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Comment by L_Rahman | Hacker News Reader

I can explain the first quote.

In a universal donor scenario, the T-cells are engineered, error corrected and tested once. From there, they can be multiplied pretty cheaply. Most of the cost is in the initial engineering.

In a patient cell scenario, each individual patient's cells must be engineered, tested and delivered. This is obviously much more expensive.

A very crude computer science analogy would be the difference between scaling up a load balanced application relative to adding a new server from bare metal without automated scripts.

Why the treatment would cost half a millions dollars at the market is outside of my purview, so I'm eager to get an explanation as well.

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Mostly profit to pay back the investors for billions of dollars in research and development, and baked in liability insurance.

Some of it also goes to pay for the R&D of other drugs that never make it to market.

This is propaganda. Spending on research and development at private pharmaceutical companies is dramatically eclipsed by marketing and sales spend.

https://www.google.com/amp/s/www.washingtonpost.com/amphtml/...

Yes, but sales and marketing has a positive ROI. If you spend $100M on sales and marketing, you'll get $150M back (for example). Otherwise, why would you do it?

So if pharma companies cut out all of their sales and marketing, they'd have even less revenue than they do today. And that would lower R&D spend.

Why do drugs need marketing?

This... I feel that we (US) should go back a bit on this, and restrict all advertising not in specific magazines/journals that target doctors, and restrict office visits of pharma reps to dr offices.

Why does anything need marketing?

Because it's one of the key ways that physicians get new information about drugs. Not every doctor has the time or the proclivity to do research on every newly launched drug. Having a rep come in and answer questions goes a long way to getting doctors up to speed on the latest information.

The treatment also requires a bone marrow transplant (which requires destroying the patient's immune system). It's a lot of medical care.

Are you sure? I don't find that claim in the articles or report. The bone marrow procedures seem performed in the context of the chemotherapy treatment - which failed in combination. They dont seem to indicate how necessary or unnecessary that combination was to this treatments success here.

The "Subject 1" and "Subject 2" sections of the paper both speak of persistent malignancy in bone marrow.

I have not the experience to read this report with any confidence, but your comments are so far too brief to convince me that you have. Fig 2 in the report includes a chart which appears to indicate a bone marrow reading clearing in response to application of allo-SCT. How do you ascertain that this treatment does not in itself improve malignancy in bone marrow?

These “off-the-shelf” CAR T cells were then used to treat two infants with relapsed refractory acute lymphocytic leukemia and bridge them to allogeneic stem cell transplantation.

I don't have much knowledge of the subject but a stem cell/bone marrow transplant seems to be a common treatment in aggressive cases of leukemia.

Private insurers are too fragmented and small to negotiate a reasonable price for treatment. They lack the leverage that something like a national single-payer system would have.

The largest insurer in the US covers more people than the NHS. The second and third largest insurers rival other continental health services.

Please offer an alternative rationale for why they aren't as effective. I'm trying to understand why US healthcare is so broken.

It's easy. The UK can say "no" to paying for certain drugs. They take some political flak for it, but overall they've been able to keep spending down.

Even mention not paying for something in the US and holy hell happens. Even Medicare and Medicaid can't say no for the most part.

If American's want cheaper healthcare they are going to have to get used to having less of it and not get all the fancy new technology right away.

Insurance companies only pay for what they consider usual and customary.

>It's easy.

No, clearly it's not.

I work for a startup that's delivering health services. Insurance companies have a very high bar for what they cover.

They are very conservative about covering new therapies. There's a lot of snake oil in medicine (acupuncture, homeopathy) and they don't want to pay for what doesn't keep their members healthy.

It's not easy to execute, but it's easy to figure out one of the key drivers of increased costs in the US.

Compare drug coverage in the US vs. Canada or the UK. New drugs are often covered immediately post-FDA approval in the US. Heck, look at Exondys 51 for Duchenne's. The FDA barely approved it and pretty much every US insurer is paying for it. That doesn't happen in other countries.

A great example is the diabetes drug called Jardiance. It has better efficacy than older drugs and every US insurer covers it. It's not covered in many Canadian provinces.

If by that you mean they can't dictate the price of drugs, sure. But that has more to do with not being an arm of the state than being "fragmented and small".

The CHS and NHS are able to negotiate drug prices even though they can't coerce US companies with force.

"You give us this price or we don't use your drug" isn't coercion?

The drug company can walk away from the negotiation. Either party can say no. That's the difference between coercion and negotiation.

The difference is governments don't have competition. If you play hardball with a drug company in the US, one of the reasons they can walk away is there are other insurance companys to which they can sell their drugs.

And insurance companies can't throw drug company officers in jail.

> The difference is governments don't have competition.

There are many governments in the world. If one government plays hardball with a drug company, drug company can go find a different government, or negotiate with private insurers in that same country. Yes, private insurers exist even in countries that provide basic healthcare to all their citizens. [0]

> And insurance companies can't throw drug company officers in jail.

Show me where this has happened. This scaremongering and black-ops has nothing to do with the practice of negotiating price. There are many people that wish Martin Shkreli went to jail for gouging AIDS patients, but that's not happening.

0. http://thehealthcareblog.com/blog/2012/01/16/the-awkward-wor...

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