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Comment by ada1981 | Hacker News Reader

ada1981

what seems to happen is the drug is trivially tweaked or a new delivery system is created, they get a new patent, then dump marketing & lobby dollars to secure the revenue stream.

The new patent on Ketamine for depression is an example.

Ketamine is already used to treat depression and it’s a cheap generic drug.

The nasal spray being touted is many times more expensive and is really just a marketing play.

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There are lots of marketing plays on existing, well-established technology. That's like half the things Silicon Valley develops. So what?

With regard to the Ketamine example, what the drug company is selling is a nasal spray (versus the traditional method of using an IV), and freedom from the stigma of taking a "party drug": https://www.theverge.com/2019/3/11/18260297/esketamine-fda-a....

Ketamine has long been prescribed off label for depression, so I'm not clear on how this is freeing people freedom from the stigma.

The "so what" is that the current system prevents people from getting affordable access to drugs.

This may not matter to you, and that is certainly well within your rights, but many people do seem to care about ensuring other humans aren't priced out of medicines that may help.

Ketamine delivered by IV can continue to be prescribed for depression (and if it can't, that's an FDA issue, not a patent issue). What exactly is your problem with the situation?

I offered the Ketamine example of how a company will try to patent a new delivery system of existing generic drugs as a way to increase the price.

Ketamine as a generic work and is available in lozenges, IV, and other ways. This nasal spray is being marketed as a breakthrough for depression (even though it isn't), costs more, and because there are no marketing dollars behind the other equally effective method, people will likely end up using this branded version.

I would consider a change from ingestion via IV to insufflation is a pretty major development and all around improvement on the existing drug and.method of administration. If someone managed to create an ingestable pill or nasal spray for insulin they'd win a Nobel prize. While the scale and importance of that discovery is greater, the fact that such a switch in delivery method is that significant leads me to believe this controversy surrounding a nasal spray is more outrage porn than actual reality.

> If someone managed to create an ingestable pill or nasal spray for insulin they'd win a Nobel prize.

We already had inhalable insulin in 2006 (Exubera) and again in 2014 (Afrezza), both of these medications were withdrawn from the market for lack of sales. And yet people still get upset when Pharma spends money on marketing...

Fair enough. The policy question is should we be paying our tax dollars ($700 per dose!) to reduce people's stigma?

There was a similar example with anticoagulants where the generic (warfarin) required monthly blood tests, so the drug company developed a version that doesn't require the monthly blood tests, and charges $5k/yr more for it. Is it good public policy to spend $5k/yr per patient to avoid a monthly blood test? We don't have that conversation in the US, and it costs us.

Note that patient doesn't see the $5k/yr increase. They just pay the $35/mo co-pay instead of the $15/mo co-pay. However, the rest of us do pay that cost. Again and again and again.

Not sure where I stand on the issue, but the response to

>There are lots of marketing plays on existing, well-established technology. That's like half the things Silicon Valley develops. So what?

The "what" is that here, peoples' health is at stake, and simply taking a market-driven approach may not be to the benefit of society.

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