Well, PrEP is a miracle drug that has gone criminally underutilized in the fight to eradicate HIV. It would be nice to see governments really push it hard for a change.
For those curious; in Australia, it's prescribed and costs about $50-60 p/month. In the UK, it varies; England and Wales are doing trails, and Scotland it's prescribed. Under the NHS, it's £9. In Canada, the generics cost upward of $300 per month.
You might think it's improper, but the evidence says otherwise - PrEP is safe, well-tolerated, marginally cost-effective at proprietary prices and clearly cost-effective at generic prices.
One of the fundamental principles of modern medicine is informed consent. Patients have the right to make their own decisions about their treatment based on their own assessment of the risks and benefits. PrEP is an incredibly compelling proposition for a lot of patients.
PrEP is well tolerated given it's known side effects but conservative medicine dictates that we don't prescribe medications unless we have a measurable benefit and that's not a large group of people. A homosexual male who has lots of unprotected sex with strangers should probably be on it. A hetereosexual mostly monogamous person probably shouldn't be.
A big factor here is that the prevalence of HIV in the US is low, at .34%. Globally it's a bit higher at .48%. It is also often not that contagious. That being said, under the right circumstances it could be so it's real important to be aware of the risk factors.
My husband and me both take prep, his first Doctor refused since it promoted "promiscuity" and would only prescribe it if you are in a relationship with someone positive.
Which is bull.
Find a new doctor that is actually sex positive and won't refuse it for stupid reasons.
(Admittedly I am lucky where I am though to have a doctors office that focuses on LGBT issues, which happens to include HIV prevention/care)
Also about 20% of Americans are on medicaid, and generally do not pay any premiums, deductibles, or copays
Fucked up private insurance in US, they charge that much and then do the reimbursement so they can bill the huge monthly cost to plans / government that will cover it.
We should be giving this out for free.
My MD said Truvada might go generic next year, so perhaps there's hope.
The US should establish an agreement whereby US patients pay a LOT less but that the foreign patients need to pay the same.
The amount the industry earns should be low enough to make it reasonably financially accessible to patients but high enough to prompt our best and our brightest to pursue new drug development as a career.
That people are flying abroad is the start of ripping up their local monopoly along with uncertifified online pharmacy importation and grey market sales - taking risks to avoid costs is a sign that the market /isn't/ bearing it.
> Adjusted product gross margin was 87.3% compared with 84.2% in the year-ago period. Research & development (R&D) expenses were relatively flat at $916 million. Selling, general and administrative (SG&A) expenses increased 20.8% to $1.01 billion.
https://finance.yahoo.com/news/gilead-gild-q2-earnings-sales...
They’re doing OK, I think.
What about when you take all the pharma companies and average how well they do over several years? The average net profit margin for the industry is 14.05% according to a January 2018 study by New York University’s Stern School of Business.
14.05%, not great, not terrible.
In addition, the overwhelming majority of those dividends and share buybacks from one company are subsequently plowed back into the industry in different companies depending on which of those companies are working on the most profitable drugs.
source: I have several friends that control a lot of AUM that specialize in pharma investments.
Profiting off someone's misery would be when you cause the problem and provide the solution. If you merely recognize an existing problem and provide a solution where there previously was none or where the previous solution was inadequate/inferior.
Attitudes like yours makes me not want to continue using my talent to create on solutions to problems that qualitatively and quantitatively improve people's lives. If people are going to look at it as profiting off misery and deny me the opportunity to increase my wealth, I and others will just take our talents elsewhere. There is no lack of other industries and problems where those capable of contributing solutions can make money and not be subject to your shitty attitude towards how they make a living.
Lastly, I say all this as someone who takes an orphan drug myself that would not exist at all if the US didn't have a legal framework that gives pharmaceutical companies the incentive to bring drugs to market. The drug I take is available in only one other country and only because a US pharmaceutical company brought it to market.
The consumer didn't choose to have greedy companies that like to make a quick bug over someones suffering.
