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Cancer Drugs - Why So Damned Expensive?  
User currently offlineCxsjr From , joined Dec 1969, posts, RR:
Posted (8 years 4 months 2 days 15 hours ago) and read 1702 times:

Here in the U.K., we hear on the news with monotonous regularity how the N.H.S. (our health service) have said they will not pay for certain cancer drugs as they are not deemed to be 'the best use of their money'.

Admittedly, some of these drugs are only proven to work, for example, in only 25% of cases.

However, in a currently highlighted case, a lady whose bowel cancer has not been responsive to chemotherapy, and who is being denied access to the potentially life saving medication by the N.H.S., is being told if she wants it, it will be made obtained at a cost of (up to) £75,000 - why in hells name does it cost so much?!!?

Is this just the suppliers to try to recoup the research and development costs (and if so, how come this isn't sourced out of the £bns donated to such charities each year?) or is it just that the 'ingredients' of the drug (so to speak) are so expensive to source??

Either way, what cost someones life ..... very sad  frown 

18 replies: All unread, jump to last
 
User currently offlineRichardPrice From , joined Dec 1969, posts, RR:
Reply 1, posted (8 years 4 months 2 days 15 hours ago) and read 1696 times:

Quoting Cxsjr (Thread starter):
Is this just the suppliers to try to recoup the research and development costs (and if so, how come this isn't sourced out of the £bns donated to such charities each year?) or is it just that the 'ingredients' of the drug (so to speak) are so expensive to source??

These drugs cost a *lot* to bring to market, significantly more than whats given to charity.

Drug companies plan on 30, 40, 50 year or longer timescales for recouping money invested in R&D on a drug, as it has to pass the clinical trials, then the field trials, then licensing etc. A basic cure found today can take 30 years to enter production as a usable drug, and only at that point will the money start rolling in. This is also why drug companies patent their drugs to the hilt.

Charity money unfortunately only pays for very small amounts of the costs, and the costs involved in buying new drugs off the shelf also go to pay for the hundreds of other drugs that fail to make it to market despite running up hundreds of millions of dollars in research and testing costs.


User currently offlineCxsjr From , joined Dec 1969, posts, RR:
Reply 2, posted (8 years 4 months 2 days 15 hours ago) and read 1675 times:

Thank you Richard, as always, your posts are extremely informative and clarifying .... I guessed this would be the case with these cancer drugs.

As I said though, it really doesn't make it right .... you can't price someones right to life in my mind.

(BTW; where did you get your super wallpaper for your Mac?!?)


User currently offlineKaddyuk From Wallis and Futuna, joined Nov 2001, 4126 posts, RR: 25
Reply 3, posted (8 years 4 months 2 days 14 hours ago) and read 1662 times:

Quoting Cxsjr (Reply 2):
you can't price someones right to life in my mind.

Insurance companies manage to price them up rather well... At the moment, if i die my next of kin (Mother) would recive about £75,000.

I think that my mother would rather have the money tbh...



Whoever said "laughter is the best medicine" never had Gonorrhea
User currently offlineJGPH1A From , joined Dec 1969, posts, RR:
Reply 4, posted (8 years 4 months 2 days 14 hours ago) and read 1661 times:

Quoting Kaddyuk (Reply 3):
nsurance companies manage to price them up rather well... At the moment, if i die my next of kin (Mother) would recive about £75,000.

Mum (on phone): Hello, is that the Acme Extra-Judicial Termination Agency ? It's about my son...


User currently offlineKaddyuk From Wallis and Futuna, joined Nov 2001, 4126 posts, RR: 25
Reply 5, posted (8 years 4 months 2 days 14 hours ago) and read 1658 times:

Quoting JGPH1A (Reply 4):
Mum (on phone): Hello, is that the Acme Extra-Judicial Termination Agency ? It's about my son...

I do think i'm more likely to die at work in an accident than my mum is to win the lottery...

How about THOSE odds...



Whoever said "laughter is the best medicine" never had Gonorrhea
User currently offlineJGPH1A From , joined Dec 1969, posts, RR:
Reply 6, posted (8 years 4 months 2 days 14 hours ago) and read 1654 times:

Quoting Kaddyuk (Reply 5):
I do think i'm more likely to die at work in an accident than my mum is to win the lottery...

