Why Chemotherapy That Costs $70,000 in the U.S. Costs $2,500 in India
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Because healthcare payments are not functionally a government-controlled monopoly (ie. socialized healthcare) in the US, this doesn't happen. So Novartis can sell Gleevec for $75,000 in the US, because a healthcare provider will agree to pay and just bill it to private insurance companies, and those private insurance company will agree to pay and just increase their premiums on the customers, who probably won't notice because, assuming they have employer-provided health insurance, their employer won't take anything more out of their paycheck, but then say increased operational costs means nobody can get a raise.
So US healthcare leads the way in innovation because device and pharmaceutical manufacturers can make a lot more money than in countries with socialized healthcare. So these companies make most of their profits in the US, and then they'll grumble and accept lower prices in every other country, because at that point it's just icing to them. After the profits made in the US, getting $2,500 from Indians for Gleevac is better than getting $0.
The US is effectively subsidizing advanced healthcare for every other country in the world. This is pretty crappy, obviously, but this is a complex problem to solve. Because if you move to a cost-controlling system, then you will stifle legitimate innovation. Why jump through all our FDA clinical trial hurdles if there's no promise of a big payout at the end? Why invest in R&D without the protections of patent law to prevent your drugs from being trivially replicated?
I'm not trying to say, "oh, those poor profits of the drug companies." I recognize this may not be a sympathetic argument. But it's likely to be tough to control costs and yet maintain R&D and innovation. Right now, every other country essentially gets the US to pay the bill for the innovation and they reap the benefits at a lower cost, but with US healthcare already consuming 1/6 of our economy, this isn't sustainable.
The truth in the case you're making is not specific to healthcare and is that "research (private and public) of rich countries that can afford it" benefits poorer countries. So what, let's stop advancing science? We're all better off this way!
Quite the opposite. From early chemotherapy on to the human genome, stem cells, the Allen Brain Atlas, The Gates Foundation, modern biotechnology, organ regrowth, medical devices like the CT scanner (half invented in the US) or the da Vinci system of robotic surgery, etc etc etc the modern healthcare / pharma / biotech world owes a spectacularly massive debt to the US. To say nothing of the surrounding infrastructure everything requires related to technology from the microprocessor to the Internet. How much did that tech speed up R&D, try quantifying that little contribution.
Your 100 year cut-off point is entirely arbitrary and chosen only because it supports your arguments.
[1] http://en.wikipedia.org/wiki/History_of_mathematics
[2] http://en.wikipedia.org/wiki/Origin_of_language
[3] http://en.wikipedia.org/wiki/History_of_writing
[4] http://en.wikipedia.org/wiki/Printing_press
[5] http://en.wikipedia.org/wiki/History_of_scientific_method
I don't see how the HGP was unrelated to government investment...
If you want to play that game then Japan is incredibly subsidized by the US and Europe, but that's not the question at hand. :)
That's just a thesis. It's an interesting one, I'd be interested in reading some discussion of it, especially insightful comments backed with data.
From those 1/3, about 95% of all core research is supported, and around 80% of all research into medical conditions that are life threatening.
Health care system, insurance companies and patents are for everything else...
*The 95% and 80% is number from a talk, and for the moment I can't find references. What I could find is statements about majority funding is used on basic research (http://jama.jamanetwork.com/article.aspx?articleid=205216 and http://www.nsf.gov/statistics/seind12/c5/c5s1.htm). In the future I will hold off on those number in comments until I got direct sources to use with them.
Yes, academic institutions do a lot of low level work that pharma companies build on top of, but you'd be surprised how often potential new molecular entities (truly new drugs) do not originate from government sponsored academic sources.
(However, the tools, understanding and/or methodologies that made that new NME possible did likely come from those labs!)
Then we add patents and insurance companies into the mix, and some people want to paint a picture how innovation gets created. My comment was thus mostly to inform that the largest single funder to medical research is not some for-profit company like Pfizer, but rather tax supported NiH.
Every aspect of this system has to be questioned relentlessly, because each of them requires huge investments of social and financial capital. I am happy to doubt the value of the private drug companies' contributions. Many of their discoveries are reformulations of older drugs meant to allow a repatenting and re-marketing of old ideas. Many of the new supposedly breakthrough drugs do not provide significant improvements in mortality, but do cost huge amounts of money so that they can recoup their investment.
There are of course important developments that come from everywhere, but the question is about signal to noise. If, as these statistics imply, you can show that the drugs and other changes in medical care that provide positive changes to quality of life and mortality are coming from government research significantly more so than other sources then why subsidize private research, why protect the private drug development system that results in outrageously priced drugs, why waste 2/3rds of research money to produce such a disproportionately small portion of the advancements in medical knowledge?
Again, I would like to see sources for the numbers, but regardless, there should be no assumptions made about the value of private or public investment because that's the way it has been.
