Hep C Discussion Forum

Isiscat2011 wrote:

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That wasn't a debate, PW.   

 

 

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Well, whatever you want to call it I hope you didn't take anything personally as I didn't intend it to be.  You seem like a good person to me.  We don't agree on this issue, but I know your heart is in the right place.  I doubt you think mine is but that's ok.  If you knew me better you'd know I'm not a bad guy. :)

About the Diane Rheem show,   Patiently , Why don't you wright to her and see if she is interested

patiently_waiting wrote:

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I think you know that's not what I've said.  Maybe you should offer your ideas on who should pay for the drugs.  Are you willing to get out your check book?  Someone has to pay for them - that fact is indisputable.  Who do you think it should be?  Let's just say it cost $12Bn to bring this drug to market, which shouldn't be too far off.  Where should that money come from?

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 Alternatives have been suggested, PW, but you stopped listening a long time ago.   I don't think you ever really started.  

A word comes to mind, "impasse"... Just my .02.

Tig

This would be a great topic for the Diane Rheem Show. 

Isiscat,

I respect your opinion as well, I just happen to disagree with it.

1) I never said the U.S.  I was referring to capitalist, free market countries *who respect intellectual property*.  This would include Europe, Japan, you get the idea.  It's the respect for intellectual property that is at the heart of my argument, not the other things you're raising like education, etc.  The Forbes article isn't really relevant, though as an aside the bullet "China has replaced the U.S. as the world's largest technology exporter" has nothing to do with innovation.  Much of that technology they have stolen and just reproduce with cheap labor.

2) It was actually the Indian judicial system as opposed to elected representatives (I think), but in any case it is not me who is punishing anyone.  I just take exception to getting stuck with the bill from freeloading countries who make ridiculous excuses like "old science".  As I noted in my bullets about how a drug's cost is set, if there are more paying patients the price comes down.  It's economics/marketing 101.  Drug companies have shown they will reduce the cost of their drugs proportionally to various countries' ability to pay. That of course means countries with higher GDP per capita pay more, which I'm fine with.  I'm not fine with outright theft.  I think you're overlooking the fact that these drugs will be paid for one way or another.  If some steal it then those who pay make up for that loss.  When the cost rises for paying patients to make up for the freeloaders, this does make it less accessible and therefore can cost patient's their health and potentially their lives.  Also, I'm not wealthy enough to pay other people's bills and I'm not a communist either so I don't believe I should have to.  I am fine with my tax dollars going to help the disabled in my own country, but there are limits.

All that said, I am not opposed to price controls, so long as they don't inhibit investment into R&D.  As I understand it there really isn't much oversight at all in the U.S. so it's tough to know what's fair and what isn't.  I won't make that judgement based on uninformed public outcry nor from objections from insurance companies who are obviously biased.  Unbiased and honest oversight would be a good thing I think, though.

-- Edited by patiently_waiting on Wednesday 28th of May 2014 09:21:44 PM

Isiscat2011 wrote:

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Thanks for adding that context, Don.  That just about covers it.   To me it is inconceivable to view India as the thief and Gilead as the victimized hero.  Just goes to show how upside down perspectives can become particularly when people are afraid.   There really is a better way.  Best regards.  

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 My opinion isn't rooted in fear, Isiscat.  I just perceive the world as it is and it's not a Disney movie.  At no point have I called Gilead a hero and I haven't stated their pricing is fair.  However, nobody posting in this thread including me knows what a fair price would be because we don't have all the facts.  At a minimum all these things will go into a drug's price:

- Expenses for all the clinical trials and other expenses related to FDA approval

- Acquisition costs (in this case $11B)

- R&D (may not apply to Gilead since it was an acquisition, but Pharmasset spent money from investors on R&D which was reflected in the acquisition cost)

- RISK: Yes, there is a $ figure attached to this in order to attract investment.  If you don't offer the potential for big profits investors will not put their money in a very risky endeavor like a novel drug to start with.  Without investors the drug never gets to market/to patients.

- Drug manufacturing costs (typically insignificant)

- Potential market (i.e. total number of *paying* patients): the fewer this number, the higher the drug cost will be for *paying* patients/insurance companies (see India)

- Duration of market (i.e. how much time will the drug continue to sell): in this case there are many competitors just around the corner

- Other minor costs like marketing, etc. (the above is all that comes to me off the top of my head)

I don't think there's anyone here who has all the answers to the above.  If not, nobody can call the pricing unfair.  Maybe it is and maybe it isn't.  I don't know.  You may be right that there's a better way, but based on what I've heard so far your way would result in a total death of innovation.

I know defending drug companies is about as popular as defending Nazis, but popular opinion is very often divorced from reality.  The system we have is far from perfect, but it's currently the best in the world in terms of developing new treatments.  A much larger government investment in drug R&D *may* reduce costs as investors would not have to be paid so much on the risk they're taking.  We're talking about a hell of a lot of money here though so I don't think we can count on tax dollars going to this any time soon.

