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CEO of UHG Shot and Killed in NYC - WTF is wrong with you New York


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2 hours ago, Jkwellborn said:


No kidding? Damn, we had a guy going to one and that fool couldn’t see before. Hate to know how bad his vision was when he was driving back.

It's frustrating and distressing because it happened so quickly to my (somewhat mild) near-sightedness that I thought I was losing my mind just on the short drive home from the hospital. Also I had ordered new frames and lenses before I started with HOC and I can't even use 'em so I have no idea if they're even correct. Fortunately Fort Collins is small and I rarely have to drive more than a couple of miles. Before I started using the HOC I didn't need reading glasses but about a week ago my far-sightedness got worse. Tomorrow is my last day of using the HOC for at least 3 and a half weeks so we'll see if my eyesight returns to base. Apparently the therapy can "temporarily" change the shape of the eye lens.

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20 hours ago, chainsaw said:

Drug patents should be illegal

Any monopoly, even a temporary one, on a product like a drug is going  to evoke this reaction.

But, pharma is a research and development intensive industry and the limited monopoly is intended to facilitate or incentivize investment in such endeavors and the innovation they produce.  For all pharma's faults and fuckery, this is fundamentally true.

Maybe a shorter term is in order, but no one else in the world is doing that.

As mentioned previously, a lot of the gambits employed by pharma in the patent system have been legally removed, and more are in-progress and have been for years.  Still, when it takes several years to work a patent through the system, and it lasts for about two decades more, it takes some time for those change to ripple through to the present day.  Remember that the patents we're bitching about today were filed 20 years ago.

The other thing is the price itself.  It's not the price the market will bear if no one is actually paying that price.  Europe grants patents with essentially the same effect and duration as US Patents, but they pay a lot less, or at least the publicized price is a lot less.   Same is true in every other first-world country.

There are a lot of other things going on here besides patents.

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2 minutes ago, TwiceHorn said:

research and development

I hear this tossed around a bunch, but this talking point usually unravels if you ask for facts, evidence, and details. I agree though that there's more to blame than just patents, as you correctly point out they have patents in other countries and their prices aren't extortionate as they are here.

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2 minutes ago, chainsaw said:

I hear this tossed around a bunch, but this talking point usually unravels if you ask for facts, evidence, and details. I agree though that there's more to blame than just patents, as you correctly point out they have patents in other countries and their prices aren't extortionate as they are here.

 I don’t know this in any way, but I think in other first world countries the manufacturer/patent holder has to deal with the entire country because of nationalized healthcare. More leverage there, perhaps.  I mean, isn’t that one of the reasons some want to nationalize healthcare here?

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I am reading this thread and think that it's really fucked up to see so many people on here either celebrating murder or sympathizing with the killer. No one here should be judge, jury and executioner when it comes to life and death. That's the job of the AI algorithm the insurance company authored in order to maximize profits from your death. 

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2 hours ago, Horn Under a Bad Sign said:

I am reading this thread and think that it's really fucked up to see so many people on here either celebrating murder or sympathizing with the killer. No one here should be judge, jury and executioner when it comes to life and death. That's the job of the AI algorithm the insurance company authored in order to maximize profits from your death. 

I don't like when a private company murders people, it should be the people on street who should murder people. We can call it The Purge. It's a way for the masses to control the means of murder! 

When the people chose who's wrong, who can disagree? Not the man under the blade of the guillotine.

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5 hours ago, workswithseed said:

I don't like when a private company murders people, it should be the people on street who should murder people. We can call it The Purge. It's a way for the masses to control the means of murder! 

When the people chose who's wrong, who can disagree? Not the man under the blade of the guillotine.

When corporations and generationally wealthy oligarchs pull this sort of shit and ensure that nobody can make any meaningful changes, it all but guarantees violence. Historically speaking, at least.

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On 12/26/2024 at 9:21 PM, chainsaw said:

I hear this tossed around a bunch, but this talking point usually unravels if you ask for facts, evidence, and details. I agree though that there's more to blame than just patents, as you correctly point out they have patents in other countries and their prices aren't extortionate as they are here.

