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

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

#91

Post by pkaye » Sat, Mar 09, 2019, 9:07 PM UTC

pard68 wrote: post #69

radicalbyte wrote: post #24

It's worth noting that pharmacists in The Netherlands have a doctorate and the same training requirements as MDs (the study last until 24/25 with no skip years). The requirements are considerably lower in other countries (in the UK for example they just need a BSc). Source: my wife is a pharmacist and could have worked in the UK after only completing 1/3rd of her study.

In the US it takes: * 4 years undergrad, of which 90 credit hours must be a specific series of courses * 4 years PharmD, doctorate program * 1800 hours of internship At this point a student has met all requirements to sit for the two license exams (NAPLEX and MPJE[^1]):). Many students will elect for an additional period of education due to the competitive nature of pharmacist jobs in the USA. Those two extra opportu…

12 years of training... does that even make economic sense? Do pharmacists get paid a lot?

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

#92

Post by dodobirdlord » Sat, Mar 09, 2019, 9:13 PM UTC

AndrewGaspar wrote: post #55

jknz wrote: post #50

Earlier quoted context omitted.

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 tha…

> 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")

These already exist. Donor organs are a scarce resource and there aren't enough to go around, so some person(s) has to decide who lives and who dies. People already regularly die in the United States because it is uneconomical to have Level I/II trauma centers within emergency response distance of the entire country.

People have very different ethical standards for how people should act in advance planning scenarios versus in the moment. I think most people agree with the unreasonableness of arranging to have an on call neurosurgeon in a small town in the middle of nowhere. But I think people would have a very different reaction if the same neurosurgeon refused to skip a day of teaching medical students to instead walk across the hospital and carry out a 12 hour brain surgery on a 90 year old patient with dementia who will be dead from lung cancer in two months anyway.

I think people will just have to get over it. There aren't alternatives.

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

#93

Post by dmitriid » Sat, Mar 09, 2019, 9:28 PM UTC

aaavl2821 wrote: post #68

JKCalhoun wrote: post #60

Earlier quoted context omitted.

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

One could make a pretty good argument that a government funded drug research system would end up with more expensive drugs (in the form of higher taxes) than a for profit system Drugs, as a whole, aren't that expensive today compared to other healthcare. They make up 9.8% of US health care expenditure, which is pretty much middle of the pack compared to OECD countries. Hospitals, largely "non profit" (but sometimes m…

> One could make a pretty good argument that a government funded drug research system would end up with more expensive drugs (in the form of higher taxes) than a for profit system

Please, do.

Meanwhile: https://news.ycombinator.com/item?id=19264699

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

#94

Post by duxup » Sat, Mar 09, 2019, 9:31 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…

In the US a while back there was a lot of political drama over "death panels". For the record it was all BS there were no "death panels" proposed in Obama care and it was nothing like the people who used that phrase implied.

Interesting enough the one thread that the folks pushing that concept picked out was a provision that paid doctors for consulting with people about what kind of end of life care they would like. That's all it was. There had been strides that showed individuals chose all on their own to refuse some of the most expensive late stage life care after having talked to a doctor about it. The result also meant there was significant cost savings, reduced stress for those dying and their families.

Sadly the BS surrounding "death panels" meant that provision was left out of Obamacare.

I don't know if there is an afterlife with any sort of destination based on people's choices, but I like to think if there is there's a special room in hell for folks who used that provision to score political points, and likely meant that some folks may have suffered more because of it.

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

#95

Post by dmitriid » Sat, Mar 09, 2019, 9:31 PM UTC

aaavl2821 wrote: post #19

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…

Drug companies increasingly fund r&d with their balance sheet, not with internal r&d. So the money they pay for new drugs is not reflected in the profit and loss statement. There are maybe 15 pharma companies that commercialize a large portion of the drugs developed in the world. The vast vast majority of drug companies never make a penny in profit. They sell their products or companies to bigger, commercial companie…

R&D spending has been relatively stagnant. While industry revenue increased by 45 percent, or $241 billion from 2008 to 2014, industry spending on R&D increased just 8.5 percent in that same period, from $82 billion to $89 billion (GAO 2017). By some measures, R&D expenditures are actually falling, as more firms are outsourcing R&D to third parties. In that seven-year period, purchased R&D increased from $20.5 billion to $31.2 billion while in-house R&D fell from $61.7 to $58.2 billion (GAO 2017). Finally, the industry can only claim partial credit for recent medical breakthroughs. The federal funding provided by taxpayers contributes around 25 to 30 percent of all R&D spending per year, and a Bentley College study found that all 210 drugs approved between 2010 and 2016 were rooted, in whole or in part, on National Institute of Health (NIH)-funded research (Cleary et al. 2017).

http://rooseveltinstitute.org/wp-content/uploads/2019/02/RI_....

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

#96

Post by Pharmakon » Sat, Mar 09, 2019, 9:41 PM UTC

pkaye wrote: post #82

Pharmakon wrote: post #77

Earlier quoted context omitted.

