Technically, compulsory licensing is allowed under TRIPS (https://www.wto.org/english/tratop_e/trips_e/public_health_f...). But the US and others opted out of this (https://www.wto.org/english/docs_e/legal_e/31bis_trips_annex...).

A. The issue becomes creating a manufacturing and cold chain distribution system involving the fewest people with compartmentalized knowledge. I'm not sure how you'd launder it or keep enough of it a secret to not get eventually busted because someone would open their mouth. It'd probably be busted with RICO if any sort of profits were involved. Must pay taxes, for sure.

B. DIY chems home pharma kit is another approach.

C. Traffic from other countries like France at near cost prices.

D. Send patients to low-cost countries to buy up medications for their own personal use, and post or FedEx it back to themselves in bulk.

E. Hold politicians accountable and make the FDA and FTC set hard limits on price gouging so that Medicare, health insurance co's, and American patients aren't overcharged. You'd think health insurance co's would be right out in front complaining about the high cost of medications and lobbying for change.

Historically, the black market for medication has been vanishingly small. People don't as a rule trust drugs they get off of alibaba or wherever; even the viagra gray market is a small fraction of the prescription revenue.

And this doesn't treat something critical, it's a weight loss drug. To be blunt most people would probably choose to remain fat vs. buying an illegal generic.

The other reasons are:

1/ Even the manufacturer doesn't know everything about how the drug was made. They characterize the final compound but the compound was made by some sort of living cells so each one has different properties. For the same molecule, one cell line may produce a drug with entirely different toxicology profile compared to another. You need a full manufacturing chain with different departments analyzing it at different stages to guarantee the desired effect.

2/ Patents make sure that the vanishingly few groups with the capability to do the above characterization would not want to risk their business doing it.

3/ For every one molecule that made it to market, dozens or hundreds of others were discarded. They all cost about the same amount to develop up to the point they were thrown away. Due to the amount of regulations in place, the cost to research is obscene and the final manufacturing cost is peanut compared to the price of the pipeline what the drug went through.

because the US is largely responsible for the rich world's tyrannical patent and copyright laws?

Why not do away with patents and IP altogether if the standard is that as soon as someone makes something needed it can be stolen?

That’s what “demand” represents in this equation. Not people who want faster cars or different colored Stanley cups, but access to life saving drugs and treatment. I’m not saying para-socialized systems are better (it’s capitalism with a wig) but the “benefits” of capitalism are nowhere near equally shared and in fact highly concentrated at the top. The benefits are in fact over-appreciated by those who have them and they will do anything to keep the dirt people away from their stash.

I don’t have a solution, but my point is praising mass death for the squalid masses is tacky and I personally wouldn’t do it on public forums.

*edited for spelling error

What benefits? The benefit of mortgaging your home to pay for cancer treatment? The benefit of having your access to healthcare directly tied to your employment (especially considering that many wage workers are kept from working more than 35 hours a week lest they become eligible for employee sponsored health plans)? The benefit of having folks like Martin Shkreli corner the market on generic drugs and raise the prices, not because manufacturing costs have risen but because they are seeking windfall profits?

Seriously, what benefits? We have this silly notion that capitalism provides us with choice, and that this choice is a desirable good in itself. Choice is overrated. Health care is a commodity. You walk into any doctor with a broken arm, diabetes, COVID, pneumonia, depression, or any one of hundreds of other maladies, and the treatment for those will be the same regardless of the physician or the hospital or the clinic.

Right. This is why drugs like BPC-157, mentioned above, go for $25/month. There's a lot of competition on the gray market, and often the only way for vendors to differentiate themselves from the pack is on pricing, so drugs rarely if ever sell for more than double their manufacturing cost.

In the world of legitimate patented pharmaceuticals, the manufacturing cost is not even a consideration. It is often -- as it is here -- less than a single percentage point of the sale price.

This is so hilariously wrong I'm not even going to address it.

This argument is always that if the government would just step out of the way the private market would provide for everyone and there would be full employment. As though somehow things like minimum wages and OSHA are what keep capitalism from reaching its full potential. As though things were better in the 19th century.

I've read Friedman and Hayek. The world they wanted is a terrifying world indeed.

If you gave a vaccine 100% effective against cancer to 18 year olds it would probably look like a money loser on a 10 year timeframe but that's clearly not the window to measure.

… and that reason is because obese people have lower lifetime medical cost. Anything that reduces obesity will tend to increase long-term healthcare spending, because it’s cheaper to die of congestive heart failure at 50 than to live to 80 and incur a couple hip replacements and a bunch of expensive end-of-life care.

(technically it varies by country, depending on their particular allocation of end-of-life spending vs earlier care, but generally the expected cost of a 1-unit BMI reduction is more likely to be neutral or positive than an overall total reduction. And the US is even worse since we weight spending enormously heavily towards senior care due to Medicare - someone dying at 40 is a very cheap outcome for our system.)

> A one-unit decrease in BMI showed gains in life expectancy ranging from 0.65 to 0.68 year and changes in total health care costs varying from -€1563 to +€4832.

https://pubmed.ncbi.nlm.nih.gov/37222003/

Skinny people have been absolute bastards about the whole thing from the start, they don’t want to lose the ability to look down on and belittle a class of sub-humans, they want to smirk and tell people to eat less and work out more, and losing that underclass will hurt their own perceived social standing. So now that there’s a drug that helps people eat less, it needs to be argued against strenuously lest that eventuality come to pass.

That’s why you’re seeing the moralizing and “they should lose weight without medical assistance!!!” come out instantly yet again. It was never about actually wanting them to lose weight per se, it was about the ability to moralize to an underclass who that group argues deserves their status - the whole “my assholery is an incentive to lose some weight!” school of thought that is so prominent.

Semaglutide and the class of drug is overall extremely well-studied, well-tolerated, and effective at treating several different families of chronic medical problems around the reward system of the brain. And that’s frankly terrifying to a large group of people who are low-key bigots and are facing the loss of their favorite punching bag. Like what if there was a drug that you just took it and 90% of people lost significant amounts of weight? That’s terrifying to a group of people who without a subclass to look down on will now move down a rung on the social ladder themselves.

The black mirror with the exercise bikes nailed it. People want to toss soda cans at fatties forced to work menial subclass jobs and tell them to lose some fucking weight, that’s what it’s always been about in this discourse from the start. They just can’t quite get away with physical assault in our reality, but they’ll certainly endorse emotional abuse and unequal treatment, “for their own good” etc.

It’s just a shame that this sentiment has also hindered the ability to look into endocrine disruption or gut microbiome etc. There are lots of interesting things that skinnies were too emotionally vulnerable to allow research into, that have just been vaulted over by semaglutide.

> And now for the bad news, her insurance no longer covers it.

This is one of the reasons why I think these GLP-1 drugs are going to be classified by insurance as a temporary tool to help people improve their health. Rather than a long term medical necessity like insulin.

> I think we need more time to see

I agree with this statement, we definitely need more time. We don't fully understand the long term effects of GLP-1 in large populations.

I'm in the camp of, if its possible to use GLP-1 as a ramp to building sustainable habits and then wean off the drug, then as many people as possible should be weaned off.

Probably this will be the next patent-ever greening strategy pursued after the weight loss thing.

It’s an absolutely wild drug in medical terms. “The white whale” is an understatement here. It literally is a white whale for multiple whole fields of medical science.