According to the Pfizer press release [0] Paxlovid uses Ritonavir [1], which is a known HIV antiviral, originally patented in 1989.
At the start of the covid pandemic, chinese scientists even tried Kaletra, a generic that combines Ritonavir with another HIV antiviral, and found it to not improve outcomes [2], but this might have been due to them not giving the drug early enough in the infection, but only to hospitalized patients, while Pfizer gave it to non-hospitalized patients with a risk of later hospitalization.
[0]: https://investors.pfizer.com/investor-news/press-release-det...
Both are protease inhibitors.
> PF-07321332 is designed to block the activity of the SARS-CoV-2-3CL protease, an enzyme that the coronavirus needs to replicate. Co-administration with a low dose of ritonavir helps slow the metabolism, or breakdown, of PF-07321332 in order for it to remain active in the body for longer periods of time at higher concentrations to help combat the virus.
So the main job is done by PF-07321332 even, while ritonavir is only there to keep PF-07321332 a bit longer from being destroyed by the body.
On the other side: what are you folks not curing, with your magic powers, just because you know you won't be able to make a buck from it...?
This is such a ridiculous argument, IMO. As a thought experiment consider something like cancer treatment. If some pharma company researcher found a way to 100% prevent or reverse cancer, why would the company hide that? In the best case, they could make a ton of money from it by selling it cheap to everyone. In the worse case, they could make a ton of money selling it to the ultra wealthy with an obscene price tag. If they tried to hide it, the researcher would share the information elsewhere, no?
Novel drug research is extremely expensive and time consuming, logically speaking a for-profit pharma company will assign its resources to the research which is most likely to make a profit.
As a result rare conditions will not attract the research necessary to create drugs to treat them. To give you a concrete example, AFAIK there was never a vaccine for MERS which is a coronovirus which preceded COVID-19.
And that's separate from the Office of Orphan Products Development: https://www.fda.gov/about-fda/office-clinical-policy-and-pro...
It's not a recent thing, too. Different programs have been enacted in the US going as far back as the Orphan Drug Act of 1983. https://en.wikipedia.org/wiki/Orphan_Drug_Act_of_1983
Broader reading: https://en.wikipedia.org/wiki/Orphan_drug
I'm not saying the pharma companies pursue all possible opportunities to research/create new drugs, just that it's ridiculous to think if they did find one, they would suppress that information. It seems conspiratorial.
The Orphan drug act or incubators you link don't contradict the point I'm trying to make, but maybe that's on me.
> Can you provide an example of a treatment people would like that 'big pharma' wouldn't produce because they couldn't make a profit on it?
That's very different from:
> You're saying hiding the discovery of novel, profitable, drugs because profits from the existing treatment is widespread?
?
You are the head of strategy presenting to Big Pharma CEO.
You say 'Here are 5 new drugs which have potential for great impact, each will cost a billion. 4 of them are vaccines, which will be very inexpensive, and nobody will buy and we will lose money. One of them is a fairly expensive cancer treatment. Which one do you want to focus on boss?'
Supply/Demand and just Basic Economics generally work their way into the system.
Some drugs are much more profitable than others, many of them are not going to be profitable, and there's less incentive to work on them. Vaccines in particular.
It's a big part of the equation we have to deal with.
I like to write and publish books, but only because I know that several thousand people are going to buy them (yeah, humblebrag...). I wouldn't bother with them if my audience was two orders of magnitude smaller. It is just not worth the hassle.
Similarly, most programmers here probably work on projects used by thousands at least as well. Few people will put hours and energy into something that will only be used by, say, three users.
Rare diseases suffer from the same problem. The cost of development of drugs under current regulatory regime is high and in case of rare disease, cannot be amortized later over a huge set of patients. Moreover, most promising drugs actually fail in human trials, but the costs are already incurred.
Writing a book for yourself may have some sort of forcing function to understand a topic. But mostly I wouldn’t write a whole book to do that.
1) use of Psylocibin (mushrooms) assisted Congitive Behavioural Therapy for curing PTSD, depression, anxiety, etc. we have seen extremely good results from this and pharma companies could have likely pushed it much much sooner
2) Biofeedback/Neurofeedback has been around for more than a decade and is under-researched, under-insured, and under-prescribed for treatment of a lot of mental issues from anxiety to post-concussive syndrome to ADHD.
both of these can negate the need for a years or decades long reliance on SSRIs or stimulants.
Pharma mostly avoids low-profit avenues, but at least partly because that would be a good way to go out of business. However, to suggest that they intentionally suppress researchers with the goal of reducing costs seems a bit far-fetched.
many pharma do invest some of their portfolio into things that are unlikely to have short-term or any payoff, and many of them also maintain compassionate programs to get expensive drugs to people who wouldn't be able to otherwise afford them. They do this because they are highly profitable, which unfortunately is as much explained by their marketing acumen as much as it is by solid research and development.
Mine was not a conspiracy-innuendo, but rather a simple critique of profit-driven research in health-related sciences. Humans can do wonderful things when they work together, so it's rather sad that we seem to do that only when there are riches on the line.
