Dr. Lucky Tran 
Gilead has announced that lenacapavir, the game-changing HIV prevention drug just approved by the FDA will cost $28,218 USD per person per year.
Researchers say a generic version could be made for just $25 per person a year.
Capitalism kills.
Sources:
The Lancet
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5293409
crispy branzino ☭ (skin)@luckytran expect a generic version that the global south gets to enjoy for $5.
Piper@luckytran I'm curious what the PBMs will negotiate that price down to. There's a 0% chance anyone will ever spend $28k on a single dose, but will the PBMs negotiate it down under $10k? Under $1k?
Maier Amsden@pmc @luckytran It's just like rich folks paying ridiculous amounts for super new cutting-edge tech (like the laser disc of the early 90s) and such. Of course, AIDS kills, so it won't just be a hobby/ status symbol. But I'm guessing a handful of rich people will buy it.
pmonks (330ppm)@luckytran Of course a generic version could be manufactured more cheaply - those companies don’t incur much if any R&D, clinical trial, regulatory approval, etc. costs.
And before anyone accuses me of living at the opposite end of the spectrum, no I don’t think drug developers should be able to generate massive profits off their IP in perpetuity either. But the cost of development is real, substantial (especially due to the large %age of R&D failures that we never hear about), and has to be amortised somehow or else drug innovation will halt.
Kris Hardy@pmonks @luckytran Many of these costs are often funded by NIH contracts. I haven't gone through to see how much of US taxpayer dollars have already gone into it's development, and Gilead hasn't published their ROI AFAIK, so it is currently impossible to tell whether the price is reasonable or not. And THAT is a huge problem.
The Doctor
unlofl [Promoted Toot]@drwho @nonlinear @pmonks @luckytran and marketing is frequently a bigger part of their capital expenditures than research.
If we ban drug ads, then they'd be able to make drugs without gouging us /s
@unlofl @drwho @nonlinear @luckytran While I 100% agree with banning marketing of pharmaceuticals (and medical devices, and supplements, and beauty products, and …), and indeed some countries do exactly that, I dispute your claim that it’s a larger part of the cost of drug development than R&D. I suspect you’re failing to account for the majority of R&D that silently, but expensively, fails. Science is *hard*.
@pmonks @drwho @nonlinear @luckytran I'm just saying we should fuck them until they stop turning a profit, then we can readjust from there to give them a reasonable 10-20% return
And science is hard, which is why they avoid investing in it most of the time.
@unlofl @drwho @nonlinear @luckytran Abrupt changes such as the ones you’re suggesting will cripple innovation in the short to medium term. Are you willing to gamble with your health, and the health of your friends and family, in the years it will take for that to play out?
And to reiterate the 2nd paragraph in my original reply: no I don’t believe that drug developers and manufacturers should be given carte blanche to maximise profit off vulnerable sick people. But innovation is also valuable (especially given how many diseases are poorly treated or untreatable today), and has to be paid for somehow.
@drwho @unlofl @nonlinear @luckytran Heck there are mainstream illnesses that we don’t have great treatment options for yet - things like pancreatic cancer.
Världens bästa Kille™@pmonks @drwho @unlofl @nonlinear @luckytran Gotta go with pmonks here.
I’ve been working with (big) pharma advertising and other marketing A LOT. In Sweden we have a very good system for that. The background is we had a lot of pretty shade practises until the ~90’s, pharma corps paying for luxurious dinners/conferences etc.
Under threat of legislation the industry association imposed self regulation.
@pmonks @drwho @unlofl @nonlinear @luckytran
The result is a system where all companies try to make other companies look bad by ratting on them. The tiniest claim that isn’t perfectly worded etc. cost them dearly. Every single word has to have a peer reviewed article behind it. And they can’t pay for anything lest the care provider pays 50 % too. Can’t even go straight to the doctors, has to go by the head of the clinic.
@pmonks @drwho @unlofl @nonlinear @luckytran
It’s a good system. I can happily say it made my job virtually impossible.
Also the generic drugs will come. Patents last about ten years (they are sometimes re-parented, I don’t remember the details).
New drugs are really expensive because there are enormous costs creating them. It helps to have tax funded care.
