F#@K pharmaceutical companies!!!

[mongooz]

These "problems" are a huge step forward from the American system. Of course Canada's isn't perfect, but I'd take it in a heartbeat over the mercenary system of profiteering we have in the US. And, the Canadians are still trying to improve theirs. The republican party down here keeps trying to make ours worse.

Then take a look at the French or Norwegian systems to see the idea implemented even better. Do you really think the United States isn't as capable as France to create a great healthcare system?

actually, no i do not think america is capable of creating a system even like canada's, let alone the others. our system/society is way too attached to profit and greed. short of a full revolution, i don't see it happening . the criminally rich will never allow it.

 

[Chad]

I want to say again, I don't dislike folks who work for pharma or insurance companies. Everyone has to make a living. The ones who suck are the ones at the top making 20 million a year. I'm pretty sure those aren't the folks here, I know if I had 20 million, I would spend my time swimming naked in my money, not posting on a guitar forum.

 

[GDSmithTX]

It's not first-come-first-serve, it's triage.

When I was first diagnosed with cancer, at 22, I had an MRI in the morning, consulted with a neurologist that afternoon, consulted with a neurosurgeon above 10 days later, was admitted that afternoon, and had my first surgery that Friday. All in all, about 16 days. Since then, I've had more surgeries, and regularly scheduled MRIs every 3 months.

If I was living in the US, I'd literally owe millions.

Canadian health care horror stories are just that; campfire stories intended to scare, not to reflect reality. Not saying it's perfect, but you don't have to weight the pros-and-cons before visiting the Emergency Room or calling 911.

I work for a large, multinational firm and we have good insurance; on Sunday I will have been there for 14 years.

Back in 2008, a friend and coworker named Maria and I were the last people left on our floor of the building, working to get a proposal out before Thanksgiving holiday. As I was wrapping things up and transmitting the submittal to the client, Maria came into my office, looking sweaty and pale, and said she was feeling odd. I felt her forehead and could tell immediately she had a serious fever, so I took her downstairs and drove her to an urgent care facility a few blocks away, near her home. Then I took a taxi back to the office and got my car and left for the holiday.

When I got back to work on Monday, I found that she'd been admitted to MD Anderson hospital here in Houston with leukemia, and that if she'd delayed seeing a doctor for even a few hours, she'd certainly have died. She never came back into the office again. At her request, I took a company laptop to her in the leukemia ward of MDA downtown, and she worked as much as she could through her treatments (she was a technical English/Spanish/Portuguese translator, something very much in demand in my field) so she could stay on 100% salary as long as she could (long term disability pays 60% salary).

Fast forward to today, nearly 8 years later. After years of excellent treatment, she's still alive. But my company's excellent insurance reached its financial limit years ago. She was placed on long term disability and eventually let go, with LTD insurance providing her with a smaller income. She is still fragile and can't work, and she has to go back into the hospital two or three times a year when her immune system breaks down.

The last time I asked about it, which was a couple of years ago, her personal medical bills (without including the surely millions that our insurance paid for her care) were very near $2 million. It has doubtless exceeded that by far now.

She's alive .... but she's 59 years old, unable to work, and saddled with debts that would cripple her for the rest of her life .... even if she suddenly makes a complete recovery and is able to work another 40 years.

And that's someone with excellent insurance.

Ladies and Gentlemen: the US Healthcare System.

 

[Beyer160]

But even then, I was aware of exceptions such as anything that had to do with pollution and external costs

Indeed.

In the the early 1980s, International Paper began dumping a toxic byproduct of the paper making process called "black liquor" in the Androscoggin river in Maine. The logic behind this was that after deregulation by the Reagan administration, the EPA fines for dumping were now cheaper than properly disposing of the stuff. How exactly would a "free market" have stopped that? Were people all over the US just supposed to know about this and boycott IP? Does anyone think a school system in Texas or a printer in Chicago would cancel their paper contracts with IP just because some hicks in Maine had their water poisoned? I don't understand how supposedly intelligent people believe this stuff- and obviously, you don't either.

