[HN Gopher] Meet the Anarchists Making Their Own Medicine (2018)
___________________________________________________________________
Meet the Anarchists Making Their Own Medicine (2018)
Author : mvanaltvorst
Score : 81 points
Date : 2022-01-05 10:44 UTC (12 hours ago)
(HTM) web link (www.vice.com)
(TXT) w3m dump (www.vice.com)
| nynx wrote:
| I hope we can eventually have self-contained machines that can
| synthesize many different types of medications. By certifying the
| machines or testing them thoroughly, you can lessen the worry
| that people will synthesize the drugs wrong.
|
| I think this is almost possible for a large range of simple,
| small-molecule drugs.
| aijeq wrote:
| The point of this exercise is that the regulatory capture
| effectively prevents life saving treatments from reaching the
| people who need them.
|
| For example, better quality insulin is far more expensive
| because there's tremendous capture not only in the insulin
| market but the bioreactors required to make the insulin from
| bacteria. The process isn't insanely complicated, chemistry-
| wise, but the fact that only a few can make it and its MUCH
| better means they can charge more.
|
| Another example is one-off drugs for rare but potentially
| curable conditions. They are often so expensive that they're
| pulled from the market because 1% of 1% of the population needs
| them and you can't use that to drive revenue.
|
| 3D printing took off precisely because of the LACK of
| regulatory capture. Imagine you had an FDA synthesizer that
| could make something common and simple like blood pressure
| medication for fractional cents on the dollar. You wouldn't be
| able to find the plans for this like you could for a 3D printed
| gun, for example, because the technology requires actual
| expertise to use. So you'd likely be left buying it from some
| biotech firm who will happily charge a price equivalent to a
| lifetime supply of all the drugs it can produce. You once again
| reach the affordability problem. Not because the technology is
| that far out of reach or so esoteric, but to be able to even
| get the device into the people's homes who need it you would
| need to find centuries of deeply entrenched and well
| capitalized special interests. Pharma would rather you die from
| something preventable than leave a single penny uncollected.
| Normally this would be considered hyperbole but in this case
| it's absolutely, verifiably true.
|
| You can be certain if any DIY "3d molecule printer" ever took
| off there would be heavily armed alphabet soup boys at the DEA
| ready to kill whoever to keep the interests of big pharma in
| power.
| tehjoker wrote:
| This is pretty interesting, but skimming the article I didn't see
| any mention of lab testing the purity and quantity of drugs
| produced. There's a lot of fiery talk but how do we know that the
| results are usable?
| netizen-936824 wrote:
| This is a very important step in the production of medications.
| We need to know that nothing went wrong with the synthesis and
| we aren't ingesting toxic and potentially fatal byproducts.
| Dosage can also be wrong if measuring an impure compound.
| Xenoamorphous wrote:
| Due to the pandemic I've often thought about what the ideal model
| for vaccines and other drugs would be. I understand that there's
| enormous costs for pharma companies to bring a new drug to the
| market, and I guess a lot of new drug prospects end up not going
| anywhere, but it's hard to swallow that there's drugs out there
| that are cheap to manufacture and are life saving (or life
| changing) for people that need them yet some/many of them can't
| afford them.
|
| What's the best way to fix this? Direct government funding?
| Indirect one via subsidising the drugs for those who need it? Im
| 2OEH8eoCRo0 wrote:
| > After a few minutes of gloating about pharma bro Martin Shkreli
| "rotting at Fort Dix" for raising the price of Daraprim, a
| lifesaving HIV medicine, from $13 to $750, Laufer grew serious.
| "It's been two years, but despite everything that's happened, the
| price of Daraprim hasn't changed," he said.
|
| Shkreli went to jail for securities fraud- not raising the price
| of a drug. I think Shkreli was a convenient scapegoat for the
| pharmaceutical industry though. All the time and energy people
| spent angry at Shkreli was time spent not directing their anger
| at the industry that allowed it.
| trhway wrote:
| while all that drama on the surface, the industry had coopted
| government's War on Drugs and pushed opiates (great thing when
| used as needed) into the opioid epidemics, and now they coopted
| government's War on Covid and has been pushing billions of
| doses of the vaccines (great thing when it works) which clearly
| fail to control the spread (and thus these vaccines have only
| limited use, i.e. only for the people who really need it (like
| high risk groups, etc.) - the situation pretty similar to
| opioids. And if one looks at those 3rd, 4th, ... boosters -
| sales tactic wise it looks eerily similar to the jacking up the
| "12hr" opioid dose approach as it simultaneously increases
| sales and creates addiction). I wonder if several years down
| the road we'll see vaccine trials/settlements similar to the
| opioids ones.
