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Ardlen posted:Glybera was a cure for a rare form of pancreatitis. The company charged $1 million for the cure, sold it once, and now it is off the market entirely. Their reasoning for pricing it that high was because treatments for similar rare diseases normally cost $300,000 / year for the rest of the patient's life. quote:Alipogene tiparvovec was a gene therapy for LPL deficiency available in Europe until 2017 when the sponsor declined to renew market authorization. While TG levels normalized in 12 weeks, levels then returned to prior baseline by 6 months after therapy. https://www.acc.org/latest-in-cardiology/articles/2020/03/03/15/08/clinical-review-on-triglycerides 6 months is not a cure by any stretch. While US corporate culture is a major problem, the issues with healthcare in the US are not going away without proper regulation, and that seems unlikely without somehow solving the issue of lobbying. I don't think that expecting corporations to suddenly ignore the pressure to make number go up is going to be successful. I grew up in the UK and worked in research in the NHS for a long time and think a properly funded national system is the best healthcare setup. Having said that I now live in an extremely capitalist country with a privatised system (Switzerland), and while it's expensive it's properly regulated so everyone has health cover and pre existing conditions are always included. The system seems to work pretty well. The US could very easily implement the same system, but doesn't because of politicians' vested interests. A country that specifically outlaws its state healthcare scheme from negotiating drug prices is just mad.
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Aug 8, 2020 09:12
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F_Shit_Fitzgerald posted:I've tried pointing out that people have a right not to be forced into medical bankruptcy, and that M4A doesn't mean that doctors and nurses don't get paid, but it's like talking to a wall. Adjacent to this, I occasionally read the medicine subreddit and it's surprising and disappointing how many doctors are libertarians. There's quite a lot of opposition to universal coverage in there, on the basis that they will earn less. Doctors' salaries in the US are pretty insane, and the justification for the high pay is that medical school is expensive and residency is poorly paid. I'm not against doctors being well paid but it highlights to me that solving the problem of high healthcare cost in the US also includes solving the high university cost. Medicine should really also be an undergraduate degree, it involves no research and is a driver behind the doctorification of all professions in the US.
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Aug 15, 2020 13:26
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Yeah american exceptionalism is particularly powerful in healthcare, where it is least plausible. I do worry that even if a M4A bill was passed it would be deliberately hosed with sufficiently that it does actually fail. But the perfect is the enemy of the good etc.
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Aug 19, 2020 10:22
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Communist Thoughts posted:It's American exceptionalism to think that only Americans think their country is exceptional. Oh yeah, I'm acutely aware of that, it's the cornerstone of the self-immolation happening in the UK (as I know you know). It is particularly acute in the US though. I don't live in the States, but doing US-based medical research for a US company I do find that lots of people are simply unaware of what is happening globally, even in their own field at a global company. And of course this is a thread specifically about US healthcare.
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Aug 20, 2020 08:56
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I also work in clinical drug development (my background is 60% academic clinical research and 40% industry). Drug development is incredibly expensive and characterising it as just marketing is disingenous and pretty lazy. Discovery and basic research is mostly better done at universities including work funded by the NIH, but then the universities spin off companies or sell the assets for further development (and get the money from that). The subsequent clinical development costs are really significant, often hundreds of thousands of USD per patient. This goes into collecting and verifying the clinical data, translational, biomarker, PK and Pd testing, safety monitoring, reporting, all over the cost of actually providing the drug and paying for the patients' treatment. Drug development costs don't finish at first approval either, the research costs continue in identifying new indications and ways the treatments can be used. Biotech and pharma companies are really well placed to do large comparative trials, and getting them done quickly, and also doing post approval studies to monitor how the drugs are doing. I am a huge supporter of socialised medicine and think the prohibition of drug price negotiation in the US is crazy. It must be the largest way drug cost increases are enabled in the US, though there are peverse incentives for health insurers to keep costs high as well. This does not look likely to be fixed unless there is a change to the way lobbying and money influences lawmaking in the USA. In addition to unconstrained drug costs there are other drivers. Hospital costs in the US are many times higher than in other countries, even at "non-profit" hospitals; again the solution has to be proper regulation and collective negotiating on pricing. While it is not a great proportion of costs, many medical and other healthcare salaries are absurd in the US. High university tuition costs are often held as the justification for this (as well as the terrible US medical residency system), so again better regulation, by lawmakers who are not unduly influenced by the people they are regulating, is key. There are huge overheads to the current insurance system. All unnecessary. Pharmacy benefit management companies? Unnecessary. The health system in the USA would actually be very straightforward to solve (though of course complex in implementation). Even here in ultra-capitalist Switzerland there is a way better system, and it is for-profit. I personally can't see the problems being solved until there is a shake-up in how politicians are paid and funded.
