[HN Gopher] The Price of Remission
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The Price of Remission
Author : danso
Score : 68 points
Date : 2025-05-08 12:17 UTC (2 days ago)
(HTM) web link (www.propublica.org)
(TXT) w3m dump (www.propublica.org)
| planck_tonne wrote:
| Crazy how they managed to restrict the competing researchers from
| obtaining the drug.
|
| How did they do that?
|
| Why is the sale of a super expensive drug used exclusively to
| treat a super specific type of cancer even controlled in the
| first place? What is even the argument?
|
| I couldn't think of any argument before. After reading, I can
| only think of "to restrict competition".
| throwanem wrote:
| The argument in essence is that only permitting pharmaceutical
| companies these outrageous profits will induce them to continue
| investing the likewise outrageous costs of new drug development
| now that all the low-hanging fruit like antibiotics, and
| sildenafil and other antihypertensives, has been picked. This
| extends (usually by implication) to trivial variations in
| molecular chemistry which have no functional effect on a
| medication but which are used to extend patent protections
| solely on the basis of a structural change - a practice also
| visible in the history of one family of drugs I have mentioned,
| and one which without _some_ sort of justification might be
| taken for an example of a law 's letter being abused to violate
| that same law's intent.
|
| Look, I didn't say I _buy_ it. But you asked for the basic
| argument advocates make in support of such practices, and here
| it is.
| throwawaymaths wrote:
| it's not a great argument since iirc half of pharmaceutical
| company spending is on marketing; far far outstripping r&d
| smt88 wrote:
| And a lot of pharma research is based on publicly-funded
| research in the first place.
| nradov wrote:
| Sure, but that's a bit of a red herring. The largest
| expense in bringing a new prescription drug to market is
| the phase 3 clinical trial, which now costs on the order
| of $1B each. Those often fail, so it's a huge gamble.
| There is very little public funding for type of research.
| throwanem wrote:
| And a drug like Revlimid makes its manufacturer _tens to
| hundreds_ of billions; the "legacy" portfolio in which
| BMS classes it pulled in a cool $5.6b just in Q1 '25, of
| which Revlimid itself was about a sixth, or just under a
| billion - _down_ by almost half year on year. See
| https://www.bms.com/assets/bms/us/en-us/pdf/investor-
| info/do..., pp. 8-9.
|
| It is as if VCs in the tech industry demanded the
| taxpayer guarantee them a healthy rate of profit, to a
| standard of health the VCs themselves are privileged to
| define. Indeed, as with Allred and the regional airlines,
| perhaps now we see whence Altman has cribbed _his_
| "innovation."
| nradov wrote:
| I don't understand your point. Some drugs are enormously
| profitable. Others lose money. There are no taxpayer
| guarantees. Pharmaceutical companies on average don't
| generate higher shareholder returns than other industrial
| sectors. A few like K-V and Dendreon have even gone
| bankrupt.
|
| One could make an argument that taxpayer subsidized
| health plans which include prescription drug coverage
| such as Medicare Part D or Medicaid should limit the
| prices they are willing to reimburse on a QALY basis. And
| Medicare has started a limited drug price negotiation
| program. But generally, voters have been unwilling to
| accept the trade-offs inherent in drug price controls.
|
| https://www.cms.gov/newsroom/fact-sheets/medicare-drug-
| price...
| throwanem wrote:
| My point is that if you want to provide support for the
| advocacy argument, you've quite a long way yet to go. A
| good place to start would be to pick any one claim you
| have made and attempt to substantiate it. Until then,
| I've nothing with which to attempt further to argue.
|
| (If you want to do something else, I can't tell what it
| would be.)
| nradov wrote:
| What advocacy argument? You're not making any sense and
| are just posting lazy, low-effort criticism. None of my
| claims require further substantiation, you can easily
| look up for yourself if you want to understand how the
| system works and the incentives involved.
| mikeyouse wrote:
| Phase 3 trials don't cost $1B - they're more on the order
| of $20M.
| nradov wrote:
| Sorry I should have been more specific. Average total
| cost to bring a new drug to market is on the order of
| $2B.
|
| https://www.fiercebiotech.com/biotech/drug-development-
| cost-...