I think you're confusing evergreening, which is a real problem, with the number of NME's that are being generated. NME's are "new molecular entities", or totally new formulations.
>Many of the new supposedly breakthrough drugs do not provide significant improvements in mortality, but do cost huge amounts of money so that they can recoup their investment.
Low hanging fruit has been taken and newer methods of discovering safe and effective drugs are needed.
You might find this shocking, but pharma is a dying business. Companies are divorcing their drug development departments into separate businesses so they can fail gracefully. The blockbuster drugs that can recoup the investment of looking for a needle in a haystack aren't coming any more.
>If, as these statistics imply, you can show that the drugs and other changes in medical care that provide positive changes to quality of life and mortality are coming from government research significantly more so than other sources then why subsidize private research, why protect the private drug development system that results in outrageously priced drugs, why waste 2/3rds of research money to produce such a disproportionately small portion of the advancements in medical knowledge?
This is absolutely, 100% totally and COMPLETELY false.
The government IS NOT INVOLVED IN DRUG RESEARCH. Honestly, period. They can't afford it! It costs a billion dollars to whittle 10,000 drug candidates into 1 FDA approved drugs. NIH grants aren't even 1% of that cost.
The government is not responsible for very much actual drug development at all. They don't own or fund the labs. They fund the schools that do the work on the lower level theory, on the tools and concepts that will one day be commercially viable.
Private labs handle the vast majority of all new molecular entity discovery, pre-trial, trial, etc. They have the money, labs and teams capable of handling it -- NIH funded labs often don't!
Here's a list of NME's for 2013 so far: http://www.fda.gov/drugs/developmentapprovalprocess/druginno...
Remember, the FDA is the gatekeeper and these companies research thousands and thousands of candidates looking for something that they can statistically prove safety and efficacy of to the FDA, and the FDA gets to decide.
As you can see from that list, the FDA doesn't allow new molecules out very often.
Some people have argued that maybe those 2/3 should be tax money too. Its a bit weird situation where the state already pays for 1/3 of the R&D, and then on top of that give state enforced monopoly in 20 years periods for those who invest in the other 2/3 (additional monopoly period is also granted by the FDA after an successful drug trial). State enforced monopoly is often describe as tax raised outside congress control, and has its history and name (letters patent = royal decree) from that purpose.
One question we should ask is what the industry brings to the table if we took away all state funded involvement. Is it more efficient to bring competition through patent grants rather than direct research and development grants? Do we get larger and more spread out pool of investment that could not happen without a few blockbuster drugs to get gambling money? We should ask for data which prove that the current method (1/3 of the funding and granted state monopolies) is the best use of tax money. Maybe at least demand some kind of high standard when a company take research supported by the 1/3, and claim a new invention based on already known and disclosed techniques. The India model is to demand an increased efficiency, beyond showing that the modification of the old drug is novel.
We could get into a back and forth of yelling, but you are also it seems 100% wrong. Government funding underlies the vast majority of advances in basic science understanding, what you referred to as lower-level theory, that then is utilized by drug companies to direct their new drug development. A good example is the relatively recent isolation of the Angiotensin II receptor, which in turn is leading to drug development. The basic science and years of research underpinning that discovery is not a byproduct of private investment. Lower-level theory is not lower at all, and is of no less value or less important to the person who is at the receiving end of this entire system; the patient.
The FDA doesn't allow new molecules out very often because most of them are useless, harmful, or redundant. I think that their standards for redundancy should be tightened. Low hanging fruit have not all been taken, its just that pharma doesn't invest enough in basic research because they're trying to pick all the low-hanging fruit from other people's work.
Going back to my original reply; I objected to the unquestioned acceptance of the value of private research. I would also object to the unquestioned acceptance of government research as being inherently valuable. While I think it is fairly clear that I believe that the government funded research gives far more value per dollar for society as a whole, it doesn't mean that I will blindly accept either form as the right one. I asked for references to backup stats that reinforce what I believe, rather than just run with it as a bludgeon against your argument.
game recognize game, son.
I would also add a bit old paper about cancer research (http://www.iom.edu/~/media/Files/Activity%20Files/Disease/NC...), through they include all various stages of development. They attribute a 31% to industry.
Also manufacturing is stupid also. Only one company makes Oxycodone (Pain Killer) there use to be two companies. Now the price has sky rocked and can be in short supply. So my son suffered for a few days due to not getting all the pills he needed. Great system.
If you're not American, I don't see what there is to take offense at. That's just the shitty (for us) way that it is. Due to structural problems, greed, boondoggles, lack of political will, lobbying/corruption, the US simply can't have low drug prices compared to other rich and poor countries. On the other hand, the US enjoys relatively low prices for electronics and other consumer goods (as our Australian friends can attest to). You win some and you lose some.
His website is at: http://www.badscience.net/
No (well, yes), it's illegal in -every single country- in the world except for the US.