Perhaps we can make certain "arrangements". It's amazing how easily you can get sucked into a Trent, if you put your mind to it.  Smile


User currently offlineRichardPrice From , joined Dec 1969, posts, RR:
Reply 7, posted (8 years 4 months 2 days 14 hours ago) and read 1649 times:

Quoting Cxsjr (Reply 2):
Thank you Richard, as always, your posts are extremely informative and clarifying .... I guessed this would be the case with these cancer drugs.

You're welcome, I try my best  Smile

Quoting Cxsjr (Reply 2):
(BTW; where did you get your super wallpaper for your Mac?!?)

I have a few sites that I peruse for wallpaper every now and then.

lemongrass came from http://www.simondodson.com/dtps/index.php

pixelgirlpresents.com is another very good site for backgrounds and stuff.


User currently offline777236ER From , joined Dec 1969, posts, RR:
Reply 8, posted (8 years 4 months 2 days 14 hours ago) and read 1644 times:

Quoting Cxsjr (Thread starter):
Here in the U.K., we hear on the news with monotonous regularity how the N.H.S. (our health service) have said they will not pay for certain cancer drugs as they are not deemed to be 'the best use of their money'.

Regarding today's bowel-cancer drug report, Avastin costs £16,824 per patient and Erbitux costs £11,739. Combine that with the fact it prolongs life by a small amount (4-5 months) during the end stages of the disease (pain, poor quality of life for those months) and the fact that chemo and radiotherapy would already have been provided by the NHS.

Then look at the causes of bowel cancer: smoking, diet, physical inactivity, excessive alcohol consumption, HPV (use a condom guys) amongst others.

In this case, the ends don't justify the means. With a public health service, compromises must be made.


User currently offlineCfalk From , joined Dec 1969, posts, RR:
Reply 9, posted (8 years 4 months 2 days 14 hours ago) and read 1644 times:

Quoting RichardPrice (Reply 1):
Drug companies plan on 30, 40, 50 year or longer timescales for recouping money invested in R&D on a drug

I'm not too sure about that. Pharmaceutical patent rights only last something like 7 or 10 years, before everyone can start to make generics. That means maybe as little as 7 years to recoup your investment.


User currently offlineSlamClick From United States of America, joined Nov 2003, 10062 posts, RR: 68
Reply 10, posted (8 years 4 months 2 days 14 hours ago) and read 1640 times:

Here in the US one might speculate (if one were terribly cynical) that the cost of being the sole sponsor of the evening news on ABC, CBS, and NBC factors into it. Budget that under "public opinion management" Of course this is not a dead loss. Every single night of the week there is a three or four minute "news story" about some new disease or drug. The inevitable conclusion of these stories is that drugs make your life possible and the pharaceutical companies are the unquestioned good guys. In short, it is a commercial. Watch and see if this isn't true!

Also a factor is the relative lack of interest the US Government has in prolonging the lives of Social Security recipients. If I'm wrong they will streamline the process of permitting use of new drugs. If I'm right they won't. Social Security is (really) bankrupt, it is just being propped up from time to time. The big reason it is bankrupt is that YOUR senator and congressperson borrowed the money to pay for other programs. So wouldn't it be a disaster if we started living longer after retirement?

But of course that would all be terribly cynical.



Happiness is not seeing another trite Ste. Maarten photo all week long.
User currently offlineRichardPrice From , joined Dec 1969, posts, RR:
Reply 11, posted (8 years 4 months 2 days 14 hours ago) and read 1640 times:

Quoting Cfalk (Reply 9):
I'm not too sure about that. Pharmaceutical patent rights only last something like 7 or 10 years, before everyone can start to make generics. That means maybe as little as 7 years to recoup your investment.

My timescales are including time to market, generally a company will apply for a patent at the start of the trials, which can last for 12 years until the drug is approved. Pharmaceutical patents are the same as any other, lasting roughly 20 years from approval, so they expect 8 - 10 years of 'owned' sales before generics come along.

Companies do not however expect to retrieve ALL costs during that 8 - 10 years, which is why they sell their own product under a generic label near the end of hte patent period.

This is why I stated up to 50 years, as it includes the R&D, testing, trials, patent period and generic phases which a company will usually plan for to recoup. They usually recoup 80% of total costs in the patent period.

Companies releasing drugs into a small market, under 200,000 worldwide patients, are usually granted by the FDA a 7 year monopoly on the drug if its not patentable, along with protection from any outstanding patents and some tax benefits.


