How Much Profit Do You Think Pharmaceutical Companies Are Entitled to?

[IheartIheartTesla]

In general corporate research disincentivizes projects that are open ended, super-large in scope that may take multiple years with no tangible results from quarter to quarter, and are complex (for instance, that may involve collaboration across multiple disciplines). In that sense, academic research is a bit more free, and having tenure would definitely help for "pie-in-the-sky" projects. Some of the above comments then make sense, in that there isnt much malice in the way pharmaceutical R&D occurs. Still, they would rather tackle smaller pieces of the problem that can yield tangible results sooner (for instance, drug cocktails that help manage symptoms of diseases) rather than the root cause of the disease itself. Its just the nature of the way business operates, having performance reviews every year and having something to show for it.

[Which Tyler]

Just come across this article (there have been many similar ones over the last couple of years, but this thread exists now). I thought it might be of interest:

 

https://medium.com/@drjasonfung/the-corruption-of-evidence-based-medicine-killing-for-profit-41f2812b8704

[Mudguard]

1 hour ago, Which Tyler said:

Just come across this article (there have been many similar ones over the last couple of years, but this thread exists now). I thought it might be of interest:

 

https://medium.com/@drjasonfung/the-corruption-of-evidence-based-medicine-killing-for-profit-41f2812b8704

Yeah, here's a related paper published in a peer reviewed journal by a Stanford professor that argues that most published research findings are false.  It's pretty depressing.

Quote

Summary

There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, I discuss the implications of these problems for the conduct and interpretation of research.

Unfortunately, there is no easy solution to this problem.  Eliminating for profit pharma, biotech, and medical device companies would not solve this problem.  It might help a bit in some respects, but it would cause all sorts of other problems.  

Getting back to the original question, I'm in favor of limiting profits but I'm not in favor of eliminating profits.  I don't think nonprofits can adequately replace all the functions of the for profit companies.  They each have their pros and cons.

[TrueMetis]

Did I miss something? Peer review is a great resource but being peer reviewed in not supposed to mean the conclusion of the paper is correct. A paper being peer reviewed and published means is just supposed to mean it's free of obvious flaws and its methods sound. (Not that this standard is always met)

The problem is people are skipping the next step of the scientific process. Repetition. Repeat the experiment or study, look for ways of doing it better. Alter variables to check the effect. Do that a whole bunch of times. Then you can start making claims whether it was correct or not.

[Mr. Chatywin et al.]

18 hours ago, lokisnow said:

Iirc that was a bill clinton special, classic neo liberal bullshit deregulation that screws everybody but the elites donors and buddies.

Looks like you're correct. It was first established under Reagan, but the FDA in 1997 under Clinton really revved it up. 

[Mudguard]

1 hour ago, TrueMetis said:

Did I miss something? Peer review is a great resource but being peer reviewed in not supposed to mean the conclusion of the paper is correct. A paper being peer reviewed and published means is just supposed to mean it's free of obvious flaws and its methods sound. (Not that this standard is always met)

The problem is people are skipping the next step of the scientific process. Repetition. Repeat the experiment or study, look for ways of doing it better. Alter variables to check the effect. Do that a whole bunch of times. Then you can start making claims whether it was correct or not.

It's not as simple as you make it seem.  For example, clinical trials cost millions of dollars to run (often tens of millions or more) and can take many years to complete.  Who is going to do the repeat studies?  Are you going to do them sequentially?  Simultaneously?  Who provides the funding?

Turning to academic studies, who is going to replicate the study published by a professor's lab?  The same professor that originally published the study?  Other professors?  Where are these people getting the funding to go around repeating other people's studies?  In academia, it's publish or perish, and funding is often tight in many labs.  I'm pretty sure that it's extremely difficult to get a grant proposal approved if you simply state that your goal is to repeat someone else's or your own study.  And a professor isn't going to get tenure by spending a lot of time replicating other peoples studies.  Phd students aren't going to get much credit for replicating other people's studies either, especially if they end up getting the same results.  

[TrueMetis]

That's a problem with the culture that's built up around the process. Not the process. Repetition, and publishing null results for that matter, are integral to the scientific method. Blaming the method for not producing correct results when you've only done half the process is not the method's fault.

"repetition costs money" or "repetition isn't as prestigious" are piss poor excuses.

