Open Letter from Gilead CEO: Remdesivir Pricing | Hacker News Reader

Open Letter from Gilead CEO: Remdesivir Pricing

stories.gilead.com

38 pointsdrinker109 comments

Indian companies have already started manufacturing Remdesivir (under license from Gilead) and selling them at a price of ~$70.

I wonder how other countries are going to respond since the US seems to have bought up the entire global stockpile from Gilead (who are charging $390 - $520 to Americans).

[1] https://www.hindustantimes.com/india-news/india-s-hetero-pri...

[2] https://www.indiatvnews.com/business/news-covid19-drug-cipre...

This isn't just paying for the R&D on remdesivir itself. It's paying for all of the other antivirals which were developed and then failed clinical trials, and all the other antivirals that turned out to be largely useless because (like SARS, MERS, and Ebola) there was never a large-scale outbreak. If you require remdesivir to be sold at cost, then any company developing antivirals will reason out:

Scenario A: There's a huge pandemic and massive demand, but the drug can only be sold at cost, so we break even.

Scenario B: The drug fails clinical trials. We lose a bunch of money.

Scenario C: The drug works, but no pandemic ever happens. We lose a bunch of money.

.... and then no one will develop antivirals, because on average, you can only come out behind.

As to why the government can't do everything itself, I'll quote Paul Graham on venture investing, which (like drug development) is a highly technical, winner-take-all business where most projects fail:

"Why not just have the government, or some large almost-government organization like Fannie Mae, do the venture investing instead of private funds?

I'll tell you why that wouldn't work. Because then you're asking government or almost-government employees to do the one thing they are least able to do: take risks.

As anyone who has worked for the government knows, the important thing is not to make the right choices, but to make choices that can be justified later if they fail. If there is a safe option, that's the one a bureaucrat will choose. But that is exactly the wrong way to do venture investing. The nature of the business means that you want to make terribly risky choices, if the upside looks good enough."

You know what government is really good for?

Expensive projects for the public good with no mandate to turn a profit.

If you're part of a government agency whose entire purpose is to develop and research new drugs, you're not going to be unduly risk averse. You're going to be doing your job, trying new things, working on getting new, effective, efficient treatments and cures developed, tested, and released to the public.

Personally, I don't know to what extent I believe that pharmaceutical companies have actively suppressed research on cures for diseases, in favour of life-long treatments, but the incentives definitely support the theory. Publicly-run pharmaceutical research would also be much more likely to do a proper, thorough investigation of the kinds of treatments that can come out of well-known natural/easily-synthesized substances (as opposed to the existing pharmaceutical industry, which is incentivized to do research into things that require more specialized expertise & equipment, so the people who want the drugs must but them from them).

> In the U.S., the same government price of $390 per vial will apply. Because of the way the U.S. system is set up and the discounts that government healthcare programs expect, the price for U.S. private insurance companies, will be $520 per vial.

Sigh

How many years of normalizing and internalizing the utter insanity that is the US medical industrial complex does it take to be able to just say that with a straight face?

> How many years of normalizing and internalizing the utter insanity that is the US medical industrial complex does it take to be able to just say that with a straight face?

I hate to tell you, but it's not better in Europe just because the racket is obfuscated by several more layers.

Not sure why they down-vote you, you didn't said anything about 'free' healthcare, and you are absolute right, the 'customer' does not see much of those layers, but ask any Healthcare-worker that has to work with insurance...they can tell you story's!

Very few people have private health care in Europe, at least in the UK - they are either comparatively very rich or have a job that provides it (again, very rare and probably a job that pays very well to begin with).

You will see a lot of buying power from free health care providers as they represent tens-hundreds of millions of people - they will most likely pass on a price gouging drug in favour for others. They won't pay market rate, whatever the drug manufacturers say.