| cogman10 wrote:
| The NIH already creates grants for Phase 1 and Phase 2
| trials. It's a bit insane that we don't also do phase 3
| trials. Heck, even drug manufacturing is already done
| both by the DoD and the VA. It's crazy that we have a
| vision that private investment will somehow make things
| either cheaper, more affordable, or more available.
|
| Big pharma is providing very little benefit and a lot of
| cost. We've seen their playbook with people like Martin
| Shkreli who'll buy up patents to existing drugs and jack
| up the price to make a quick buck. Do we really need that
| sort of "private investment"?
| nradov wrote:
| I don't think anyone is seriously making the argument
| that private investment in drug development is making
| things cheaper or more available. So that's a strawman
| argument.
|
| The primary claim in support of the current system is
| that it encourages greater levels of innovation than
| would happen under a socialized central planning system
| where government bureaucrats allocate funding for all
| trials. We don't have any solid evidence about that one
| way or the other. But year after year, US pharma
| companies do consistently release more new drugs than any
| other countries on a per-capita basis. We don't want to
| wreck that just because of high prices on a few patent
| protected drugs. Let's take a longer view and consider
| possible second-order effects before making any drastic
| changes.
| cogman10 wrote:
| > innovation than would happen under a socialized central
| planning system where government bureaucrats allocate
| funding for all trials.
|
| What innovation? All the innovation with the current
| system happens outside the big pharma companies. They are
| merely swooping in at the final steps and manufacturing
| to benefit from the public investment.
|
| The actual innovation is happening because of public
| social investment. Not because if private investment (at
| least in terms of medicine). Private investment here is
| simply leaching off of the public investment.
| throwanem wrote:
| > I don't think anyone is seriously making the argument
| that private investment in drug development is making
| things cheaper or more available. So that's a strawman
| argument.
|
| > The primary claim in support of the current system is
| that it encourages greater levels of innovation than
| would happen under a socialized central planning system
| where government bureaucrats allocate funding for all
| trials.
|
| Oh, I see. You argue against the barely reanimated corpse
| of Nikita Khrushchev, in the breath after you accuse
| someone _else_ of playing with a strawman.
|
| Considering that I obviously disagree with the argument
| you've been trying to advance, I hope I can be forgiven
| some surprise at having presented so much stronger a
| formulation to argue _against_ than you seem prepared to
| present in arguing _for._ Whom do you imagine yourself
| convincing in this way?
| cogman10 wrote:
| Meh, I'm fine with it. The general argument for
| capitalism is usually one of cost and market efficiency
| which is why I argue that doesn't happen with medicine.
|
| But if you want to argue innovation instead, I see that
| as particularly worse in terms of medicine and science.
| Pure research is rarely profitable which is why you
| pretty rarely see it in an open marketplace.
|
| It's not that it never happens. Obviously some research
| specifically targeted at manufacturing efficiency does
| happen as that will increase profits. However, outside of
| maybe semiconductors you'll almost never see a purely
| private institution invest in something like material
| sciences. More often than not, that research actually
| comes from something like the DoD contacting out to a
| defense agency trying to do better tank armor.
|
| With medicine in the US, pretty much all innovation has
| come from public investment. The polio vaccine, for
| example, didn't come from a drug company, it came from a
| university researcher. That's the story of a large number
| of modern medicines.
|
| A private company doesn't need or in some cases even want
| new medicines. Why would they want to make something that
| benefits 1/100000 of the population when something like
| insulin has a huge market and few competitors.
| Manufacturing new medicines for rare diseases isn't
| profitable, so why would they ever research it in the
| first place?
| throwanem wrote:
| It is too specific an argument to be applicable here.
| Thalidomide was privately developed, as is the cancer
| miracle drug derivative of it, Revlimid or lenalidomide,
| discussed early in the article.
|
| The argument is also not too well presented, in that it
| lacks grounding. For example:
|
| > Why would [a pharma company] want to make something
| that benefits 1/100000 of the population when something
| like insulin has a huge market and few competitors?
|
| _Because_ insulin has a huge market and few competitors.
| That means they have defense in depth on pricing because
| their manufacturing will be highly specialized and high-
| throughput, else they could not continue to serve the
| market unless protected: someone would acquire them or
| shoulder them out. If you try to disrupt that incumbent,
| the same will happen to you; you 'll be either
| acquihired, vivisected, or left to go bankrupt in peace
| for lack of anything novel enough to attract interest.
