People looking to save money aren't buying branded drugs, they're buying generics. Which are still far too expensive in the US, compared to other OECD markets.
The US, with a few exceptions, actually has lower priced generic drugs than other countries, including the EU.[1]
Interestingly, the study also shows that the U.S. has one of the highest levels of generic drug use relative to total prescription volume, and that generic prices are lower in the U.S. than in all the countries except Canada, where the difference is 6%.
The manufacturer is the same, but manufacturers rarely sell directly to consumers. They sell to pharmacies, and medications at Canadian pharmacies are (surprise) generally priced based on whatever price controls and negotiated rates apply to Canadians. When those rates are 1/10th of the USA cost for the same drug from the same factory the same lot number, either someone's getting the drugs at less than cost or someone else is getting screwed on price.
Or put differently, "Why does the USA fund so much of basic drug research and drug company profits daddy?" "Regulatory capture and bought politicians, son."
The price differences between domestic and international medicines can be truly outrageous. I just got back from a work trip to a hospital in Sierra Leone, where the anthelmintic medicine Albendazole costs the equivalent of $1 USD at a private pharmacy (or even less if you don't care about packaging). The same treatment in the US (a single dose) cost me $430 USD (before insurance). This medicine is out of patent; the R&D costs have been recovered. There's no reason for it to cost as much as is does in the US, apart from greed. It's more of a niche drug in the US than it is in sub-Saharan Africa, but it is shelf stable unlike say the antibodies of an immunotherapy, or the rabies vaccine, so it's not perishable. I trust the purity of the US version more than the version sold internationally, but that is probably an irrational fear. Even with added costs of laboratory purity testing and import tariffs, those in the US would still be better off if we could import drugs from overseas.
Some medicines are expensive for a reason: they're new and need to have R&D (and FDA) costs recovered (this is why we have patents), they have niche use and are produced in small quantities (cancer immunotherapies), they're perishable (biologicals), or all three. Many others are expensive because we have no regulatory protections against price gouging. Epi-Pens are another example. A 1mL vial of epinephrine costs ~$5, and the syringe to inject it costs pennies. Auto-injectors add some value, but not the $700 Mylan charges. They're fundamentally a pre-filled syringe a spring, and an injection molded case.
I wonder what the system would look like if we granted longer pharmaceutical patents (say, 30 years), with the change that upon expiration of the patents medicines would be produced by the government and sold at cost (or provided for free).
You'd expect just that to happen. The domestic market for human-rated albendazole is so small that it will sustain just one manufacturer, it's effectively a monopoly, and the monopolist can set prices to whatever he wants. We know what to do in such a situation (turn the monopolist into a regulated utility), but the current political climate won't permit this action.
This sort of rhetoric might work, but it doesn't in the face of Indian manufacturers who can easily be certified who will produce it for $1 and ship it to you the next day for $1 more. It's simply regulatory capture and a way of printing free money for people who already have money so they can rob the masses who don't. It's a scam, and it's stupid that we fall for it. The rich do get richer, and not for any other reason then they have money to affect regulatory capture. Generics should be nearly free. There is no reason for anyone to be making such large sized gains on generics.
This is why we don't want to import drugs from India:
Thakur knew the drugs weren’t good. They had high impurities, degraded easily, and would be useless at best in hot, humid conditions. They would be taken by the world’s poorest patients in sub-Saharan Africa, who had almost no medical infrastructure and no recourse for complaints. The injustice made him livid.
Ranbaxy executives didn’t care, says Kathy Spreen, and made little effort to conceal it. In a conference call with a dozen company executives, one brushed aside her fears about the quality of the AIDS medicine Ranbaxy was supplying for Africa. “Who cares?” he said, according to Spreen. “It’s just blacks dying.”[1]
Everyone loves to hate on the FDA until there's a compounding pharmacy that really messes up. A couple of years ago there was one that distributed some medication for injection that had a fungal contaminant, and there were several dozens of fatalities. You'd ask yourself what would happen without adult supervision.
And yet somehow the US imports mind-boggling quantities of other things we put in our bodies at safety standards that appear to generate no controversy whatsoever.
There are 74 US FDA-approved manufacturing facilities in India, more than in any other country outside the U.S. (This I believe has increased further over the last year)
Ranbaxy has been banned by the FDA for one thing or another for a long time now. Please use FDA approved Indian manufacturers. There are several dozens of them.
> Sounds like textbook comparative advantage, and in any sane market, imports would be about as controversial as paint drying.
This isn't comparative advantage, especially since we're often times talking about reimporting drugs (both brand-name and generics) that were manufactured in the US, but sold abroad for cheaper prices. The article doesn't make that very clear, and I wish it did, because it's an important distinction.
But your point is spot on - from a free market standpoint, this is a no-brainer. There is literally no reason to prevent US patients from buying drugs that were manufactured in the US from Canadian or European wholesalers. Except, of course, that this is a massive source of profit for pharmaceutical companies.
> There's no reason for it to cost as much as is does in the US, apart from greed.
The reason is people don't "pay" for it. Insurance does, and so nobody cares.
Edit: Well, the insurance companies should care, but if it's something that's rarely prescribed, it might be easier to just pay the claim instead of devoting people to negotiating a lower price.
A lot of those costs are taken indirectly via suppressed wages as many people get insurance via employment. It seems to me that a great deal of effort goes into hiding the costs of services and products from those who are paying them in this market.
Um, no, the tax payers pay for it through Medicaid.
People seem to have very strange ideas about how the healthcare industry actually works. But it's not a secret, you can go look at their SEC filings and see the numbers in black and white. Most insurance companies are enjoying record profits because of ever-expanding government funded health programs like Medicare [1]. This is just a fact. Now combine the "limitless pockets" of the Federal government with the total lack of price controls and you get exactly what you would expect in the USA -- prices going straight to the moon.
