Because Science

[BansheeOne]

I get the part where you can demand practically any price for drugs treating rare conditions because you don't have any competitor. However, if research cost is largely covered by government grants, why the often-criticized overall high prices of drugs in the US vs. Europe? The frequent explanation that American patients somehow subsidize the rest of the world in research because US pharma companies need to recoup their cost for it from them never made sense anyway, since the latter are not the only ones coming up with new medication; but if pretty much the entire argument has no base anyway, why the gap?

[nitflegal]

53 minutes ago, BansheeOne said:

I get the part where you can demand practically any price for drugs treating rare conditions because you don't have any competitor. However, if research cost is largely covered by government grants, why the often-criticized overall high prices of drugs in the US vs. Europe? The frequent explanation that American patients somehow subsidize the rest of the world in research because US pharma companies need to recoup their cost for it from them never made sense anyway, since the latter are not the only ones coming up with new medication; but if pretty much the entire argument has no base anyway, why the gap?

Basic research costs are largely goverment subsidized; so how things work generally.  Industry focusses on anything detailed; how does this ion channel respond to drug challenges, what do the receptors found during basic research actually do, etc.  Think of it as basic research understands how an internal combustion engine works, industry designs the actual engine.

The last is broadly accurate.  Unfortunately.  Strictly speaking, the cost is borne by US insurance companies.  Truthfully, there's a reason the EU made having research sites in Europe mandatory to market drugs within the EU.  Which is the regulations and oversight is just terrible so people were closing European research sites left and right.  As an example, look what Sanofi did in the mid-teens.  Their European sites were the most expensive to operate (more expensive than in Japan, which tells you something), produced the least useful output (not on the researchers, but the constraints on operations) and if you wanted to reduce headcount (lab no longer needed because the company was no longer pursuing that therapeutic area) you had to pay all employees for three years beginning after their termination date.  So they ended up killing off US based sites because if they had to pay staff in Europe regardless they might as well pay them.  This piece from Vox isn't bad and they are certainly not a right wing outlet. https://www.vox.com/science-and-health/2016/11/30/12945756/prescription-drug-prices-explained

However, it is murkier because the higher prices in the USA allow the pharmaceuticals to be bloated and inefficient.  I could make an argument that if the government here negotiated the process more then they have enough inefficiency that they could maintain operations and output with at least a modest reduction in pricing.  Not to EU levels of price chopping but there has to be significant room.  However, this would lead to many fewer competitors for any given drug (what you see in the EU) so that patients would not have a selection as they are used to.  Which isn't trivial as the alternate drugs often have fewer side effects for a particular patient or better efficacy.  So if there is a cheaper drug available but it makes you puke your guts out a few times a week or suffer depressive episodes (real examples) it sucks to be you.  

From a research standpoint it has demonstrably curtailed research in companies that don't have access to the US market.  We saw that when European and Japanese companies (which are usually quasi-owned by the state) tried to focus thos key companies only for the European market.  They started to collapse within half a year and the EU scrambled to take those restrictions off.  That's why in the late 2000's/early 2010's so many European sites closed all at the same time, they couldn't fund their sites with the price caps in the EU.  

[nitflegal]

2 hours ago, Wobbly Head said:

Viagra was originally developed for hypertension but once the boner side effect was discovered it became the best selling drug in the world. 

 Drug companies will finance medical research, but they are companies. The main aim of companies is to make money. So they will aim thier research towards what makes money. There is no money in curing rare diseases but there is in boner pills and heart disease of people who don't want to exercise and diet to be healthy and would rather take the easy route off popping a pill.

Just one other thing, the orphan disease are a big mid-tier cash-cow.  If you look at the last 20 years the biggest biotech pharmaceuticals (EG Genzyme, Biogen) had as their whole business model targeting rare disease with tiny patient populations and they were multi-billion/year revenue companies.

[sunday]

3 hours ago, DB said:

Exactly the point I was making, I think?

Pretty much, yes.

3 hours ago, nitflegal said:

That's not actually true. (...)

Quite true, as far as oversimplifications go.

There is also the issue of cures that stop being actually effective, like improperly used antibiotics once resistant strains of bacteria appear.

[nitflegal]

23 minutes ago, sunday said:

Pretty much, yes.

Quite true, as far as oversimplifications go.

There is also the issue of cures that stop being actually effective, like improperly used antibiotics once resistant strains of bacteria appear.

I haven't seen anything benchmarked for the pharma industry since 2016 but at the time drugs that were cures (eg Gilead Hep C) made up ~40% off all drugs brought to market in the previous decade and that percentage had actually climbed over the decade.  In theory that oversimplication makes sense but the dirty little secret is that from a development standpoint cures are far simpler than treatments.  Chronic problems are a bitch to address chemically.  Considering that a biotech can destroy the entire treatment market with a cure, sell their biotech to Pfizer for a billion dollars and all the executives retire with tens of millions they have a huge incentive to come up with that cure.  

[sunday]

Number of different products launched to market is one thing, but sales volume is another thing.

See, for instance: https://www.fiercepharma.com/special-reports/top-20-drugs-worldwide-sales-2021

[nitflegal]

5 hours ago, sunday said:

Number of different products launched to market is one thing, but sales volume is another thing.

See, for instance: https://www.fiercepharma.com/special-reports/top-20-drugs-worldwide-sales-2021

Sure.  But what's at issue is that while everyone focuses on the blockbusters the second tier meds are the actual foundation of most pharmaceuticals lie.  The industry learnt this during the Cox-2 debacle that pinning your company on 1-2 blockbusters means if Vioxx craps the bed your company falls apart.  You stated that there is no money in cures; the fatc that almost half of the drugs that go to market, which means the companies spent hundreds of millions of dollars just in R&D even before the GCMP compliance costs and setting up multi-million dollar production lines suggests they feel they will make their money back from it.  To put it in the frame of the website, everyone salivates over the tanks and bombers and forgets the trucks and transport aircraft and ships.  

[sunday]

There exist cash cow products. Survival of a business without cash cow products is difficult. One could make a distinction between products that are cash cows, and products that are not, and express that distinction by means of an oversimplification. It should be easier for drugs used in lengthy treatments to be cash cows.

Same way, mostly, that when establishing boundary conditions to state differential equations to calculate the neutron population in the inside of a nuclear reactor one could consider the population of neutrons outside the vessel, thus the reflector, is 0, even when actually is high enough to be deadly. But there are orders of magnitude of difference between the population inside the reactor vessel and outside the vessel, so the results obtained are good enough in the inside of the reactor.

Oversimplifications are not meant to be taken literally. They belong to Aristotelian Rhetoric, not to Aristotelian Dialectic.