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      This book is a bit long in the tooth now, having been published in 95.  The role it suggests for emotion in the use of reason is, in generalities, no longer controversial. But it was a landmark book for me, when I read it, and it’s still relevant and worth reading. There’s been a LOT […]
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Tuesday: Cross My Mind


Does a cancer drug really cost $2.7 billion to bring to market? Yes and no. This is something I actually know a little bit about. I’ve bored you people with it before. Will probably do it again.

Here’s the money quote from a related article about the cost of Kymriah, a new gene therapy treatment for a rare form of leukemia:

Drug makers argue that the prices ought to reflect the value of a curative treatment to the patient. Dr. Kesselheim and other experts are far from convinced.

“We don’t pay the fire department that way,” he said. “When the fire department shows up at a burning house, they don’t ask, ‘How much is it worth to you to put out the fire?’ ”

Executives at drug companies declined to say what they plan to charge for the gene therapies they are developing. But they said a variety of factors justified setting unprecedented prices.

By definition, there are very few patients with the rare diseases that the treatments target. Companies thus will have comparatively fewer opportunities to make enough money to pay for their investment, to turn a profit and to fund future research.

So, yes, research is very expensive. It takes a lot of trial and error and mucho dinero to research and develop and test a drug.

BUT, and here’s why the business dudes have made the situation worse, it used to be that drug makers had a large portfolio of small molecule drugs for cardiovascular disease, central nervous system disorders, diabetes, antibiotics, reproductive health yadayadayada. They don’t now. That’s what laying all of the small molecule R&D staff was all about in the wake of the patent cliff. Small molecule research got to be too expensive. The FDA kept raising the safety profiles in the middle of the pipeline making patents less profitable if the drug ever got approved. And what did get approved was immediately set upon by brigands in the class action legal profession. Oh, sure, it’s all fun and games to sue over an unavoidable and previously undetected rare side effect until all of us lose some really important therapeutic agent.

So the business bros decided to concentrate on cancer therapy and orphan drugs for rare medical conditions.


Because the patients’ lives depend on them, they’re chronic conditions, they’ll indenture themselves to get them and no one complains about side effects.


Now, if you have schizophrenia, heart disease, high blood pressure, a multi-drug resistant infection or want a better birth control option, you’re SOL.

The business side abandoned that kind of research. They put all their eggs in the cancer – orphan drug areas. That’s where the money is and the lawsuits ain’t.

Why, yes, it *is* opportunistic and evil. Why do you ask?

Next week, why the NIH grants don’t REALLY produce drugs in the university and how the business bros convinced a lot of PIs that they were mini gods so they could get the almost free graduate students to do the dirty work at a fraction of the price -and speed. And expertise. Really, there’s a reason we call them students.


Jacob Weisberg and Lawfare’s Benjamin Wittes talk about how to read journalists’ codes about where they get their sources on the latest episode of Trumpcast.

Maybe this is easier for me because scientists never commit to anything. I just figure that “sources familiar to the investigation” could include Capitol Hill staffers, congresspeople, FBI people, and the cleaning ladies.

Who knows? Need Moar Data.

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