FDA approves first monthly injectable to treat HIV infection
statnews.com
statnews.com
Median income in the US is ~$31K apparently. So even in a rich country, this is like 50% more than the income of a typical person.
My understanding is the funding for the trials was partly from NIAID. This seems like yet another case where public funds are used for research, but a company ends up with the ability to dictate pricing.
I'm glad that this works and that there is another, more convenient and effective treatment option. But shouldn't we have some setup where if tax dollars pay for the research, the government should own a share of the IP commensurate with their funding level, and should then be able to have some say in pricing?
Or, if you think that the government itself shouldn't own IP for a product on the market, can we create an independent non-profit which receives ownership, and whose charter aligns with actually treating as many people as possible?
I'm not saying that when real, innovative work happens, pharmaceutical companies shouldn't get some meaningful return on the money they put in. But when the public supports the work, we shouldn't get nothing.
I have no particular insight into the pricing of this drug, but in general, NIAID funding doesn't get anywhere close to the level of investment needed to bring a drug to market (NIAID's total budget is something like $5Bn. A single drug can easily require that much money to go to market).
Moreover, it isn't a bright-line distinction between public and private funding: if a novel drug is developed (entirely privately) against a target for which academic researchers once received public funds, does it count as public funding? There's a huge gray area in between. Nearly all drugs can be characterized as "publicly funded", if you look hard enough.
Rules like this sound great, but in practice, they'll lead to perverse incentives (like drug companies completely avoiding targets from the academic world, in the previous example). Nobody rational wants to spend billions of dollars doing late-stage development and clinical trials to be torpedoed by a researcher who took a small amount public funding decades prior.
According to [1] "the estimated median capitalized research and development cost per product was $985 million, counting expenditures on failed trials." That billion dollar figure is risk adjusted per product meaning that's the cost of all R&D and clinical trials against the number of products that hit the market. A lucky startup can pull off a successful trial for a few hundred million (i.e. Sofosbuvir), if not tens of millions for an orphan drug.
The most expensive ("oncology and immuno-modulatory drugs" which are similar in complexity to HIV therapeutics) come in at a median of $2.8 billion and a mean of $4.5 billion but only because of an extreme outlier, Dupixent, which cost over $6 billion to develop. Dupixent costs $40k/year and has a much larger target market than this HIV treatment (IIRC on the order of 10 to 100x). This HIV injection is far more likely to be discounted in the developing world so the sticker price likely reflects that too.
A $5 billion a year budget can go very far and the people should get the rewards for taking the risk, especially for a disease like HIV that has significant quality of life impacts on vulnerable populations.
[1] https://jamanetwork.com/journals/jama/article-abstract/27623...
and
http://sitn.hms.harvard.edu/flash/2020/modern-drug-discovery...
are decent reads.
Mostly it's the complexity of the compounds involved, the supply chain, and regulatory costs.
>it takes a hundred dollars of drug revenue 17 years from now to motivate someone to invest one dollar today. No wonder drugs are expensive.
That is a 10,000% return on investment required to break even.
http://www.cureffi.org/2019/04/29/financial-modeling-in-rare...
Phase I trials, for example, are usually carried out under constant medical supervision and push the dosage as high as they can until 50% of the cohort will no longer tolerate it. That alone is usually thousands or tens of thousands per day per patient.
By the time you get to phase III where you have hundreds to thousands of patients, you're shelling out up to $1k per patient for the incentive and $100-1k per checkup for the length of the trial. A 1k person phase III can easily cost tens of millions in labor just to administer the drug and collect samples once a month for a year. Data provenance and normalization is important so a not insignificant chunk of this time is largely unavoidable paperwork.
https://www.nature.com/articles/nrd3078
(one can certainly quibble over the "cost of capital" assumptions these days, but the model isn't wildly wrong.)
> That billion dollar figure is risk adjusted per product meaning that's the cost of all R&D and clinical trials against the number of products that hit the market.
Yes, but as you know, you can't simply separate the successful products from the ones that fail. The former pay for the latter.
> A lucky startup can pull off a successful trial for a few hundred million (i.e. Sofosbuvir), if not tens of millions for an orphan drug.