I want to be very clear about this as well: I am not calling any patient anywhere a thief.  I would do anything necessary to get medication to cure me and I don't fault anyone else for doing the same.  I do fault foreign governments for stealing intellectual property, thus increasing costs for all of us who get stuck with the bill for that theft.  If we did things their way many people posting in this very thread would probably live shorter lives.

Edit: PS.  One thing to add: I do think an honest and thorough investigation should be done, though I doubt there is legal standing to do so.  If an investigation was done which considered all the facts and it was found that Gilead is in fact abusing their near monopoly on a cure, I will grab my pitchfork along with everyone else.  To my knowledge this has not been done so there isn't yet justification to cry foul.  You can take any comments from politicians with a grain of salt as we all know they are saying things that play well to the public with truth being a distant second in priority.

Yeah, to each their own. Trust taken out of context it's just oneupmanship, a waste of time. If you want to TRUST a greedy person with your wallet versus a benevolent or kind person, that's your choice. No one would say that money ind profit are not motivators for specific people, but greed denotes excess. When greed supersedes people, then its theft. For example, the S&L scandal, the 2000 Wall St., crash, the 2008 Wall St. crash where hundreds of thousands of people lost their entire savings, but the bankstas were rewarded. There are better alternative systems, than "trust me". India knows that their #1 responsibility is to their people, while they are not taking away monetary rewards for innovation, research, and development. I prefer to live in a world where I trust the honest people and either punish or restrain the dishonest people. But that is just me.

Some historical context may be useful. It is scientists who do the research, while investors finance it, hoping to get a fair return on their money. I won't argue what is fair or not, but just to say that it is not money alone that makes these breakthroughs. Rather it is dedicated researchers. Take sovaldi i,for example. It was developed by a researcher at Pharmasett. He was not rewarded for his discovery. Rather Pharmasett owned the patent and it went along with the sale of the company to Gilead.What if this same research team was salaried and funded by the national laboratories or a philanthropic trust fund? I doubt if the results would cost the American people more.

To sum up, Pharmaset was a pharmaceutical company that developed many powerful antiviral drugs, not only for HCV (Sofosbuvir/gs7977/sovaldi), but also for HIV (including racivir), and hepatitis B (including clevudine, marketed as Levovir), not to mention many others. Pharmaset was sold to Gilead for $11 billion in November 2011. It has been reported that Gilead has made $4 billion from sovaldi alone in  less than 6 months of sales. If we keep in mind that the $11 billion purchase of Pharmasett was for other high price patents as well, we can see how Gilead has come out as a bandit. Gilead also caused an international uproar in the medical community when it balked at the 99% cure rate using gs-7977 and bms-5885 together. That balk delayed effective DAA treatment for a full year wherein many who were not eligible for other options died. Just some history. Again I don't think it is necessary to make money over the dead bodies of others. We need balance in the medical arts in order to serve our people. [steps off soapbox]

Kudos again to India!

Don 

Don:

I just checked with my accountant and I'm pretty sure that, if I play my cards right, by the time my tx is over I'll have just enough money left to buy a nice, sturdy, rope with which to hang myself.  Aahhh...the American Dream.  Gotta love it.  

Yes, it does seem that placing trust in greedy exploiters sets one up to be exploited in the end. Who would choose that? There is fair wages and profit, and there are excessive profits. One doesn't need to be a genius to understand the disparities today between the salaries and benefits of CEOs and the average man. In short, most of these drugs would be much cheaper and more widely available to those who need them without the greed. Most hepatologists  and gastros have openly voiced their concern. My concern is for those who are going to die without it who don't have the dough. Me, all I had to do is sell one of my 3 yachts. No big deal :)

Don

patiently_waiting wrote:

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If I'm sick (I am) and I'm depending on medical discoveries to make me well, I will put my faith in "greed" over altruism as the latter is not quite as reliable as the first.  I would love to be able to depend upon people like Dr. Salk, but they don't seem to be the ones giving me the meds I'm about to start taking that will hopefully cure me.  Sofosbuvir may have been invented by one young chemist, but his checks were being signed by somebody.

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I suppose this philosophy falls into the category of:  "If you can't beat them, join them.  If you can't join them then support them in the hopes they will give you what you need."  The problem is the greedy don't care about what you need.  You are there to serve their needs. 

I disagree completely that greed is more reliable than kindness.  That is simply an idea adopted and accepted by a dysfunctional society.  But, I'm sure Ayn Rand would have approved.   

Gilead did not invent Sofosbuvir. Young chemist Mr.Clark employed by Pharmasset (in a shady government employed contract) made compound called PSI-7977 (later to be named GS-7977>Sofosbuvir). After a first clinical trial they announced results @ one conference. 2 weeks later Gilead bought Pharmasset for 11bil $, although the value of Pharmasset was realistic round 2bil $. It was a pure smell the money acquisition biz move.

