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"Outrageously" priced weight-loss drugs could bankrupt US health care

arstechnica.com

81–90 of 102 posts

Re: "Outrageously" priced weight-loss drugs could bankrupt US health care

#81
post #21

This is silly because it doesn't take into consideration all the health issues that are alleviated when people stop overeating and get down to a normal weight

Which ones weren’t accounted for in the CBO report, which tried to take into consideration other health issues (from a financial perspective at least)? It states that “at their current prices, [anti-obesity medicines] would cost the federal government more than it would save from reducing other health care spending—which would lead to an overall increase in the deficit over the next 10 years”

> It states that “at their current prices, [anti-obesity medicines] would cost the federal government more than it would save from reducing other health care spending—which would lead to an overall increase in the deficit over the next 10 years”

… and that reason is because obese people have lower lifetime medical cost. Anything that reduces obesity will tend to increase long-term healthcare spending, because it’s cheaper to die of congestive heart failure at 50 than to live to 80 and incur a couple hip replacements and a bunch of expensive end-of-life care.

(technically it varies by country, depending on their particular allocation of end-of-life spending vs earlier care, but generally the expected cost of a 1-unit BMI reduction is more likely to be neutral or positive than an overall total reduction. And the US is even worse since we weight spending enormously heavily towards senior care due to Medicare - someone dying at 40 is a very cheap outcome for our system.)

> A one-unit decrease in BMI showed gains in life expectancy ranging from 0.65 to 0.68 year and changes in total health care costs varying from -€1563 to +€4832.

https://pubmed.ncbi.nlm.nih.gov/37222003/

Skinny people have been absolute bastards about the whole thing from the start, they don’t want to lose the ability to look down on and belittle a class of sub-humans, they want to smirk and tell people to eat less and work out more, and losing that underclass will hurt their own perceived social standing. So now that there’s a drug that helps people eat less, it needs to be argued against strenuously lest that eventuality come to pass.

That’s why you’re seeing the moralizing and “they should lose weight without medical assistance!!!” come out instantly yet again. It was never about actually wanting them to lose weight per se, it was about the ability to moralize to an underclass who that group argues deserves their status - the whole “my assholery is an incentive to lose some weight!” school of thought that is so prominent.

Semaglutide and the class of drug is overall extremely well-studied, well-tolerated, and effective at treating several different families of chronic medical problems around the reward system of the brain. And that’s frankly terrifying to a large group of people who are low-key bigots and are facing the loss of their favorite punching bag. Like what if there was a drug that you just took it and 90% of people lost significant amounts of weight? That’s terrifying to a group of people who without a subclass to look down on will now move down a rung on the social ladder themselves.

The black mirror with the exercise bikes nailed it. People want to toss soda cans at fatties forced to work menial subclass jobs and tell them to lose some fucking weight, that’s what it’s always been about in this discourse from the start. They just can’t quite get away with physical assault in our reality, but they’ll certainly endorse emotional abuse and unequal treatment, “for their own good” etc.

It’s just a shame that this sentiment has also hindered the ability to look into endocrine disruption or gut microbiome etc. There are lots of interesting things that skinnies were too emotionally vulnerable to allow research into, that have just been vaulted over by semaglutide.

Re: "Outrageously" priced weight-loss drugs could bankrupt US health care

#82
post #39

My hot take on these GLP-1 drugs is that they won't work long term for most people. If the plan is to give the drug to as many obese people as possible and take a victory lap, thats going to fail. I don't think its resonable for most people to continue taking GLP-1 antagonists all their lives. Its been widely shown that most people rapdily gain back ~2/3 of their weight after stopping semaglutide. This means that the…

While I 100% agree that GLP-1 antagonists won’t lead most to making actual changes to their behaviors with food outside of forcing them to not over-eat when actively taking the drug, I am not so sure about your hot take here. A woman I know has been on this stuff for a couple years now and while she has plateaued for about 6 months, her current weight is now in a healthier spot. It’s crazy what losing some weight can…

There is also a nexus with the reward system of the brain in general, and semaglutide definitely seems to have effects similar to ADHD medication in these respects. It also seems to help alcoholism for the same reasons - it helps reduce the underlying dysregulation in the reward system that keeps people in that loop.