Sure, one can always hit the lottery. But unlike startups (where the N-independent-failures model works OK), drugs don't make it to market without a deep-pocketed company willing to set huge piles of money on fire in the final phases.
Your other comment below does a good job of explaining why trials are insanely expensive...which is why lucky startups almost never run their own. So you're dependent on a system where deep-pocketed mega-corporations need to exist simply to get the drugs on the market, and they are reliant on massive returns to take the risk in the first place.
However, that’s overly generous as a great deal of tax breaks etc indirectly subsidize that 2.3 Billion. So, it’s true drugs are expensive on average to create, larger numbers tossed around are generally intentionally misleading.
But one thing to keep in mind is using your number, there are plenty of drugs that get approved that only have a few billion in sales over their lifetime. So either break even or not even breaking even. It’s a massive blockbusters like Lipitor ($10B in sales per year) that pays for all the mediocre drugs.
While time value of memory explains some of that it’s still a huge discrepancy. Advertising etc make up the difference and while cost effective for the company, their harder to justify as a fraction of drug prices. Especially when over prescription is so harmful due to side effects and adverse drug interactions.
This requires the starting axiom that profits are more important than human lives with respect to global public health. This is something that we as humans can decide, not some law of nature.
Big pharma's lobbying to enshrine IP rights by embedding them in the WTO has led to untold deaths from lack of access to medications in the developing world.
This Citations Needed podcast on "Vaccine Apartheid" contains much interesting information, even if you don't agree with the headline.
https://citationsneeded.medium.com/episode-129-vaccine-apart...
On a purely technical note, it's interesting to think about why it's cheaper to do the R&D to put a rocket into orbit than to develop a new therapy. Why does cutting-edge lab equipment cost $100k - $1M? This supply chain seems ripe for disruption.
Generic versions of expensive American drugs tend to be released by Indian pharmaceutical companies into developing countries after a while.
https://link.springer.com/chapter/10.1007/978-981-13-8102-7_...
If you read patents filed by defense contractors and pharma/universities they often say something like this "This invention was made with Government support under Contract no. F29601-03-C-0191 awarded by the Air Force Research Laboratory, Kirtland AFB, N. Mex. The Government has certain rights in the invention."
https://patentimages.storage.googleapis.com/f9/bc/b9/dd132ea...
Basically the same reason that "I changed the deal, pray i do not change it further" is a strategy that works at most once.
Remember though that this is a replacement for an existing drug therapy, not something totally new. Does anyone know how much the daily pills cost per month?
There is a proposal for such an entity: https://en.wikipedia.org/wiki/Health_Impact_Fund
> The patent would not be used for any other purpose than to prevent the taking out of a patent by other persons. When the details of the method of preparation are published anyone would be free to prepare the extract, but no one could secure a profitable monopoly.
How did that go? 1,000% price increase, accounting for inflation. (US numbers)
Edit: Removed rant-driven generalization and miss-information regarding legal obligations.
Thanks for checking me. I get to upset reading these things.
Where is this true? It’s not even a definable legal standard.
I obviously need to go out for a walk before I comment on these type of news. It's super exciting but also extremely depressing since the ones who'd need this the most likely wont afford it.
I find excitement in the fact that we have found a way to get new treatments and cures. Other systems have been tried that weren’t so successful at pumping out new tech.
The USSR had a Ministry of Medical Industry and I think Japan might have gone with a bounty model? You can probably find more info.
Where everything falls over is that it’s just such a long journey from point A to B, where A is “a chemist has found something” and B is “an entire patient population is taking the drug.” There are a lot more steps than you’d think, and any alternative system needs to do well at each step due to the wildly varying incentives between participants.
As a toy thought experiment not based on real-world events, suppose the government has just paid a $500 million bounty for new Drug X that otherwise wouldn’t have been developed. The government now owns Drug X. Okay, great. But doctors aren’t prescribing it. So the government creates a Ministry for Doctor Education that tells clinicians what to prescribe. But the Ministry for Doctor Education develops its own goals and forgets that it’s supposed to help out the pharma bounty program in marketing new drugs. In the meantime, the government is outbid in manufacturing Drug X, and its contracted manufacturers are exporting Drug X overseas, so the government nationalizes the manufacturers. But then the manufacturers forget that they’re supposed to work on novel drugs and decide only to take on low-risk work. Etc. etc.
