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Comment by ramraj07 | Hacker News Reader

Are you sure THIS treatment above is only 500k? It’s too bespoke and no way I can imagine it costing less than a few million per patient.

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OP is talking about CAR-T therapy which is in routine clinical practice. In the UK costs have gone from £600k to around £250K That includes the surrounding medical, nursing and follow up care. In the US costs are likely to be more than that.

The article is talking about a very bespoke process where they take a patient's cancer, sequence the whole thing, select mutations they think will be presented on MHC-1, predict the antigens visible, and 'somehow' (I need to read the article more carefully to figure out how they did this) select a TCR sequence which will bind to that. Then they use CRISPR to graft that onto the TCR gene of a T cell from the patient (3 types by the looks of it), and re-infuse the targeted cells.

So yes, that would cost several million.

> that would cost several million.

But it sounds like many of the steps should be amenable to an engineering solution so the cost should fall dramatically if only it can get started.

I responded to another post similar down but you are correct. The drug is $500k, the surrounding medical care / hospitalizations etc pushes the total cost to over $1,000,000

>The drug is $500k, the surrounding medical care / hospitalizations etc pushes the total cost to over $1,000,000

In the US. Outside the US, hospitalization isn't that expensive.

For reference, here in South Africa, it's about 250$ per day of hospitalization. Or 1500$ for ICU hospitalization per day.

And we have private Healthcare here.

Pardon me.

Is the 250$ per day in a public or private health facility?

Private, though you don't pay it out of pocket for 95% of stuff as the medical aid covers it using your premium. Public is probably much much cheaper (free) but not a place any sane middle class person here would ever want to experience.

US healthcare really does put a new spin on the term "life savings".

Here in the Democratic People's Republic of Sweden healthcare is government funded and universal.

Independently of where one stands politically, we Swedes are lucky that our government can import expensive medical treatments from large evil US corporations that do the work for us.

Its not like US is the only manufacturer of medical tools which and treatments for the only way to pay is via that ridiculous medical system they have there. Thats a nice fable that US pharma would like you to believe since they profit from it generously.

Those items are done all around the world, ie in Switzerland. And a lot of tools come from ie Germany (Siemens), Netherlands (Philips) etc.

I chuckled when I read this, because when I think about the "brand" for Philips/Siemens, my default assumption is "American company". When you mentioned it, I recalled "Oh yeah, I've heard that Siemens is german before", but being raised with the "American Exceptionalism" mental framework means this thought isn't the default. (Versus brands like Volkswagen/Ikea/Toyota).

Embarrassing example: I was watching Federer play Nadal and thought "Wow, American athletes are great. I'm proud that we have the best. Wait... neither of these guys are american. Let me google where they're from. What am I so proud of exactly??"

The number of times we hear "this is the greatest country in the world" on a daily basis is really quite sad.

I am not trying to come across as patronizing, but the US is, in my opinion, the greatest country in the history of the world.

I am sorry that you feel that way about your country as a fellow human (I am not being sarcastic), but my positive view on American exceptionalism has nothing to do with you personally, just your culture.

Americans are often embarrassed of America, which I think tends to stem from the fact that they think it can be even better than it is. Which isn’t a bad way of looking at things, IMHO.

The US has for 70 years enjoyed the distinction of being the most powerful country in the world by various reasonable metrics, almost certainly the most powerful to have ever existed. But is it the greatest country in the history of the world? Depends on what you mean by "great". We've undertaken atrocities; started wars; destabilized entire regions. Despite being unbelievably rich we have people dying to treatable illnesses like diabetes for lack of medical care. We face more violent crime than other comparably rich nations, and whole swathes of non-white individuals have valid reasons to fear the very police force that should serve a protecting role. Despite being in certain respects undereducated, we saddle those who seek higher education with enormous debt burden. I could go on and on.

I'm not saying that other nations haven't done things worth vehemently criticizing, but it seems a bit ... gauche to call the US the greatest country in history full stop.

One metric, in fact the only metric for me as father of 2 small children currently is: where do I want to raise my kids, to have the best environment to grow up, to be happy, know true freedom and have these qualities transfer also into adult life?

Despite all its qualities and uniqueness, objectively US wouldn't rank in first 10.

If you re-read my comment and the comment I was replying to, you will see that I wasn't making any claims about America being or not being the greatest country in the world. I was pointing out how "American Exceptiolism" will sometimes cause me to think things which "are great" as being american when they aren't american at all.

* you: Swedes can import expensive treatments from US corporations

* Parent: Alot of those are from non-US (Switzerland, Germany, Philips)

* my comment: When I think of "Philips", I think it's an american company

* my comment: When I was watching 2 top athletes, my default assumption was that they were american, even though it's extremely obvious that they aren't. Which exposes how ridiculous the framing is.

Unless a company actively promotes that it’s a foreign company in their branding, “German engineering”/“Swedish design” or similar with their name/branding, I will assume it’s an American company.

I think one of the reasons "American Exceptionalism" is dangerous, is that it holds us back from improving on things which aren't actually the best. If an American politican says "This is the greatest country in the world", that is an emotional argument to keep things exactly the same.

Makes sense, thank you!

I’m sitting here in America, literally half a mile from one of Philips major research facilities. I know folks who work there - although many are Indian grad students.

Not sure how the whole “German” thing is relevant.

I live near a big tech campus and am surrounded by foreign firms who do massive amounts of R&D in my neighborhood.

The US is of course not the source of all the tools. But the ability to charge Americans high prices for novel treatments make the US the dominant source of funding for clinical and pre-clinical medical research, whether or not those funds flow into German tooling.

German designed, American funded.

Who said anything about medical treatments?

This is like complaining about how much it costs to buy a car because gasoline costs too much.

The cost of staying in a hospital bed in the US is ridiculously expensive, without any treatment at all, much less advanced drug therapies.

Would the Democratic People's Republic of Sweden be willing to drop that kind of dole on a single patient? It seems wasteful to me.

yes, in the Democratic People's Republic of Germany (specifically in the anarchist Berlin enclave), a friend of mine received successful cancer treatment that ended up costing well over 500k (and she is not even German)

Reading stuff like this just short circuits my brain because I can't even fathom such a society existing. Yet, it clearly does.

this member of the anarchist enclave berlin is paying 750EUR per month (plus the 750EUR my employer does) for these treatments. solidarity ftw!

That sounds potentially pretty similar to US insurance costs.

Germany has a different setup than most EU countries: one can be insured privately or publicly.

Public insurance costs are based on income. Private insurance costs are based on health/age etc.

Moving from private insurance to public is almost impossible, as far as I know.

To give you an idea, I recently switched to private insurance and cut my monthly cost by 50%.

Depends on your definition of waste. Is it wasteful if it ends up saving a life?

But it could save more lives if spent differently.

So you're saying we should kill most people the day they become pensioners? Because at that point the vast majority have negative economic value ...

Are you saying hospitalization isnt that expensive to the patient or where its socialized medicine the overall cost?

It's not as expensive as the US, but it's still bloody expensive to get intensive care in a hospital.

It's not unusual for a premie baby who stays in an nICU in Canada for a month to have a treatment cost well over $500,000.

Actual cost, or billed cost? Because they're not the same.

There is no difference in Canada for public hospitals. All billing rates are set by the government.

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