Probably this will be the next patent-ever greening strategy pursued after the weight loss thing.

It’s an absolutely wild drug in medical terms. “The white whale” is an understatement here. It literally is a white whale for multiple whole fields of medical science.

Re: "Outrageously" priced weight-loss drugs could bankrupt US health care

#83
post #56

Earlier quoted context omitted.

Going to leave a link here to a reddit thread I ran across recently for the curious. https://old.reddit.com/r/unitedkingdom/comments/1cn8dy8/what... Look at how many times NHS is referenced and how it is viewed by those utilizing the system. In my opinion, socialized medicine tends to fail as the overall demand for healthcare will usually exceed the available supply in most societies. I'm sure there are counterexampl…

> I think the benefits of a capitalist healthcare system are underappreciated What benefits? The benefit of mortgaging your home to pay for cancer treatment? The benefit of having your access to healthcare directly tied to your employment (especially considering that many wage workers are kept from working more than 35 hours a week lest they become eligible for employee sponsored health plans)? The benefit of having…

It's not just choice but access. The access to see a specialist without waiting months. The access to see a different provider if you don't like your care. The access to pay cash for services. Choice is also underrated.

Those same people you say can't afford healthcare are the ones that are heavily subsidized by others through ACA, free community health plans, or Medicaid.

Healthcare is not a commodity despite your claim. It requires labor.

It seems most people are generally satisfied with their health insurance in the USA as opposed to the UK (see links below). In fact, the satisfaction from employer provided healthcare was much higher pre-ACA than it is currently. The middle class got shafted with increased premiums and deductibles to help subsidize those with low income. This has led to lower healthcare utilization rates in the middle class. The rich don't care since it's a marginal cost relative to their income/wealth. And, the biggest spenders (elderly) don't care since they are mostly on Medicare.

Most of the countries that report high satisfaction with their socialized medicine are both rich and have a low population count.

---

https://www.kff.org/private-insurance/poll-finding/kff-surve... Most insured adults (81%) give their health insurance an overall rating of “excellent” or “good,” though ratings vary based on health status.

https://www.nuffieldtrust.org.uk/news-item/public-satisfacti... Overall public satisfaction with how the NHS runs now stands at 24%

Re: "Outrageously" priced weight-loss drugs could bankrupt US health care

#84
post #15

Earlier quoted context omitted.

> Serious question: Why not just bootleg the stuff? Historically, the black market for medication has been vanishingly small. People don't as a rule trust drugs they get off of alibaba or wherever; even the viagra gray market is a small fraction of the prescription revenue. And this doesn't treat something critical, it's a weight loss drug. To be blunt most people would probably choose to remain fat vs. buying an ill…

I don't think this is true. Look at the number of people buying Modafinil off Indian websites.

Well technically because India is not a black market, more like a grey market. They didn't pay for IP, Indians just copied the drugs, but they achieved their goal - selling affordable medicine with good enough quality to an average Indian.

Re: "Outrageously" priced weight-loss drugs could bankrupt US health care

#85

Earlier quoted context omitted.

I'm down for it or something similar. Not even joking. A. The issue becomes creating a manufacturing and cold chain distribution system involving the fewest people with compartmentalized knowledge. I'm not sure how you'd launder it or keep enough of it a secret to not get eventually busted because someone would open their mouth. It'd probably be busted with RICO if any sort of profits were involved. Must pay taxes, f…

> get eventually busted because someone would open their mouth Aren't this what "corporations are people" prevent? Plenty of people doing shady, or outright evil stuff, get their way because they're behind a corporation.

It's more like conspiracies fall apart whenever there is more than 1 person. When there are 800, then it's over immediately.

Evil or shady acts must first be illegal to be potentially prosecutable crimes or be injurious to have standing as tort claims. And limited liability isn't unbounded.

