[HN Gopher] FDA approves first monthly injectable to treat HIV i...
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FDA approves first monthly injectable to treat HIV infection
Author : apsec112
Score : 256 points
Date : 2021-01-25 22:44 UTC (1 days ago)
(HTM) web link (www.statnews.com)
(TXT) w3m dump (www.statnews.com)
| TimPC wrote:
| I'm hopeful that this is a step towards getting an injectable on
| a longer time scale even though it's likely the treatment
| technology would be different. If we could get to something on a
| 2-year or 5-year time horizon we may just start giving it to
| everyone preventatively, the way we do tetanus shots. The larger
| volume might mean enough total profits at a price scale that
| makes it affordable for the pharma company to do that at a price
| point that makes sense for the buyer. If we get to a universal
| treatment that we can apply globally, we may see AIDS become a
| thing of the past in a few generations. Given unequal access to
| care that may be substantially challenging in regions with poor
| health care and we may need an outright vaccine that lasts
| permanently to successfully treat it globally. But this seems to
| be a step along that pathway even if new technologies are needed
| to complete it.
| ed25519FUUU wrote:
| > _In 2018, for instance, there were approximately 36,400 newly
| infected patients living with HIV in the U.S._
|
| This number seems insane to me _in the USA_. Why is a well known
| deadly disease, with well understood transmission vectors, still
| spreading so prominently here?
| bpodgursky wrote:
| Because people really, really like having risky and unsafe sex?
| damnyou wrote:
| No, that's not the reason, given that PrEP exists. The actual
| reason is that Truvada, like other healthcare, can be hard to
| get in the American system.
| [deleted]
| renewiltord wrote:
| Have we considered telling people to "just stay home" and
| to "not have sex"? Maybe that's the trick.
| _jal wrote:
| No, that's the strategy for lower-caste straight people.
| Telling them that leads to socioeconomically capturing a
| large percentage of them by burdening them with children
| before they can hit early potential.
| damnyou wrote:
| Right. Abstinence doesn't really work in the real world,
| only in the spherical-cow world where humans are
| perfectly obedient.
| bpodgursky wrote:
| Condoms also exist, and are trivial to buy, in the American
| system.
| damnyou wrote:
| And I'm sure transmission rates would be even higher if
| condoms were harder to get.
| kansface wrote:
| The incidence rate of HIV infection is the same in the US
| as it is in France, Span, or Italy though higher than the
| Scandinavian countries. I couldn't easily find data for the
| current rate of new infections, but its not immediately
| obvious to me that access to health care is the major
| driving factor.
|
| https://en.wikipedia.org/wiki/List_of_countries_by_HIV/AIDS
| _...
| damnyou wrote:
| I don't know enough to comment on European countries, but
| I wouldn't be surprised if access was a big problem there
| as well. The American healthcare system is pretty bad,
| but it's not the only bad system in existence. There may
| be other linked factors like stigma at play as well.
| minikites wrote:
| Because people don't have healthcare. We've decided as a
| society that it's better for undesirable people (gay men, IV
| drug users) to die instead of paying a cent more than we
| absolutely must in taxes.
| just_steve_h wrote:
| Why is it spreading? Because ACCESS TO CARE is extremely
| unevenly distributed. It can be extremely difficult for people
| with limited resources to get proper care.
| badwolf wrote:
| Not even proper care, it's extremely difficult just to get a
| lot of at-risk people tested (let alone tested regularly)
| refurb wrote:
| Canada, with universal healthcare has about the same number
| of new cases per capita.
|
| So it's not access to care.
| thisrod wrote:
| I was about to reply: because no one ever recovers from HIV
| infection. Then I realised it isn't true. People being treated
| for HIV are not contagious, so they "recover" in the
| epidemiological sense the moment they start treatment. The only
| way that can happen is if a lot of people have HIV but don't
| know it.
| arbitrage wrote:
| Ronald Reagan had a hand to play in this, and the AIDS epidemic
| in america can be seen as the real birth of the neoconservative
| movement in united states' politics.
|
| Regan refused to even acknowledge the disease until he couldn't
| get away. This put the US on a deficit addressing AIDS that
| continues to this day.
|
| American Republicanism kills people.
| eznzt wrote:
| I could tell you, but I would get banned from this website.
| cestith wrote:
| It's good to see articles on new drugs include pricing
| information.
| abeppu wrote:
| > The cost, however, is steep -- the list, or wholesale, price is
| $3,960 a month, or more than $47,500 a year. The list price for
| the one-time initiation dose is $5,490.
|
| Median income in the US is ~$31K apparently. So even in a rich
| country, this is like 50% more than the income of a typical
| person.
|
| My understanding is the funding for the trials was partly from
| NIAID. This seems like yet another case where public funds are
| used for research, but a company ends up with the ability to
| dictate pricing.
|
| I'm glad that this works and that there is another, more
| convenient and effective treatment option. But shouldn't we have
| some setup where if tax dollars pay for the research, the
| government should own a share of the IP commensurate with their
| funding level, and should then be able to have some say in
| pricing?
|
| Or, if you think that the government itself shouldn't own IP for
| a product on the market, can we create an independent non-profit
| which receives ownership, and whose charter aligns with actually
| treating as many people as possible?
|
| I'm not saying that when real, innovative work happens,
| pharmaceutical companies shouldn't get some meaningful return on
| the money they put in. But when the public supports the work, we
| shouldn't get nothing.
| TaylorAlexander wrote:
| Great interview on problems with intellectual property rights
| in the drug market. https://www.youtube.com/watch?v=u6OpapwQOks
| offtop5 wrote:
| 3k month sounds about right for a chronic condition.
|
| Many many people pay at least this to stay alive. That said ,
| Universal Health Care is needed for stuff like this to work. At
| 3k a month it makes the most sense to try and emigrate to a
| better country.
| markdown wrote:
| > At 3k a month it makes the most sense to try and emigrate
| to a better country.
|
| Countries won't let you in if you're going to cost taxpayers
| too much. For example, New Zealand won't let you emigrate
| there if you have serious psoriasis, since treatment can cost
| thousands of dollars/month.
| jacquesm wrote:
| That doesn't scale. If you push the cost of healthcare to
| other countries when it becomes too expensive instead of
| fixing the system in the country where you live then every
| other country with a better system's healthcare will collapse
| as well.
|
| Vote to improve the system where you live and make sure that
| your representatives realize that it could be them or their
| relatives in your situation.
|
| Quite a few countries have restrictions in this anyway, so
| whether it would even work in individual cases is another
| matter, for instance, here is Canada's provision:
|
| https://www.canada.ca/en/immigration-refugees-
| citizenship/se...
