Comment by lbhnact | Hacker News Reader

Comment by lbhnact | Hacker News Reader

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I agree the non-negotiation was a major compromise. However it was, as I am told, basically required to get the ACA passed at all.

The drug companies were represented by Billy Tauzin [1] who, as I am told by insiders that worked directly with him, was able to get the Pharmacos to not fight the ACA. Their support was not just critical, but a necessary factor in getting anything done.

It was a trade-off, whether or not is was worth it is hard to know.

As for your own care, I am sorry to hear about the lack of insurance. Some states (for often historical market reasons) make it hard for providers to sell or even give medications to their patients, which is also part of this problem.

If you look around, there are occasionally 'Direct Primary Care' providers or community clinics that stock generics for their own patients and will provide them at no or low-cost. Many organizations and states have processes for the uninsured to obtain medications at low cost as well. If you find a clinic with PCPs who are mission-driven, and they are out there, they perhaps can help you enroll.

[1] https://en.wikipedia.org/wiki/Billy_Tauzin

It was a trade-off, whether or not is was worth it is hard to know.

It depends on whether you care about there being any new drugs developed in the future or not. ck2 is having trouble paying his current drug costs and would seem to be in one camp.

I can pay mine---granted, they've all gone generic---but with a barely, maybe, kinda treatable genetic in my case but generally common condition for which nobody has come up with a cure including an effective drug, I'm in another camp (heck, if new drug discovery had been shut down before the mid-90s or so, I might well be dead, or suffering enough you wouldn't be blessed with my contributions to HN). And as more and more people die due to antibiotic resistance infections I suspect more people will shift into mine.

Ditto importing from Canada, with their small market the easiest thing for drug companies to do is simply cease exporting brand name drugs to them so they don't suffer from re-importation and still have something of a new drug development budget.

New drug development is mostly paid for by other party's. The major drug company's spend money on acquisitions, advertising, and minor tweaks to get around patents.

ex: Viagra> Uprima and Cialis

Sure, Pfizer for example does spend billions on R&D. But, far more of this is Development than Research. They also call a lot of dubious spending R&D.

Then I guess it's just my imagination that in the same decade Pfizer brought Viagra to market, AstraZeneca developed and brought to market the drug that just barely manages to keep me functional.

Try again.

ADDED: Side note, apomorphine AKA Uprima is so old a drug Wikipedia tells us Agatha Christie featured it in a story in 1940.

First Viagra was actually an accident. Initial human trials failed, but there was a useful side effect.

Second, if we want to spend money on research then we can just fund that directly. Which we do. Subsidizing company's that spend more on advertising than research is stupid.

US government, Foundations, University's, Pharm all play a roll, but Parma's role in novel cures is actually the smallest. Granted, still vital as the others rarely pay for clinical trials.

Your comment on Viagra is entirely wrong. It was first tested in pulmonary hypertension and they noticed the ED effect. It was approved for both conditions.

Second, the only reason why a pharma company spends on advertising is because they get a return on it. That is, they spend $10M and get $10M + X in sales from it. Why else would you spend money?

And finally, most drugs are discovered by private companies, not by the gov't. It's about a 2/3rd private company and 1/3rd gov't split.

Effective != successful. It's considered an Off Label use for very good reasons.

Second, people take a lot of unnecessary drugs with bad side effects. Sure, that's profitable for drug companies, but so is flat out robbing people. Considering how useless many widely prescribed drugs are robbing people may actually be better for society.

Finally, your flat out wrong on the drug numbers. Drug discovery is very different from bringing drugs to market. We get ~50 drugs per year, but we discover vastly more than that.

Then I suppose this web site is also a figment of our imagination: http://www.revatio.com/

Is there any point at which the number of things you claim to be true that we can trivially point out to be false might cause you to reconsider your apparent total disdain for the ethical drug industry? The same one that keeps people like me functional, and joeskyyy alive?

Pulmonary hypertension

While sildenafil improves some markers of disease in people with pulmonary arterial hypertension, it does not appear to affect the risk of death or serious side effects as of 2014.[5] https://en.wikipedia.org/wiki/Sildenafil#Pulmonary_hypertens...

I am going to call that a failure, you may disagree.

So is the study cited by Wikipedia in the half or greater of biomedicine studies that are just plain wrong, or the half that might be right? And is that true for all patients prescribed it?

Down in the trenches, doctors don't pay so much attention to studies, as a new resident who's taken over the primary care of my condition noted. Instead, he depends on what his experienced supervising doctor has figured out over time, and of course what he's learning in the world of real patients and ... well, we really don't know how real the drugs are once they go generic, not when, for example, Indian companies, even when operating plants in the US, cargo cult their HPLC tests of batch purity and correctness. The supervising doctor I mentioned was always interested in my reports of apparent real world bio-equivalence as the two drugs he prescribed me went generic.

It's a meta study of the available literature, so I would put more weight behind it than a normal study. However I am not a MD.

As to doctors listening to studies, IMO the good ones listen to meta studies. And specialists I have spoken with try and keep up with their area. Granted, there are only so many hours in the day, but there is also a fairly limited number of new drugs every year.

PS: The FDA has only approved ~1,500 novel drugs in it's history. That's a lot but many of them are fairly irrelevant to most doctors.

the only reason why a pharma company spends on advertising is because they get a return on it.

I don't think they'd consider this to be a legitimate point, the gravamen of the case is that this money is not being spent on truly new drug development. Which ignores the minor detail of how are doctors and patients going to learn about new drugs in the first place.

Of course, in their ideal system, there would be no new drugs, and I daresay there also wouldn't be 26 different types of antidepressants available to prescribe.

Of course pharma companies get a return on advertising - for example, getting doctors to prescribe their products over cheaper generics or for patients where they're of questionable use is incredibly profitable. The trouble is, they're getting that return by making healthcare more expensive and worse for actual patients. You and other patients are paying for them to convince doctors to make prescribing decisions that cost more and even give worse outcomes.

Retric didn't make a categorical statement, a single counterfactual doesn't contradict the "mostly".

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