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American health care vs the world!
Posts
I thought it was already illegal to import drugs from other countries to the US?
http://battlelog.battlefield.com/bf3/user/Mort-ZA/
@MortNZ
http://steamcommunity.com/id/mortious
No what happens is:
DrugCo spends millions and develops CureAll.
India disallows the patent on CureAll, so IndiaGenericCo can make.
Now the 1.2b Indians get CureAll and DrugCo gets $0.
So who pays for all the R&D, the US.
The US really needs to flex is muscle more on IP stuff across the board. Its a huge drain to be footing the bill to develop stuff and then having it stolen not just by a competing company, but a foreign government.
Oh, I fail to get outraged on that I guess.
http://battlelog.battlefield.com/bf3/user/Mort-ZA/
@MortNZ
http://steamcommunity.com/id/mortious
Sure, because you aren't paying for it. NZ NZ NZ NZ NZ.
e: It's not India subsidizing it for their poor, or negotiating a lower rate. India is in effect stealing it.
Maybe I would feel differently if I didn't grow up in South Africa during the height of the AIDS medication cost debacle.
The US enforcing their patents on India doesn't mean they'll get tons more money, it means tons of people won't get treated.
http://battlelog.battlefield.com/bf3/user/Mort-ZA/
@MortNZ
http://steamcommunity.com/id/mortious
Probably it would result in the US reclassifying it as "foreign aid". So, essentially, no change but we'll take credit for it.
I would be interested in seeing research on this idea. It has logic to it, but whether or not it is actually true in any meaningful way, that being the creation and delivery of useful medication is less certain.
It must be something that has been studied extensively though
And to the point about the US muscling its IP - well they do. Check out the US-Australian FTA deal of a few years back re IP and drug purchasing. They try it on with us regularly as well.
Something that's extremely costly and was out of her reach back in SA.
They only do one though, she'll have to pay for the other one if she wants it. $40k iirc. Costly, but not exorbitantly so.
http://battlelog.battlefield.com/bf3/user/Mort-ZA/
@MortNZ
http://steamcommunity.com/id/mortious
Firstly; the extra expenditure the US consumer makes is more likely to go to DrugCo's US marketing budget and profit margin both of which are generally larger than their R&D costs.
Secondly; DrugCo will be working off prior development and basic research done in lots of different places and funded by lots of different bodies, its not just the US consumer footing the bill.
Thirdly, the US is not the only place which develops drugs, Europe and Japan somehow has thriving pharma R&D development despite UHC and vastly lower drug cost to the consumer.
The hubbub over the US 'subsidising' other markets is cooked up by pharma lobbyists who generally find fertile ground building on preconceptions of American exceptionalism. It does happen, but when Pfizer and Merck are posting >10% annual profits, its not a fucking huge drain when compared to the Indians getting zero drugs situation.
Edit: for reference here is the fortune 500 pharmaceutical companies with profits as a percentage of revenue, 2012:
Pfizer 14.7%
Johnson & Johnson 14.9%
Merck 13.1%
Abbott Laboratories 12.2%
Eli Lilly 17.9%
Bristol-Myers Squibb 17.5%
Amgen 23.6%
Gilead Sciences 33.4 %
Mylan 8.8%
Allergan 17.2%
Biogen Idec 24.5%
Celgene 27.2 %
These poor companies are struggling to find sufficient resources for their R&D work
Heard an interview with one of the champions of Indian copied AIDS medicine from the height of the epidemic in South Africa, making it in India and shipping it there and other places. He was well aware of what he was doing and had zero regret, and he and his colleagues should have none.
Fact of the matter is that DrugCo was getting zero dollars for their patented AIDS medicine from that area of the world because to the patients in need it was unattainable because of the price. Especially considering it is a medicine you need to keep taking, getting a hand of one box for all of your family's money means shit when you later cannot keep affording it.
So really DrugCo got zero dollars no matter how that went down, but with the copied medicine people got to live a bit longer.
Anyway, to my knowledge threat of sanctions and a WTO deal has since made copying and exporting less easy and less common.
Just as an aside (and this is going off memory a decade old, so the numbers might be off) it was around $15,000 (usd) a year for AIDS treatment back before all this WTO and UN intervention. Back then it also wasn't covered by insurance (which was a different issue).