I very much expect this is not going to change any time soon. There is no political desire or will to limit Medicaid and/or institute price controls. This makes investing in health insurers very lucrative. The industry has been enjoying record profits since 2009 [2] and this will continue until the American public learns to do math...
In normal countries they have price controls. That approach works extremely well, in fact so well that price controls on pharmaceuticals in America are politically unworkable.
That article is long and completely without substance. I don't know why I didn't turn back sooner but lesson learned.
Anybody who thinks the drug industry charges so much for "innovation" is just dumb. Like all sellers the drug industry charges exactly what buyers are willing to pay. When the buyer is the federal government (and make no mistake, the federal government is indeed the biggest purchaser of healthcare and healthcare has been thoroughly "medicalized" [1][2]) then there's absolutely no limit to what you can charge. This situation thoroughly accounts for the high drug prices unique to the US and there is no need to crap out a bunch of words about innovation.
I don't know the parent's goals in trotting that out, but in general, I love how often this line is used as a defense of the "free market" in drugs.
Aside from the military[1], in what other categories of product do those waving that banner support mandatory payments to private entities supporting their preferred agenda[2]?
Never mind that the military is the best comparison to drugs in terms of regulation - the only products less "free-market" in the US than drugs are military weapons. In a way, there's a funny symmetry there.
[1] A huge amount of that money goes directly to private firms, just like pharma payments.
[2] Well, I guess one can opt out of medical care.
Patents distort what would happen in the absence of patents, but so does every other kind of property right. Markets in the absence of patents exhibit free rider effects, which are themselves undermine market efficiency.
I'm not defending a free market in drugs. I actually don't believe such a thing can exist. I'm simply observing the price board does what almost all price boards do: maximizing short-term political gains. It's a response to parent pretending a complex discussion has one true answer.
In Europe price controls have been in place since the War, if not earlier, and the pharma industry in Germany, France, Belgium, Switzerland and the UK did extremely well until the 1980s.
Pfizer opened their Sandwich site in 1954 and when they closed it in 2011 it wasn't because of the NHS.
Pharma takes from publicly funded research (globally) and then turns around and milks the public while lining their own pockets. I work tangentially in the pharma world, and much of the complicated biochemistry, assays, fermentation protocols etc have been figured out at universities. The value that Pharma companies' R&D brings in, is primarily in jacking up the downstream product yield so they can make money, and sometimes, lower costs.
Having worked in the industry, this is widly inaccurate. First off, a majority of drug discovered (~80%) are discovered by private companies.[1]
Of the 252 drugs approved from '97 to '05...
58% from pharmaceutical companies, 18% from biotech companies, 16% from universities, transferred to biotech
8% from universities, transferred to pharma
Second of all, discovering a drug gets you about 1/4 of the way to an approved, marketed drug. Typically the breakdown between research and development costs are 1/3 and 2/3. No academic institutions do the development part, where most of the cost is.
Since you didn't bother to read the article, let me summarize it for you:
118 of the drugs during this period were considered to have scientific novelty (46%), and of those:
44% were from pharmaceutical companies.
25% were from biotech companies, and
31% were from universities (transferred to either biotech or pharma)
Of the 118 scientifically novel drugs (new MOA, etc), 69% were NOT from academia. That is, academia has zero to do with the discovery all the way up to the approval of the drug.
>That is, academia has zero to do with the discovery all the way up to the approval of the drug.
Please don't insult our intelligence.The context for this discussion is about greedy companies using existing research for free and contributing nothing back. The linked article doesn't show which scientific research contributed to the product development. Universities are not all primarily engaged in drug discovery.
The article show where the drug was discovered. And as I mentioned, almost 80% were discovered by a private company.
Now, if you'd like to claim that that discovery was based on science paid for by the gov't, I won't disagree, but continuing that line of thought we could claim that drug companies are greedy because they are taking advantage of organic chemists who did work 200 years ago.
The problem is that they have no incentive to actually cure.
And near not incentive to provide cheap medication- which the patent system incentives you too, by running out after x Years. (Unless you are a frozzen Princess aka Disney)
Lots of diseases are only researched at universitys.
They have however a incentive, to sell anything expensive, to a audience desperate (that alone is a free market killer).
And they do.
I just try to understand how one can defend a held-hostage situation with free market rethoric.
That has nothing to do with what I'm saying. OF COURSE the Pharmas spend money on product development. They can't expect that for free too!! They already benefit a lot from publicly funded R&D, and contribute very little back in terms of pure science R&D. I work in vaccine automation and lemme tell you, the secret sauce to getting high yield ain't leaving the company.. ever.
>No academic institutions do the development part, where most of the cost is.
Because they got for free all of the decades of scientific research.
Because they got for free all of the decades of scientific research.
Yes, the scientific research that cost maybe 1% of the total cost of bringing the drug to market. Makes sense that the company should share some of the wealth.
Incorrect. They contribute _zero_ to our understanding of science. Its easier to build a bridge after someone else has already figured out what does and doesn't work. I don't blame them completely for using public domain information since there is no point reinventing the wheel. But after they've built their company on the backs of taxpayers who funded the research, we'd be fine if they just said thank-you and went on their way, instead of turning back and gouging everyone.
They contribute _zero_ to our understanding of science.
I definitely disagree here. There has been plenty of basic science discovered at private companies. I do agree they are hesitant to share it, but that's doesn't mean it doesn't happen. A great example of the Upjohn dihydroxylation reaction. Discovered at Upjohn Pharmaceuticals, freely disseminated through journal publications and now a key technology in organic synthesis.
Through collective bargaining Insurance companies tells big pharma what they will pay for a particuliar drug. They tell all aspects of medicine what they will pay.
