From the news:
https://www.ctvnews.ca/health/u-s-to-set-up-plan-allowing-prescription-drugs-from-canada-1.4530955
Unless there is some coercive power requiring manufacturers to agree to this, I can tell you right now why this will not work.
Most drugs are manufactured by multinational companies who distribue the same drugs in various markets. The price of patented drugs tends to be significantly lower in Canada, largely because of federal price controls. Manufacturers are willing to sell the same product at a lower price, because even at the lower price, they still make money per unit sold.
However, they aren't willing to undercut themselves. If they start to face significant imports of cheaper drugs they themselves sold in Canada at the Canadian price, they will do one of the following things.
First, they will arrange by contract with their distributors and wholesalers that they must only sell the product in the territory to persons in the territory, and that territory being Canada; and that everyone down the chain of distribution must agree to these terms. Some already do this. The manufacturers have reasonably sophisticated ability to measure compliance. While there may be some "diversion", there is no way they would fail to discover large amounts of product being shipped to the US - recalling that the US population is ten times that of Canada.
Second, if that fails, threaten to pull out of the Canadian market to apply leverage on the Canadian government. Canadians already sometimes face drug shortages. Manufacturers are already unhappy with the arbitrary and excessive actions of the Canadian price control system (particularly for high priced "orphan" drugs). Canadians could still get such drugs, through the Special Access Program, but at US prices. The government here would presumably be persuaded to enact regulatory controls on cross-border exports that cannot benefit Canadians and may threaten Canadian supplies of drugs.
Finally, actually pull out of the Canadian market. They would be reluctant to do this, because that would allow the Canadian government to licence generic products; but for the highest priced drugs, that may be difficult (biologics etc.). Particularly for "orphan" drugs which may only have a handful of Canadian patients.
Time to start an online drug company...
(https://pics.me.me/the-simpsons-did-it-quickmeme-com-19280695.png)
I had a few medical tourists over the years. What americans fail to realize is that in 99% of cases, the drugs they need require a prescription, and the prescription needs to be from a canadian doctor.
"Just call my CVS in Milwaukee!". Yeah, it doesn't work like that. Dumbass.
Quote from: Zoupa on July 31, 2019, 10:00:27 PM
I had a few medical tourists over the years. What americans fail to realize is that in 99% of cases, the drugs they need require a prescription, and the prescription needs to be from a canadian doctor.
"Just call my CVS in Milwaukee!". Yeah, it doesn't work like that. Dumbass.
Do you ever get docs in your province who specialize in co-signing US prescriptions to get around that?
Quote from: crazy canuck on July 31, 2019, 01:37:47 PM
Time to start an online drug company...
We'll need a lawyer who specializes in pharmaceuticals. :hmm:
Its the kind of shit brexiters come up with. Thinking they're being awesome and original by promoting sneaky work arounds that work for ordinary people but for very good reasons obviously wouldn't work if made official.
Quote from: Tyr on August 01, 2019, 07:50:03 AM
Its the kind of shit brexiters come up with. Thinking they're being awesome and original by promoting sneaky work arounds that work for ordinary people but for very good reasons obviously wouldn't work if made official.
Yeah and if it is well known enough that politicians are recommending it well...
Quote from: Zoupa on July 31, 2019, 10:00:27 PM
I had a few medical tourists over the years. What americans fail to realize is that in 99% of cases, the drugs they need require a prescription, and the prescription needs to be from a canadian doctor.
"Just call my CVS in Milwaukee!". Yeah, it doesn't work like that. Dumbass.
I always appreciated your stupid customer anecdotes.
Quote from: Tyr on August 01, 2019, 07:50:03 AM
Its the kind of shit brexiters come up with. Thinking they're being awesome and original by promoting sneaky work arounds that work for ordinary people but for very good reasons obviously wouldn't work if made official.
I doubt they seriously intend it to work - for one, they didn't bother to actually consult the Canadian government on their plan.
A glance at the relative populations of the two nations would indicate a small problem with the notion of sneakily importing Canadian drugs ...
This is just grist for the US political mill - appearing to sock it to the gouging drug companies without actually socking it to them (by instituting anything like price controls, or even bargaining over prices by insurers - both of which occur everywhere else). Then, when it inevitably doesn't work, they can blame the drug companies and/or Canada.
Is there no end of the evil of big pharma!!!11??
AARP has been running radio commercials encouraging us to agree with Trump on some of his statements about prescription drug prices being too high. Funny, I thought AARP was solidly anti-Trump.
Quote from: derspiess on August 01, 2019, 08:15:45 AM
AARP has been running radio commercials encouraging us to agree with Trump on some of his statements about prescription drug prices being too high. Funny, I thought AARP was solidly anti-Trump.
Automatically rejecting everything a political opponent says and taking the exact opposite position out of spite, even when you would otherwise agree with them - well, not everyone does that. It's more of a Trumpian Republican thing. :D
Quote from: Malthus on August 01, 2019, 08:22:02 AM
Quote from: derspiess on August 01, 2019, 08:15:45 AM
AARP has been running radio commercials encouraging us to agree with Trump on some of his statements about prescription drug prices being too high. Funny, I thought AARP was solidly anti-Trump.
