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Comment by j-james | Hacker News Reader

> It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system ... The wholesale cost in the developing world is about US$0.04. In the United States, it costs about US$5.30 per dose. [1]

That's a little over 132x more expensive. Compared to other common medicines like ibuprofen ($0.04 in the developing world, $0.05 in the USA [2]), what makes chloroquine so uniquely pricey in the USA? (or, I suppose, ibuprofen so uniquely cheap?)

[1] https://en.wikipedia.org/wiki/Chloroquine

[2] https://en.wikipedia.org/wiki/Ibuprofen

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Ibuprofen can be manufactured by almost any company and sold in almost any store. So open competition in the sector drives down prices.

Chloroquine exists in a walled garden where pharmaceutical companies and the government have rigged it so that rent-seeking behavior is the optimal financial strategy.

Why can't Chloroquine ? Maybe there's not as much money in it, unless it requires special permissions.

Does anyone know if there's a lot of supply in hand and if it can be made in large quantities fast?

The price reflects opportunity cost, there is low demand for Malaria treatment in the US. Ibuprofin is a staple drug.

Except drugs can be shipped around the world very cheaply, even in small doses, so demand alone can't explain price difference.

exactly. My point was this is prob a demand issue, not a government intervention. I wonder how fast they can make it...shipping can be done via charter planes this time.

False. Government prohibits importation of most medicines from abroad. It's corruption hidden in the form of "please just think of the children."

"FDA cannot assure the safety and efficacy of unapproved drugs" is the main excuse used in drug importation court cases.

Reference: https://www.pharmacycheckerblog.com/online-pharmacies-person...

But it wouldn't take an act of Congress to change that. Your link says it's up to the FDA, which could easily choose to allow importation to combat the pandemic.

The Lancet has published a study this week that anti-inflamatory drugs may help Ncovid penetrate cell walls and actually speed up the process.

France has stopped over-the-counter sales of Ibuprofen as of mid January.

https://www.afrinik.com/anti-inflammatory-drugs-can-make-cor...

Not only anti inflammatory drugs but also ACE inhibitors used to treat hypertension.

This has been disputed:

"This speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.

The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak.

The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the Covid-19 infection. " [1]

There are also the brilliant MedCram updates, where the issue of ace inhibitors et. al just happened to be discussed yesterday. In it he describes the mechanics of ACE-i and ARB treatment: https://www.youtube.com/watch?v=1vZDVbqRhyM

[1] https://www.escardio.org/Councils/Council-on-Hypertension-(C...

That is not actually a refutation.

Not a native speaker, but refutation to me translates to disputed… anyways edited for clarity.

To dispute something usually just means to disagree with it. Refutation generally implies positive evidence that a position is wrong.

Yeah, disputed is much better.

The GP was talking about NSAIDS and you're posting about blood pressure medicine. There are similarities, but still.

Not familiar with afrinik, but this has been reported in The Guardian

https://www.theguardian.com/world/2020/mar/16/health-experts...

The Lancet article was not a study, it was a "correspondence," an educated guess from a researcher.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2...

I don't know if it's more responsible for the researchernto ouvlish their educated guess immediately - it's perhaps more likely than not to be right based on their expertise and they truley believe it's a really issue and might feel obligated to talk about it. Or, if it's more responsible to do the work first and get some preliminary evidence. Those few days during the pandemic could be crucial for rapid response, and if there's a strong rationale for it maybe it's worth communicating, but this isn't like "it can spread in xyz manner" that really changes behavior - you still be have to do social distancing whether or not Advil makes you more susceptible -is the panic that your painkiller will give you the coronavirus worth it?

I have in-laws in Nigeria. We just tipped them off a couple of days ago that now might be a good time to buy some Chloroquine and keep at the house, in case the situation gets worse. This is a commonly known medicine down there, that you can get from pharmacies without prescription.

But based on what we're seeing so far, it seems plausible that this virus prefers cooler northern climates. So hopefully it will turn out to be an unnecessary precaution.

In the east coast of Spain we have had great weathee (25+ degrees celsius) and it didn't seem to greatly influence transmission speed :(

The numbers so far suggest you need tropical heat and humidity to slow down transmission speed. That would need to be 35C+ weather, and no air conditioning.

Before I've read you message I was sure that dry air slows down transmission speed. But indeed, it's humidity https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767

The rapid transmission in industrialized countries is most likely helped by the daily indoor concentration of people in the big cities, during commute, in large schools and workplaces. Large cities in Africa will surely get it to some extent, but the spread might be slower since Africans don't spend as much time indoors, and the rural communities are already practicing "social distancing" to some degree.

I think you have a very Hollywood view of African societies...

Having lived in African countries for more than 5 years I don't rely on Hollywood for my sources.

I'd offer the Ebola outbreak as a counter-example.

Ebola is different: It does not spread over air like the Corona virus.