It just empirically works to have a tech transfer model where a set of entities gets rich by taking a drug on the entire journey into the bodies of thousands/millions of patients.
>Or, if you think that the government itself shouldn't own IP for a product on the market, can we create an independent non-profit which receives ownership, and whose charter aligns with actually treating as many people as possible?
The current model of government funded research is like backing a Kickstarter because you want to see the product made, but get no direct benefit. It is made because we as a people think the world will be better off with the product, than without, and are willing to pay to make that happen.
I think government co-venture is also great option, as long as it is negotiated up front and we can keep political corruption out of it. However, the question then becomes if drug development will dry up once the the government has locked down all the IP and nobody wants to partner with them.
I think another good model would be seed support for independent non-profit pharmaceutical(s) charted to balance reinvested profits with social benefit (without government owning the IP). The question and risk here becomes one of oversight and accountability.
Because of the disease, I had uncontrollable orthostatic hypotension (low blood pressure when sitting/standing up), and I was passing out multiple times a day. I also was diagnosed with multiple types of arrhythmia.
If it were not for the US government, I would not be alive. I am a dual US|EU citizen, and while being American is naturally a huge part of my identity, I would not be afraid to renounce my US citizenship. The only reason why I do not is because the US literally saved my life and others with the disease I have, worldwide.
Many many people pay at least this to stay alive. That said , Universal Health Care is needed for stuff like this to work. At 3k a month it makes the most sense to try and emigrate to a better country.
Vote to improve the system where you live and make sure that your representatives realize that it could be them or their relatives in your situation.
Quite a few countries have restrictions in this anyway, so whether it would even work in individual cases is another matter, for instance, here is Canada's provision:
https://www.canada.ca/en/immigration-refugees-citizenship/se...
https://khn.org/news/americans-cross-border-into-mexico-to-b...
People buy insulin off Craigslist, in a way that is similar to a drug deal, because they cannot get it elsewhere. They sit in the car while their “insulin dealer” brings them the insulin from Mexico/Canada and they pay them in cash.
Let's say there are two variables you can optimize for, X and Y, and that there are tradeoffs between optimizations such as optimizing for X often reduces Y and optimizing for Y often reduces X.
The problem with the popular discussion today is that no one ever acknowledges what the US system does well. They only talk about what it does poorly. If you don't acknowledge what it does well, it's trivially easy to come up with solutions that address the things it does poorly, but often at the expense of creating a new replacement that now does poorly at the thing that the previous system did well.
In the US, the system is remarkably effective at optimizing for financial incentives. The replacement system many people argue for will likely lay waste to optimizing for financial incentives. This doesn't come without a cost however. Eliminate the financial incentives and you will at minimum get less of two very important things: (1) investment by companies and capital markets in R&D, and (2) investment in a career in the field of drug R&D by individuals deciding what career to pursue. The loss of one or both would be devastating to the development of novel treatments in perpetuity.
As a general heuristic, I've found it valuable to figure out what a system does well before I propose a solution to replace it. If I can't articulate what a system does well, it's typically a sign that I don't yet understand the system well enough and don't understand what that system's designers were optimizing for when it was first implemented. This heuristic is applicable to all pretty much all systems, not just health care.
Countries won't let you in if you're going to cost taxpayers too much. For example, New Zealand won't let you emigrate there if you have serious psoriasis, since treatment can cost thousands of dollars/month.
But psoriasis wasn't the point. Expensive treatment that's expected to be ongoing is.
My god, what a horrible way to look at life.
And as others have said gov’t funding tends to be a small fraction of total cost of R&D.
And the funding tends to come very early - some professor is researching a new anti-viral and stumbles across a new molecule. It’s still several hundred million and a decade or more away from market.
I'm taking an orphan drug that was approved in 2002/3 and costs more than this per month and last I checked the company that developed the drug was still in the red.
This idea that drugs should be cheap and accessible the moment they are approved is incompatible with economic reality. You need a system with a profit motive so that many people and investors are motivated to invest their lives, careers and money in that market so we get progress year after year.
