Author Topic: There may be a cure. On the other hand, not finding a cure is very lucrative.  (Read 13456 times)

DrTesla

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Do you think there are a few (many?) companies out there that are withholding cures for the many diseases of the world to increase their earnings in treatment products and services yearly?

Greed is a very powerful force.

http://www.sott.net/article/267478-Greed-Why-an-accepted-cure-for-cancer-wont-be-found


Hamster

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MissStache

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No, but I think there are many companies that are funneling research money to treatments and not cures, because the money is in the treatment. 

acroy

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Big Bang Theory:
"there's no money in science"

Bernadette (working for Big Pharma): "Speak for yourself - We invented and cured a disease last month!"

GuitarStv

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TreeTired

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A simple "no" is too simple.

I don't think that a cure is currently being withheld, but it does trouble me deeply that there are huge financial incentives to suppress a cure if found.

I learned of a simple cheap non-surgical non-pharmaceutical cure for back pain that could probably help millions and millions of chronic sufferers, and yet it seems people just don't want to know.  I was practically an invalid, and have been pretty much pain free for 25 years.  People continue to go to their doctors and accept diagnoses of pinched nerves, bulging/bursting discs, misalignments and treat the "problem" with drugs and surgery.  What do most doctors do?  They prescribe drugs.   What do surgeons do?  Surgery.   /rantoff

Somebody will ask,  the answer is:

http://www.amazon.com/Mind-Over-Back-Pain-Sarno/dp/0425087417 

TrMama

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No.

However, most pharma companies will only come up with treatments for "diseases" that happen to people who can afford to buy their treatment.

This is why we have several treatments for erectile disfunction (an invented disease that's actually a normal part of human life) but really crappy treatments for malaria, yellow fever, or any other debilitating disease that mostly happens to poor people.

Roland of Gilead

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Well, there is a current situation where GILD has discovered a nearly perfect cure for hep C.   They want to price it high because of the R&D that went into it and the fear that if they cure everyone they will quickly lose the market for their drug.  I tend to agree with them but Congress wants to beat them up.   Congress doesn't do much to help out drug companies (or investors) who spend billions then have their product fail.  When one succeeds though, they want it sold for $5.

Argyle

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No.  I hear people say, "They're withholding the cure for cancer because..."  But the thing is, the people who work in pharmaceutical companies and in medicine — they and their families get cancer too.  Do you think they'd hide a cure when their own child or parent had cancer?  They're as desperate to cure it as anybody.

matchewed

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So you feel that given the 3 million people in the US that an $84,000 price tag to cure Hep C is reasonable? Congress has asked only that they justify the price tag given that people on medicare/medicaid will be paying the same, and how about people with lower income but not in those programs.

Also let's do the math. 3000000*84000= 252,000,000,000

252 billion it will cost if Gilead has its way. How much did the R&D cost if you happen to know? Consider that their annual R&D expenses from 2010 - 2013 below in millions of dollars -
R&D Expenses   1,072.9   1,229.2   1,651.9   2,119.8

Let's be generous and knock off all 2 billion from the cost. Still left with 250 billion. Maybe all the rest of their operating expenses over the same time frame -
Selling General & Admin Expenses, Total  1,044.4   1,213.5   1,349.4   1,699.4

(Source for numbers)

So another 1.7 billion.

248 billion left. Maybe we should shift the perspective from worrying that actually curing diseases when you are a drug manufacturer will reduce the market to just realizing that you can still make a profit and still cure people with out asshattery levels of charging.

No one said $5 in any of the articles I read. But some company did say $84k and that company is Gilead Science.

Heck we could roll the entire four years of operating and R&D expenses together. 11.4 billion. Still a pretty chunk of change coming their way. But what do I know. I may be missing something in this.

But no I don't think companies are withholding cures. They just want to charge a good amount of money for it, and sometimes they want to charge a crapton amount of money for it.

BlueHouse

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Profit driven industries like big pharma want to continue making profits, so they maximize research into long-term pharmaceuticals that provide repeat customers (viagra, rogaine, diabetes-drugs, lipitor and other statins.  It makes financial sense that they not spend most of their research dollars on treatments that end in a cure. 
Sad, but true. 

GuitarStv

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The posted article works really hard to discredit itself:

- Make outrageous claims that they don't attempt to prove.
- Blame things like 'chemtrails, aluminum in deodorants, antiperspirants, vaccines' for causing cancer.  Again without any evidence.
- Use terms like 'medical mafia' and attribute the term to the 'alternative news field'.
- Quote studies with very small sample sizes (21 in the article about Tumeric) where the researchers themselves indicate "it’s important to expand our work to more patients to confirm our findings."
- Quote studies of brine shrimp cancer growth as somehow equaling human studies, or being indicative of human response.
- Claiming things like: 'As conscientious consumers, it's our job to continue pushing the information that supports natural solutions and cancer prevention practices.'  - Myself, I'd be happier to push for information that prevents/cures cancer . . . if there's a natural solution, cool.  If there's a pharmaceutical solution, cool.  I certainly wouldn't look down on either provided that there was evidence that it could help me.

Shor

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Profit driven industries like big pharma want to continue making profits, so they maximize research into long-term pharmaceuticals that provide repeat customers (viagra, rogaine, diabetes-drugs, lipitor and other statins.  It makes financial sense that they not spend most of their research dollars on treatments that end in a cure. 
Sad, but true.