Even as someone in the top 2% of earners, in one of the richer areas of Africa, I'm not sure that's something I could afford year after year.
http://battlelog.battlefield.com/bf3/user/Mort-ZA/
@MortNZ
http://steamcommunity.com/id/mortious
Except for that whole "being illegal" thing, sure.
"Do you want the real thing, or the cheap chinese knockoff?"
"What's the difference?"
"They both have the exact same active ingredient, I'd go for the generic."
"What's the price difference?"
"$12"
So I took the cheap knockoff and got a footlong for lunch. Mmm, delicious IP theft.
I'm pretty sure the US has generics as well.
http://battlelog.battlefield.com/bf3/user/Mort-ZA/
@MortNZ
http://steamcommunity.com/id/mortious
HAART is expensive, but it's cheaper than dealing with the opportunistic infections that arise with HIV. It also reduces (though, obviously, does not eliminate) the likelihoods of communicating HIV and communicating secondary infections to other people.
So, on a broad, public health level, HAART saves a country money. At least, it does in first world countries where you're paying medical practitioners a first world salary and incurring first world operating expenses at your medical facilities.
In any case, it's not that expensive to produce. That expense is entirely licensing costs. It only costs Indian generics producers about $300 to manufacture a year's dose.
Well, we do, but one of my pet issues is that generics aren't required (anywhere) to have "the exact same active ingredient."
They're required to be "bioequivalent," which gives the generics producer some leeway. The exact amount of leeway differs from drug to drug, and the precise implications of bioequivalence policy differ from drug to drug and condition to condition.
Most of the time, for most drugs, conditions, and patients, this literally does not matter. A generic will do just as well for you as the name brand will, for a fraction of the price.
Sometimes, though, the difference can be dramatic.
Yeah I'm not exactly frothing at the mouth at the idea that my comparatively rich ass is subsidizing medicine for the poor.
The dumb thing is that they could let Indian generics manufacturers make their own version of HAART at $300, kick GSK et. al. back $1000 a year in licensing, and the pharma companies would be making profit while India gets their cheap meds.
But, no, that's just not good enough for pharma. The only reason Indians are getting HAART at all is because the Clinton foundation (yes, that Clinton) and the UN negotiated prices on behalf of India.
I don't know what the Indian government is currently paying for HAART. I can't find a solid source on that anywhere. WHO's recommendation was to bring it down under US$1800 a year. BTW, India's GDP-per-capita is US$600 a year. Just to put things in perspective.
And of course they are generating those profits while trying to do the most expensive and limiting possible research of all, trying to find 'treatments' for chronic conditions with no cure. Such things are hugely expensive, almost assured to fail, but (if they succeed) create a huge windfall for the company.
Drug resistant bacteria? Yes, its a lot down to the overuse of antibiotics, but there's also a big chunk of problem coming from companies not doing any good research in the area. It's just not as attractive to make a pill that cures someone and costs $50 for a course of treatment compared to a pill that someone has to take for their whole lives. Bacteria aren't 'super-bugs', it is pretty much universally true that immunity to one pharmaceutical comes at the cost of vulnerability to another, since evolution has no sense of 'future proofing'. After all, the body and bacteria have been going back and forth for years with the body maintaining a slight upper hand. Drug companies should be able to be smarter than random evolutionary combinations which occur once every generation.
The drug companies just aren't making the other types, and are eagerly using their current functional ones wherever they can.
I don't really agree with this, just having worked in pharma for a while.
There are a lot of nasty things you can say about pharma. Deliberately avoiding research on cures isn't one of them. It's a myth that, IMO, has only caught on because it sounds appealing.
The sad reality is that drug design, even "rational drug design" isn't that rational. It's very trial-and-error based. Most of the time, with the small exception of certain biologics (like monoclonal antibodies), designing a drug is like using a shotgun to swat a fly. The pharma company generates dozens or hundreds of candidates, runs them through computer simulation or assays, and finds the ones that look like they might work on the receptor or biomarker in question. Then out of those, they use animal or tissue studies to weed out the ones that don't actually work in vitro the way you expect them to work in silico.
Monoclonal antibodies are the closest thing we have to an actual "cure for cancer" right now (for any given type of cancer; cancer isn't a single disease). They also cost thousands or tens of thousands per dose. If a pharma company discovered a cure for cancer, that's exactly what they'd do - they'd charge through the nose for it, reap ungodly amounts of money, and immediately change their marketing slogan to "The company that cured cancer."
