Goldman Sachs report: "Is curing patients a sustainable business model?"

boing
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I don’t really expect politicians to publicly acknowledge costs. They’re essentially there to win battles, not debate policy. It’s also why I don’t expect anything interesting from what a politician says publicly.

Oops - you’ve triggered a hot button. Forgive me for one my rants (not aimed at you, just a generic rant)…

I’m far more concerned about the thousands of channels (such as this blog) where such policies are hashed out. After all, if one cannot acknowledge the costs of a policy, one is scarcely likely to be able to evaluate its overall benefit. Worse than that, people often so resent the fact that there is a cost that they end up demonizing those who will suffer (“well, they deserve it.” being typical rationalization.)

I once challenged a group of people to state their favourite policy and then give three ways that that policy will cause harm. The presumption, of course, was that they felt the benefits of the policy strongly outweighed the harms.

It was eye-opening, if a little disheartening. Many were angry, most confused. How could you support a policy if you felt it caused harm? (My reply of “How can you support a policy in which you can’t enumerate the harms?” was not well received :-)).

So one of my bug-bears is to clearly enumerate the costs of any policy I support. Yet I still find it amazing (because I’m a slow learner) how many people ignore the “I support this policy” part of the sentence and assume that I must disagree with it because I’ve pointed out a negative element.

– end rant

Indeed, which is why I agree that we’d be better off with some limitation on allowed incentives. But that doesn’t mean there’s no price.

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83

The trouble is that this affects public research as well. After all, shouldn’t we be funding research that aims to improve the most lives possible? Isn’t that what responsible government does?

Which is a variation of the universal truth that “having needs outside of the norm sucks and the further outside the norm, the more it sucks.”

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84

No argument from me regarding the patent system as currently practiced. Not least, you don’t dare ever read patents for their intended purpose (spreading of knowledge) because it increases the liabilities in case you get sued. Most of mine (a score plus) are what I would have said weren’t worth pursuing; a couple really were and for the previously cited reason were not useful to others who had to reinvent them and then got sued for their efforts.

85

Lots of things. Not always in the public good. if you’re jacking up the price so high that people can get the medication they need, and then fucking dying, then it’s not much of a public good is it.

An individual becoming rich is not a great way to measure public good. And on top of that, intellectual property has become a means of ensuring corporations continue to hoard wealth off of ideas as opposed to eventually moving into the public domain so that we can all benefit.

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86

excuse me? No. They are elected to pass public policy. That’s part of the problem with the current congress and congress for the past few years - they don’t get shit done.

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87

My guess would be that Bill Gates is (a) smarter and (b) better at getting results than government of, for, and by the lobbyists.

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88

Allowing some financial firms to fail in 2008 (thanks for nothing Bush), or prosecuting some mortgage fraud (thanks for nothing Obama) or passing financial reform which prohibited bailouts (thanks for nothing Congress) would have been a big step in the right direction. It’s easy to win big when the taxpayer will make good your losses.

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89

Sorry for not making it clearer - I view passing public policy against an opposition as a battle (of sorts). And you don’t really build support for a policy by pointing out its costs. Any such admissions will be be “weaponized” by the opposition.

However, while pointing out costs is not ideal for promulgating policy, not pointing out costs is fairly poisonous for formulating policy. Alas, our culture has progressed to a point where there are few arenas for formulating policy, only fighting for policy that we somehow already “know” is correct.

I don’t feel this serves us (or society-at-large) well.

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I think you are referring to status quo bias. We are not evaluated freshly each time, we are evaluated one what we’ve been earning before. And that’s for logical reasons - it’s pretty hard to tell if someone is “worth” $x, but it’s rather more likely that he or she is if a bunch of other people have felt that they’re worth $x.

But I’d argue this is true for almost any $x. Manufacturing hit a lot of lower $x hard (and is a bigger crisis simply because there are a lot more people affected), but outsourcing certainly ended a large number of careers, thus halving the income of a lot of six figure salaries.

