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Comment by ceejayoz | Hacker News Reader

> Another big concern is the cost. While Novartis will not estimate the price it will ultimately put on the treatment, some industry analysts project it will cost $500,000 per infusion.

Welp, guess my insurance premiums aren't stabilizing anytime soon.

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There won't be that many people who need this drug, and supposedly it's a one-time cure that isn't a life-long drug treatment. I'm a layman when it comes to biotech, but my hope is that longterm the prices come down for this and other drugs that use a similar technique to treat diseases. I'm happy researchers are focusing on cures rather than "living-with" a disease.

Also, shoutout to Boston (and Cambridge) which I don't think gets enough love on HN. #1 in the entire world for biotech, #2 for software, #1 for higher ed, #1 for healthcare, you can actually afford to live here, solid public transportation, amazing skiing / hiking / beaches, NYC in 4 hours. If you are tired of SF think about Boston

You can afford to live there? I was looking at 1 br apartments in Cambridge and it was pretty darn close to SF Bay. Interviewers I was talking to said they commuted in 45 minutes just so they could own a house.

The unspoken assumption is that it's affordable if you have roommates (or a solid dual-income household). I have a place in Providence, RI and commute to Cambridge, MA by train (38 minutes to South Station via Amtrak, double that via MBTA). It's a shorter commute than when I rented in Brookline. Because of all of the Boston-area colleges, students set the standard. The housing stock is higher quality (and lower price) once you escape Boston/Cambridge, where students will live in any sort of derelict apartment, and use loans to pay inflated prices for the privilege. Boston has many things going for it, but the housing market is a real problem. Don't get me started on "broker fees"...

it's affordable if you have roommates

This is the story in NY too. It definitely does not qualify as "affordable" for anyone with a family.

>commuted in 45 minutes

I live in and work in Boston, and my commute is 45 minutes. I'm planning to move further out to buy a house, and my commute will probably still be roughly 45 minutes.

Unless you live within walking distance of your office or feel like you have a safe enough bike route to the office, 45 minutes is a fairly standard commute here.

I live in Waltham and while I don't work in Boston (work from home) it only takes me 15-25 minutes (depending on where in the city) to get into Boston.

The Boston area has awesome suburbs that aren't really suburbs like Newton, Arlington, Waltham, Brighton, Melrose (where incidentally Martin Fowler lives) etc. I know everyone wants to live in the city cause its cool but these mini cities are pretty darn cool as well.

From most of these areas you can get into the city in 20 minutes by car. 40 minutes if there is bad traffic.

And of course there is public transportation.

Compare this to most of the metropolises in America: Atlanta, Dallas, Houston, etc that have massive traffic and suburbs that are truly suburbs (boring as can be).

Compare this to most of the metropolises in America: Atlanta, Dallas, Houston, etc that have massive traffic and suburbs that are truly suburbs (boring as can be).

Yet those boring metropolises have something key: affordable housing. Which is why the world is looking a lot more like them: http://www.newyorker.com/magazine/2017/07/10/americas-future.... While most MA suburbs prohibit most development, thus causing prices to skyrocket: https://www.bostonglobe.com/business/2017/05/16/somerville-h...

I generally agree but often those affordable houses are massive cheaply made McMansions (particularly in Texas).

Living in New England I'm often envious and this is probably coming from jealously but really family's of 5 don't need 6000 square feet, a pool, a 3 car garage, and 2 acres of land. You can always live like the Europeans and most of the rest of the world does and there are condos sub 300,000 in the MA suburbs.

Sure you can, but would you want to? 6000 square feet means I have a place for my hobbies, with the tools all setup so I can do something for 10 minutes if that is all the time I have for them. I like my pool, it is a lot easier to go swimming when the pool is just out your door as opposed to having to go someplace else. I like having room in my garage for my collectable car. I like having my garden close enough that I can get fresh greens on a whim.

The point is different life choices enable different lifestyles. I've seen wood workers in Europe produce beautiful things in a tiny apartment. They prove it can be done, but they don't have the space for a table saw and as a result everything they do takes longer. Even if hand tools are the goal, in the large shop you turn around and your saw bench is there, while the European has to get it out of the closet. When done the American sweeps and is done while the European counterpart has to put the bench away as well. When I'm working I want the American style shop.

Your choices may be different, that is your choice. Do not try to force other people to like your choice.

Funny... Weren't these studies done in Philly, not Boston? And isn't the Novartis lab based out of Switzerland? I missed the part about Boston in this article...

You lost me at "amazing skiing" ;-)

This won't affect your insurance - the patient population is too small.

Now, if a similar treatment gets approved for, say, prostate cancer... that's going to affect your insurance.

Eh, probably not for prostate cancer, very treatable if caught early, and a lot of people have "watchful waiting" as it does less harm to leave it in for a while than take it out.

Now, if there was a gene therapy for breast, colon or liver cancer, then it would be a problem.

Yes, well, that's all true for prostate cancer, but if we had a drug that could cure it people would want that over surgery or "watchful waiting".