ETA: If people have a problem with not getting correct results, they can either use the method as described and repeat the studies and experiments, they can do the impossible and figure out a method that requires testing only once, or they can get over themselves and accept that sometimes, often even, results will be wrong.

[TrueMetis]

9 minutes ago, Triskele said:

I agree with this post, but I was responding more specifically to the common conspiracy that drug companies are sitting on or suppressing cures.  You know, the person who thinks a doctor with a urine treatment in Texas or vitamin B17 found in apricot pits will cure their cancer and that the drug companies are hiding the Truth too.

At least that one will invoke natural selection.

[Which Tyler]

10 hours ago, Mudguard said:

Yeah, here's a related paper published in a peer reviewed journal by a Stanford professor that argues that most published research findings are false.  It's pretty depressing.

There have been many such articles over the last 20-25 years (possibly longer, I became aware of them at Uni - naturally). The one I posted above was published yesterday, and as this thread happened to be open at the time, I put it up here.

9 hours ago, TrueMetis said:

Did I miss something? Peer review is a great resource but being peer reviewed in not supposed to mean the conclusion of the paper is correct. A paper being peer reviewed and published means is just supposed to mean it's free of obvious flaws and its methods sound. (Not that this standard is always met)

The problem is people are skipping the next step of the scientific process. Repetition. Repeat the experiment or study, look for ways of doing it better. Alter variables to check the effect. Do that a whole bunch of times. Then you can start making claims whether it was correct or not.

But the Peer Review process isn't what's being criticised; it's the bias inherent in presenting papers for review; the bias of the editors in what of that they choose to publish; and the coporate nature that kicks in with not looking for repetition (some of which can come down to patent law); and the human nature that kicks in with not reading the LTEs and research that disagrees.

With Pubmed, a credit card (or a good library with all the right subscriptions) and enough hours to spend doing it, you can do a Lit. Review that proves just about anything in medicine (maybe not Homeopathy / Reiki though..). Then the following year do another it review that disproves the exact same thing; both done with enough rigour, both would get published, and not many people would see both reviews as they'd be reflecting different opinions and promoted amongst different circles. Hell I've seen Lit Reviews published in respectable journals that only look at articles previously written by the same author or others in his team. They're not worth the paper they're printed on, but they get through thhe editorial process. Once those articles are up, they stay up, however much contrary research or LTEs exist; and they're then free to be quoted as truthful and accurate - whether by the sensationalist media or the next author with that same bias.

In essence, any Lit. Review that ends with a strong conclusion has a flawed methodology and is rife with bias.

6 hours ago, Triskele said:

I agree with this post, but I was responding more specifically to the common conspiracy that drug companies are sitting on or suppressing cures.  You know, the person who thinks a doctor with a urine treatment in Texas or vitamin B17 found in apricot pits will cure their cancer and that the drug companies are hiding the Truth too.

Well yes, but I don't think anyone here was going down that route.

There absolutely is bias in what research corporations are willing to fund; and things like prevention or cure are nowhere near as profitable as things like lifetime-care.

Then there's bias in what research is put forwards to publish; the big companies can and do carry out essentially the same research 4-5 times, and then publish the one with the best results for the company.

Then there's bias with what the research decides to look for - often after the results are in, and they can tweek the questions asked at the start - it's called P-value mining/farming/hacking.

Then there's bias at the editorial level - editors are human, and are more likely to accept dodgy research that confirms their pre-existing bias, than they are that challenges it; and far less likely to return it for revision.

Then there's bribery at the editorial level - editors are look more kindly on research from the company that pays their mortgage than fro the one that doesn't.

At the Dr level, we've got the human nature of the Sales Rep.s; and the confirmation bias of what the Dr has already been taught and is interested in - which informs that articles they then read, what conferences they go to etc. No-one (well, noone worth taking seriously) thinks that any Dr or researcher is sitting on a known "cure for cancer" and simply not bringing it to market; but funding is funnelled away from it.

ETA: Oh yes, and then Stateside you seem to have the bias of allowing advertising to target the most vulnerable and most ignorant into hassling their doc and demanding medication that they don't need (whether opioids, statins, or whatever the hell else)

 

 

IMO we can say the same about Peer Review as we do about Democracy. It's pretty rubbish, just the best we've got.

[mcbigski]

On 4/9/2018 at 2:28 PM, GAROVORKIN said:

Fines are simply not enough.  Perdue Pharma should have been put out business for what they did and those in charge should have faced criminal prosecution .  

