The million-dollar drug (2018)(newsinteractives.cbc.ca) |
The million-dollar drug (2018)(newsinteractives.cbc.ca) |
It just barely got approved by the EMA and based on feedback the company didn't bother to pursue FDA approval.
By extension, this story demonstrates how we price life. What if the cure was a billion dollars, is that worth society paying? What about a trillion? At one point a limit is reached, and it seems that one million is one of those limits that we all quietly agree upon.
Since it's a one time cure, I think the 1mio price was reasonable. At least compared to 10+ multiple day hospital visits. This was just the government fudging their negotiation.
The real culprit here is the system of laws and controls that forbid anyone else from stepping in to fill the hole they've left. The regulations and regulators deserve to be held up as the problem here. If it wasn't illegal to compete then maybe someone would. Maybe even one of the people who need the drug.
The ugliness of inequality fueled by capitalism is more pronounced in medical treatments, I've witnessed it firsthand several times.
In early 90s as 6-7 year old I had to undergo a revolutionary treatment at most expensive private hospital in India, days before surgery the doctor privately demand a large sum of unaccounted money. This repeated several times for subsequent surgeries and my father had to go in large debt each time.
We were a middle-class family by Indian standards yet my family's lifestyle were severely limited by from my medical expenditures, A poor family doesn't even stand a chance. What's worse is that the doctor had made incorrect diagnosis of my ailment at that time which lead me to a life-threatening recently.
This is what worries me about the COVID pandemic, Medical professionals who honestly believed that they're doing a service to humanity rushed to the front lines without any regard to their or their family's safety and many of them have perished. Now the ratio of corrupt entrepreneurs masquerading as medical professionals who flew to COVID-free islands during pandemic to the medical professionals who treat their profession as a service has now further worsened.
From the submitted article:
"...The first drug ever approved that can fix a faulty gene.
It's called Glybera, and it can treat a painful and potentially deadly genetic disorder with a single dose — a genuine made-in-Canada medical breakthrough..."
Patent protection makes sense to inventivize development and production. In this case development already happened and only production stopped. So it doesn't make sense to uphold this patent.
So we can have governments continuing to subsidize research, but forbid universities and research institutions to sell the rights to only one company.
It's just a lie, one of very many we tell ourselves.
https://patents.google.com/patent/CA2370081C/en?q=Alipogene+....
"Novartis' Zolgensma, a one-time gene therapy for spinal muscular atrophy tops the list with a price tag of $2.125 million."
https://www.biospace.com/article/gene-therapy-zolgensma-tops...
My, you innocent child, that you have to ask this.
(I have a genetic disorder commonly treated with one of those drugs that cost $300k annually.)
Edit: I was going to delete this in short order but now that it's flagged, I'm leaving it. People with genetic disorders get all kinds of hatred from the world and medical system for just wanting to be healthy and how dare we say that online.
I don't think the voices of the few should be silenced.
Its uncomfortable maybe, but I think not a discussion to avoid.
Your comment seems very defeatist. Actually this whole thread seems defeatist.
It isn't the investors' duty to bankrupt themselves to produce this drug. They tried to find a way to get this produced through the private sector, and they found that it was impossible. It should instead be handled through the public sector, and it is the general public who are ultimately responsible.
By the way, that's one of the reasons drugs are so expensive: pharma co. needs to recoup the costs before the patents expire.
For something like Aspirin, that's not a high bar to clear, an avid experimenter could probably do that in their basement, but for gene therapy drugs I feel confident in saying that it's orders of magnitude higher.
Then again, they could kickstarter it and say that if they get X orders or raise Y money they'll do it, make and sell the 20-30k doses for everyone and then close up shop with a healthy profit.
All her life, Turcotte has had to follow a strict diet. She can't eat cheese or chocolate or any food that contains fat. And she can't drink even a drop of alcohol."
Jesus.
Edit: Looked up the wiki article, here is their explanation;
>Additional measures are avoidance of agents known to increase endogenous triglyceride levels, such as alcohol
https://pubmed.ncbi.nlm.nih.gov/23511381/
Probably more pertinent:
Alcohol changes the structure of the liver cells and slows down the liver’s ability to process fats. This is the second way that triglycerides begin to accumulate and the levels rise. This is also the beginning of fatty liver disease.
https://findpulse.com/what-liquor-raises-your-triglycerides-...
NAFLD is also highly correlated with diabetes, so I wonder if there could be something to learn from studying this or related genes.
I wish people weren't so short sighted when it comes to economic cooperation.