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Oct 21, 2020 12:59
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Jaxyon posted:I'm aware of the process by which drugs are approved, how long they take, and how much it costs. Ehh, you've repeatedly said that drug development is just marketing, which isn't close to true. And drug companies absolutely do discovery work and basic research, it's just more effectively done at universities. Rare diseases may need to be approached differently. Yeah companies are not going to spend money on treatments they can't recoup, so governments have the ability to incentivise the development. Governments generally do not want post the $1bn upfront to develop therapies so it kind of needs to be done by industry. The key is pricing control at the buyer side. quote:Notably, Switzerland is I believe the only country that comes close to the US in per capita healthcare spending. Even given the inefficiency and profit motive the proportion of GDP in Switzerland is hugely lower: 12% vs 18%. Anyway the point is that even by the standard of a very suboptimal system the US spend is ridiculous, and a proper insurance or national health system could slash those costs and also deliver better outcomes. knox_harrington fucked around with this message at 20:59 on Oct 21, 2020 |
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Oct 21, 2020 20:57
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Jaxyon posted:Is it important to make a new cancer treatment available for more cancers because cancer sucks? Yeah absolutely that work needs to be done. I fail to see why that would suffer under socialized a universal healthcare system. If the answer is "reduced revenue for the companies and they're greedy so they won't cut stock buybacks before they cut R&D" then that suggests some solutions that are entirely possible. I don't think universal healthcare (with implied price negotiation) in the USA would drastically reduce medical innovation. It would probably impact it a little but the main impact would be on industry profitability. It all depends on how it's implemented and (as I said before) the susceptibility of US lawmakers to financial influence has a huge impact on this. I do think you are conflating several different issues and to be honest I am not quite sure what the exact point you are making is. Can I ask what it is you are proposing?
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Oct 23, 2020 18:45
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Seems to me that most people here agree that universal healthcare is good and preferable, and that lack of drug price negotiation by medicare is stupid. From there it's a massive, giant leap to say "therefore all drug companies should be nationalised". The infrastructure to do global public-funded clinical research would be hard to put in place and I don't think you would get much agreement between countries on which studies to run. Drug development via international committee would be very slow and ex-US companies would likely be able to get drugs to market way quicker. Drug development is already pushed in particular directions by things like the orphan drug program, and I think that kind of carrot with price control as the stick is the option most likely to work. But, as I've said before, even this will require major political reform, and drug pricing is only a minor driver of excess health sector spending in the US. Like other posters have said "just nationalise it" isn't a plan it's an ideal. Also: related to the thread title, drug development is not "healthcare". Just sayin. knox_harrington fucked around with this message at 23:06 on Oct 25, 2020 |
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Oct 25, 2020 22:40
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Well, I've worked quite a bit on academic multi-centre trials funded by research councils (MRC and Horizon framework etc) and they take a really long time and are not suitable for generating registrational level data as implemented. Not that they couldn't be but it would need huge organisation and lots of money. You could form a company to do it funded / owned by the constituent countries in the same way big defence projects are run, but they're not exactly paragons of efficiency and value. Writing a NDA or MAA is a huge undertaking on a different level from running an academic study and publishing a paper. Centrally directed drug development could also suffer from the continually shifting political landscape (see also defence projects) where the goalposts are shifted so often that your research never gets anywhere. QALYs are absolutely a valid measure of drug utility (or rather $ per QALY) and the US would need something like the much-maligned but actually pretty good UK NICE in a single payer system to work out if they'll pay for a treatment (cue screeching about death panels from the Right). While you don't know the efficacy you would need to have a rough guess at it and likely cost, and then factor that into whether you want to research a particular therapy. Would people be interested in discussing drug pricing? Personally I think that is the most difficult subject for drug company stooges like myself to answer, and thus probably where the key information lies.
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Oct 26, 2020 08:45
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Jaxyon posted:We've already nationalized a bunch of research via the NIH. I think you have at least 3 drug development professionals largely agreeing that single payer is fine and that better drug development can be done, while giving good insight into what it would take to achieve a different system and what that might look like.. and one saying it won't work for reasons. Jaxyon posted:Others: Who's saying this? Certainly not me. I'd appreciate it if you stop trying to pick fights and actually contribute to the discussion.
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Oct 26, 2020 23:15
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