It depends ... the treatment may be wanted, but unless it has a much higher cure rate than the current regimen, no insurer will offer it, and no single payer system will either.

In the UK we have NICE (National Institute for Clinical Excellence) who make the decision over what drugs can be used on the NHS (and most private insurers use the same gradings), if it doesn't offer a clear benefit over the existing treatment in both effectiveness and then cost it won't be approved.

> the patient population is too small.

I think that cancer is one of the great filters. At some point a species will develop an unreliable way to treat cancer (chemotherapy); at which point cancer becomes a genetic problem as natural selection is displaced by medicine. Over many generations, this will kill a species unless a reliable cure is found - we seem to have that cure. Our cure is symptomatic (cancer being the symptom) but the same technology could eventually be used for designer genetics.

Essentially, more and more people are going to rely on this treatment until we are able to completely eradicate hereditary cancer. Probably not in our lifetimes.

What displacement of natural selection? Hereditary cancers are the exact type of cancers that haven't been affected by natural selection since they generally are post-reproduction age.

Furthermore, eradicating hereditary cancer (and many other diseases) is technologically possible already (screening of embryos, genetic testing of parents) but it's socially and politically complex; we as a society currently don't want to e.g. enforce restrictions on procreation just to prevent these diseases.

This discussion already happened below.

What is the selective pressure /for/ cancer-predisposing genes? And it's not as if most cancers act as a reproductive filter -- the majority of them emerge well after the onset of reproductive ability, drastically reducing, if not eliminating, their selective effect.

> What is the selective pressure /for/ cancer-predisposing genes?

Evolution does not and never has selected /for/ things. It is a process of elimination. What this means is that, since the advent of chemotherapy, we have eliminated selection /against/ certain types of cancer.

> the majority of them emerge well after the onset of reproductive ability

Correct, we have never had an impact on that and likely won't for a very long time (we don't know enough about our genome to do so). As-per this study, we have been curing cancer in children (as we absolutely should) with very little knowledge as to how/why they developed cancer so young. Will their children also be at risk for leukemia? What about their millions of descendants? We don't know. If treatments like this work out then we might not have to care.

Actually evolution may well be selection against cancer in older people. (may is key - we don't know for sure) Enough Young girls of breeding age have a small tendency to breed with old men. This increases our lifespan by ensuring those who have whatever genetics it takes to live older have more children. It is a small effect, but it is something.

But cancer isn't primarily a genetic problem; it's a consequence of the way our bodies work at the cellular level. We all accumulate genetic damage over time from a variety of sources, and we'll all get cancer eventually if something else doesn't kill us first.

That is the story for most people today but is not the entire story. If your mother had breast cancer then you are at a higher risk - if not for genetics that would be magic. That is why I specifically said "hereditary cancer."

Yep, other hereditary cancer syndromes too, such as Von-Hippel Lindau, which is a mutation in a tumour suppressor gene.

how much is getting cured of cancer at a very young age worth? dying vs. living another 80-90 years?

less than a Tesla? more than a house?

interesting questions arise around immuno-oncology.

should Apple be the most profitable company - or someone that literally cures cancer?

> how much is getting cured of cancer at a very young age worth? dying vs. living another 80-90 years? > less than a Tesla? more than a house?

It's worth so much that a person shouldn't be required to pay for it. Like a right.

>> It's worth so much that a person shouldn't be required to pay for it. Like a right.

It can't be a right. That would mean someone has an obligation to provide it. I would say it's worth so much that a monopoly on it should not be allowed.

> It can't be a right. That would mean someone has an obligation to provide it.

By that logic, voting can't be a right, because someone has to register voters, run the polling booths, count the votes, etc.

If the health care system was mostly staffed by unpaid volunteers, I might agree. As it stands health care is 17% of US GDP (10% global) and growing.

Society has an obligation to provide it, just as it does drinking water.

I get a water bill every month...

Also, I know folks on well water that live outside of the city, society does not provide their drinking water.

Also, There is Flint MI.

YOU get a bill. Society pays for public drinking fountains, homeless shelters, section 8 housing, etc... where water is provided for the less fortunate at a scaled societal contribution (or free).

Flint MI is an absolute crisis and the government has stepped in, the state of Michigan sued the city, and there have been over a dozen criminal indictments. Multiple governments have stepped in to repair the obligation of clean drinking water, and to punish those who failed the citizens.

You got it backwards. There is no obligation to provide drinking water. In fact most places where the city puts it in they force people to use the provided water and NOT put in wells. Then they send a bill.

This is bonkers logic. It's wrong to coerce someone into providing the cure, but it's right to coerce someone out of forming a monopoly?

An IP-based monopoly can't exist unless the society enforces the concept of that IP, e.g. coerces anyone to not make the treatment without a valid licence.

The monopoly isn't made by the company, it's a conditional and time-limited offer given by the society to promote the creation of such things.

