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Comment by impostervt | Hacker News Reader

My daughter, like many kids, has an allergy that requires us to have epipens on hand. There was a good article the other day about how the owner of epipen have raised the price of epipen from $57/pen in 2007 to over $400/two-pack of pens today. I don't think you can get just one pen, btw.

I think the difference is they didn't raise the price in one fell swoop. Frogs in boiling water, etc, etc.

http://www.bloomberg.com/news/articles/2015-09-23/how-market...

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My wife had a great job at a family controlled, small drug company named King Pharmaceuticals. They were based in Bristol, TN, and had fewer than 1000 employees. King developed, owned the patents on, and sold the epipen.

Of course, what happened next is exactly what you'd expect. Pfizer made a bid for a hostile takeover and the shareholders approved it. What was the first order of business on day 0? Exactly what you'd expect: lay off 90% of the King employees and more than double the price of epipens. Why? Because they could.

I have deep appreciation for pharmaceutical research, but it's folly to imagine any of it's ultimately driven by anything but profits. The exception may be the fewer-every-year small pharmas.

Btw, after Pfizer laid her off, my wife went to work for Salix, another small-but-successful pharma based in Raleigh that specializes in GI drugs. Guess what happened after barely over a year? Valeant bought Salix and laid off 90% of the workforce. Valeant is far worse than Pfizer, too. Their entire business proposition is finding "under-performing" drugs, buying the companies, then cutting costs and doing a better job marketing them. It's working so far, but has cost a lot of good folks their jobs/careers.

I have deep appreciation for pharmaceutical research, but it's folly to imagine any of it's ultimately driven by anything but profits.

I disagree with you. I remain convinced that research is driven by the curious geeks with a passion for solving the problem at hand.

Research is, unfortunately, funded by profiteering assholes.

The market does not allow people like Roy Vagelos, Sigurd Varian or Bill Packard to thrive today, all we get instead is locusts like Valeant and Shkreli. That's the reality. The incentives are completely messed up, and there is no path to improvement.

I worked for big pharma and medium (sized) pharma, i discovered several new chemotypes to treat pathologies, all eventually patented. i never got a dime, because that was the terms of my employment. i watched the market price rise on many of the pharmaceuticals i had worked on each time they were sold, placed under new contracts, and re-sold. Our salaries didn't rise as a result, our equipment wasn't modernized. Where did that extra profit go? "It's all fungible", one suit told me at a company meeting; but you're correct, our normally fixed salaries did filter down through the growing salaries of "profiteering assholes".

What could be done to encourage pharmaceutical research/progress?

Would something like demanding (say) at least 20% of the profits should go into research be viable?

How about funding this stuff publicly, where there is an actual democratic peer-review process? The only reason people end up working for pharma is because they can't get a grant. Just up the NIH & NSF budgets, and scientists will be free to work without profiteering assholes to worry about. It's not that fucking complicated.

Well I would say it's complicated: we're talking about an industry worth hundreds of billions of dollars, an army of researchers and a network of institutions with discoveries made all around. Also, simply increasing government budget frees scientists to do work (great!) but does nothing about the "profiteering assholes" that already exist, they can still play around with drug prices for profit simply because people are hostage to their drugs. Offloading all work to government may have perils too; markets are usually more quick at adapting with price signaling, and overall efficiency is usually higher in those organizations (less bureaucracy, more agility).

Drugs do not operate in a market. It is definitely not true with patented drugs (which operate under a government monopoly), and as we're seeing now that monopolies are taking over generics that's becoming less true there as well.

In addition, it's simply false that businesses are more efficient than the government. For example, compare overhead in public health care systems (e.g. Medicare) to private insurance systems and you'll find that the overhead is vastly lower in the public systems - something like 3% vs. 15%. Giant businesses are as burdened by bureaucracy as any other large institution, and they're only as efficient as they need to be, which in an industry with monopoly rents is not very efficient (pharma spends as much on research as the government for much less in research outcomes). Government at least has Republicans keeping it trim.

They do not operate in a market, but there are market-driven pressures for developing new drugs: efficient companies assign research priority according to their expected returns from drug development.

In any case, reform is definitively needed; and complaining without demanding reform is pointless. Discovering new drugs is a scientific endeavor and so it really should be as open as possible. I am a little skeptical of plain massive government research agencies, but maybe it's a good way to go. Maybe patent reform or something else is instead better. If you look at machine learning research the industry is not bad at sharing results because of two factors, apparently: 1) Companies know that progress will be much faster if everyone decides to share 2) To attract to researchers, they need to show they do high caliber research and share.

I can hear the "Socialism" shouts from here, that goes against the god of free market, and how the hell the corporations are going to get the funds to buy politicians.Next you are going to ask is basic health care for the poor.