| abeppu wrote:
| Or to approach the same issue from the other direction: Does
| public funding for research of this type self-sabotage, if it
| enables pharmaceutical companies to set pricing at a level
| which meaningfully limits the use of the results of that
| research?
| fastball wrote:
| How exactly are is big pharma limiting the result of that
| research? Anyone can use the research.
| refurb wrote:
| Anyone can't use the research. Bayh-Dohl Act basically
| passes ownership of any IP to the person who received the
| grant.
|
| https://en.m.wikipedia.org/wiki/Bayh-Dole_Act
| Robotbeat wrote:
| If the patents relating to likely avenues of that research
| are tied up, it makes it much harder.
| nceqs3 wrote:
| I believe that the government does own a portion of the IP.
|
| If you read patents filed by defense contractors and
| pharma/universities they often say something like this "This
| invention was made with Government support under Contract no.
| F29601-03-C-0191 awarded by the Air Force Research Laboratory,
| Kirtland AFB, N. Mex. The Government has certain rights in the
| invention."
|
| https://patentimages.storage.googleapis.com/f9/bc/b9/dd132ea...
| hn_throwaway_99 wrote:
| So then why is the government letting the company reap so
| much of the benefits of their IP?
| s1artibartfast wrote:
| It depends on the contract made between the government and
| the developer before funding was issued.
| timr wrote:
| > My understanding is the funding for the trials was partly
| from NIAID.
|
| I have no particular insight into the pricing of this drug, but
| in general, NIAID funding doesn't get anywhere close to the
| level of investment needed to bring a drug to market (NIAID's
| total budget is something like $5Bn. A _single drug_ can easily
| require that much money to go to market).
|
| Moreover, it isn't a bright-line distinction between public and
| private funding: if a novel drug is developed (entirely
| privately) against a target for which academic researchers once
| received public funds, does it count as public funding? There's
| a huge gray area in between. Nearly _all_ drugs can be
| characterized as "publicly funded", if you look hard enough.
|
| Rules like this sound great, but in practice, they'll lead to
| perverse incentives (like drug companies completely avoiding
| targets from the academic world, in the previous example).
| Nobody rational wants to spend billions of dollars doing late-
| stage development and clinical trials to be torpedoed by a
| researcher who took a small amount public funding decades
| prior.
| akiselev wrote:
| _> I have no particular insight into the pricing of this
| drug, but in general, NIAID funding doesn 't get anywhere
| close to the level of investment needed to bring a drug to
| market (NIAID's total budget is something like $5Bn. A single
| drug can easily require that much money to go to market)._
|
| According to [1] _" the estimated median capitalized research
| and development cost per product was $985 million, counting
| expenditures on failed trials."_ That billion dollar figure
| is risk adjusted per product meaning that's the cost of all
| R&D and clinical trials against the number of products that
| hit the market. A lucky startup can pull off a successful
| trial for a few hundred million (i.e. Sofosbuvir), if not
| tens of millions for an orphan drug.
|
| The most expensive ("oncology and immuno-modulatory drugs"
| which are similar in complexity to HIV therapeutics) come in
| at a median of $2.8 billion and a mean of $4.5 billion but
| only because of an extreme outlier, Dupixent, which cost over
| $6 billion to develop. Dupixent costs $40k/year and has a
| much larger target market than this HIV treatment (IIRC on
| the order of 10 to 100x). This HIV injection is far more
| likely to be discounted in the developing world so the
| sticker price likely reflects that too.
|
| A $5 billion a year budget can go very far and the people
| should get the rewards for taking the risk, especially for a
| disease like HIV that has significant quality of life impacts
| on vulnerable populations.
|
| [1] https://jamanetwork.com/journals/jama/article-
| abstract/27623...
| pgt wrote:
| Genuinely curious - why do these drugs cost so much? Can we
| make it cheaper? I know there's a lot of hit & miss and
| that the cost of the drug also covers the misses, but it
| feels like we should be able to do this for millions, not
| billions.
| ryanmercer wrote:
| https://www.pcisynthesis.com/want-to-know-why-early-drug-
| dev...
|
| and
|
| http://sitn.hms.harvard.edu/flash/2020/modern-drug-
| discovery...
|
| are decent reads.
|
| Mostly it's the complexity of the compounds involved, the
| supply chain, and regulatory costs.
| s1artibartfast wrote:
| And the the time value of money. see my sibling post.
| s1artibartfast wrote:
| It has to do with the time value of money and long
| development timelines. Here is a great blog post from a
| scientist trying to find investors for drug to cure his
| wife's terminal disease.[1]
|
| >it takes a hundred dollars of drug revenue 17 years from
| now to motivate someone to invest one dollar today. No
| wonder drugs are expensive.
|
| That is a 10,000% return on investment required to break
| even.
|
| http://www.cureffi.org/2019/04/29/financial-modeling-in-
| rare...
| akiselev wrote:
| It genuinely takes a massive amount of labor using mostly
| highly paid professionals like doctors, nurses, and
| research scientists. Even before any trials start, the
| support materials for a premarketing application for a
| drug are usually in the thousands of pages and include
| clinical trial protocols that describe minutiae like how
| blood samples will be drawn so data is comparable between
| hospitals. Then you have to find participating hospitals,
| PIs, and patients which means lots of negotiation and
| patient screenings and TV/radio/web advertising. Then you
| have to manufacture the drugs in small to medium
| quantities. Then you have to actually run the trials
| which means paying a _lot_ of people and most if not all
| of their medical care related to the clinical trial.
|
| Phase I trials, for example, are usually carried out
| under constant medical supervision and push the dosage as
| high as they can until 50% of the cohort will no longer
| tolerate it. That alone is usually thousands or tens of
| thousands per day per patient.
|
| By the time you get to phase III where you have hundreds
| to thousands of patients, you're shelling out up to $1k
| per patient for the incentive and $100-1k per checkup for
| the length of the trial. A 1k person phase III can easily
| cost tens of millions in labor just to administer the
| drug and collect samples once a month for a year. Data
| provenance and normalization is important so a not
| insignificant chunk of this time is largely unavoidable
| paperwork.
| timr wrote:
| Yeah, $5Bn may be a bit of an exaggeration, but it's not
| off by an order of magnitude; this review, based on data
| from Eli Lilly, put the fully capitalized R&D number at
| $1.8Bn in 2010:
|
| https://www.nature.com/articles/nrd3078
|
| (one can certainly quibble over the "cost of capital"
| assumptions these days, but the model isn't wildly wrong.)
