as a compromise given the clear need for the state to force companies to publish their drug formulas for research. Allowing companies to just keep their drugs secret would be even more capitalistic, and would increase drug prices even more.

This is where prizes come in. If you create a drug and keep it secret, the government can grant you a large prize as an offer to reveal your secret.

This is a much better compromise. The company will end up with more money(and faster!) as a result of this prize than under a patent system - since the patent system induces dead-weight losses, and the government will end up with more lives saved.

Re: Hospitals and universities repurposing drugs at lower cost

#70

Post by rvba »

mothballed wrote: post #55
_DeadFred_ wrote: post #49

Earlier quoted context omitted.

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 g…

If we're just letting doctors yolo* off-label, i have no problem with that, but that functionally relegates FDA protections to testing risk profile at some particular dose regimen, with a bunch of extra bullshit tacked on that is highly inefficient process for off-label use even if partially applicable. It's pretty clear if you're allowing off-label use you can just gate dose-risk profile at one gate and then just ad…

Problem with FDA is that they try the "one size fits all" what often leads to blocking something that works onlu for a group of patients.

Problem with doctors preascribing against FDA is that it can lead to problems or abuse.

Om an unrelated note, FDA could have been bribed to ban something same way a doctor cpuld have been bribed to prescribe it.

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