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Comment by bun_at_work | Hacker News Reader

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?

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?

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The practice is so widespread that the FDA had to create an incubator/accelerator to incentivize drug-making for rare conditions: https://www.fda.gov/about-fda/center-drug-evaluation-and-res...

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

You're saying hiding the discovery of novel, profitable, drugs because profits from the existing treatment is widespread?

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.

Your question:

> 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?

Drugs work in economies of scale like everything else.

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.

I put a lot of time into things that are only used by one person: me.

Some things are obviously useful for yourself. Indeed, sharing them can often be effort with no expectation of return.

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.

Whilst I don't buy the malice (big pharma deliberately not curing things they could) argument, there's plenty of things they don't do 'cause they don't think they'll make a profit on them.

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.

"This is such a ridiculous argument, IMO."

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.

Two concrete examples of this I can think of are

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.

Sandoz's original explorations into LSD were medically focused and it was marketed (and distributed for free in high purity) for psychiatric indications, but after it grew in popularity an illicit drug, all pharma got out of the business of working with highly psychoactive compounds for decades because of the negative press assocations.

I can tell you from first hand experience that neurofeedback is a life changing treatment. Far superior to ADHD stimulants which is a nightmare for some.

I don’t think it’s pharma companies responsibility to ‘push’ psylocibin - it sounds like that sits more between doctors, public/university pharmaceutical researchers and legislators.

New antibiotics for one -- if they make a new one that has no resistances in the wild yet, doctors would avoid prescribing it as long as possible, only after all older drugs are tried, so the usage would be extremely low. Nobody wants to sink a few billion into something like that.

Antibiotics https://www.nature.com/articles/d41586-020-02884-3

The companies who make today's lengthy and expensive cancer treatments, are also making the mass-marketed personal care products that have carcinogens inside of them.

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