@thelovebing @pmonks @unlofl @nonlinear @luckytran I've heard Legal talk about the black ops and funny business that goes on around keeping patents alive, but thankfully that's not my area of expertise. I've got my own ten pounds of coffee to drink on the systems engineering side.
@drwho @thelovebing @unlofl @nonlinear @luckytran Yep those kinds of shenanigans are absolutely the kind of thing that suggest we’re not at an optimal point on the spectrum I mentioned earlier. Heck the mere existence of Martin Shkreli and his ilk is proof of these dark arts.
@pmonks @thelovebing @unlofl @nonlinear @luckytran That asshole..
I don't think that it's possible for there to be an optimal balance now. There was a slim chance before, but now it won't happen.
@drwho @thelovebing @unlofl @nonlinear @luckytran That doesn’t mean we give up and don’t try to bend things the right way. But asserting that pharmaceutical companies deserve zero protected revenue (as the original post implied) is also not the answer. Generic manufacturers are inherently parasitic, and without new drugs being developed by *someone*, they suffer too (as does anyone with a disease that has no treatment today, but might in the future if we support innovation).
@nonlinear @pmonks @drwho @unlofl @luckytran
True. Having said that there should be a system for funneling money back to universities/the State when they’ve been involved in development. That’s not always the case now (fyi a Uni in Sweden is a special kind of independent government agency).
As for the marketing and advertising thingy the US is terrible. The EU is much, much better at regulating that stuff.
@pmonks @drwho @unlofl @nonlinear @luckytran Fun fact about that self regulation. LIF (the Pharma Industry Association) instituted Iinformationsgranskningsmannen, IGM, (literal translation "the Information Review Man"). In my day his name was Göran, and he dealt oput cease and desists and fines like they were birthday cards. We asked him a few times to pre-check our work. He never did.
Smart, because that meant the Medical and Legal people at the companies were scared shitless.
@pmonks @drwho @unlofl @nonlinear @luckytran
Doing nothing or, if they really had to, do something well within bounds was their default mode.
As I said, my job (I'm an advertising creative) became virtually impossible. To the point where I quit my fancy agency job because I got to do too much of that shit. Polishing turds isn't all it's cracked up to be.
Ψ*Ψ@pmonks @unlofl @drwho @nonlinear @luckytran antibiotics, antifungals, anything without strong market incentives
Lord Bowlich@pmonks @unlofl @drwho @nonlinear @luckytran
I hardly consider the efforts of private firms innovative.
If we wanted innovation, we would nationalize them so they no longer would need to be tethered by the limitations of profitability.
@lordbowlich @unlofl @drwho @nonlinear @luckytran Where do you think the majority of drugs approved in, say, the last 30 years came from?
@pmonks @lordbowlich @unlofl @nonlinear @luckytran Research grants are nationalization of an organization.
@drwho @lordbowlich @unlofl @nonlinear @luckytran Research grants are predominantly for the “R” in “R&D”, not the “D”. Plus a majority of drugs approved in the last 30 or so years were primarily venture funded, not grant funded.
(and at the risk of sounding like a broken record, through both R *and* D - both are necessary to get a drug approved)
Peter@drwho
Skimmed this entire thread to see someone draw this parallel.
Wilson@pmonks @unlofl @drwho @nonlinear @luckytran A way to pay it could be paying part of the cost of test and certification directly with public money, instead of indirectly by buying the drug once it's certified
It was somehow done for COVID vaccines, so it could be doable without much disruption
PS: I'm not advocating for it, I'm sure I'm not qualified, it's just a try to give some material to debate that is oriented to build a different way instead of just abandon the current one
@drwho @unlofl @nonlinear @luckytran It doesn’t really. Drug development is *essentially hard*, and if we as a society want innovative new drugs, we have to amortise the inevitable failures along the way.
@pmonks @unlofl @nonlinear @luckytran Drug development is a Hard Problem; we agree on this.
The company I do research for right now does not do a lot of advertising because they're a consultancy. But some of our clients spend $10us for every $1us of product on advertising alone. They race to get the line going up in the same quarter as the product hits the market.
Relative size of the company is part of it. The big ones got big by being maniacs about getting as much sales revenue as possible.
@drwho @unlofl @nonlinear @luckytran Yep, and as I said way back in my original reply, I’m by no means in favour of pharmaceutical companies having an unrestricted perpetual monopoly on the drugs they develop. But I *STRONGLY* feel that without _some_ level of protected revenue for drug developers, innovation will cease, and that leaves society at large in a far worse position.
