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Comment by bsaul | Hacker News Reader

All of this is true, but americans have to realize one thing : all the drugs for cancer are created in the US. Because your system in general is expensive but that makes it possible to do research. Our doctors are not billionaires, our private hospitals aren't making an insane amount of money, and the state is collapsing under its debts. So almost nobody has the money to run research, and when they do, drug companies look for the american market to cover their costs.

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Source? If you look at expenditure on pharmaceutical research and development in the UK vs. the US, you see that 9% of global R&D expenditure is UK based, and 49% is US based.

This very closely matches the population differences between the UK and US (at a population of 63M vs. 317M).

Within Europe, the UK represents 23% of all pharmaceutical R&D funding; France is only slightly lower at 20% of the total.

http://en.wikipedia.org/wiki/Pharmaceutical_industry_in_the_... http://en.wikipedia.org/wiki/Demographics_of_the_United_Stat... http://en.wikipedia.org/wiki/Demographics_of_the_united_king...

Source is a very close friend of mine who's doing research in biology, and who knows how things work here vs the US.

He witnessedthe difference in how the interns are paid, how the researcher are paid, how the labs are funded, gow modern the equipments are, and how much money the pharma corp are ready to spend todevelop new drugs. And this is a completely different world.

Now you're perfectely right and the market size is a big factor. I should have compared europe vs the US. The conclusion would have been the same.

The US healthcare industry runs at a profit, so your point is moot.

How people is paid also reflects the cost of education - in Europe higher education is vastly cheaper than in the US (in many cases free). If American researchers end up with $200,000 in college debt and a European has $10,000, they'll be requiring different salaries.

The research expenditure isn't meaningful to the consumer. The question is where the companies intend to profit off of that research, and whether they would bother if they were only reimbursed what the NHS pays.

US medical R&D spending is about $500/year per capita. US overspending on medical care compared to other first-world countries is about $3000/year per capita. That doesn't account for more than a small part.

That's a fair point, but R&D isn't the only thing encouraging the development of new drugs and technologies. A huge market willing to "overpay" is a massive driver. Look at the history of MRI penetration in Canada vs. the U.S. for an oft-used example.

Anecdotally, I've been told of pharmaceuticals that only get cleared for future development because the expected U.S. pricing will make them viable.

> Anecdotally, I've been told of pharmaceuticals that only get cleared for future development because the expected U.S. pricing will make them viable.

That doesn't mean those meds are effective or even not actively harmful. People willing to pay tens of thousands of dollars to gamble on getting an extra 4 weeks of shitty quality life doesn't sound like a good way to run medication development.

That is simply not true. A company behind a few leading cancer treatment drugs that are in use today is Novartis - and that's a Swiss company: http://en.wikipedia.org/wiki/Novartis

To be fair, the Swiss pay only second to Americans in health care costs (~10%) and have the private but mandatory insurance thing also.

They [drug companies] are satisfied with the status quo because they ARE making money. The problem is that the FDA makes it near impossible for biotech startups to develop revolutionary and competitive oncology tech. Investors don't want to invest in early/mid stage biotech companies due to the extreme risk. Essentially these startups could have a viable product, yet get stonewalled by the FDA for years while waiting for trials and run out of money and dry up.

In many cases it's not really the research that drives the cost, but rather the ability to charge the cost they do because people want to live. I understand that perspective is controversial and some will down-vote me for it. One instance was when my Dad had Metastatic Melanoma and was on DTIC therapy (Dacarbazine). It was nearly $20k per infusion. Are you kidding me, $20K/infusion!? They did 8-10 infusions. Unfathomably expensive. Oh and DTIC is one of the crappy old drugs from the 1970's. Anyone who believes that the cost to produce the drug is anywhere within several orders of a magnitude of what it costs patients is delusional.

TL;DR The FDA and their non-startup friendly political processes are suppressing new players from emerging in the medical field who could create companies with revolutionary treatments. These treatments would bring a natural balance back to medical pricing through free market principles. Instead we're stuck with the current oligopoly where there's no major inventive to create cures which would cost billions in research while simultaneously ending hundreds of billions per year in recurring revenue on current semi-effective treatments.

/rant

That is not true at all. It is not at all difficult to get a cancer drug approved, providing of course that it works.