The most relevant industry to this board (IT) usually provide private healthcare though. I’ve had BUPA from work since I graduated. Granted this is across only two jobs but when I’ve been applying for jobs in the past private health has always been one of the perks

Maybe it’s different in the start up world but larger companies all seem to offer private health insurance.

My experience in IT in the UK is:

VC backed companies will sell you private health insurance as a perk. It is rarely useful. I suspect it is a way of funnelling money at low rates of tax to the VC's other holdings in at least one case, but have no proof. It certainly funds the privatisation agenda at low cost to the investor, though.

Seniority is signified through leadership or contracting. The latter you can get private insurance as a perk through your own company, but again, it is useless.

Most permanent non-lead roles I've had that have been more conventional haven't had it, though.

When comparing healthcare costs between USA and Europe, everybody speak about the public systems vs. USA, but I would like to see the cost per person of the private plans in Europe against the cost per person in the USA.

For what I read about USA, in HN and in other places, I suspect Americans would be surprised too. Those private plans have a very hard competitor in the public system, so, somehow, at least in my area, they manage to be pretty affordable.

in Germany, private plans are often 1/2 of the public plan. But only at young age, prices will go up with age and switching back in the public system is legally blocked (for most cases).

Also private plans are mostly only available above a certain income level. So the demographics are skewed towards better educated, richer and thereby healthier people in the privat plans.

The only place I've ever had private healthcare in the UK was from an American company (BlackRock).

>Very few people have private health care in Europe, at least in the UK

In Europe at least in Switzerland quite many have private health care (the price difference is quite small because the obligatory insurance is tremendously high already), and if you think 'we' are rich..you are wrong.

Switzerland is a complete outlier in this respect, Zürich is much closer to Boston than to Paris.

No not really...that comparison is completely wrong.

The obligatory insurance is also private.

From private company yes, but with private we mean the 'luxury' addon...the obligatory is regulated by the state, but administered by private company's.

Who is “we”?

We the people.....of Switzerland

I don't think I've ever heard anyone say "private insurance" to refer to the "supplementary insurance" (Zusatzversicherung / assurance complémentaire / assicurazione complementare), so if it's used in that sense it's not universal.

Supplementary insurance is conceptually different, by definition, from comprehensive private health insurance which provides alternative coverage for what is already covered within the public healthcare system.

Private Spitalversicherungen im Schweizer Vergleich:

https://www.moneyland.ch/de/privat-versicherung-spital-vergl...

There is even a 'half-private' one

What is private/semi-private in that phrase is the hospital room that the insurance covers, not the insurance itself.

Not just the room, also better treatment more expensive medication etc

That is whats called private, if you never heard the phrase private krankenkasse...well everyone uses it, it's also the first (maybe second) question when you go into any hospital.

Not just the kind of hospital room, but I'd say it's the main difference (there are many different supplemental insurance products anyway). And I don't thing "semi-private insurance" is a thing anywhere else.

Even if you're right and the term is used more generally than I thought, my main point stands: it's quite different from what people in other countries call "private health insurance" so in the context of the discussion here the distinction is relevant.

>my main point stands: it's quite different from what people in other countries call

You never made that point...sorry

I got slightly side-tracked when you said "we mean" and I wanted to clarify if you meant "the people having this discussion in this thread".

But I actually made the point:

    Supplementary insurance is conceptually different, by definition, from comprehensive private health insurance which provides alternative coverage for what is already covered within the public healthcare system.

Maybe I could have added for more clarity:

  And that's what the person you replied to means with "very few people have private health care in Europe, at least in the UK".

> and if you think 'we' are rich..you are wrong.

Switzerland is one of the richest countries in Europe - it's GDP/capita is the 9th highest in the world.

This place (news.ycom) really has a skewed sense of reality. "Oh, you only got $100k offer straight out of University? That's a low number."

99% of the world lives far below anything you consider average.

For a website full of smart people, you all have trouble recognising your own extreme privledge.