|
| > That billion dollar figure is risk adjusted per product
| meaning that's the cost of all R&D and clinical trials
| against the number of products that hit the market.
|
| Yes, but as you know, you can't simply separate the
| successful products from the ones that fail. The former pay
| for the latter.
|
| > A lucky startup can pull off a successful trial for a few
| hundred million (i.e. Sofosbuvir), if not tens of millions
| for an orphan drug.
|
| Sure, one can always hit the lottery. But unlike startups
| (where the N-independent-failures model works OK), drugs
| don't make it to market without a deep-pocketed company
| willing to set huge piles of money on fire in the final
| phases.
|
| Your other comment below does a good job of explaining why
| trials are insanely expensive...which is why lucky startups
| almost never run their own.
| joshuaissac wrote:
| > So even in a rich country, this is like 50% more than the
| income of a typical person.
|
| Generic versions of expensive American drugs tend to be
| released by Indian pharmaceutical companies into developing
| countries after a while.
| rtx wrote:
| They do it after the patent expires.
| chefkoch wrote:
| Not always, the cancer drug lenalidomid (Revlimid) is
| around 20 000$ for 21 pills in the US, the indian generica
| is around 200$.
| s1artibartfast wrote:
| India does not allow patents on pharmaceuticals.[1] As a
| result, they have an excellent market for generics, but new
| medicine is 6-8 years behind the rest of the world.
|
| https://link.springer.com/chapter/10.1007/978-981-13-8102-7
| _...
| inasio wrote:
| In contrast, the napkin estimate for the cost of a year's worth
| of HIV drugs (latest generation integrase inhibitors) was 20K
| as of around 2 years ago, for western countries. Dolutegravir
| became generic, but prices likely won't change dramatically
| (specifically in western countries).
| s1artibartfast wrote:
| >I'm glad that this works and that there is another, more
| convenient and effective treatment option. But shouldn't we
| have some setup where if tax dollars pay for the research, the
| government should own a share of the IP commensurate with their
| funding level, and should then be able to have some say in
| pricing?
|
| >Or, if you think that the government itself shouldn't own IP
| for a product on the market, can we create an independent non-
| profit which receives ownership, and whose charter aligns with
| actually treating as many people as possible?
|
| The current model of government funded research is like backing
| a Kickstarter because you want to see the product made, but get
| no direct benefit. It is made because we as a people think the
| world will be better off with the product, than without, and
| are willing to pay to make that happen.
|
| I think government co-venture is also great option, as long as
| it is negotiated up front and we can keep political corruption
| out of it. However, the question then becomes if drug
| development will dry up once the the government has locked down
| all the IP and nobody wants to partner with them.
|
| I think another good model would be seed support for
| independent non-profit pharmaceutical(s) charted to balance
| reinvested profits with social benefit (without government
| owning the IP). The question and risk here becomes one of
| oversight and accountability.
| m12k wrote:
| > can we create an independent non-profit which receives
| ownership, and whose charter aligns with actually treating as
| many people as possible?
|
| There is a proposal for such an entity:
| https://en.wikipedia.org/wiki/Health_Impact_Fund
| reimertz wrote:
| Independent non-profits trying to fight for individuals in a
| capitalist-driven society seems to be doomed to fail. An
| depressing example; Insulin and how the inventors made sure
| to make the the process available to anyone;
|
| > The patent would not be used for any other purpose than to
| prevent the taking out of a patent by other persons. When the
| details of the method of preparation are published anyone
| would be free to prepare the extract, but no one could secure
| a profitable monopoly.
|
| How did that go? 1,000% price increase, accounting for
| inflation. (US numbers)
|
| Edit: Removed rant-driven generalization and miss-information
| regarding legal obligations.
|
| Thanks for checking me. I get to upset reading these things.
| lotsofpulp wrote:
| > where corporations and their boards are legally bound to
| maximize profit, ignoring morals for profit.
|
| Where is this true? It's not even a definable legal
| standard.
| reimertz wrote:
| You are definitely correct and thanks for pointing it
| out. Generalizations and miss-information doesn't help at
| all.
|
| I obviously need to go out for a walk before I comment on
| these type of news. It's super exciting but also
| extremely depressing since the ones who'd need this the
| most likely wont afford it.
| refurb wrote:
| If, as a company, you have the option of charging $X if you
| accept gov't funding or 400% * $X, doesn't that sound like a
| great way to disincentivized taking govt funding?
|
| And as others have said gov't funding tends to be a small
| fraction of total cost of R&D.
|
| And the funding tends to come very early - some professor is
| researching a new anti-viral and stumbles across a new
| molecule. It's still several hundred million and a decade or
| more away from market.
| MBCook wrote:
| > The cost, however, is steep -- the list, or wholesale, price
| is $3,960 a month, or more than $47,500 a year.
|
| Remember though that this is a replacement for an existing drug
| therapy, not something totally new. Does anyone know how much
| the daily pills cost per month?
| chefkoch wrote:
| It looks like conventional treatment is between 400$ and
| 1500$ per month.
| transfire wrote:
| While good news, it is unfortunate to know we will probably never
| see an actual cure. Capitalized medicine disincentivizes cures.
| That's why we see so many symptom treatments and vaccines -- they
| are far more profitable, by multiple orders of magnitude.
| TheAdamAndChe wrote:
| There are plenty of researchers who would find a cure if it was
| possible. HIV integrates into the DNA of the cells it infects,
| and is virtually impossible to detect and remove completely.
| Merman_Mike wrote:
| Instead of downvotes, I'm curious what evidence there is on
| either side of this claim.
| dougmwne wrote:
| I am sure there is some evidence on both sides, but at the
| end of the day, people get into medicine and medical research
| to heal people, not keep them sick. The USA does not have the
| only medical system in the world and many countries run their
| systems with the goal of controlling costs, not increasing
| them. I don't think this kind of pessimistic conspiracy
| thinking adds to the conversation.
| incrudible wrote:
| If there's more money to be made from keeping people sick
| than outright curing them, that logically is a disincentive
| from curing them.
|
| It's not conspiracy thinking to look at the incentive
| structures within systems to predict possible negative
| outcomes.
|
| Of course, there's a _moral_ incentive to not keep people
| sick, but history shows that we can not rely on people
| acting morally. The pessimism is justified.
|
| If we expect companies to provide cures over treatments, we
| at least must allow them to profit as much or more from a
| cure as they would from a treatment.
| JumpCrisscross wrote:
| > _It 's not conspiracy thinking to look at the incentive
| structures within systems to predict possible negative
| outcomes_
|
| It is when one mischaracterizes the system.
