Fort Botox, Where a Deadly Toxin Yields $2.8B Drug (2017) | Hacker News Reader

Fort Botox, Where a Deadly Toxin Yields $2.8B Drug (2017)

bloomberg.com

41 pointsTomte41 comments

This has only been posted fourteen times before. Eight of those were by the current OP, "tomte". Whats up with that, Tomte?

It got no traction any of the previous times, though, and has been posted approximately twice yearly, which isn't that excessive. https://hn.algolia.com/?query=inside-fort-botox&type=story

Interestingly it looks like it this made it to the front page via the second-chance pool: https://news.ycombinator.com/pool

> Interestingly it looks like it this made it to the front page via the second-chance pool: https://news.ycombinator.com/pool

Why are almost all the submissions on /pool by the same accounts (I see ~4 Tomte)? Are they the ones curating the pool?

I dunno anything about the user but they sumbit lots of stories every day. Just a wild-ass guess: there's a script underlying the submissions, which works from a finite pool of Tomte-curated links.

It is curious. They seem to repeatedly submit old stories over and over. Some other examples:

20 CDs curated by Steve Jobs & the iPod team - submitted 20 times over 7 years:

https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...

Prefix for SQLite Tmpfiles - submitted 10 times over 7 years

https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...

The submissions do seem to be good though. Perhaps they just re-read old articles occasionally and re-submit them.

I've got a few links that I resubmit periodically to HN.

I do that because they've never gained traction and I would like to see discussion about them.

I visit HN daily more times I'd like to admit and I hadn't seen it before.

If OP gets some karma every time he posts it, like he did from me this time, what's wrong with that?

They are quite the prolific poster - enough to not have the value shown in the HN leaderboard [1] O.o

[1] https://news.ycombinator.com/leaders

The article is also old with outdated information

I would say the cost of a vial of medicine for neuromuscular spasms and dystonia (the initial purpose, not cosmetic) is cost prohibitive for a lot of people. Usually, insurance should cover it, but the cost is $1,000/vial for a medicine that was approved over 30 years ago, and the price has only gone up, not down. Some plans (off the top of my head, some Blue Shield plans and anyone who is on straight Medicare/Medicaid) won't cover the cost.

There are a couple of competitors that work roughly the same and are slightly cheaper but it def seems like an oligopoly to keep the costs artificially high.

You go to any country outside of North America and you can get medicines the exact same ones for a fraction of the cost on the dollars. US generally is up charged due the ability squeeze insurance and then the patient. So definitely greed, some regulations should be applied. Insurance companies would be happy to not be squeezed, if some sort of regulation was made to prevent squeezing it would be nice. Even a culture where doctors were glorified over YouTube stars would help too. Asia for example if you're a doctor you're making money! But the scary thing is that doctors in Asia don't charge 100,000 USD for said surgery. Just think about it.

> Insurance companies would be happy to not be squeezed, if some sort of regulation was made to prevent squeezing it would be nice.

Insurance companies are bound by ACA profit caps where 80% of revenue has to go to “medical claims”. This leads to a perverse situation where their theoretical maximum profit is tied to higher cost of services. If they’re at that limit and actually negotiated lower prices, they’d be in violation of those (perverted) profit caps.

This is very interesting and completely new to me (I'm European). Suddenly so much of the situation in the American health business makes sense.

I'm the last to defend the drug companies, but at a basic level, they get the right to sell at high prices because of the cost to bring to market which is absolutely enormous. Once it goes to market the cost of producing the drug is often very low compared to the price but it's in order to encourage companies to invest in future drugs.

In this case, the drug is 30 years old. I’d say any cost to bring to market is well paid now, and even if it isn’t, this is why the public should fund the research via taxes, not locking profits up via corporate entities.

The product is long off patent. The only thing stopping someone from selling it cheaper in the US is the government itself and limited economic returns.

Not patented, trade secret.

Sure, but it's only the USA paying the most truly ridiculous prices. They're usually quite affordable in the rest of the world.