Automatically rejecting everything a political opponent says and taking the exact opposite position out of spite, even when you would otherwise agree with them - well, not everyone does that. It's more of a Trumpian Republican thing. :D
It's one of those attitudes that convinces people that Russians are more trustworthy than Democrats (or intelligence agencies).
Quote from: Malthus on August 01, 2019, 07:38:02 AM
Quote from: Zoupa on July 31, 2019, 10:00:27 PM
I had a few medical tourists over the years. What americans fail to realize is that in 99% of cases, the drugs they need require a prescription, and the prescription needs to be from a canadian doctor.
"Just call my CVS in Milwaukee!". Yeah, it doesn't work like that. Dumbass.
Do you ever get docs in your province who specialize in co-signing US prescriptions to get around that?
No. I don't think the market is there for that kinda thing. Plus the local doctors would expose themselves to all sorts of disciplinary reviews/punishment from their professional order. Not worth it.
So how are people getting their prescriptions in Canada now, then? We know it happens. A whole crowd just went across the border to get insulin.
These stories are always about insulin because you don't need a prescription to buy it in Canada.
Quote from: Zoupa on August 01, 2019, 01:01:41 PM
Quote from: Malthus on August 01, 2019, 07:38:02 AM
Quote from: Zoupa on July 31, 2019, 10:00:27 PM
I had a few medical tourists over the years. What americans fail to realize is that in 99% of cases, the drugs they need require a prescription, and the prescription needs to be from a canadian doctor.
"Just call my CVS in Milwaukee!". Yeah, it doesn't work like that. Dumbass.
Do you ever get docs in your province who specialize in co-signing US prescriptions to get around that?
No. I don't think the market is there for that kinda thing. Plus the local doctors would expose themselves to all sorts of disciplinary reviews/punishment from their professional order. Not worth it.
It sometimes happens here, for Internet pharmacy orders, but is highly frowned upon. In every province it's considered unethical and subject to discipline, but some physicians do it, in large volumes, for Internet pharmacies.
The CMPA announced it won't defend physicians accused of doing that.
https://www.cmpa-acpm.ca/en/membership/protection-for-members/principles-of-assistance/internet-and-cross-border-prescribing-to-non-patients
It was a thriving business in the past. But as Malthus and Zoupa suggest, it became more heavily regulated/enforced especially when it started to create shortages in the Canadian market. But as someone already noted, this is not really about making prescription drugs more affordable for Americans. If trump wanted to do that there are a lot of other ways of achieving that goal. This is a sound bit that makes no sense that Fox will spin into a meaningful policy initiative that shows Trump wants to reduce the cost.
Quote from: Malthus on August 01, 2019, 08:22:02 AM
Quote from: derspiess on August 01, 2019, 08:15:45 AM
AARP has been running radio commercials encouraging us to agree with Trump on some of his statements about prescription drug prices being too high. Funny, I thought AARP was solidly anti-Trump.
Automatically rejecting everything a political opponent says and taking the exact opposite position out of spite, even when you would otherwise agree with them - well, not everyone does that. It's more of a Trumpian Republican thing. :D
Just thought it was odd for an organization like that to sort of masquerade as pro-Trump.
There's a really easy way to get Canadian level drug prices in the US - impose a Canadian-style price regime in the US.
Declaring as official policy the encouragement of parallel imports to achieve the same end point is just an indirect way of imposing a national price control regime.
Something worth noting about insulin, is the stuff sold at (admittedly too-high) prices to American patients today isn't the stuff Banting and Best were injecting back in 1922. Reformulations of it occur regularly, insulin sold at large scale in the 1980s for example isn't the same formulation as sold today. You can actually still buy older formulations, Wal-Mart has a program where their pharmacies sell some of the older formulations of insulin for quite cheap. But it is not as good in terms of outcomes for insulin dependent diabetics. Wal-Mart sells a formulation called NPH that was first formulated in 1950, another that was formulated in 1982, and another that was formulated in 1989. They sell them by the vial for like $24 and they have prescription subscription plans that make them available very cheaply.
Lots of diabetes advocates point out that these aren't great options for insulin dependent diabetics and there are reasons newer formulations are more desired.
Maybe neither here nor there, just pointing out that high insulin prices in America aren't a consequence of companies just jacking up the price of ancient medication due to quasi-monopoly power, the insulin sold decades ago is still made, and sold cheaply because it is not patent protected, it's also relatively "simple" to produce compared to newer formulations.
Except the same insulin formulations are priced differently in our two countries.
Quote from: crazy canuck on August 01, 2019, 02:58:23 PM
Except the same insulin formulations are priced differently in our two countries.
