Prescription Drug Pricing - late night brainstorm

[knight on horse]

Suppose President Trump succeeds in getting companies to lower the costs of prescription drugs. Certainly this will be another downward pressure on pharmacist salary, no?

Perhaps it is not so simple, and the amount of waste and mismanagement in the existing healthcare system is enough to buffer the revenue loss by the concomitant elimination of graft. Wonderful

But what other reasons could there be for high pharmaceutical costs? Martin Shkreli, of Shkreli fame, contends that he does help financially needy patients, but more to the point, that the high drug costs are necessary in order to fund drug research and development.

I had suggested that part of the high cost of medications is the need to fund and recoup R&D costs during one of my rotations, but my preceptor, bless his heart, was busy with retail operations and comfortable with the globalist pabulum that the United States was doing nothing special except doing poorly, and that companies having centers in Europe was proof enough that they weren't American (true in a sense) even though in my estimation they are likely tax dodging, and American universities are for better or worse still the best in the world

Indeed, there is undoubtedly corruption and temptation of corruption, I am as adamant about its prosecution as anybody, (being descended from military police after all ), yet despite it being an industry shill talking point the cost of development argument is persuasive.

To bring things around, I submit that it is absolutely necessary to restructure American society away from Wall Street, which is after all parasitic. America was already the most prosperous and powerful society in history before Wall Street uber alles, you cannot eat gold, though the 'elite' are sure they can, and the high incomes on Wall Street are skewing the cultural zeitgeist and draining too much scientific talent.

Not a fundamentally new point but one that has important consequences for the pharmaceutical industry and pharmacy in general. Drugs don't come out of nowhere, they have to be invented, the process cannot expand quite like other industries and there is reason to believe that it will only get more difficult in the future. If drug companies cannot attract sufficient quality talent there could be a total collapse of research and a return to the Age of Plague. In order to attract top tier talent, in general they will need to pay, and with the hollowing out of the country and the economy, be located in thriving cities, where the cost of living is of course high and also driving pay up.

If we rein in the skews in incentives, whether by restoring Middle America and controlling Wall Street or some other measures, this may yield many gifts to future generations to come, even more than may have erstwhile been imagined.

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[PharmDBro2017]

Cliffs?
TL;DR

edit: this is the 2nd novel of yours that I have seen today. Hop off your high horse, knight on horse, and make an effort to be concise.

 

[owlegrad]

If I read your post right, you think that one of the hurdles of drug development is that research companies lack talented researchers because the high salaries on Wall Street are attracting too much of the talent in that direction? Maybe but I doubt very many of the Wall Street investors would otherwise be drug researchers.

 

[Ackj]

If I read your post right, you think that one of the hurdles of drug development is that research companies lack talented researchers because the high salaries on Wall Street are attracting too much of the talent in that direction? Maybe but I doubt very many of the Wall Street investors would otherwise be drug researchers.

I agree. Ibanking vs drug discovery are very different personality types. Are there some high school seniors who will go after whatever job pays X amount? Sure, but I don't think that's a major issue crippling the drug pipeline and affecting pricing.

 

[lord999]

That's hilarious. Yeah, there's something to the regulation bit for the US, but a deep, dark secret about the industry is that the Australians (Wellcome), British (too numerous), French-speaking parts of France, Belgium, and Switzerland (Aventis, Sanofi), and Germans (too numerous) more than pull their weight in research, the US doesn't save the day in this industry and never has. Most immunization research is still French. Most autonomic system research is British. The best work in large biological stabilization is Irish and Australian. It's an industry joke that the Americans provide the funding while everyone else does the research. Even if the US got its act together, it would be more to import the fruits of research from particularly France and Germany which they themselves don't have! It is very unusual for the US to be the prime mover on anything in the pharmaceutical industry due to its regulation.

How about this for an explanation, there really isn't any low-hanging fruit for small molecular entities (SME's) anymore? With the exception of psychiatry, neurology, and endocrinology which a large part of the complaint is that we do not have good disease models (can you tell me how any of the "centrally acting" psychiatric meds actually work?) to work on. There's plenty of money that could easily be made in dementia and schizophrenia with a captive audience. There really aren't good leads right now.

This blog is over a decade old and still going, but Derek's still the best at the explanation of these matters (so much so that he basically has free speech when before FDA or NIH):
http://blogs.sciencemag.org/pipeline/archives/2004/02/18/how_drugs_die

Most biological research is concentrated on synthesis and chemical engineering, not actual discovery. Until the 00s, most of those compounds were impossible to manufacture at the large scale nor stabilize. That's why the argument for follow-on biologics is so difficult as it's not trivial to show the identity like we can chemically for SMEs. But even that is coming to a plateau.

Guess you've never understood the Ecotechnic Future implications on the way technology and finance interact and are a technological utopian. There are some things you can't invent your way out of cheaply. We would love to figure out an anti-weight gain pill, a non-addictive wakefulness pill, and a cure for cancer, but it's not a question of effort, it's a question of reality on if we can do these things. It's not expensive for the hell of it or because there's a lack of scientists on it. Hell, the big 5 make it a point to shed researchers when they acquire new companies (Kalamazoo which was Upjohn, Groton which was old Pfizer...)

