I'm having trouble following the exact thread of the post, but is the idea that this conflicts with Conventional Lefty Wisdom about big pharma? If so, two companies working on a dengue vaccine as part of their portfolio at different doesn't say much about the overall picture.
(Also pharma R&D has been light on big breakthroughs lately, so I can see these companies putting new focus on this if it's the best they've got.)
I got the same thing out of the post that Minivet did, but am likewise not sure I grasp the point.
Anyway, the correct argument seems to be that pharma companies, not left-liberals, failed to pick up on a market signal.
Critical medicine costs are so awful in this country that they're practically tantamount to willful homicide. My experience with them is via having a cat with pre-existing conditions so I have to buy some critical human medicines for her at no-insurance prices*, and it's absolutely absurd. A 3mL Lantus Solostar pen costs about $95, which lasts a month. The one that really gets me is Flovent HFA, her asthma inhaler. A 220mcg inhaler, also about a month's supply, costs $400. That's entirely due to the patent on the propellant used, not the medicine itself. I've started buying an overseas equivalent product by the same company, GlaxoSmithKline, where I pay $150 for three inhalers. That's $1050 savings per three month period. That difference is 100% rent seeking. I'm lucky in that I can afford it and it's just a cat.
I want to blame big pharma, and they of course share blame for profiting from and lobbying for this situation, but this is mostly a regulatory fail. Every dead diabetic or asthmatic is on our legislators and regulators.
* If you're also a big softie about animals, I'd say don't make my mistake and get pet insurance, but I'm not sure how well coverage continues year to year--does a covered condition in year 1 become a pre-existing condition in year 2?
How do you get a cat to inhale at the right time?
I am mystified by the insulin thing. That is, this is going to sound naive, and the answer is going to be some version of either monopoly pricing power that anti-trust enforcement has overlooked, or some effective coopting of regulatory power. So I believe there's an answer, but I don't know specifically what it is. That said:
Insulin is generic. There are modern insulins that are still under patent and can be kept expensive for that reason, but insulin that was adequate enough to keep people alive until a few years ago is off-patent, and it should be possible for any company capable of producing it to make a profit selling it for the cost of production plus a small margin. What's keeping that from happening? Is there cheap insulin on the market, but doctors won't prescribe it because they don't understand that their patients are dying because they can't afford the expensive stuff? Or is there no cheap insulin available at all?
There must be journalism out there that explains what's going on, I just haven't seen it.
4: Stick one of these over their face. It has a mechanism that makes it easy to measure how many breaths they take. Luckily my cat is pretty calm and well-behaved about it.
That's way more sensible than what I was thinking.
Was just viewing The Constant Gardner last night. Big Pharma bad in that movie - my sister, who worked for one of the bigger Big Pharmas, fulminated against it.
We are also running short on a bladder cancer drug. https://www.statnews.com/2019/02/20/supplies-bladder-cancer-drug-bcg-dwindling/
This seems like a really good situation for a nationalization of a generic drug maker, with a mandate to ensure supplies of any drug without at least 5 suppliers.
5: Does this explain it? I'm not sure.
So, when it comes to insulin and other pharmaceuticals, drug companies are not competing to offer consumers the lowest price, according to TIDF. Instead, they are competing to offer benefit managers the highest rebate on list prices. The higher drug companies set their list prices, the higher the rebate they can offer benefit managers. This feedback loop explains why the price of insulin keeps going up even though the drug has been around for decades.
It's just great how this thread has been entirely about chronic medications for diseases of the rich. And their cats.
chronic medications for diseases of the rich.
A once a day pill to treat affluenza?
12: Diabetes is not a disease of the rich. But it will be if treatment becomes unavailable to the poor.
All Americans are rich by global standards.
We had an interesting discussion on this at work, as we of course see ourselves differently from companies who jack up prices on generics. I believe the term used to describe Shkreli's and similar behaving companies was blight on the industry.
In the bigger picture, drug companies have long had compassionate distribution or even entire programs that they gave away to poor countries. Merck famously gave away the cure to river blindness. But lately it's been all about profit and stupid incentives like the whole PBM scam.
Commentary on the economics of vaccine development?
Diabetes prevalence is rising faster in low-income countries. (As for asthma, it correlates with air pollution; 1/10 of the world's asthmatics live in India. While they're probably most urban, I doubt they're mostly rich. I assume similarly with China.)
Jesus God, but American health insurance is evil as well as fantastically stupid.
Maybe the answer is that Dengue is returning to the United States as tropical mosquitoes expand their range.
Also, Dengue was pretty rampant when I was in Trinidad. Both rich people and poor people got it. I imagine those rich people would pay good money for a vaccine.
19: Almost as if those countries are getting richer! Who knew? Also, 1/10 1/7 of the world's asthmatics humans live in India.
I thought India was getting diabetic way faster than it was getting rich.