This is a trolley car problem. On one track are all the people you can save in the present by making something immediately accessible to all regardless of the economic reality of those that produced the drug. On the other track all the the people that you can save long term by having an economically viable industry that can continue making advances that save lives in perpetuity.
I know that orphan drugs are lifesaving and it is life-and-death for the people who do and don’t receive them, but this is generally not true, including for orphan drugs. I know because I have 2 rare immune mediated neurological diseases affecting my peripheral nervous system and I take an orphan drug (blood product) known as subcutaneous immunoglobulin.
Soliris, one of the world’s most expensive drugs, costing ~$600,000/year in countries with “socialized medicine” is estimated to cost less than 1% of that price to produce, as in less than $6,000/year. This is from industry insiders who have technical experience. Not only that, it is estimated that 80-90% of the work was discovered on public, government funds. See at 11:30 https://youtu.be/0uYCw5EDX8U
I have a background in applied science and I agree that this is the general ballpark case for orphan drugs, based on reading patents.
For example, about 7% of the world’s population collectively has some sort of a rare disease, which is theoretically treated with orphan drugs. There are also people who chronically live with cancer who end up living quite a long time. Diabetes, (type 1 or type 2) with or without complications, is quite expensive in the US.
I personally have 2 rare immune mediated neurological diseases affecting my peripheral nervous system. The only medication that has kept me in pharmaceutical remission is subcutaneous immunoglobulin (intravenous immunoglobulin did not work), and I have tried 10 different treatments plus combinations of them. When I was living in the US, my private commercial insurance paid, under contract (not the amount that was being billed which was much higher!), $100 per gram. In other words, they were paying $23,500/month for my blood product or $282,000/year.
In Europe, where I live now, the price goes for 40 Euro (about $50/gram).
Anyways, you should watch this, “The World’s Most Expensive Drug” (which it no longer is), which is quite revealing: https://youtu.be/0uYCw5EDX8U
Alexion (a pharma company) started the trend and now the have drugs that cost millions per year over, that are required over the course of a lifetime: https://www.nytimes.com/2019/08/25/health/drug-prices-rare-d...
There is a good documentary on it (requires a Hulu subscription): https://www.nytimes.com/2019/08/23/the-weekly/rare-diseases-...
Anyways, the prices of these drugs are an insult to the intelligence of a lot of scientists and (formal) engineers.
I also have type 1 diabetes, and because of my training in electrical engineering, I could tell by reading patents on analog insulin patents that a 10 mL bottle of insulin cost somewhere between $1-$10 to produce. Turns out that it costs between $3-$6 to produce. At its worse, in the US, it cost $350 per 10 mL vial for analog insulin.
Anyways, the best way of dealing with this situation is by having even the most disabled people working to offset these prices, along with having universal healthcare with price controls. Unfortunately worker protection against discrimination in the US is very poor and when your health benefits are tied to work then it just does not work. Patent law also needs to be reformed, and if the prices are obscene and unjustifiable, then they should be seized.
Supporting a subculture that's heavily into anal sex is extremely expensive.
0: https://www.ema.europa.eu/en/medicines/human/EPAR/rekambys#p...
What is this based on? Was I misinformed about Truvada's effectiveness? Is this a decrease in an already very low chance of transmission? Or is this in comparison to people forgetting to take their daily pills vs a shot that a health care provider had record of administering?
It's currently common in the gay community for sexually active, healthy people to take Truvada proactively to protect against HIV because it's understood to be even more effective than condoms. If there is a better option or if the current option is not as effective as widely believed then standard of care should change.
No, effectively used Truvada works very well.
> Or is this in comparison to people forgetting to take their daily pills vs a shot that a health care provider had record of administering?
Probably almost certainly yes or it's just a small improvement at the margin.
"...abotegravir – a component of Cabenuva – was 89% more effective in preventing infection among women than Truvada"
That 89% when was compared to Truvada.
Do healthcare workers actively take Prep or is it administered within the 72 hour period after exposure?
Prep from what I understand can be hard on the body's organs and you will need to do a kidney function test every few months when on it
PEP =/= PREP. PEP is after the fact treatment, there's more than just Truvada in that protocol.
PEP is typically much harder on the body than PREP.
Most every gay man I know takes PREP with few or no side effects.