What do you mean? One of the points of government funded health care is that you get rid of several layers of needless indirection and profiteering. You basically vertically integrate a big chunk of the industry and have it work together to minimize overall costs instead of maximize profit of each individual component.

In the UK we pay a fraction of what companies in the US do. See also, our nightmarish trade negotiations with the US: https://www.theguardian.com/politics/2019/nov/01/nhs-drugs-b...

Not a scholarly article, intentionally. I wanted to give a flavour of the existential (to our health system) nature of the problem of US style drug pricing.

There's also the small matter of pricing varying highly by country. Another more emotive example: https://www.drugwatch.com/featured/us-drug-prices-higher-vs-...

So actually, it is substantially better in Europe.

Europe is one of the primary reasons US drug pricing is so messed up. Many European countries negotiate drug pricing on cost to manufacturer (practically nothing) with a negotiated slim profit margin. Then the drug companies just offload the rest of the R&D cost onto the US consumer. But, almost the entire cost of a drug is in the R&D.

Imagine if the rest of the world only paid for CPUs based on the per unit cost of silicon but none of the fab or engineering cost. So $20 CPUs for the rest of the world and $20k CPUs for the US since the US consumer has to cover the 10s of billions for fab/R&D cost while the rest of the world only pays for the silicon.

That's what happening with drug pricing right now. People _need_ medicine, which is how we got into this mess of drug pricing since it's frowned on to price people out of medicine. But European countries aren't exactly poor struggling post-war economies anymore. They can afford to shoulder more of the R&D cost instead of laughing at the US subsidizing the world.

You're subsidising paying other Americans extremely high salaries. You're also subsidising share holders and C-level people's luxury lifestyle. The same drug wouldn't cost $2b to create in any other country. It's not Europe's fault you treat basic healthcare like any other business to make money from.

If that were actually the case, Europe should've had a huge competitive advantage in drug development and priced the majority American drug companies out of business. Isn't anywhere close to happening, is it?

The barrier to entry to the pharmaceutical business is fairly high. Not only is it a pretty heavily regulated field (for damn good reasons), the equipment needed to start a drug company is significant and expensive, and the time between first investment and first payoff can be very long.

Various reasons, including patents. Cost is not a "huge competetive advantage" or literally everything would be produced by other countries with fewer regulations for cheaper. There's plently of protected industries in nearly every country.

So, are you saying that the European countries should stop being so selfish and stop negotiating collectively to get better prizes?

Would not be the logic solution that the USA started negotiating as a block too?

The US negotiating as a block would be the logical solution. And the US sorta does, between the megasized insurance companies and Medicare, it's not a single block, but it's far from nothing. But the US isn't going to bankrupt a US company over it. So then it becomes a nation-nation negotiation via trade pacts (which are happening, much to Europe's annoyance).

Pharma is just a zero sum game; for the US to win, someone has to lose.

> Then the drug companies just offload the rest of the R&D cost onto the US consumer. But, almost the entire cost of a drug is in the R&D.

How much do drug companies spend on advertising in EU vs US?

Usually the marketing spend ranges from half to double the spend compared to R&D. However, advertising (specifically the direct to consumer variety that's uniquely allowed in the US) only consists of ~10% of the marketing budget. Over half the marketing budget is free samples and a quarter is physician outreach/training, which happens in both the EU and US.

So there's potential for ~3-7% cost improvement if direct-to-consumer advertising is banned in the US.

US pharma R&D intensity averages ~40%, which is more than double of Europe's average intensity.

Those are the numbers that always make one wonder. If you look at margins of pharma companies, you see the potential for price improvement: from 2% to about 20%.

And this is not what anyone of the people complaining are looking for. That would make somewhat optimistically make Remdesivir $350 per vial, and that pricing would cause ... exactly the same outrage.