Correct, it's usually a totally different company that is researching and working towards the development of a cure as this team is focused on the treatment. If they were going to withhold the cure, they wouldn't be working towards it in the first place.

Would they withhold a cure?
If company A is making billions from the treatment, and Company B is holding the cure which dries up all of that profit for the competitor, by golly you release that cure as fast as you can proof it. Capitalism at work.

Roland of Gilead

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So you feel that given the 3 million people in the US that an $84,000 price tag to cure Hep C is reasonable? Congress has asked only that they justify the price tag given that people on medicare/medicaid will be paying the same, and how about people with lower income but not in those programs.

Also let's do the math. 3000000*84000= 252,000,000,000

252 billion it will cost if Gilead has its way. How much did the R&D cost if you happen to know? Consider that their annual R&D expenses from 2010 - 2013 below in millions of dollars -
R&D Expenses   1,072.9   1,229.2   1,651.9   2,119.8


Well, I do know that Gilead is not trading as if it expects anywhere close to $252,000,000,000 in profit.  It is actually down 3% today.

Who protects the company in 10 years when the drug is no longer being sold and it is found out 0.1% of the people who took it develop some condition?  Does Congress step in and block the class action lawsuit against the drug company who agreed to sell their drug at a reduced rate?  All I see on tv is commercials for 1-800-BAD DRUG from some lawyers wanting to sue.

I have invested in a number of biotechs and I have lost money when the drug failed in phase III or in the case of Affymax (AFFY) there were a number of deaths after the drug was FDA approved and the company all but folded.

matchewed

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So you feel that given the 3 million people in the US that an $84,000 price tag to cure Hep C is reasonable? Congress has asked only that they justify the price tag given that people on medicare/medicaid will be paying the same, and how about people with lower income but not in those programs.

Also let's do the math. 3000000*84000= 252,000,000,000

252 billion it will cost if Gilead has its way. How much did the R&D cost if you happen to know? Consider that their annual R&D expenses from 2010 - 2013 below in millions of dollars -
R&D Expenses   1,072.9   1,229.2   1,651.9   2,119.8


Well, I do know that Gilead is not trading as if it expects anywhere close to $252,000,000,000 in profit.  It is actually down 3% today.

Who protects the company in 10 years when the drug is no longer being sold and it is found out 0.1% of the people who took it develop some condition?  Does Congress step in and block the class action lawsuit against the drug company who agreed to sell their drug at a reduced rate?  All I see on tv is commercials for 1-800-BAD DRUG from some lawyers wanting to sue.

I have invested in a number of biotechs and I have lost money when the drug failed in phase III or in the case of Affymax (AFFY) there were a number of deaths after the drug was FDA approved and the company all but folded.

How much it is down today has little to do with the expectation. That expectation in profit was determined in the stock price way back when it was said they could sell the product.

You're claiming the company needs protection. That has yet to be proven and is pure speculation. What we do know is how much they want to sell it for. We can back of the napkin math some of the profits. Crying martyr for an event that hasn't happened yet doesn't justify the selling price.

I'm so sorry you lost money because Affymax alongside Takeda Pharmaceuticals developed an injection that killed .02% of the people who took it and the trials they were running found it wasn't any more effective than other current drugs on the market which is probably more the reason than it was just killing people. But we have something which has a 90% cure rate for Hep C. Which is much more effective than other treatments on the market. Your anecdote about Affymax has little to nothing to do with Gilead's pricing.

wild wendella

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I'll agree with what NC_MJ and others have said.  Withholding?  No.  Pursuing?  Eh.  We think we have a Health Care System, but what our capitalist economy actually has is a Disease Care System.  The goal is profit.  There just wouldn't be much profit in true health care.  If you go to a health care practitioner, and they convince you to eliminate sugar, drink alcohol only very rarely, eat tons of fruits and even more vegetables, consume no pesticides, growth hormones or antibiotics, use no toxic chemicals in your home or on your body, stop using aluminum deodorant, stop using cookware with teflon or plastic, get flame retardant chemicals out of your car and home, purify your water, stop taking drugs for minor aches and pains, exercise and meditate... etc. etc.. well, it's unlikely you would ever need to go back for follow-up consultations, and you definitely wouldn't need to be prescribed high blood pressure medication until the day you die.

In terms of cancer, our disease care professionals are mostly pushing removal (surgery) and radiation. Really?  That's the best solution *anyone* has come up with? 

Roland of Gilead

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I'm so sorry you lost money because Affymax alongside Takeda Pharmaceuticals developed an injection that killed .02% of the people who took it and the trials they were running found it wasn't any more effective than other current drugs on the market which is probably more the reason than it was just killing people. But we have something which has a 90% cure rate for Hep C. Which is much more effective than other treatments on the market. Your anecdote about Affymax has little to nothing to do with Gilead's pricing.

It has everything to do with Gilead's pricing.  For every Sovaldi there are 10 Omontys and probably hundreds that don't make it past phase II trials (but still cost the company millions in R&D).   When they hit on a winner they have to milk it to pay for all of these other failures.  Because the failures disappear, it can make the whole industry look more profitable than it is because only the winners survive.