Re: "Outrageously" priced weight-loss drugs could bankrupt US health care

#87

The USA should nationalize the health care industry and all the pharmaceutical companies. Illness should not be a source of profit.

Like education, government involvement only causes prices to go up. Why wouldn't they? The government has unlimited money. The education and healthcare industry beats the government like a money pinata. Why would you suggest more government to a government created problem? Usually because people don't realize the government as the root cause in the first place. Get the government out, let people actually pay for thei…

> government involvement only causes prices to go up

This is so hilariously wrong I'm not even going to address it.

Re: "Outrageously" priced weight-loss drugs could bankrupt US health care

#88

> A study by researchers at Yale estimated that drugs like Wegovy can be profitably manufactured for less than $5 per month. Serious question: Why not just bootleg the stuff? It's a very small protein, easy to make, and "research chemical" companies that sell structurally similar bodybuilding drugs and nootropics are a dime a dozen. Search online for "BPC-157" (a protein drug of only slightly inferior complexity) and…

Many reasons. One of them being doctors won't prescribe an off brand drug and insurance won't cover anything related to it. The other reasons are: 1/ Even the manufacturer doesn't know everything about how the drug was made. They characterize the final compound but the compound was made by some sort of living cells so each one has different properties. For the same molecule, one cell line may produce a drug with enti…

Utter nonsense, especially point #1. Drugs absolutely are not random mixtures. Semaglutide's molecular structure is completely characterized -- on its wikipedia page, in its patent application, and elsewhere -- and it's very easy to make identical molecules in the lab.

Novo Nordisk's patent -- US8129343B2 -- lays out the process, which is nothing more than Fmoc solid state synthesis. "The protected peptidyl resin was synthesized according to the Fmoc strategy on an Applied Biosystems 433 peptide synthesizer in 0.25 mmol or 1.0 mmol scale. . ." So they don't make it in cells, but by totally conventional peptide manufacturing techniques.

As for #2, you must be unfamiliar with the existing gray market for pharmaceuticals. Among others, both the bodybuilding community and the nootropics community experiment extensively with pharmaceuticals -- and they do drug synthesis and distribution in a way that's actually extremely cost-effective! (Necessarily, because their customers are humans who pay out of pocket directly.)

#3 is trite and overstated. It's a standard drug industry talking point, but it really has no bearing on this discussion.

Re: "Outrageously" priced weight-loss drugs could bankrupt US health care

#89

> A study by researchers at Yale estimated that drugs like Wegovy can be profitably manufactured for less than $5 per month. Serious question: Why not just bootleg the stuff? It's a very small protein, easy to make, and "research chemical" companies that sell structurally similar bodybuilding drugs and nootropics are a dime a dozen. Search online for "BPC-157" (a protein drug of only slightly inferior complexity) and…

> Why not just bootleg the stuff?

because the US is largely responsible for the rich world's tyrannical patent and copyright laws?

Re: "Outrageously" priced weight-loss drugs could bankrupt US health care

#90
post #72
post #51

Earlier quoted context omitted.

Do you similarly object to the insane gross margins on software? Like in software, pretty sure the main expense is R&D.

The consumer costs are significantly lower for software. For example, the cost of ChatGPT is minuscule in comparison, while the R&D costs are still quite high. The real difference between the two sectors is that for medicine, you have a captive audience. People are willing to give up their life savings for certain medical interventions. That same cannot be said for software.

The other real difference is that the addressable market for most drugs is quite small in terms of number of customers. The vast majority of people just don’t need a particular medicine, especially the life-saving variety. The more niche, the more you have to charge to make up for the large R&D costs.

There are, of course, also instances of gouging. But it’s not like these things should inherently cost $20/mo, or whatever, if you want to be able to pay biomedical researchers enough not to go do something else highly compensated like finance/consulting/whatever. Sadly, I had a lot of classmates in engineering school who went that route instead. We urgently need more nuclear reactors, but one of the smartest guys I know, a nuclear engineer, is doing healthcare private equity.

A lot of saas is more like $200+/mo for businesses, and chatgpt might be $20/mo for consumers, but there are companies paying $1m/mo or more for that api.

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