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Comment by ssl232 | Hacker News Reader

So a promising treatment for the cold was dropped by the drug company because it was too expensive to develop, and the potential payoff too small. Drug companies' profit models pretty much require them to focus on developing drugs that people have to use for the rest of their lives - that manage a condition rather than treat it.

Is there a good reason why we shouldn't club together as rich countries and fund a not-for-profit drug research body that does fund this sort of thing?

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> Drug companies want to make drugs that people have to use for the rest of their lives - that manage a condition rather than treat it

Recent evidence contradicts this statement. Notably, the pay-off to Gilead for its hepatitis C cure [1].

Besides, TFA outlines non-conspiratorial reasons underlying pharmaceutical companies’ nervousnous around developing vaccines. (TL; DR people are unwilling to pay as much for prevention as they are for a cure; also development is expensive and risky.)

EDIT: [1] https://mobile.nytimes.com/2015/02/04/business/sales-of-sova...

Do you think insurance companies are going to be willing to pay $100K per person to cure the common cold?

No, but it would be reasonable to pay ~ $1000 per person, which could mean hundreds of billions of dollars of revenue. Pretty good for $1B in R&D.

> Do you think insurance companies are going to be willing to pay $100K per person to cure the common cold?

This is a straw man.

Millions of Americans contract a rhinovirus strain every year [1]. The number is closer to 30,000 for HCV [2]. A rhinovirus cure thus has orders of magnitude more potential customers across which to spread fixed costs.

On the demand side one has, on one hand, 7 to 10 days of the sniffles; on the other hand, fatal liver failure.

Nobody would pay, nor should expect a third party to pay, $100,000 to cure their common cold. The article eyeballs the value of the vaccine market. It’s approximately the present value of 8.7 hours per year * your marginal hourly earnings over your remaining working years.

[1] https://www.cdc.gov/features/rhinoviruses/index.html

[2] https://www.hepatitisc.uw.edu/pdf/screening-diagnosis/epidem...

I am not saying that curing the common cold would not be incredibly valuable to society, but responding to the OP who was suggesting that since we have a treatment for HepC we can have one for the common cold. The pharma companies look at what insurance companies will pay for and develop drugs and vaccines that they will pay for. The insurance companies know the cost to their bottom line of hepC and they know the cost of the common cold.

Is that supposed to be an excuse, or the beginning of an argument for disbanding the current pharma and insurance industries? You've articulated very clearly why their adverse incentives are bad for society.

At least in Germany, most common cold remedies are not paid for by insurance companies but private people (since they have not been proven to work etc.). So insurance companies would only save the additional costs once the cold develops into something worse, which is relatively rare.

So let the pharma companies charge $100k.

If you're in the top whatever percent of rich people with a net worth over $100 million, would you not pay $100k to be better from the common cold? Call it the Tesla model - don't go for the price conscious mass-market first. Sell to those for whom money is no object first.

Build the Model-S of common cold treatment. When you feel a cold coming on, your private house-call-making doctor comes to your house, you cough on a petri dish with rhinovirus food, the doctor takes it back to the lab, rushes it through whatever testing is required, then comes back the next day, gives Bill Gates a pill or a shot, and the day after, he's right as rain.

Simultaneously, work on getting the cost of the equipment down. Depending on what's being research, a medical lab could easily cost over $10 million - too expensive to scale quickly, but making lab equipment that's orders of magnitude cheaper will pay dividends for itself. The first human genome that was sequenced cost ~$3 billion, now we're just waiting for it to drop below $1000 (currently at $1400). (23&me's $200 kit isn't technically sequencing, but they definitely also benefitted from that work.)

Once the cost is brought down, bring it to a broader market. Charge $1,000 to never get the common cold again, and reap in money selling both the cure and the supporting equipment. There are enough people paying over $1,000 for elective surgery to support many plastic surgery clinics; I'd venture a cure for the common cold would be able to sustain a few, at least until a competitor comes out with a vaccine.

Unfortunately, the NTSB and the FDA regulations, as well as the behavior of patents on things like car transmissions vs drugs, are very different things (for good reason, mind you), so this isn't a likely scenario.

Would I pay $100k to prevent me from getting the common cold, I am absolutely able to afford it?

Hell no. I might pay for treatment for someone who were immunocompromised. For me? Nope. It's just a virus. It'll go away.

