Health Care Reform thread

[PhillyPhreak54]

I'd like to see direct marketing to consumers by pharmaceutical companies banned outright. 

I agree with this.

I'm curious to know how you feel, MMH.

I can't help but thinking that the direct marketing causes the weak minded to think they have these symptoms and to run to the doctor to be checked for whatever malady they think they have. The doc then prescribes this medication and gets kick back for doing so. Is that a fair assessment?

The commercials are downright annoying. I love how the happy actor recites the potential side effects at the end.

As I mentioned earlier in this post, I think direct marketing is the single most destructive thing we as an industry has ever done (to ourselves;  we lobbied like hell for this).  I believe this had a major role in the Vioxx deaths.  Vioxx was approved for RA and OA in extreme cases, but was then marketed to anyone with sore joints ad nauseum on TV, mags, etc.  Celebrex too.  If used as intended, the body count certainly would have been lower.  But, you know, Merck would have had less profit, so...

Pharma is a business, a very risk oriented business, but maximizing profits at patient's expense is bad economics in my opinion.

Cool, thanks for checking in.

One other thing...I don't recall the name of this drug (Procrit, I think), but prior to my grandfather dying, they were giving him shots of this and the price tag was something like 10K per dose.

How is that possible?

Also in the same earlier post, I was in a meeting where a director was asked how the price of drugs was determined.  He said, whatever people will pay.  This is not a good answer.

As I said, Pharma is a business, and needs to make a reasonable profit.  New compounds are patented long before they reach market, limiting exclusivity by the time they reach market.  And they're expensive as hell to develop.  To get a cancer drug on the market, one of the speediest paths to approval, costs approximately 500-700 MM.  Drugs for, say, diabetes or arthritis don't get fast-tracked (adequate compounds are already available), and they require a much longer time to monitor efficacy.  These cost over $1 billion to get to market.

Add to that, we aren't very good at predicting efficacy/safety, so only about 10% of all drugs make it from discovery to market.  Many die in late stage clinical trials, after 100s of millions has been spent.  The ones that make it need to pay for all that, and they usually only have 5-7 years of exclusivity by the time they make it to market, which again drives up the price.

Procrit is a biologic for anemia.  That means we can't make it from scratch, but need to harvest it from other biologic organisms such as yeast or plants.  That's very expensive, and purification isn't trivial.  Additionally, Procrit in particular is a derivative, so after it's purified it's modified.  That being said, 10K an injection is probably inflated for the reasons above.

I think the key is to partner with the gov't.  Gov't allow drug patents to be longer, say 20-25 years instead of 15.  Pharma agrees to maintain profit margins, meaning they make the same profit during exclusivity as if the patent were shorter.  This lowers consumer prices.  If Pharma decides to be bitchy about it, use price fixing as leverage.  Pharma can't be run like a hedge fund, and unfortunately right now it kinda is.

Great stuff, thanks for sharing. It makes sense and I can see how a company would want to recoup their losses in previous projects; but the 10K just struck me as holding a patient hostage. If he hadn't had adequate coverage, would that have even been approved for him to take? Or better yet, what if he couldn't afford it? That situation is one reason why I think health care and insurance need's fixing.

So if Pharma did partner up with Uncle Sam and extend the patents, how would that affect the folks who make the generic drugs? Would they (could they?) lobby capitol hill to stop it? Do they carry enough weight to do that?

[MadMarchHare]

They would, and they do.  And generics clearly bring the price of drugs down, which is a good thing.

But here's the problem.  Back in the 90s, Africa decided AIDS drugs were too expensive (they were) and went to India or Singapore or the like and had them ignore the patents and make the drugs.  Naturally, Merck, Glaxo, etc. sued, with the backing of the American and European govt's.  The AIDS activists went ballistic and brought the wrath of god down, and Pharma backed off, saying they'd make the drugs available cheaper for underdeveloped countries (they made the pill a different color, so it could be distinguished and not sold in the developed world).

Then they all quietly shut down their anti-viral research programs.  Now noone in big pharma is doing research into AIDS.  No one.  Interestingly, you'll remember that anthrax attack right after 9-11?  Well, at the time, the only drug that was approved for anthrax was Cipro, still under patent to Bayer.  The gov't went to Bayer, and said they need enough series of Cipro to treat everyone in America, and offered a very low ball price.  Bayer said no, and the gov't threatened to break their US patent.  Africa waved HI!

Fallout?  All big pharma quietly shut down their anti-biotic research programs.  Go to Estonia, over 70% of tuberculosis cases are incurable with the 4 drug combination typically used to treat that disease.  And it's spreading, as is MRSA.  Soon, you'll either get better, or you won't.  Pharma is a high risk business with unbelievable overhead.  Profitability must be maintained, or they'll do something else, which is not good for an over-populated world.

[mpmcgraw]

It seems to me that not getting xyz vaccine is almost universally stupid especially when your doctor suggests it, but whatever. 

[PhillyGirl]

It seems to me that not getting xyz vaccine is almost universally stupid especially when your doctor suggests it, but whatever. 

Seems to me that everyone on this board is right.