Only in America does your friendly pharmaceutical giant spend more money and energy on telling you what's wrong with you via non-individualized, vague 30 second spots - "Do you not get excited about anything? Cymbalta may help!" - than your healthcare providers.
As a healthcare professional -in the US-, this disturbs me hugely.
If a drug is best in its class doctors will not need "seminars", "education" to use it - it will be self evident by the trials and outcomes. Oh but wait - you cannot compare drugs to other drugs. You only compare them to placebo thanks to the cuffs put on the various government agencies by the intense lobbying of the industry.
Edit: To get the drugs past the FDA you only need to show it behaves better than placebo. Comparative trials of drugs are a minority and rarely done.
I am not an expert, but look at the following study which compares two drugs.
Where's the line? Maybe I don't "need" a new prescription painkiller with substantially fewer gastrointestinal side effects than the OTC one I'm taking, but if it would greatly improve my quality of life, I certainly might want it. Maybe I'm lucky enough that I see my doctor regularly and he keeps up (without any pharmaceutical marketing?) on every medicine that might help me out, but why should consumers be force to depend on that?
The idea that there are hordes of people making doctor's appointments to demand brand name drugs they heard about on TV, and doctors are "forced" to write what they consider useless or overpriced prescriptions for these drugs seems silly to me.
You think that marketing helps? Maybe your doctor is unduly influenced by pharma marketing and prescribes you the worse drug that give you IBD; hell, maybe he prescribes you the wrong drug altogether because of marketing, and you die. It may sound beyond the pale, but borderline cases involving antidepressants (perhaps the most overmarketed drugs) have already happened.
Not really. You need to show how it works compared to the current regimen.
If someone suffering from a disease currently takes drugs A, B, and C, and you have what you think is a better C (let's call it C++), then the study would compare people on (A,B,C) to people on (A,B,C++).
Unless there is no treatment at all for the disease, in which case, go for the placebo.
That said you'll notice Samsung doesn't advertise it's chips or raw display panels, because they are not actually sold to the people watching The Daily Show.
Say you spend $1 billion to develop a drug. That $1 billion number is a sunk cost; it is irrelevant to figuring out how much to spend on advertising and marketing.
Limiting marketing to less than that $1 billion that was spend on research makes no sense.
Perhaps; even if true, the fact is that drug companies claim they need patents (and other protections, both explicit and implied) to be able to recoup their R&D costs. If their R&D costs are swamped by their advertising costs, perhaps the problem isn't the cost of R&D, but mismanagement? I mean, honestly, it's not like they are producing luxury items. These companies are supposedly making a product that sells itself because their customers will die without it. To add to all that, arguments can (and have) been made that pharmaceutical advertising is a negative input to society by unduly influencing prescribers.
In the US, you have no monopoly on the healthcare side, but the drug companies have a monopoly on the drugs they produce. I'm not saying neither that you should drop the patents nor that you should introduce social healthcare -- but you should restore the balance in some way.
Personally, I'm for dropping or drastically reducing the patents on new drugs. I know that the argument against it is that it will discourage the research, but I don't believe it -- actually, it would enable further research on already existing drugs, improving them, and finding new uses and applications (think Viagra). But that's my personal opinion, and I'm not even a US citizen; you should find the right solution for yourselves.
In a way there is a monopoly on the healthcare side in the US, but it only impacts a certain segment of the population. Medicare is able to negotiate significant discounts on the cost of healthcare compared to private insurers precisely because for so many people it is the de facto provider.
There was a really interesting Planet Money podcast a month or so ago about healthcare costs in the US which covered why the difference between private insurers and Medicare is so great: http://www.npr.org/blogs/money/2013/02/26/172996963/episode-...
Medicaid is certainly allowed to negotiate over drug prices. Medicaid gets an automatic 23% off the drug price and if the states can get an even bigger discount, they often get to keep it.
The problem is that the US healthcare system isn't a capitalist system; it's an oligopoly.
Considering the context of the discussed business and that the offer is not always just something optional, I might add "or die with it..."
That's a very misinformed statement.
Add other regulation and inefficiencies, and subsidized research would work with 1/10 the money.
Not to mention that because of the commercialization of medicine, tons of research is for BS like Viagra and other such drugs (like the tons of stupid feel-good "energy" drugs, so that your boss can squeeze even more overtime out of you), where far more important but less lucrative stuff is ignored.
That's how you get the US sucking donkey's balls in infant mortality rates. As if it was some third world country.
Because their lower investment levels should be producing returns so much higher, that they would quantum leap the US while spending less. That hasn't even remotely happened.
Sucking donkey balls on infant mortality? You should become better educated.
How about Canada, at 5.22/1000 versus 6.81 for the US. That's your magic line on 3rd world countries and donkey ball sucking? Well Singapore is 1.92, and Japan is 2.6, so Canada, New Zealand, Australia and Britain are apparently 3rd world countries by comparison.