I'd pay a lower amount, however.

Assuming you had the means, would you pay 100k with the knowledge that, as an early adopter, you will be helping making future treatments more affordable for those who really need it? think of it as a 100k donation, and you get a cold cure for free.

No, but I'd donate that to a viable cause. I used to be pretty poor so I still know how much $100,000 is worth. (It's a whole lot of skeeball.)

So, I'd not pay that to cure me of the common cold. Not a chance. I don't mind the cold. You sniffle and feel poorly for a few days. Meh... The benefit isn't worth that much to me. I'd probably pay up to a few thousand for it, but not that much.

“Yescarta and Kymriah do work similarly, though. Each involves removing a patient's T-cells and shipping them to a facility where they're engineered to spot and bind to CD19, a protein commonly expressed by B-cell cancers. Once the companies have finished altering the T-cells, they're infused back into the patient.”

This seems to be quite an outlier in a discussion on general vaccine economics.

EDIT: wrong link; replaced.

The article you linked to discusses the cost of CAR-T therapies for DLBCL and ALL, not a Hep-C cure. That's what the previous commenter was referring to as 'an outlier'.

My bad—fixed. Thanks for the heads up.

Potential payoff for treating the single most common illness in the world is too small? I don't buy it. The first company to come up with the cure would be sitting on a goldmine.

the first company to be willing to disrupt the industry by offering it cheap to mega corps that want their productivity up will be rich.

We need a Big Pharma version of Elon Musk.

> Is there a good reason why we shouldn't club together as rich countries and fund a not-for-profit drug research body that does fund this sort of thing?

Oh yes. Most of the people that would be involved in this decision are linked near of far to the drug companies.

As far as I understand, the main reason for this is that you would need to invest a billion dollar. You might have success with that but you also may not and then there a lot of other nice things you can do with a billion dollar. Governmental research projects have the tendency to go on even after everyone knows that they will fail, so money would be saved by doing them in the private sector where investors stop a failed project sooner. Unfortunately, if the backbone of the therapy has been developed in the 60s and 70s most patents have run out so there is nothing that would return most investments. The only one I could imagine doing this would be a private philantropist like the Gates Foundation.

>and the potential payoff too small.

I don't want to put some chemicals in my body for cold. I would imagine that to be case for many people.

I think the fact that there's an entire aisle in the grocery store for tylenol/ibuprophen, mucinex, robotussin, and other cold-related products is a good hint that a sufficient number of people will seek chemical solutions.

> Drug companies' profit models pretty much require them to focus on developing drugs that people have to use for the rest of their lives - that manage a condition rather than treat it.

Not true - there are plenty of examples of genuine cures developed and marketed by pharma.

What drug companies do require is a return on their investment, which can be in the multiple-billions. This isn't evil-big-pharma stuff... this is just how any sensibly-run company operates, pharma or otherwise.

Achieving an ROI is seen as difficult in this particular case because (as TFA says) people don't value vaccines highly enough because they are taken when they're well, and (as you say) they're only needed once.

(Personally, I think the article over-estimates this challenge; sell 100m doses at $50/dose and [assuming CoG is not a problem] you've got a major blockbuster. Even if the NHS/insurers didn't want to pay, employers and individuals likely would, at this price level. And 100m doses is pretty low-ball, if you consider the likely uptake of a vaccine promising a genuine cure for the commonest cause of the common cold.)

> Is there a good reason why we shouldn't club together as rich countries and fund a not-for-profit drug research body that does fund this sort of thing?

I've wondered about this in the past. I think a major aspect is risk.

If it was easy to pick a disease to cure and a way to do it, then we'd not be in this situation in the first place - developing drugs is actually incredibly difficult and unpredictable. This is well-demonstrated by an analysis published in Forbes a few years ago. https://www.forbes.com/sites/matthewherper/2013/08/11/the-co...

Rather than taking an individual drug and pricing the work done on it to bring it to market (as with many previous studies) this analysis looks at total R&D spend by individual pharma companies over time, and divided that spend by the number of new drugs brought to market. As such, it takes into account the extraordinarily high rate of attrition in drug development - the time and money spent on countless thousands of drug candidates that are abandoned before the ever make it to market. (Note the analysis does have one major weakness, but now's not the time.)