User currently offlineJacobin777 From United States of America, joined Sep 2004, 14968 posts, RR: 59
Reply 12, posted (8 years 4 months 2 days 4 hours ago) and read 1590 times:

Quoting Cxsjr (Thread starter):
Is this just the suppliers to try to recoup the research and development costs (and if so, how come this isn't sourced out of the �bns donated to such charities each year?) or is it just that the 'ingredients' of the drug (so to speak) are so expensive to source??

Having worked in the pharmaceutical research/molecular pharmacology/drug development industry for a decade, I can tell you...it take a lot of time and a lot of money to develop a drug.....

one meets some of the most brilliant people in the world..bar none... no ....

7-10 years from inception to completion...

there are 3 "phases" for the test..

1)phase one is the general chemical tests
2)phase two are animal experiments
3)phase three are human trials..

the cost for developing a drug run from $700million to $1 billion now..

add the cost of marketing, sales rep., etc...and one can see why a drug comany derserves "exclusivity rights" (that is what the term is called) for about 20 years before a generic drug comes out


next time someone tells you that "why are they ripping people off-it costs only 0.03 cents to manufacture that pill"......let them know that it takes a $1 billion to manufacture the first pill..... Wink



"Up the Irons!"
User currently offlineAR385 From Mexico, joined Nov 2003, 6596 posts, RR: 35
Reply 13, posted (8 years 4 months 1 day 22 hours ago) and read 1562 times:
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Quoting Cxsjr (Thread starter):
Is this just the suppliers to try to recoup the research and development costs

This is my opinion, so take it as such. I belive Cancer already has a cure, but there is a whole chain of industries that benefit from giving long term Cancer treatment. So in the particular case of pharmaceutical companies, they'll recoup there investment on R&D by making available the treatment drugs. They go laughing all the way to the bank.

I belive Cancer patients, the mayority of them, this is a generalization, brought it upon themselves. My father died a year and a half ago from stomach cancer. He had a mass that occupied 80% of his stomach. Non Hodgkins Lymphoma. However, he was asymtomatic until the very end. He was 62. But he smoked at least five packs a day. I love him and I miss him, terribly, my best friend disappeared from one day to the next, but there are at least a number of ethical questions that need exploration. For example, would you give my father the drug for treatment because he can pay for it, or would you give it to someone who got Cancer because of bad genes? And this is only one of many questions that society needs to sit down and debate about.


User currently offlineFlyingbabydoc From , joined Dec 1969, posts, RR:
Reply 14, posted (8 years 4 months 1 day 21 hours ago) and read 1554 times:

Quoting AR385 (Reply 13):
I belive Cancer already has a cure, but there is a whole chain of industries that benefit from giving long term Cancer treatment. So in the particular case of pharmaceutical companies, they'll recoup there investment on R&D by making available the treatment drugs. They go laughing all the way to the bank.

There is no such a thing as "cancer". It is a generalization, but you cannot handle pathologies completely different in etiology and biological course as the same disease. Akute lymphoblastic leukemia has a cure rate of 95% in children, while other tumors like Osteosarcoma only 15%. But to say that pharma companies actually profit from the suffering and death of the patients to go laughing to the bank is at least a cavalier way of looking into a very delicate problem. These billions spent in research have evolved our knowledge tremendously, and for that they should be compensated.

Quoting AR385 (Reply 13):
this is a generalization, brought it upon themselves.

Well, you are more than welcome to come to the unit I am working now (children's oncology unit) and discuss this point of view with an 8-month old with neuroblastoma (or his family) or with a 15 y.old with a rib-tumor (Ewing Sarcoma). I would say this view is rather callous. And, even if the patients have brought the disease upon themselves, it is not our place to judge - but to understand, to help, to eliminate the suffering to the best of our abilities.

Just my  twocents 

Alex


User currently offlineKieron747 From , joined Dec 1969, posts, RR:
Reply 15, posted (8 years 4 months 1 day 20 hours ago) and read 1537 times:

Quoting Jacobin777 (Reply 12):
Having worked in the pharmaceutical research/molecular pharmacology/drug development industry for a decade, I can tell you...it take a lot of time and a lot of money to develop a drug.....

 checkmark 

Agreed. During my Ph.D in synthetic chemistry, you get a VERY small taste of the process, and trust me, it takes ages.

As I understand it now (I know work in the area of chemical patents) generally new drugs are protected by 'Product' Patents which cover specific drugs and a whole range of variations.