| jjoonathan wrote:
| Pro-opiate _and_ anti-vax? Niiiice!
| kragen wrote:
| I'd like to be able to discuss ideas on their merits
| instead of being confronted with factional applause lights
| like "anti-vax".
| jjoonathan wrote:
| Arguments like "clearly fail to control the spread" are
| low effort Gish Gallops that need to be treated as such.
|
| Publicly slugging it out in the weeds grants an optical
| stalemate to an argument that deserves to lose. Do this a
| million times in a row and you can launch an entire
| contrarian movement off vapors -- which is exactly what
| we have seen.
| hhpindia wrote:
| snakeboy wrote:
| Seems like they're pretty different cases, given how life-
| destroying opioid addiction is.
|
| Pushing vaccines is mostly just profiting by adding another
| layer of bureaucracy and annoyance into daily life.
|
| I'm not really more angry at pfizer than I am Booz Allen for
| wasting however many billions of my tax dollars.
| trhway wrote:
| >Seems like they're pretty different cases, given how life-
| destroying opioid addiction is.
|
| Pfizer/Booz Allen waste of billions of tax dollars do come
| with resulting indirect damage to people health and lives
| who could have been helped otherwise. And for direct damage
| - I think jury is still out on that one. For example, in UK
| according to the link they already count 0.3M of heart
| issues which they officially pinned on pandemic stress
|
| https://www.standard.co.uk/news/health/post-pandemic-
| stress-...
|
| with more expected to come:
|
| "Mark Rayner, a former senior NHS psychological therapist
| and founder of EASE Wellbeing CIC, said that as many as
| three million people in Britain are already suffering from
| PPSD, thanks to stress and anxiety caused by the effects of
| Covid-19.
|
| He fears this could result in a dramatic rise in physical
| health issues, such as coronary heart failure, if cases are
| not detected or treated early."
|
| Pinning on pandemic stress means they couldn't pin it on
| covid - either it is non-infected people or timing isn't
| correlated enough. Now, simple politically correct choice -
| stress or mRNA vaccines known for causing heart issues?
| GuB-42 wrote:
| I remember a few years ago, someone made a suggestion, that,
| because a lot of these overpriced drugs are paid by insurance
| companies.
|
| So why don't insurance companies contract an independent lab to
| make their own medicine instead of paying ridiculously high
| prices for out-of-patent medicine? Of course, it would be a
| proper lab, with certifications and quality control, not some
| guy's basement, so it would be expensive, but on the other hand,
| the alternative is also way too expensive.
| mrxd wrote:
| > "If you're going to die and you're being denied the medicine
| that can save you, would you rather break the law and live, or be
| a good upstanding citizen and a corpse?"
|
| It's obviously better to risk using DIY medicine than to die, and
| it sounds appealing--mutual aid, neighbors helping neighbors,
| saving lives with free medicine! But framing it this way
| significantly misrepresents the issue of for-profit medicine.
|
| People mostly aren't dying because they can't afford life-saving
| medicine. They are selling their homes, emptying retirement
| accounts and their kids college funds, going into debt and going
| bankrupt to pay for life-saving medicine.
|
| These guys have given people a new option. You don't have to go
| into debt--you could instead choose DIY medicines of dubious
| quality that could have costly medical consequences for you.
|
| This isn't quite as appealing. It isn't some radical, utopian
| alternative. It's just how the system works today for poor people
| in so many areas of life: education, housing, food, medical care,
| etc. The rich can afford quality, while the poor have to make
| hard trade-offs and take risks to stretch their dollars.
| pessimizer wrote:
| > People mostly aren't dying because they can't afford life-
| saving medicine.
|
| No, people are definitely dying because they can't afford
| medicine. They're not taking things they need, they're cutting
| pills in half, they're diluting injections. When they finally
| die from some acute episode, what got them there is never
| recorded.