Well, R&D is a real thing.  Pharmas, among other entities, have to do it to stay afloat.  I didn't say it justified their pricing.

But to say they don't engage in R&D and don't actually innovate is foolish.

There's a notion that patents stimulate or incentivize invention.  I think that's false because inventors gonna invent.  Patents do incentivize investment in invention.

Patents also tend to be viewed a tool for abuse of little guys by big money.  But they are also used to good effect by little guys, individuals and small businesses.  Often when we "reform" the patent system, it winds up fucking little guys more than big ones. https://jtbg.org/about

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24 minutes ago, TwiceHorn said:

Well, R&D is a real thing.  Pharmas, among other entities, have to do it to stay afloat.  I didn't say it justified their pricing.

But to say they don't engage in R&D and don't actually innovate is foolish.

There's a notion that patents stimulate or incentivize invention.  I think that's false because inventors gonna invent.  Patents do incentivize investment in invention.

Patents also tend to be viewed a tool for abuse of little guys by big money.  But they are also used to good effect by little guys, individuals and small businesses.  Often when we "reform" the patent system, it winds up fucking little guys more than big ones. https://jtbg.org/about

I just wanted to point out a trend in this thread (not by you though) to talk about "how much healthcare spends on R&D" and then move the goalposts to "well they only pay for development, not research". 

Well which is it? Do they receive the majority of their R&D funding through public means or not? Holy shit why is everything a goddamn shell game with healthcare and the leeches who sit and charge tolls between caregivers and patients

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4 hours ago, TwiceHorn said:

Well, R&D is a real thing.  Pharmas, among other entities, have to do it to stay afloat.  I didn't say it justified their pricing.

But to say they don't engage in R&D and don't actually innovate is foolish.

There's a notion that patents stimulate or incentivize invention.  I think that's false because inventors gonna invent.  Patents do incentivize investment in invention.

Patents also tend to be viewed a tool for abuse of little guys by big money.  But they are also used to good effect by little guys, individuals and small businesses.  Often when we "reform" the patent system, it winds up fucking little guys more than big ones. https://jtbg.org/about

Here's where I stand:

4 hours ago, TwiceHorn said:

R&D is a real thing

True

4 hours ago, TwiceHorn said:

Pharmas, among other entities, have to do it to stay afloat. 

I doubt it. My sense of things is that there are dozens of companies we've never heard of, who don't innovate shit, and have perfectly healthy balance sheets and don't want anything to change so they lobby the fuck out of politicians to make sure nothing changes, and if anything does change, it's only to make their business even more cushy.

4 hours ago, TwiceHorn said:

I didn't say it justified their pricing.

I wouldn't accuse you of saying something like that. But yes, R&D certainly wouldn't justify their prices.

4 hours ago, TwiceHorn said:

But to say they don't engage in R&D and don't actually innovate is foolish.

If by "they" you mean the companies themselves, I don't think the answer is quite that black and white. A lot of public grants go to researchers at universities, and some grant money gets mixed up with private investments that are linked to pharma companies, and while there are some strings attached it's usually a stretch to say "they" (the pharma companies) are "engaged" in that research. I'm not saying these companies don't have research departments, but I've not heard of anything worthwhile happening in those labs. I could be wrong, but I get a distinct impression that private researchers are MLS whereas the minds in academia are Champions League caliber.

It's not black and white though, as I said, so I'm sure there are some rockstars in private research and some flameouts in academia, and of course due to all the public-private partnerships and the way research gets funded, the line between "them" and not-"them" is blurry.

I can agree with you that innovation DOES happen. I don't think I can agree that the innovation is rightfully "theirs" when it's more often the innovation of some grad students.

5 hours ago, TwiceHorn said:

There's a notion that patents stimulate or incentivize invention.  I think that's false because inventors gonna invent.  Patents do incentivize investment in invention.

I agree. Patents incentivize investment in invention, but not necessarily the invention itself.