Such patents last roughly 20 years, after which generic drug companies can start to make them. There also exist, however 'Process' patents which protect methodologies (synthetic routes) to make certain drugs.

Patent law is very complicated, with several countries having different interpretations. When a drug is coming to an end of it's protection, the companies can (and often do) apply for patents which cover the drug in novel ways, for example 'Method of Use', 'Composition' or 'Preparation' Patents.

Take one example. Insulin, for diabetes patients, is a small protein, the structure of which has been know for many years. Insulin itself is no longer really covered by patent, however an oral administration of insulin is protected as it is a new method for administering the 'drug'.

Let's not forget also, that patent applications are costly, and maintaining a patent application for many years while the drug goes through synthesis, testing, and clinical trials takes a long time.

I agree totally that such drugs are extremely expensive. But as they say, "What can you do!?"

Kieron747


User currently offlineAR385 From Mexico, joined Nov 2003, 6596 posts, RR: 35
Reply 16, posted (8 years 4 months 1 day 20 hours ago) and read 1531 times:
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Quoting Flyingbabydoc (Reply 14):
These billions spent in research have evolved our knowledge tremendously, and for that they should be compensated.

While recognizing you have a much more thorough and academic background on the topic, I did state it was my opinion. I never said it was the case. I am also of the opinion that they should not be compensated by putting human lives at stake. Government subsidies may be one way to cheapen the drugs, I do not know how efficient that would be, but it's an idea.

Quoting Flyingbabydoc (Reply 14):
Well, you are more than welcome to come to the unit I am working now (children's oncology unit) and discuss this point of view with an 8-month old with neuroblastoma (or his family) or with a 15 y.old with a rib-tumor (Ewing Sarcoma). I would say this view is rather callous. And, even if the patients have brought the disease upon themselves, it is not our place to judge - but to understand, to help, to eliminate the suffering to the best of our abilities.

Again, I said, and you quoted, that what I wrote was a generalization. You have swore the hippocratic oath, so it may not be your place to judge. But others who have not made that oath, do have an obligation to recognize the ethical dilemmas Cancer is generating these days. Take the example of Brasil and South Africa with the HIV drugs in order to be able to produce cheaper drugs. This is by itself an ethical issue too. You as a doctor may find what I wrote callous, I understand that. But what I find callous and irresponsible is the status-quo and not a single attempt to discuss the ethical issues Cancer creates.

Regards,

[Edited 2006-08-22 13:32:27]

[Edited 2006-08-22 13:36:55]

User currently offlineConcordeloss From United States of America, joined Nov 2003, 388 posts, RR: 0
Reply 17, posted (8 years 4 months 1 day 19 hours ago) and read 1511 times:

Quoting RichardPrice (Reply 7):
I have a few sites that I peruse for wallpaper every now and then

What did you mean by peruse?

pe·ruse ( P ) Pronunciation Key (p-rz)
tr.v. pe·rused, pe·rus·ing, pe·rus·es
To read or examine, typically with great care.


--------------------------------------------------------------------------------
[Middle English perusen, to use up : Latin per-, per- + Middle English usen, to use; see use.]
--------------------------------------------------------------------------------
pe·rusa·ble adj.
pe·rusal n.
pe·ruser n.
Usage Note: Peruse has long meant “to read thoroughly” and is often used loosely when one could use the word read instead. Sometimes people use it to mean “to glance over, skim,” as in I only had a moment to peruse the manual quickly, but this usage is widely considered an error. Sixty-six percent of the Usage Panel finds it unacceptable.



"You're not as stupid as you look, or sound, or our best test indicates" Burns to Homer
User currently offlineRichardPrice From , joined Dec 1969, posts, RR:
Reply 18, posted (8 years 4 months 1 day 19 hours ago) and read 1509 times:

Quoting Concordeloss (Reply 17):
What did you mean by peruse?

Precisely this -

Quoting Concordeloss (Reply 17):
Sometimes people use it to mean “to glance over, skim,” as in I only had a moment to peruse the manual quickly



Quoting Concordeloss (Reply 17):
but this usage is widely considered an error. Sixty-six percent of the Usage Panel finds it unacceptable.

And with all due respect to Dictionary.com, language meaning is defined by common usage, and that meaning is in wide usage so therefore it has been accepted by the english speaking public, no matter what a 'panel' may say.

Interesting tho, nice point.


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