[dekhn]

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.

[notch656a]

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]

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]

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.

[refurb]

Most of the work is NOT done by academia (i done the academic work myself). I’d say maybe 80% is done by pharma.

You think academia know how to optimize structure? Bulk manufacturer? Organize clinical trials across the globe? Check all the regulatory boxes?

[bmer]

> You think academia know how to optimize structure? Bulk manufacturer? Organize clinical trials across the globe? Check all the regulatory boxes?

Yes? That is literally where the standards for these things are developed, and constantly tested? For example: the techniques for optimizing structure? Developed in academia. Bulk manufacturing? Reliant on tons of science, engineering, and mathematics, that was developed in academia.

[whearyou]

Then you would be mistaken. The proficiency in these tasks and the cost of their execution is borne by Pharma.

Regulatory capture etc is quite real and toxic. But this eat the rich stuff is getting a little out of hand.

[bmer]

I don't understand, where does eat the rich come in here? Academia is usually made up of people who are (relatively) rich and privileged. This has nothing to do with "eat the rich", and everything to do with answering the question: "who bears the costs?", or more appropriately "who pays the bills?".

Answering with the "tax payer" does not now imply that capitalism is evil, and corporations are awful, etc. etc. Rather, it should sober businesses, and remind them that they are part of a system. They need consumers, and consumers need them. Hurting consumers by maintaining unfair prices ultimately comes full circle, and will hurt them, in the long run, even if they profit in the short term.

Of course, our businesses tend not to think about the long term too much, but again, this has nothing to do with "eating the rich", but everything to do with pondering human hubris.

[dekhn]

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.

[refurb]

Terrible argument that implies “nobody makes anything on their own so I have every right to use their work”.

You are free to make your own drugs and “GC/MS some shit”, though you’d just be smarter to buy it outside the US.

[notch656a]

My argument is terrible. That's why yours is found at the bottom, and mine at the top.

Fuck the thieving snakes claiming it is "their" work when an entirely different 3rd party with no prior contract with the pharma snakes uses their own reagents and chemicals and published or reverse engineered synthetic pathway to produce a substance.

"You are free to make your own drugs." I suppose you are, if you're willing to violate the CSA and FDA/DEA regulations, as my comment pertained to being able to buy drugs _someone else_ made in their basement (although I'd also like to include making your own as well).

[refurb]

Our comments are found in the same place because mine is a reply to yours?

You sounds like a very angry anarchist who doesn't really understand R&D works and what kind of effort is required to put into it.

Why would making your own medicines violate the CSA or DEA regulations? You just looking to get high?

[notch656a]

>Why would making your own medicines violate the CSA or DEA regulations? You just looking to get high?

Maybe you are unaware. Many medicines are controlled substances. Some people are ill and not just looking to get high, although I think getting high is OK too.

>You sounds like a very angry anarchist

Shit, I am an anarchist. I guess you impugned my character and my statements must be irrelevant. Oh wait, that is ad hominem fallacy.

>who doesn't really understand R&D works and what kind of effort is required to put into it.

I am not angry about R&D. R&D I find to be one of the legitimate components of pharma. It takes so many people to bring a drug to market, I don't think you can really understand the complete picture of how R&D works either. But thank you for the arrogant superiority complex. Are you in R&D or something or why do you think I'm attacking researchers? I've continually said (and perhaps this was better reflected on other comments, apologies if not clear enough on my prior) researchers are important to drug development and that they create real value.

It's the regulatory capture, lobbying, insanely high regulatory barriers that enable many pharma businesses to squash new development from competitors that leaves a bad taste in my mouth, corrupt intermingling with FDA and agencies. Amongst other things, but those are some of the larger ones.

[camillomiller]

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 75€, 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.

[dekhn]

The direct cost to the consumer is $0 (or lira, or EU, or whatever), but that's because public healthcare negotiated with the power of a volume customer to agree on a fixed price, which is paid for by the government, which is paid for by people's taxes. So what you're doing is spreading the cost of the drug across the population. I had a similar situation when I had kaiser- no out of pocket costs.

As to why drugs are expensive in the US: because the market bears it. Demand is just elastic enough (or inelastic, I always get it backwards) in the US that providers slowly edge prices up. Sometimes they get it wrong for example aduhelm didn't sell so it had a huge price drop recently.

[erosenbe0]

Drugs are expensive partly because there is not a free market. Drugs that have been off-patent for decades which have 20 generics in other countries have none or only a few here. Anti-parasitics for example, that cost a few cents in Africa are $20 a pill here, for no reason at all, other than regulatory hurdles designed to ensure profit.