|
| The amount of bullshit I have gone through to get albuterol
| inhalers (which cost $5 in civilized countries, but used to
| cost $20 in the US until a consortium of pharma lobbyists
| churned the patent and got the price up to $80.) I've met
| people in parking lots to buy out of date medicine in a
| crumpled brown paper bag. I guarantee that more than one person
| dies from this every single day, and none of them are recorded
| any differently than any other asthma death. Not being able to
| obtain this absurdly cheap to produce medicine that has been
| available for half a century has put me into intensive care for
| a week, causing years of medical debt when I was young. I
| wouldn't have been there if I hadn't been trying to manage
| without an inhaler.
|
| Daraprim and emergency epinephrine seem like the same type of
| thing. To be honest, though, I prefer to _Meet the Criminals
| Smuggling Their Own Medicine._ For Albuterol, ordering inhalers
| from India was the real answer.
| kragen wrote:
| It's also worth mentioning that albuterol and similar
| inhalers used to be an exception to the prohibitions on CFCs
| (these inhalers an't used in large enough volume to do
| significant ozone damage), but due to lobbying from the
| companies that made them, they no longer are.
|
| Why would a company lobby to outlaw its current product?
| Well, they had patents on "improved" CFC-free versions,
| allowing them to exclude new entrants from the market.
| chillingeffect wrote:
| That's what I call Metacapitalism.
| kragen wrote:
| What if the DIY medicines _weren 't_ of dubious quality? What
| if they were higher quality than the ones that cost US$750 a
| dose? What if everyone had an analysis machine that could
| analyze the medicines, DIY or not, to find out what was in
| them, and the DIY stuff turned out to be purer and more
| precisely dosed? That's what happened with Linux versus, say,
| Solaris and Microsoft Windows, and it's what's happening now
| with programmable insulin pumps.
|
| Also, medical consequences have to get pretty costly before
| they're more costly than selling your home and emptying your
| retirement account and your kids' college funds.
| mrxd wrote:
| 92% of contributors to the Linux kernel are paid by
| companies: https://www.suse.com/suse-
| defines/definition/linux-contribut...
|
| Most major OSS projects are controlled by a few companies who
| pay developers to work on them. They're more like industry
| consortiums than DIY anarchist collectives.
| kragen wrote:
| Something can be _both_ an industry consortium _and_ a DIY
| anarchist collective, like Linux; the Linux Foundation isn
| 't Linux. It turns out that industrial companies don't
| appreciate being subject to monopoly rents any more than
| private individuals do! The GPL is undeniably very
| anarchist, and it serves as a kind of constitution that
| keeps the companies that participate in GPL projects from
| controlling them. Consider, for example, Oracle and
| LibreOffice, MariaDB, and Jenkins, or GitHub (now
| Microsoft) and Git.
|
| The solution isn't to destroy capitalism or exclude
| industrial companies from participation. We tried that a
| century ago. It went badly, because, as it turns out,
| capitalism is better at limiting the damage done by
| ambitious psychopaths than the alternative systems are; if
| Beria had been born in Ohio maybe he would have ended up
| running a soap company or a division of GE instead of mass-
| murdering dissidents.
|
| Similarly, the GPL (and, to a lesser extent, non-copyleft
| open-source licensing) reduces the damage selfish companies
| can do to software projects and the people and companies
| that depend on them.
|
| We need to figure out how to do the same thing to drug
| companies and the FDA, because they are just killing far
| too many people and causing far too much needless suffering
| today.
| nwiswell wrote:
| > What if everyone had an analysis machine that could analyze
| the medicines, DIY or not, to find out what was in them
|
| I can fairly confidently predict this will not happen like it
| did for software. Chemical analysis has been around a long
| time and remains difficult for experts to do accurately
| without context, let alone for a layman. Gas chromatography,
| for example, requires large and expensive machinery and some
| idea of what the substance is composed of in order to
| determine the concentration of analytes.
|
| Reagent testing is cheap, simple, and straightforward, but it
| is generally only capable of detecting whether or not some
| class of substances are present above a particular
| concentration. You cannot use reagent testing to determine
| "how pure" a medicine is, let alone whether the impurities
| (which there will assuredly be) are potentially harmful.
|
| As is currently the case for illicit drugs, I imagine there
| will be an ecosystem to verify that A) the active ingredient
| is actually present and B) some limited range of problem
| impurities are not present, but that is a much less stringent
| form of quality control than pharmaceutical companies
| perform.
| kragen wrote:
| Clearly making it happen will require a revolution in
| manufacturing, which may or may not already be underway,
| but making it happen for software required decades of
| continuous revolution in semiconductors and
| telecommunications.