If you show up in a random hospital with an injury or disease, they are already obligated to provide care, it's just you're directly responsible for the bill.

The individual shouldn't be paying.

In the US it actually doesn't work this way. Hospitals are only obligated to provide care for people whose lives are in immediate danger. Once the patient is stabilized, the hospital is free to kick them out. There are a handful of exceptions and many hospitals will provide care out of charity, but don't expect to get a half-million dollar cancer treatment unless you have health insurance or really good credit.

Whether or not an individual pays for it has nothing to do with the pricing the manufacturer sets. In fact, setting prices becomes even more of a concern when these things are being funded by tax dollars as the government is going to need a way of determining what's reasonable.

Anglo-Saxons (in general, not all, but in particular Americans) are so very weird when it comes to the "free market".

IMO (dirty socialist/communist that I am), healthcare is not part of the free market. The industry providing healthcare should be strictly regulated and no benefits allowed.

Also, what's worth healthcare compared to the US DOD spending?

Quite a lot actually. US defense spending in 2014 was $614 billion, 3.5% of GDP. US healthcare spending in 2014 was estimated by the world bank as 17.1% of GDP.

That's total spending, but even in terms of public money, the US is at 8.3% of GDP: larger than Belgium, the UK, Switzerland, Finland, Canada and many others.

This would certainly be possible but would require a major change in gov't research funding, including many extra billions for drug R&D, "productionizing" research, and large scale clinical trials; since a "no benefits allowed" industry wouldn't be investing to create drugs like this one.

>The industry providing healthcare should be strictly regulated and no benefits allowed.

Then how would anyone be interested in launching such a company or working in that industry ?

urg

Some people believe other people to be fundamentally good and not interested only in personal enrichment (financial enrichment I mean here).

But some of you make me doubt that.

But why are some people quantum physicists researchers ? Why are there mathematicians and biologists ? They don't earn much.

Your line of thinking is so stupid and self-centered, it really makes me want to use swear words.

Public research is rather different from launching a company. It's not exactly the same hassle nor honors. There's some difference between understanding the world and selling stuff. Research rarely has products in mind, at least it's not its primary goal, unlike companies. They also don't have clients, which is a central thing for companies (and not the most enjoyable one).

And guess the reason why many researchers end up in private companies ?

Thanks for the insult, I thought this community was supposed to be mature.

When a manufacturer sets the price, they want to recoup the costs and then make a profit on each unit sold.

When a government funds the research, the marginal cost for each unit provided is time and materials, with no profit.

Government funds projects every day that are waste, spending tens, even hundreds of millions of dollars. We can continue to pour money down the F-35 drain but not provide healthcare? Make America Intellectually Honest Again

I still think it might be best if government funds the research and then allows anyone with the capability to use it. In other words, no patents. There would be competition and the price would come down. The big problem I have with this suggestion is that I don't believe in governments ability to do anything cost effectively - even funding research - but I might be wrong.

Dean Baker, an economist, has written here and there about alternative ways to pay for drug research:

"There are clearly better and worse ways to structure a system of government financed research. For example, the Free Market Drug Act, a bill recently introduced in the U.S. Congress, called for establishing a set of competing government corporations that would be evaluated at periodic intervals (e.g. 10 years) for the quality of their work. The worst performers would be put out of business with new ones created to take their place."

More here:

http://www.paecon.net/PAEReview/issue32/Baker32.htm

http://cepr.net/publications/briefings/testimony/drugs-are-c...

Considering the number of poorly performing gov't programs, I'm sure the "quality of their work" would be based on things other that actual output. Nepotism and buying votes are probably more likely.

> how much is getting cured of cancer at a very young age worth? dying vs. living another 80-90 years?

A tough question, made tougher by the side effects of doing so. $500k per infusion pays for quite a few mostly-healthy low-income uninsured kids to get basic pediatric care. The US healthcare system is already priced too high for a lot of people - I pay $2,002.25/month for my family.

> should Apple be the most profitable company - or someone that literally cures cancer?

Should healthcare really be a for-profit endeavour?

on the latter:

is it more ethical to profit from curing a disease or from causing it?

Pfizer vs. Red Bull.

and if you can't become a billionaire from curing things, how will this sector attract the same kind of talent/genius like other industries?

Biotech vs. Quants vs. SnapChat

The US federal government has basically standardized, in terms of public health and safety measures, on treating doing those interventions that will save lives if they will save lives for less than $7.5 million on average (it's been going up over time). This is for stuff like lead abatement, public safety commercials, pollution controls, etc.

That doesn't apply to medicine but it looks like this treatment is well worth it compared to the money the government spends, e.g., cleaning up lead paint. And since the number I gave is for an average life when saving a child we should be willing to spend more.

"should Apple be the most profitable company - or someone that literally cures cancer?"

Nobody needs an Apple product. Life is a basic need.

They deserve to be profitable but in a way that doesn't require bleeding dry the cancer patients themselves.

getting downvoted for asking questions.

HN sometimes really can fuck right off.

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