Half of the US infant mortality rate is due to high black poverty. Maybe you should become informed on the root causes of problems in America before making bad assumptions.
Misleading stat that doesn't look at the full cost of bringing a NME to market.
You're looking at a yearly budget for a company while ignoring reality: drug development isn't yearly, it takes about 8-12 years total. To analyze something on an 8 year cycle using 1 years worth of data is at best ignorant and at worst, intentionally dishonest.
They'll spend almost $1,000,000,000 USD to whittle 10,000 drug candidates into what is hopefully a single FDA approved new molecular entity.
>That's how you get the US sucking donkey's balls in infant mortality rates. As if it was some third world country.
Did you hear that loud crack? It was you smashing your head against correlation/causation. You might want to have that fallacy checked out. Looks bad, man.
Just as with the development of computers and the internet, we can thank the US taxpayer and government for subsidizing pharmaceutical innovations. Which is then sold back to us at hilarious rates.
Pharmas reap wonderful profits in other countries (otherwise they probably wouldn't operate in them), just not extreme profits they can extract from US people. It's propaganda that high US prices benevolently subsidize pharma for the rest of the world; this narrative increases nationalism, and sets up an entitlement complex. Propaganda's a great way to get your targets to believe in their own fleecing.
It takes more effort (particularly since you don't want to cite bad evidence), but is necessary.
And the issue is, people who want truth gotta dig. Otherwise they'll be doomed to live the rest of their lives believing lies written by some PR flack. (I've known some PR flacks. They eloquently phrase what their bosses want communicated. And even being careful, I'm sure I believe many serious lies and falsehoods, at least to some extent.)
The European countries pay big bucks for their own defense, thank you very much.
And the US doesn't provide any defense at all. It merely uses its pressure to get the European countries to participate in its inane crusades and wars, from Korea to Iraq, which are for it's own interests.
Plus, defense against what? The only thing that brings any trouble to European countries is mostly aligning with US interests in some wars (e.g EU got some terrorist attacks by islamist groups in revenge for this -- few and far between in any case).
Not to mention that what the US officially considers "threats" are either lies (like Bush's WMDs in Iraq) or BS third world countries that couldn't harm a duck even if they wanted to (and which could not care less about having any war with Europe) but happen to be rich in oil or other resources.
I also think you have absolutely no clue who international politics works by your blatant naivety. There's a lot more at stake than "access to oil". FYI Iraq showed oil reserves far superior to that of Saudi Arabia, and FYI Saudi Arabia has a military far exceeding most European states (UK, France and Germany obviously excluded due to the amount they do spend, but the Saudi Air force exceeds the UK for active combat air planes). Iraq with more money than Saudi Arabia and an intense hatred for the US/Europe would have been a massive fucking deal. Saudi Arabias royal family however is on good terms with the US government, and I'm sure the US didn't want a regional war between Iraq and Saudi Arabia locking down all Middle Eastern Oil production to ever be a possibility.
The War in Iraq was less about getting our hands on Iraqi oil, but getting their Regimes hands off of Iraqi oil. Had they been left alone since before the first gulf war, allowed to buy Russian hardware and build a military superior to that of Saudi Arabia, the region would be under their thumb and so would a massive chunk of the western worlds oil supply for military purposes. Not to mention they would have been well within the budget range to develop nuclear weapons without ever having to test like North Korea.
The US also didn't sit around and leave Europe high and dry in conflicts like the Kosovo War, because following your logic why should the US be dragged into a purely European conflict. Basically, because the US gives a shit about keeping its allies in place and stable and their enemies crippled and weak, which is what the rest of the world is trying to do too.
So when NATO countries have a vested interest in keeping a country down (Iraq) because it developing a military will support an old adversary (Russia), you can bet they'll tell the public whatever they fucking want to justify a situation like the Cold War never gets the opportunity to arise.
It's a sad state of affairs that crippling the development of foreign countries is in our own best interest, but personally I enjoy my way of life and the world isn't a John Lennon song.
> personally I enjoy my way of life
Personally it didn't improve my quality of life one bit, I had friends and family get deployed over there and I would have preferred they weren't for their and my own sake. I was opposed to the war, I was calling the WMD claims bullshit from the start. I know why the war happened, but I'd have rather our people have been kept out of it and just let Saddam and Ahmadinejad fucktard it out by killing hundreds of thousands of their own people.
I don't know if you're actually Iraqi, or just trying to make a point, if you are I'm sorry for my callousness, but I honestly don't think my friend should have had to be in a Hummer that got hit by an IED because the Iraqi government had a history of going apeshit with mustard gas on civilian populations, just because my government didn't want some retard fiesta in the Middle East to put us into a great depression when the oil industry and all derivative industries halt.