I'm fairly certain there's a reason that Libertarians are all about Free Market economics and weed- the two are definitely related.

 

[Tiltsta]

Whenever someone brings up the "high cost of developing drugs" (which is really just code for "high executive salaries"), I counter with- "well, why should the US shoulder the drug development costs for the entire world?" If every other developed nation on earth can tell the pharma industry "no, we won't pay usurious prices to give your c-suite outrageous bonuses, thanks" then why can't we?

More food for thought: 20-some years ago, pharma giant Glaxo bought pharma not-quite-as-giant Smith-Kline Beecham. SKB's research policy had been to allow teams to pursue studies of scientific merit for a certain amount of time, regardless if there was a potential profit in it or not, just in the interest of science (and because you never know where research is going to lead). Glaxo stopped that immediately. Today, GSK (as they are now known) has dispensed with its research department entirely and will be buying their data from independent research facilities. So clearly, the emphasis in medical research is now heavily weighed towards drugs that will be most profitable, regardless of their humanitarian value. In other words, boner pills trump obscure epilepsy drugs.

I would love to see more regulation of pharma.

I disagree that the high costs of drugs are due to just executive salaries. Screening for drugs is expensive. The last full deck small molecule screen my academic non-profit lab ran took 3 years and budgeted out at around 2 million dollars. We screen at about 1/10th the scale of a Merck or other pharma. The project is currently in med chem SAR, which might take 3 years or so, and probably will run a coupe of million dollars. This might involve back to basic research for a few years to reply understand the mechanism of how a drug works and acts. It could be a one year process or a ten year process. Figure around 500k a year for this for a tiny academic lab, and way more for a big company. We then have preclinical work in animals, which will run around a million. If everything goes well, we will have a new investigational drug to submit to the FDA for a phase I. We can never afford the trial, so the idea is to then license it out or partner with someone who can. For every 100 times you go through this process, you get to that phase I trial stage once. Many fail early in the budget, and a lot fail late. Some even fail long after they hit clinical trials where the expenses are in the tens of millions. Companies have to recover the costs of all those failed attempts somewhere, so they charge a fuck ton for the drugs that make it. Pharma screens decks 10-20 times bigger, so you can multiply the costs. We are non-profit, so we get access To a lot of tools for free, where pharma has to pay licensing to IP holders to use technologies. Then you have patent issues,more FDA compliance tests, etc. Point is, you can get to that brand new drug and have hundreds of millions in costs to recover, and that is huge, even compared to executive salaries. A friend at a big pharma once told me they only work on blockbuster drugs with 1 billion or more in sales potential, as they can't afford to work on smaller markets.

So, yeah, pharma CEOs are douchebags and get paid way to much to screw all of us, but the actual science is stupid expensive to do, and, unfortunately, our system of pharma has placed for profit companies in charge of this stuff. They are not in business to go out of business. I think we need some type of reform of the whole mess, but I don't see that happening any time soon.

GSK still has basic research labs. I know people who work there. Of course, I agree that the days of a Roche Institute or GNF are long gone. The basic science people at GSK now do basic research restricted to very narrow therapeutic areas that are product development target areas. I suppose it is debatable if this is really basic research. It isn't to me, and that is why I don't work in industry.

Apologies for the solid block of text. I had to type this on my phone. If it sounds disjointed and crazy, it is because I am typing between parent teacher conference meetings for my kids and having to save as I go. Also, I'm not trying to be argumentative, and I apologize if it comes off that way. I agree with you on a lot of things you posted. I'm just trying to add some of my perspective as a nerd who actually looks for drugs as part of my job.