[programmarchy]

Inelastic means less price sensitive i.e. people will pay more. You can kind of think of it like immutable vs mutable.

[kragen]

How much does public healthcare pay for them? That's the crucial question here, not whether the cost is borne by the individual using the good or by the taxpayers as a group. I mean, clearly universal access to healthcare is improved by collectivizing the cost, but it's improved even more by eliminating the cost, or most of it.

[tastyfreeze]

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?

[camillomiller]

No. Spreading the costs over millions of taxpayers makes the cost you pay into the system way smaller, plus gives the government a huge contractual power when dealing with pharma companies. It’s really not that hard to comprehend, but I yet have to find a single American that for some reason doesn’t try to justify or straight up defend the US broken and unequal healthcare system.

[tastyfreeze]

Yes, medical cost in the US is out of control. No, the government should not be the provider. That doesn't fix the problem. It just makes new ones. Our government is extremely limited by the Constitution on what they are supposed to do. Unless "providing medical services" is added as a power of government to the Constitution there will continue to be a large, vocal opposition to government healthcare.

[colinng]

Apologies in advance if I’m mistaken, but isn’t your Constitution supposed to protect your right to “life, liberty, and the pursuit of happiness?”

How does one have life and liberty if they have a crushing burden of medical bills?

More simply, how does one have life if the medication needed to save you - is $750 a dose? or $300 an injection (and expiries with no refundable “core charge” whether you use it or not)?

[dragonwriter]

> Apologies in advance if I’m mistaken, but isn’t your Constitution supposed to protect your right to “life, liberty, and the pursuit of happiness?”

You are mistaken. But, that's okay, even many Americans get confused about attributes of the Declaration of Independence vs. the Articles of Confederation vs. the Constitution, and tend to misattribute things from the first two to the last one.

[kragen]

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]

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.

[erosenbe0]

Umm, the variance in prices in only very slightly due to quality, like often 5% or 1% or less than 1% of the variance. Please show data accounting for why anti-parasitics that costs 5 cents per dose for a horse or 5 cents per dose in India with 20 high quality generic versions are $50 in the US. Hint. BECAUSE WE DO NOT HAVE A FREE MARKET ON HIGH-QUALITY AND SAFE DRUGS. WE HAVE A PAY TO EXTRACT RENT SYSTEM.

[kragen]

I wish you wouldn't post things like this because, although what you are saying is factually correct, you are saying it in a patronizing and shouting way, which will lead people to associate these insights with acting like an asshole. That makes it harder for them to assimilate them, even when I'm the one explaining them and even if I'm managing not to act like an asshole.

[erosenbe0]

I'm sorry but I used to work in healthcare and we see people suffer because they can't afford the $10 monthly copay on drugs that should cost no more than $10 or $20 for a year supply, like a giant bottle of generic aspirin. The fact that they suffer due to pure exploitation is disturbing.

[kragen]

I understand, and I appreciate your compassion.

[kragen]

Also, the person you were shouting at and saying "Hint" to probably knows about 100 times more than you do about the economics of drug companies.

[erosenbe0]

Sure, if we are talking about on-patent drugs I don't know that much. But if we are talking about off-patent generics there isn't a lot to know. We in the United States have a variety of financial, temporal, regulatory, and competitive barriers that bloat prices, sometimes by a factor of 100, over consumer market price in somewhere like India, or even Mexico.

[kragen]

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]

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.

[kragen]

In the comment you responded to, I am not taking up the subject of how to achieve testing, replication, QC, and transparency. I am merely pointing out that, to reason clearly about the issue, it is essential to distinguish these goods—genuinely valuable benefits to drug users which should be maximized—from any potential means for achieving them, such as regulatory compliance, which is a deadweight loss to be minimized, even if it is an unavoidable one, as you claim it is.

To do otherwise is similar to measuring the progress of a software project in lines of code, measuring the quality of an airframe design by its weight, or measuring the security provided by the TSA in the number of fingernail trimmers confiscated. It's counting regulatory compliance activities on the wrong side of the ledger.

[erosenbe0]

The people who write the rules take money from the rent extractors and the people who enforce the rules have huge conflicts of interest and go immediately to and from working with the rent extractors. It is a corrupt system of rent extraction that has some quality benefit for the consumer that is extremely inefficient. CRONY-CAPITALISM, MONOPOLIES past patent expiration, and A LACK OF A FREE-MARKET extracts rent from the consumer and destroys a countries' industrial competitiveness as does any form of corruption. Just look up how many generics are available in somewhere like India, or look at drug costs on the Mexican [more] free-market, or just do some research into what is actually happening.

[petermcneeley]

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]

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).