I do think the drug is priced a bit on the high side.

matchewed

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I'm so sorry you lost money because Affymax alongside Takeda Pharmaceuticals developed an injection that killed .02% of the people who took it and the trials they were running found it wasn't any more effective than other current drugs on the market which is probably more the reason than it was just killing people. But we have something which has a 90% cure rate for Hep C. Which is much more effective than other treatments on the market. Your anecdote about Affymax has little to nothing to do with Gilead's pricing.

It has everything to do with Gilead's pricing.  For every Sovaldi there are 10 Omontys and probably hundreds that don't make it past phase II trials (but still cost the company millions in R&D).   When they hit on a winner they have to milk it to pay for all of these other failures.  Because the failures disappear, it can make the whole industry look more profitable than it is because only the winners survive.

I do think the drug is priced a bit on the high side.

I understand what you're saying. And you're right that companies and their investors take a huge financial risk to develop drugs. But to paint Gilead as some how being maligned by Congress is a bit extreme.

It is rather off to claim that Congress doesn't help drug companies. Consider tax breaks, preferential treatment of R&D costs (R&D Tax Credit), I'd say that Congress has every right to act as an oversight to the costing of the drug as they have helped in their own way to ensure that the company pays minimal taxes so more money can be funneled to R&D.

The wonders of private and public working together.

Well, there is a current situation where GILD has discovered a nearly perfect cure for hep C.   They want to price it high because of the R&D that went into it and the fear that if they cure everyone they will quickly lose the market for their drug.  I tend to agree with them but Congress wants to beat them up.   Congress doesn't do much to help out drug companies (or investors) who spend billions then have their product fail.  When one succeeds though, they want it sold for $5.

warfreak2

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However, most pharma companies will only come up with treatments for "diseases" that happen to people who can afford to buy their treatment.

This is why we have several treatments for erectile disfunction (an invented disease that's actually a normal part of human life) but really crappy treatments for malaria, yellow fever, or any other debilitating disease that mostly happens to poor people.
I totally disagree with your "invented diseases" classification; eyesight deterioration, for example, is also a normal part of human life, but I don't see why it would make sense to call it "invented", or not develop treatment for it.

Poor people wear glasses too. Opticians operate profitably generally not because rich people want glasses, but because lots of people want glasses. Financial motives aren't so badly out of line with human interest in this regard; the more people in need of treatment, the more profitable it is to develop treatments for them.

That said, here in the UK, we have a single-payer health system which decides which treatments to allocate money to, directly based on which treatments provide the best life improvement for their cost. Obviously that's hard to measure objectively, but it does work pretty well; and it means if you want to make money selling treatments in the UK, the way to do so is to improve life as much as possible, relative to cost.

Also, the Bill & Melinda Gates Foundation spends rather a lot of money fighting malaria, for example, based on research which suggests that this is the best use of their money to bring the biggest improvement to life.

If this was the norm in larger economies like the USA, it would have a much bigger effect in aligning financial motives with human interest.


squatman

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Sovaldi is priced at a level that insurance providers will pay. There are many angles of this equation that aren't being examined:

1) A high percentage of Hep C patients are either ex-military or on Medicaid, so they are paying very little out-of-pocket for these treatments
2) Doctors have been warehousing Hep C patients for years waiting for Sovaldi (and the similar products coming from AbbVie among others) because it works better than the current treatments like Incivek/Victrelis and the overall course of therapy is actually cheaper.
3) Insurance companies would rather pay 83k of the 84k (with the patient footing the rest) to cure them forever of Hep C, preventing these patients from eventually developing cirrhosis/liver cancer and requiring 1M+ in treatment for a liver transplant.
4) The prevalence of Hep C far outstrips its incidence (way more people have it than new people are getting it), so this is a somewhat short-term bolus of craziness.

There are many aspects of modern healthcare and pharma that are terrible, but moving one lever - forcing drug prices down - isn't going to solve the problem. Figure out a way to make the ENTIRE health care system sustainable AND non-profit, and then we can talk.

Roland of Gilead

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If you believe drugs should come under heavy price controls then you should also believe that doctors should have caps in pay.  $300,000 salary for one person is quite ridiculous when a barista at Starbucks is only making $12/hr.   But why not stop there?  How about hospitals charging $500 a day for a room when a motel 6 is only around $50 (and you get more sq ft plus free breakfast).

matchewed

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If you believe drugs should come under heavy price controls then you should also believe that doctors should have caps in pay. 

Why?

MicroRN

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I used to work in cancer research, and one thing that always comes up is "a cure."  There's no such thing as a cure for cancer, because every cancer is different.  It's your own cells, but there are different ways the cells grow.  Some are more susceptible than others to certain treatments.   

There are other methods than just surgery/radiation/chemo.  I worked on an immunological approach.  We drew blood, separated out immune cells, and fed them tumor so they would recognize it as foreign.  The cells were then injected back into the person, with the hope that the immune cells would find and destroy the tumor.  The method is quite effective on melanoma if caught early, but not as effective on certain other forms of cancer.  I've met many, many cancer researchers, and not one has been in it for the money.  They pour their lives into research because they want to cure people. 

Roland of Gilead

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If you believe drugs should come under heavy price controls then you should also believe that doctors should have caps in pay. 

Why?

Why not?

squatman

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I used to work in cancer research, and one thing that always comes up is "a cure."  There's no such thing as a cure for cancer, because every cancer is different.  It's your own cells, but there are different ways the cells grow.  Some are more susceptible than others to certain treatments.   