For sure, there's price controls in Canada. I'm just saying it's frequently claimed here in the United States that companies like Novartis and et al. are just jacking up the price of an "ancient drug" because few other companies manufacture it. That's not really true, these newer insulin formulations are newer, patented formulations. The patents mean it is essentially not legal to compete with them in the United States. The actual "ancient" insulins still exist and are widely manufactured by lower cost producers (many of them are used for diabetic animals where the negative side effects of the older formulations are less concerning.)
Quote from: OttoVonBismarck on August 01, 2019, 03:00:45 PM
Quote from: crazy canuck on August 01, 2019, 02:58:23 PM
Except the same insulin formulations are priced differently in our two countries.
For sure, there's price controls in Canada. I'm just saying it's frequently claimed here in the United States that companies like Novartis and et al. are just jacking up the price of an "ancient drug" because few other companies manufacture it. That's not really true, these newer insulin formulations are newer, patented formulations. The patents mean it is essentially not legal to compete with them in the United States. The actual "ancient" insulins still exist and are widely manufactured by lower cost producers (many of them are used for diabetic animals where the negative side effects of the older formulations are less concerning.)
"Novo Nordisk's NovoLog, which is known in Canada as NovoRapid, for roughly $30 a pop. The same drug retails for $289.36 in the U.S."
I understand you saying this is not an 'ancient' drug - but the price disparity is considerable.
I mean there's no price controls in the U.S. A simple understanding of economics would predict a company with a monopoly patent to sell an insulin formulation will sell it for much more in a non-price regulated market. Not sure why you're even quoting my stuff about this, has nothing to do with anything I said.
The newer insulins offer marginal benefits at most.
It's part of a widespread pattern of "R&D" in pharmaceutical companies. Basically they tweak an existing molecule, test and market it as a new drug and get around patent expiration.
There's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
"R&D"
It's why I gave up on research and went to work at a community pharmacy.
Quote from: OttoVonBismarck on August 01, 2019, 06:18:58 PM
I mean there's no price controls in the U.S. A simple understanding of economics would predict a company with a monopoly patent to sell an insulin formulation will sell it for much more in a non-price regulated market. Not sure why you're even quoting my stuff about this, has nothing to do with anything I said.
Ok, you seemed to be suggesting that people who thought the price was being jacked up were not properly analyzing the situation. But so long as you acknowledge that the price is being jacked up because the regulatory environment, or lack thereof, in the US permits such a practice then there is no disagreement between us.
Quote from: Zoupa on August 01, 2019, 06:21:20 PM
The newer insulins offer marginal benefits at most.
It's part of a widespread pattern of "R&D" in pharmaceutical companies. Basically they tweak an existing molecule, test and market it as a new drug and get around patent expiration.
There's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
"R&D"
It's why I gave up on research and went to work at a community pharmacy.
And when insurance companies call this out and ask doctors to prescribe the older drugs, they're vilified for not covering "the good stuff".
Quote from: Zoupa on August 01, 2019, 06:21:20 PM
The newer insulins offer marginal benefits at most.
It's part of a widespread pattern of "R&D" in pharmaceutical companies. Basically they tweak an existing molecule, test and market it as a new drug and get around patent expiration.
There's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
"R&D"
It's why I gave up on research and went to work at a community pharmacy.
Very interesting, thanks Zoupa for the insight.
Quote from: Zoupa on August 01, 2019, 06:21:20 PMThere's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
Sounds about right for a lot of studies we did when I was with a Contract Research Organization. Another big thing was off label uses - application of medication to conditions they weren't originally designed for, to increase market/customer base.
Quote from: Syt on August 02, 2019, 12:52:11 AM
Quote from: Zoupa on August 01, 2019, 06:21:20 PMThere's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
Sounds about right for a lot of studies we did when I was with a Contract Research Organization. Another big thing was off label uses - application of medication to conditions they weren't originally designed for, to increase market/customer base.
The horrors of using a drug to treat an additional issue?
It's generally a good thing (if working), but also comes across as, "We need to sell more of this, let's see what else it's good for."
Quote from: Syt on August 02, 2019, 01:51:59 AM
It's generally a good thing (if working), but also comes across as, "We need to sell more of this, let's see what else it's good for."
Well yes, they are companies not non profits. :P
I guess my pre-caffeine point that I was trying to make, clumsily, was to tie into the low hanging R&D fruits described by Zoups.
Quote from: garbon on August 02, 2019, 01:49:34 AM
Quote from: Syt on August 02, 2019, 12:52:11 AM
Quote from: Zoupa on August 01, 2019, 06:21:20 PMThere's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
Sounds about right for a lot of studies we did when I was with a Contract Research Organization. Another big thing was off label uses - application of medication to conditions they weren't originally designed for, to increase market/customer base.
The horrors of using a drug to treat an additional issue?
The horrors of using your already limited r&d dollars to treat bullshit fringe crap with drugs whose IP you own instead of developing treatments for cancer, dementia, HIV etc.
Quote from: Zoupa on August 02, 2019, 02:53:42 AM
The horrors of using your already limited r&d dollars to treat bullshit fringe crap with drugs whose IP you own instead of developing treatments for cancer, dementia, HIV etc.