|
| Some kinds of analysis machinery, like GC, ICP, and DSC or
| DTA, are probably inherently fairly large; other kinds,
| like FT-IR, other kinds of spectrometry, TLC, HPLC, other
| kinds of liquid chromatography, XRF, XRD, and NMR, can be
| miniaturized and mass-produced. There hasn't been much
| pressure to do this because bio and chem labs don't care if
| their spectrophotometer costs US$0.12 or US$12000 or
| whether it weighs 100 mg or 100 kg; they need one to get
| their work done, they don't need it to be portable, and
| they aren't going to lose it because it stays in the lab.
| But that doesn't mean it can't be done. Even Victorian-era-
| style reagent testing can be made quantitative in some
| cases!
| nwiswell wrote:
| > Some kinds of analysis machinery, like GC, ICP, and DSC
| or DTA, are probably inherently fairly large; other
| kinds, like FT-IR, other kinds of spectrometry, TLC,
| HPLC, other kinds of liquid chromatography, XRF, XRD, and
| NMR, can be miniaturized and mass-produced
|
| Many of the types of analysis listed here are elemental
| analysis only, which are useless for trying to identify
| pharmaceutical analytes or determine their concentration.
|
| Out of all of these, microfluidic liquid chromatography
| is the least science fiction. There's plenty of
| literature about it but nobody really "has it working",
| and the reality is that it's not likely to ever have the
| same capability as benchtop HPLC.
| dekhn wrote:
| Miniaturized NMR? can you explain how that would work?
| kragen wrote:
| Benchtop NMR spectrometers already exist (for decades
| now), and some are already cryogen-free, permitting room-
| temperature measurements, eliminating the dewar and
| cryogens which account for a lot of the mass and volume
| of traditional NMR spectrometers. We now have room-
| temperature superconductors, which might work to
| eliminate the bulky, heavy permanent magnets in current
| benchtop devices, though the pressures required may turn
| out to be impractical. Beyond that I can handwave at
| improved electronics and SQUIDs, but I don't really know.
|
| Do you think there are some fundamental obstacles to
| miniaturizing NMR, and if so, what?
| fabian2k wrote:
| Benchtops are at 60-90 MHz field strengths. That is
| barely enough to look at more complex molecules, the
| bigger routine NMR spectrometers are at 400-600 MHz (and
| there are even larger ones, but those are not used for
| small molecules that much). And even then those benchtops
| cost something close to 100k USD, that's quite far from
| affordable.
|
| The "room temperature" superconductors are not used at
| room temperature in these cases, they're still cooled
| down. And so far the only spectrometer I know of where
| they are used is the still extremely new 1.2 GHz Bruker.
| And that one is almost certainly somewhere between 10 and
| 20 million USD. The new superconductors are low
| temperature superconductors, not room temperature. And
| even then they still work better at lower temperatures.
| At best you can remove the liquid helium from the system
| and use liquid nitrogen only, which is an advantage but
| still really far from room temperature.
| dekhn wrote:
| benchtop NMR doesn't solve this problem, it's not
| powerful enough.
|
| If you had improvements to NMR they would actually go
| first to other things than doing chemical analysis of
| anarchist drug batches. IE there are other industries
| that will buy all your machines if they existed.
|
| The real question is why would you EVER use NMR for just
| about anything? It's really high cost and the total value
| of the data is lower than just about any other technique.
| It really only makes sense in research situations.
| philipkglass wrote:
| They use rare earth permanent magnets and don't offer the
| resolution of superconducting magnet NMR, but they are
| much smaller and cheaper (tens of thousands of dollars,
| new) than superconducting units or the even older
| resistive magnet NMR units. The first one I saw was from
| picoSpin, which has since been acquired by Thermo Fisher
| Scientific. I think that there are multiple vendors now.
| Here's a current picoSpin unit:
|
| https://www.thermofisher.com/order/catalog/product/912A09
| 13
| dekhn wrote:
| An 80MHz desktop NMR in 2022 is hilarious. This owuld be
| great to put in a research lab or to teach students, but
| it's not something that could be used in a high volume,
| high quality pharma testing situation.
|
| (my phd in nmr is from 20 years ago... even then it was
| hard to justify the expense of nmr machines in structural
| biology...)
| notch656a wrote:
| I'm not arguing with what you're saying, but GC/MS can be
| bought for like $100 a sample and it's conceivable a system
| can be invented where private auditors audit the output of
| an unregulated pharmaceutical manufacturer in such a way
| that the QC assurances to the consumer are as good or
| better as in our current system, with much lower regulatory
| costs.