The actual issue is "too many" medicines. More and more effective and specialized medicine. But, of course, that you can just sidestep as an individual (you'll have to have your doctor on board, but that may be doable). It boils down to the same thing: if you're willing to forego the most expensive treatments and best possible outcomes you can avoid a lot of the financial problem. There's just zero willingness to do that.

Best possible treatments, no matter the human effort required to do that, at zero cost to anyone (not carried by the actual patients, not collectively carried by insurance, not carried by government, not by church, institutions or charitable giving). And we're not willing to give anywhere (for instance, cheaper drug trials, something the government could simply decide to provide at frankly minimal costs). This is not happening.

There just doesn't seem to be any solution here that I can see.

Please back up such an unlikely sounding claim with several excellent sources.

Here in the UK, there is exactly one layer: the NHS. It negotiates prices directly with drug suppliers, and as the sole buyer (monopsony) is able to get a great deal. It also sets the prices paid by consumers (the prescription price), which is a flat price charged for all drugs (yes really all of them) and is currently £9.15 (about 11 USD) for a prescription (i.e. a full course of multiple tablets of the drug). If you are given drugs in a hospital as part of an inpatient treatment the charge is usually nil.

Are these drug companies British?

Some. American drugs companies too, though. They want our bargaining power to be mediated by the coming UKUSA trade agreement so we have to pay through the nose like Americans do. At the moment they either sell to us or lose out on our custom (the NHS is not above refusing to buy a drug on expense grounds). They're trying to make this impossible for us to do by levering political power, because single payer healthcare doesn't permit them to abuse their market power over here.

> They're trying to make this impossible for us to do by levering political power, because single payer healthcare doesn't permit them to abuse their market power over here.

You’re saying that if you joined some sort of union that you could negotiate from a much stronger position, similar to single-payer healthcare?

Have you ever looked at the amount of money we spend on pharmaceuticals a percent of our total Healthcare spending?

Drugs are more streamlined, but most of the NHS looks a lot like the US system. There are 8 major private electronic health systems, and many have not signed interoperability pledges. 145 CCGs. Foundation Trusts, remember just 10 years ago GP Practices would become part. Quasi-private GP Practices. Mergers going on every year (195 CCGs to 145 last year). Funding comes out of a myriad of mystery buckets (winter funding).

The NHS employs about 1.4 million people (and I don't think that includes GP practices). Of course an organisation that big is going to have quite a bit of structure. I never intended to dispute that.

I was disputing that specifically drug purchasing is a "racket" with "more layers" the US system, which is what the parent comment claimed. None of the organisations or organisational units that you mention have anything to do with drug price negotiation, so I don't see what they have to do with the conversation.

The "Kassenärztliche Vereinigung" in Germany is a tremendous lobbying force for doctors, and they are fully driving health policy here. I've yet to see them do anything positive for me as a patient.

Glad to hear things in the UK are so jolly.

Not here in NL. My monthly premium for myself and child is around €130 for a premium plan with a €500 yearly deductible, and most normal costs and doctors visits are excluded fro this. I had an injury that required surgery and physical therapy and did not hit this deductible.

Someone I know had cancer which required two years of therapy and also somehow did not hit their yearly deductible. A friend had a burnout and needed therapy over a long period of time, also very little personal costs.

This premium that I pay is more or less matched by my employer, that money goes into a fund to balance out insurers who have more risky demographic coverage. The government does offer subsidies for people who cannot afford the monthly premium, this obviously comes from taxes.

That’s pretty much it for funding the system. Personal premium + employer premium + tax subsidies for the poor. Dutch people complain about costs ‘spiraling out of control’, and it is true that over the years healthcare has gotten more expensive, but these criticisms are laughable when compared to the US.

It’s possible to fix the US healthcare system. Just pick any other western developed nation at random and do what they do. You’ll be better off.

I don't really understand the outrage. Surely, the price is only too high in the event that they can't sell their product? It's a business, not a charity.