23: So India's rate is at 0.7 times the world average. That's not that much less? Even if the diseases correlate weakly with wealth, there's a substantial number of poor people with them, by any definition of poor you'd like. Calling them "diseases of the rich" doesn't seem useful, unless you meant "diseases of the rich, but also of the very many poor people who have them."
25: Indeed! Now, wasn't that more profitable than thinking about your cat?
Asthma is more likely in poorer Indian states than richer ones. To my surprise, it's also more common in rural than urban areas--I would have assumed that proximity to industrial air pollution (which probably doesn't correlate with wealth) is the main cause, but perhaps indoor fires are a stronger cause?
I was mostly talking about cost in the American context, and brought up the cat to explain why I'm coming at it from the perspective of an uninsured person. I thought that was reasonable given the OP's aside. I apologize if I've been bringing the profitability ratio of the thread down, or increasing its American-centric myopicity.
Like, so much more profitable.
I also want more Austen references. You people are letting me down.
29: Don't let yourself be cat-shamed.
I have no objection to cats, so long as they earn their keep in rats.
33: Insulin information wants to be free.
Honestly, cats are horrible at giving rats orgasms.
But lately it's been all about profit and stupid incentives like the whole PBM scam.
Pretty sure the PBM thing is itself something of a scam - not that PBMs aren't bad actors, but big pharma in the last couple of years saw themselves in an increasingly precarious public position and mounted a full court press to get journalists, think tanks, committees, etc. to start blaming drug pricing on PBM practices to draw away fire.
28: AIMHMHB indoor air pollution is a huge and virtually unknown health story. An old friend of mine works on it at WHO. I think she said it's about the fourth biggest cause of mortality and morbidity IN THE WORLD and it's overwhelmingly due to cooking indoors over open fires without proper fireplaces. So it mainly harms women (who cook) and young children (who the women keep indoors with them so they can watch them while they cook).
Rural Indians, I would imagine, are less likely to have stoves and chimneys - hence more air pollution.
(Or less likely to use them. Another friend was incensed to visit her in-laws in rural Cameroon and see them cooking over an open fire in the middle of the floor - the smoke drifting up and eventually oozing out through the thatch - while a perfectly good stove with chimney sat unused in the corner. Cooking over an open fire was good enough for their grannies fifty years ago and they're damn well going to keep doing it now. She took her kid away with her sharpish and now cooks on an electric stove in north London. The kid's fine.)
On the subject of insulin, we are now at serious danger of running out of the stuff in a few weeks, which will be fun. The prime minister is herself a diabetic, so at least she can't be accused of putting personal gain before (idiotic) principle.
Another friend was incensed
Also an underappreciated source of air pollution.
41: There are for real op-eds about it round here.
Dengue has been heavily researched and many vaccine studies have been done. The less-neglected Neglected Tropical Diseases are basically malaria, other single-celled parasites (Schistosomes and Trypanosomes), dengue, yellow fever, west nile virus, and the new entrants into the field Chikungunya, Zika, and Ebola.
Dengue in particular is very hard to vaccinate for. The reason is that there is a disease called Dengue Fever, and then there is a WORSE disease called Dengue Hemorrhagic Fever. People at risk for Dengue Hemorrhagic Fever are people who were already infected with one strain of dengue virus, and therefore have antibodies against it, who then get infected with another strain. The antibodies make the disease worse. More likely to have dangerously low blood pressure and other signs that look like the septic shock you get from hyperinflammatory bacterial blood infections.
DHF is really a side effect of globalization. People in areas where strain 1 was endemic very rarely got infected with strain 2, and vice versa, until after the Second World War. There are 4 major strains. For a vaccine to work it needs to protect against all of these strains very well. If it protects against 2, 3 and 4, but still lets you get infected with Dengue strain 1, your disease will be worse because you have all these antibodies from the vaccination.
Or that's what I learned in class.
There was a cute bit in the Hob Gadling story (Gaiman) where an old man in 1489 is inveighing against the new invention of "chimblies." Gadling has been living immortally at this point since the 14th century.
Old man: When we had honest braziers our heads did never ache. The smoke was good hardening for the timbers of the houses and good medicine for the man and his family.
Gadling: Old idiot! I tell you, chimneys is brilliant. Not having your eyes watering all the time. Not freezing from all the holes in the wall.
41: I believe it. Always makes me sneeze. Whatever my conscious convictions, my mast cells are apparently firmly Low Church.
43: OP Sanofi link goes into that (the antibodies broke their trial). Also apparently there's now a fifth strain.
Anyway, massive amounts of neoliberalism aside, it's certainly not the case the pharma isn't attuned to demand from large, governmental purchasers. They might not always watch the right governments.
Indeed. I hear some of them are developing dengue vaccines for governmental purchasers.
Many of which have larger economies/budgets than in decades past.
Almost as if they're getting richer! Who knew!
I don't know if this was mentioned or how much of the cost is attributable to it , but a lot of patients prefer the insulin pens to drawing a vial.