However, from reading the article, I do think there’s a convenience factor at play related to the struggles of taking pills daily.
Note though, the article mentioned a trial of _women_ where truvada and one-shot prevention effectiveness were compared and the one-shot was deemed 89% more effective.
A quick search explains _why_ this might be the case for women. Basically, it takes more truvada to get rid of the disease in vaginal and cervical tissue than it takes for rectal tissue.
Source: https://www.uspharmacist.com/article/why-do-women-need-highe...
Also, doctors have been recommending a different drug, Descovy, for prep instead of Truvada. This isn’t due to effectiveness but side effects I believe. I guess if one experienced side effects though, they would be less likely to continue taking the medicine.
https://www.poz.com/drug/cabenuva seems to suggest it is intramuscular (administered in the buttocks, which is not hard to do by oneself) but requires a healthcare provider. Not sure why, there might be storage requirements and such.
Even if you self-inject and find it easy, I’m sure you’re not saying it’s easier and less of a hassle than taking a pill lmao.
Also, just because something appears convenient doesn’t mean that it actually is.
Have you looked up how many women use one of those invasive contraceptive implants?
Technically, a woman only has to get a new implant once every 4 years+. But have you not read the horror stories about the implants becoming dislodged and causing internal bleeding and severe damage?
Also, people on PrEP already need to do regular bloodwork, so needles and appointments are already involved every few months. Doing an appointment every 2 months instead of every 3 and not needing to take a daily pill as well is a huge win in level of effort.
Your first sentence makes no sense. You say that I’m implying that pills are more popular yet you confirm that indeed they are.
Unless, you’re saying that I was implying that they’re _heavily_ more popular, which is also not what I implied.
You’re completely missing the point. I’m gay and on prep myself for several years.
The grandfather post mentioned that 2 million people are doing an injection as if that implies that many people prefer that over pills.
I could write more and explain more but I’m tired of talking to so many morons for today.
I think this is a wonderful thing and that we should spread the word when these new treatments are available so that more people know they have options if they like the sound of occasional injections but don't like daily pills or vice versa.
Injectables seemed scary right until the moment when I started taking them, after which they became a normal part of my life.
EDIT: Not sure why this is getting downvoted. Since when on HN is it acceptable for someone to say “I think this way so it must be a fact” without providing an explanation? Even when it comes to subjectivity, there’s an expectation that people share why they believe in their opinion, right?
I swear I dislike this site and the people who use it more and more every week.
All you said was “it’s easier” in your original point. You obviously felt the need to clarify yourself in your most recent comment. So clearly your first comment was lacking information. There was no reason to downvote me just because you felt my original comment made you look stupid.
FWIW, even though “easy” is subjective, there’s still a consensus to be considered. For example, finding piercing your skin with a needle to be an asthetically-pleasing act does not fit that consensus...
Something that _does_ fit the consensus is that taking a pill every day is a hassle.
Stop being facetious just to prove a point.
This pandemic has been hard on all of us. Take care.
I looked at your comment history and you say “in fact” without supporting your opinions _often_ to the point that I laughed.
Also, you edited your original comment which probably led to the downvotes.
I’m assuming you must also correlate the pandemic with your immaturity then.
Also, if you click damnyou@‘s comment history, you’ll clearly see that he loves using the phrase “in fact” without supporting his assumptions. I didn’t deserve to be downvoted.
I edited my comment within a couple minutes of posting it. Sorry about the confusion.
And sorry if you actually do prefer those gender terms. But honestly, it sounds like you’re just making shit up. I’m assuming you’re just a young white kid. I’ve met many of you in the tech industry who act like that. “Oh, I said something stupid and fucked up, let me pretend to be ‘woke’”. People like you exhaust me.
I had to do some digging to find any source on the effectiveness on preventing transmission (the recent FDA approval is for post infection treatment).
The study I found is [0]. In a double blinded study of 4,600 participants, half were given the cabotegravir injection, and half were given the daily oral treatment. The study notes a "high level of adherence to oral therapy"; however, the actual numbers on adherence are:
> Adherence to oral FTC/TDF was high, based on a random subset sampling that detected tenofovir (> 0.31 ng/ml) in 87% of all samples tested.