There are other methods than just surgery/radiation/chemo.  I worked on an immunological approach.  We drew blood, separated out immune cells, and fed them tumor so they would recognize it as foreign.  The cells were then injected back into the person, with the hope that the immune cells would find and destroy the tumor.  The method is quite effective on melanoma if caught early, but not as effective on certain other forms of cancer.  I've met many, many cancer researchers, and not one has been in it for the money.  They pour their lives into research because they want to cure people.

From my experience as a researcher and then an outsider working with pharma companies, I'd wholly agree that the researchers themselves have only the best of intentions. Unfortunately, a disconnect forms between them and the people who are responsible to shareholders.

vern

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"Trust Your Mechanic"


Hamster

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I'm not in ANY way trying to justify the pricing of Sovaldi.

But, the fact that it can be bought for $84,000 for a treatment course that will CURE for Hep C argues that finding a cure can be more lucrative than finding a treatment.

warfreak2

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If you believe drugs should come under heavy price controls then you should also believe that doctors should have caps in pay. 

Why?

Why not?
Because if you're the one asserting that someone else should believe something, the onus is on you to explain why they should believe it.

There are many arguments in favour of drug price controls that simply don't apply to doctors' pay. They may or may not be good arguments, depending on your point of view, but it's perfectly consistent to be in favour of one and not the other.

matchewed

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If you believe drugs should come under heavy price controls then you should also believe that doctors should have caps in pay. 

Why?

Why not?

*Edit to fix the post*

Sorry but your the one making an open claim without any support or reasoning. I haven't made a claim or rebuttal. So I'm asking for more of your thoughts on the matter. The answer to that inquiry can't just be "why not?" as it doesn't say anything as to why medicine pricing is related to doctors wages.
« Last Edit: April 24, 2014, 06:09:52 AM by matchewed »

Roland of Gilead

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Well, what are the reasons a doctor receives $300,000+ in pay?

1)  They have a long education process and a shorter time to recoup in the job market

2)  They usually took on a large debt and should be compensated for the risks

3)  They are in demand and we need doctors, so the pay encourages people to choose this field (you are fooling yourself if you think a majority of doctors would have chosen the profession if the pay was $50,000/yr)

So now look at the reasons a bio receives a large amount for a new drug.

1)  They have a long development process and a short time to recoup (patent length before generics)

2)  They almost always take on a large debt and the risk of both not getting approved, or having a problem after approval (1 800 BAD DRUG) is very real.

3)  The drugs are in demand and we need them, so the investment return encourages the research and development of new drugs.  (you are fooling yourself if you think investors and a company would be willing to spend $12,000,000,000 on a drug and then give it away)

warfreak2

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Because each drug can only be sold by the company which patents it, drug prices are mostly determined by what people are willing to pay - this has no relation to the marginal cost of production.

Because there is no monopoly on educations in medicine, doctors' salaries are mostly determined by what doctors are willing to be paid - i.e. the marginal cost of producing a doctor's appointment.

The latter is a correctly functioning competitive market. The former is not. Regulatory intervention can only be appropriate when the market isn't already achieving the desired result.

greaper007

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Profit driven industries like big pharma want to continue making profits, so they maximize research into long-term pharmaceuticals that provide repeat customers (viagra, rogaine, diabetes-drugs, lipitor and other statins.  It makes financial sense that they not spend most of their research dollars on treatments that end in a cure. 
Sad, but true.

Of course in the case of those medications the cure is absolutely diet and exercise.   Even ED doesn't seem to occur in men that maintains healthy weight and circulatory system.  So big pharma is just filling a niche for people that don't want the easy answer.

matchewed

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Well, what are the reasons a doctor receives $300,000+ in pay?

1)  They have a long education process and a shorter time to recoup in the job market

2)  They usually took on a large debt and should be compensated for the risks

3)  They are in demand and we need doctors, so the pay encourages people to choose this field (you are fooling yourself if you think a majority of doctors would have chosen the profession if the pay was $50,000/yr)

So now look at the reasons a bio receives a large amount for a new drug.

1)  They have a long development process and a short time to recoup (patent length before generics)

2)  They almost always take on a large debt and the risk of both not getting approved, or having a problem after approval (1 800 BAD DRUG) is very real.

3)  The drugs are in demand and we need them, so the investment return encourages the research and development of new drugs.  (you are fooling yourself if you think investors and a company would be willing to spend $12,000,000,000 on a drug and then give it away)

Thank you.

What do you think then of the patent process which is designed to aid the profitability and exclusivity for drug makers? Doctors don't have the same protection. Does that alter how the pricing of the drug should occur since we're no longer in apples to apples comparison of doctor pay and drug cost? Or should a doctor have a patent for their education? Oh wait they don't. And doctors get paid a broad spectrum of pay all across the board. This drug isn't getting different cost structures for different scenarios. It will still cost 84k.

So while there may be some vague similarities doctor pay and drug costing don't have an apples to apples relationship. And I can think that a doctor will be fairly compensated with his salary given the education and residency requirements while maintaining that 84k is too much for a drug.

greaper007

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Well, what are the reasons a doctor receives $300,000+ in pay?