I do think it’s important to acknowledge the importance of luck, but let’s talk about the luckiest unmerited break of all - being born in the developed world. We’ve all had enormous luck even as we acknowledge that many are luckier than others (we’ve all managed to match 5 numbers in the lottery of life, some have manage to match 6).

But that also doesn’t discount the role of merit (no matter how you define it) in success as well, which is why I don’t think (for example) a 95% marginal rate at $100K is optimal.

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91

I’m not trying to argue here, and happy to be shown I’m off, but I just don’t see how those numbers work out.

Pharma spent $5.6 billion on DTC marketing in 2016. Now, I realize, too, that those numbers don’t reflect advert /marketing costs to doctors or hospitals, but it can’t be that much more again than that.

http://www.mmm-online.com/commercial/drugmakers-again-boost-dtc-spending-to-56-billion-in-2016/article/642028/

And, here’s a 2015 E&Y report that lists north of $60 billion in acquisitions – even if any three or four of these are completely pre-approval, spending nothing on marketing – these numbers are already showing a bigger spend on research. Most of big pharma has very little internal R&D these days because they’d rather buy stuff that’s proved out, at least to Phase I or II.

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92

I don’t believe this.I was a pharma rep, and before that I did biology research, so I have a little perspective. University research is pure research. On animals, like mice, etc or on cultured human cells. As we work out how cells and organisms work, that definitely CAN give ideas on how to design drugs. But, as we sadly know, there are a ton of “breakthroughs” in cell science that simply do not translate into anything medically useful. Lots of compounds work really well in various animal models, but do not work at all in humans.

Work done in government research - like the NIH, etc I am not so familiar with.It could well be that drug development is done there, and it would be very interesting to propose that there be a Federal Pharma department set up so government monies → government research → novel drugs, they could be tested, approved, patented, and then manufactured by the government for people to use. Worth exploring!

But it would be controversial, I bet, because the lion’s share of drugs that get discovered, and make it all the way to human trials, do not pan out. Literally, it a hundred to one shot or worse. And then you have the expense of human trials - they cost a fortune. Really-hundreds of millions of dollars, or sometimes, more than a billion dollars per drug. And seven out of ten of those result in drugs that can not be approved.

This is a part of the reason - a legitimate part - of why true novel, breakthrough drugs are so rare, and expensive. And the sad thing is - and this has been talked about for about twenty years now - the pharma industry is in a gigantic slump. The “easy” therapies have all been discovered a while ago. We are dealing with diseases that are much harder nuts to crack.

Personally, I believe in socialistic solutions. I would love to see all of medicine become a commons project. But I am guessing that spending hundreds of billions at the NIH every year without much to show for it would become controversial.

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93

“Markets will not, on their own, fund profoundly effective cures for diseases that destroy our lives and families.” That’s not exactly true. Gilead’s stock skyrocketed after it bought Pharmasset (the company that actually came up with the Hep C cure which it purchased for a big sum). Gilead’s stock declined years later given that other companies (Abbvie and Merck) developed their own cures, resulting in a price war. Gilead is still way more valuable than it was before the hep C drugs. While this doesn’t mean markets are perfect, cures are still valued.

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94

I am really confused.
Are these blue, dried, pills for frogs?
Or pills that cause frogs to become blue and dried?
Or pills made from blue, dried frogs?
Or are the pills blue, and made from dried frogs?
Or are the pills to make dried frogs happy again?
Or do the blue pills re-hydrate dried frogs, (probably making them happy again)?
Or do they turn the taker into a blue, dried frog?
Or…
(Omg, I think it’s blue dried frog pills all the way down!)

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95

Anyone up for a bet on how long it will be before one of the purveyors of a gene-editing based cure takes the obvious(if potentially PR-problematic and deeply lawful evil) step of arguing that cured patients, their cells full of patented and/or copyrighted DNA sequences added during the course of the cure; are committing grave infringement with every round of cell division unless they have an appropriate license?