Other companies will be looking hungrily at these earnings and invest in developing their own antivirals---which is exactly the desired outcome.

Sure, it would be great to have this drug available to everyone right here, right now, for cheap. But investing on those terms is not very attractive; hence the drug simply wouldn't exist.

That sounds like an argument that only people with money should get medicine.

American taxpayers contributed at least $70m to the development of this drug[0] and our reward is to be gouged by Gilead. It's the exact same shit they've pulled with Truvada[1] and it's grotesque.

[0]: https://www.citizen.org/article/the-real-story-of-remdesivir... [1]: https://www.nytimes.com/2018/07/16/opinion/prep-hiv-aids-dru...

It typically costs ~$2B to develop a new drug. Taxpayer contributions are practically negligible.

Has anyone checked the $2B or is this what pharma tells?

Here's what our government says about it: https://www.ncbi.nlm.nih.gov/books/NBK50972/

Derek Lowe has an article about it that might help.

https://blogs.sciencemag.org/pipeline/archives/2017/10/18/dr...

How much did the Fed spend buying Gilead's bonds?

And how much more/less effective is Remdesivir compared to the generic Dexamethasone anti-inflammatory?

If you think Remdesivir is not effective you could simply choose to not take it.

They are not really comparabale as they are indicated at different points in the disease progression.

This ~$2B is an estimate that factors in the positive feedback loop high prices create.I'd expect minimal costs to achieve the same results to be one to two orders of magnitude less.

P.S. I worked for J&J once, seen their inefficiencies first-hand.

I briefly worked for GSK. It's not like the inefficiencies are limited to only US companies because they can charge more. Nor have I seen the public sector run any more efficiently or effectively (and it's often worse). The reality is that it takes a very large organization to develop a drug and large orgs tend to be run inefficiently.

> It's not like the inefficiencies are limited to only US companies because they can charge more.

US companies cannot really charge more than European companies [+]. They all charge more in the US and less elsewhere.

[+] In general, there are also cases where the same drug is marketed by a US company in the US and a non-US company in the rest of the world.

The US companies inherently had a home field advantage. Yet non-US companies were willing to jump through the hoops to follow the US drug funding model. If their original funding and development mechanism were sufficient or better, why go through the trouble? Why did all of them do it?

I don’t understand what are you referring to. Big pharma companies are multinationals that will adapt to the regulatory requirements and commercial practices of the different markets where they want to operate. Why would European companies renounce to be present in the principal drug market?

$70M is a fraction of what it has taken to get Remdesivir to the point where it is today. The argument that government is paying twice for drugs is usually deeply misleading, though in this case it did sponsor some trials. Usually government funds pay for understanding biology and pharma pays for figuring out how to drug those findings. It’s a symbiotic process, and depends on drug discovery being a lucrative business.

All this said, Pharma has abused its position and pricing power. Remdesivir is an ok but not amazing drug, and pricing it this high is bad policy. Part of what they are doing is protecting their flank. Pricing it too low would cause people to say, “see! You CAN price drugs low, let’s make you price other things lower.” This is immoral reasoning but it’s part of the logic.

Drug pricing is super complicated, it’s worth understanding more deeply. Remdesivir is a weird case, and should be viewed in a larger context. See this post as a great place to start with further links within:

https://blogs.sciencemag.org/pipeline/archives/2019/12/11/ar...

(Conflict declaration: I founded a biotech)

Thanks for this. I knew at a distance how the pharma industry worked, but this filled in a lot of the gaps.

This is actually pretty much the dumbest argument if you take just a moment to think about it.

Imagine some drug that costs $100 million to develop and that the most it can earn in the market is $70 million at a price of $1000. Okay, but then the government thinks it's really important to provide, so it's going to subsidize the development to the tune of $40 million. The drug company could then spend $60 million for development and earn $70 million. Over the typical drug development and sales lifetime, that's actually a quite mediocre return, but let's not worry about that.