| nwiswell wrote:
| In the limit what you are describing is a generic
| drugmaker.
|
| It's certainly possible to audit drug quality by sending
| it to labs, and people do that for darknet drugs all the
| time, but there are still problems:
|
| 1) There is no way to use ex-post analysis alone to
| achieve the kind of QA that pharmaceutical companies do;
| they have visibility into the entire manufacturing
| process and process control. Put another way, a sample of
| a drug cannot be used to verify that the process used to
| manufacture it is safe.
|
| 2) There is no assurance that anything you get in the
| future is made with the same process.
|
| The only way I see this working, honestly, is for a rogue
| jurisdiction to offer safe harbor to "generic pirates".
| The rogue jurisdiction would offer legitimate regulatory
| oversight in exchange for tax revenue, and the drugs
| would be smuggled out of the jurisdiction for sale. To
| some extent this is already the case in grey markets
| where brand name drugs which are sold for less in other
| countries get arbitraged/smuggled back to high-cost
| markets.
| notch656a wrote:
| I think we are seeing the same thing, a system designed
| to remove corruption/regulatory capture/lobbying as far
| as possible from the process. I'm seeing a "rogue"
| auditor that performs the same service, while you are
| seeing a rogue government. If the outcome is the same, I
| am fine with either. Your pointed weakness regarding
| auditing the manufacturing process could be incorporated
| into either.
| nwiswell wrote:
| > I think we are seeing the same thing, a system designed
| to remove corruption/regulatory capture/lobbying as far
| as possible from the process
|
| Not really. It's more like a system to selectively remove
| intellectual property rights without destroying the
| financial incentive to develop drugs.
| notch656a wrote:
| Oh. So you don't want a system that removes corruption,
| regulatory capture, and lobbying as far as possible? I
| don't want to destroy the financial incentive either, I
| think it's great people that bring wanted goods to market
| profit from it.
|
| IP is an interesting point, although I'm not convinced
| that generating the IP is more than a small fraction of
| the cost of a drug. An aggregate I saw from 2011-2018
| puts Research at only 17% of revenue, and only some
| proportion of that is geared towards generating IP. That
| is to say, with all else removed you could generate an IP
| only company for 17% the cost of drug sales.
| LiquidSky wrote:
| >it's conceivable a system can be invented where private
| auditors audit the output of an unregulated
| pharmaceutical manufacturer in such a way that the QC
| assurances to the consumer are as good or better as in
| our current system, with much lower regulatory costs.
|
| No, it's not. This is ideological libertarian nonsense.
| There's a reason pharma came to be regulated in the first
| place. All this will lead to are more injuries and death
| of consumers.
| [deleted]
| notch656a wrote:
| >No, it's not. This is ideological libertarian nonsense.
|
| If I could flag your post, I would. This is purely
| political nonsense and a god-like attempt to disprove
| something through fiat.
| rootusrootus wrote:
| Heck, even the FDA can't guarantee all generics are
| equivalent to the branded version (some anticonvulsants
| come to mind). Might be a while before this ability comes
| to the masses.
| LiquidSky wrote:
| >What if everyone had an analysis machine that could analyze
| the medicines
|
| Because, as a post below notes, this is a pure fantasy. At
| this point you're proposing actual magic.
|
| >Linux versus, say, Solaris and Microsoft Windows
|
| Your choice of operating system isn't going to severely harm
| or kill you. "Move fast and break things" is a problem when
| the "things" are people.
|
| >medical consequences have to get pretty costly before
| they're more costly than selling your home and emptying your
| retirement account and your kids' college funds.
|
| Welcome to the reality of healthcare in the US for the
| uninsured (and often times for the poorly-insured).
| notch656a wrote:
| Meh it's the classic black market vs white market debate,
| where here the white market is a huge oligopoly with insane
| markups to pay off lobbyists / regulator / advertisers /
| the rich people who own the pharma companies. Sometimes the
| black market is even more expensive but in DIY it often
| isn't.
|
| If it were me I'd just make it all in one go, hopefully
| enough to be set for life, huge pile of it whatever drug I
| need to stay alive. Create a homogeneous mixture, GC/MS the
| mixture for purity and then package it for long term
| storage.
| LiquidSky wrote:
| >Meh it's the classic black market vs white market
| debate,
|
| No, it's classic libertarian fantasy bullshit. Medicines
| aren't toys, and we know exactly what happens when
| they're unregulated.