As for the Tobacco Industry , why are they still allowed to be in business ?

That's easy.  The government is essentially a major shareholder of the tobacco companies now.  Or to use an alternative metaphor, they've been paying their protection money so nothing bad is going to happen.

[all swedes are racist]

On 4/9/2018 at 0:11 PM, Kalbear said:

Zero. 

/thread

[Aemon Stark]

On 2018-04-09 at 4:34 PM, lokisnow said:

Take a look at a universal medical advance: general anesthesia, which has many many medical uses, such as allowing time for safer and more intricate surgeries. 

Magnificent public outcry, and enormous opposition from medical professionals prevented the monetization of the patent on ether, and the courts around the world refused to grant the patent or enforce it if it were patented.

Well, ether had long been isolated before it was ever used as an anesthetic. But that doesn't mean that volatiles like halothane on down were generic to start. And who do you think makes those anesthetic machines? 

On 2018-04-09 at 8:27 PM, GAROVORKIN said:

Celldex Therapeutics and 4 other companies are doing  research for Cancer Drugs.  There have to be other other companies doing similar research.

There is a vast number of companies involved in cancer treatment; even aside from usual cytotoxic chemotherapy, there are ever more "targeted" receptor therapies. 

On 2018-04-09 at 8:29 PM, Kalbear said:

But not cancer cures. 

Lots of curative therapies exist for various maligancies. Most myeloma patients, for example, died within about 2 years of diagnosis. Now survival is often more in the range of 15-20 years. That's just one example. Yes, for many things there are ongoing adjuvant therapies that continue for a long time to maintain sustained remission, but there are lots of cancer cures via some combination of chemo, surgery, radiation, and now "targeted" therapies. 

On 2018-04-09 at 8:55 PM, Ser Scot A Ellison said:

It is.  But the point is that drug companies make more money “treating” cronic and “incurable” diseases than seeking to cure those diseases.

Perhaps. Drugs like Harvoni have revolutionized hepatitis C treatment in the last few years, rendering it an effectively curable infection and no longer a chronic disease. 

On 2018-04-10 at 9:54 PM, Triskele said:

Drug companies largely seek to make money by finding "blockbuster" drugs and make as much money as they can off of them for the years before the patent expires.  Drugs that are "cures" would fit this bill.  I suppose one might say that if you have to take the drug continuously that's better for the drug company, but how are we defining cure?  Take Gleevec, one of the most successful cancer drugs.  If you have a certain kind of Leukemia this drug took that disease from being close to a death sentence to being something usually completely manageable.  That probably feels like a cure to most people even though you have to keep taking it.  But also, if the same thing could cure the disease permanently in a few doses the companies would probably just jack the price enormously to compensate and make the same arguments about how much money it takes to bring a drug to market, blah blah, and insurance companies would probably cover it.

CML hasn't generally been a death sentence at diagnosis, but did progress inexorably without treatment. It has always had curative therapy available - stem cell transplant. Unfortunately that carries a lot of risks in itself. You're not going to get benign treatments for severe systemic diseases. 

[Mudguard]

7 hours ago, Triskele said:

Sorry if I got that detail wrong.  Would you say that Gleevec is indeed a game-changer for that disease though?  

I actually almost chose Harvoni as my example instead of Gleevec, but my knowledge of drugs isn't all that great.  Those were two of the blockbusters that first came to mind.

Your overall point was pretty solid.  Gleevec was indeed a game changer for the treatment of CML for many patients.  And the drug company that patented it charged outrageous prices in the US because there was no competitive alternative.  The price was jacked up so much that eventually, one year of treatment in the US costed over $100,000, and this for a small molecule drug that costs a couple hundred dollars to make.  Yeah, the company should be able to earn some profits, but this level of pricing is obscene.

I also agree with you that companies and scientists aren't trying to avoid finding cures.  It's just really, really hard to develop cures, and even treatments for that matter. 

And even if a nonprofit discovers a cure or a potential cure, it's most likely going to be taken from the lab and developed to an actual product by a for profit company.  Very few nonprofits if any (none come to mind) are set up to take a product from the lab and develop it into a product that can be sold in the market.  It's hard for me to imagine a completely nonprofit based system working well.  If the US tried to implement such a system, it would simply drive out all drug, biotech, and medical device companies out of the US.  The idea is so impractical and unfeasible that it's not worth seriously considering.