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Is allowing Goldman Sachs to exist a sustainable civilization model?

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I think that last sentence is supposed to say “can’t”?

Anyway, Apple has a gross profit margin of not quite 40%. The lowest gross margin for this list of major pharmaceutical firms is 42%, going up to 90%. Big familiar names lime Johnson & Johnson, Pfizer, and Bristol Meyers? Between 60 and 70% gross margin.

I think it’s appropriate to call that an unreasonable profit margin. Companies like Apple (which everyone loves to bash for its high margins and high priced gadgets) are mere amateurs when it comes to this level of naked corporate greed.

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Yes, I typo-ed. Also sure 42% is a whole lotta profit. I’m good with coming up with another way to do it that doesn’t happen to produce that profit margin…my prime motivation is to make people better though, it may or may not produce very different margins. To me that is very secondary…although I expect if it produces no profit it is less likely to succeed.

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I used to be a public university psychopharmacology researcher, mostly working with rodent models.

Some of it was pure research (what does this neurotransmitter do?), but most of it was applied. I worked on mechanisms of neurotoxicity in recreational drug use; others in my lab investigated the neurological and behavioural impacts of pharmaceutical therapies. SSRIs, chemotherapy drugs, pharmaceutical addiction therapies etc.

Our research began with benchtop and rodent work, but it also included human trials. As most of what we did was either nonprofitable (e.g. my work with party drugs) or directly opposed to pharmacorp interests (e.g. my colleagues’ work on the negative effects of psychiatric drugs), there wasn’t a lot of pharmacorp money involved.

Our funding came from a mix of government money and private donations. The lab gained about half a million dollars in government funding on the back of my research, and shortly after I left they recieved a $20,000,000 private donation to work on therapeutic cannabis (courtesy of a wealthy donor whose daughter had recently died of cancer).

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100

Couple of years ago, I joined Twitter thinking I’d find some people who also have fatigue syndrome and maybe find some tips and advice. At least four or five foundations or such association types aggressively tried to recruit me to join them in their fight against “rare” diseases. Meanwhile the incidence of ME/CFS is higher than Multiple Sclerosis. I kept saying, but it’s not rare. They kept saying… join us… we need donations. So that was when I caught on. Scam, from start to finish.

Honestly every middle aged woman with thyroid issues knows this already, but to have it spelled out is really a novelty.

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Step 1; force pharma to stop advertising and marketing. No such activity allowed, ever. Put the savings into defraying costs.

Step 2: For every 2 years that a pharma company has a treatment for a disease but not a cure, they must pay into a pool to fund a cure, some percentage of their profits from the treatment. If they do have a cure, but it’s less than 85% effective, they must continue to pay until they get an acceptable cure.

Step 3: Informed consent is exactly that. It’s spelled out in detail, even if jargon must be used. Consent forms must be provided a week in advance of treatment so that people have time to search on line or ask their MD for help. If that’s not possible, then the MD doing the procedure must spend a minimum of 25 minutes taking questions on it.

Step 4: No more speed dating office visits. Minimum 25 minutes per visit.

Step 5: If a person is taking more than 3 drugs for any reason, the reason is updated every 3 months with an explanation in their record, and if it’s going to continue, why that isn’t “treatment failure.”

Step 6: Obesity centers open, that specialize in fatigue syndrome, thyroid issues (including reverse T3 correction), SIBO and repeated gut infection, screening for IBD and Celiac, sleep diagnostics and treatment that really works including circadian reversal, PCOS and other specifically female illness. There is a payment plan where they pay you and your workplace to go there, instead of the reverse. They pay you from “lack of cure” penalty money they get from the pharmacos. Some percentage is worked out so you can keep your home and pay your bills while there, and your workplace doesn’t have to pay you as much for your time off.

Step 7: Clinical Practice Guidelines and Pharmacy Practice Managers are abolished so that your doctor can plan your health for you as they always should’ve been able to, and the merry go round of generic brands can stop.

This would make a start on a healthier society.

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