If they cave and sell it at a price that doesn’t recover their R&D costs (mentioned in the article to be hundreds of millions of dollars), then that’s that, they’ve just lost all of that money. If they sit on it there’s at least a chance that someone in future might pay them for it.
sure a chance in that it is not impossible the same way that a talking centaur with the ability to blow up planets with its mind is impossible, but given what we know about economic reality it is practically impossible that the million dollars per patient will be paid.
There's a saying that one should not throw good money after bad, in this case it would seem they are refusing good money because it won't cover the bad.
Also tax writeoffs exist, so I'm not sure what that R&D actually cost them?
And let's not forget that this business often operates with sickeningly huge profit margins.
Which is to say that you have an investor group that expects to either be paid or they'll take their medicine away and the public be damned.
Or perhaps a perverse process. The system is how you get new, actually amazing drugs. The system is also how actual health care has become really terrible in the US in particular.
No other companies were interested in buying the drug and it required more costly trials and upkeep.
You drop the price and buyers are even less interested, meanwhile the costs keep coming in.
I think the mistake people are making is assuming the drug was in a position to be revenue positive at a lower cost when it wasn't.
Iirc economists have estimated that a human life is valued around 3M$ by society (a couple of years ago, probably higher now), the price doesn't necessarily seem too high.
So the question of who did the initial research and who funded it isn’t really important to the question of whether invalidating patents left and right will negatively impact the rate at which new drugs are brought to market.
If the government wants the company’s patents and distribution rights, at this point I’m sure they’d be willing to sell everything over to the government at cost. Clearly no government is interested in buying the rights for $200M, any more than they are interested in buying doses for $1M each. The company that brought this treatment to market has clearly gotten utterly screwed here, and the nature of the comments on the article suggest that a lot of people here are disappointed that no governments have intervened to screw them even more for the audacity of thinking that they should be compensated for their work.
Perhaps the lesson here is that maybe seizing their parents for not selling their treatment at a loss isn’t actually a bad idea. Maybe there’s no risk of discouraging pharmaceutical companies from developing expensive treatments for niche conditions, since it’s already clearly a terrible idea, and companies already won’t be making the mistake of ever doing it again.
If that busy work consists of keeping people alive and advance medical science it's at least a better use of human potential than working via door dash.
Clinical trial data and manufacturing know how cant be leveraged from the original approval.
It is incredibly difficult to get investors to fund a second round of development for a product that made it to market and still failed.
You might say this is an opportunity for the government to step in as investor, but they have little interest, knowing that they could use the same money to save many more lives in other areas.
A good plan should never have "and then people act against their own interests" as a step.
As I’ve discussed in other comments, this is why pharma companies have to recover their entire investment off of sales in the first world. The rest of the world is never going to buy their drugs at a price that would make the R&D spending worthwhile. This is why companies sell their drugs for much cheaper in countries where incomes are much lower, and also why drugs produced and sold cheaply in other countries generally can’t be legally imported into the United States. It’s also why claims that drug prices could be lowered in the United States by importing them from countries where they are sold more cheaply are fundamentally ridiculous. The reason drug prices are high in the United States and to a lesser extent in Europe is that they are subsidizing the rest of the world by doing substantially the entirety of pharmaceutical R&D spending in the world.
https://www.healthaffairs.org/do/10.1377/hblog20170307.05903...
"To put the excess revenue in perspective, lowering the magnitude of the US premium to a level where it matches global R&D expenditures across the 15 companies we assessed would have saved US patients, businesses, and taxpayers approximately $40 billion in 2015, a year for which the Centers for Medicare and Medicaid Services (CMS) reported that total US spending on pharmaceuticals was $325 billion."
Seems there is a room for another India at least.
https://www.resetera.com/threads/guy-cures-himself-of-lactos...
It's been a bit since I watched the two videos* he made, so I don't remember the details. But it was the first time I ever felt anything positive about gene therapy. I'm too used to seeing people like me treated like Frankenstein's monster so people can do cool science and not care about the suffering of their human guinea pigs.
But most likely the short version is that he was only using this on himself. He didn't need to get FDA approval or do clinical trials.
That's an enormously frustrating process for the folks with incurable conditions who just tear their hair out over decisions to deny approval because something bad might happen down the road. We tend to feel like "Let me live long enough to have those problems, you ass!!!!"
But those processes exist for a reason. (Look up Thalidomide if you care to know how wrong things can go.)
Maybe someday there will be a readily available gene therapy for lactose intolerance. Maybe his work will be the starting point for it.