| notch656a wrote:
| I wasn't aware that analytical instruments could measure
| your economic or political ideology.
| hammock wrote:
| Affordability is not the only reason people are being denied
| medicine. Many people have wanted, e.g. ivermectin, monoclonal
| antibodies, etc; and even gone to court to fight to get them,
| not because of the cost but because doctors, pharmacies and/or
| government bodies refuse to provide.
| elchief wrote:
| this will be useful in 20 years when society has collapsed, but
| you want to survive
| petermcneeley wrote:
| Not an Anachist but I wonder how much of the danger here is due
| to the law. Ideally they would simply be selling the epipencils
| and doing testing etc but there is no way they would be able to
| do this. So instead the best they can do is create DIY kits.
|
| I wonder how far they can legally push the DIY kit. Can they ship
| you supplies with the kit? Can they ship you expresso-like packs
| for your DIY machine?
| mastazi wrote:
| This reminds me of vaping in Australia: since vaping liquids
| containing nicotine are illegal, people make their own liquid
| by mixing nicotine-free vaping liquids (which are legal) with
| nicotine extracted from products such as Nicorette (which are
| also legal) - unfortunately some just go back to cigarettes
| rather than going through all that trouble.
|
| Luckily, I didn't go back to the stinkies - I never smoked
| again (I also quit vaping after a while, quitting vaping is not
| hard because it's not nearly as addictive as ciggies are).
| trutannus wrote:
| My first thought was how dangerous this is. Then after thinking
| some more, I was left questioning how a developed country can
| mess up so badly that some people feel this is their only option.
| hirundo wrote:
| > I was left questioning how a developed country can mess up so
| badly that some people feel this is their only option.
|
| Regulatory capture.
| trutannus wrote:
| That and market failure.
| dgb23 wrote:
| I'm not sure if life saving medicine should or even can be
| understood through economic equilibrium. This is ultimately
| a question of ethics, politics and sheer survival. This
| isn't a market in the first place and it doesn't help that
| we pretend it is.
| netizen-936824 wrote:
| If you send your compounds off for proper testing it shouldn't
| be that dangerous, but that will increase the cost a few 100%
| most likely
|
| Testing usually doesn't come cheap, but you also might be able
| to drop by a well equipped Chem department at a university for
| testing as well
| tablespoon wrote:
| > If you send your compounds off for proper testing it
| shouldn't be that dangerous, but that will increase the cost
| a few 100% most likely
|
| > Testing usually doesn't come cheap, but you also might be
| able to drop by a well equipped Chem department at a
| university for testing as well
|
| I don't think it's that easy. Even if you successfully
| synthesize the right chemical, you also have to get dosage
| and delivery right (consistently!).
|
| From the OP:
|
| > In response, Four Thieves published the instructions for a
| DIY epipen online that can be made for $30 in off-the-shelf
| parts and reloaded for $3.
|
| If I had to depend on an epipen to save my life, I don't
| think I'd want a DIY version that may not work when I need it
| (e.g. mechanism fails, storage stability issues, dosage
| issues, etc.). Sure I guess it's better than nothing, but
| it's also proof this clearly isn't the solution to the $600
| epipen problem.
|
| > Shkreli drove the price of the lifesaving HIV medicine
| Daraprim sells up to $750 per pill. So Four Thieves developed
| an open source portable chemistry lab that allows anyone to
| manufacture their own Daraprim for just 25 cents apiece.
|
| The article calls Daraprim and "HIV medicine" throughout, but
| isn't that misleading? I thought it was an anti-parasitic
| (that may be used by HIV patients to treat secondary
| infections).
| wizzwizz4 wrote:
| > _If I had to depend on an epipen to save my life, I don
| 't think I'd want a DIY version that may not work when I
| need it. Sure I guess it's better than nothing, but it's
| also proof this clearly isn't the solution to the $600
| epipen problem._
|
| DIY versions are normally more expensive than mass-produced
| equivalents. So either this DIY version has _atrocious_
| quality, or $600 is far too expensive. (Judging by the
| prices in normal countries, $600 is far too expensive!)
| tablespoon wrote:
| > DIY versions are normally more expensive than mass-
| produced equivalents. So either this DIY version has
| atrocious quality, or $600 is far too expensive. (Judging
| by the prices in normal countries, $600 is far too
| expensive!)