Saudi Arabia, after the first Gulf War, was not in any way threatened by Iraq. Saudi Arabia supported Iraq in its war with Iran.
It is most interesting that you point out Iraq's usage of mustard gas. Said usage occurred during the Iran/Iraq war. The usage was supported by the U.S. until it was applied to Iraqi Kurds. Then there was some moral posturing but the weapons, support, and money kept flowing to Iraq so that they could continue the fight with Iran.
Personally I don't think my friend should have had to be in a Hummer that got hit by an IED (he's fine, well tinnitus but I got that from a Motorhead concert) because Saddam liked bombing civilians with mustard gas, but given my work is solely dependent on petroleum products I kind of like having a job right now.
"Subsidized to have an ally country" is completely different to "subsidized" (as in, "we did them a favor"). Plus, did they get those 1/5 of the orders for free? If not, I can't see how the fact that they paid 1/20th of the cost of the R&D comes into play at all. Do you expect them to pay the R&D on top of the price they buy the stuff?
Plus, the UK is not "Europe". Heck, they're considered mostly US lackeys down in the "continent", what with Blair and all.
>I also think you have absolutely no clue who international politics works by your blatant naivety.
I don't think Americans not in the government have any clue of international policy. For one, their access to good information is extremely limited, and most of their coverage (from news to books) comes from officially sanctioned party lines (with some faux-heretics thrown in for good measure). Even the american leftists have very mediocre analysis and take for granted a lot of ideology.
>There's a lot more at stake than "access to oil". (...) The War in Iraq was less about getting our hands on Iraqi oil, but getting their Regimes hands off of Iraqi oil.
So the well known situation with Saudi Arabia aside, that people in Europe (where we actually read newspapers and discuss international politics all the time, and not just what our government wants to bring into the spotlight to prepare the public consensus for some aggressive foreign policy) know even in High School, you wrote all that just to come around to that it's all about "access to oil"?
>Had they been left alone since before the first gulf war, allowed to buy Russian hardware and build a military superior to that of Saudi Arabia, the region would be under their thumb and so would a massive chunk of the western worlds oil supply for military purposes. Not to mention they would have been well within the budget range to develop nuclear weapons without ever having to test like North Korea
And that makes the business of a sovereign country something the US has any say in it because?
>The US also didn't sit around and leave Europe high and dry in conflicts like the Kosovo War, because following your logic why should the US be dragged into a purely European conflict.
The US shouldn't have been involved at all in the Kossovo war. They just wanted to establish Kosovo as a protectorate, and have a solid base in the Balkans. If the European people had their say (instead of our governments) they would have told the US to go and shove their participation in this conflict.
>So when NATO countries have a vested interest in keeping a country down (Iraq) because it developing a military will support an old adversary (Russia), you can bet they'll tell the public whatever they fucking want to justify a situation like the Cold War never gets the opportunity to arise.
We really hope something like the Cold War does arise. The Cold War was an era where none of the two bloody superpowers could do as it pleased. The so-called "balance of terror" worked in the favor of smaller countries (hence the tons of sovereignty and anti-colonial fights all around the third world). Now we just have one global cop, which does as it pleases, invaded who they like, takes care of its interests by stepping down on sovereign countries and such. Let's hope China can play the counter-balance in the future. (Sure, China has it's flaws. But the counter-balance does have to be totally progressive or democratic. Just as the US is not. It just have to be there, and stand as a limit to the other's power0.
>It's a sad state of affairs that crippling the development of foreign countries is in our own best interest, but personally I enjoy my way of life
Sure. Who wouldn't, if his country fucked up the world for him to enjoy cheap gas, financial domination, et al?
I don't think we have to introduce your head to your ass, because I think they're well acquainted with each other.
Boo hoo, US evil, blah blah.
Trident is a sore point for the UK for several reasons:-
> It's not an independent nuclear deterrent, we're on a US leash even if we try to sell it otherwise.
> They're based in Scotland, a country within the UK which has fairly low support for nuclear weapons, which the primary elected party are dead against having them, going as far to make it a platform for the independence vote in 2014.
> We need to buy them and pay for upkeep. Theres talk of £100bn costs to renew the things, and I believe the lions share of that goes right back to the US.
I can't tell you whether or not it was subsidised, but I doubt it was when you get down to it and the comparison you are making isn't completely apt.
Not being a viable target for nukes is just the icing on the cake.
It's a shame all polls suggest we're rather content being ignored by the status quo though.
Ironic, coming from a citizen of the same country where 80% of the people believe in "miracles" ( http://www.npr.org/templates/story/story.php?storyId=1240075... ) and a large percentage cannot point their country on a map, much less a foreign country. Heck, it's the country the Presidents and political candidates are even know to do grave mistakes on international affairs, even confusing whole countries with others on camera.
>Boo hoo, US evil, blah blah.
