All true, but the root of the expense lies with the science. It’s very difficult to come up with new medicines, particularly ones that are genuinely new classes of drugs. That’s just at the discovery level - mix in the Western world’s current attitude to risk and subsequent regulatory expectations and you have a fiendishly difficult process.
The type of long term research project structure and management you need to tackle these issues are in direct opposition to shareholders wanting big returns on their drug company stocks. The tensioning between the two is currently gone all to shit, hence the pharma industry being on its back at the moment, having eaten itself.
Wait, what? I’m sorry, I gotta take offense to that, even as a second language English speaker: what was wrong with the style of that post? It might have been brief, but what exactly are you talking about?
Besides, people more knowledgable than I have made the point better than I could have done.
It’s not the answer, no, although it is a small symptom IMO. There’s not much scope for a more stratified benefits-outweigh-the-risks assessment in drug approval.
But to think the damn gubbmint is standing in the way of pharma rolling out effective cancer treaments at 1$ a pop would be completely wrong. The discovery process is too difficult. If the FDA were abolished tomorrow it would make zero difference to the discovery of a new Alzheimer’s treatment, or lung cancer, or obesity, or schizophrenia or any CNS disease. How could it? You’re talking about major breakthroughs required across several branches of science.
Research and development and approval testing costs, including making profits to cover the cost of other, failed candidates, are a significant contributor.
Patents are IIRC good for 20 years, and it could take 10 to finish testing and approval processes; so there is only 10 years to recoup those costs.
Yes, some processes are complex and expensive. All the simple stuff has been tested already. This includes not just developing the drug, but also devising mass-production techniques.
Finally, and not to be underestimated, is the gravy train. Like the movie industry, like the music industry before Napster, like Wall Street banking or government contracts - there is a hot river of money flowing by, and those with the power to do so jump in and enjoy the jacuzzi-like experience of hot cash bubbling up from around their cheeks. You can see the money in the large profits, the massive advertising campaigns, the goodies salesmen lay on customers like doctors, the lobbyists and political contributions… and the loud and frequent recitals of the first few reasons as why their gravy train should be protected.
And this is how ridiculously bad grammar persists and becomes mainstream.
If you managed to pull a coherent point out of his post, bravo. Take up a career in mind reading.
The rest of us will have to get by with commonly accepted syntax.
[moderating] echo6160, this is the GQ forum. Please stay focused on the question instead of making disparaging remarks about other people’s language skills.
[/moderating]
A friend of mine is a professor of chemistry at a state university. Hehas talked about this very thing. The most basic research on new drugs is mostly perform by publicly funded studies at universities. Only when a substance shows some promise do the pharm companies start to sponsor the research. So while they do put substantial resources into developing a drug, they do not start by picking a pig in a poke. Universities have already sorted out the bests pigs for them to start with.
Note: I’m not trying to politicize this, so don’t take it that way.
There’s one more twist to the “making profits to cover the development costs” angle, which is that due to the fixed prices that many other countries’ socialized medicine programs are willing to pay for drugs, much(most?) of that profit has to be made in other places where there are not fixed prices.
This means that the prices in the US on many drugs, including cancer drugs, are somewhat higher than they’d be if those development costs could be spread out across all the consumers of the drug, not just the ones where the price can vary.
Also, there aren’t that many people with specific cancers that these drugs are targeting - not like, say, diabetes drugs, which can count on a much larger group of people to make up those development costs.
well, the OP is about cost and availability of cancer drugs. So to stick with the OP it would make sense only to talk about moving cancer drugs out of FDA’s purview or else drastically changing FDA process specifically for cancer drugs. In practice, given how good American government is at changing gears and doing the right thing after doing the wrong thing for decades, changing the process within the context of the same old agency seems very dubious. Probably would be better to make another agency from scratch or else delegate the task to a similar agency in another country with a better track record than American FDA.
BTW, the whole drugs regulation business sounds like an ideal area for trying out outsourcing tasks to better providers. Let’s say Nigeria probably sticks to American or European FDA-type rules which are available to them for free rather than doing its own serious regulation research. So in the same way America could cut down FDA budget and “shop” for drug regulations elsewhere, possibly with practices taken from different sources for different drugs. E.g. Japanese rules might be too conservative for cancer drugs, but maybe they would make good sense for some other area of policy.
Cancer affects a lot of people, but so do type II diabetes and cardiovascular disease. And many of the medications for those 2 diseases are dirt cheap. Each one has a wide variety of drugs on the $4/month prescription plan, plus other generics that are usually less than $20/month.
Orphan drugs are expensive because of the patents and because few people have the illnesses. But cancer is widespread. So I don’t know why the drugs would be more expensive than an on-patent drug for cardiovascular disease. Even with orphan drugs, aren’t the costs usually under $1000/month?
Lipitor is still on patent for another year, but it only costs $60/month. It doesn’t cost 50k a year like some cancer drugs. Other chronic diseases like COPD, diabetes, CVD, etc. have on patent drugs that are higher than equivalent generics to recoup the cost of R&D. But those on patent drugs usually are $200/month or less. Cancer drugs seem far far more expensive than $200/month.
Also, Lipitor has competitors that are not extremely less effective. Competition keeps the cost down - if Lipitor cost $50k a year then doctors would prescribe and insurance companies would only reimburse for some other statin. I believe this is true for many other diseases (blood pressure meds, diabetes meds) - the on-patent drugs are improvements, but not the only game in town.
Cancer drugs are often the only one addressing a particular cancer, or are so much better than the alternatives that there is no meaningful competition. If the choice is $50k or death, people will often pay the $50k.
Even when you have a monopoly, supply/demand still dominates except that supply and price is company determined, not market determined. The company does an analysis on each drug to determine what approximate combination of supply and price maximizes profit and then charges that price and delivers that supply.
Different drugs have completely different demand and supply curves (affected by market size, alternatives to medication such as surgery, older less effective generic drugs, perceived risks with medication, dosage and length of dosage required, etc), therefore the profit maximizing prices will be different. It is inappropriate to say that a cardiovascular drug costs X, therefore a cancer drug should also cost X.
Now if people could use the cardiovascular drug to treat cancer, then we could generally expect the prices to converge towards to the cheaper one.
Try not to let all them facts get in the way of your world view. Regardless of the real reason the drugs are really expensive the Pharma companies are still eeevullll!
Because no matter how benevolent and nice the drug companies like to make themselves appear, they are in the market to make a profit, and are willing to take advantage of the desperation of people who have cancer to do so.
It’s not really a free market. Patents are a distortion of free market principles. We encourage this distortion because we think there’s a greater public good to be served by encouraging innovation at the risk of potentially higher prices for some goods.
Which demonstrates exactly that there’s not actually a free market but one which only partially operates on a competitive basis.