1)  They have a long education process and a shorter time to recoup in the job market

2)  They usually took on a large debt and should be compensated for the risks

3)  They are in demand and we need doctors, so the pay encourages people to choose this field (you are fooling yourself if you think a majority of doctors would have chosen the profession if the pay was $50,000/yr)

So now look at the reasons a bio receives a large amount for a new drug.

1)  They have a long development process and a short time to recoup (patent length before generics)

2)  They almost always take on a large debt and the risk of both not getting approved, or having a problem after approval (1 800 BAD DRUG) is very real.

3)  The drugs are in demand and we need them, so the investment return encourages the research and development of new drugs.  (you are fooling yourself if you think investors and a company would be willing to spend $12,000,000,000 on a drug and then give it away)

I don't think the Dr. thing is completely accurate.   I would argue that doctors make as much as they do because the ADA functions as perhaps the most powerful union in the country (and I say that with total respect).     They completely control the means of production and how many doctors can be certified to practice in the US.    Thus they create a system of scarcity that demands doctors receive high pay.     

Doctors primarily make high pay because there are very few medical schools that take a handful of students that want to be doctors.    Compare that to law schools that just continue to pop up around the country.    Students that go to these schools often have loans that are just as high as loans for medical school, but the resulting salary from a 3rd tier law school doesn't have a tenth of the return that a doctor's salary has.

I used to be an airline pilot and would often have this conversation with my first officer or captain (at cruise on auto pilot).    We would comment that if only our union would serve pilots as a whole, not pilots from each individual carrier.   Along with taking on the certification of pilots, pay would be much higher and the risk of major career hurdles from things like a carrier going belly up would be much less of a threat for the individual member.   

Doctors and some dock workers really do have the last strong union left, that's why they get paid well.

Roland of Gilead

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Well, what are the reasons a doctor receives $300,000+ in pay?

1)  They have a long education process and a shorter time to recoup in the job market

2)  They usually took on a large debt and should be compensated for the risks

3)  They are in demand and we need doctors, so the pay encourages people to choose this field (you are fooling yourself if you think a majority of doctors would have chosen the profession if the pay was $50,000/yr)

So now look at the reasons a bio receives a large amount for a new drug.

1)  They have a long development process and a short time to recoup (patent length before generics)

2)  They almost always take on a large debt and the risk of both not getting approved, or having a problem after approval (1 800 BAD DRUG) is very real.

3)  The drugs are in demand and we need them, so the investment return encourages the research and development of new drugs.  (you are fooling yourself if you think investors and a company would be willing to spend $12,000,000,000 on a drug and then give it away)

Thank you.

What do you think then of the patent process which is designed to aid the profitability and exclusivity for drug makers? Doctors don't have the same protection. Does that alter how the pricing of the drug should occur since we're no longer in apples to apples comparison of doctor pay and drug cost? Or should a doctor have a patent for their education? Oh wait they don't. And doctors get paid a broad spectrum of pay all across the board. This drug isn't getting different cost structures for different scenarios. It will still cost 84k.

So while there may be some vague similarities doctor pay and drug costing don't have an apples to apples relationship. And I can think that a doctor will be fairly compensated with his salary given the education and residency requirements while maintaining that 84k is too much for a drug.

There is an entire process that protects doctors too.  I cannot practice medicine or prescribe drugs because I have not become a doctor.  The government will arrest me if I tried.  There are certification boards and licenses.  Doctors are in a pretty exclusive club.  So while a doctor doesn't have a patent for his education, he does have a permit (for a longer time period than a patent I may point out) that allows him to have a monopoly over other people who have not obtained this permit.

$84,000 for a drug that prevents $300,000 to $1,000,000 in doctor and hospital costs over the life of the patient really doesn't seem that outrageous.

warfreak2

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There is an entire process that protects doctors too.  I cannot practice medicine or prescribe drugs because I have not become a doctor.  The government will arrest me if I tried.  There are certification boards and licenses.  Doctors are in a pretty exclusive club.  So while a doctor doesn't have a patent for his education, he does have a permit (for a longer time period than a patent I may point out) that allows him to have a monopoly over other people who have not obtained this permit.
But this is not a monopoly in comparison to drug patents, whereby even if another company did all of the research and developed their own drug, they aren't allowed to sell it if it is too similar to what their competitors patented first.

Quote
$84,000 for a drug that prevents $300,000 to $1,000,000 in doctor and hospital costs over the life of the patient really doesn't seem that outrageous.
Perhaps not, but value to the customer is not how prices are determined in a competitive market.

You have set the bar very high for yourself by arguing that someone who is in favour of controls on drug prices should also be in favour of controls on doctors' pay. It's not enough for you to give an argument that seems convincing to you; your argument must convince everybody who is in favour of drug price controls, for whatever their own reasons are. This is why it's a bad idea to tell other people what they should believe, based only on another thing that they do believe; you don't know what their reasons are for favouring controls on drug prices, so you don't know whether or not those reasons apply to controls on doctors' pay. (Most of the reasons don't.)

Roland of Gilead

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You can look at it another way.  How many new blockbuster drugs have been developed in the USA, where there are no price controls, versus other countries which do have price controls?  Do we really want a system that pulls down everyone to the lower bar?

Hamster

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You can look at it another way.  How many new blockbuster drugs have been developed in the USA, where there are no price controls, versus other countries which do have price controls?  Do we really want a system that pulls down everyone to the lower bar?
Take a look. Half of the biggest pharma companies are in Europe.