If it's bullshit fringe crap, why are end users willing to pay a premium for the faster uptake insulin? Do you know something they don't?
Quote from: Zoupa on August 02, 2019, 02:53:42 AM
Quote from: garbon on August 02, 2019, 01:49:34 AM
Quote from: Syt on August 02, 2019, 12:52:11 AM
Quote from: Zoupa on August 01, 2019, 06:21:20 PMThere's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
Sounds about right for a lot of studies we did when I was with a Contract Research Organization. Another big thing was off label uses - application of medication to conditions they weren't originally designed for, to increase market/customer base.
The horrors of using a drug to treat an additional issue?
The horrors of using your already limited r&d dollars to treat bullshit fringe crap with drugs whose IP you own instead of developing treatments for cancer, dementia, HIV etc.
Yeah, no one is working in the fields of oncology and HIV these days....
On the broader point, costs of bringing a drug to market are very expensive. It shouldn't be a surprise that such costs can make some companies averse to forking over cash on risky developments leaving them out a significant amount of cash and time invested for naught.
At the same time, there is a lot of innovative stuff being done by biotech startups...which when pharma buys once trials are looking promising. :D
The real innovative work (and the stuff that causes both biggest profits and worst moral dilemmas) is in the field of so-called "orphan" drugs - drugs used to treat very rare conditions.
Some of these are indeed "cures", even "miracle cures" (or in the terms used by our price regulatory agency, "breakthrough" drugs). Problem is that they are very, very expensive to develop - and the manufacturers naturally attempt to push the price envelope as much as they dare.
The dilemma is this: how much, as a society, are we willing to pay to cure (or at least control) a very rare, debilitating or life-ending disease that affects only a handful of people?
The following points make this situation difficult:
- these drugs are very expensive to develop - a small patient population makes everything difficult, and the regulatory and clinical trial costs have to be spread over and so recouped from a tiny number of sales.
- The price control methods used for other drugs don't work well for these products. "Reference pricing", such as used in Canada (comparing the drug to the price in other countries and against others in the same therapeutic class) won't bring the price down, because the same drug is also expensive elsewhere and there are often no others in the same therapeutic class. The PMPRB has responded by essentially ignoring its own Guidelines and the legislation and inventing new tests for such products (and so far, the lower court has allowed them to do so).
- Patient advocacy groups are very effective at mobilizing popular support to pay for such products.
- Drug companies gamble on them - they fund many "losers" for every "winner", and so argue that they must charge the maximum for each "winner" to pay for all the "losers".
- The public simply can't spend an infinite amount on these products; their price is becoming impossible to pay.
- If the companies aren't able to make a substantial profit on these products, they won't develop them.
Quote from: Zoupa on August 01, 2019, 06:21:20 PM
The newer insulins offer marginal benefits at most.
It's part of a widespread pattern of "R&D" in pharmaceutical companies. Basically they tweak an existing molecule, test and market it as a new drug and get around patent expiration.
There's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
"R&D"
It's why I gave up on research and went to work at a community pharmacy.
Good post Zoupa.
Quote from: garbon on August 02, 2019, 03:17:54 AM
Quote from: Zoupa on August 02, 2019, 02:53:42 AM
Quote from: garbon on August 02, 2019, 01:49:34 AM
Quote from: Syt on August 02, 2019, 12:52:11 AM
Quote from: Zoupa on August 01, 2019, 06:21:20 PMThere's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
Sounds about right for a lot of studies we did when I was with a Contract Research Organization. Another big thing was off label uses - application of medication to conditions they weren't originally designed for, to increase market/customer base.
The horrors of using a drug to treat an additional issue?
The horrors of using your already limited r&d dollars to treat bullshit fringe crap with drugs whose IP you own instead of developing treatments for cancer, dementia, HIV etc.
Yeah, no one is working in the fields of oncology and HIV these days....
:rolleyes:
Quote from: Admiral Yi on August 02, 2019, 03:10:38 AM
Quote from: Zoupa on August 02, 2019, 02:53:42 AM
The horrors of using your already limited r&d dollars to treat bullshit fringe crap with drugs whose IP you own instead of developing treatments for cancer, dementia, HIV etc.
If it's bullshit fringe crap, why are end users willing to pay a premium for the faster uptake insulin? Do you know something they don't?
You can treat someone with diabetes using 1950s insulin and they have the same life expectancy as the control group. Same co-morbidity too.
I'm not saying the new insulins aren't "better". They are better in terms of number of injections per day for example. They usually also require less blood testing.
I'm saying that the millions invested into making an insulin that lasts 24 hours instead of 12 could have been invested in worthier fields.
Your concern for the QoL of insulin-users warms the old heart.