I once had a blood test, and a newer antibiotic (forget the name). I got a $1200 bill in the mail.
I knew I had good insurance, so I called my Insurance company. They told me they paid the bill. It was $90 for the blood work, and $20 for the antibiotic. The kind lady told me how the system works.
I paid 10% of that--$11.00
I thought about all the people who don't have collective bargaining rights, and think about that bill every time this is brought up.
So insurance doesn't just pay. They pay as little as they can get away with, and make those huge profits.
It's the guy who has lousy insurance, high deductibles, and no insurance; that gets reamed.
I'm not sure they "should", at least from a financial standpoint. The ACA basically put a cap on insurance company profits, as a percentage. It's not phrased quite that way, but it's the upshot (look up "medical loss ratio"). This is the worst provision I know of in the ACA, because it sounds like a nice idea, but if you think it through, it actually disincentivizes insurance companies from doing what they can to lower costs.
It basically says that the maximum amount that insurance companies can keep is 20% of premiums (assuming no administrative cost or other overhead). Say the average cost per person is $4000 / year, so the average premium is $5000 / year; they're able to make a $1000 profit, or 20% of the premium. Now suppose the insurance company negotiates costs down to $3000 per year. Well, the maximum premium they can charge now is $3750, so they lose 25% of their profit. On the other hand, if they sit by and let costs skyrocket to $6000, they can raise premiums to $7500, and make $1500 in profit.
Now, of course insurance companies also compete on their premiums, so in theory, they still have some incentive to negotiate lower costs. But it seems like that must be seriously mitigated by the profit cap.
I'm not an expert on this by any means, so if someone who is wants to set me straight, I'd love to hear it. But I'm just very confused as to why this provision was thought to be a good idea.
I'd need to go digging through old talking points, but this always seemed obvious to me as a provision added for the sheer political calculus/motivation that it sounds good to people. It's just an easy sell—we're going to cap the percentage of profits focuses the attention away from the real cost side effects, and the ability to increase profits by not reducing costs exactly as you described.
Insurance companies don't care, period. If they somehow lose money one year, they raise the premiums next year. They don't even need to lose money. If their payments go up, they show that to their regulators, who allow them to charge us higher prices. And since the regulators allow them to have a certain profit margin, actually the insurance companies have the economic incentive to pay more.
> The wholesale cost in the developing world is between 0.01 and 0.06 USD per dose. In the United States, however, it is very expensive as of 2015 at about 201 USD per dose.
Several states have passed tort reform laws, including Texas. It hasn't made any difference.
The big pharma players spend more on marketing than R&D. The smaller players like Mylan specifically try to find niche drugs so they can buy the rights and jack the prices. It's pure rent-extraction and a drain on our healthcare system and economy.
> This medicine is out of patent; the R&D costs have been recovered. There's no reason for it to cost as much as is does in the US, apart from greed.
So apparently this medicine is used for treating parasitic worm infections, which I imagine is a vanishingly small market in the United States. That means that the costs of tooling up to produce the drug (and producing it to the standards of safety and purity demanded of any medicine produced in the U.S.) must be amortized over a tiny population of customers.
To make a comparison: a commercial Common Lisp IDE runs nearly $1,000 for a hobbyist edition, while you can get professional versions Clion or Jetbrains for $100-400. But there's no patent or other protections limiting competition in the development tools industry. It's simply the economics of making a product that caters to a tiny niche of potential customers.
It'd be really interesting to see their actual costs for whatever run size is justified by the US market (and some ancillary information like how much they throw away to keep the supply fresh and so on).
> So apparently this medicine is used for treating parasitic worm infections, which I imagine is a vanishingly small market in the United States.
It's incredibly common in veterinary medicine in the US.
Veterinary pharmaceuticals are oftentimes (though not always) manufactured in the same plants. Sometimes the inactive ingredients are not safe for human consumption, so that doesn't mean that you can always just take veterinary drugs safely, but sometimes (particularly in the case of antibiotics), they are literally manufactured on the same lines, and are simply packaged and distributed differently.
Given the massive difference in price between albendazole for humans and albendazole for animals, I'm willing to bet that this is another attempt at market segmentation (which we already know is rampant in the US pharmaceutical industry - that's how they make their global profits!), rather than a real necessity of the scale.
Texas has tried pretty much every piece of trope certain political parties like to trot out to "fix" medical care, including tort reform. It hasn't done a damn thing.
What nonsense. It's out of patent. There's no cost anymore except production and distribution. It's not a matter of recovering costs anymore, it's an oligopoly fixing the prices.
What percent of, say, Merck's annual budget goes towards paying out due to court cases they have lost where tort reform might make a difference? (I mean, ignore any lawsuits surrounding business practices, or from a competitor) Or pick any other pharma giant.
I tried to google it myself but didn't find anything clear on the matter.
Then perhaps we should look at the benfits of having such rigorous purity standards, if it makes drug prices 10000% higher than in other markets that have wider use.
Since my wife works in pre-fills and other things I can tell you for a fact that you still have to go through FDA approval. If you change something slightly, you go through approval. There are often clinical trials if the change is not incremental, sometimes even if it is. Change the packaging? FDA review. Change the color of the label? FDA approval. Change suppliers? FDA review.
So yes, the syringe and container themselves don't cost that much on a per unit basis (no clue but it's not nothing.) The regulatory costs are astronomical and have to be paid for over time. The general inanity of this stuff is mind boggling. The amount of paperwork insane.
Mylan has a patent on some minor improvement to Epipens. So it isn't just the FDA, they pushed generics off the market.
Mylan flat out admitted that costs aren't any more than $150 per pen when they launched a generic version of their own branded product. Everything above that is clearly them working to get as much price differentiation as possible.
So why not sell Epipens without those minor, patented improvements for $20? Surely if there's profit to be made another provider would come in and destroy the $700 marginally better Epipen market.