[Seli]

On 09/04/2018 at 4:47 PM, GAROVORKIN said:

When it comes to the medications that they develop  They spend millions researching and developing and marketing  drugs to cure and combat diseases and yes...

 

 

Drug discovery and development cost billions, rather than millions (although there is a healthy debate on the best way to calculate costs. Having said that current for-profit is a disaster for keeping cheap proved drugs on the market so we need a different system in addition to that.

On 09/04/2018 at 8:18 PM, GAROVORKIN said:

Hypothetical question , suppose some researcher  comes up with a universal cure for cancer.  Its 100 percent safe and effective. Given ther potential PR fallout do you think company its right mind would suppress such discovery?

Cancer is not a single disease, it is a collection of hundreds upon hundreds of them, which is why a universal cure is very very far away.

[A wilding]

I thought I would add a link to this:

Goldman Sachs asks in biotech research report: 'Is curing patients a sustainable business model?

It seems that the answer may well be no. And also that the company that cured hepatitis C shot itself in the foot by doing so.

 

[Aemon Stark]

19 hours ago, Triskele said:

Sorry if I got that detail wrong.  Would you say that Gleevec is indeed a game-changer for that disease though?  

I actually almost chose Harvoni as my example instead of Gleevec, but my knowledge of drugs isn't all that great.  Those were two of the blockbusters that first came to mind.

Yeah. Sorry if I seemed to be nitpicking. The thing about Gleevec is that it's at this point an "old" drug that has been superseded by "better" BCR-ABL inhibitors. The problems with drug company profits vs prices arise from poor and/or insufficient regulation, since at some point they become rent seekers that "innovate" only insofar as they have a marginally different drug than the nearest competition. 

10 hours ago, Mudguard said:

And even if a nonprofit discovers a cure or a potential cure, it's most likely going to be taken from the lab and developed to an actual product by a for profit company.  Very few nonprofits if any (none come to mind) are set up to take a product from the lab and develop it into a product that can be sold in the market.  It's hard for me to imagine a completely nonprofit based system working well.  If the US tried to implement such a system, it would simply drive out all drug, biotech, and medical device companies out of the US.  The idea is so impractical and unfeasible that it's not worth seriously considering.

The device industry if anything has less robust regulation than pharma. Not to say that devices aren't safe (some aren't!), but the evidence underlying their use is often a lot poorer and even more industry-driven. But you're not going to get non-profits to manufacture anesthetic machines or endoscopes. The reason we need regulation is not because "profits" in themselves are problematic, but the market imperfections and failures in health care more broadly create such intractable problems of information and "demand". 

[Kalbear]

On 4/12/2018 at 7:21 PM, Aemon Stark said:

Lots of curative therapies exist for various maligancies. Most myeloma patients, for example, died within about 2 years of diagnosis. Now survival is often more in the range of 15-20 years. That's just one example. Yes, for many things there are ongoing adjuvant therapies that continue for a long time to maintain sustained remission, but there are lots of cancer cures via some combination of chemo, surgery, radiation, and now "targeted" therapies. 

How many of them came from for-profit agencies, though? Not very many, is my understanding; most came from cancer research facilities and nonprofits. 

 

[Mudguard]

6 hours ago, Kalbear said:

How many of them came from for-profit agencies, though? Not very many, is my understanding; most came from cancer research facilities and nonprofits. 

 

How many non-profit research labs or facilities actually took a cancer therapy to market and sold that therapy to patients?

I don't doubt that many of these therapies start out at an academic lab or a nonprofit research center's lab, but they don't develop the actual product that is sold.  They just patent their discovery and license the patent to a for-profit company.  You can't just get rid all the for profit drug, biotech, and medical device companies and expect that the non-profits can take up the slack.  You'd have to try and build a massive replacement organization to replace all the for profit companies.  Good luck with that.

What about hospitals and doctors?  Is it OK for them to make a profit, or should their profits also be capped at zero?

[felice]

1 hour ago, Mudguard said:

What about hospitals and doctors?  Is it OK for them to make a profit, or should their profits also be capped at zero?

Doctors should be paid for their work just like anyone else. The for-profit hospital is just as disgusting a concept as the for-profit pharmaceutical industry.

[GAROVORKIN]

3 hours ago, felice said:

Doctors should be paid for their work just like anyone else. The for-profit hospital is just as disgusting a concept as the for-profit pharmaceutical industry.

Profits tend to win out.