I recently saw a presentation from a diabetes specialist mentioning a study that showed you can still get good control with NPH insulin, so maybe people should switch back.
Surely you mean "chronic medications for the diseases of the handsome, clever, and rich."
Insulin prices are unlikely to be just about the PBM deals. By law Medicaid must be offered the lowest price on any drug.
And, at least here, it is notoriously difficult to get them to approve coverage for a Type 2 diabetic.
53: Mostly just rich. Prostituting the handsome, clever ones doesn't scale.
||
Gilbert set sail in June 1579 after a spell of bad weather, and promptly got lost in fog and heavy rain off Land's End, Cornwall, an incident which caused the Queen to doubt his seafaring ability. His fleet was then driven into the Bay of Biscay and the Spanish soon slipped past and sailed into Dingle harbour, where they made their rendezvous with the Irish. In October Gilbert put into the port of Cobh in Cork, where he delivered a terrible beating to a local gentleman, smashing him about the head with a sword. He then fell into a row with a local merchant, whom he murdered on the dockside.[citation needed]
"In March 2018 Gilbert was appointed State Secretary for Brexit."
Oh, yay, a thread where conversation hasn't moved on before I arrived AND I have things to say.
Lots of big pharma companies have divisions devoted to neglected and third-world diseases. Check out Novartis Institute of Tropical Disease, or the Takeda Initiative. The Gates Foundation has negotiated with pretty much all major pharma players to provide free compound libraries for screening against tuberculosis for no cost to various researchers.
Folks are correct that government purchasing makes a difference. WHO funding does, too. Also, public-private partnerships, that neoliberal evil, frequently support costs of clinical trials.
The insulin thing is an absolute mess. All I can guess at is evil, greed, and collusion. The "new" styles of insulin went off patent in 2013 and 2014. It isn't a patent issue. Old style insulin does work reasonably well (not quite as well), but it's expensive, too. Here's an explainer from Vox that does a good job covering what is going wrong.
https://www.vox.com/science-and-health/2017/5/12/15621952/insulin-price-increases
vaccine for dengue? sign me up! since narnia is rich it's of necessity a disease of the rich here, I suppose. nonetheless it's awful and people do die of dengue hemorragic fever every year. when one or more people get dengue in a certain area the government posts signs that it is a hot spot, and then focuses intensively on getting people there to do what is mandated by law: changing the water in cut flowers, making sure the dishes under plant pots are kept dry, even putting caps on the supports you put the bamboo poles into to hang your laundry. I have gotten two mosquito breeding tickets in my life here; they can come into your house anytime.
we have malaria here also, but again it's controlled pretty well. still a constant hazard. (honestly the main way they control it is the fogging, which kills the mosquitoes before they bite anyone.) whatever, but if I can get everyone vaccinated against dengue I will be very happy indeed. it's hideously painful. and the prospect of everyone in indonesia getting it is awesome.
the thing we're getting reamed on is epipens, they've more than doubled in price because of some one company taking over another chicanery, I think. and though they claim to expire after a year I am both skeptical and unwilling to risk it.
We did some lab work with Dengue and had to get special training and make sure no one had antibodies that could lead to DHF.
it's hideously painful.
For those who didn't read through the whole Wikipedia article, one thing we learned in training is that a historical name was "break-bone fever" because the pain is so bad it can cause convulsions that result in breaking your own bones.
I knew somebody who had to give insulin to their cat every day. Is that the same insulin? Because priorities.
Al - there is a generic epipen now. Still hideously expensive but less so.
The Missus is a Type 1 diabetic and yeah, the increased cost sucks. Basically what's going on is the quality of insulin has increased significantly as a result of patented improvements. (Its effects are now more predictable than they used to be, for instance, and different kinds of insulin have different effects.) I'm not even sure if people can get animal-based insulin any more.
Patents have expired, but competitors haven't really risen up in significant numbers.
Personally, since I can afford it, I'm happy to be able to take the tradeoff of increased efficacy in exchange for increased price. But of course, in a well-managed healthcare system, that tradeoff wouldn't be nearly as harsh. And I'm not sure why it's getting worse, rather than better, concurrently with patent expiration.
Basically what's going on is the quality of insulin has increased significantly as a result of patented improvements. (Its effects are now more predictable than they used to be, for instance, and different kinds of insulin have different effects.) I'm not even sure if people can get animal-based insulin any more.
It's like in 2011, when the price of the cheapest TV at Best Buy had risen from $30 to $250, because they didn't sell CRTs anymore.
And you needed a new TV every month to live.
In a certain sense, a phone that can stream video is analogous to an insulin pump.
70: "In a certain sense" -- and that certain sense is the complete absence of sense?
72 I did judge you. My verdict was the analogy ban doesn't apply when the analogy is sufficiently preposterous.
Any sufficiently preposterous analogy is indistinguishable from logic