|
| If, conversely, you can go to one person in every hundred
| thousand and offer them a pill that will make the
| difference between life and death - a pill that _no one
| else,_ ideally, can possibly sell them - well, what _can
| 't_ you ask in return? The traditional rate I understand
| to have been in the order of one to ten firstborn sons
| and heirs.
|
| We do things differently now, of course, or less overtly
| at least. But the business case when considered amorally,
| as any of that species must be to be understood on its
| own terms, is trivially clear. The discussion you really
| want to have is that of whether income inequality can and
| must be allowed to dictate even partially the dimensions
| of a human life, versus whether that can and must be
| prevented. I'm not going to pretend I could summarize the
| state of the field on _that_ one, which has much older
| names even than "theodicy."
| cogman10 wrote:
| A fair point, but I'd point out that the research which
| showed revlimid was a well tolerated cancer medicine
| didn't happen because of private investment, but rather
| public NIH grants and funding. The lead author that ran
| the trials wasn't a pharma employee, but rather a staff
| member of a cancer research institution.
|
| If someone is going to find that Benadryl can treat a new
| disease, it won't be a pharma company.
| throwanem wrote:
| A fair point, indeed. Now we reach the question in a way
| that anyone can follow: if the cost of development is
| already sunk, and the cost of discovery is publicly
| defrayed, then what justifies these absurd revenue
| multiples of development cost when they come at a price
| measurable in human suffering and death?
|
| _That 's_ the sort of question folks like my prior
| interlocutor, who appears now to have abandoned the
| effort, really don't want to answer, and no wonder.
| There's no way for them to do so while maintaining the
| usual comfortable abstraction over the essential
| bloodthirstiness of their philosophy.
| SAI_Peregrinus wrote:
| "How can we lower the cost of phase 3 clinical trials
| without allowing non-functional medication (scams) to
| proliferate" is very important. The point of a phase 3
| trial is to prove that a medication treats what it claims
| to treat.
| tough wrote:
| the argument might be, the more profits the pharma's make,
| the more available cash to buy out poltiicians or create
| SuperPAC's or whatever they have at hand..
|
| America, the land of the dollar
| ricksunny wrote:
| >America, the land of the dollar
|
| Correction: America, the land of the rent-seeking.
| bschne wrote:
| 2024 numbers -- Selling, General & Admin vs. R&D
|
| Roche (Pharma Division): 7533 MCHF vs. 11096 MCHF
|
| Novartis: 12566 MUSD vs. 10022 MUSD
|
| Pfizer: 14730 MUSD vs. 10822 MUSD
|
| Eli Lilly: 8594 MUSD vs. 10991 MUSD
|
| AstraZeneca: 19977 MUSD vs. 13583 MUSD
|
| Johnson & Johnson: 22869 MUSD vs. 17232 MUSD
|
| The left side here contains more than just marketing, and
| already "far far outstripping" seems like a
| mischaracterization.
|
| For comparison, the average R&D spend between these firms
| is bigger than the 2024 NSF budget (~9bn) and bigger than
| 1/4 of the 2024 NIH budget (~37bn).
| dgacmu wrote:
| I think you meant to say NIH for the second budget
| number?
| bschne wrote:
| correct, edited, thanks
| derektank wrote:
| Also worth considering that this only includes internal
| R&D, not R&D acquired through acquisition of smaller
| biotech firms (known as in process R&D). VC investment in
| smaller biotech firms is at least in part built around
| the assumption that acquisition by a larger
| pharmaceutical firm is a viable exit strategy. To take
| the example of Eli Lilly, I think they spent an
| additional 10-20% of their R&D budget on IPR&D, though
| this obviously can fluctuate more year to year. They
| acquired Morphic, which produces a pharmaceutical that
| treats IBS, and Scorpion Therapeutics, which produces a
| precision oncology treatment, this year and I'm guessing
| neither spent much on consumer sales.
| tptacek wrote:
| That's part of it, but pharma is also a portfolio business,
| like VC or music; the winners have to pay for the losers.
|
| (I don't know how much that matters in this case, where a
| tiny company lucked into a blockbuster and then used every
| lever in the system to protect their exclusivity).