|
| Yeah, the answer is $600 is far too expensive.
|
| IMHO the answer is some kind of regulation (e.g. limiting
| the profit margin on generics or even drugs more
| generally), or some kind of boutique government-owned
| generic maker tasked with being a manufacturer of last
| resort and selling generics at _its cost_ (which should
| be higher than a non-price-gouging private company, so it
| works to put a price-ceiling on those companies and also
| acts as insurance against unavailability).
| ur-whale wrote:
| > IMHO the answer is some kind of regulation
|
| IMHO, the solution is actually _less_ regulation.
|
| If any company could enter that market with being sued
| into the ground, you'd get top notch a quality product
| for a fraction of the price before you could finish
| spelling epinephrine.
| tablespoon wrote:
| > IMHO, the solution is actually less regulation.
|
| > If any company could enter that market with being sued
| into the ground, you'd get top notch a quality product
| for a fraction of the price before you could finish
| spelling epinephrine.
|
| I doubt it. IIRC, EpiPens are off-patent, and the only
| thing holding back competition is the need to demonstrate
| the competing product is safe, reliable, and equivalent.
| I even believe a competitor product was withdrawn from
| the market because it was delivering an unreliable
| dosage.
|
| So if you remove the regulations, you'll probably get a
| flood of corner-cutting crap that's dangerous. That's
| likely especially true for an "emergency use" item like
| an EpiPen, which literally sits on a shelf unused unless
| there's an emergency (leaving a big opportunity to sell
| defective items undetected by consumers).
| wizzwizz4 wrote:
| The computer market is not particularly regulated, yet we
| still have international big tech monopolies stifling
| competition. I think the US simultaneously needs:
|
| * less regulation, to reduce barriers-to-entry
|
| * more regulation, to allow competition
|
| Normally, I'd be concerned about reduced regulations
| having safety implications, but the existing situation is
| _already_ unsafe.
| waterhouse wrote:
| Patents are a big part of how the stifling is done.
| Getting rid of them, or at least cutting their term by a
| factor of 3-4, would help a great deal.
| waterhouse wrote:
| Also, the article mentions an MIT professor's safety concerns,
| but, upon reflection, given the conditions some of these drugs
| are meant to treat, the error rate would have to be _very_ high
| to make it worse than no treatment.
| dekhn wrote:
| I know a bunch about pharma. The folks who are doing this and
| saying it's cheaper are often completely neglecting costs that
| are borne by corporations: the initial R&D, but also the immense
| amount of quality control and regulatory compliance.
|
| I've also talked to the biohackers. S ome of them are smart,
| careful, and just get stuff done in the lab. Then there are the
| attention hogs who inject themselves on youtube (typically with
| no ability to know if they did anything at all), many of whom,
| after a few years, realize that what they are doing is naive, and
| that there was actually a reason for the entire establishment
| around pharma.
| kragen wrote:
| R&D and quality control provides benefits to patients, and it
| is critically important to figure out how to reduce the cost of
| R&D and quality control so we can do a lot more of them. That's
| what Four Thieves Vinegar and other biohackers are doing.
|
| Regulatory compliance doesn't provide benefits to patients;
| it's a deadweight loss. As you are presumably aware, to a
| significant extent, the reason that regulatory compliance is so
| costly is that, being costly protects established drug
| companies from competition.
|
| Quality control and initial R&D have nothing to do with why Epi
| Pens, insulin, or Daraprim are absurdly overpriced in the US.
| That's purely monopoly rent extraction.
| dekhn wrote:
| Nothing I said above disagrees with the fact that many pharma
| are indeed doing what you call "monopoly rent extraction". I
| think all of those drugs are overpriced for non-economic
| reasons.
|
| Regulatory compliance, for example, with the FDA approval
| process, isn't a deadweight loss; it's a process that reduces
| the risk a dangerous drug will be given to the public. It's
| mostly costly due to incompetence and bureaucracy, not
| because pharma is evilly plotting to continue to be the only
| people who can get stuff through the FDA.
|
| If somebody comes up with magical ways to reduce the costs of
| R&D and QC in pharma, I'm all for it. Just be aware: I've
| worked around pharma for decades and it will only get more
| expensive to do any of this. Nobody is going to come in and
| magically disrupt the business with a new technology pharma
| didn't think of yet.
| kragen wrote:
| What reduces the risk that a drug will be dangerous is
| testing, quality control, replication, and transparency.