To quote the article: "For companies that have launched more than three drugs, the median cost per new drug is $4.2 billion; for those that have launched more than four, it is $5.3 billion."

And there's the rub: I'm sure you could find some way of funding a few hundred million if it was guaranteed to result in a cure for a disease - Governments, the Gates Foundation, etc. But do such bodies genuinely have the will to spend countless billions, every year, to chase those few new treatments that might --or might not-- emerge? And having found a new treatment, would they just give it away... or would they want to recoup some of the costs they'd invested?

>"there are plenty of examples of genuine cures developed and marketed by pharma."

Name one.

Abbvie (Mavyret) and Gilead (Solvadi, Harvoni) have both developed and marketed treatments which cure Hepatitis C.

Roche sells MabThera which (together with chemotherapy) cures about 2/3rds of a common type of lymphoma. They also recently failed with a large phase III study in this setting, having hoped to cure even more people with an improved treatment.

Celgene and Abbie/Pharmacyclics both have large phase III trials running in the same disease, aiming to cure more patients through the addition of their drugs to the current standard-of-care treatment.

Novartis has just launched Kymriah, a CAR-T treatment which offers the prospect of long-term remissions in paediatric ALL. (Too early to say whether some of these will effectively represent cures.)

Various pharmaceutical companies are attempting to develop new antibiotics, which would cure infections.

(Just recent examples, and off the top of my head...)

I was like "MabThera?" but then I Googled it and that's Rituximab which I'd heard of. I had Hodgkins (which is one of the less common Lymphomas) so I got ABVD which doesn't involve Rituximab, but I read about loads of the chemotherapy drugs because I was morbid.

The closest you came to naming one was MabThera. I'll check it, thanks.

Edit: Oops, also Harvoni, etc.

The influenza vaccine has to be administered every year, and employers & individuals do choose to pay for it.

I guess my statement that drug companies are only interested in long term treatments was a bit sensational, but as we both agree, they need a return on their investment. I understand that developing drugs is both intellectually hard and extremely expensive, but there are in my view a few benefits that (super)national collaborations have over private companies:

- you only need one cure, so the work only needs to be done successfully once (competition is in this case potentially wasteful)

- knowledge and good people are pooled (not hoarded by the companies able to offer the best compensation)

- access to larger sources of funding for individual projects

- knowledge from failed projects could be publicly disseminated instead of locked up in the company's archives

- no need to turn a profit

The usual arguments I hear against state- or superstate-run organisations over the private sector is, as others have said here, the perceived wastes of resources when projects don't appear to be on a successful track: a private company would cancel early to avoid more waste, whereas a publicly funded organisation wouldn't necessarily do so as the project managers aren't incentivised by shareholder value. However, it seems to be to be just a case of having the right incentives. If they were instead tasked with improving patient outcomes measured over, I don't know, 10 years, then that could be a valid reason to use to cancel research that doesn't seem to be going anywhere ("it doesn't seem like this drug, even if it passes trials, will make a meaningful improvement in patient outcomes"). Another aspect of public organisations could be that the scientists in charge of the research would have their own reputation to consider, instead of that of the company. It would be in their own interest for costly projects to fail quickly if they go nowhere.

Here's a thought: would it work if such a public organisation could underwrite the research of private drug companies? These companies could then be paid a "non finders fee" for failed drug projects that nevertheless showed significant promise, in return for low-cost access to the successful ones, and of course public sharing of the reasons why the drug failed. Would the economics of such a system work, or would drug companies find ways to game the system?

Is there a good reason why we shouldn't club together as rich countries and fund a not-for-profit drug research body that does fund this sort of thing?

This already happens with major threats, there was Ebola that got solved quickly. Keep in mind that government resources are also limited.

The problem is not the profit motive, it is the regulations. We demand such safety and so much data of pharmaceutical companies that it is basically impossible to make a vaccine for a disease like the common cold.

If we are willing to take more risks and require less paperwork we could have a vaccine for the common cold in a few years.

We could also have lots and lots of deformed and/or dead babies then. There’s a reason these regulations exist and are updated often to keep up with current best practices.

We could save lots of people by replacing all sidewalks with rubber matting and limiting cars to driving 5 miles an hour. Safety is not an absolute, it is a trade off and medical safety should be no different to any other.

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