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GAROVORKIN

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

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Posted (edited)

Yeah, the direct-to-consumer marketing with our creepy drug ads is a relatively recent phenomenon.  I think it only became legal in the US in the 90's and is only legal elsewhere in New Zealand.  

I would push back on the idea that the companies don't want to find cures.  I think that's fairly conspiratorial.  It makes a degree of sense on the surface (pharma seeks big profits, cures would mean no more profits, etc...).  But just because that surface level seems plausible does not mean it's so.  I think for one that people underestimate who profitable cures would be and also misunderstand the science of cancer.  

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.

But to me the biggest reason that this is conspiratorial is what it assumes about doctors.  To think that we're actually sitting on cures and that it's just not being released is to allege that all of the top doctors in the world are pretty much in on this together even though many of them do not even work for pharma but rather work in private clinics or work at university hospitals and labs.  Keep in mind too that the prestige in finding permanent cures to the diseases you treat would be a level of prestige better than any other for these people, and keep in mind that while medicine is a great paying field many of these people did go into it with the chance to treat disease being a motivator.  To suggest that this many of the most educated people in society (many, many thousands of people) are all in on this is simply not possible.  

ETA:  Put Switzerland by accident instead of New Zealand at first.

Edited by Triskele

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It means in  general things like researching better antibiotics, better standard medicines, and medicines that will likely destroy a certain thing (such as malaria) are not prioritized, because they simply don't make the money other drugs too. It doesn't assume anything about doctors or conspiracy; it assumes rightly that corporate money will always favor making more money, and point of fact they have a duty to do so if they're a public company.

There are lots of other people working on cures, as I said - but they tend to be nonprofits, funded by philanthropic organizations or by government orgs. They are the ones that are the leading edge on producing things and tend to have the highest prestigious doctors. 

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5 hours ago, Tywin et al. said:

I've always wonder how this is even legal. I remember the first time I saw an ad asking to to ask my doctor if I needed drug X. It seemed wrong then and it does now too. My doctor should be telling me what I need, not the other way around.

*slow clap* 

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

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Posted (edited)

I think pharma companies serve a legitimate purpose, at least when they're not being allowed to do stuff like buying up the rights to drugs with few or no generic competitors and jacking up the prices on them until they can't. 

The amount of spending that private pharmas do on R&D is larger than public drug R&D spending in the US. Moreover, the public spending tends to be either general research or finding potential "targets" that could turn into drugs - which is not the same thing as developing drugs. Actually testing all those targets (most of which will turn out bad, because finding targets is the easier part), turning them into drugs,  putting them through multiple rounds of testing to satisfy safety rules - that's largely done at the private sector level. 

You occasionally see proposals for alternatives to the existing system. I'd love to see public efforts do more to test drugs, but I don't like the idea of moving towards a fully publicly directed system for drug research. One of the advantages of the existing system is that it encourages companies to try all kinds of drugs as long as they can potentially make a profit off of them, which is good because we don't tend to know in advance where the "low-hanging fruit" is when it comes to drug discoveries. A publicly directed system could pour a ton of money into a particular kind of research with little to show for it for years because it's popular and has political support, while a bunch of potential other easy discoveries go little touched for lack of funding. 

As for antibiotics, the lack of discovery of those has more to do with it being really hard to find new ones that work and aren't toxic. A number of the existing "last line" antibiotics are already pretty toxic (Colistin is nasty on your kidneys, for example). 

EDIT: For the OP, it's not so much about a specific profit number as it is about preventing particular kinds of predatory practices. Having the US government negotiate drug prices for a single-payer system would be good. Blocking companies from drastically raising the prices of drugs long out of patent would be good (or at least cap the increase to a certain percentage per year). Allowing for matching approval of drugs with other countries whom we believe have adequate FDA-style approval of drugs would be good. 

 

 

Edited by Fall Bass

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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.

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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.

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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.

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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. 

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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.  

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Posted (edited)

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.

Edited by TrueMetis

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22 hours ago, Kalbear said:

It means in  general things like researching better antibiotics, better standard medicines, and medicines that will likely destroy a certain thing (such as malaria) are not prioritized, because they simply don't make the money other drugs too. It doesn't assume anything about doctors or conspiracy; it assumes rightly that corporate money will always favor making more money, and point of fact they have a duty to do so if they're a public company.

There are lots of other people working on cures, as I said - but they tend to be nonprofits, funded by philanthropic organizations or by government orgs. They are the ones that are the leading edge on producing things and tend to have the highest prestigious doctors. 

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.

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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.

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Posted (edited)

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.

Edited by Which Tyler

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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.

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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. 

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41 minutes ago, Aemon Stark said:

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. 

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.

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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.

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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.

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