You're an idiot.

[PhillyPhreak54]

They would, and they do.  And generics clearly bring the price of drugs down, which is a good thing.

But here's the problem.  Back in the 90s, Africa decided AIDS drugs were too expensive (they were) and went to India or Singapore or the like and had them ignore the patents and make the drugs.  Naturally, Merck, Glaxo, etc. sued, with the backing of the American and European govt's.  The AIDS activists went ballistic and brought the wrath of god down, and Pharma backed off, saying they'd make the drugs available cheaper for underdeveloped countries (they made the pill a different color, so it could be distinguished and not sold in the developed world).

Then they all quietly shut down their anti-viral research programs.  Now noone in big pharma is doing research into AIDS.  No one.  Interestingly, you'll remember that anthrax attack right after 9-11?  Well, at the time, the only drug that was approved for anthrax was Cipro, still under patent to Bayer.  The gov't went to Bayer, and said they need enough series of Cipro to treat everyone in America, and offered a very low ball price.  Bayer said no, and the gov't threatened to break their US patent.  Africa waved HI!

Fallout?  All big pharma quietly shut down their anti-biotic research programs.  Go to Estonia, over 70% of tuberculosis cases are incurable with the 4 drug combination typically used to treat that disease.  And it's spreading, as is MRSA.  Soon, you'll either get better, or you won't.  Pharma is a high risk business with unbelievable overhead.  Profitability must be maintained, or they'll do something else, which is not good for an over-populated world.

Damn! Interesting stuff. So all AIDS research is done by private funding? Is there no recourse to them refusing to develop and research these diseases?

I understand its a business, but where does the "good of the people" come into play?  How does the gov't allow this to happen?

It's not like this is a car dealership or retail sales, it's literally life and death business.

[rjs246]

I understand its a business, but where does the "good of the people" come into play?  How does the gov't allow this to happen?

This, more than anything, might be the question of our time.

Also, is this an actual adult conversation going on? I might cry. Or forget about it entirely.

[PhillyGirl]

MMH, what are your thoughts on the rushed to market H1N1 vaccine being "tested" out on pregnant women right now?

[MadMarchHare]

The gov't can't mandate Pharma work on everything.  Maybe offering tax breaks would help, but it's still just not profitable enough, and the 3rd world nations will still not want to pay.

And I think you misunderstand.  While the AIDS virus is being researched in academe, NO ONE is trying to make the next generation therapeutic.  I think there's a biotech out there claiming they have a potential vaccine, but....

Unfortunately or otherwise, the "good of the people" doesn't come into play.  And it's definitely life or death (and damn soon, I'll warrant).  A researcher (can't remember who) put MRSA with another bacteria strain on the same agar plate.  Within 2 days, the second strain was also methycillin resistant.  He was so terrified he just bleached the whole plate.  HIV is a retrovirus just like the common influenza virus.  DNA splicing is hardly an accurate process, and it isn't inconceivable the two could mix in a patient leading to an airborne HIV virus.  Fun stuff.

Bottom line:  developing drugs is expensive.  The gov't sure as hell isn't going to do it.  Just don't make it un-profitable and we will.  The people I interact with every day (i.e. not senior management) do this because it's cool to make drugs which help people, not to make a profit for Pharma.  But without the latter, we aren't allowed to do the former.

[MadMarchHare]

MMH, what are your thoughts on the rushed to market H1N1 vaccine being "tested" out on pregnant women right now?

I think it's a necessary evil.  The data out of Mexico, and the Southern Hemisphere, clearly demonstrates pregnant women are at increased risk of complications and death from H1N1.  And, unfortunately, we have no other way of determining whether the vaccine is safe to a fetus.

EDIT:  Oh, and I should mention, this is hardly mandatory.  Every mother in this trial volunteers and (hopefully) signs an extensive and clear form explaining the potential risks, not the least of which is death of the fetus.

[PhillyGirl]

MMH, what are your thoughts on the rushed to market H1N1 vaccine being "tested" out on pregnant women right now?

I think it's a necessary evil.  The data out of Mexico, and the Southern Hemisphere, clearly demonstrates pregnant women are at increased risk of complications and death from H1N1.  And, unfortunately, we have no other way of determining whether the vaccine is safe to a fetus.

EDIT:  Oh, and I should mention, this is hardly mandatory.  Every mother in this trial volunteers and (hopefully) signs an extensive and clear form explaining the potential risks, not the least of which is death of the fetus.

I can't even imagine signing up for that. Who the farg would ever do that?

[hbionic]

The poor and uninformed.

[PhillyGirl]

The poor and uninformed.

They have to tell you that there is risk to the fetus. They cant be THAT uninformed.

[General_Failure]

Nothin'll happen to my baby.

[MadMarchHare]

It's risk-reward, right?  If you get H1N1, you are at higher risk of dying (and thereby killing your fetus).  If you enter the trial, you have the potential of getting the vaccine, and protecting yourself and the baby, months before anyone else.

But you're probably right, they're going to have a hard time filling that trial.

[PhillyGirl]

I see no reward in it.

I'd rather get the flu, thanks.