* He has made a lot more than two videos but there are two specifically about this gene therapy he administered to himself.
This is grossly misinformed
Looking at the UniQure Tax filings for 2020, They had 37M in revenue, -122M in R&D expenses, and -42M in general expenses, so they were -125M in the hole that year.
https://uniqure.gcs-web.com/static-files/8f960e6d-c40c-474e-...
From a collegue I know that they purged drugs from their portfolio because it made less than <80% net profit.
But you are right. It is very different.
No company is gonna cut a an approved drug with hundreds of million in net profit because the % profit is <80. I could see them cutting drugs if the total profit is low tho. This helps them focus on other more profitable drugs with. That is to say, most companies don't want to be making 100 products that net low millions each. They want a few products that make 100 million+ each.
Also, I don't think marketing is a big issue for such drug which is the only available option for affected people.
We can speculate on what the cost per dose would be with no profit, but ultimately, there wasn't enough profit at a reduced price for uniQure to provide it.
The fact that no other companies are licensing the drug shows that they agree that there isn't enough of profit to be made.
Here is an article with some more information.
https://web.archive.org/web/20170901212655/http://www.fierce...
They are a drug development company, marketing their drugs to national government health services and private insurance companies. This is an iterative game, in game theory terms. Caving and selling at a loss just guarantees that counterparties will refuse to buy at the stated price next time too, and wait for them to cave and sell at a loss. Sitting on the drug until the parents expire and losing the entire investment rather than selling at a loss has the benefit of proving seriousness in future price negotiations.
And the article mentions that the ongoing care costs for someone with this disorder is hundreds of thousands of dollars per year. In the years since they refused the $1M price tag in an attempt to drive a hard bargain, the national governments and private insurance companies have no doubt spent more than $1M per patient they refused to buy a dose for.
Hardly seems like planet-destroying centaur levels of implausibility that they may eventually come around to the idea that $1M was actually a perfectly reasonable price, given the circumstances.
> Also tax writeoffs exist, so I'm not sure what that R&D actually cost them?
I think you have some major misunderstandings about what tax writeoffs are and how they work.
I wouldn't make the assumption on that, given the disease is potentially deadly. I would more likely make the assumption that the private insurance companies especially did the math and figured they end up a couple hundred thousand ahead in the most likely scenarios. But I'm prone to cynicism.
>> Also tax writeoffs exist, so I'm not sure what that R&D actually cost them?
>I think you have some major misunderstandings about what tax writeoffs are and how they work.
perhaps, but I do experience that sometimes in my business it can make sense to spend money on things and make less profits in order to have less taxes to pay, on paper things might look worse off but I somehow feel that I'm doing better nonetheless.
With purged I mean exactly this. Purged. 80% was low from their point of view. Don't know how many products they had. Couldn't believe it at all.
But moreover, losing money for tax purposes only makes sense in a narrow window dictated by tax rate. Leaving aside tricky confounders like government R&D grants, if your corporate tax rate is say, 10%, and you have an investment opportunity that won’t turn a cash profit but will grow the value of your business by 95% of what you invest, it can make sense to make an unprofitable investment and lose 5% on it over realizing the profits, paying taxes, and losing 10% on it. But for this to make sense you have to have an investment opportunity that already very close to breakeven, corporate tax rates aren’t that high. And just throwing money away to count the losses on your taxes never makes sense.
ok but it would seem to me that supposition sort of works against the supposition that they don't want to lower the price because then they would not be taken seriously in future negotiations, unless the company has some other sources of revenue to keep them going it would seem unlikely they would be available in that future.
in fact in the article it says
>In the 2 1/2 years it took to win EMA approval, AMT, which had no other products to sell and no revenue from Glybera, lost millions of dollars. The company was formally liquidated in 2012. Its assets were acquired by a new private company, uniQure.
I doubt they bought those assets for the millions that were lost - when I look at uniQure https://www.crunchbase.com/organization/uniqure it looks like they have reasonable money.
from the quotes in the article there are 100s of millions invested in uniQure but I'm not sure if that investment was made because people were like 'whoa, they got this million dollar drug!', if so seems weird that investors would invest for that reason because if I heard a company was selling a million dollar drug my next question would be 'how many billionaires need that drug?'
If nobody thought they could make money, Glybera would never have made as far as it did.
You could start a non profit to make Glybera today as the main patents are expired, but nobody would give you the money to develop it and run trials without a profit motive.
Charities and the government have better ways to spend money than help a few people with a rare disease.
If you want to get rid of the profit motive, you have to find something better to replace it.