|
| Medical research is not an oligopoly. It is oligopolistic
| within some domains, but as we've seen with the Covid
| vaccine, there are at least four nation-state domains (
| _e.g._ Russia, China, India and "the West") operating
| competitively, and within those domains, there are
| varying degrees of competitiveness ( _e.g._ Pfizer vs.
| Moderna vs. AstraZeneca).
|
| If you have a cure to something everyone else can only
| treat, you'll make a money selling the cure and taking
| your competitors' market share. Because if you don't,
| they will. It's a classic cartel / prisoner's dilemma
| problem with the added explosive of a multi-decade
| patent-protected monopoly for the first mover.
| jjcon wrote:
| > we at least must allow them to profit as much or more
| from a cure as they would from a treatment
|
| I think that's where you go wrong. There are huge profit
| incentives for a cure. If a biotech company comes up with
| a cure they will instantly have the business of every
| afflicted person on the planet. The market for that and
| price they can charge will be way larger than a slightly
| different treatment.
|
| Beyond that, there are labs all over the world funded by
| public dollars to research avenues to a cure, it's just
| way more complicated than effective treatment.
| [deleted]
| call_me_dana wrote:
| There are indeed huge profit incentives for a cure. There
| are even larger profits to be had from a monthly
| treatment that the patient has to take for the rest of
| their lives.
|
| Are you saying people that aren't taking a monthly
| biologic injection for example will start coming out of
| the woodwork for a cure when normally they wouldn't seek
| treatment for their malady?
| tsimionescu wrote:
| People don't buy medical treatments in most of the world.
| Countries do.
|
| And countries will always pick the best priced possible
| treatment.
| whimsicalism wrote:
| Well not sure if it is "evidence", but in terms of marginal
| preventing people in the US from getting HIV, lowering the
| cost of Truvada from $2,000 out of pocket and publicizing it
| would likely have a much larger impact than this once a month
| shot.
| eli wrote:
| I'm not sure every claim is worthy of debate. Setting aside
| all the private investment and philanthropy dollars going
| towards a cure, governments spend billions annually on HIV
| research.
| call_me_dana wrote:
| Yes, they spend billions on developing the exact types of
| treatments that this article is about. Their business model
| depends on maximizing revenue so any treatment cannot cure
| the patient and it cannot kill the patient. Sad, but true.
| eli wrote:
| The business model of the NIH and the UN does not depend
| on maximizing revenue
| icegreentea2 wrote:
| The claim logically holds together. There is even evidence on
| its side.
|
| But one reason for the downvotes may be that it might be too
| narrow-minded. For one thing, it completely neglects to
| consider the relative difficulty of treating symptoms versus
| being fully curative. Secondly, it half undermines itself by
| lumping vaccines into the same bucket as symptomatic
| treatment. Clearly the economic incentives for vaccine,
| versus symptom management, versus cure depends on the disease
| being treated.
|
| Finally, while it carefully uses the word "incentive" instead
| of talking in black and whites, it doesn't explain why "big
| pharma" makes cures at all. A lot of the the supporting
| material for "pharma makes more money on symptom treatment"
| references Gilead's experience with Hep C. But the economics
| of how that drug would have worked was clear as day before
| Gilead spent resources of it. So why would Gilead have gone
| to market with a cure at all?
| TimPC wrote:
| The claim doesn't logically hold together: it assumes a
| monopoly in medicine. It might not be profitable for the
| company with a treatment regimen to develop a cure. But for
| the company without the treatment regiment to develop a
| cure and take away all of a competitor's business and
| capture a significant part of it as their own? That's
| extremely profitable. You can charge far more for a cure
| than for a regular preventative treatment (per dose) so
| margins are far higher even if volume over time is lower.
| Suffice it to say cures are sufficiently profitable to
| enough of the actors in the system that they are worth
| exploring. And there is evidence of cures being researched
| successfully as referenced in the comment above. Also, I
| don't think all pharma companies are perfectly 'rational'
| actors in this sense. They are composed of people who got
| into medicine with the interest to help people, and those
| people know both cures and vaccines help more than just
| symptom mitigation. The motivation of the actors in the
| system to do good leads to even more research of cures and
| vaccines than the non-zero amount that is sufficiently
| incentivized (even if cures are less profitable than
| symptom mitigations).
| samatman wrote:
| Coming up with a cure for HIV infection would be an easy
| Nobel Prize in medicine.
|
| That's a pretty powerful motive, historically. If you want to
| argue that it doesn't apply here, the burden, I'm afraid, is
| on you, not us.
| JumpCrisscross wrote:
| > _I 'm curious what evidence there is on either side of this
| claim_
|
| Looking at the list of the most deadly non-tropical
| infectious diseases [1], most can be vaccinated against
| and/or cured. The standouts remain lower respiratory
| infections, _e.g._ influenza, and HIV /AIDS.
|
| When confronted with a novel coronavirus, it took a few
| months for the world's medical systems to devise various
| treatments and a vaccine. Neither of those are recurring
| revenue streams.
|
| Most damning to this conspiracy theory is the recent Hep C
| cure. That's a real disease. It was profitable to treat. But
| it's more profitable to cure. Those incentives remain
| elsewhere. A cure for HIV is worth billions.
|
| Dealing with mortality and sickness is difficult. It's more
| comforting to some to imagine an evil cabal holding back
| medicine, and I don't need to take that from them. But if
| you're entertaining these thoughts as anything more than a
| coping mechanism, the last half century--or even decade--of
| progress in curing, not treating, curing a variety of medical
| issues has been under-reported (lots of niche illnesses) and
| breathtaking.
|
| [1] https://en.wikipedia.org/wiki/Infection
| throwawaygal7 wrote:
| I came here to post about the Hep C cure. You did a great
| job.
|
| Only thing I would embellish on is that, much like software
| - when something is wrong its easier to treat the symptoms
| than to fix the problem a lot of the times. So it's really
| no wonder alot of treatments are amelioration rather than
| cures.
|
| I recently did a major refactor at work to fix database and
| caching problems in our backend. It took months but only
| yielded 50% scaling improvements. Past teams just kept
| stacking shit and adding hardware and we can all understand
| why.
| dang wrote:
| Could you please stop creating accounts for every few
| comments you post? We ban accounts that do that. This is
| in the site guidelines:
| https://news.ycombinator.com/newsguidelines.html.
