Wednesday, November 2, 2016

On the discovery of Sovaldi, Gilead's miracle drug for Hepatitis C

Continuing with our theme of healthcare costs, I thought this Sci-Am article was interesting. The author does a good job of refuting some of the clumsy claims regarding drug prices, e.g. focusing on the manufacturing costs and dismissing discovery/research costs. The author himself is a drug scientist. This quote is extremely interesting:
Drug discovery is one of the most wasteful research activities on the planet and it's all because most of the times we have no idea of how to go about discovering a new drug or what's going to happen when we put it inside the human body. The complexities of human biology thwart us at every stage and luck plays an inordinately large role in our success. Even basic issues in drug discovery - understanding how drugs get past cell membranes for instance - are generally unsolved problems, and the profligate inefficiency of the process would truly shame us if we knew how to do it better. The path from a new idea in pharmaceutical research to an actual drug is akin to a path trodden by a blind man along the edge of a cliff at night; any survival, let alone success, seems like a miracle in retrospect. No drug scientist will admit it, but every drug scientist crosses his or her fingers when a new drug makes it to the market because we are just not smart enough to figure out exactly what it will do in every single patient. That is why most drugs fail in advanced clinical trials, when hundreds of millions of dollars have already been spent on them.
This is kind of reminiscent of what my high school physics teacher used to tell us. (Apparently, he was a research chemist working on pesticides before he took up high-school science. He told us they'd randomly test chemicals on insects and pick the combo that yielded the least bug survival rate.)

But note that the author doesn't discuss the following.

  1. US consumers pay significantly more for the same drugs than their counterparts in the rest of the developed world do. As I mentioned before, this probably stems from the absence of an "all payer rate setting" in the US drug market.
  2. Gilead acquired a company called Pharmasset that had begun developing Sovaldi. The research that inspired the creation of this company was originally federally funded.
  3. The US taxpayers also fund the FDA, whose effective functioning is critical in bringing these drugs safely to the market.
So all in all, the US taxpayers seem to be funding a lot of useful things like university research and FDA, only to be punished later with higher drug costs.

Nonetheless, I'd rather have big pharma get filthy rich than, say, Wall Street, e.g. Wells Fargo executives. They do cure the sick after all.

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