The Ebola virus " spreads to people initially through direct contact with the blood, body fluids and tissues of animals. Ebola virus then spreads to other people through direct contact with body fluids of a person who is sick with or has died from EVD". [0]

[0] https://www.cdc.gov/vhf/ebola/about.html

Only 2 Ebola outbreaks have had more than 1000 infected people.

This thing is in the early stages still and there are already 7x more recorded cases than the largest Ebola outbreak.

Nirobi, Metro Area Population 10 million

https://www.civitatis.com/en/nairobi/

Compare:

Largest cities in Africa

https://en.wikipedia.org/wiki/List_of_cities_in_Africa_by_po...

Largest cities in USA

https://en.wikipedia.org/wiki/List_of_United_States_cities_b...

It's not a matter of big cities only. People in the big cities in industrialized countries spend their time indoors with large crowds to a much higher degree. It indicates that the spread will be slower in Africa (while not absent)

What exactly do you expect those 10M people to do during the day?

Citation needed on it preferring colder climates. My own quick glimpse of the global numbers showed plenty of equatorial cases per capita. Many aren’t rigorously tested populations, too.

It's something I first read from the Goldman Sachs client call notes that has been circulating:

https://www.forbes.com/sites/abrambrown/2020/03/16/the-priva...

Certainly not the best citation, and I have no idea where GS gets their analyses, but seems plausible enough that I'm at least hoping there could be some truth to it. See e.g. India, the virus doesn't seem to have taken off there despite a few early cases.

If it's wrong, I fear things could get really bad, especially in heavily populated cities like Lagos.

I think this presentation is a great source of facts.

https://drive.google.com/file/d/1DqfSnlaW6N3GBc5YKyBOCGPfdqO...

Weather: Maybe 10 oF increases the doubling time 2x (steady-state reduction in exterior virus levels by 50% per Pubmed 22312351, plus reducing time × concentration of people indoors).

I don't think a paper about SARS-CoV-2 and temperature has been written yet (that I've seen), but people are hoping it reacts like SARS-CoV. See here: https://www.ncbi.nlm.nih.gov/pubmed/22312351

Keep in mind, that doesn't mean zero cases in hot weather, just that it is less contagious.

“ It may also explain why some Asian countries in tropical area (such as Malaysia, Indonesia or Thailand) with high temperature and high relative humidity environment did not have major community outbreaks of SARS.”

Iirc, Maylasia has a pretty strong breakout on its hands. They recorded their first death today and are at something like 670 cases. I think their double rate was 2-3 days. Edit-it’s 1 day today. See link. Not good news I think for the hypothesis.

https://ourworldindata.org/coronavirus

Sorry, I'm now picturing email offers from Nigerians that I would openly welcome.

> But based on what we're seeing so far, it seems plausible that this virus prefers cooler northern climates. So hopefully it will turn out to be an unnecessary precaution.

Wuhan has temps around 50F-75F (~15C-22C). Certainty not hot, but not a cooler climate given how it's still winter in this hemisphere.

Italy and Spain aren't known for being especially cold either, mountainous areas notwithstanding.

All of these locations are still cooler northern climates. I agree that they're not exactly cold.

btw, not sure if you cited the ibuprofen example merely as a comparison. I hope you are aware that early data is indicating that NSAIDs including ibuprofen have shown high degree of correlation with mortality in younger patients.

To an extent that the French govt has officially released it as a statement. https://edition.cnn.com/2020/03/16/health/coronavirus-ibupro...

Not uniquely.

USA is famous for very high prices of essential medicines, and being an expensive country in general.

This was already implied in the question. They're asking why something like ibuprofen is different.

Maybe because it's one of few medicines being sold by foreign companies in USA?

America doesn't have a lot of opportunities for foreign players, let alone in such militantly overregulated sector like medicines.

I'm assuming because ibuprofen is OTC and chloroquin is prescription.

If a medicine isn’t used very often usually only one manufacturer will continue making it. They then can set monopoly pricing. I also have a belief that there is some actual or implicit collusion where they are dividing the market for generic drugs into monopolies by strategically dropping out.

FDA rules make it expensive to start new production or enter from abroad, so a new manufacturer is in for as price war they will probably lose.

There are lots of super cheap prescription meds. Many for a penny a dose wholesale. They have robust competition but still make money at that price point, although some makers may be selling fraudulent drugs.

In theory, when the patent on a popular medication is over, new players should pull the price down to marginal cost. These days that is not happening for many products and I’d like to know why. Any economists know?

Ibuprofen can be sold on somewhat recurring cycle.

Its a prescription drug in the US, and pharmacists get paid a bunch. Most developing countries you can buy OTC.

https://rxsaver.retailmenot.com/drugs/chloroquine-phosphate/... has it at 60c/dose in my area.

For what it is worth - on my surgery bill one tablet of ibuprofen was billed at $40+. Insurance accepted $20+. So I would guess it will heavily depends on provider as well.

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