I still find it immoral for someone to be able to monopolize life-saving or livelihood-saving treatment.

5 hours ago, TwiceHorn said:

Patents also tend to be viewed a tool for abuse of little guys by big money.  But they are also used to good effect by little guys, individuals and small businesses.  Often when we "reform" the patent system, it winds up fucking little guys more than big ones. https://jtbg.org/about

I'm not against the patent system, I'm against capitalistic mechanisms that deprive people of the care they need. In this particular case, I think monopolies on drugs (whether it's a patent or whatever the fuck orphan thing Shkreli was exploiting) are immoral. There has to be a better way to reward innovation, and a better way to reward people who are willing to pay for research even when the research itself doesn't pay off. Those are losses I'm fine with socializing, and I don't believe these losses are so great that the only way to offset them is by depriving people of the care they need.

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Some good points here. I'll give my $0.02, with the caveat that I've spent a two decade career in industry 'R&D'.

First, R&D should really be broken up to understand the process. The 'R', as far is internal research, is often a minor fraction of what an overall biotech or pharma might spend in other areas, for instance advertising. One lazy example I found quickly here, but there are many others. Personally I think allowing more direct advertising of drugs was a mistake...generally. It certainly increased the amount companies spend in that area where they could be spending it elsewhere. That said, I can also think of areas where it's helpful, as once you get out of large cities or 'Centers of Excellence', there's a huge education gap with some physicians when it comes to the latest treatment options. Directly reaching the patients is often a very, very tangible way to improve access to the best treatments available. A topic for another post, perhaps.

'R' is taking an idea - I want to hit Target X - and making it into a drug. The biggest issue is time to the clinic, which does cost money for sure, and many ideas and approaches fail. But in general - startup or pharma - R is fairly cheap. 'D' - taking it to the clinic, approval, and launch - is a money sink. I can think of several personal examples where a clinical trial costs $1mil/patient - and that's just Phase 1 (safety, dosage and pharmacokinetics) or Phase 2 (the first hints of seeing if it might work). Those are 'just' 20-200 patient trials, before you get to phase 3 or 4 when you expand to many hundreds to thousands of patients to really understand the benefit. Clinical trials are massively expensive and no company would invest in them without some guarantee at the end that, should it work, one has some amount of exclusivity time to compensate for the upfront risk and expenditure. There's a debate for sure on how long that exclusivity should be. Note that those patents are for a specific 'lock and key' if you will for Target X. Someone else can come up with another way to hit Target X and make their own drug, so it doesn't hinder development in that way.

A different type of 'R' is when large companies sign agreements with smaller startups who have their own asset, but lack both the $$ as well as the massive, massive clinical and informational infrastructure to successfully take it through clinical trials. Most medium to large biotech/pharmas blend internal research of ideas with strategic partnerships either with good ideas they didn't have, or technology which would be too difficult, time-intensive, and costly to develop internally.

In my 20+ years in large medium and small companies, not once has a drop of my research been funded by the taxpayers. On the contrary, ideas for 'hitting Target X' that have come from academia are very heavily protected by their own patents, and increasingly I've seen much more successful spin-outs from academia, into startups in the past 10 years, and it's steadily increasing (which is a good thing). The public-private lines get a little crossed when we get to the 'D' portion, again in the clinical development phase. A good summary of how this plays out is here.

The patent protections in the US are certainly important to the success and innovation we have, but it's not exclusive. There are similar processes in most of Europe and Asia, and that's why you also see not only top-notch companies and innovation there, but successful clinical development. Most large pharma companies depend on development in multiple areas. That said, places like China and India are the wild-wild west, and while that has not prevented them from developing their own home-grown innovation, it has time and again proven to be a detriment for US/European pharmas from making large-scale investments there, despite the large market.

With all that said, the decisions around pricing can still be head-scratching, and even with all my years of experience I don't understand it, and fundamentally our health-care system is flawed. I know my employers are not altruistic, but in general the business model is completely dependent on ensuring as many patients who can benefit from the drugs I develop get access to them. On the contrary, the insurance companies profits hinge on taking in more premiums than distributing payments. In my current organization, one of our number one issues is trying to get insurance reimbursements. In many cases, it is far, far easier to reach patients in Europe.