Quote from: Zoupa on August 02, 2019, 12:32:14 PM
Quote from: garbon on August 02, 2019, 03:17:54 AM
Quote from: Zoupa on August 02, 2019, 02:53:42 AM
Quote from: garbon on August 02, 2019, 01:49:34 AM
Quote from: Syt on August 02, 2019, 12:52:11 AM
Quote from: Zoupa on August 01, 2019, 06:21:20 PMThere's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
Sounds about right for a lot of studies we did when I was with a Contract Research Organization. Another big thing was off label uses - application of medication to conditions they weren't originally designed for, to increase market/customer base.
The horrors of using a drug to treat an additional issue?
The horrors of using your already limited r&d dollars to treat bullshit fringe crap with drugs whose IP you own instead of developing treatments for cancer, dementia, HIV etc.
Yeah, no one is working in the fields of oncology and HIV these days....
:rolleyes:
:mellow:
Quote from: Zoupa on August 02, 2019, 12:36:10 PM
Quote from: Admiral Yi on August 02, 2019, 03:10:38 AM
Quote from: Zoupa on August 02, 2019, 02:53:42 AM
The horrors of using your already limited r&d dollars to treat bullshit fringe crap with drugs whose IP you own instead of developing treatments for cancer, dementia, HIV etc.
If it's bullshit fringe crap, why are end users willing to pay a premium for the faster uptake insulin? Do you know something they don't?
You can treat someone with diabetes using 1950s insulin and they have the same life expectancy as the control group. Same co-morbidity too.
I'm not saying the new insulins aren't "better". They are better in terms of number of injections per day for example. They usually also require less blood testing.
I'm saying that the millions invested into making an insulin that lasts 24 hours instead of 12 could have been invested in worthier fields.
Like the other diabetes meds that didn't exist in the 50s?
Why do you keep moving the goal posts?
Quote from: The Brain on August 02, 2019, 12:38:01 PM
Your concern for the QoL of insulin-users warms the old heart.
I think we should make coal power plants 1% more efficient instead of developing nuclear power plants.
See what happens when random weirdos opine on stuff way outside their field?
Anyhoo. You guys can believe what you want. It's no skin off my back.
Quote from: Zoupa on August 02, 2019, 03:36:23 PM
Quote from: The Brain on August 02, 2019, 12:38:01 PM
Your concern for the QoL of insulin-users warms the old heart.
I think we should make coal power plants 1% more efficient instead of developing nuclear power plants.
See what happens when random weirdos opine on stuff way outside their field?
Anyhoo. You guys can believe what you want. It's no skin off my back.
I think you know that there is no specific fixed sum that society invests in medical research. Or electricity generation.
Quote from: Zoupa on August 01, 2019, 06:21:20 PM
The newer insulins offer marginal benefits at most.
It's part of a widespread pattern of "R&D" in pharmaceutical companies. Basically they tweak an existing molecule, test and market it as a new drug and get around patent expiration.
There's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
"R&D"
It's why I gave up on research and went to work at a community pharmacy.
My understanding is the actual long term outcomes of newer vs older insulins is marginal, but the newer insulins require less education/diligence to use, so once a patient is used to using them they have worse outcomes when they try to use older insulins that are not as fast-acting and require more planning and etc in terms of scheduling meal times and carb consumption etc. I definitely think the cheaper vials sold by Wal-Mart are very viable to live with diabetes w/proper education, but it seems like PCPs overwhelmingly prefer to put patients on newer formulations, and most people don't like to use drugs against doctors orders.
FWIW I think the older formulations of insulin are actually sold OTC in the U.S. as well.
Quote from: The Brain on August 02, 2019, 03:48:38 PM
Quote from: Zoupa on August 02, 2019, 03:36:23 PM
Quote from: The Brain on August 02, 2019, 12:38:01 PM
Your concern for the QoL of insulin-users warms the old heart.
I think we should make coal power plants 1% more efficient instead of developing nuclear power plants.
See what happens when random weirdos opine on stuff way outside their field?
Anyhoo. You guys can believe what you want. It's no skin off my back.
I think you know that there is no specific fixed sum that society invests in medical research. Or electricity generation.
Ok. What's your point?
Quote from: Zoupa on August 02, 2019, 04:24:38 PM
Quote from: The Brain on August 02, 2019, 03:48:38 PM
Quote from: Zoupa on August 02, 2019, 03:36:23 PM
Quote from: The Brain on August 02, 2019, 12:38:01 PM
Your concern for the QoL of insulin-users warms the old heart.
I think we should make coal power plants 1% more efficient instead of developing nuclear power plants.
See what happens when random weirdos opine on stuff way outside their field?
Anyhoo. You guys can believe what you want. It's no skin off my back.
I think you know that there is no specific fixed sum that society invests in medical research. Or electricity generation.
Ok. What's your point?
The obvious one: a dollar spent on better insulin doesn't mean a dollar isn't spent on more "noble" endeavours. And if you hate investments in better insulin so much I'd hate to see what you think about investments in movies or tourism or whatever, those aren't even close to bringing new drugs to market. As is often the case the heretic is more despised than the infidel, I suppose.