Chemist that invented PSI-7977 was sacked from his job, his patent stolen by his boss (Pharmasset owner). He sued hos former boss and lost (location/jurisdiction wrong?). 2 years without a proper job, while he boss pocketed 400mil $ from those 11bil $ Gilead spitted in a rush. American dream anyone?

I am not saying Gilead is bad. There are tons of good people doing research there, but their biz managment is obviously evil or just poisoned by money game. 1k$ per pill that costs few $ to produce? if you count in clinical trials/research/marketing, it's still can't add to 1k$ per pill price. It's that obvious. Insane amount of money was paid for Pharmasset just for that magical compound we know today as Sovaldi and Gilead plans to get ROI in first 3-4 years (from 20 years of patent validity) with biggest price in history per pill.

i will again mention Dr.Jonas Salk, inventor of first polio vaccine who refused to patent it. Some say he could have been 6bil $ richer on other hand who knows how many children has he saved? millions? can we quantify that value in money?

PW:  Comparing the US to civilizations that have existed for thousands of years is hardly realistic.  America was the "fresh start" country.  200+ years later and our Empire is already in financial ruin.  The middle class is rapidly disappearing and we are becoming a nation of have and have nots.  The haves decide what medicines will be developed and to whom they will be distributed.  That is the legacy we will leave to our children and grandchildren.  We may just set a world record for self destructing.  

Greed is Good, PW.  Greed is good.  Just keep believing it.

Isiscat2011 wrote:

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PW:  You do realize that the heart of your argument is that massive profits for the few are more important than the suffering and loss of life for the many, don't you?  

Whether or not India grants patent protection to Gilead is still an unresolved legal question.  Your declaration that India, or other countries, are committing acts of theft is, therefore, not grounded in law.

Moreover, before you decide that the law trumps all other considerations you must understand that the law primarily supports the interests of the most powerful players.  The law is only as honorable as the society that enacts the laws.  There is no honor in depriving people of life saving drugs so others can make more money.  Placing profits above human suffering and loss of life is immoral and inhumane.    

 

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 Amen

It's intellectual property and it belongs to Gilead. For foreign companies to just steal their IP and reproduce it for their own profit is theft. The loss Gilead incurs by this theft is made up for by people in other countries who respect intellectual property (the West). China does it as does many others. I would never fault a patient for getting medication in any way they can, but Gilead spent invested money developing this drug and they own it. Should they be as reasonable as they can without losing money given it can save people's lives? Of course. But they shouldn't have it just taken from them.

-- Edited by patiently_waiting on Tuesday 27th of May 2014 03:33:47 AM

-- Edited by patiently_waiting on Tuesday 27th of May 2014 03:34:01 AM

I do not wonder why Gilead charges that much in USA/west, since they overpaid (11bil $) acquisition of Pharmasset (Sofosbuvir "inventors"), so no wonder we have situation like this (1k$ per pill). Pharmacology in free market economy is in one way pure evil.  Clinical trials, research etc is just a tiny fraction of the final product price in Sofosbuvir's case.

More than 40% of HIV patients use generic drugs made in India, you could say those generic drugs manufacturers are saving millions of lives.

I don't have any sympathy for pharma greed. As i mentioned, what my hepa told me as she is pretty desperate to treat her patients best she can. Vertex asked for almost a 60k$ per therapy of Incivek from state owned medicare like insurance. So who knows when we will get here in Bosnia triple therapy for HCV and all these new DAAs sound like distant SciFi. Average salary here is 500-600$. Gilead's regional manager, when my hepa asked for 6 bottles of Sovaldi for me, said it's manageable (since it's not yet on sale in EU), but hospital must pay (full price) for it. Yeah like my hospital has 168k$ just for me. I could get from my savings 5-10k$ and thats what i plan to do as soon as i see some generic Sofosbuvir in Egypt, India, wherever. Oh yeah, i guess i have to get generic Ribavirin too ;)

So, go Cipla, do it. I don't wanna wait 20 years until Gilead's patent on Sofosbuvir expires, so i can be "legal". Cheers Malcolm for that rumor :)

You could probably get a round-trip ticket to India for a couple of grand and then stay outside of the big cities for 3 months for a few thousand dollars, get a local doctor to write you a script for the generic versions of Sovaldi and Olysio (assuming there is a generic equivalent for Olysio) for a few hundred dollars and come back to the states cured for less than 10K.

I could come up with 10K relatively easy, but 160k--- that would be impossible for me.

Huey wrote:

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Taking into account the fact that this drug was put through the FDA in the fast lane, So maybe being Old Science is relay a Good thing!

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 Good thing it wasn't in the slow lane.  The lawyers and scientists would have been calling it "ancient history" by now!   lol

Taking into account the fact that this drug was put through the FDA in the fast lane, So maybe being Old Science is relay a Good thing!

Looks like India wants no part of it!

http://www.reuters.com/article/2014/04/10/us-natco-pharma-sovaldi-idUSBREA390VK20140410

http://www.msfaccess.org/about-us/media-room/press-releases/gilead-attempt-secure-patent-hepatitis-c-drug-opposed-india