And all of these companies, whether based in the US or Europe, charge Europeans and Canadians a fraction of what they charge Americans for the exact same drugs. By forbidding Medicare from bilk price negotiation and importation of cheaper meds from overseas, the US gov't is having US citizens subsidize drug development, pharma profits, and lower drug prices for citizens of other countries. Very messed up... I can see no reason aside from pharma lobbying and purchasing of politicians.


The Happy Philosopher

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Well, what are the reasons a doctor receives $300,000+ in pay?

1)  They have a long education process and a shorter time to recoup in the job market

2)  They usually took on a large debt and should be compensated for the risks

3)  They are in demand and we need doctors, so the pay encourages people to choose this field (you are fooling yourself if you think a majority of doctors would have chosen the profession if the pay was $50,000/yr)

So now look at the reasons a bio receives a large amount for a new drug.

1)  They have a long development process and a short time to recoup (patent length before generics)

2)  They almost always take on a large debt and the risk of both not getting approved, or having a problem after approval (1 800 BAD DRUG) is very real.

3)  The drugs are in demand and we need them, so the investment return encourages the research and development of new drugs.  (you are fooling yourself if you think investors and a company would be willing to spend $12,000,000,000 on a drug and then give it away)

I don't think the Dr. thing is completely accurate.   I would argue that doctors make as much as they do because the ADA functions as perhaps the most powerful union in the country (and I say that with total respect).     They completely control the means of production and how many doctors can be certified to practice in the US.    Thus they create a system of scarcity that demands doctors receive high pay.     

Doctors primarily make high pay because there are very few medical schools that take a handful of students that want to be doctors.    Compare that to law schools that just continue to pop up around the country.    Students that go to these schools often have loans that are just as high as loans for medical school, but the resulting salary from a 3rd tier law school doesn't have a tenth of the return that a doctor's salary has.

I used to be an airline pilot and would often have this conversation with my first officer or captain (at cruise on auto pilot).    We would comment that if only our union would serve pilots as a whole, not pilots from each individual carrier.   Along with taking on the certification of pilots, pay would be much higher and the risk of major career hurdles from things like a carrier going belly up would be much less of a threat for the individual member.   

Doctors and some dock workers really do have the last strong union left, that's why they get paid well.

What is the ADA?

I'm not aware of any doctor "union" that you are referring to. In fact I think it may be illegal for doctors to unionize.

You may be referring to the AMA (American medical association), which in part lobbies on behalf of doctors. I think you are overestimating the political power of the AMA. Residency positions determine supply of doctors, not medical schools. Excess residency slots are often filled with foreign medical grads. Who end up working in the us anyways. Generally oversupplied poor paying specialties have a harder time filling slots, which eventually leads to fewer docs in that specialty, shortages, better pay etc. it's a very slow inefficient market.

Doctors/hospitals negotiate with insurance companies for pricing. For Medicare/Medicaid you get whatever they decide to pay. Many providers can't break even with Medicare patients depending on overhead costs so one could argue that the AMA has done a poor job lobbying for doctors!

Many doctors making 300k or greater are sub specialists that have put in around 10 years of post graduate training. Average primary care doc probably makes closer to 200k.

ScienceSexSavings

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I'm in the sciences, and I have a very, very difficult time believing all the "evil big pharma" stories. First of all, I'd be astounded if any industry had it's shit together well enough to control things the way people claim it does. But more importantly, "cancer" isn't actually a disease, it's a huge category of different diseases, which are often slightly different from patient to patient, or even at different points in the same patient's life. There's probably never going to be one single cure for it.  The closest thing I've ever seen to cure-avoidance is when the DCA study was published, and no company wanted to touch it because the drug is already out there without a patent. In summary, a cheap drug used to treat rare problems like lactic acidosis very effectively treated certain types of cancer in rats. The drug only targets cells with a particular type of metabolism, which is a signature of cancer. Because the drug was originally approved for other diseases, it needs to be clinically tried for cancer. However, because it's already out there without a patent, no company wants to touch it because it would be a massive loss. Apparently there are stage I and II clinical trials happening in Canada now, so I guess someone decided to go there, and U Colorado managed to get a patent by working viral genetics into it. The only thing they could ever gain is good PR. I think the most selfish thing I've seen in cancer research was when someone found a neurotoxin that targeted some cancer cells and filed a patent for neurotoxin-producing genes. The fuck, man?

Bakari

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They don't have to withhold it, just don't do the research in the first place.

What I do think is a HUGE amount of cures and treatments are 50-100% placebo, and that most of the money and time spent on healthcare is for things which the body would have fixed itself with enough time, and proper exercise, nutrition, sleep and rest.  I think a huge percent of healthcare is really just about making people feel better, whether it is treating symptoms or even just making them feel emotionally better because someone is "doing" something.
I think doctors are well meaning, but there is financial (and emotional) incentive for them to pathologize as much as possible, and to reinforce the idea that they are needed.  Not unlike priests.  Its easy enough to see how every "alternative" healthcare practitioner falls into that category, but I think it applies almost as well to much of real medicine as well.

I just wrote a whole essay on this exact topic, I'll try to remember to post the link here once I put it on my blog (it'll be a couple days because I have a single topic series going up one day at a time at the moment)

squatman

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They don't have to withhold it, just don't do the research in the first place.