I'm not qualified to say if this actually indicates 87% adherence, or if a fully compliant patient may get a negative result on that test.
The result of this study was that 50 particpants got HIV, of which 12 were on the injectable and 38 were on the oral.
By my calculation, this gives a relative effectiveness of (38-13)/38 = 68.4%, although the paper reports 69%.
[0] https://viivhealthcare.com/en-us/us-news/us-articles/2020/gl...
I see nothing wrong with sacrificing a few men, who consent and sign up and know the risk, for the far larger majority.
If better drugs can be developed that would serve millions by sacrificing a hundred consenting subjects that know they run this risk, that seems like an overall benefit to me.
It seems rather irrational to not be willing to do this. — It is fine if men die, so long as their blood not be on my hands directly, but only indirectly.
It seems that whenever a perfect placebo be permissible, that is what is being used rather than the current standard of care.
Soldiers can be sent to their death for oil and other resources that benefit the larger majority? but this is “yikes”?, not a phrase I find to occur in conjunction with rational decisions often.
It is. Control groups are no-treatment if no approved treatment exists, or current standard of care if there's an approved treatment. That's standard practice.
> It seems that whenever a perfect placebo be permissible, that is what is being used rather than the current standard of care.
If by "perfect placebo," you mean "no treatment," that's not correct, and is considered unethical.
I've read plenty of pharmaceutical trials where the control was a plain placebo, not the current standard of care, when it not involve a life threatening illness.
https://clinicaltrials.gov/ct2/show/NCT00061802
Clearly this antipsychotics trial does not evaluate the drug 's effectiveness against the current standard of care's, but against a placebo's.
> If by "perfect placebo," you mean "no treatment," that's not correct, and is considered unethical.
I mean giving them a drug that lacks an active ingredient but is otherwise not to the lay eye discriminatable from an effective drug.
And that is very much what is done in the case of the antipsychotics medicine I showed. So it's only unethical when human lives be at stake, apparently.
Americans aren't going to develop an efficient approach that is not highly encumbered because the FDA stacks the deck against approval of efficient solutions in favor of whatever makes the most total profit. So you'll see that sort of thing approved overseas and we'll get it (or not) in a decade or maybe never.
They present themselves as helping the patient navigate a complex drug, but in practice this just meant they had a bunch of questions to tick off each time you talked to them. Their outreach and phone tree were both pretty bad, clearly designed for high operator utilization and not customer service.
(Well, except for that price tag.)
People, to a first approximation, are just terrible at pill compliance. Doesn’t matter the demographics, people just aren’t perfect at taking a pill, every day, at the same time, forever and ever. Having that injection where you can set it and forget it? Nice advance. Not game-changing, but still a nice move forward.
And I think it’ll be a bigger move forward for people who are at high risk of HIV, but also have not great access to medical care where they live. If you…oh boy, here I go, potentially getting into trouble. Non-white and/or non-affluent communities tend to come down much harder on homosexuality. It is much more discreet to get a periodic shot than heading to Walgreen’s and bringing home a bottle full of blue pills. It’s safer. It’s a bit more private.
Because you can totally work the systems to get it affordably. Besides insurance, there are clinics, there are coupons, there are programs…but you have to have the information literacy and the time to figure out how to jump through all those hoops.
Me, I work remotely, I have insurance, I live on the north side of Chicago, I can get my Truvada easily. You live on the west side of Chicago with no Howard Brown nearby, and you work a service sector job where your hours are algorithmically doled out to you? Far, far harder.
This is true of many medications, but Truvada is especially famous for it. As a gay man I have a lot of friends on it, and because of the aforementioned program, only two of the thirty+ pay any co-pay at all, and it's something like 20 bucks for them.
I don’t know anyone paying full price for Truvada. It’s either free, or whatever your insurance copay for drugs happens to be. (It’s annoying I have to go to a specific pharmacy with my drug plan, but whatever.)
I miss probably one dose a month, maybe two. I don’t take my pill at the same time everyday, probably in a 4 or 5 hour window vs. the 2 hour window my doctor recommends. I’ve never had any side effects and I’ve been undetectable since I began treatment.