Another interesting thing I have noticed in online discussions. Whenever it comes to putting more money in hands of the few generally considered "rich", one of the standard explanations is that they will invest and create more jobs. However, things which will put extra money in the hands of "ordinary" people; like reduction in high prices or a higher wage always comes with a threat of reduction in jobs. Money in the hands of ordinary people is almost always spent or invested, thus providing a large boost to the economy (perhaps after a short term of 6-12 months of lower employment due to the rise in cost of doing business).

That line is on Page 1 of the Book of Political Lies that gets rolled out whenever there's a fight over resource allocation.

The reality is that "invest and create more jobs" actually means "fire as many people as you can, cut wages as far as they go, make all hires as at-will as possible, and offshore to save money if you possibly can, even if it hurts the company in the long term."

The rest of the reality is that our political system is an assholeocracy. The people responsible for this kind of idiocy should be nowhere near policy - not just because of some abstract sense of moral wrong, but because it's incredibly toxic to real economic and social development.

It is better for rich people to have power than politicians. At least their wealth might have something to do with skill (creating a successful drug in the past, etc.)

Read the price of inequality by Stiglitz, he explains whay this not quite true anymore (and that's unfortunate)...

Politicians (in a liberal democracy) can have their power removed without revolution. In a different system of government in which the rich are in charge, the only way to change government is to destroy it and kill them all. They won't sit still while you're trying to do this.

> In a different system of government in which the rich are in charge, the only way to change government is to destroy it and kill them all.

70% of wealthy families lose their wealth by the second generation, and a stunning 90% by the third, according to the Williams Group wealth consultancy [1]. So the power seems to naturally defuse without having to "kill them all".

[1] http://time.com/money/3925308/rich-families-lose-wealth/

Do you think that would still be the case in a society in which they were in charge? I don't.

Eh? Rich people don't get rich because of skill, ever. No one gets rich because of skill, they get rich because they are in a position to exploit power. You simply cannot earn a billion dollars through wages. No one is that valuable or unique. The only way to do it is by appropriating the output of others, or having it handed to you. For example, the wealthiest family in America, the Waltons, owns more money than 40% of the country. All of them inherited their billions. Even if we do believe that Sam Walton deserved untold billions, how does this tell us anything about his children?

In addition, why should we empower rich people at all? Why is giving a single person a billion dollars, skillful or not, better than allowing a million people to democratically direct that wealth? Even if those million people simply redistribute that money into their pockets, the outcomes will likely be better for everyone, and it's mathematically far more likely that those people will direct it towards the common good than a single person would.

> Eh? Rich people don't get rich because of skill, ever.

That's silly, of course some do. There are any number of inventors, entertainers, etc, who've gotten rich largely from their own efforts (and luck).

> The only way to do it is by appropriating the output of others, or having it handed to you.

There would be no output to appropriate without the skill and direction of the rich person who had the idea and took the risk. As for the inheritance angle, who better deserves the money than the children of the original rich guy? They're the ones most likely genetically to share the same traits that enabled the original guy to get rich.

> In addition, why should we empower rich people at all? Why is giving a single person a billion dollars, skillful or not, better than allowing a million people to democratically direct that wealth? Even if those million people simply redistribute that money into their pockets.

Because they've proven to be able to direct capital in a beneficial way. Regular people haven't. Regular people would just buy the same old trinkets and necessities and innovation would halt. It would be a very boring existence with no hope of a better life to strive for.

> There would be no output to appropriate without the skill and direction of the rich person who had the idea and took the risk.

I think that it is a bit much to suppose that every rich person is benefiting exclusively, or even mainly, from his or her own skills and ideas.

> As for the inheritance angle, who better deserves the money than the children of the original rich guy? They're the ones most likely genetically to share the same traits that enabled the original guy to get rich.

Down this road lies kings!

> Down this road lies kings!

You'd think so, but as I wrote in another comment, 70% of wealthy families lose their wealth by the second generation, and 90% by the third. Rich kids do a crappy job of holding on to wealth (although I'm sure they're still better than poor kids would be).

I meant by "this road" the idea that there is some sort of genetically inherited fitness to rule, not anything about wealth in particular. (Also, I daresay that rich people elevated to hereditary power would find that their resources would allow them to hold onto their wealth.)

although I'm sure they're still better than poor kids would be

Why, exactly?

"demanding"? this is an industry which fires us if we ask for a raise, or hint at collective bargaining, or even if the 'big hit' has just been discovered and research is foolishly seen as unnecessary for a while. this is an industry where foreign work visas are rife, with threats of the jobs being declared 'unnecessary' if extra hours aren't put in (with the poor folks having to return to their original countries). this is the industry which tries to offshore as many aspects of the process as possible. there is no "demanding" anything, unless you already have another situation lined-up; and even then they threaten you with NDAs and non-competition clauses.