IOW there’s a balance that has to be struck between unreasonable profits on the one hand and lack of innovation on the other. I doubt we’re at the optimal point on that spectrum (heck I doubt there *is* a static optimal point on that spectrum), and should be actively and continually striving to move towards where we think it is, but people who make naive binary statements like “pHaRMa BaD gENeRiCs gOoD” have a remarkably shallow understanding of how drugs (and medical equipment, and …) are actually developed.
@pmonks @unlofl @nonlinear @luckytran I saw that; I get that. It's the seeking unreasonable profits that makes me angry, and from seeing the wiring under the board once in a while as often as not they're pretty honest about it. Just because I'm an engineer doesn't mean I'm not listening in, you know?
@pmonks @unlofl @nonlinear @luckytran That said, I've been analyzing the data I've been collecting in the process and I have found a correlation between how big and how old a pharmaceutical company is and how maniacal they are about making money hand over fist.
@drwho @unlofl @nonlinear @luckytran 100% agree - again, I said this in my very first reply in this thread.
But those who say the answer is “no profit - just let the generic manufacturers in right away and let them make a little bit of money instead of gouging the public” are completely missing the point about how drugs get developed.
@unlofl @nonlinear @pmonks @luckytran Depends on the company. Not long ago I was part of a captive audience when Dr. John LaMattina spoke. Cutting out the "we do it for the people" bullshit (because it was eye rollingly bullshit), his argument boiled down to "companies exist to make money. If we can't make money, you can't live."
@drwho @unlofl @nonlinear @luckytran Absolutely depends on the company, and yes, making money is a powerful motivator in the economic system in which I (and I assume you) exist. I personally have no problem when that motivator is leveraged in a controlled manner so that smart people are able to invent lifesaving drugs, devices, and procedures that otherwise wouldn’t exist.
@nonlinear @luckytran Depends. A lot of biotechs are VC funded rather than NIH funded, and even then the grants that the NIH does provide (often to academic institutions - research hospitals and the like) aren’t fully covering their costs anyway.
But yes to your point, lack of transparency is part of the problem surrounding drug development costs vs drug pricing. Ultimately, people are far too quick to buy into naive “pHaRMa BaD” hot takes, without any understanding of what it takes to bring a lifesaving drug like this one to market. The end result of that line of thinking is greatly diminished innovation, which is probably not what those same people actually want when they get sick.
Erin@pmonks @nonlinear @luckytran I get what you mean, but Gilead has previously benefited from NIH funding and partner studies for other PReP medications. It’s hard to tell, but I have seen some evidence that it’s true for this one as well. To my knowledge, their justification for this has been that they offer some grants, and that they donate to some queer resource groups and Pride events. I think it’s warranted criticism here.
@quietewe @nonlinear @luckytran Do you know how many alternative drug candidates Gilead researched but that failed to meet safety and/or efficacy criteria, before they settled on this one? That work, despite producing nothing, also has non-zero cost that must be amortized somehow.
fear is not a Weltanschauung@pmonks @quietewe @nonlinear @luckytran I dunno, costs a lot of money to design, develop, test, prototype a smartphone phone; companies are expected to just recoup their costs via unit sales without charging 28k per unit. Pharma charges what the market will bear and the market will bear much more for a drug than a phone because fewer people die for lack of access to the latest developments in smartphone technology; people will spend their life savings and more if they're buying their lives.
@wouldinotcallmyselfahumanbeing @quietewe @nonlinear @luckytran Unlike drug developers, phone manufacturers don’t utterly fail a majority of the time, in large part because biology is substantially more variable and complex than technology.
@pmonks @quietewe @nonlinear @luckytran when developing an entirely new class yes, but an awful lot of drugs are based on other drugs.
(edit—"and another thing!,":)
Plus tell me Microsoft's developing a quantum processor hasnt been and won't continue to be a high-failure-rate r&d proposition OR that when consumer machines ship with them they'll retail for 28k each and i may yet accept the inverse vocational awe protecting pharmaceutical exceptionalism.