One could make a pretty good argument that a government funded drug research system would end up with more expensive drugs (in the form of higher taxes) than a for profit system. That sounds like a pretty interesting argument, but I notice that you didn’t actually make it. The rest of your post is full of claims sans evidence, and a lot of numbers out of context. For example how many of those newly approved drugs are…

> rejiggered stereochemistry to keep a patent Can someone tell me how this patent extension works? If they improve on something, is that a new patent? Does the original patent expire or gets extended? Why couldn't someone else have discovered the new stereochemistry before the original inventor dose so? If the new discovery is not significant, wouldn't its be sufficient to use the generic form of the original chemist…

A great, easy to understand example is found in the drug Prilosec vs. Nexium, the latter of which is a stereoisomer of the former. Prilosec is Omeprazole, which is part of a class of drugs called Proton Pump Inhibitors (PPI’s) which treat severe recurrent heartburn and GERD, as well as esophageal erosion from those conditions. Prilosec (Omeprazole) was due to go generic, so the company decided to isolate and purify the S isomer and worked hard to convince the FDA that it represented a truly new treatment. IIRC the rationale was that the enantiopure drug was half the dose of the racemic mixture, and regulatory capture did the rest of the work. Of course there was no tangible benefit to taking 10mg of Esomeprazole vs 20mg of Omeprazole, except the monetary benefit for the company.

As to why some other company didn’t snap up the patent, it’s an expensive proposition and not trivial to make enantiopure drugs, so a lot of the R&D budget touted by apologists and shills is entirely self-serving. Now sometimes an isomer is actually superior to a racemic mixture and there are plenty of cases where one isomer is therapeutic and the other is ineffective or toxic. Of course in those cases none of this patent fuckery applies, and there is no way to get a new patent issued or FDA writ because only one viable form of the drug exists.

It’s also true that a generic in the case of something like Esomeprazole vs. Omeprazole is viable, and that’s where the astronomical marketing budget that dwarfs R&D comes into play. Advertising directly to patients and doctors ensures that plenty of people won’t understsnd the value of a generic is they were even aware of it. You also get cases, as with Epi-pens, where supplies of the generic are scarce compared to the expensive branded version.

Good list of this kind of thing found here: https://en.m.wikipedia.org/wiki/Enantiopure_drug

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

#97

Post by nicoburns » Sat, Mar 09, 2019, 9:43 PM UTC

dnautics wrote: post #78

ams6110 wrote: post #76

Earlier quoted context omitted.

Lately, with respect to the government, I think it's fair to shorten the statement to simply "the US can't get anything done."

And maybe that's not such a bad thing. There's a ton of space between "things companies" should do and "things government should do". In the US, the policy agenda is (still) broadly defined by tribalism along polarizing issues (e.g. abortion). In other countries, it's slightly less bad but the phenomenon is similar. If less social goods were coupled to politics the world might be a better place, but it also might tak…

I think the US needs a paradigm shift where it stops thinking of income taxation as taking something from someone. It's not, because under the rules of society, that person is never due that money in the first place. That money is the portion of the nominal sum that is "earned" that accrues to society for the support and conducive living environment that the provide to the individual.

It's true that it is coercive: that the individual may not want to live in a society where that is the rule. But this is also true of all laws, including private property laws. The idea that property laws are natural and obvious, whereas other laws are impositions is utterly unhelpful and the source of a lot of issues, especially in the US where it seems pretty much all non-military public programs are underfunded.

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

#98

Post by sametmax » Sat, Mar 09, 2019, 9:55 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…

It's true for new drugs, but insuline price have been multiplied by 5 during the last decade (https://www.ontrackdiabetes.com/type-1-diabetes/insulin-pric...), which is a drug that should actually cost less to make, since we know it very well, and have a lot of demand now with the obesity epidemic.

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

#99

Post by consumer451 » Sat, Mar 09, 2019, 10:09 PM UTC

aaavl2821 wrote: post #19

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…

Drug companies increasingly fund r&d with their balance sheet, not with internal r&d. So the money they pay for new drugs is not reflected in the profit and loss statement. There are maybe 15 pharma companies that commercialize a large portion of the drugs developed in the world. The vast vast majority of drug companies never make a penny in profit. They sell their products or companies to bigger, commercial companie…

I am pretty uninformed in this space, but the D in pharma R&D includes the cost of direct to consumer advertising, correct?

I see a lot of expensive looking ads on TV. Those ads were made legal in my lifetime. Maybe it’s time to ban prescription ads again?

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

#100

Post by GunlogAlm » Sat, Mar 09, 2019, 10:24 PM UTC

radicalbyte wrote: post #24

It's worth noting that pharmacists in The Netherlands have a doctorate and the same training requirements as MDs (the study last until 24/25 with no skip years). The requirements are considerably lower in other countries (in the UK for example they just need a BSc). Source: my wife is a pharmacist and could have worked in the UK after only completing 1/3rd of her study.

> in the UK for example they just need a BSc

That doesn't seem to be true? This page says you need an MSc, in the UK, to register and be a licensed pharmacist: https://www.healthcareers.nhs.uk/explore-roles/pharmacy/stud...