But wait, the government paid 40% of the development cost. Why the fuck should that company be able to charge $1000, they should only be able to charge 60% of that, they should charge $600. Well, then they are fucked because they are right back at the same equation for whether it is profitable to work on that drug.

In general, with a moment's thought, any intelligent person will realize that expecting discounts on products based on how much the development was subsidized by the government completely obviates the entire point of subsidies.

They say the goal is to help as many people as possible, and that this principle has guided their development and pricing of the drug.

How do they reconcile this principle with the huge price difference between the USA and the rest of the world? Or between the developed world and the developing world?

I assume they are still making a profit selling doses at low costs to developing countries. If the goal is to help as many people like they say, why not extend that pricing to everyone?

It’s disappointing that taxpayers fund the development of these drugs and then get screwed by the same companies when it comes time to make a profit.

There must be a thousand ways to codify their stated objective 'to help as many people as possible', but I can't imagine why you'd think a completely flat pricing structure would be optimal for any of them.

> I assume they are still making a profit selling doses at low costs to developing countries.

Why would you assume that, instead of assuming that the high prices in the developed world are subsidizing losses elsewhere? (Or, at least, that they are amortizing R&D costs with the prices in the developed world, and doing so allows them to make a profit selling more of it above the marginal cost of producing more.)

The message from the CEO which this is about, says they have the exact same price across the globe, ie no subsidizing losses by that means, or there are no losses.

The US price is in practice the same - they just had to account for the always-expected discount which will push it down to the same as others.

> with the huge price difference between the USA and the rest of the world

That doesn't really matter as the Trump administration has bought essentially the whole production capacity of Remdesivir for July, August and September.

https://www.theguardian.com/us-news/2020/jun/30/us-buys-up-w...

They’re not selling the drugs to developing countries and won’t be for a while. There simply isn’t enough stock to go around.

Read it. They dont make the drug for developing nations. they let generics do that, presumably because it would be bad to try to prevent it (if possible at all). i think it mostly makes sense. but it does show they are afraid of negotiating with governments which is why usa is getting punished for being all private.

Aside from the sensitive topic of pricing the new drug, I'd like to take this opportunity to remember the late Czech scientist Antonin Holy.

His lifelong research led to creation of many groundbreaking drugs against HIV, hepatitis and now Covid. This humble "invisible" guy's work literally saved millions of lives and is behind many of current Gilead drugs.

See https://english.radio.cz/antonin-holy-one-countrys-most-reno...

This Open Letter is bullshit (purely personal opinion obviously). I note they are transparent about the pricing in specific markets but that the CEO fails to be so transparent about the pricing for generics in other markets. I’m aware of the studies regarding its effectiveness but hate hand-wavy B.S. like this so here's some snippets taken from Gilead's own website.

"All descriptive printed matter, including advertising and promotional material, relating to the use of the remdesivir clearly and conspicuously shall state that: :the remdesivir have not been approved [sic] :the remdesivir have been authorized by FDA under an EUA [sic]" page 6 https://www.gilead.com/-/media/files/pdfs/remdesivir/eua-fda...

and "Remdesivir is an investigational drug that has not been approved by the FDA for any use." https://www.gilead.com/remdesivir

I was in two minds about correcting the grammar but since they are all snips from the links decided to leave as is.

[Edit to clarify] My main point was that if they were pricing generics at a reasonable price they would have been trumpeting in the same press release as this. eg. if one is so reasonable that they openly discuss it then why not the pricing of generics.

> In normal circumstances, we would price a medicine according to the value it provides.

Which makes medicine so expensive that it provides no value to the many people who are in a bad position and cannot afford it. Pricing by the value something provides is only relevant for those who can afford that value in the first place (they assume you stay for the duration; you are lucky if you do not); for the rest it provides no value at all because they don't get into that position in the first place.