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10 hours ago, Captainant said:

I just wanted to point out a trend in this thread (not by you though) to talk about "how much healthcare spends on R&D" and then move the goalposts to "well they only pay for development, not research". 

Well which is it? Do they receive the majority of their R&D funding through public means or not? Holy shit why is everything a goddamn shell game with healthcare and the leeches who sit and charge tolls between caregivers and patients

Well, I think universities do a lot of fundamental research, but that doesn't deliver final product or clinical trials of final product.  Some have called the latter development.

So the feds potentially have march-in rights on the university patents, but that would be taking revenue from universities, who license-out to industry, so they don't really do that.

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35 minutes ago, TwiceHorn said:

Well, I think universities do a lot of fundamental research, but that doesn't deliver final product or clinical trials of final product.  Some have called the latter development.

So the feds potentially have march-in rights on the university patents, but that would be taking revenue from universities, who license-out to industry, so they don't really do that.

 

I think it is free for government use for research. So instead of a drug which requires development, let's talk about a basic research product like a green fluorescent protein. The NIH can pass it around internally and not have to pay royalties. However, the NIH still would usually just buy it from a company anyway instead of passing it around because it helps validate the research by saying it was purchased from a commercial entity.

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4 hours ago, Txzen said:

'D' - taking it to the clinic, approval, and launch - is a money sink.

Do you think it needs to be?

4 hours ago, Txzen said:

Clinical trials are massively expensive and no company would invest in them without some guarantee at the end that, should it work, one has some amount of exclusivity time to compensate for the upfront risk and expenditure.

This is where I become less sympathetic to the pharma industry. Like, we can't just quantify "the upfront risk" as some huge number as a pretext for hiking prices beyond what ordinary people can pay. We probably know more or less what percentage of drugs that enter Phase 1 Clinical Trials are going to ultimately get FDA approved, and I don't exactly think the odds are so much worse than any other business. Just pull the rip cord before jumping in to Phase 2 and save some money, or whichever phase, if you can't pass the phase you just paid for. Most of those sunk costs are probably tax advantaged.

Exclusivity, fine, but with some strings attached to ensure the monopoly isn't being abused to the public's detriment.

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32 minutes ago, chainsaw said:

Do you think it needs to be?

This is where I become less sympathetic to the pharma industry. Like, we can't just quantify "the upfront risk" as some huge number as a pretext for hiking prices beyond what ordinary people can pay. We probably know more or less what percentage of drugs that enter Phase 1 Clinical Trials are going to ultimately get FDA approved, and I don't exactly think the odds are so much worse than any other business. Just pull the rip cord before jumping in to Phase 2 and save some money, or whichever phase, if you can't pass the phase you just paid for. Most of those sunk costs are probably tax advantaged.

Exclusivity, fine, but with some strings attached to ensure the monopoly isn't being abused to the public's detriment.

Well, patents in the general case can be a bit of a pain in the ass for competitors, and, in turn, for customers.  But while the patent monopoly ostensibly confers pricing power, it doesn't often result in the exorbitant prices we see from pharma.  

Part of it is the nature of pharma patents:  chemical composition patent claims tend to be pretty precise and foreclose most if not all "equivalents," making them difficult to avoid or design-around.  This is not necessarily the case with mechanical or electrical/electronic patents.  So the monopoly conferred by a pharma composition patent may be broader and more effective than other types of patents.

Also, there are tons of other market distortions at work in pharma pricing that patents don't account for.

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10 hours ago, TwiceHorn said:

Well, patents in the general case can be a bit of a pain in the ass for competitors, and, in turn, for customers.  But while the patent monopoly ostensibly confers pricing power, it doesn't often result in the exorbitant prices we see from pharma.  