|
| You needn't use your real name, of course, but for HN to
| be a community, users need some identity for other users
| to relate to. Otherwise we may as well have no usernames
| and no community, and that would be a different kind of
| forum. https://hn.algolia.com/?query=community%20identity
| %20by:dang...
| makomk wrote:
| The Hep C cure wasn't all that profitable, from what I
| understand. On paper it was a clear win-win - the cure
| would save the various healthcare services lots of money
| compared with treatment, whilst still raking in boatloads
| of money. The trouble is that healthcare services
| everywhere balked at buying it regardless of their
| structure and despite the fact that not doing so would cost
| them money in the long term, and even at those rejected
| prices it wouldn't have been nearly as profitable as a
| long-term ongoing treatment because it eliminates its own
| customer base.
| refurb wrote:
| The hepatitis C cures was massively profitable. Gilead
| paid $11B for Pharmasset's portfolio and everyone said
| they were dumb.
|
| They then had sales of $10.4B in the first year on the
| market. That's one year and one drug (they've developed
| newer drugs and launched those too).
| grawprog wrote:
| https://www.ncbi.nlm.nih.gov/books/NBK217902/
|
| https://fee.org/articles/curing-diseases-is-sustainable-
| gove...
|
| https://www.bmj.com/content/363/bmj.k4351
|
| https://theconversation.com/amp/how-pharmaceutical-
| companies...
|
| https://yaledailynews.com/blog/2017/02/09/lewis-the-need-
| for...
|
| https://www.medpagetoday.com/blogs/revolutionandrevelation/7.
| ..
|
| https://pnhp.org/news/eliminate-the-profit-motive-in-
| health-...
| Merman_Mike wrote:
| Many of these seem to support GP's comment.
| grawprog wrote:
| I don't really understand the downvotes and reactions of
| the other commenters to the gp's post. There's a whole
| bunch of studies showing there's less incentive to find
| cures opposed to ongoing treatments under for profit
| health systems.
|
| On a website where products as a service are discussed
| regularly i'm confused as to how the parallels between
| that and profit driven 'healthcare as a service' are
| ignored or looked at with hostility.
| Merman_Mike wrote:
| .
| dang wrote:
| It was a generic ideological flamewar tangent. That
| includes several good reasons for downvoting.
|
| https://news.ycombinator.com/newsguidelines.html
| Merman_Mike wrote:
| .
|
| [just gonna stop commenting on this site]
| pvg wrote:
| A comment that spawns a lengthy subthread of meta trying
| to parse out what the commenter actually meant, why
| precisely they are being downvoted, etc, is bad. As is
| the subthread of meta.
| dang wrote:
| > _Is the flamewar tangent part of this the comment on
| capitalism or "Capitalized medicine"? Doesn't really seem
| flamie to me but obviously others disagree._
|
| The problem is the generic ideological tangent. You can
| perhaps (maybe!) imagine a substantive article and thread
| on the economics of cures vs. treatments. But that would
| require different initial conditions--primarily an
| interesting, informative article that brought lots of
| relevant information. Relevant information is flame
| retardant.
|
| The situation is different when the _topic_ is "FDA
| approves first monthly injectable to treat HIV infection"
| and the comment is swerving _generically_ into
| "capitalized medicine". Generic tangents, especially when
| the impetus is snarky or unsubstantive, make threads
| reliable less interesting, and generic ideological
| tangents almost always turn into flamewars. The reason is
| that there's very little specific information to discuss
| --that's the meaning of "generic".
|
| Off-topic tangents can be great when they're
| unpredictable and curious, but generic tangents are the
| opposite of that. They're more like getting sucked into
| the gravitational field of a much larger body, if not a
| black hole, that pulls all nearby topics toward itself
| and renders them all the same. Avoiding repetition is the
| biggest problem that a forum like HN--dedicated to
| curiosity--actually has, so it's a big deal: https://hn.a
| lgolia.com/?query=curiosity%20repetition%20by:da....
|
| I hope this helps explain things a bit. There are lots of
| past explanations at https://hn.algolia.com/?query=generi
| c%20discussion%20by:dang... also, but you'll
| unfortunately--and ironically--have to wade through some
| generic repetition to find the interesting bits.
| throwaway292893 wrote:
| Yeah, that's why the US leads the world in healthcare research.
| [deleted]
| dang wrote:
| " _Don 't be snarky._"
|
| https://news.ycombinator.com/newsguidelines.html
| dang wrote:
| " _Eschew flamebait. Don 't introduce flamewar topics unless
| you have something genuinely new to say. Avoid unrelated
| controversies and generic tangents._"
| https://news.ycombinator.com/newsguidelines.html
|
| Especially not generic ideological tangents:
| https://hn.algolia.com/?query=generic%20ideolog%20by:dang&da...
| [deleted]
| lake-effect wrote:
| Pharmacy (i.e. the cost of drugs) is a big contributor to rising
| healthcare costs and injectables are an increasingly more popular
| and very expensive way to deliver drugs. This is a good example
| of how R&D and drug development works in the US. Invest time and
| energy in a much more profitable form of treatment for a disease
| that is already managed.
| refurb wrote:
| Pharmacy is about 10% of total healthcare costs so not a major
| driver of rising healthcare costs, but it gets a lot of media
| attention.
|
| And no, they didn't create an injectable drug because it's
| "popular". They did it because it address compliance of oral
| therapies.
| xiphias2 wrote:
| All the low hanging fruit for medical treatments have been done
| already, so right now it's incredibly hard to improve on the
| situation.
|
| I'm really hopeful though about the genetic revolution that's
| happening though, I just wish it was happening faster (my
| girlfriend just got diagnosed with cancer again today :( )
| outlace wrote:
| Great news. There are definitely a number of people out there
| who, in part due to social circumstances have difficulty taking
| meds daily and this will likely help a good proportion of them.
| [deleted]
| jennyyang wrote:
| As someone who grew up in the 80s with the fullblown AIDS crisis,
| this really is a testament to human ingenuity. When we were kids,
| this sounded like the end of the world: a virus that attacks the
| immune system itself. It was so terrifying to hear about such a
| horrible disease that had no cure, and was so insidious that we
| couldn't even create a vaccine to stop it.
|
| In a few decades we as a species have found a way not only to
| completely eradicate it to undetectable levels (it still hides in
| cells to protect itself) but now we are at a monthly injection.
|
| The way we have created a vaccine for SARS-CoV-2 is also
| absolutely incredible. It's great to be alive these days, now if
| only we can get a firm solution over cancer and other diseases
| like dementia, etc!
