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Comment by runholm | Hacker News Reader

The issue is that with medicine, it cost vast amounts of money to develop and test a medicine. If there was nothing making sure the investment would pay of, there would be much less money spent developing medicine.

I am not saying the system is perfect, and some companies push the prices to the ridiculous to exploit people in need, but removing medical patents altogether would require some other equally strong economic incentive to keep development rolling.

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I think you're missing the point on both the money and the patent laws in India. According to the article "Successive governments have taken a view that patents should be granted only for major innovations, not updates to existing compounds — allowing domestic manufacturers to make generic versions of drugs at vastly lower cost." - which basically means you get a patent for real innovation, not minor cosmetic changes to keep your cash flow going.

The second - "Pharmaceutical firms say India’s disregard for patents will stifle innovation or make drugs commercially unfeasible — Gilead paid $11 billion to buy the developer of Sovaldi in 2012."

Note that it didn't cost $11B to research the drug but what it cost to buy the company. It is disingenuous to claim that their R&D cost is that high.

Not sure how much it cost to develop Sovaldi, but in general it costs $1-2Bn and ~10-12 years to develop a drug and only 1% of drugs in pipeline actually reach the market. So $11b seems a reasonable cost to assume.

That $1-2 billion figure pharmaceutical companies like to throw out is the risk adjusted cost, which includes all of the failed drugs and clinical trials for each successful product. The acquisition price for Pharmasset included Sovaldi and several other drugs.

> The issue is that with medicine, it cost vast amounts of money to develop and test a medicine.

If that is the real issue, then subsidize the costs of clinical research, instead of accepting that everyone pays the price of drugs 10 times what they should cost.

There's an international co-ordination problem there. National governments don't want to foot the bill for research that the whole world needs.

You can make an international body (or use the WHO) to fund such clinical trials then. It's not like we lack global organizations either.

UN budget around 5.5bn$ for two years, WHO around 4bn$. Not enough by a long way if drugs are costing 1-2bn$ to develop.

So instead nations still foot the bill for research. The draconian US patent system proportedly produces more drug R&D than elsewhere, but where are those patents applicable?

The US, and anyone agreeing to honor its patents.

Everyone else gets free drug R&D without anything close to international discourse on funding drug research, because its privatized and thus in the scope of trade law.

Even better, the drug patent system means novel treatments are being developed for life threatening conditions that the suffers are disproportionately unlikely to be able to afford ("The Sick", as a demographic, are much poorer than average for obvious reasons). So not only are you subsidizing global drug research, you are doing it on the backs of the poor.

That kind of command and control economy was tried in many countries (the whole Soviet block) and pretty much failed spectacularly every single time.

The prices pharma companies ask for is ridiculous and makes the drug unavailable to 90% of the people that need it.

if they priced their drug to make it more accessible they could easily make the development cost back by making money off the 90% they left to die or hunt for drugs on the Indian market.

There needs to be a balance between getting drugs to the people that need it and making a profit. Currently that balance is non existent and pharma companies charge ridiculous amounts knowing full well that us insurance companies will pay it.

You know how the rest of the planet feels when your insurance company refuses to pay for your drugs and you have to pay for it yourself.

Would you invest your money in a pharma company that returned below-the-market risk-adjusted returns?

No because the market is part of the problem. I would however invest (read as donate) in a non profit pharma with the sole goal of developing drugs and covering their development cost.

You can do that already, just donate to universities and public research institutions doing drug research.

Now, do you think that investors should be forced to invest in pharma companies offering lower-than-market returns?

I wouldn't be so sure about it. 8 years ago my dad was diagnosed with GIST, for which there was only one drug at the time - Glivec made by Novartis. He had to take 2 boxes a month, each one costing 5x the average national montly salary. Fortunately, the national health insurance in Poland covered the cost of the drug fully, so he never paid anything for it.