 

[mongooz]

well then....i guess the 'for profit' business model is fatally flawed, in that it's prime objective is to make money, not turn out a product is useful or helpful to the consumer.

our system is a failure and will continue to fail spectacularly until the profit is taken out of it, in favor of the best interest of the people.

oh wait.....did i just paraphrase the decclaration of independence??

 

[Beyer160]

Also, I'm not trying to be argumentative, and I apologize if it comes off that way. I agree with you on a lot of things you posted. I'm just trying to add some of my perspective as a nerd who actually looks for drugs as part of my job.

Not in the least, I appreciate your perspective. It was my understanding that GSK was in the process of outsourcing all its research, but I may very well be wrong. I do know they've sold off most, if not all their labs in RTP and the staff became contractors to the new owners.

 

[Tiltsta]

Not in the least, I appreciate your perspective. It was my understanding that GSK was in the process of outsourcing all its research, but I may very well be wrong. I do know they've sold off most, if not all their labs in RTP and the staff became contractors to the new owners.

I know some basic research people working at GSK at RTP. These are people I went to grad school with and such. I can't say if they are a select few who still have jobs there or not. It certainly wouldn't be outside the norm for a company to outsource. I'm likely not seeing a broad picture, as I know people in a few therapeutic areas that don't come close to covering GSK's portfolio.

The trend I see is that lots of pharma work like investment banks now, preferring to acquire IP by buying smaller companies. It is cheaper than doing research and getting to that investigative new drug phase. They all have scaled back research over the years. I've heard some desire to go back to the old internal research system as they often have a hard time with reliability of acquired IP. I don't know where the market is going, but I suspect a mix of acquisition and de novo research in the future.

Another common trend that causes closures of facilities is the incentive scam. Big company gets a tax break to build a lab (often paid by taxpayers for the facility) in a new place, they do, and meet the terms of the deal, then pull the plug and move to the new tax break site as soon as they can. They fire most of the scientists and start over in a new place with young cheap people. Pfizer has done this lots of times in my career. They hosed the UK on their Sandwich facility a few years ago. Friends who work in industry are used to this stuff. Many of them have worked together like 4-5 times at different companies and facilities.

 

[GDSmithTX]

well then....i guess the 'for profit' business model is fatally flawed, in that it's prime objective is to make money, not turn out a product is useful or helpful to the consumer.

our system is a failure and will continue to fail spectacularly until the profit is taken out of it, in favor of the best interest of the people.

oh wait.....did i just paraphrase the decclaration of independence??

No, but you made a hell of a lot of sense.

 

[Bob411]

The libertarians who say "well, it is not truly a free market so it is not working right"

Not a libertarian, just somebody that's self employed and, taken it up the rear end for years from insurance companies and, really, really wanted single payer.

I do agree it's not a free market. I think any insurance creates a false demand. Take car insurance, "not saying we shouldn't have it", it's just a good example. You come out of the grocery store, apparently, the car that was parked next to you scraped your car from one end to the other. No, they didn't leave a note. It's drivable, even the doors work. It just looks like shit. Estimate to fix it is $3,000. There is a percentage of people who want their baby perfect but, a lot of people would just live with it.

 

[Chad]

I would love to see more regulation of pharma.

I disagree that the high costs of drugs are due to just executive salaries. Screening for drugs is expensive. The last full deck small molecule screen my academic non-profit lab ran took 3 years and budgeted out at around 2 million dollars. We screen at about 1/10th the scale of a Merck or other pharma. The project is currently in med chem SAR, which might take 3 years or so, and probably will run a coupe of million dollars. This might involve back to basic research for a few years to reply understand the mechanism of how a drug works and acts. It could be a one year process or a ten year process. Figure around 500k a year for this for a tiny academic lab, and way more for a big company. We then have preclinical work in animals, which will run around a million. If everything goes well, we will have a new investigational drug to submit to the FDA for a phase I. We can never afford the trial, so the idea is to then license it out or partner with someone who can. For every 100 times you go through this process, you get to that phase I trial stage once. Many fail early in the budget, and a lot fail late. Some even fail long after they hit clinical trials where the expenses are in the tens of millions. Companies have to recover the costs of all those failed attempts somewhere, so they charge a fuck ton for the drugs that make it. Pharma screens decks 10-20 times bigger, so you can multiply the costs. We are non-profit, so we get access To a lot of tools for free, where pharma has to pay licensing to IP holders to use technologies. Then you have patent issues,more FDA compliance tests, etc. Point is, you can get to that brand new drug and have hundreds of millions in costs to recover, and that is huge, even compared to executive salaries. A friend at a big pharma once told me they only work on blockbuster drugs with 1 billion or more in sales potential, as they can't afford to work on smaller markets.