What I do think is a HUGE amount of cures and treatments are 50-100% placebo, and that most of the money and time spent on healthcare is for things which the body would have fixed itself with enough time, and proper exercise, nutrition, sleep and rest.  I think a huge percent of healthcare is really just about making people feel better, whether it is treating symptoms or even just making them feel emotionally better because someone is "doing" something.
I think doctors are well meaning, but there is financial (and emotional) incentive for them to pathologize as much as possible, and to reinforce the idea that they are needed.  Not unlike priests.  Its easy enough to see how every "alternative" healthcare practitioner falls into that category, but I think it applies almost as well to much of real medicine as well.

I just wrote a whole essay on this exact topic, I'll try to remember to post the link here once I put it on my blog (it'll be a couple days because I have a single topic series going up one day at a time at the moment)

Do you have scientific justification for any of this? IMO the last century of biomedical research would like to have a talk with you. Hell, one of the main drugs in this thread - Sovaldi - is a CURE for Hep C, a disease that guarantees liver failure regardless of the amount of time/sleep/good nutrition.

Roland of Gilead

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Do you have scientific justification for any of this? IMO the last century of biomedical research would like to have a talk with you. Hell, one of the main drugs in this thread - Sovaldi - is a CURE for Hep C, a disease that guarantees liver failure regardless of the amount of time/sleep/good nutrition.

Nah, a good night's sleep will go a long way toward preventing polio and curing malaria.  Everyone knows that.

LowER

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Well, what are the reasons a doctor receives $300,000+ in pay?

1)  They have a long education process and a shorter time to recoup in the job market

2)  They usually took on a large debt and should be compensated for the risks

3)  They are in demand and we need doctors, so the pay encourages people to choose this field (you are fooling yourself if you think a majority of doctors would have chosen the profession if the pay was $50,000/yr)

So now look at the reasons a bio receives a large amount for a new drug.

1)  They have a long development process and a short time to recoup (patent length before generics)

2)  They almost always take on a large debt and the risk of both not getting approved, or having a problem after approval (1 800 BAD DRUG) is very real.

3)  The drugs are in demand and we need them, so the investment return encourages the research and development of new drugs.  (you are fooling yourself if you think investors and a company would be willing to spend $12,000,000,000 on a drug and then give it away)

I don't think the Dr. thing is completely accurate.   I would argue that doctors make as much as they do because the ADA functions as perhaps the most powerful union in the country (and I say that with total respect).     They completely control the means of production and how many doctors can be certified to practice in the US.    Thus they create a system of scarcity that demands doctors receive high pay.     

Doctors primarily make high pay because there are very few medical schools that take a handful of students that want to be doctors.    Compare that to law schools that just continue to pop up around the country.    Students that go to these schools often have loans that are just as high as loans for medical school, but the resulting salary from a 3rd tier law school doesn't have a tenth of the return that a doctor's salary has.

I used to be an airline pilot and would often have this conversation with my first officer or captain (at cruise on auto pilot).    We would comment that if only our union would serve pilots as a whole, not pilots from each individual carrier.   Along with taking on the certification of pilots, pay would be much higher and the risk of major career hurdles from things like a carrier going belly up would be much less of a threat for the individual member.   

Doctors and some dock workers really do have the last strong union left, that's why they get paid well.

So many factual errors I'm not even sure where to start.  I had hoped that airplane pilots had more sense than your post belies.  The ADA I believe is the American Diabetes Association.  If you are referring to the AMA (American Medical Association - not to be confused with the American Motorcycle Association), wow, I don't know of a single doc who belongs to that big bag of bloated shit.  In fact, more than 200,000 docs post at sermo.com and not one of them will admit to endorsing ANYTHING that organization believes in.  Most feel that the downfall of their profession is at least partially blamed on the AMA!  Every doc I know hates the AMA, and most have no idea who the ADA is.

It is against federal law for docs to unionize.

And you flew a plane with unsuspecting passengers/cargo on board?  Shame on you!

LowER

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If you believe drugs should come under heavy price controls then you should also believe that doctors should have caps in pay. 

Why?

Why not?

*Edit to fix the post*

Sorry but your the one making an open claim without any support or reasoning. I haven't made a claim or rebuttal. So I'm asking for more of your thoughts on the matter. The answer to that inquiry can't just be "why not?" as it doesn't say anything as to why medicine pricing is related to doctors wages.

Doctors' wage only account for about 8% of healthcare costs.  Enough said.

warfreak2

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I'm in the sciences, and I have a very, very difficult time believing all the "evil big pharma" stories.
Oh, there are a lot of true "evil big pharma" stories, but they aren't the popular ones like "vaccines cause autism", "pharmaceutical companies hide cures because treatments are more lucrative", &c. Mostly it's hiding evidence and evading regulation - Ben Goldacre's book Bad Pharma is an excellent summary of the real problems.

Bakari

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They don't have to withhold it, just don't do the research in the first place.

What I do think is a HUGE amount of cures and treatments are 50-100% placebo, and that most of the money and time spent on healthcare is for things which the body would have fixed itself with enough time, and proper exercise, nutrition, sleep and rest.  I think a huge percent of healthcare is really just about making people feel better, whether it is treating symptoms or even just making them feel emotionally better because someone is "doing" something.
I think doctors are well meaning, but there is financial (and emotional) incentive for them to pathologize as much as possible, and to reinforce the idea that they are needed.  Not unlike priests.  Its easy enough to see how every "alternative" healthcare practitioner falls into that category, but I think it applies almost as well to much of real medicine as well.