According to [1], the amount of money invested in research in Europe and in the US seems to be of the same magnitude. And it makes sense to me to claim that the "drugs are created in the US" to prove your point. When you have developed a treatment, you can sell it worldwide, thus making profit worldwide to pay for the development/future developments.

Not to mention that France has some very edgy teams working on cancer treatments, such as for leukemia at Hopital Saint Louis in Paris or for various cancers at Hopital Paul Brousse and Institut Gustave Roussy in Villejuif (for instance they are sort of world leader on chronotherapy of cancers, team of Pr. Francis Levi)

[1] http://www.nejm.org/doi/full/10.1056/NEJMp1311068

Isn't it a much simpler explanation that healthcare should never be a free market as one of it's participants, the "patient" is not participating voluntarily?

(This is not a direct response to your post, but I place it here as you put a market argument upfront)

I'm not judging the systems. I, personaly, much rather live under the french nhs than the US one.

But i just wanted to provide some perspective to that generaly over optimistic OP post. The fact that cancer drugs are created in the US is not a coincidence. It's an ecosystem where there is a lot of money to be made, and as we know it in IT, money drives innovation.

ICI discovered tamoxifen before AstraZeneca bought them. They're British. Femara (letrozole) and Afinitor (everolimus) are Novartis (Switzerland). Campostar was discovered by Pharmacia, a Swedish company that's now part of Pfizer.

The U.S. by no means has a monopoly on "cancer drugs".

It would be interesting to see where the labs for those companies are, and what's their primary market.

But thanks, i didn't know that. Maybe the british and swiss R&D isn't in such a bad state as France.

The majority of health care costs are non emergency, at that point it's no different than needing food.

It's very different from food: While the majority is not emergency, the majority IS chronic conditions, which are not comparable to food:

If McDonald is too expensive for you, you can switch to Ramen.

If Insulin is too expensive for you, what do you switch to?

If Radiation therapy is too expensive, what 7do you switch to?

If Dialysis is too expensive for you, what do you switch to?

If psychiatric drugs (for bipolar disorder, or schizophrenia) are too expensive for you, you lose the ability to be part of society.

Totally unlike food, despite being non-emergency.

The moment you have patents on drugs (which you do), and a $400M cost-of-bringing-to-market independent of the resarch (which you do), it's not a free market. Totally unlike food.

The point is market forces can apply most arguments against nonsocialized health care focus on the emergency aspect.

Pharmaceutical not equal doctors. The former is not funded by doctors but by the patients. So it will be better to extend medicaid to more people to fund the former...

It's an ecosystem. Doctors and hospitals are the pharma industrie customers for many many things such as medical equipment. Doctors in france fees have their fees regulated by the state. They can't charge what they want. If the fee in the OP story was 18€ it's not because the doctor think it's fair to be paid just like a maid, but because the state fixed the price.

And fixed prices is a big reason why our social security has been working in the last decades in France, and why medicaid may not work in the US.

It is an ecosystem, where everyone has to aggree on keeping the prices down.

It's not the case that americans would stop spending on health care if they went social. They'll spend a bit less, but I don't think it would make an impact on research. They will still look to the american market to cover their costs because it's the biggest market. It doesn't matter if it's the taxpayer's pocket or the private insurance paying out.

The thing is,in my opinion, you can't have a balanced insurance system with health costs as high as the US ones. So you would have to force everyone to reduce their rates, and thus decrease the cash generated by this economy ( and thus less R&D) French doctor rates are fixed (unless they decide to have their fees not rembursed by the NHS), and they are orders of magnitude lower than the US ones ( remove one and sometimes two zeros for exam fees). And even with thoses restictions, french NHS is struggling economicaly.

An of touted argument that is patently and demonstrably false and if you had of done some research you would know that

Didn't expect so many downvotes on that post. It seems many people here ( most of them living in the US i presume) don't want to hear about the downsides of a system i'm currently living in. I suppose this is a too sensitive subject to have a pros/cons type of discussion.

French NHS works because everybody accepts to lower the rates of everything. We ( the french) live in a pseudo state-regulated health economy. When you're doing this, you're reducing the total amount of money that's flowing into that economy, which logically impacts the financing capabilities for R&D.

Other people have said the same thing : http://www.nber.org/digest/may05/w11114.html

bullshit

FYI: http://ycombinator.com/newsguidelines.html

I upvoted him/her. Because parent posted bullshit.

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