As I read online, the entire treatment in India is well under $100[0]. I am all for getting the R&D money back, but charging medicine based on value (who determines that value anyway; that's highly subjective) it may provide is a recipe for disaster. Especially in this case; they stand to sell 10s of millions of these vials (even though they don't really seem to 'provide value' as clearly as advertised as others have mentioned here), so the R&D/investment story is... not very good.

[0] https://www.hindustantimes.com/world-news/european-regulator...

What this letter did not address is the fact that the US is hoarding almost all of Gilead's Remdesivir in the upcoming few months. Leaving the rest of the world with almost nothing.

Source: https://www.theguardian.com/us-news/2020/jun/30/us-buys-up-w...

not sure if totally accurate but if it is then it serves the rest of the world right for playing nice with the US while the US screws them over anytime it is convenient

I'm not sure there is much the rest of the world can do given that Gilead is an American corporation.

the rest of the world can do the same. stockpile their own products, e.g. ventilators, masks, etc. then everyone dies, cause you need all the parts for a full cure. anyway, it's more about the attitude of the US. I doubt stockpiling this drug has any consequence on the rest of the world. the just bought the first batches I guess. more will be produced.

Isn’t the welfare of its citizens basically the primary job for any government?

Hopefully now that this is determined as effective the manufacturing can ramp up and the whole world can get access.

Generic versions of Remdesivir are already available in India for $70 (under license from Gilead). I hope other countries ramp up production too.

https://www.hindustantimes.com/india-news/india-s-hetero-pri...

Surely they patented it so it can be trivially reproduced by others outside the US, right?

I wonder if this will indirectly lead people to start thinking about whether socialized medical systems stifle innovation and make the systems reliant on innovative "capitalist" economies.

Pharmaceuticals is a big part of the UK economy where we have "socialised" health care.

It's fine. The formulation will get out there, and the world's chemists will figure out how to make it, and then the Indian generics factories will pump it out en masse.

The hard part with drugs is usually finding out if they work. This one is hard to make, but they'll figure it out.

And then each country gets to make the choice for itself of how much it loves IP law and how much it loves human life.

from OP's article:

> In the developing world, where healthcare resources, infrastructure and economics are so different, we have entered into agreements with generic manufacturers to deliver treatment at a substantially lower cost.

I assume this means that:

1. Remdesvir is not that hard to manufacture.

2. Gilead will license the drug to 3rd party factories, so no need to manufacture them in the US.

They did not know what to do with this drug, because it turned to be flop almost for every virus they tried. They would have scrapped it, if not for covid. Now they are telling us they need to recover R&D price. Very funny.

Seems expensive for a drug with "no significant benefits"

https://www.barrons.com/news/antiviral-remdesivir-showed-no-...

If it is an effective treatment, tell me why we should pay $2,340 per patient, and not just invalidate their patent on the grounds of public good? The US gov partially paid for its development in the first place.

Maybe so that next time we need them, they don't just say, naahh, gonna do something instead that actually pays?

That worked so well for opioid crisis victims.

Care to convert that sentence into a coherent argument?

At $2340 a patient, the drug is an expensive treatment plan but not overpriced imo. If the claimed reduction in time to recovery is true, then around $600 a day of reduced recovery time is probably worth the hospitalization and long term health costs.

Besides having to recoup the costs of development of Remdesivir, as well as the costs to trial various drugs that never make it to market, Remdesivir is currently in short supply and probably costs a significant amount to produce. It seems unreasonable to expect a good in such short supply to be sold for cheap. The overall cost of $2k isn’t prohibitively expensive such that many lives would be lost over this anyways.

When you need a whole letter to explain the new price, you know it's going to be loaded with crap and the price will be excessive. This one doesn't disappoint.

That's bullshit. Companies have "whole letter"s for pretty much everything they do. Gilead had a "whole letter" when they said they'd provide 1.5 million doses for free. Was that also loaded with crap and the "$0" price excessive?