I don't know why there weren't more competitors. Apparently part of it is that it is difficult to get right. Adrenaclick generics have been on the market much of that time for $150 or less.
One thing though, they would be epinephrine auto injectors, not Epipens, that's one of the things the patent did, it made it so that a prescription for Epipen could only be filled with Mylan's product.
>This medicine is out of patent; the R&D costs have been recovered.
Do you think the financial analysis involved with a new drug stops at "costs recovered"? Why should it?
I find it completely bizarre that, instead of getting behind the fact that the US is essentially subsidizing drugs for the 3rd world, people think rich first worlders should be paying sub-Saharan rates.
What truly upsets me is that not a single politician really knows or wants to see how to fix healthcare!
Right now its like pulling a rope - we keep Obamacare at cost of billions of dollars, or we lose it at cost of millions lives affected, eventually.
Meanwhile big pharma thrives and examples like yours prove how corrupted US system is!
I'm still waiting for one single politician (not its not Trump) to actually start fixing healthcare from the bottom up! Fix the cost of drugs, therapies, etc, and all of sudden we need 1/10,000th of the initial costs.
Lots of people are working on this, but there are also lots of moving parts. It sounds like you know how large the health industry is, do you have any idea how hard it is to change a multi-trillion dollar market?
okay I guess in this case since its such a big issue, let's leave it like it is and add another 10 trillion in debt because we need to pay 400x what other countries pay for the same drug.
If you happen to be in NYC (USA), stop by any major Chinese grocery store in Flushing, Queens. You'll find albendazole and other anthelmintics for about $10/pack.
This is such an oblique position for legitimately grassroots activism to take. I mean, it's not like people are dropping dead en masse in Canada, out of all places, from taking supposedly sketchy, industrially-produced medication. Meanwhile, importing copycat generics from India is fine [1] (taken from an article with an obvious slant against Walmart, one major importer of such medications).
On the regulatory front, the difference is that India lets the US FDA work there and inspect plants that export to the US [2], while Canada doesn't, and although the US and Canada have been slowly easing into formally trusting the other's regulatory frameworks [3] by working up from food safety [4], they are not quite there on the medical front. How much of this is legitimately grounded in science, logistics, diplomacy, and protectionism are up for debate.
This is good investigative journalism. It certainly raises some additional questions that would have been difficult for an average person to learn on their own -- including questions about this nonprofit, about whether both parties' past attempts to allow Canadian drug imports have been comparable or different, about whether an organic movement concerned about drug safety exists at all, about the author's motivations for writing this piece; all good questions worthy of more research and conversation.
This is a pretty standard play inside the beltway. Many, many advocacy non-profits, some you have heard of, are really vehicles for increasing the ROI on corporate lobbying dollars. A humorous example: http://www.motherjones.com/mojo/2012/03/fight-save-paper-dol...
If you allow imports of drugs that are already approved by the FDA, then the objections are mostly about economic incentives (i.e. high prices reward the companies that made the drug, etc..)
If you allow imports on drugs that are approved in other countries but not by the FDA (iirc this was advocated by Ted Cruz in his debate against Bernie Sanders on health care a few months back), then the objection is that it basically neutralizes the ability of the FDA to block dangerous drugs and makes it easier to push drugs to market that aren't ready by promoting the drug in whichever country has the loosest standards or is most corrupt.
In India most of the Doctors go on a vacation to foreign countries at least twice a year, these are sponsored trips by non profit orgs of big pharmaceutical brands. There is also a massive lobby working in india to block generic drugs ; the present government thankfully did not yield to their lobby , the price of Stunt is now reduced by 80% , thats how much the price was marked up !
Unfortunately, insurance is the reason we have this health care issue in the US. There is no one to fight these special interest lobbys in the health care world. The hospitals don't care and a good number of patients don't care because of insurance. From what I see , people without insurance are treated as losers and their voice is not heard. Without insurance hospitals and doctors would fight the drug manufacturers on the patients' behalf.
Insurance is the tip of the iceberg compared to the very existence of lobbying. You could completely remove the concept of insurance, and lobbying as it exists today in the US would still find a way to reign as the controlling interest. I recommend to all to watch the 2016 film "Miss Sloane". It does a fairly reasonable job of trying to showcase how corrupt lobbying is, though it's still a pathetically naive view of the situation actually in play. The film is far too gentle and not nearly vicious enough in portraying just how corrupt the system really is.
At the end of the day, if everyone truly understood exactly how lobbying works, most citizens would send every single lobbyist, senator, and politician directly to jail for life without parole (I'd say death penalty, but I don't believe in that). The very concept of supposed "democracy" in the US would fail and require replacing it with something else. Every single political actor is in it for their own career, pure and simple. There is no such thing as a "politician for the people". It just doesn't exist. Stop trying to contradict me as you read this; Democrats, Republicans, and all third parties do not have your interests at heart. Corruption isn't just rampant, it is the very definition of the political institution that reigns today.
Every single election I almost want to commit suicide, when I see the majority of your citizens having an apparent IQ of 10, fighting amongst themselves as if their choice of vote makes a single goddamn difference. The US is going to be the sole reason World War 3 happens in the next 50 years, and it will happen regardless of whether the Republicans or Democrats are in power. The party currently in control has absolutely no effect on how policies are put into action. They may publicly declare different views, but they all continue to perpetuate the exact same system of power. We are doomed to destroy ourselves, and it doesn't matter who you vote into power - we will get there regardless of any "democratic choice" the public tries to elect.