(edit—"and another thing!,":)
Plus tell me Microsoft's developing a quantum processor hasnt been and won't continue to be a high-failure-rate r&d proposition OR that when consumer machines ship with them they'll retail for 28k each and i may yet accept the inverse vocational awe protecting pharmaceutical exceptionalism.
@pmonks @quietewe @nonlinear @luckytran
Big pharma isn't uniquely evil. The same dynamic is at play in medical tech, insurance and any other field where the consumers' lives are literally at stake. The issue i take is the idea that maximising value extraction is inherently virtuous and maximally productive and efficient, even when imposed upon the most vulnerable.
Big pharma isn't uniquely evil. The same dynamic is at play in medical tech, insurance and any other field where the consumers' lives are literally at stake. The issue i take is the idea that maximising value extraction is inherently virtuous and maximally productive and efficient, even when imposed upon the most vulnerable.
@wouldinotcallmyselfahumanbeing @quietewe @nonlinear @luckytran Hard agree. In fact (private) health insurance is imo a vastly larger issue in health care (especially in the US) - there is almost no better example of an industry that actively pursues “rent seeking off the desperation and misery of vulnerable people”. At least pharmaceutical companies provide _something_ of value, even if there are (reasonable) concerns about how much profit they make from their products.
@wouldinotcallmyselfahumanbeing @quietewe @nonlinear @luckytran That doesn’t reduce the costs of developing those drugs as much as you might think. Recent history is littered with “revisions” to existing drugs that just didn’t hold up to scrutiny. Iberdomide being one recent example that I’m somewhat familiar with; it made it all the way into phase 1 clinical trials before being dropped - that represents a LOT of sunk cost for zero revenue (let alone profit). That loss has to be amortised somehow.
@pmonks @quietewe @nonlinear @luckytran and the Ford Pinto had to be recalled because it had an awful tendency to kill its passengers by exploding in a sudden fireball. Pharma, again, is not unique in spending vast resources bringing a product to market without absolute certainty of success. That's capitalism, baby.
@wouldinotcallmyselfahumanbeing @quietewe @nonlinear @luckytran As I already said elsewhere, well understood technologies (like phones and cars) don’t have anywhere close to the kinds of failure rates that drug development has.
@pmonks @quietewe @nonlinear @luckytran as I said earlier, Microsoft's literal quantum processor will on be rolling out with a 28k price tag.
@wouldinotcallmyselfahumanbeing @quietewe @nonlinear @luckytran You’re still missing the point. Complete failures in tech (including phones, cars, and quantum computers - the examples brought up in this thread) are the exception, not the norm. In drug development that ratio is inverted. For every Rituximab, there are hundreds of (costly) failures.
@pmonks which therefore necesitates behaviour like purchasing existing medications whose exclusivity period has lapsed, making cosmetic changes to their make-up and inflating their cost hundreds of times. Because the cost "must" be amortised "somehow". Excusing exploiting the vulnerable and condemning those who are not sufficiently liquid assets, insisting that uninhibited predation is the price of entry to society's access to pharmecuticals is capitalist realism. that is *my* point.
@wouldinotcallmyselfahumanbeing As I made clear in my very first reply in this thread and several other replies since, I’m not advocating for unrestricted profit taking by drug developers. I’m simply pointing out that drug development is expensive, and if we want new drugs to be developed then we have to amortise those costs somehow. To pretend those costs don’t exist is to kill innovation, and condemn a lot of sick people who have few or no current treatment options to short brutal lives of misery.
@pmonks I am nor pretending they don't exist, I am insisting the way the costs are currently amortised are unacceptable except in a paradigm in which human lives are a resource from which to extract value, and that said paradigm is bad actually.
@wouldinotcallmyselfahumanbeing Don’t forget the other half of your argument: suggesting that the fix is to eliminate the incentive that drives innovation.
Regardless, we’re in broad agreement that the current state of affairs is not optimal. We just disagree on how much innovation we’re willing to stifle to fix it. It should go without saying, but throttling innovation *also* kills vulnerable sick people.
@pmonks I disagree fundamentally with your inference that the capitalist conception of free market dynamics, of economic value as the only material form of value, is the only condition in which innovation exists. The market incentive is not to be eliminated, it is to be replaced. But in order for that to happen, one must be capable of concieving that such a thing is possible. The inability to do so, even subconsciously, is capitalist realism, and I suspect you are a victim of it.