That's fine if you want to make a PR splash with a donation.

But don't do the same while you are gouging consumers. In other words, don't piss on me and call it rain.

I do in $20 or less what costs $800 there. Americans pay probably $200 of that $800 and think "oh insurance covered it" when really they just payed 10x the price.

The US is so full of morons they must love being ripped off or something.

Few pay that much. It's the insurance companies who for some reason can't negotiate better. But also, note that you get it for $20 because americans are subsidizing you.

Good thing we bailed them out bought their bonds and now get to pay way too much for a drug that don't work! Yay!

What's the price of equivalent doses of Hydroxychloroquine + Zinc?

Very low, but obviously not comparable at all.

Do you have a randomized clinical trial comparing the two treatments?

I’m not certain it matters. The hydroxychloroquine paper was retracted: that’s not a great sign for it’s effectiveness as a treatment.

The paper that was retracted was a paper that concluded that hydroxy chloroquine usage caused higher fatality rates in covid patients.

There are hundreds of trials in various states of completion for hydroxychloroquine [1]. At least 10 of them specifically call out using it in combination with zinc, though some completed trials that don't specifically call it out in the title also used zinc if you read the papers.

There are about 35 trials in various states of completion of remdesivir [2].

If hydroxychloroquine actually does anything, we'll eventually find out. But the cold hard truth is that all the evidence so far is that remdesivir is a weakly effective treatment (shortens length of stay in hospital slightly, not a miracle cure) while hydroxychloroquine hasn't been shown to do much of anything useful in COVID. Both aren't as big a deal as Dexamethasone, which significantly reduces mortality in the sickest patients.

Most facilities have settled on using remdesivir + dexamethasone as the standard treatment for the sickest patients and have totally ditched hydroxychloroquine. Many are still administering zinc and other low-risk treatments like vitamin C and D to patients because while the evidence isn't there, there's no cost or safety reason not to try it.

The problem with talking about hydroxychloroquine is that it has become the rallying cry of the conspiracy theorist, so any talk about it results in someone saying you are "testing it wrong". The most common response is "it is a preventative treatment, not a treatment of already sick people! they are testing the wrong patients in trials!" or "it only works in combination with zinc!" or whatever. The good news is all those combinations are being trialed and if it actually does anything, we'll eventually find out. Whether anyone ever comes up with evidence that hydroxychloroquine does anything useful in COVID patients, it will definitely be one of the most studied drugs ever.

[1] https://clinicaltrials.gov/ct2/results?cond=covid&term=hydro...

[2] https://clinicaltrials.gov/ct2/results?cond=covid&term=remde...

Here's a recent study from France on 3700 patients treated with HCQ+AZ and it shows a 66% reduction in hospitalizations: https://www.sciencedirect.com/science/article/pii/S147789392...

I would love for HCQ to be shown to be effective, but this pre-print study is not super convincing.

First, this is not a randomized trial with a control group. It's a retrospective look at patients in Marseille where they gave HCQ+AZ by default to all patients who would take it and then compared those patients against the small number of people who either refused it or were too at risk of side effects to get it.

If you look at the breakdown of the groups, it's comically unbalanced. Of the 3,737 people they tracked, only 162 didn't receive HCQ or AZ. And the rate of heart disease in those 162 untreated people was 2.7x the rate in the group treated with HCQ+AZ (11.1% vs 4%)! Furthermore, only 28 of the 162 untreated people were in the high risk >= 65 age group. No deaths in any group were reported under the age of 60.

In other words, if you compare a couple tens of people with 2.7x the rate of chronic heart disease to a random assortment of other people, you get numbers that may or may not mean anything.

Meanwhile, there are other studies with proper control groups and balanced patient enrollment that show no benefit of HCQ and lots more studies still in progress that test it in different doses and times of administration. At the end of the day, you have to follow the best evidence.

Good question. Also what's the price of an equivalent dose of Cheerios?

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