Aside: Trump is a fucking joke and should have never had a chance of ever being elected. The same would have been true of Clinton. What the fuck is wrong with you people, that they were the two you wound up pitting against each other? Trump and Clinton were both pathetic choices, with neither of them having a single positive attribute. The country should have gone into civil war during the last election based on those candidates. Fuck the US and their politics. You are dooming the entire planet into becoming a pile of ashes.
tldr; Fuck all Americans. You collectively make excuses to perpetuate your politicians' careers, pretending you don't have the power to change the way your country operates. Your country is the single reason our species is going to exterminate itself, and all you can offer is bullshit reasons to exclude yourselves from personally taking on any responsibility. Seriously, fuck Americans for resulting in 4+ billion deaths by the year 3000. Please incite a civil war in an election before 2028 so our species as a whole has a chance to survive.
Do you not understand where the world is headed in the mid 21st century (years 2040-2070), solely because of the US? We are going to experience World War 3, wholly and entirely because of the politics of the US. Oh sure, it will be "because of external forces" (55% Middle East, 15% North Korea, 15% Russia, 10% China, 5% India"). But the US is going to be why 30-60% of the planet's population is exterminated in a matter of 5-10 years' time in WW3.
Perhaps you have no idea just how influential the US is in the world's potential for war, even though the US does not account for the majority of the world's population. The US wants to own the entire nuclear arsenal, while decreeing that any other nation who does the same is a "dangerous enemy". The US has no right to be the "majority shareholder of nuclear arms".
The US is not "the center of the universe". Over and over again in the media, American publications are brainwashing their citizens into believing they are the central power of the planet. Fuck that. Other nations are going to fight back. And it's going to result in a loss for all of us. And it will start with the US instigating the conflict.
tldr; The US believes they are in control. The rest of the world is going to tell you to fuck off, and it will result in a war with billions of deaths... all because Americans feel like their lives are innately worth more than those from any other nation. You're wrong. RIP Planet Earth, all because one nation believes themselves to be the centre of everything.
What I do not understand is what you're suggesting to actually improve things, and end up losing myself in apparent contradictions - assuming you're doing more than just venting.
You're worried about WW3 - in no small part due to the American nuclear arsenal I'm sure, yet downplay American fears of other nuclear arsenals. In one breath you suggest the average American citizen so powerless in the grips of their political system as to be a rounding error, and in the next you suggest they perhaps take up that most powerful and deadly of exercises in political power: the ability to wage war, civil war, as a supposed means of stopping war, world war. If Americans are driven to such madness as to turn on their countrymen, what possesses you to think they'll stop there? We can't even elect a president without deciding they're a Muslim or a Russian (if only at heart), but a civil war will stay nice and contained? That we won't bomb the other side's (supposed) allies? Or actual allies? Perhaps with nukes? Do you think world war 1 or 2 could've been avoided if only there'd been a little more internal strife over on that side of the pond? Did any of the other wars to end all wars ever work?
We do face a number of existential threats. Perhaps global warming will kill us. Perhaps a big space rock. Perhaps another supervolcano. Perhaps world war 3. Perhaps even started by the U.S., yes. If we are ended by war, I imagine like all wars before it, it will be fueled by some very angry, afraid people, fed up with their circumstances, looking to demonize their enemies, those they've been sent to kill - people who have lost all faith in political systems or negotiation (regardless of whether it manipulates them or not.) I worry that I may have just described you - do you understand, then, why I'm drawn to dicker?
Most of these are not new problems, and it's not all bad. Mankind's first prophesy was, perhaps, our eventual doomsday - and yet we're still here for now. Technology brings people from across the planet together, spreading knowledge and awareness, bringing new light to old abuses and power structures, not to mention empowering the common citizen. We're closer than ever to ending the specters of famine and plagues. Globalization binds us together in mutual interdependence, with war being both more ludicrously expensive and more absolutely terrible for business than ever before. We are at perhaps a new renaissance of space exploration, and may yet spot the next rock before it hits, and redirect it, and leave our nest.
Doomsday or not, we are mortal. Let us do what we can with our remaining time to improve the world and live well, not pour fuel on the flames and live in fear.
Let us fight the good fight, if that's what's needed, rather than engage in self fulfilling prophecies. Let us work to delay the inevitable, if it truly is inevitable. But I'll ask you to ponder: is calling for civil war fighting the good fight? Even in hyperbole?
If you have a point to make on Hacker News, the guidelines ask that you make it civilly. We ban accounts that continue to violate the guidelines like this.
There was a story on NPR awhile back about how, if I remember correctly, the U.S. government gives money away to drug companies to help fund drug research in exchange for a license to manufacture the resulting drug in case there's some kind of shortage or the drug is too expensive for anyone to buy it. This right has never been exercised, but there are some who think that they should start doing so to bring drug costs down.
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[ 4.0 ms ] story [ 176 ms ] threadThey do realize that for branded drugs, the "Canadian drug manufacturer" is the same as the US drug manufacturer, right?
Interestingly, the study also shows that the U.S. has one of the highest levels of generic drug use relative to total prescription volume, and that generic prices are lower in the U.S. than in all the countries except Canada, where the difference is 6%.
[1]http://knowledge.wharton.upenn.edu/article/analyzing-brand-n...
Or put differently, "Why does the USA fund so much of basic drug research and drug company profits daddy?" "Regulatory capture and bought politicians, son."
Some medicines are expensive for a reason: they're new and need to have R&D (and FDA) costs recovered (this is why we have patents), they have niche use and are produced in small quantities (cancer immunotherapies), they're perishable (biologicals), or all three. Many others are expensive because we have no regulatory protections against price gouging. Epi-Pens are another example. A 1mL vial of epinephrine costs ~$5, and the syringe to inject it costs pennies. Auto-injectors add some value, but not the $700 Mylan charges. They're fundamentally a pre-filled syringe a spring, and an injection molded case.
I wonder what the system would look like if we granted longer pharmaceutical patents (say, 30 years), with the change that upon expiration of the patents medicines would be produced by the government and sold at cost (or provided for free).