They sure as hell wouldn't hide it.
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
How about instead those drug companies sell those medicines at reasonable prices in third countries. Everyone wins.
There's already laws against (1), and if it's insufficient then that's where work needs to be done.
Since the only negative about (2) is feeling sad, it doesn't really hold up against millions of people's health.
The country doing what's best for it's people, even at the detriment of people in another country is a view you've put forth a couple of times. Don't see how this is any different.
http://battlelog.battlefield.com/bf3/user/Mort-ZA/
@MortNZ
http://steamcommunity.com/id/mortious
Is it better in the long turn to be a pariah in the world economy by ignoring patents than to buy drugs? I don't know the answer to that. I personally much prefer the approach of having go ernmrnts but drugs in bulk for their citizens at reduced rates.
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
Then give a good reason not to have to steal the patents by selling the drugs to those people at prices they can afford. Plus, its good PR.
Well, India was never, to my knowledge, violating patent law. They were openly leveraging a legal grace period in the international IP agreement covering generic pharmaceuticals (TRIPS). Once that grace period no longer applied, my understanding is that they transitioned to purchasing them from the patent-holders directly.
They bent international law, but never actually broke it.
I might be wrong, though.
But if it costs 5 kabillion dollars for your care then there's no way you'd consider that better. Cost has to be a consideration. And once you have cost as a consideration you have to accept that the US spends double what, say, the UK does on health care so of course it should be of a better quality.
that certainly explains some things
Scenario 1: I make a drug, it makes me jillions, poor countries don't make generic versions of it and millions of people suffer and/or die which gets me nothing.
Scenario 2: I make a drug, it makes me jillions, poor countries do make a Generic version and millions of people don't suffer and/or die which gets me nothing.
Neither scenario gets me anything extra. One of them reduces suffering in the world.
Plus, the actual people doing the R&D don't give two shits - their major remuneration will be via salary, they're not going to get 'demoralised' at the idea that the company is making slightly less billions in profit.
This isn't inventors and writers working in their garage for the eventual payoff, the development outcomes aren't going to change from the existence of generics in other countries.
Since the companies themselves have decided they don't need to invest additional resources in R&D and potentially increase global quality of life down the line, I'm okay with a situation that increases global quality of life right now.
It's about rights in your property. Like I said before, just because your property is stolen for a noble purpose doesn't mean that its ok. Why did the baker deserve to lose his bread just because Jean Val Jean's family was starving? I think the better approach in these situations is selling on a discounted basis to the governments of these poor countries.
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
Well because its copying theft not physical theft, the 'baker' in your overstretched metaphor doesn't have any less bread than they had previously.
I agree that selling discounted drugs is the better solution, but when companies refuse to discount it into viability for the receiving government, I don't have any problem with governments telling them to fuck off and allow generics to be produced.
Copyright is a privilege extended to further the public interest. When enforcing the copyright acts massively counter to that public interest a state should consider other options. Pharmaceuticals are different from other IP issues in my opinion, because unlike media and consumer goods it is peoples lives or painful existence on the line, and thus the 'is this copyright worth existing' question actually has considerable weight towards 'no' in some circumstances.
Well, you and I disagree on how copyrights should be conceived (I see their ephemeral nature as a flaw in the nature of the world, not a justicarion to weaken their protections) and see no distinction whatsoever from physical theft and copying-theft (in both cases, the infringement in your right is the loss of exclusive use, and all that differs is the degree). But that is a discussion for another thread. Suffice to say, I do not think that there is a justification for other countries or people to infringe on these rights and I think that anyone who does so should be prosecuted or subjected to international sanctions. That said, I would have no problem with a mandate that drug companies provide these drugs to governments in poor countries at a signifigant discount.
"There are no necessary evils in government. Its evils exist only in its abuses. If it would confine itself to equal protection, and, as Heaven does its rains, shower its favors alike on the high and the low, the rich and the poor, it would be an unqualified blessing." -- Andrew Jackson
Yes those poor suffering pharma companies.
The ones who spend more on marketing in the US than they do on R&D.
Right. And as I said above, there's a third option.
Scenario 3: They strike a licensing deal with Indian generics manufacturers to collect a small license fee for each HIV drug produced. They make jillions on the first world market plus a billion or two on the Indian market.