This is pretty simple semantics. Not sure what you're struggling to understand here.
Well, the discussion was about the atrocious cost of HIV medication, and Gilead is the company that holds the patent on Truvada. You didn't provide a link, but http://pages.stern.nyu.edu/~adamodar/New_Home_Page/datafile/... suggests it's actually lower in 2019 at 10.94%.
From the linked Excel sheet there, there are 28 industries with higher net margins, and 65 with lower net margins. They're still doing just fine :).
As I said, not great, not terrible. They're doing just fine, but they are also far from abusing their position. An industry abusing its position would be one with higher net margins than almost all other industries. The fact that 30% of industries have better net margins suggests that this industry is far from being abusive in its pursuit of profit while improving people's quality of life.
https://www.investopedia.com/articles/personal-finance/08061...
There would be costs involved but they can always tell them to get stuffed and manufacture their own if they won't be reasonable. Notably there is a lack of pharmaceutical companies who decide to abandon world markets entirely because positive N is always greater than 0.
https://media.xconomy.com/wordpress/wp-content/images/2014/0...
I am not sure this explains the discrepancy between the healthcare cost between US and Switzerland.
More in depth analysis:
"There were two causes of this massive increase: government policy and lifestyle changes.
First, the United States relies on company-sponsored private health insurance. The government created programs like Medicare and Medicaid to help those without insurance. These programs spurred demand for health care services. That gave providers the ability to raise prices. A Princeton University study found that Americans use the same amount of health care as residents of other nations. They just pay more for them. For example, U.S. hospital prices are 60 percent higher than those in Europe. Government efforts to reform health care and cut costs raised them instead. Second, chronic illnesses, such as diabetes and heart disease, have increased. They are responsible for 85 percent of health care costs. Almost half of all Americans have at least one of them. They are expensive and difficult to treat. As a result, the sickest 5 percent of the population consume 50 percent of total health care costs. The healthiest 50 percent only consume 3 percent of the nation's health care costs. Most of these patients are Medicare patients. The U.S. medical profession does a heroic job of saving lives. But it comes at a cost. Medicare spending for patients in the last year of life is six times greater than the average. Care for these patients costs one-fourth of the Medicare budget. In their last six months of life, these patients go to the doctor's office 29 times on average. In their last month of life, half go to the emergency room. One-third wind up in the intensive care unit. One fifth undergo surgery. "
https://www.thebalance.com/causes-of-rising-healthcare-costs...
You can read the rest it is very informative. I still don't think that healthcare cost in the US is caused by the rest of the world not paying their fair share in drug discovery.
I was reflecting to this. If drug cost is part of healthcare cost than by definition it cannot be apples to oranges comparison.
That's a rather weird statement.. I suppose it's true in some sense, but what I'm reading online from real people in the US is that they get bills that are easily 10-100x as much money for going to the hospital than I get.
There's a few others I wonder about:
> These programs spurred demand for health care services. That gave providers the ability to raise prices.
At least requires some numbers, because I'm constantly hearing about Americans not going to the doctor because for the real fear it might bankrupt them.
> The healthiest 50 percent only consume 3 percent of the nation's health care costs.
This is also questionable. Again maybe technically true, but not suitable for conclusions.
The ailments, pain and other bad stuff that Americans will walk around with instead of going to the doctor is incredible (again for the real fear it might bankrupt them). In the US I spoke to a real person who was trying DIY dentistry. There was an AskReddit thread about what general advice doctors say people shouldn't do, and the top advice was: don't perform operations on yourself.
I'm pretty sure it's the price driving down demand.
> The U.S. medical profession does a heroic job of saving lives.
Wait, why does it suddenly stop comparing to the EU?
> But it comes at a cost. Medicare spending for patients in the last year of life is six times greater than the average. Care for these patients costs one-fourth of the Medicare budget. In their last six months of life, these patients go to the doctor's office 29 times on average. In their last month of life, half go to the emergency room. One-third wind up in the intensive care unit. One fifth undergo surgery.