| chrisfinazzo wrote:
| > When we were kids, this sounded like the end of the world: a
| virus that attacks the immune system itself. It was so
| terrifying to hear about such a horrible disease that had no
| cure, and was so insidious that we couldn't even create a
| vaccine to stop it.
|
| I was born in '86. Even into the 90's this line of thinking
| hadn't changed all that much. The attitude around most diseases
| and the like that had a 'social' component was best described
| as "shock and shame" - e.g, you're screwed long-term and
| society blamed you.
|
| > In a few decades we as a species have found a way not only to
| completely eradicate it to undetectable levels (it still hides
| in cells to protect itself) but now we are at a monthly
| injection.
|
| I was going to ask how this works until you answered the
| question for me (if it's undetectable, why isn't this
| considered cured?) Last I heard research is still trying to
| figure this out. At the same time, I can remember hepatitis C
| having a similar wrap in the 90's - 'you have it, and probably
| always will' - Mavyret/Epclusa changed that. It still blows my
| mind that the problem is pretty much solved at this point.
|
| Hail Science.
| limeblack wrote:
| As someone who is bipolar I will say I know many people including
| myself who _need_ injections to be able to manage life. The
| injections may be abused by a percent of the population but there
| is a much smaller percent(disabled mainly) that need them.
| jliptzin wrote:
| > In 2018, for instance, there were approximately 36,400 newly
| infected patients living with HIV in the U.S.
|
| It's 2021, why are we only seeing 3 year old HIV infection
| numbers? How come I can see coronavirus infection numbers updated
| pretty much _hourly_ but reporting on HIV infection rates in this
| country is lagging 3 years?
| ceejayoz wrote:
| COVID takes a few days to show symptoms and get diagnosed. HIV
| takes a lot longer.
|
| https://www.onlineathens.com/news/2017-11-28/cdc-lag-time-be...
|
| > In their monthly Vital Signs report out Tuesday, the Centers
| for Disease Control and Prevention reported that the median
| time between infection and diagnosis with HIV was three years
| in 2014, about seven months shorter than in 2011.
|
| If you got HIV in 2020, chances are you don't know about it
| yet.
| FalconSensei wrote:
| Couldn't find on the linked article, but what's the lag for
| people who actually get tested?
|
| I mean, seems that this 3 years lag is because people only
| get tested if they have any apparent health issue and the
| doctor thinks it might be HIV.
|
| With Covid, it might take a few days for a test show
| positive, after exposure - say, Christmas dinner. If someone
| thinks they might have been exposed to HIV, how long until a
| test can safely tell it's a true negative/positive?
| jliptzin wrote:
| I understand that, but I don't see what is so complicated
| about reporting # of HIV tests conducted in a certain
| timeframe (daily, monthly, whatever) and what portion of
| those tests came back positive, just like we currently do
| with coronavirus. It doesn't matter what the lag time is in
| between being exposed and receiving a positive test. What we
| are interested in is # of positive tests, why is there a 3
| year lag here?
| slg wrote:
| The death toll in the US for COVID over the last year is up to
| 60% of the total for AIDS deaths over the last 50+ years. That
| leads to an urgency for COVID data that doesn't quite exist for
| HIV/AIDS which presumably hasn't been changing as rapidly.
| jliptzin wrote:
| 1. I would be curious how these stats compare when measured
| in lost person-years. COVID primarily kills the elderly, AIDS
| (when untreated) kills everyone.
|
| 2. We have a 40 year head start on HIV vs. COVID. Surely it
| can't be that hard, in the digital age, to set up a central
| database with the following columns, updated in real time:
| [Datetime of Test, Zip code, Result (pos/neg)]
| slg wrote:
| It isn't that it is hard to set this up. The question is
| what value is there to setting this up? Especially the way
| that HIV/AIDS was originally and to a certain extent still
| is stigmatized. Many people have had friends or family die
| of AIDS and still refuse to acknowledge that was the reason
| for their death.
|
| The end result is that not only is this type of project
| more valuable for a new and rapidly spreading disease like
| COVID, the bar that the value needs to clear to justify
| this system is also higher because an HIV/AIDS status is
| considered more private from a societal standpoint (not
| necessarily a legal one).
| switch007 wrote:
| I think you know why. For all our societal progression, we've
| still got a way to go.
| ihsw wrote:
| Neither should be reported as they're lifestyle ailments,
| ailments that occur as a result of poor lifestyle choices.
| dougmwne wrote:
| I have always heard that Truvada (prep) was extremely effective
| at preventing HIV infection. These new injectables are reported
| by the article to be 89% and 66% more effective at preventing
| transmission.
|
| What is this based on? Was I misinformed about Truvada's
| effectiveness? Is this a decrease in an already very low chance
| of transmission? Or is this in comparison to people forgetting to
| take their daily pills vs a shot that a health care provider had
| record of administering?
|
| It's currently common in the gay community for sexually active,
| healthy people to take Truvada proactively to protect against HIV
| because it's understood to be even more effective than condoms.
| If there is a better option or if the current option is not as
| effective as widely believed then standard of care should change.
| heavyset_go wrote:
| Compliance is a big issue, as is price. In the US, Truvada's
| retail price is about $2,000 for a 30 day supply. Truvada costs
| about $40 in other countries.
| taurath wrote:
| Compliance is a huge issue because health insurance will do a
| lot to make you jump through huge hoops to get it. I have had
| prescriptions "disappear" into the CVS "specialty pharmacy"
| and you have to wait on the phone for hours for them to
| "find" it.
| maxerickson wrote:
| I helped my mom deal with 2 specialty pharmacies for some
| Parkinson's drugs she was taking. The drugs weren't
| available from other pharmacies (that CVS runs one of the
| largest specialty pharmacies can make this confusing, but
| normal CVS probably don't stock it if the prescription goes
| to their specialty pharmacy).
|
| They present themselves as helping the patient navigate a
| complex drug, but in practice this just meant they had a
| bunch of questions to tick off each time you talked to
| them. Their outreach and phone tree were both pretty bad,
| clearly designed for high operator utilization and not
| customer service.
| cestith wrote:
| I don't have stats, but Biktarvy has been advertised for PReP
| lately. Descovy is approved by the FDA for such use. The shot
| is around the same price (at list anyway) as some of the other
| treatments, so if it's even equally effective the convenience
| might win.
| vsef wrote:
| Biktarvy doesn't make any sense for PrEP, Descovy is
| emtricitabine and tenofovir alafenamide, Biktarvy is
| emtricitabine and tenofovir alafenamide plus an integrase
| inhibitor which just adds possible additional side effects
| and isn't necessary.