But as a private company they need profit to fund the science. They'd go out of business if they weren't making a profit.
It's largely the role of government to fund public goods (e.g. by providing grants to university researchers). We can't expect the scientists and engineers to work for free.
1. make drugs without a profit margin available to consumers and researchers
2. go out of business.
It seems like there's plenty of grey area in there.
Yes, as a private company. In my opinion, it's not like everything has to be a private profit-driven company, precisely because incentives are not necessarily aligned to the public good.
The problem with "Big Pharma" is generally not with the intentions or capabilities of the researchers - it's with the funding.
But most people appreciate it when as a side effect, their work save lives.
No one should work in pharma?
However on the other hand I look at https://en.wikipedia.org/wiki/HMS_Queen_Elizabeth_(R08) which cost $4 billon to build.
A billion is a lot of money but not for governments, it's kinda tragic when you look at what we spend on some things that we haven't figured out a more sensible way of allocating resources.
This is one of the most well know, tired, scammy talking point big-pharma has used for decades.
Hint: in the very document you linked, htere is a 'costing method' section, you might want to read it a bit more carefully and you will discover the big scam: opportunity cost, not cost.
Then why aren't you (or, at least, someone) out there developing new drugs on the cheap to undercut "Big Pharma"? Your opportunity awaits, dude.
You just made a straw-man argument.
I posted a 2 lines comment highlighting the fact that cost and opportunity cost are two very different things, to the point that the claim that taking a drug to market costing literally billions of dollars to poor drug companies can be taken with a grain of salt.
You main take-away was that I am "arguing that it doesn't take years of time and billions of dollars to bring a drug to market".
In your original post, you referred to the claim that it costs billions of dollars as a "scam", which is exactly the same thing as calling it false (indeed, it's not only calling it false, it's calling it intentionally and perhaps criminally false).
Now you're trying to walk back that claim by watering it down to "take it with a grain of salt" rather than calling it a "scam", but you did, in fact, deny that it costs billions.
If it doesn't, in fact, cost billions, why isn't someone undercutting them?
Yes and I still mean it, it is a scam because now people cite this study and think 'cost' where in reality they should think 'opportunity cost'.
I'm not walking back anything, this is literally a talking point coming from some lobbyists to justify the widespread practice of fake pricing of drugs in the US.
Let me just copy paste the relevant section in the document that we are referring to.
"First, we summed direct and indirect research and development spending on a therapeutic agent in each year. All sums were inflation adjusted to 2018 dollars using the US consumer price index.
Second, we accounted for failed projects by dividing total research and development expenditures on a drug in a particular year by the corresponding aggregate phase-specific probability of success, similar to what was done in previous studies of costs of drug development.3-7 For example, for each drug, we divided phase 1 costs in each year by 0.138, which accounted for spending on the other 6.2 phase 1 trials that would fail, on average, for each successful development program. We used phase 1 rates to adjust preclinical expenditures, and we used the proportion of biologics license applications and new drug applications that are approved by the FDA to adjust costs once these applications were submitted to the agency for regulatory approval. Licensing fees and milestone payments, where captured, were adjusted using the success rate for the trial phase that was ongoing when the payments were made. When a phase shift took place within the financial year, we allocated the cost proportionally to the time spent in each phase. For example, if development moved from phase 1 to phase 2 on July 1 of a given year, we divided the costs equally between each phase. Similarly, in the year of approval, we multiplied the total cost by the fraction of the year elapsed by the time of approval. Hence, if a drug was approved on July 1, we only counted 50% of the costs in the year of approval since firms often incurred postapproval costs related to pharmacovigilance or testing in other indications.
Third, we applied a real cost of capital rate of 10.5% per year (ie, weighted average cost of capital in the pharmaceutical industry), as in the DiMasi et al study.4 Cost of capital is the required rate of return for an investor and encapsulates a risk-free rate (ie, opportunity cost) and premium based on the likelihood of business failure.24"
That actually does seem to be your main point.
They, together with Microsoft, tried to calculate how much money Microsoft was losing in developing countries. So they went something like: 1 billion PCs x 1 copy of Windows 98 or whatever was popular at the time x $100 per copy, so Microsoft is losing $100 billion.
They just ignored a few key facts. Such as, for example, the fact that many of those 1 billion PC users in developing countries were making $100 per year. So if someone held a gun to their head they still wouldn't have been able to pay the license cost. They would have just used something else, maybe Linux.
The cost explosion for these things are mainly the responsibility of US regulators.
Can someone please ELI5 what makes this unique from others?
> PF-07321332 is designed to block the activity of [a specific] enzyme that the coronavirus needs to replicate. Co-administration with a low dose of ritonavir helps slow [the breakdown] of PF-07321332 in order for it to remain active in the body for longer periods of time at higher concentrations to help combat the virus.
It's a two-part drug. PF-07321332 is the new and shiny thing that impairs a crucial enzyme for the virus, while the pre-existing drug ritonavir lets PF-07321332 last longer, making it more clinically useful.
That's my take on it.