See the vet, get fenbendazole for huge dogs.
Pay-to-delay is a big one. https://www.ftc.gov/news-events/media-resources/mergers-comp...
Thakur knew the drugs weren’t good. They had high impurities, degraded easily, and would be useless at best in hot, humid conditions. They would be taken by the world’s poorest patients in sub-Saharan Africa, who had almost no medical infrastructure and no recourse for complaints. The injustice made him livid. Ranbaxy executives didn’t care, says Kathy Spreen, and made little effort to conceal it. In a conference call with a dozen company executives, one brushed aside her fears about the quality of the AIDS medicine Ranbaxy was supplying for Africa. “Who cares?” he said, according to Spreen. “It’s just blacks dying.”[1]
[1]http://blogs.sciencemag.org/pipeline/archives/2013/05/17/a_l...
Everyone loves to hate on the FDA until there's a compounding pharmacy that really messes up. A couple of years ago there was one that distributed some medication for injection that had a fungal contaminant, and there were several dozens of fatalities. You'd ask yourself what would happen without adult supervision.
This is the full story: https://en.wikipedia.org/wiki/New_England_Compounding_Center...
This isn't comparative advantage, especially since we're often times talking about reimporting drugs (both brand-name and generics) that were manufactured in the US, but sold abroad for cheaper prices. The article doesn't make that very clear, and I wish it did, because it's an important distinction.
But your point is spot on - from a free market standpoint, this is a no-brainer. There is literally no reason to prevent US patients from buying drugs that were manufactured in the US from Canadian or European wholesalers. Except, of course, that this is a massive source of profit for pharmaceutical companies.
Or, guarantee single payer and become a monopsony, thus combating the monopoly effects with an opposite market force.
The reason is people don't "pay" for it. Insurance does, and so nobody cares.
Edit: Well, the insurance companies should care, but if it's something that's rarely prescribed, it might be easier to just pay the claim instead of devoting people to negotiating a lower price.
You expect the masses to think one step further, which will not happen on enough scale.
People seem to have very strange ideas about how the healthcare industry actually works. But it's not a secret, you can go look at their SEC filings and see the numbers in black and white. Most insurance companies are enjoying record profits because of ever-expanding government funded health programs like Medicare [1]. This is just a fact. Now combine the "limitless pockets" of the Federal government with the total lack of price controls and you get exactly what you would expect in the USA -- prices going straight to the moon.
I very much expect this is not going to change any time soon. There is no political desire or will to limit Medicaid and/or institute price controls. This makes investing in health insurers very lucrative. The industry has been enjoying record profits since 2009 [2] and this will continue until the American public learns to do math...
[1] https://www.healthinsurance.org/blog/2016/03/01/no-obamacare...
[2] https://www.consumeraffairs.com/news/health-insurance-indust...
The bigger issue is the financing model that causes innovation to happen in all the wrong fields, but that is a different question and very complex.
Anybody who thinks the drug industry charges so much for "innovation" is just dumb. Like all sellers the drug industry charges exactly what buyers are willing to pay. When the buyer is the federal government (and make no mistake, the federal government is indeed the biggest purchaser of healthcare and healthcare has been thoroughly "medicalized" [1][2]) then there's absolutely no limit to what you can charge. This situation thoroughly accounts for the high drug prices unique to the US and there is no need to crap out a bunch of words about innovation.
[1] http://www.commonwealthfund.org/publications/newsletters/was...
[2] https://en.wikipedia.org/wiki/Health_care_finance_in_the_Uni...
Aside from the military[1], in what other categories of product do those waving that banner support mandatory payments to private entities supporting their preferred agenda[2]?
Never mind that the military is the best comparison to drugs in terms of regulation - the only products less "free-market" in the US than drugs are military weapons. In a way, there's a funny symmetry there.
[1] A huge amount of that money goes directly to private firms, just like pharma payments.
[2] Well, I guess one can opt out of medical care.
Pfizer opened their Sandwich site in 1954 and when they closed it in 2011 it wasn't because of the NHS.
Of the 252 drugs approved from '97 to '05... 58% from pharmaceutical companies, 18% from biotech companies, 16% from universities, transferred to biotech 8% from universities, transferred to pharma
Second of all, discovering a drug gets you about 1/4 of the way to an approved, marketed drug. Typically the breakdown between research and development costs are 1/3 and 2/3. No academic institutions do the development part, where most of the cost is.
[1]http://blogs.sciencemag.org/pipeline/archives/2010/11/04/whe...
I want to know how the R&D looks for compound group discovery. Everything else is just repackaging with a chemistry kit.
118 of the drugs during this period were considered to have scientific novelty (46%), and of those: 44% were from pharmaceutical companies. 25% were from biotech companies, and 31% were from universities (transferred to either biotech or pharma)
Of the 118 scientifically novel drugs (new MOA, etc), 69% were NOT from academia. That is, academia has zero to do with the discovery all the way up to the approval of the drug.
Please don't insult our intelligence.The context for this discussion is about greedy companies using existing research for free and contributing nothing back. The linked article doesn't show which scientific research contributed to the product development. Universities are not all primarily engaged in drug discovery.
Now, if you'd like to claim that that discovery was based on science paid for by the gov't, I won't disagree, but continuing that line of thought we could claim that drug companies are greedy because they are taking advantage of organic chemists who did work 200 years ago.
>No academic institutions do the development part, where most of the cost is.
Because they got for free all of the decades of scientific research.
Yes, the scientific research that cost maybe 1% of the total cost of bringing the drug to market. Makes sense that the company should share some of the wealth.