| Grazester wrote:
| The article states,
|
| "...abotegravir - a component of Cabenuva - was 89% more
| effective in preventing infection among women than Truvada"
|
| That 89% when was compared to Truvada.
|
| Do healthcare workers actively take Prep or is it administered
| within the 72 hour period after exposure?
|
| Prep from what I understand can be hard on the body's organs
| and you will need to do a kidney function test every few months
| when on it
| vsef wrote:
| The side effects are of the type where a small group of users
| will experience changes in kidney function, and you have to
| check for it, but the vast majority won't. The side effect
| profile for most people is very low.
| blithedale wrote:
| Truvada is PREP. PRE exposure prophylaxis.
|
| PEP =/= PREP. PEP is after the fact treatment, there's more
| than just Truvada in that protocol.
|
| PEP is typically much harder on the body than PREP.
|
| Most every gay man I know takes PREP with few or no side
| effects.
| dougmwne wrote:
| Truvada is commonly taken proactively by sexually active
| people in high risk categories. It is true that it has side
| effects, so the risk of those needs to be balanced against
| the risk of HIV exposure.
| Grazester wrote:
| Yes I do know it is take by high risk sexually active
| people. But I was wondering about health workers themselves
| and in what health field exactly.
| daniel957 wrote:
| Logistics-wise, it's easier to get someone to come into the
| doctors for blood work every 3 months for testing (as required
| for prep) than once a month for a shot.
|
| However, from reading the article, I do think there's a
| convenience factor at play related to the struggles of taking
| pills daily.
|
| Note though, the article mentioned a trial of _women_ where
| truvada and one-shot prevention effectiveness were compared and
| the one-shot was deemed 89% more effective.
|
| A quick search explains _why_ this might be the case for women.
| Basically, it takes more truvada to get rid of the disease in
| vaginal and cervical tissue than it takes for rectal tissue.
|
| Source: https://www.uspharmacist.com/article/why-do-women-need-
| highe...
|
| Also, doctors have been recommending a different drug, Descovy,
| for prep instead of Truvada. This isn't due to effectiveness
| but side effects I believe. I guess if one experienced side
| effects though, they would be less likely to continue taking
| the medicine.
| damnyou wrote:
| I'm not sure about this one but subcutaneous and
| intramuscular injectables are pretty easy to self-administer.
| I self-inject once a week myself.
|
| https://www.poz.com/drug/cabenuva seems to suggest it is
| intramuscular (administered in the buttocks, which is not
| hard to do by oneself) but requires a healthcare provider.
| Not sure why, there might be storage requirements and such.
| daniel957 wrote:
| I think people would rather prefer to take a pill than give
| themselves an injection. It doesn't matter if it's "easy"
| or not. There's the "ick" or "ahhh needle" or "breaking
| skin" factor at play.
|
| Even if you self-inject and find it easy, I'm sure you're
| not saying it's easier and less of a hassle than taking a
| pill lmao.
| damnyou wrote:
| It is in fact much easier and less of a hassle (for me)
| than taking a pill everyday, which is what I used to do
| before I switched to injectables.
|
| Injectables seemed scary right until the moment when I
| started taking them, after which they became a normal
| part of my life.
| daniel957 wrote:
| In what way is it easier besides you saying that it's
| easier? You have a hard time swallowing pills I guess? Or
| do you remember to take injections more because they
| stand out more in your mind than pills do?
|
| EDIT: Not sure why this is getting downvoted. Since when
| on HN is it acceptable for someone to say "I think this
| way so it must be a fact" without providing an
| explanation? Even when it comes to subjectivity, there's
| an expectation that people share why they believe in
| their opinion, right?
|
| I swear I dislike this site and the people who use it
| more and more every week.
| damnyou wrote:
| I'm pretty sure that "easier" is a subjective
| determination. But no, I don't have a hard time
| swallowing pills. It's just that doing something once a
| week is easier than having to remember to do something
| everyday. The injections are also more effective for me,
| as they are here. And finally there's an aesthetic aspect
| to plunging a needle into one's muscle that I appreciate.
| daniel957 wrote:
| Yes, it's subjective to some extent, hence why I asked in
| what way is it easier beside you just saying that it is?
| I left out "to you" but I thought the HN community was a
| bit smarter than that. Even if you had said "it's easier
| to me. Full stop," I still would have written the same
| reply...
|
| All you said was "it's easier" in your original point.
| You obviously felt the need to clarify yourself in your
| most recent comment. So clearly your first comment was
| lacking information. There was no reason to downvote me
| just because you felt my original comment made you look
| stupid.
|
| FWIW, even though "easy" is subjective, there's still a
| consensus to be considered. For example, finding piercing
| your skin with a needle to be an asthetically-pleasing
| act does not fit that consensus...
|
| Something that _does_ fit the consensus is that taking a
| pill every day is a hassle.
|
| Stop being facetious just to prove a point.
| damnyou wrote:
| I did not downvote you, for the record. I thought your
| questions were useful and I hope I answered them to the
| best of my ability.
|
| This pandemic has been hard on all of us. Take care.
| [deleted]
| daniel957 wrote:
| He edited his comment to say "(for me)" after I had
| replied.
| stickfigure wrote:
| Depo-Provera (monthly injected contraceptive) is used by
| over 2 million women in the US.
| daniel957 wrote:
| Ok... and 10.6 million use birth control pills according
| to the CDC.
|
| Also, just because something appears convenient doesn't
| mean that it actually is.
|
| Have you looked up how many women use one of those
| invasive contraceptive implants?
|
| Technically, a woman only has to get a new implant once
| every 4 years+. But have you not read the horror stories
| about the implants becoming dislodged and causing
| internal bleeding and severe damage?
| gizmo686 wrote:
| It is a decrease in already low transmission. For ethical
| reasons, the placebo group is not no treatment, but rather
| current standard of care.
|
| I had to do some digging to find any source on the
| effectiveness on preventing transmission (the recent FDA
| approval is for post infection treatment).
|
| The study I found is [0]. In a double blinded study of 4,600
| participants, half were given the cabotegravir injection, and
| half were given the daily oral treatment. The study notes a
| "high level of adherence to oral therapy"; however, the actual
| numbers on adherence are:
|
| > Adherence to oral FTC/TDF was high, based on a random subset
| sampling that detected tenofovir (> 0.31 ng/ml) in 87% of all
| samples tested.
|
| I'm not qualified to say if this actually indicates 87%
| adherence, or if a fully compliant patient may get a negative
| result on that test.
|
| The result of this study was that 50 particpants got HIV, of
| which 12 were on the injectable and 38 were on the oral.