The reason is that labs can decipher the drug contents and produce the drugs at a fraction of the cost. Of course, these companies never paid for the research and cost to bring to market. So yes US citizens end up carrying the cost, but in practicality, a very big number of life-saving drugs originate in US companies. I am definitely not defending these companies just pointing out the basics.

They are often sold by the same companies that make them in the US as most pattens are international. It is really they are expensive because we can and people will pay it.

I would hope so...not sure what the EU or Canada cost of a 100U vial but I would hope and be pleased if it were much less than $1k US

I plan to retire in my wife's home country where family values and everything else is just that much better.

> So definitely greed, some regulations should be applied.

Regulations are what prop up the high prices. Allow people to import drugs from overseas or Canada and you would see prices start plummeting overnight.

Regulations don't really it is an excuse every country has a board or ministry of health and some relationship to drugs.

It's like 100 usd/vial in some countries in Europe, more expensive in some others. Still ridiculously expensive.

Accusing businesshumans of greed is like accusing gas molecules of pressure. It's just part of the thing.

> But a study published in 2001 in the Journal of the American Medical Association said that a single gram in crystallized form, “evenly dispersed and inhaled, would kill more than 1 million people.”

Given the potency, how does the manufacturer make sure that dosages are dispersed equally during manufacture?

That one is a serious problem with the heroin/fentanyl/carfentanyl opiate family - more than a few people have died because their dealer didn't mix the fent with the heroin properly.

Well, they use trained chemists and not drug dealers. Its easy to correctly dilute a compound if you know what you are doing. They already do it for the fentanyl used in hospital settings without much risk, for example.

They are not likely to be mixing powders and instead perform serial dilutions of the suspensions.

https://archive.ph/kQIgV

Barring the cosmetic use, do the medical benefits of botox outweigh the bio-terrorism risk to justify its production?

For bio-terrorism you can just use dirty homemade version. For injection (for cosmetics and valid medical reasons like spasms) you'd want to use clean lab-produced. So I think that is the reason justifying its production. The security theater around, beyond the basic security, is I think mainly just a part of the moat and the politicians having to look tough on anything resembling a possibility for terrorism. I think it is similar to say marijuana research - in half the states one can do at home all the research one likes, yet the the official academia would have to jump through impossible hoops to do any marijuana research.

There are no meaningful bio-terrorism risks to production and supply chain.

The bacteria that make botulinum toxin are found naturally in many places, but it’s rare for them to make people sick. A hypothetical bio-terrorist does not need to break in to a medical factory to procure it

While it's true the toxin is found naturally, is it really so easy to make such a large quantity? Making one gram, for instance, might require a very large factory.

That I don't know. I brew beer and can grow 100g of cultured yeast in a few days in my kitchen. Botulism isn't a hobby I'm looking to get into.

Something must be tricky, because several companies have spent billions to try to make a product and failed. However, I suspect that is mostly due to purification and process control.

I assume that the reason we haven't seen a botox attack is simply because there are many easier ways to kill people for those inclined.

Clearly yes since there hasn’t been any cases of weaponized botox attacks. This probably goes to show old fashioned ways of terrorism are significantly easier or more effective for whatever reasons. If botox was an attractive weapon it would have been used already but clearly there is some Great Filter in place preventing that today.

ChatGPT seems to think so, after a lengthy cost/benefit/risk analysis: https://chat.openai.com/share/83b9dd37-487b-4474-b8ff-5df29e...

It thinks that the risk of catastrophic outcome is low, while benefit to individual quality of like is high. I don't know if I agree with this.

It is a matter of perspective, chances are ChatGPT would do just fine in case of a bio terror event.

> Is it reasonable to assume that the cons of production of botox outweigh the pros...?

Pro-tip, hypotheticals don't really work with LLMs. The rest of your interaction was contaminated by the sentiment proposed.

"Allergan says Botox has more than 90 percent of the market for medical uses of neurotoxins and 75 percent of the market for cosmetic uses. “I used to say, ‘How often do you see that distribution of market share in any category—not just drugs, just in anything?’ "

Yeah, uh, buddy, EVERYWHERE.

People forget that many products they find today especially at the grocery store are either the product of a monopoly or simply a cartel.

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