And this is different in the EU because ... ?
I don't like these statistics. I think they're using them to lie with.
All they talked about during the dinner was price fixing, tricky deals to block generics, and schemes to maximise the amount they could get each country to pay. Nothing about the science, medicine behind the drugs, or benefits to patients.
That's the reality of pharma today.
On January 25, 2007, Thailand’s interim government issued compulsory licenses–which require
manufacturers to license generic versions of their patented drugs–for two Western medicines:
Kaletra, an advanced anti-AIDS medicine manufactured by Abbott; and Plavix, a blood-thinning
treatment to help prevent heart disease, produced by the France-based Sanofi-Aventis and U.S.
firm Bristol-Myers Squibb. These attacks were preceded in November 2006 by a violation of
Merck’s patent on the anti-AIDS drug Stocrin.[5] The government threatened to break
patents on eleven more drugs.[6] Explaining the rationale behind Thailand’s decision, health
minister Mongkol Na Songkhla said that “the move is permissible under international trade
rules in the event of national public health emergencies. . . . We have to do this because we
don’t have enough money to buy safe and necessary drugs for the people under the government’s
universal health scheme.”[7]
Perhaps "evergreening" is also an issue in the USA that might keep prices high for a long time?
> On January 25, 2007, Thailand’s interim government issued compulsory licenses–which require manufacturers to license generic versions of their patented drugs–for two Western medicines: Kaletra, an advanced anti-AIDS medicine manufactured by Abbott; and Plavix, a blood-thinning treatment to help prevent heart disease, produced by the France-based Sanofi-Aventis and U.S. firm Bristol-Myers Squibb. These attacks were preceded in November 2006 by a violation of Merck’s patent on the anti-AIDS drug Stocrin.[5] The government threatened to break patents on eleven more drugs.[6] Explaining the rationale behind Thailand’s decision, health minister Mongkol Na Songkhla said that “the move is permissible under international trade rules in the event of national public health emergencies. . . . We have to do this because we don’t have enough money to buy safe and necessary drugs for the people under the government’s universal health scheme.”
It costs about £30 pm in that case which is about $40
Often they'll be running studies at the same time to assess the feasibility of Prep on the NHS.
https://www.who.int/tb/areas-of-work/drug-resistant-tb/xdr-t...
What if it becomes common enough to get into the water at much lower doses? What if people split pills to reduce costs? ISTM that there are many potential avenues for evolving resistance.
https://en.wikipedia.org/wiki/Antibiotic_prophylaxis
(I'm talking about the use in humans there)
If someone is using PrEP and is exposed to HIV, then either the drug works and they avoid infection (in which case there is obviously no impact on drug resistance) or they become HIV+. But in that case, they were either exposed to an already-resistant variant, or they were astonishingly unlucky and the drug failed to prevent infection - in which case, resistance is a moot point.
A person needs to develop an active HIV infection in order to communicate the disease to another. PrEP prevents this from happening in the first place.
That's why it's important for people taking PrEP to be screened regularly, and put on a proper cocktail if they test positive.
I wouldn't take it unless I was a non monogamous gay man[0], the risks out-weights the benefits in any other demographics imho.
[0] not that I have anything against that per say, it's just statistically the most affected demographic
(Your also discounting drug users; but unfortunately those addicted and at risk are also the least likely to have the means to acquire the drug.)
For example there's a massive campaign targeting both men and women engaging in any sort of sexual activity that includes fluid exchange promoting usage of PrEP. One can see it in a subway and on local commercials on TV.
There's some new campaign now which unfortunately i don't quite recall but it is highly bizarre. It something along the lines of "equality. make hiv undetectable. Truvada for PrEP." or something like that.
If a drug user is doing something as stupid as sharing needles they're likely not in the right state of mind to take PrEP.
https://www.injectingadvice.com/v4/index.php/articles/harm-r...
Also sex workers, also trans women, also people from countries with a high prevalence of HIV in the general population.