I think that was "demanding" in the sense of giving regulatory bodies authority to force things like that.

In the states there really is no active regulatory agency to pursue this; the FDA having been all but gutted, (all the clinical 'safety' research is now done by the applying company itself). One only has examine who are among the largest political donors to both parties to understand why this might be.

  this is the industry which tries to offshore as many aspects of the process as possible

And this :

http://fortune.com/2013/05/15/dirty-medicine/

Is a very interesting and quite frightening take on the potential consequences of such offshoring.

In my anecdotal experience, the price of asthma inhalers (Albuterol) have gone up significantly, which sucks since they have a limited shelf-life & it's common to have multiple (car, office, bedroom, etc). Like epipen-countered allergies, asthma is a life & death situation.

From a quick web search, this site[1] shows:

> To go from inhalers that cost 5 dollars to 60 dollars especially for those who don’t have prescription drug coverage has been awful.

As a consumer, I can either forgo inhalers or use expired ones (instead of spending $$$ to keep them current).

[1] http://www.dailystrength.org/health_blogs/dr-orrange/article...

Could you not buy them from another country? A quick trip across the border in either direction will save you a ton of money, and I'm sure you can mail order it too.

Not that it is frequently prosecuted in the US, but in many (most?) countries it is illegal to import pharmaceuticals without a license.

asthma inhalers are considered a pharmaceutical?

> mail order

This carries the risk of fakes, though. I mean fakes are everywhere in the first place, but through mail order the risk significantly increases.

I think the chances are very low when buying from a developed country.

From what I recall, there was a big price increase for asthma inhalers when they switched from CFCs to other propellants. That being said, I thought the new propellants were going to go generic after a few years.

Has that not happened yet? Or did people / insurance companies adapt to the higher prices so that the new generics can charge more than the old ones?

I always used non-propellant inhalers when I was a kid (in Europe). I believe they are called Diskus-type. Why do you need propellants?

I don't think albuterol is available in that form. Here's a study where a company that makes generics is testing that, I think: https://clinicaltrials.gov/ct2/show/NCT01857323. It's from 2013.

The drugs in Diskus form are typically steroids. Steroids are to prevent attacks, albuterol is to stop attacks that have already started.

No, I had both albuterol (ventolin) and steroids (flutide) in diskus form.

Edit: link to picture: http://bloggfiler.no/tcmn.blogg.no/images/441858-8-126583454...

The sorry state of asthma medication is a tragedy that could have completely been avoided.

For a long time, asthma medication was not under patent protection. The FDA, however, outlawed all generic asthma medication because it contained CFCs [0] in the late 00's, and the replacement delivery system was newly eligible for patent protection simply due to using a different propellant. [1] This wasn't some amazing new advancement in the drug formula, they just changed how it got into your lungs - ostensibly due to environmental concerns.

This case is a damning indictment of patent law and in how we handle externalities generally. The environmental cost of CFCs was an externality that no drug manufacturer ever had to pay. What's the solution to that problem? Of course it's not to tax or fine manufacturers who continuing to pollute, no: it's to reward some pharma companies with a fresh monopoly for altering the medication such that it doesn't deplete the ozone layer.

Congratulations on the amazing new drug you developed! You're now doing the bare minimum that should be required to be a citizen of the planet by not actively destroying it with pollutants! Here's your reward, a monopoly, with which you can extract money from the (mostly poor) asthma sufferers who no longer have affordable medication.

I don't understand why this wasn't a bigger story.

[0] http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/u...

[1] http://www.nytimes.com/2013/10/13/us/the-soaring-cost-of-a-s...

In EMS, there's been a big push to allow basic EMTs to draw Epi up from a vial to administer it, precisely to avoid the absurd costs associated with EpiPens. I don't know if that would be an option for individuals; perhaps it's something you can talk to your doctor about

And they expire after a year.

Where I once worked we were obliged by law to keep a huge range of medications in a dedicated emergency kit. In the years I was there none were ever used or needed. The drugs ranged from salbutamol to adrenaline to glucagon, steroids, tablets for angina etc, etc. In the mandatory refresher courses we were also quietly advised that with our level of emergency experience and thus diagnostic ability we were far more likely to do harm than good with these and so there were only a couple of items in the kit that we should ever even think of using. Only one company was approved for the supply of these kits and they'd regularly contact us advising that such and such now needed replacing and invoice us. Not only was it onerously expensive but what was really annoying was that they never supplied anything with a full shelf life. Stuff that might have several years shelf life would commonly be supplied with a year or even less left to expiry.

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