Quote from: OttoVonBismarck on August 02, 2019, 03:55:02 PM
Quote from: Zoupa on August 01, 2019, 06:21:20 PM
The newer insulins offer marginal benefits at most.
It's part of a widespread pattern of "R&D" in pharmaceutical companies. Basically they tweak an existing molecule, test and market it as a new drug and get around patent expiration.
There's very little innovation going on. No search for a cure kinda thing. It's mostly "let's add a hydrogen there, test it and see if it works". Out of the hundred different variations they'll find one where they can make the statistics say it's 1% better than the old drug. That's good enough to market it to doctors at their yearly conference in Honolulu and there ya go.
"R&D"
It's why I gave up on research and went to work at a community pharmacy.
My understanding is the actual long term outcomes of newer vs older insulins is marginal, but the newer insulins require less education/diligence to use, so once a patient is used to using them they have worse outcomes when they try to use older insulins that are not as fast-acting and require more planning and etc in terms of scheduling meal times and carb consumption etc. I definitely think the cheaper vials sold by Wal-Mart are very viable to live with diabetes w/proper education, but it seems like PCPs overwhelmingly prefer to put patients on newer formulations, and most people don't like to use drugs against doctors orders.
FWIW I think the older formulations of insulin are actually sold OTC in the U.S. as well.
Thanks Otto for the interesting viewpoint.
Quote from: The Brain on August 02, 2019, 04:32:13 PM
Quote from: Zoupa on August 02, 2019, 04:24:38 PM
Quote from: The Brain on August 02, 2019, 03:48:38 PM
Quote from: Zoupa on August 02, 2019, 03:36:23 PM
Quote from: The Brain on August 02, 2019, 12:38:01 PM
Your concern for the QoL of insulin-users warms the old heart.
I think we should make coal power plants 1% more efficient instead of developing nuclear power plants.
See what happens when random weirdos opine on stuff way outside their field?
Anyhoo. You guys can believe what you want. It's no skin off my back.
I think you know that there is no specific fixed sum that society invests in medical research. Or electricity generation.
Ok. What's your point?
The obvious one: a dollar spent on better insulin doesn't mean a dollar isn't spent on more "noble" endeavours. And if you hate investments in better insulin so much I'd hate to see what you think about investments in movies or tourism or whatever, those aren't even close to bringing new drugs to market. As is often the case the heretic is more despised than the infidel, I suppose.
Lol ok. Let's not try to improve the system or anything. I bet you've never protested for anything a day in your life.
ScandiMono.
Quote from: Zoupa on August 02, 2019, 07:20:16 PM
Lol ok. Let's not try to improve the system or anything. I bet you've never protested for anything a day in your life.
ScandiMono.
That's not "improving the system." That's demanding pharma perform charity work.
Big pharma doing charity work would improve the system.
I'm all ears for alternatives guys. Let's hear them.
Quote from: Zoupa on August 02, 2019, 07:47:33 PM
Big pharma doing charity work would improve the system.
If you consider big pharma being unable to attract investors or lenders because they're engaged in unprofitable activity an improvement.
QuoteI'm all ears for alternatives guys. Let's hear them.
Hey, I've got one. How about big pharma continues researching drugs they think they can turn a profit on, and other people donate money to nonprofit organizations which fund research on things like cancer and HIV?
So basically, absolutely no change to the current system. Got it.
J&J made over 16 billion dollars in profit last year. Profit, not revenue. Somehow I think they can "attract investors or lenders" with little difficulty.
Unrestrained capitalism will be the end of our species.
Quote from: Zoupa on August 02, 2019, 07:20:16 PM
Quote from: The Brain on August 02, 2019, 04:32:13 PM
Quote from: Zoupa on August 02, 2019, 04:24:38 PM
Quote from: The Brain on August 02, 2019, 03:48:38 PM
Quote from: Zoupa on August 02, 2019, 03:36:23 PM
Quote from: The Brain on August 02, 2019, 12:38:01 PM
Your concern for the QoL of insulin-users warms the old heart.
I think we should make coal power plants 1% more efficient instead of developing nuclear power plants.
See what happens when random weirdos opine on stuff way outside their field?
Anyhoo. You guys can believe what you want. It's no skin off my back.
I think you know that there is no specific fixed sum that society invests in medical research. Or electricity generation.
Ok. What's your point?
The obvious one: a dollar spent on better insulin doesn't mean a dollar isn't spent on more "noble" endeavours. And if you hate investments in better insulin so much I'd hate to see what you think about investments in movies or tourism or whatever, those aren't even close to bringing new drugs to market. As is often the case the heretic is more despised than the infidel, I suppose.
Lol ok. Let's not try to improve the system or anything. I bet you've never protested for anything a day in your life.
ScandiMono.
I don't follow.
Quote from: Zoupa on August 02, 2019, 08:44:41 PM
J&J made over 16 billion dollars in profit last year. Profit, not revenue.