I’m not sure I’m interested in this injectable regimen. My HIV treatment will last for the majority of my life; I don’t feel like I can risk any amount of reduced long term efficacy with a new drug. I also don’t love needles. I’m excited to talk to my doctor about it, though.
Like birth control, the more options there are, the better. HIV treatment is truly a marvel of modern medicine.
In a few decades we as a species have found a way not only to completely eradicate it to undetectable levels (it still hides in cells to protect itself) but now we are at a monthly injection.
The way we have created a vaccine for SARS-CoV-2 is also absolutely incredible. It's great to be alive these days, now if only we can get a firm solution over cancer and other diseases like dementia, etc!
I was born in '86. Even into the 90's this line of thinking hadn't changed all that much. The attitude around most diseases and the like that had a 'social' component was best described as "shock and shame" - e.g, you're screwed long-term and society blamed you.
> In a few decades we as a species have found a way not only to completely eradicate it to undetectable levels (it still hides in cells to protect itself) but now we are at a monthly injection.
I was going to ask how this works until you answered the question for me (if it's undetectable, why isn't this considered cured?) Last I heard research is still trying to figure this out. At the same time, I can remember hepatitis C having a similar wrap in the 90's - 'you have it, and probably always will' - Mavyret/Epclusa changed that. It still blows my mind that the problem is pretty much solved at this point.
Hail Science.
It's 2021, why are we only seeing 3 year old HIV infection numbers? How come I can see coronavirus infection numbers updated pretty much hourly but reporting on HIV infection rates in this country is lagging 3 years?
https://www.onlineathens.com/news/2017-11-28/cdc-lag-time-be...
> In their monthly Vital Signs report out Tuesday, the Centers for Disease Control and Prevention reported that the median time between infection and diagnosis with HIV was three years in 2014, about seven months shorter than in 2011.
If you got HIV in 2020, chances are you don't know about it yet.
I mean, seems that this 3 years lag is because people only get tested if they have any apparent health issue and the doctor thinks it might be HIV.
With Covid, it might take a few days for a test show positive, after exposure - say, Christmas dinner. If someone thinks they might have been exposed to HIV, how long until a test can safely tell it's a true negative/positive?
2. We have a 40 year head start on HIV vs. COVID. Surely it can't be that hard, in the digital age, to set up a central database with the following columns, updated in real time: [Datetime of Test, Zip code, Result (pos/neg)]
The end result is that not only is this type of project more valuable for a new and rapidly spreading disease like COVID, the bar that the value needs to clear to justify this system is also higher because an HIV/AIDS status is considered more private from a societal standpoint (not necessarily a legal one).
I'm really hopeful though about the genetic revolution that's happening though, I just wish it was happening faster (my girlfriend just got diagnosed with cancer again today :( )
And no, they didn’t create an injectable drug because it’s “popular”. They did it because it address compliance of oral therapies.
That's good to know and something I've been curious about. Do you have a source that breaks down the other 90%?
The best analysis I've found so far is from McKinsey.[1] They took a very clever approach to benchmark US healthcare spending to other OECD countries. They adjusted for US GDP (richer countries spend more on healthcare), then broke down costs by category and figured out how much more/less the US spent compared to OECD countries. Very eye opening if you check out the graph at the bottom of page 4.
Findings: 1) out-patient care is driving ~70% of the extra cost, 2) in-patient costs are ~10% higher than OECD, 3) the US spend 50% more on drugs, but it's a small part of overall spending, 4) administration is 200% higher, but again, it doesn't add up to that much, 5) the US spends less on long-term and home care and 6) the US invests 50% more in healthcare, but it's not a large absolute amount.
[1]https://www.mckinsey.com/~/media/mckinsey/dotcom/client_serv...
This number seems insane to me in the USA. Why is a well known deadly disease, with well understood transmission vectors, still spreading so prominently here?
I personally stay home as much as I can, but I have certain privileges many others don't.
https://en.wikipedia.org/wiki/List_of_countries_by_HIV/AIDS_...
So it’s not access to care.
Regan refused to even acknowledge the disease until he couldn't get away. This put the US on a deficit addressing AIDS that continues to this day.
American Republicanism kills people.
It usually takes weeks to months from treatment start until your copy number becomes non-contagious.
https://www.niaid.nih.gov/diseases-conditions/10-things-know...