| Regulatory compliance is, at best, a means to those ends,
| not an end in itself. At worst, and far too often, it's a
| major obstacle to them.
|
| People don't have to be evilly plotting when their
| incentives are set up to empower only people who do evil
| things. Don't forget that, in the US, we're talking about
| the same regulatory regime that rejected magainin, hasn't
| brought a new class of antibiotics to market in half a
| century, has outlawed the flavored vape liquids that help
| people quit smoking, won't allow you to buy a blood sugar
| meter until _after_ you have diabetes, prohibited covid
| testing at the beginning of the pandemic, delayed covid
| vaccination until five or six months after China was doing
| mass vaccination, and routinely cuts off opiate addicts
| cold turkey. It 's a Kafkaesque farce, as you know very
| well, and quite possibly the primary cause of death in the
| US today.
| dekhn wrote:
| So, uh, how are we going to ensure that all that testing,
| QC, and transparency occurs... without some sort of
| regulatory agency that enforces it? and that agency woudl
| use compliance (submit this and that form and follow this
| and that process)... so it would seem that they act as
| proxies for the value of the things you listed.
| petermcneeley wrote:
| There is a really simple number that tells you what the costs
| of a company are vs its prices to users. Its called profit. So
| are the pharama companies profitable?
| dekhn wrote:
| Yes, most large pharma are very profitable (it's one of the
| most profitable sectors). As we liked to joke, Roche isn't so
| much a pharma company as it is a wealthy family that invests
| in pharma because it's so profitable (until recently there
| was a very interest structure of family cross-ownership of
| all the Basel-based pharma firms that was set up for or less
| for MAD purposes).
| notch656a wrote:
| Those costs aren't all borne by corporations, just the profits.
| The cost is the cost of public schooling of the children that
| invent these things, the invention and development of internet
| partially funded by DARPA that allows quickly conveying
| scientific information these companies use, the millinia of
| scientific research that precedes the invention.
|
| The corporation then benefits from regulatory capture, and
| insanely high regulatory barriers to lock away less capitalized
| competitors from introducing their own unique drugs. Those who
| can afford the insane regulatory costs then can squeeze
| consumers dry.
|
| Open up a maximally free market for pharmaceuticals and watch
| these snakes die. If I want to GC/MS some shit I bought out of
| some guys basement to check purity myself then let me.
| mayapugai wrote:
| Even in academia, where most research originates and matures
| before being sold to corporations, the vast majority of
| research is tax-payer funded. I wholeheartedly agree with you
| stance. It's unsurprising that these regulatory barriers keep
| all but the wealthiest corporations out of the market
| considering that big pharma and insurance account for
| significant share the donor-base of most politicians in the
| United States.
|
| Tax base funds the work, donor base collects the rewards.
| dekhn wrote:
| Most of the R&D done to make drugs isn't done at
| universities. They do some initial discovery work and
| invent entire new categories of drugs, but their overall
| role in the process of taking a druggable target to market
| is limited.
|
| Academia gets to keep rewards; universities patent
| discoveries and license the technology to industry. This
| made $$$ for Stanford and UC (billions of dollars).
|
| I am sympathetic to the idea that regular joe of US doesn't
| get enough benefit for their tax payments but actually I
| think if you look at all the benefits americans get
| indirectly from living here, it's hard to say for certain
| that individuals aren't recompensed properly. And, I
| suppose, if they wanted, many people can buy stock in
| pharma and enjoy the profits themselves.
| dekhn wrote:
| QC and regulatory costs are absolutely borne by the
| corporations that are getting their drugs approved. Those are
| major expenditures.
|
| I'm not completely arguing with the idea that pharma
| overprices drugs, but to me, that's a distinct problem from
| who pays for, and benefits from research and development.
| camillomiller wrote:
| Just to frame all this a bit better: in Italy epipens cost...
| wait for it... ZERO - nil - nada. You have a diagnose of
| anaphylactic shock risk? You get epipens. Public healthcare
| pays for it, therefore everyone pays for it with their taxes.
| Without a prescription, you can get one for around 75EUR, which
| is already considered criminally expensive.
|
| This is true for thousands other products. So please now tell
| me again how r&d and other costs justify the US prices for the
| same drugs that are sold profitably Yet way cheaper in other
| western markets.
| tastyfreeze wrote:
| I'm confused. Isn't this like saying I bought you lunch with
| money I took from you last year so your lunch was free?
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