And what was their return on equity?
www.google.com
Apple made billions in profits last year, Nisses Ved och Porr only made a few thousands. Both numbers are irrelevant without knowing the return on equity. To say that a business made a lot of money does not really indicate how much the investors got or how profitable the business is.
Sigh. Roe was over 30% since the beginning of the year.
Yikes, that's nice, I bet they could afford to throw some of that money away, the owners would probably like that.
R&D on useful stuff is throwing money away. Ok then.
Ima tiptoe out of this trainwreck of a thread and let y'all circlejerk to the thought of for-profit healthcare.
It's not pharma companies responsibility to research unprofitable stuff. They are companies, they are only in it to maximise the owners profit. To try and blame them for not doing unprofitable stuff is like trying to blame a fish for being wet. To expect pharma companies to spend money on clearly unprofitable medicine is like expecting Ford to give away free cars or Skanska to give away free houses. It would be totally irresponsible behaviour.
If you want research into unprofitable diseases you probably want it from government or voluntary sources. So go request it from your politicians, not from corporations.
My proposal:
Jack up taxes on corporate profits over a certain ROI, and increase tax breaks for companies doing investigative research into marginally profitable drugs that are deemed socially desirable. DO this in some magic way that doesn't result in creating perverse incentives, by getting some people way smarter than I am to figure out how to make that work, and make it flexible so we can tweak that system as needed.
Basically, make the incentives better for investing in drugs that the current straight market model doesn't incent well.
So arbitrarily punish the pharmaceutical industry?
Quote from: garbon on August 03, 2019, 06:24:31 PM
So arbitrarily punish the pharmaceutical industry?
Why does it have to just be the pharmaceutical industry? It could be all corporations. And you might want to look up the meaning of "arbitrarily" before you misuse it again.
I have no idea how that could be done without creating perverse incentives and without creating massive loopholes, but the plan relies on magic, just like the Republican tax cuts for "job creators."
Quote from: grumbler on August 03, 2019, 06:54:20 PM
Quote from: garbon on August 03, 2019, 06:24:31 PM
So arbitrarily punish the pharmaceutical industry?
Why does it have to just be the pharmaceutical industry? It could be all corporations. And you might want to look up the meaning of "arbitrarily" before you misuse it again.
I have no idea how that could be done without creating perverse incentives and without creating massive loopholes, but the plan relies on magic, just like the Republican tax cuts for "job creators."
Well Berkut said nothing about applying it to all industries so...
Quote from: Berkut on August 03, 2019, 04:08:33 PM
My proposal:
Jack up taxes on corporate profits over a certain ROI, and increase tax breaks for companies doing investigative research into marginally profitable drugs that are deemed socially desirable. DO this in some magic way that doesn't result in creating perverse incentives, by getting some people way smarter than I am to figure out how to make that work, and make it flexible so we can tweak that system as needed.
Basically, make the incentives better for investing in drugs that the current straight market model doesn't incent well.
*tiptoes back in*
I'm no economist. As you can tell by my avatar, my preferred mean of production is a collective one :P So I have no idea if this could work, but it's a good basis for an improvement to the current system.
Berkut gets 1 Zoupa point :hug:
Quote from: Berkut on August 03, 2019, 04:08:33 PM
My proposal:
Jack up taxes on corporate profits over a certain ROI, and increase tax breaks for companies doing investigative research into marginally profitable drugs that are deemed socially desirable. DO this in some magic way that doesn't result in creating perverse incentives, by getting some people way smarter than I am to figure out how to make that work, and make it flexible so we can tweak that system as needed.
Basically, make the incentives better for investing in drugs that the current straight market model doesn't incent well.
Probably more efficient for government to directly fund the research
Yeah, I'd like more government investments in the pharmaceutical sector. Would also provably have positive spillover effects on new pharma companies. Probably a more efficient use of society resources than punishing successful companies.
I am beginning to think that pharmaceuticals (and healthcare in general) is one of those areas that is better handled through socialist means.
Capitalist competition is generally superior for creating consumer goods. But pharma and healthcare generally appear to be different. If left uncontrolled, their costs seem to continually increase relative to other expenses.
A big part of that could be the fact of an aging population using more drugs and healthcare generally, of course. I suspect a big part is that there is simply no limit to what people are willing to spend to stave off illness and death; so marginal increases in efficacy are rewarded disproportionately.
Quote from: Malthus on August 06, 2019, 07:49:04 AM
I am beginning to think that pharmaceuticals (and healthcare in general) is one of those areas that is better handled through socialist means.
Capitalist competition is generally superior for creating consumer goods. But pharma and healthcare generally appear to be different. If left uncontrolled, their costs seem to continually increase relative to other expenses.
A big part of that could be the fact of an aging population using more drugs and healthcare generally, of course. I suspect a big part is that there is simply no limit to what people are willing to spend to stave off illness and death; so marginal increases in efficacy are rewarded disproportionately.
Yeah if you don't have your health, you don't have anything.