So, yeah, pharma CEOs are douchebags and get paid way to much to screw all of us, but the actual science is stupid expensive to do, and, unfortunately, our system of pharma has placed for profit companies in charge of this stuff. They are not in business to go out of business. I think we need some type of reform of the whole mess, but I don't see that happening any time soon.

GSK still has basic research labs. I know people who work there. Of course, I agree that the days of a Roche Institute or GNF are long gone. The basic science people at GSK now do basic research restricted to very narrow therapeutic areas that are product development target areas. I suppose it is debatable if this is really basic research. It isn't to me, and that is why I don't work in industry.

Apologies for the solid block of text. I had to type this on my phone. If it sounds disjointed and crazy, it is because I am typing between parent teacher conference meetings for my kids and having to save as I go. Also, I'm not trying to be argumentative, and I apologize if it comes off that way. I agree with you on a lot of things you posted. I'm just trying to add some of my perspective as a nerd who actually looks for drugs as part of my job.

I'm not saying the high cost is only the executive salaries. It is part of it. When you add that to the lobbyist pay, the tv commercials, the buying lunch for huge doctor's offices, it starts to add up. I know it's expensive to discover and create these drugs, my uncle is a chemical engineer for a big pharma company we've had discussions about it. I'm saying when you throw, 20 million here, 40 million there, a couple hundred grand at that it starts to add up and where does the cost end up getting dumped? On the sick people who depend on the drugs. There needs to be huge reform in the entire system.

 

[gtrjunior]

i get that, but also....how many people died waiting for the drugs that could have saved their lives?

Also, how many people died taking drugs they couldn't afford

 

[Chad]

i get that, but also....how many people died waiting for the drugs that could have saved their lives?

While that is true, think of how many people could die as the result of a drug that hasn't been fully tested. It's a fine line between overly cautious and reckless. I'm sure the FDA requires far too much testing, red tape and a little payola. Trust me, I had non-Hodgkins lymphoma in 1975. The medicine and radiation I had wrecked me and cause me to have heart failure, most likely since I was in middle school, maybe even sooner. I'm sure there were new drugs on the horizon that could have been less toxic for me that just hadn't made it through yet. Luckily I'm still here to bitch about pharma and insurance companies on a guitar forum. BTW, my mom didn't work when I had cancer and my dad was a school teacher making less than 10k per year and we had almost 0 out of pocket expenses. Insurance was much better then, it wasn't about lining the share holders and CEO's pockets.

 

[Flamencology]

I'm suspect that a major issue is that the FDA is probably underfunded.

 

[TomcatMF]

I have to agree with much of what Tiltsta has said about the high cost of R&D. I don't work in the pharmaceutical industry, but I do work for a company that is heavily in telecommunications R&D, and I can personally tell you that it is insanely expensive to develop new technology. Pushing the envelope to the bleeding edge is often trial and error, and it takes a lot of man hours with highly skilled, and therefore highly paid, professionals to sort out the issues and get things to work. And for someone to invest the 10's of millions it takes to get through all that, it's not unreasonable to expect a return on that investment.