The market hasn't failed, we've hit maturation, and we can never grow like we did again. Physics went through this in the 1980s (where's my hyperdrive, where's my ray gun), I expect our industry to dissipate in the next decade. The new thing is large scale biologics (where's my genejack slave, where's my custom-built "flowers"). That's true for most things as the easy gains are now done. There isn't going to be the sort of productivity gain that electrification, clean water, and sewer access did for the US in the mid-20th Century until now.

https://www.federalreserve.gov/econresdata/feds/2016/files/2016080pap.pdf

 

[knight on horse]

Yes, Germany is historically a chemistry powerhouse, a fact that they are now in the process of abolishing

This blog is over a decade old and still going, but Derek's still the best at the explanation of these matters (so much so that he basically has free speech when before FDA or NIH):
http://blogs.sciencemag.org/pipeline/archives/2004/02/18/how_drugs_die

Most biological research is concentrated on synthesis and chemical engineering, not actual discovery. Until the 00s, most of those compounds were impossible to manufacture at the large scale nor stabilize. That's why the argument for follow-on biologics is so difficult as it's not trivial to show the identity like we can chemically for SMEs. But even that is coming to a plateau.

Guess you've never understood the Ecotechnic Future implications on the way technology and finance interact and are a technological utopian. There are some things you can't invent your way out of cheaply. We would love to figure out an anti-weight gain pill, a non-addictive wakefulness pill, and a cure for cancer, but it's not a question of effort, it's a question of reality on if we can do these things. It's not expensive for the hell of it or because there's a lack of scientists on it. Hell, the big 5 make it a point to shed researchers when they acquire new companies (Kalamazoo which was Upjohn, Groton which was old Pfizer...)

The market hasn't failed, we've hit maturation, and we can never grow like we did again. Physics went through this in the 1980s (where's my hyperdrive, where's my ray gun), I expect our industry to dissipate in the next decade. The new thing is large scale biologics (where's my genejack slave, where's my custom-built "flowers"). That's true for most things as the easy gains are now done. There isn't going to be the sort of productivity gain that electrification, clean water, and sewer access did for the US in the mid-20th Century until now.

https://www.federalreserve.gov/econresdata/feds/2016/files/2016080pap.pdf

That is precisely the problem, there are real constraints to pharmaceutical research that are ominous for the future.

It is not so easy to invent new drugs out of whole cloth when the low hanging fruit has been picked and there are real limitations as far as the compatible molecular configurations go

"Never understood" lol in your rush to sound smart you miss that I'm one of the ones who came up with the idea:

Drugs don't come out of nowhere, they have to be invented, the process cannot expand quite like other industries and there is reason to believe that it will only get more difficult in the future. If drug companies cannot attract sufficient quality talent there could be a total collapse of research and a return to the Age of Plague. In order to attract top tier talent, in general they will need to pay, and with the hollowing out of the country and the economy, be located in thriving cities, where the cost of living is of course high and also driving pay up.

I assumed the audience knew, and you assumed I didn't, now that is interesting

Btw i was already thinking of putting in computational efforts, non traditional work from ancillary fields, BGI etc, however decided the hour was late; just think, with that one line could have saved you from that effort post

 

[knight on horse]

It is because it is harder, that we need smarter people to go after it.

It won't be good if everyone goes to Wall Street, or else we have to pay everyone not to go to Wall Street

And think a little harder: Can you think of why it is not like physics?

Yes, it is because our antibiotics are failing, one after another (hence Age of Plague), a consequence of misuse and also possibly an inevitable development. In our own grandparents' day, people died from as much as a scratch. Or are you one of those with blinders on blissfully unaware and rushing towards a dark future, even with a blog that you excitedly link to

 

[knight on horse]

If I read your post right, you think that one of the hurdles of drug development is that research companies lack talented researchers because the high salaries on Wall Street are attracting too much of the talent in that direction? Maybe but I doubt very many of the Wall Street investors would otherwise be drug researchers.

Perhaps, but we can't have them running the country. It will not unnaturally be purely for their interest, perhaps even more so than other fields as they are concerned only with money. As we see, in such an environment, the better industries cannot thrive

We cannot afford to tempt the brightest (won't say the best, lol at those Wall Street nerds) away from productive fields when research is harder than ever, with the consequences so dire. Remember that many surgeries require antibiotics to be practical, that even in our own grandparents time, people could die from so much as a scratch

The potential brain drain is a known problem for all disciplines, not just chemical research.

When livelihood is threatened, when the rest of society is hollowed out, when so much untoward influence is accrued to the financial sector, why would a brilliantly talented person go into science, when he may be able to assure his family for all time of money and buy up all his dreams

 

[ldiot]

I don't think lower drug prices would necessairly put downward pressure on pharmacies/pharmacists because the profit margin on a rx is not proportional to the price of the drug, due to insurance contracts and PBMs which reward cost savings. Maybe some evidence of this is the fact that we make much more on generics than brand name drugs. Drug prices have been rising while profitability has been simultaneously shrinking for pharmacies over the past decade. At least that's my thinking but I don't claim to be anything even close to an expert on the topic.