The point I am trying to make is that when he was diagnosed, there was 6 other people in Poland who have been diagnosed with the exact same type of cancer. By the time he died last year(thanks to Glivec he lived much longer than the original predicted 6-12 months with traditional chemotherapy) the total number of people with GIST in Poland taking Glivec was 30-40. That's in a country with 40 million citizens.

So sure, the drug is not affordable to pretty much anyone in Poland, if the national insurance wasn't paying for it. But even if it wasn't ultra-expensive, there still a very limited number of people who need it, so I can see why Novartis charges what they do to make at least some money back.

I doubt the insurance was actually paying the sticker price on that medicine anyway. It's all part of the illusion.

It's nationalised insurance. They don't need to mislead you to convince you there is a value in the service they provide. Since it's government the information is public. For example, when I buy medicine in France (also nationalised) it shows how much I pay and how much the government pays. So yes, they are paying whatever the receipt says.

If this is true, that is awful. That means nations are lining drug companies coffers for profit rather than just doing the research themselves and selling the fruits of research at the cost of manufacturing rather than arbitrarily insane prices due to state guaranteed monopolies.

No, the state negotiates as low price as possible because the national health service is given a certain budget that they have to fit in. The difference here is that in US your insurance company might say that they will pay 50% and you have to pay the remaining 50%. In Poland the national health service would never offer you such a deal. Either it's fully covered or it's not offered at all. Therefore companies are willing to lower their prices so that the government accepts their medicine at all, rather than having it rejected and not offered at any of the hospitals.

And the last time I checked the treatment with Glivec is a lot more expensive in US than it is here, so this system must be working at least partially.

We already have publicly funded research, which is an altogether more effective way of developing new medicines anyway.

Nonsense, disregarding the pink elephant in the room (reproducibility in academia) once a method has shown potential it is often spun off into some sort startup (often SBR recipients). If they keep gaining clout, a bigger pharmaceutical will buy them out. New medicines are developed 10% by a university and 90% by industry.

Not 90%. 58%. According to JAMA.

https://jama.jamanetwork.com/article.aspx?articleid=185198

When the public funds drug research it also doesn't "magically" discover that its drugs are really effective when they aren't:

http://articles.mercola.com/sites/articles/archive/2006/06/1...

You're seriously going to post Mercola on HN?

Yes, go ahead and down vote me for flagging links to a quack's website.

Please don't post comments about getting downvoted: https://news.ycombinator.com/newsguidelines.html

The comment was unsubstantive and dismissive. If there's something wrong with a source, it would be better to explain what that is instead of just snarking, which (a) undermines civility and (b) teaches us nothing.

Very well. Joseph Mercola[1] to put it politely, is not burdened by objective reproduction of claimed results when hawking his alternative remedies.

[1] https://en.wikipedia.org/wiki/Joseph_Mercola

If you're going to disagree with the source, disagree with the source, not the website that cited the source:

"Researchers from the Beth Israel Medical Center in New York City examined four journals: American Journal of Psychiatry, Archives of General Psychiatry, Journal of Clinical Psychiatry and Journal of Clinical Psychopharmacology. They found drugs were favored in roughly:"

Is Beth Israel full of quacks?

I doubt it, but since Mercola didn't link me to their meta-study I can't find the reference directly. It's not the JAMA link that was in the OP.

Actually when the public funds drug research it's often not reproducible 1. From personal experience the number of times when the work isn't a fabrication is less than the number of fingers on my right hand.

1 http://blog.scienceexchange.com/2012/04/the-need-for-reprodu...

And the university likely pockets a nice little "non-profit"

> which is an altogether more effective way of developing new medicines anyway

I would like to believe that, but have you got any data to back this point? How many new medicines are developed by public research?

See the downvoted answer below for citations.

Developing the actual therapeutic is a very different endeavor, not one that academic institutions are well set up for. You need to do pre-clinical studies on efficacy and toxicity, modify your drug to make sure your animal models work, then scale that to humans including engineering the right delivery format, dosage, etc. that process for the most part is inefficient, expensive, and has a high rate of failure.

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