I don't believe in "evil". I'm rational. US is just ruthlessly pursuing it's interests, and fuck everybody else (literally). Including fuck them with illegal and unethical means (from invading a sovereign country to drone murders). You can afford it when you are top dog. It's not like European colonial powers on their day behaved any better.
Speaking about knowledge of international politics, this statement is simplistic and arguably wrong. Saudi Arabia does have one of the largest military budgets in the world, but that does not translate to better or more military. It translates to buying more equipment and giving more money to the weapons industry in the US, the UK and other countries. The US is the main beneficiary, so it is kind of like protection money.
In particular, Saudi Arabia is far from the biggest military force in the Middle East in practice. Israel, Egypt, Iran, and Saddam-era Iraq are/were all far stronger. The last fact is the reason that Saudi Arabia and Kuwait invited the US and the coalition when Saddam invaded Kuwait, despite the loss of face. And it is the reason the US is military active in the Gulf region: Saudi Arabia is nowhere near Iran military speaking..
The Saudi Arabian army does not project any power in the region, and is not a player. Saudi Arabia is not even able to support its allies in Lebanon against Iran-backed military players.
That's a little one-sided. You forgot to mention that the US got the ability to build military bases on UK soil for no rent / charge.
Infant mortality? What, you think Bosnia and Russia actually beat the US in infant mortality, or is it more likely they're lying? (given Russian men live to 60).
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mor...
It lists Bosnia at 6.1 (50% lower than the Wiki).
The Wiki entry claims it uses the CIA factbook as a source. So I'm not really sure which source that Wiki entry is relying on.
[1] http://en.wikipedia.org/wiki/List_of_countries_by_life_expec...
[2] https://www.cia.gov/library/publications/the-world-factbook/...
Edit: Here's a relevant reference, from the WHO, if anyone has doubts about this being a serious issue: http://www.who.int/bulletin/volumes/86/6/07-043471/en/
A natural entity to pay for drug development is health insurance companies, who would save a lot of money if drugs were patent-free. But they don't in fact fund patent-free drugs, since their competitors could free-load.
Bernie Sanders proposed a solution: tax the insurers so none can freeload, and use the money for drug development, and keep everything patent-free. The insurers could come out ahead. (Iirc he had a slightly more complex arrangement that didn't require the government to decide who would be funded.)
It's worth noting that patents don't only reward inventors, they also increase their costs. The book The Gridlock Economy talks about this, and mentions one biotech firm that thought it had a cure for Alzheimer's. It infringed on thirty patents, and each patent-holder thought it had the most important part and charged accordingly. They had to abandon the whole thing.
NIH pays for the research and development of new drugs, and we do not give out patents for any of it. Pharmaceutical companies are free to produce whatever drugs they want, and cannot prevent anyone else from producing those drugs; they must only meet the quality control standards set by the FDA. All drugs would be sold like today's "generics," in a competitive market that keeps prices down.
The claimed expenses for "research" are mostly about bringing slight variations of drugs to market in order to extend patent protections - that is, they are rent-seeking.
> "More than four fifths of all funds for basic research to discover new drugs and vaccines come from public sources."
http://www.bmj.com/content/345/bmj.e4348?ijkey=Y1g4ZVUImIbtX...
The story of healthcare costs in the U.S. is entirely to do with profits for drug companies and hospitals, and has almost nothing to do with "innovation".
You can discover a new drug for a few tens of millions of dollars. Now to get that drug to market? You need to cough up a few hundred million dollars.
Discovering a drug doesn't save any patients, getting it to market does and THAT is paid for by private companies.
Several forces are pushing trials elsewhere, the researchers noted: cost (a trial at a top medical center in India may cost less than one-tenth per patient what it would cost at a second-tier U.S. center); faster approval times; and less red tape. http://health.usnews.com/health-news/managing-your-healthcar...
PS: Of note: In the US, sponsors may receive a 50% tax credit for certain clinical trials. http://en.wikipedia.org/wiki/Clinical_trial#Economics
Or, you can look at the actual drugs that get approved, and back-trace them to their sources. Hey, someone already did that. Here: http://pipeline.corante.com/archives/2010/11/04/where_drugs_...
There are no miracles in this world and US is not an exception. Wait and see world turning back on the dollar, and we'll have a level playing field. Then we'll see how much the USA is really worth. Without subsidies.
Inflation has been painfully low for years. Many have said it needs to be higher actually.
I'm running a biotech/healthcare startup, and this point is rather interesting for me.
Most of these arguments against "crazy high" drug pricing in the US work to vilify the large pharma and biotech companies. I don't seek to defend them, but perhaps we can look at some of these conundrums through a startup's lens:
Getting my product to market is incredibly challenging. There's a good amount of novel technology development and research around it, and we're not even developing a therapeutic. We're working in a scientifically challenging space (cancer pathology), so things aren't easy.
