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Comment by ecobiker | Hacker News Reader

A simple fix could go a long way - disallow really minor improvements and work hard to get rid of evergreening.

http://www.nature.com/news/indian-court-rejects-novartis-pat...

How do you define "minor"? These insulins have dramatically different serum half lives (for example there are fast acting ones for postprandial administration, others that are optimized for pumps, etc) and so there is a clear pharmacological difference. Moreover, discovering these variants is nontrivial, as each insulin must be checked against igf-1 receptor cross reactivity, lest it become teratogenic. Making matters worse, the exact binding of insulin and igf-1 to their receptors is not known making this endeavor especially difficult to predict.

What is not clear is whether these modifications are an over optimization over "the original". For each patient the cost/benefit calculation will be different and based on many variables.

http://theconversation.com/explainer-evergreening-and-how-bi...

I'm not an expert and I can't comment on specifics. But I'm of the opinion that a small enhancement is not the same as an invention of a drug and it doesn't come anywhere close to extending the life of the patent - unless that tiny change actually makes a big different in effectiveness.

Any good patent system should find a good balance between the two seemingly conflicting goals of incentivizing companies to innovate and keeping the price down for patients.

These insulin changes are like the difference between a spanner and a torque wrench, or a spanner and a ratcheting wrench. The torque wrench is definitely more effective for certain use cases, as is the ratcheting wrench, both are nontrivial, but 99% of the time the spanner would do just fine / maybe be a bit more of a hassle.

(for Americans: "spanner" -> "hammer")

I believe you meant wrench.

One thing I don't understand about drug patents: how does evergreening work? Doesn't the original patent still expire, allowing anyone who wants to make the old version?

That is correct. From here[1]:

"[The authors] describe the history of insulin as an example of “evergreening,” in which pharmaceutical companies make a series of improvements to important medications that extend their patents for many decades. This keeps older versions off the generic market, the authors say, because generic manufacturers have less incentive to make a version of insulin that doctors perceived as obsolete. Newer versions are somewhat better for patients who can afford them, say the authors, but those who can’t suffer painful, costly complications."

This isn't really a story about patents, it's about marketing and a chicken-and-egg problem. You could buy dirt cheap generic insulin if anyone made it, but they don't, because nobody wants to buy it, probably because nobody makes it.

[1]: http://www.hopkinsmedicine.org/news/media/releases/why_peopl...

I don't really believe that there isn't a lot of low- and middle-income people with diabetes that wouldn't buy drastically cheaper insulin if it was still rather effective, especially pre-Obamacare. It's clear that there's collusion to keep cheap product out of the market.

This is exactly spot on. I would also add that "nobody wants to buy it" refers to the "doctors", not the "patient" - which is a very restricted and more easily targetted channel for marketing versus the patients.

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