| leereeves wrote:
| > This extends (usually by implication) to trivial variations
| in molecular chemistry which have no functional effect on a
| medication but which are used to extend patent protections
| solely on the basis of a structural change
|
| How does that work? Does it extend patent protection on the
| original molecule? Or if not, what stops generic copies of
| the original version?
| throwanem wrote:
| I found a menu. https://www.obrienpatents.com/extending-
| life-patents-pharmac...
| jmward01 wrote:
| This is trickle down economics for healthcare. It is stupid.
| No, it is worse than that, it is evil.
| photochemsyn wrote:
| Bayh-Dole legislation in the 1990s allowed universities to
| _exclusively_ license researcher inventions to private parties.
| Hence:
|
| > "Celgene had acquired the rights to thalidomide patents held
| by researchers at Rockefeller University in 1992."
|
| Change Bayh-Dole law to non-exclusive licensing, but with some
| level of royalties paid to institution that originated the
| patent, and other corporations could have made the drug - and
| it would be a competitive market, so costs would drop due to
| lack of a monopoly on the drug.
|
| This one simple change to Bayh-Dole - 'non-exclusive' - would
| upset the academic-corporate apple cart well beyond
| pharmaceuticals. Eg the PageRank algorithm created at Stanford
| could not have been exclusive licensed to Google - any American
| corporation or person could have applied for a license to the
| invention, entirely erasing the benefits of a monopolistic
| patent to the corporation.
|
| One great benefit of this change is that corporations who
| wanted exclusive patents would have to finance their own
| private R & D divisions, instead of just capturing the output
| of taxpayer-financed researchers.
| y-curious wrote:
| It makes me wonder, is there a way to get this drug from a
| Chinese or Indian lab? I'm sure there are severe legal
| repercussions, but purely theoretically. It reminds me of the
| film The Dallas Buyers' Club
| the_pwner224 wrote:
| Yes, it's readily available to buy online from India for
| <$1/pill.
|
| In practice there aren't legal repercussions. If you import
| scheduled drugs (adderall, opioids, etc.) and get caught that's
| obviously going to be a big issue. But with most prescription
| medications, the worst case scenario is that Customs will just
| toss your package. And the likelihood of that is low; the
| majority of the time it makes it through undetected.
|
| I've done this in the past with another drug. In the US it was
| $30/month but from India I got 1000 pills for $30 + $40
| expedited shipping. For me the big factor wasn't cost, but
| rather the convenience of not needing to go through the process
| of getting a prescription.
| csours wrote:
| Remember the time that Florida fought the federal government for
| access to socialized medicine?
|
| https://www.flgov.com/eog/news/press/2024/florida-becomes-fi...
|
| > "Today, the DeSantis administration received U.S. Food and Drug
| Administration (FDA) approval of its Canadian Prescription Drug
| Importation Program. The Agency for Health Care Administration
| (AHCA) submitted this first-of-its-kind plan to safely import
| cheaper drugs from Canada to the FDA nearly 37 months ago, and
| after filing a lawsuit against the FDA due to delays, has finally
| received approval. This approval will save Florida up to $180
| million in the first year."
| eterm wrote:
| > But Revlimid is also, I soon learned, extraordinarily
| expensive, costing nearly $1,000 for each daily pill.
|
| Thanks to the bargaining power of my nationalised healthcare, my
| government pays around 1/5th of that, and I'll pay nothing
| myself.
|
| Revlamid is listed under it's generic name Lenalidomide, price is
| in pence:
| https://www.drugtariff.nhsbsa.nhs.uk/#/00791628-DD/DD0079145...
| comrade1234 wrote:
| My wife's company developed a multiple myeloma immunotherapy that
| is for people that have had previous treatments of other drugs
| but then go into remission.
|
| It works so well that their efficacy reports have caveats like
| "not enough patients that were treated have died yet" to provide
| meaningful statistics.
|
| The drug was initially developed in china. They presented results
| at a conference in the USA but no one believed them other than a
| skeptical Pfizer who sent a big team to china to confirm the
| data. Pfizer soon invested billions into the company and drug to
| bring it to market.
|
| The drug's sales are on track to be $1 billion this year but the
| stock is heavily depressed because of the china connection.
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