On the other hand, I can agree that the current system is not working, and the ACA hasn't helped matters at all, and has in fact made it worse for those of us that have health coverage from their employer. Deductibles are much higher, and out of pockets costs have soared for me since this law went into effect. Now add to that the fact that the companies who profit from this are really sticking it to us. This includes the health insurance companies, pharma, hospitals, etc. And this recent case with the Epi pen costs is a prime example of that. They are just gouging everyone because they can. It is not a new drug, and the R&D costs were recovered long ago. This is greed pure and simple. It's wrong, but how do you regulate the cost of these drugs without impacting R&D investment on the next big thing? There really is no perfect solution here. Whatever the government does, there will be unintended consequences.

 

[Beyer160]

While that is true, think of how many people could die as the result of a drug that hasn't been fully tested. It's a fine line between overly cautious and reckless.

In 1955, the first mass vaccination program against polio had to be abandoned when a faulty batch of vaccine caused 40,000 cases of polio in the US, paralyzing 200 children and killing 10. The FDA certainly needs reform, but lets remember why they're cautious in the first place.

 

[mongooz]

In 1955, the first mass vaccination program against polio had to be abandoned when a faulty batch of vaccine caused 40,000 cases of polio in the US, paralyzing 200 children and killing 10. The FDA certainly needs reform, but lets remember why they're cautious in the first place.

i'm not against trials and caution. but the way our FDA operates, it is a LOT of red tape and beauracratic/political bullshit. the other countries with the better healthcare also have review/testing agencies and you don't see their citizens dropping like flies because of bad/ill tested new drugs.
in fact many of OUR citizens (that can afford it) go THERE to get the treatment they need that was approved years ago THERE, and we're still mired in bullshit holding up approval here.
if other countries have the new drug out and it's being prescribed and it's being successful and it's not causing undue side effects/deaths, then why the hell can't the FDA put those (already approved by others) drugs at the head of the line and expedite them out to the public?
because if they suddenly became more efficient, then congress would not approve the crazy ass budgets that they ask for each year.

 

[Flamencology]

I'm suspect that a major issue is that the FDA is probably underfunded.

@Tiltsta - can you speak to this, one way or another?

 

[Tiltsta]

@Tiltsta - can you speak to this, one way or another?

The FDA has been chronically underfunded for many years. I can provide a shit ton of examples and articles to this effect if needed. Suffice it to say, the FDA has around half the budget they require to perform their mandated duties. The FDA does a lot more than approve new drug applications. I think the FDA needs more money, but I think even if fully funded, new drugs wouldn't go from IND to approved medication much faster than they do today (maybe a year faster out of the ten years it might take). The limiting issue is how fast one can conduct clinical trials that meet appropriate safety and efficacy standards. You can be good, or fast, but not really both.

 

[Beyer160]

i'm not against trials and caution. but the way our FDA operates, it is a LOT of red tape and beauracratic/political bullshit. the other countries with the better healthcare also have review/testing agencies and you don't see their citizens dropping like flies because of bad/ill tested new drugs.
in fact many of OUR citizens (that can afford it) go THERE to get the treatment they need that was approved years ago THERE, and we're still mired in bullshit holding up approval here.
if other countries have the new drug out and it's being prescribed and it's being successful and it's not causing undue side effects/deaths, then why the hell can't the FDA put those (already approved by others) drugs at the head of the line and expedite them out to the public?
because if they suddenly became more efficient, then congress would not approve the crazy ass budgets that they ask for each year.

"Some have argued that the EMA’s processes allow for quicker approval than those of the FDA,[7] but closer review demonstrates that the FDA typically approves drugs more quickly than the EMA—both new medicines generally and cancer therapeutics specifically"
http://www.cancernetwork.com/oncolo...l-implications-drug-development-and-cost-care

And they don't receive "crazy ass budgets." You're thinking of the military.

Evidently, someone has been very successful at planting a false impression in your mind regarding government inefficiency and waste. Who might that be?