Even if we can build what we are trying to, that's not the sum total of our costs. We have to invest a huge amount of energy into validating that what we've built is scientifically accurate, and then medically appropriate. This isn't for regulatory approval, this is simply to convince our customers (and basic ethics/QA, I suppose).
The standards to which our product will be held are quite high because we influence peoples' lives. That's the curse and the blessing of healthcare.
Given all the work we're putting into this and the nontrivial cost of the project, we'll need to generate significant revenue to make it work out. It doesn't come cheaply, but in the US we think there's room in budgets for us. We don't seek to price exorbitantly, but there's a fine line between that and barely surviving.
The problem with market-based approaches to medical research and medicine distribution is that they force people to make economic decisions about their healthcare. Nobody, regardless of their income level, should have to sit down and ask themselves, "Do I want to treat my cancer now, or do I want to buy food for my children?" The same arguments for a universal healthcare system apply to federal funding for medical research. Yes, medical research is expensive; no, we do not want to fund it with a system that denies medicine to people who need it.
I do not want to be overly critical of your startup. Nobody says, "Man, there are too many ways to treat cancer!" On the other hand, your startup does need to bring in enough money to cover its costs, which means you cannot just give your drug to anyone who needs it -- you need to charge them for it. That is why the funding model needs to be overturned, so that the cost of developing the drug is not an issue in getting the drug to people who need it.
I didn't see your email in your profile, but feel free to shoot me an email through my profile (anand at percept dot us)
A key point here is that the original drug itself was patented, and has expired. The issue that the Indian court had with Gleevec patent application is that it only rearranged the molecule in a new crystal pattern, ie Polymorphism. The Indian court consider polymorphism to be a well known technique when working with drugs, and just applying polymorphism to a old drug and record what it did do not fulfill the requirement for patentable.
The reason to have copyrights and patents is to fairly compensate the innovators (that part works really well). But there's an expiry on both patents and copyright - that's explicitly there so innovations can benefit the people, and to spur new innovation. And that's where the US system falls apart. Loopholes are found times and again and in the US once you have a copyright or patent, you basically have it forever. A monopoly, hurrah!
That's just plain wrong. The US needs to fix its system. I imagine when that happens it will also make more sense for Pharma industry to spend more on R&D than they spend on marketing and bribing Doctors and healthcare providers and politicians.
Really happy to hear Indian courts don't fall for this sort of crap.
How can Disney have a copyright on Mickey Mouse? An absolute joke.
I might have different feelings about it if India just rejected the initial patent, but the reapsearch has been paid for, profits taken...
Not really related, but I wanted to mention this, since some people really want to show Novartis as evil, and while they probably charge too much for their drugs in the US, their medicine actually saves lives, my dad being the best example of that.
The only way to combat this is to have a national health care system,that sets their own prices for drugs it buys from companies. If my country says that the maximum it can pay per box of Glivec is $3000, then Novartis can't do anything about it. Well, they could decide to not sell the drug at all, but they would rather have some money than none.
Yes, it is very much evil.
> The only way to combat this is to have a national health care system,that sets their own prices for drugs it buys from companies.
No. All it takes is a different patent system that reduces the (artificial, granted by society) monopoly awarded to patent holders. Or, as a more radical change, eliminate monopolies for drugs entirely and fund research publically.
And as for the patents - how would you deal with a problem that after spending millions on research somebody could copy you and sell the same product for the 1/100 of the price? I know that the US patent system is broken, but this problem is very real.
As for the publicly funded research - this is the best option, but some countries like US oppose this so strongly that I don't think it would work.
note that I said "reduce" the monopoly, not eliminate it. Perhaps a limit on the markup or some sort of mandatory licensing scheme.
And yes, companies donate money/products to charity, but only when they have "spare" money, so money they have no current use for, no ongoing investment plans and so on. And most of the time, giving money to charity is written off as a PR expense, improving the company image by donating to the poor. So yes, there are ways to spend money for noble causes if you want to, but you can't knowingly make a decision that would make the company make less money.
I wish people would quit saying that. IANAL, but I never have found anything that definitively says that. It would seem that in the case of company sale or takeover, yes, the board has to "maximize shareholder value". But in day-to-day operations there is nothing stopping a company from saying, "we're not going to be assholes" at the expense of maximizing shareholder value. Shareholders don't like it? Sell your shares.
As one example, I refer you to Costco, with profits capped at 15%, to the chagrin of some on Wall Street.
As for the Jobs/Apple example, I sure hate to play the [citation needed] card, but I don't think he exactly said that Apple legally had its hands tied.
EDIT: found my own citation. Jobs said nothing of the sort. http://www.nytimes.com/2012/01/22/business/apple-america-and...
The article even quotes someone from the Labor Department as saying that companies used to use US workers at the expense of "maximizing shareholder value", without anyone going to jail, but they don't now.
Oligopoly, it's like a monopoly, only legal.