I just wrote a whole essay on this exact topic, I'll try to remember to post the link here once I put it on my blog (it'll be a couple days because I have a single topic series going up one day at a time at the moment)

Do you have scientific justification for any of this? IMO the last century of biomedical research would like to have a talk with you. Hell, one of the main drugs in this thread - Sovaldi - is a CURE for Hep C, a disease that guarantees liver failure regardless of the amount of time/sleep/good nutrition.

Of course its not 100% of 100% of cures.  If you have diabetes or cancer or a bacteria infection modern medicine is the difference between life and death.  But the dramatic cases aren't what most doctor visits are for, they are for rashes and colds and hurting backs.
Up to 90% of all doctor visits are for "conditions" caused by stress:
http://www.webmd.com/mental-health/effects-of-stress-on-your-body

The scientific evidence?  Between 35 and 90% of people get better with either no treatment or placebo, depending on the condition
http://skepdic.com/placebo.html

Also, doctors don't keep up with the best available research anyway:
http://www.utne.com/science-and-technology/a-study-a-day-keeps-the-doctor-away.aspx

so even if a cure exists, it isn't necessarily what health care is going to consist of
« Last Edit: April 28, 2014, 07:55:36 AM by Bakari »

greaper007

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Well, what are the reasons a doctor receives $300,000+ in pay?

1)  They have a long education process and a shorter time to recoup in the job market

2)  They usually took on a large debt and should be compensated for the risks

3)  They are in demand and we need doctors, so the pay encourages people to choose this field (you are fooling yourself if you think a majority of doctors would have chosen the profession if the pay was $50,000/yr)

So now look at the reasons a bio receives a large amount for a new drug.

1)  They have a long development process and a short time to recoup (patent length before generics)

2)  They almost always take on a large debt and the risk of both not getting approved, or having a problem after approval (1 800 BAD DRUG) is very real.

3)  The drugs are in demand and we need them, so the investment return encourages the research and development of new drugs.  (you are fooling yourself if you think investors and a company would be willing to spend $12,000,000,000 on a drug and then give it away)

I don't think the Dr. thing is completely accurate.   I would argue that doctors make as much as they do because the ADA functions as perhaps the most powerful union in the country (and I say that with total respect).     They completely control the means of production and how many doctors can be certified to practice in the US.    Thus they create a system of scarcity that demands doctors receive high pay.     

Doctors primarily make high pay because there are very few medical schools that take a handful of students that want to be doctors.    Compare that to law schools that just continue to pop up around the country.    Students that go to these schools often have loans that are just as high as loans for medical school, but the resulting salary from a 3rd tier law school doesn't have a tenth of the return that a doctor's salary has.

I used to be an airline pilot and would often have this conversation with my first officer or captain (at cruise on auto pilot).    We would comment that if only our union would serve pilots as a whole, not pilots from each individual carrier.   Along with taking on the certification of pilots, pay would be much higher and the risk of major career hurdles from things like a carrier going belly up would be much less of a threat for the individual member.   

Doctors and some dock workers really do have the last strong union left, that's why they get paid well.

What is the ADA?

I'm not aware of any doctor "union" that you are referring to. In fact I think it may be illegal for doctors to unionize.

You may be referring to the AMA (American medical association), which in part lobbies on behalf of doctors. I think you are overestimating the political power of the AMA. Residency positions determine supply of doctors, not medical schools. Excess residency slots are often filled with foreign medical grads. Who end up working in the us anyways. Generally oversupplied poor paying specialties have a harder time filling slots, which eventually leads to fewer docs in that specialty, shortages, better pay etc. it's a very slow inefficient market.

Doctors/hospitals negotiate with insurance companies for pricing. For Medicare/Medicaid you get whatever they decide to pay. Many providers can't break even with Medicare patients depending on overhead costs so one could argue that the AMA has done a poor job lobbying for doctors!

Many doctors making 300k or greater are sub specialists that have put in around 10 years of post graduate training. Average primary care doc probably makes closer to 200k.

Yes, that was a typo, not sure why it came out as the ADA.    I was under the impression that they were the organization that licensed medical schools, I apologize.

Still, compare doctors, lawyers and pilots.   What's the major difference?   There's essentially no barrier to entry to becoming a pilot.   Sure you have to pass check rides with the feds and get some hours before you can get a job that pays you to fly.    But there aren't officially licensed schools that only take a small number of graduates.     Law school is a little tighter, but the law profession has been saturated with lawyers from an ever increasing amount of law schools.    Many of these lawyers don't break $30,000 and have $200,000 in debt from a third rate school.

Now, doctors have a very high barrier for entry.   Whether you want to define that as medical school or residency doesn't really matter.    The fact is that there have never been too many doctors, thus doctor's pay has always been high.   Professional organizations seem to ensure that, I call that a union even if it isn't officially one.    I would put median pay in aviation at about $50,000-$70,000 a year.   There are a few very well paid major and legacy captains that skew the average.    My best year was $42,000 as a captain at a regional and I started at $17,000.