I definitely disagree here. There has been plenty of basic science discovered at private companies. I do agree they are hesitant to share it, but that's doesn't mean it doesn't happen. A great example of the Upjohn dihydroxylation reaction. Discovered at Upjohn Pharmaceuticals, freely disseminated through journal publications and now a key technology in organic synthesis.
I once had a blood test, and a newer antibiotic (forget the name). I got a $1200 bill in the mail.
I knew I had good insurance, so I called my Insurance company. They told me they paid the bill. It was $90 for the blood work, and $20 for the antibiotic. The kind lady told me how the system works.
I paid 10% of that--$11.00
I thought about all the people who don't have collective bargaining rights, and think about that bill every time this is brought up.
So insurance doesn't just pay. They pay as little as they can get away with, and make those huge profits.
It's the guy who has lousy insurance, high deductibles, and no insurance; that gets reamed.
I find it all sickening.
I'm not sure they "should", at least from a financial standpoint. The ACA basically put a cap on insurance company profits, as a percentage. It's not phrased quite that way, but it's the upshot (look up "medical loss ratio"). This is the worst provision I know of in the ACA, because it sounds like a nice idea, but if you think it through, it actually disincentivizes insurance companies from doing what they can to lower costs.
It basically says that the maximum amount that insurance companies can keep is 20% of premiums (assuming no administrative cost or other overhead). Say the average cost per person is $4000 / year, so the average premium is $5000 / year; they're able to make a $1000 profit, or 20% of the premium. Now suppose the insurance company negotiates costs down to $3000 per year. Well, the maximum premium they can charge now is $3750, so they lose 25% of their profit. On the other hand, if they sit by and let costs skyrocket to $6000, they can raise premiums to $7500, and make $1500 in profit.
Now, of course insurance companies also compete on their premiums, so in theory, they still have some incentive to negotiate lower costs. But it seems like that must be seriously mitigated by the profit cap.
I'm not an expert on this by any means, so if someone who is wants to set me straight, I'd love to hear it. But I'm just very confused as to why this provision was thought to be a good idea.
Source: https://en.wikipedia.org/wiki/Albendazole
Albendazole is used to counter a rabbit parasite called E. Cuniculi. A complete 30-day Albendazole regimen, for a rabbit, is about $40.
The big pharma players spend more on marketing than R&D. The smaller players like Mylan specifically try to find niche drugs so they can buy the rights and jack the prices. It's pure rent-extraction and a drain on our healthcare system and economy.
So apparently this medicine is used for treating parasitic worm infections, which I imagine is a vanishingly small market in the United States. That means that the costs of tooling up to produce the drug (and producing it to the standards of safety and purity demanded of any medicine produced in the U.S.) must be amortized over a tiny population of customers.
To make a comparison: a commercial Common Lisp IDE runs nearly $1,000 for a hobbyist edition, while you can get professional versions Clion or Jetbrains for $100-400. But there's no patent or other protections limiting competition in the development tools industry. It's simply the economics of making a product that caters to a tiny niche of potential customers.
It's incredibly common in veterinary medicine in the US.
Veterinary pharmaceuticals are oftentimes (though not always) manufactured in the same plants. Sometimes the inactive ingredients are not safe for human consumption, so that doesn't mean that you can always just take veterinary drugs safely, but sometimes (particularly in the case of antibiotics), they are literally manufactured on the same lines, and are simply packaged and distributed differently.
Given the massive difference in price between albendazole for humans and albendazole for animals, I'm willing to bet that this is another attempt at market segmentation (which we already know is rampant in the US pharmaceutical industry - that's how they make their global profits!), rather than a real necessity of the scale.
Unless it's okay because we can rationalize it as "it helps make the product accessible to poorer countries".
Want to lower drug prices? Enact tort reform.
I tried to google it myself but didn't find anything clear on the matter.
So yes, the syringe and container themselves don't cost that much on a per unit basis (no clue but it's not nothing.) The regulatory costs are astronomical and have to be paid for over time. The general inanity of this stuff is mind boggling. The amount of paperwork insane.
Mylan flat out admitted that costs aren't any more than $150 per pen when they launched a generic version of their own branded product. Everything above that is clearly them working to get as much price differentiation as possible.
One thing though, they would be epinephrine auto injectors, not Epipens, that's one of the things the patent did, it made it so that a prescription for Epipen could only be filled with Mylan's product.
Do you think the financial analysis involved with a new drug stops at "costs recovered"? Why should it?
I find it completely bizarre that, instead of getting behind the fact that the US is essentially subsidizing drugs for the 3rd world, people think rich first worlders should be paying sub-Saharan rates.
Could you explain more about what makes it a "fact" ?
Right now its like pulling a rope - we keep Obamacare at cost of billions of dollars, or we lose it at cost of millions lives affected, eventually.
Meanwhile big pharma thrives and examples like yours prove how corrupted US system is!
I'm still waiting for one single politician (not its not Trump) to actually start fixing healthcare from the bottom up! Fix the cost of drugs, therapies, etc, and all of sudden we need 1/10,000th of the initial costs.
Evergreen suggested reading: http://steve-yegge.blogspot.com/2009/04/have-you-ever-legali...
On the regulatory front, the difference is that India lets the US FDA work there and inspect plants that export to the US [2], while Canada doesn't, and although the US and Canada have been slowly easing into formally trusting the other's regulatory frameworks [3] by working up from food safety [4], they are not quite there on the medical front. How much of this is legitimately grounded in science, logistics, diplomacy, and protectionism are up for debate.
This is good investigative journalism. It certainly raises some additional questions that would have been difficult for an average person to learn on their own -- including questions about this nonprofit, about whether both parties' past attempts to allow Canadian drug imports have been comparable or different, about whether an organic movement concerned about drug safety exists at all, about the author's motivations for writing this piece; all good questions worthy of more research and conversation.