|
| By my calculation, this gives a relative effectiveness of
| (38-13)/38 = 68.4%, although the paper reports 69%.
|
| [0] https://viivhealthcare.com/en-us/us-news/us-
| articles/2020/gl...
| dougmwne wrote:
| This is awesome, thank you! The likelihood of pill compliance
| does seem to be probably higher than normal since everyone
| had 2 month follow-up appointments for injections, plus
| presumably they knew they were being blood tested. This looks
| like a game changer for HIV prevention. 6 shots a year and
| you can have better protection than any other known method.
| To me it looks like this is something that should be rapidly
| adopted.
| erosenbe0 wrote:
| Cabotegravir is somewhat novel -- not a recompounding of
| current therapy with different pharmacokinetics.
|
| Americans aren't going to develop an efficient approach that
| is not highly encumbered because the FDA stacks the deck
| against approval of efficient solutions in favor of whatever
| makes the most total profit. So you'll see that sort of thing
| approved overseas and we'll get it (or not) in a decade or
| maybe never.
| Blikkentrekker wrote:
| > _It is a decrease in already low transmission. For ethical
| reasons, the placebo group is not no treatment, but rather
| current standard of care._
|
| I see nothing wrong with sacrificing a few men, who consent
| and sign up and know the risk, for the far larger majority.
|
| If better drugs can be developed that would serve millions by
| sacrificing a hundred consenting subjects that know they run
| this risk, that seems like an overall benefit to me.
|
| It seems rather irrational to not be willing to do this. --
| _It is fine if men die, so long as their blood not be on my
| hands directly, but only indirectly._
| apendleton wrote:
| Yikes. There's absolutely no reason to do this. You get
| equally useful results by comparing to current standard of
| care, and that's the thing you ultimately need to measure
| for approval of a treatment for which existing treatments
| exist anyway (the FDA wouldn't approve a drug that's better
| than nothing but markedly worse than the current standard
| of care, so that's the benchmark).
| Blikkentrekker wrote:
| Then why isn't it done as such in all instances?
|
| It seems that whenever a perfect placebo be permissible,
| that is what is being used rather than the current
| standard of care.
|
| Soldiers can be sent to their death for oil and other
| resources that benefit the larger majority? but this is
| "yikes"?, not a phrase I find to occur in conjunction
| with rational decisions often.
| apendleton wrote:
| > Then why isn't it done as such in all instances?
|
| It is. Control groups are no-treatment if no approved
| treatment exists, or current standard of care if there's
| an approved treatment. That's standard practice.
|
| > It seems that whenever a perfect placebo be
| permissible, that is what is being used rather than the
| current standard of care.
|
| If by "perfect placebo," you mean "no treatment," that's
| not correct, and is considered unethical.
| Blikkentrekker wrote:
| > _It is. Control groups are no-treatment if no approved
| treatment exists, or current standard of care if there 's
| an approved treatment. That's standard practice._
|
| I've read plenty of pharmaceutical trials where the
| control was a plain placebo, not the current standard of
| care, when it not involve a life threatening illness.
|
| https://clinicaltrials.gov/ct2/show/NCT00061802
|
| Clearly this antipsychotics trial does not evaluate the
| drug 's effectiveness against the current standard of
| care's, but against a placebo's.
|
| > _If by "perfect placebo," you mean "no treatment,"
| that's not correct, and is considered unethical._
|
| I mean giving them a drug that lacks an active ingredient
| but is otherwise not to the lay eye discriminatable from
| an effective drug.
|
| And that is very much what is done in the case of the
| antipsychotics medicine I showed. So it's only unethical
| when human lives be at stake, apparently.
| whimsicalism wrote:
| > Was I misinformed about Truvada's effectiveness?
|
| No, effectively used Truvada works very well.
|
| > Or is this in comparison to people forgetting to take their
| daily pills vs a shot that a health care provider had record of
| administering?
|
| Probably almost certainly yes or it's just a small improvement
| at the margin.
| perardi wrote:
| As someone who is in this high-risk community: good news.
|
| _(Well, except for that price tag.)_
|
| People, to a first approximation, are just terrible at pill
| compliance. Doesn't matter the demographics, people just aren't
| perfect at taking a pill, every day, at the same time, forever
| and ever. Having that injection where you can set it and forget
| it? Nice advance. Not game-changing, but still a nice move
| forward.
|
| And I think it'll be a bigger move forward for people who are at
| high risk of HIV, but also have not great access to medical care
| where they live. If you...oh boy, here I go, potentially getting
| into trouble. Non-white and/or non-affluent communities tend to
| come down much harder on homosexuality. It is much more discreet
| to get a periodic shot than heading to Walgreen's and bringing
| home a bottle full of blue pills. It's safer. It's a bit more
| private.
| tyingq wrote:
| It's a shame that PrEP is still so expensive.
| perardi wrote:
| It's frustrating that it's so expensive for the most at-risk
| communities in the US.
|
| Because you can totally work the systems to get it
| affordably. Besides insurance, there are clinics, there are
| coupons, there are programs...but you have to have the
| information literacy and the time to figure out how to jump
| through all those hoops.
|
| Me, I work remotely, I have insurance, I live on the north
| side of Chicago, I can get my Truvada easily. You live on the
| west side of Chicago with no Howard Brown nearby, and you
| work a service sector job where your hours are
| algorithmically doled out to you? Far, far harder.
| monopoledance wrote:
| I think, same as with vaccinations, this clearly highlights
| how all of society really benefits from universal health
| care. In fact, why isn't preventable infectious disease
| talked more about in that debate? Pretty obvious, no?
| [deleted]
| SargeZT wrote:
| It is expensive, but it is accessible. Truvada for PrEP has a
| program both for insured patients that covers co-pays up to
| $7,200 per year (I pay zero dollars a year because of this),
| and a medication assistance program for uninsured patients
| where after signing up and meeting eligibility requirements
| (which are basically 'are you at risk of getting HIV' and
| 'are you not wealthy to the point where you should definitely
| be able to afford insurance') you receive the medication at
| zero cost.
|
| This is true of many medications, but Truvada is especially
| famous for it. As a gay man I have a lot of friends on it,
| and because of the aforementioned program, only two of the
| thirty+ pay any co-pay at all, and it's something like 20
| bucks for them.
| monopoledance wrote:
| After long, long pressure from activists, PrEP is now covered
| by insurance in Europe (at least Germany). Same as the
| accompanying monthly(?) bloodwork for potential side effects
| (liver damage?), of course.
| afrojack123 wrote:
| Subscription based healthcare. lol
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