[voisin]

> I'd argue that there's a moral imperative to bootleg the drug and distribute it to those who would benefit from it at a fair price.

Why not do away with patents and IP altogether if the standard is that as soon as someone makes something needed it can be stolen?

[nsagent]

I'm not sure what the right solution is, but making 160x the manufacturing cost seems a bit obscene. Not sure what the total cost of R&D was, but at that rate of return those R&D costs have to be recovered relatively quickly and then it becomes a pure profit machine.

[ericd]

Do you similarly object to the insane gross margins on software?

Like in software, pretty sure the main expense is R&D.

[nsagent]

The consumer costs are significantly lower for software. For example, the cost of ChatGPT is minuscule in comparison, while the R&D costs are still quite high.

The real difference between the two sectors is that for medicine, you have a captive audience. People are willing to give up their life savings for certain medical interventions. That same cannot be said for software.

[ericd]

The other real difference is that the addressable market for most drugs is quite small in terms of number of customers. The vast majority of people just don’t need a particular medicine, especially the life-saving variety. The more niche, the more you have to charge to make up for the large R&D costs.

There are, of course, also instances of gouging. But it’s not like these things should inherently cost $20/mo, or whatever, if you want to be able to pay biomedical researchers enough not to go do something else highly compensated like finance/consulting/whatever. Sadly, I had a lot of classmates in engineering school who went that route instead. We urgently need more nuclear reactors, but one of the smartest guys I know, a nuclear engineer, is doing healthcare private equity.

A lot of saas is more like $200+/mo for businesses, and chatgpt might be $20/mo for consumers, but there are companies paying $1m/mo or more for that api.

[throwaway-blaze]

No one is mentioning the liability costs (and liability insurance costs) here in the US vs other western countries, which is playing into the costs of these new-to-market drugs. In 10 years or so, when there's an established history of non-issues with the drugs, premiums will be lower for the companies. Plus these initial versions will begin to lose patent protection and generics will flood the market.

Personally I'd rather have a system where these kinds of innovations are made and where they eventually become widely available than a system where govt or others forcefully take or force-price an innovation, thus harming future innovations.

[moate]

>Why not do away with patents and IP altogether if the standard is that as soon as someone makes something needed it can be stolen?

laughs in anarchist don’t threaten me with a good time!

We also need to differentiate “theft” (actually taking a tangible thing) from “ripping off” (stealing an idea and making that thing yourself).

Theft is bad (depending in who you steal from and why), ripping off is only bad if you believe current economic models/practices are good. But

I’m only talking about conceptually since this doesn’t account for the consumer’s safety. In practice one downside to unregulated markets is they get exploited by bad actors for profit by making inferior products that harm consumers, unlike regulated markets that get exploited by bad actors for profit through regulatory capture.

[JKCalhoun]

Why not make an exception for life-saving patents/inventions?

The irony that, were it not priced outrageously, it could save the health care industry billions as these people with obesity will otherwise require epesneive treatments if the remain obese.

[A_D_E_P_T]

There are already exceptions for technical products that must be licensed on fair, reasonable, and non-discriminatory terms. (RAND or FRAND. See: https://en.wikipedia.org/wiki/Reasonable_and_non-discriminat... )

Why not carve out a new exception for breakthrough drugs that have the potential to add X% to the GDP or save X lives/annum?

[swatcoder]

> it could save the health care industry billions as these people with obesity will otherwise require epesneive treatments if the remain obese.

"Could" is doing a lot of work there. We don't really know what to expect for these patients 20 or 40 years out.

Long-term outcomes and population-scale polypharmacy risks are not really clear, and won't be for decades.

These drugs enable a valuable intervention for individuals at high risk of health hazards and it's fantastic that they're available, but the perspective changes when you look at outcomes for tens (hundreds?) of millions of people over long spans of time -- there are a lot of inescapable unknowns. One can't actually be sure that the benefits of fast, widespread use will outpace the costs, or at what scale.

Many genuinely effective drugs have gone through exactly this kind of hype cycle only to lead to regret, embarassment, and/or skepticism later on.

Good science, and the good public policy that's informed by it, moves slowly.

[bryanlarsen]

Liraglutide has been in wide use for 14 years and trialled for a decade before that; we do have a good idea of what to expect for patients 20 years out.

Semaglutide was approved in 2017 and been very widely used (>9 million people). That's been wide & long enough to determine that risks are either exceedingly rare or significantly slow acting.

OTOH the risks and costs of obesity are massive and well known. We're weighing massive known benefits against risks that are either rare (likely less than 1 in a million) or take decades to manifest.

[moate]

Exactly. I’m old enough to remember the Fen-Phen fallout.

A truly harmless weight-loss drug is the white whale of the pharmaceutical (assuming it can be profitable enough to offset the losses that would go along with the decrease in needed treatment for problems ancillary to obesity). These drugs, so far, seem pretty good but some of the side effects should take the shine off for people who thing this is ”The Cure” for obesity.

[mech422]

check out the DES babies (0) or Thalidomide if you want to see how little we understand long term effects...My mom was a nanny and one of the girls she raised was born sterile due to DES her mom was given _to support pregnancy_ !

0) https://en.wikipedia.org/wiki/Birth_defects_of_diethylstilbe...

1) https://en.wikipedia.org/wiki/Thalidomide_scandal

[BurningFrog]

If it can actually save the health care so many billions, you'd think it was worth paying high prices for it.

[andsoitis]

> Why not make an exception for life-saving patents/inventions?

This ain’t it though.

[alphazard]

It's possible to believe that the best system of laws to operate in contains concepts like patents and intellectual property, and that the best thing for you to do individually is to take advantage of poor enforcement. This probably matches the attitudes of most people here about Piracy for example.

[ClassyJacket]

I'm in favour of doing away with patents entirely. Or maybe make them 3 years and not 20.

[voisin]

And what about the second order effect of nobody wanting to do billions of dollars worth of research and trials for the slim possibility of hitting a safe and effective drug, only to have exclusivity for 3 years?