Quote from: Malthus on August 06, 2019, 07:49:04 AM
I suspect a big part is that there is simply no limit to what people are willing to spend to stave off illness and death; so marginal increases in efficacy are rewarded disproportionately.
There is no limit to what people are willing to spend on anything, if some entity without a human face on it is footing the bill.
Quote from: DGuller on August 08, 2019, 08:43:32 PM
Quote from: Malthus on August 06, 2019, 07:49:04 AM
I suspect a big part is that there is simply no limit to what people are willing to spend to stave off illness and death; so marginal increases in efficacy are rewarded disproportionately.
There is no limit to what people are willing to spend on anything, if some entity without a human face on it is footing the bill.
The US situation provides a different perspective, as some middle-income people there lack a "faceless entity" to foot the bill for medical care - and nonetheless go into insolvency to pay for it, apparently.
Quote from: DGuller on August 08, 2019, 08:43:32 PM
Quote from: Malthus on August 06, 2019, 07:49:04 AM
I suspect a big part is that there is simply no limit to what people are willing to spend to stave off illness and death; so marginal increases in efficacy are rewarded disproportionately.
There is no limit to what people are willing to spend on anything, if some entity without a human face on it is footing the bill.
And yet our system is less expensive
Quote from: crazy canuck on August 09, 2019, 02:17:40 PM
Quote from: DGuller on August 08, 2019, 08:43:32 PM
Quote from: Malthus on August 06, 2019, 07:49:04 AM
I suspect a big part is that there is simply no limit to what people are willing to spend to stave off illness and death; so marginal increases in efficacy are rewarded disproportionately.
There is no limit to what people are willing to spend on anything, if some entity without a human face on it is footing the bill.
And yet our system is less expensive
we die on a waiting list instead of dying for lack of funds to pay for the surgery :)
Quote from: viper37 on August 12, 2019, 11:45:39 PM
we die on a waiting list instead of dying for lack of funds to pay for the surgery :)
Wait times certainly exist and they are generally longer in Canada - but both nations have wait times:
QuoteWait times
One complaint about both the U.S. and Canadian systems is waiting times, whether for a specialist, major elective surgery, such as hip replacement, or specialized treatments, such as radiation for breast cancer; wait times in each country are affected by various factors. In the United States, access is primarily determined by whether a person has access to funding to pay for treatment and by the availability of services in the area and by the willingness of the provider to deliver service at the price set by the insurer. In Canada, the wait time is set according to the availability of services in the area and by the relative need of the person needing treatment.[citation needed]
As reported by the Health Council of Canada, a 2010 Commonwealth survey found that 39% of Canadians waited 2 hours or more in the emergency room, versus 31% in the U.S.; 43% waited 4 weeks or more to see a specialist, versus 10% in the U.S. The same survey states that 37% of Canadians say it is difficult to access care after hours (evenings, weekends or holidays) without going to the emergency department over 34% of Americans. Furthermore, 47% of Canadians and 50% of Americans who visited emergency departments over the past two years feel that they could have been treated at their normal place of care if they were able to get an appointment.[51]
A report published by Health Canada in 2008 included statistics on self-reported wait times for diagnostic services.[52] The median wait time for diagnostic services such as MRI and CAT scans is two weeks with 89.5% waiting less than 3 months.[52][53] The median wait time to see a special physician is a little over four weeks with 86.4% waiting less than 3 months.[52][54] The median wait time for surgery is a little over four weeks with 82.2% waiting less than 3 months.[52][55] In the U.S., patients on Medicaid, the low-income government programs, can wait three months or more to see specialists. Because Medicaid payments are low, some have claimed that some doctors do not want to see Medicaid patients. For example, in Benton Harbor, Michigan, specialists agreed to spend one afternoon every week or two at a Medicaid clinic, which meant that Medicaid patients had to make appointments not at the doctor's office, but at the clinic, where appointments had to be booked months in advance.[56] A 2009 study found that on average the wait in the United States to see a medical specialist is 20.5 days.[57]
In a 2009 survey of physician appointment wait times in the United States, the average wait time for an appointment with an orthopedic surgeon in the country as a whole was 17 days. In Dallas, Texas the wait was 45 days (the longest wait being 365 days). Nationwide across the U.S. the average wait time to see a family doctor was 20 days. The average wait time to see a family practitioner in Los Angeles, California was 59 days and in Boston, Massachusetts it was 63 days.[58]
Studies by the Commonwealth Fund found that 42% of Canadians waited 2 hours or more in the emergency room, vs. 29% in the U.S.; 57% waited 4 weeks or more to see a specialist, vs. 23% in the U.S., but Canadians had more chances of getting medical attention at nights, or on weekends and holidays than their American neighbors without the need to visit an ER (54% compared to 61%).[59] Statistics from the Canadian free market think tank Fraser Institute in 2008 indicate that the average wait time between the time when a general practitioner refers a patient for care and the receipt of treatment was almost four and a half months in 2008, roughly double what it had been 15 years before.[60]
https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_systems_in_Canada_and_the_United_States#Wait_times