[1] http://www.huffingtonpost.com/al-norman/india-wal-marts-drug... [2] https://www.fda.gov/forconsumers/consumerupdates/ucm333944.h... [3] http://trade.gov/RCC/ [4] https://www.fda.gov/food/newsevents/constituentupdates/ucm49...
If you allow imports of drugs that are already approved by the FDA, then the objections are mostly about economic incentives (i.e. high prices reward the companies that made the drug, etc..)
If you allow imports on drugs that are approved in other countries but not by the FDA (iirc this was advocated by Ted Cruz in his debate against Bernie Sanders on health care a few months back), then the objection is that it basically neutralizes the ability of the FDA to block dangerous drugs and makes it easier to push drugs to market that aren't ready by promoting the drug in whichever country has the loosest standards or is most corrupt.
At the end of the day, if everyone truly understood exactly how lobbying works, most citizens would send every single lobbyist, senator, and politician directly to jail for life without parole (I'd say death penalty, but I don't believe in that). The very concept of supposed "democracy" in the US would fail and require replacing it with something else. Every single political actor is in it for their own career, pure and simple. There is no such thing as a "politician for the people". It just doesn't exist. Stop trying to contradict me as you read this; Democrats, Republicans, and all third parties do not have your interests at heart. Corruption isn't just rampant, it is the very definition of the political institution that reigns today.
Every single election I almost want to commit suicide, when I see the majority of your citizens having an apparent IQ of 10, fighting amongst themselves as if their choice of vote makes a single goddamn difference. The US is going to be the sole reason World War 3 happens in the next 50 years, and it will happen regardless of whether the Republicans or Democrats are in power. The party currently in control has absolutely no effect on how policies are put into action. They may publicly declare different views, but they all continue to perpetuate the exact same system of power. We are doomed to destroy ourselves, and it doesn't matter who you vote into power - we will get there regardless of any "democratic choice" the public tries to elect.
Aside: Trump is a fucking joke and should have never had a chance of ever being elected. The same would have been true of Clinton. What the fuck is wrong with you people, that they were the two you wound up pitting against each other? Trump and Clinton were both pathetic choices, with neither of them having a single positive attribute. The country should have gone into civil war during the last election based on those candidates. Fuck the US and their politics. You are dooming the entire planet into becoming a pile of ashes.
tldr; Fuck all Americans. You collectively make excuses to perpetuate your politicians' careers, pretending you don't have the power to change the way your country operates. Your country is the single reason our species is going to exterminate itself, and all you can offer is bullshit reasons to exclude yourselves from personally taking on any responsibility. Seriously, fuck Americans for resulting in 4+ billion deaths by the year 3000. Please incite a civil war in an election before 2028 so our species as a whole has a chance to survive.
This is supposed to avoid WW3? Hmm.
Err... and have better results than our elections?
Perhaps you have no idea just how influential the US is in the world's potential for war, even though the US does not account for the majority of the world's population. The US wants to own the entire nuclear arsenal, while decreeing that any other nation who does the same is a "dangerous enemy". The US has no right to be the "majority shareholder of nuclear arms".
The US is not "the center of the universe". Over and over again in the media, American publications are brainwashing their citizens into believing they are the central power of the planet. Fuck that. Other nations are going to fight back. And it's going to result in a loss for all of us. And it will start with the US instigating the conflict.
tldr; The US believes they are in control. The rest of the world is going to tell you to fuck off, and it will result in a war with billions of deaths... all because Americans feel like their lives are innately worth more than those from any other nation. You're wrong. RIP Planet Earth, all because one nation believes themselves to be the centre of everything.
You're worried about WW3 - in no small part due to the American nuclear arsenal I'm sure, yet downplay American fears of other nuclear arsenals. In one breath you suggest the average American citizen so powerless in the grips of their political system as to be a rounding error, and in the next you suggest they perhaps take up that most powerful and deadly of exercises in political power: the ability to wage war, civil war, as a supposed means of stopping war, world war. If Americans are driven to such madness as to turn on their countrymen, what possesses you to think they'll stop there? We can't even elect a president without deciding they're a Muslim or a Russian (if only at heart), but a civil war will stay nice and contained? That we won't bomb the other side's (supposed) allies? Or actual allies? Perhaps with nukes? Do you think world war 1 or 2 could've been avoided if only there'd been a little more internal strife over on that side of the pond? Did any of the other wars to end all wars ever work?
We do face a number of existential threats. Perhaps global warming will kill us. Perhaps a big space rock. Perhaps another supervolcano. Perhaps world war 3. Perhaps even started by the U.S., yes. If we are ended by war, I imagine like all wars before it, it will be fueled by some very angry, afraid people, fed up with their circumstances, looking to demonize their enemies, those they've been sent to kill - people who have lost all faith in political systems or negotiation (regardless of whether it manipulates them or not.) I worry that I may have just described you - do you understand, then, why I'm drawn to dicker?
Most of these are not new problems, and it's not all bad. Mankind's first prophesy was, perhaps, our eventual doomsday - and yet we're still here for now. Technology brings people from across the planet together, spreading knowledge and awareness, bringing new light to old abuses and power structures, not to mention empowering the common citizen. We're closer than ever to ending the specters of famine and plagues. Globalization binds us together in mutual interdependence, with war being both more ludicrously expensive and more absolutely terrible for business than ever before. We are at perhaps a new renaissance of space exploration, and may yet spot the next rock before it hits, and redirect it, and leave our nest.
Doomsday or not, we are mortal. Let us do what we can with our remaining time to improve the world and live well, not pour fuel on the flames and live in fear. Let us fight the good fight, if that's what's needed, rather than engage in self fulfilling prophecies. Let us work to delay the inevitable, if it truly is inevitable. But I'll ask you to ponder: is calling for civil war fighting the good fight? Even in hyperbole?
Thanks for reading.