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Comment by giantg2 | Hacker News Reader

"You can't threaten them because they have little to lose."

This also reminds me of how some drug companies are pricing gene therapy drugs (like to restore sight, fix muscular dystrophy, etc). They have admitted that they weren't pricing the drug based on what it cost to develop but based on what that person's [function] is worth to them. If your pricing model is based on desperate people being willing to pay anything, then I don't think these executives have thought this through. Desperate people may be willing to pay anything, but when they have nothing to pay, then they are also willing to do anything.

I think this can be a similar situation in the "justice" system. If you have no faith in the system do to their track record of misconduct, mistakes, etc, then you have no incentive to believ in them or try the legitimate path.

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>I think this can be a similar situation in the "justice" system. If you have no faith in the system do to their track record of misconduct, mistakes, etc, then you have no incentive to believ in them or try the legitimate path.

I believe this is why high level politicians and the wealthy get out of trouble. They know the system is a sham, so there's no point in going along with it.

They can afford to perceive the system as a sham.

I might understand that it’s a sham, but I’d be miserable and powerless to push against it. So it’s a pointless belief to have.

But after that, it becomes a bit chicken and egg: Is it a sham only because you have power to make it a sham or was it a sham all along?

I meant this in terms of justifying it to themselves. They wouldn't lose also over "evading justice" because they don't think it's really just.

>But after that, it becomes a bit chicken and egg: Is it a sham only because you have power to make it a sham or was it a sham all along?

I disagree with this point. It was a sham all along. I think the chicken and egg problem is that people feeling like the system is a sham makes the system into a sham. Which came first? A system that's a sham or the belief?

> They have admitted that they weren't pricing the drug based on what it cost to develop but based on what that person's [function] is worth to them.

That's bog-normal value-based pricing which is used almost everywhere, especially in the software industry. You'll find many, many upvoted blog posts on HN that explain why you should do this.

Now you can certainly argue that this should not be done for medical products, especially those granted a monopoly via patents so that there is no price competition.

But you better have a really good idea of how exactly you're going to prevent it and how you avoid destroying the incentives for doing the (very, very costly) research and clinical trials to create these drugs in the first place.

My point was just that when you essentially extort desperate people, those people may do desperate things. You don't see this same type of desperation in tech or other things. For example, it's more believable that a parent of a child that needs one of these therapies may steal it, or even kill the executive that makes those sort of statements than someone not having the latest iPhone (although that occurs too).

"how you avoid destroying the incentives for doing the (very, very costly) research and clinical trials to create these drugs in the first place."

This just isn't true, and is built on typical industry lies. You have many people who would work on this type of societal improvement products for a well paid but not excessively lavish lifestyle. Look at people like Salk.

Pharma executives are some of the highest paid. Much of the research is government funded. The companies spend more on lobbying and advertising than they do for R&D.

Personally, I'm fine with the pace of progress slowing if it means we aren't allowing companies to manipulate the public and hold people's health hostage for obscene salaries and bonuses. There's too many people on the planet anyways.

Brazzy is right and you are wrong.

For big pharma to extort, first they need the product that actually works. Most gene therapy is pipe dream. There are some drugs on the market for some orphan (rare) diseases but the development is very costly and the market is very small.

Obviously it will mean that the price will be very high. Most people are not in the position to pay it and it is up to the insurers or the government to decide if they can afford it or not.

Here is the story of the first approved gene therapy drug: https://en.wikipedia.org/wiki/Alipogene_tiparvovec

They sold the drug to 1 person only. The original company developing this drug went bankrupt.

That's a pretty bold claim to blanketly say that one person is wrong and another is right when there are multiple points in each statement.

Do you realize they went bankrupt largely due to their pricing model? If you have a valid market and plan, you can get funding. This seems like they didn't have a good plan. Just because you give one example of a bankrupt small company doesn't mean that is representative of the industry. There are plenty of examples of other companies being successful. Some of these tend to get bought out by the larger companies. This article suggests that R&D costs about $1M (and 2 people recieved the treatment from the company that went bankrupt due to the high price). I'm sure there are additional costs for testing and approval.

https://geneticliteracyproject.org/2017/12/12/gene-therapy-c...

Having executives making a combined $14M per year seems like a major factor in the price when the patient population is small. For example, 1k patients per year would have to pay $140k each just to cover the executive overhead.

https://www.execpay.org/company/jeffrey-d-marrazzo-766

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