If Biogen charged only the price of aspirin, they would never recoup their R&D costs, let alone make a profit.
It all comes down to risk-reward. Even though the FDA has very rigorous efficacy and safety standards, drugs still get through that kill people.
If you want to make drug approvals cheaper, then you have to be willing to put up with a higher risk of drugs getting through that shouldn't have.
It's not circumventing the patent. It's not granting the patent. People think that patent is some kind of innate natural right and if you manage to trick one country into giving you monopoly you are somehow in the right now and other countries that don't see the point of giving you similar monopoly are circumventing your sense of entitlement.
see 'Calling big pharma's bluff' http://www.thehindu.com/opinion/lead/calling-big-pharmas-blu...
"This article is misleading from the beginning. India did not refuse to issue a patent for Gleevec, it refused to extend the patent Gleevec already had, based on merely superficial changes to the formula, a practice known as "evergreening", which pharmaceutical companies use to extend the monopoly on their medications as long as possible."
That is completely accurate, and more informative that the article in fewer words.
If what the courts are saying is true and the new patent covering crystallization is trivial, the expired patent should be just as effective and free to use? If it's not as effective, that seems to make the case for the new Novartis patent.
"The issue the Indian court had with Gleevec patent application is that it only rearranged the molecule in a new crystal pattern"
...in other words the American patenting system is more corrupted than India's. Reading again my last written sentence I can not but awe - I never thought I might ever compare America with India and find something less corrupt in the last one!
WHY IS THERE NOT ONE NEW PEDIATRIC CHEMOTHERAPY IN THE PAST @) YEARS INTRODUCED IN AMERICA?
http://www.cancer-research-awareness.com/why-chemotherapy-ne...
http://www.smashcancer.com/2010/08/22/cancer-lies-and-the-me...
http://current.com/green/89138817_cancer-is-not-a-disease-ch...
Just a few writings and articles speaking about the lie that is chemotherapy.
I have an idea how medicine works, let me spell it out here for you:
1. Poison the foods (GMO, sugars, fats, overprocessed crap that is the idea of western food)
2. Sell medicine for people who eat this poisoned food
3. Profit!
Now, this is _my_ idea. You are allowed to have your own idea about this.
He never smoked, didn't really have GMO crops even available to him to eat for most of his life.
I don't get why people like to have this idea that avoiding cancer is as simple as shopping at a more expensive supermarket. In a way it's almost a culture of victim blaming.
These big companies are then spending billions of dollars in marketing in favor of chemotherapy and other medications that can easily cost thousands of dollars per month.
And the more they sell their medication, the more money they get, as their patients stay sick. What is their motivation really to heal their patients ?
The truth also is, many people die from the actual chemotherapy process. Good thing your dad is still alive.
Just rattling the normal view here.
As someone that is in preventitive medicine: It's a bit more complicated. But one of the hardest part is changing peoples habits. Besides the rather crappy data available on prevention/diet etc.. Sensationalism and fear can help some to change their life. But there are better (more positive) methods.
Don't take me too seriously though. If chemotherapy works, good for you. Just trying to present alternative views into this. I've heard so many stories and people talking how chemotherapy was the cause that killed them.
But sure, I am just shooting opinions here. Like everyone else here.
And I believe I have some idea how science works, so don't assume something you don't know.
That's exactly why science is not at all like a religion: "can be measured" really just means "affects the real world". If something affects the real world (and that includes the human mind), it can be studied using scientific methods. If it doesn't, well... what's the point?
As for chemotherapy, yes, most of it is really nasty stuff that can kill you (and in gruesome ways, too). But cancer is really nasty stuff that will kill you in gruesome ways. That's the only reason why such dangerous therapies with really bad side effects are used - because sometimes they're the only thing that can keep you alive. Quite often actually, though it may not feel that way at the time.
I think it's disingenuous to lump all cancer and all chemo together. There are thousands of types of each, some more effective than others. Cancer is a horrifically complicated set of diseases.
Also, would I have gotten cancer if I didn't eat GMO food? Who knows. There's zero evidence that that's true.
Science doesn't work by conspiracy theories, nor without data, nor by opinions. The data points to this "idea" being absolutely wrong.
Unlike politics or art, opinions don't count.
Please, let's engage with the real science that has been done, studying the mechanisms by which cell growth control goes awry and chemotherapy targets proliferative growth. Yes, let's talk about how chemotherapy is poorly targeted, and ways we can improve it to really only kill cancer cells.
But let's stay away from pseudoscience. We can do better.
The first problem is the money they spend on buying laws, aka bribes, aka "lobbying" as the USA likes to call it. Corruption in its finest form. That's why they get perpetual patents;
The second problem - and I kind of assume that that falls under "marketing" expenses - is that they can basically bribe healthcare providers and doctors to use their products.
Result: Most expensive health care system in the world, by a large margin.