Part of it is the nature of pharma patents:  chemical composition patent claims tend to be pretty precise and foreclose most if not all "equivalents," making them difficult to avoid or design-around.  This is not necessarily the case with mechanical or electrical/electronic patents.  So the monopoly conferred by a pharma composition patent may be broader and more effective than other types of patents.

Also, there are tons of other market distortions at work in pharma pricing that patents don't account for.

I'm not against every patent all of the time, I'm only against abuses of the monopoly that go beyond anticompetitive (something which is inherent in any monopoly, by design) and become harmful to public health (something that only happens when greed overpowers decency). The true culprit(s) is/are likely these non-patent market distortions, so we're in full agreement on that.

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12 hours ago, Bevo said:

 

I think it is free for government use for research. So instead of a drug which requires development, let's talk about a basic research product like a green fluorescent protein. The NIH can pass it around internally and not have to pay royalties. However, the NIH still would usually just buy it from a company anyway instead of passing it around because it helps validate the research by saying it was purchased from a commercial entity.

The march-in rights I refer to actually force the patent owner (of an invention made with federal assistance) to grant licenses to qualified licensors and if they fail to, the government itself can do it.  So it's in the nature of an ownership interest.  Such rights rarely or never are exercised. https://crsreports.congress.gov/product/pdf/R/R44597

It's pretty similar to what's known as a compulsory license, which tend to be disfavored in most capitalistic/commercial economies, kind of like price controls.

But, Bayh-Dole, which provides for it, does automatically grant the government a license to use the invention free of charge.  But, you're right, the practicalities of the scenario probably mean the government acquires "molecules" on the open market like anyone else, assuming there's any complexity to making them.

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12 minutes ago, chainsaw said:

I'm not against every patent all of the time, I'm only against abuses of the monopoly that go beyond anticompetitive (something which is inherent in any monopoly, by design) and become harmful to public health (something that only happens when greed overpowers decency). The true culprit(s) is/are likely these non-patent market distortions, so we're in full agreement on that.

And, I don't disagree that the Patent Act, particularly those provisions peculiar to drugs, should be massaged/revised/repealed.  Pharma is one of the only industries that has peculiar patent provisions.  My worry is that we engage in some sort of wholesale "patent reform" that fucks up everything for everyone.

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Putting R&D in the hands of universities rather than (mostly) private for-profit companies with patent protection? This reminds of the former NSF director’s quote that more or less said “if the NIH had been put in charge of treating polio, the US would’ve developed the best iron lung in the world, but never a polio vaccine.”

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On 12/30/2024 at 11:32 PM, Murfdogg21 said:

Putting R&D in the hands of universities rather than (mostly) private for-profit companies with patent protection? This reminds of the former NSF director’s quote that more or less said “if the NIH had been put in charge of treating polio, the US would’ve developed the best iron lung in the world, but never a polio vaccine.”

The actual polio vaccine was created while Jonas Salk was researching at the University of Pittsburgh and was never patented, and no one tried to make a profit off of it. 
 

Not to worry because we are speed-running a polio return and I am sure that will offer some shareholder value. 

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8 minutes ago, 956 Worldwide said:

The actual polio vaccine was created while Jonas Salk was researching at the University of Pittsburgh and was never patented, and no one tried to make a profit off of it. 
 

Not to worry because we are speed-running a polio return and I am sure that will offer some shareholder value. 

The march of dimes funded the pivotal translational trials.

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36 minutes ago, Anastasis said:

You just did that think that you shit on pronghorn for doing. Some of y'all are more like the fucking offshore bots than you realize. 

Care to clearly state the #bothsides here? Or since it's a new year do we have to put up with a deductible of bullshit before you get on with it

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I think that I was pretty clear.

The actual story wrt the polio vaccine is fascinating. Particularly for the geopolitics involved. March of dimes supported both salk and sabin development, but sabin couldn't get funding for the translational research after the success of the salk trials, so the Russians took the baton and funded it. The sabin approach was actually adopted for international production because of certain advantages, and was the primary approach responsible for the international "eradication" of polio. The sabin version allows for breakthrough infection though, which is what RFK talks about a lot. What a world. 

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