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Desert Island Economics

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popular
2 hours ago
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rachel
8 hours ago
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cambridge, ma
vitormazzi
9 hours ago
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Brasil
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tedgould
9 hours ago
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Using a desert island to look at the practical results of liberty, and even a bit of communism.
Texas, USA

Doctors tried to lower $148K cancer drug cost; makers triple price of pill

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A drug that treats a variety of white blood cell cancers typically costs about $148,000 a year, and doctors can customize and quickly adjust doses by adjusting how many small-dose pills of it patients should take each day—generally up to four pills. At least, that was the case until now.

Last year, doctors presented results from a small pilot trial hinting that smaller doses could work just as well as the larger dose—dropping patients down from three pills a day to just one. Taking just one pill a day could dramatically reduce costs to around $50,000 a year. And it could lessen unpleasant side-effects, such as diarrhea, muscle and bone pain, and tiredness. But just as doctors were gearing up for more trials on the lower dosages, the makers of the drug revealed plans that torpedoed the doctors’ efforts: they were tripling the price of the drug and changing pill dosages.

The drug, ibrutinib (brand name Imbruvica), typically came in 140mg capsules, of which patients took doses from 140mg per day to 560mg per day depending on their cancer and individual medical situation. (There were also 70mg capsules for patients taking certain treatment combinations or having liver complications.) The pills treat a variety of cancers involving a type of white blood cell called B cells. The cancers include mantle cell lymphoma, which was approved for treatment with four 140mg pills per day, and chronic lymphocytic leukemia, approved to be treated with three 140mg pills per day. Each 140mg pill costs somewhere around $133—for now.

Imbruvica’s makers, Janssen and Pharmacyclics, have now gotten approval to sell four different tablets of varying strengths: 140mg, 280mg, 420mg, and 560mg. But the new pills will all be the same price—around $400 each—even the 140mg dose pill. The makers will stop selling the old, cheaper 140mg pill within three months, according to a report by the Washington Post.

The plan nixes any chance to lower costs with lower dosages. Even if patients can drop down to just 140mg a day, they’ll pay three times what they pay now for each 140mg pill.

In a statement to the Post, Janssen and Pharmacyclics explained the move by saying the new line-up is “a new innovation to provide patients with a convenient one pill, once-a-day dosing regimen and improved packaging, with the intent to improve adherence to this important therapy.” They noted that those taking 560mg a day will save money with the new pricing.

But doctors balked at what they saw as an underhanded move. In an interview with the Post, oncologist Mark Ratain of the University of Chicago Medicine put things bluntly: “That got us kind of pissed off.”

Ratain and colleagues wrote a commentary in the weekly newsletter Cancer Letters this month, decrying the price hike and new pill series, calling it “highly unusual.” In addition to thwarting efforts to help lower treatment costs, the doctors pointed out that the new dosage lineup will make it harder to nimbly adjust patients’ doses by simply advising them to take different numbers of pills each day. Switching a patient from a 280mg or 420mg per day dose down to 140mg will require paperwork, filling a new prescription, and having patients return unused pills—a process that can drag out for weeks. And increasing a patient’s dose would either be just as lengthy of a process or risk multiplying their treatment costs even further by doubling or tripling the pills each day.

In their commentary, titled in part “Sales Revenues at the Potential Expense of Patient Safety,” the doctors lay out examples of when quick dosage changes would be necessary. Those include when a patient needs to drop down while they’re on a short course of antibiotics or to adjust for new combination-cancer treatments. “Any putative convenience advantage of taking one pill a day is negated by the marked inconvenience to the patient of having to return pills every time there is a need for a dosage change,” they write.

Ratain and colleagues end with a call to the Food and Drug Administration to look into the matter, “given that it creates a barrier to optimal prescribing for some patients,” they write. “We further urge the FDA to recognize that the combination of the high price per pill and the flat pricing scheme are specific impediments to safe administration, and that ignoring the marketing approach for ibrutinib is antithetical to fostering optimally safe dosing and administration.”

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jhamill
3 days ago
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This coming after the Goldman Sachs guy asking if curing disease was a viable business model it is clear the Free Market and Capitalism does NOT value people's lives. I get that you're in business to make a profit. But, you're in HEALTHCARE to care for people and sometimes that means you have to take a loss to HELP people.

My gut reaction to this would be a bill that would criminally punish CEOs and companies that raise drug prices.
California
quad
23 hours ago
When are the "sometimes" firms should take losses? How does this reasoning not apply to every drug?
satadru
4 days ago
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And thus endeth any future research into probing the lower end of the therapeutic range of drugs still under patent protection. There's just no longer any incentive to improve patient outcomes by reducing price any more.
New York, NY
popular
1 day ago
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dnorman
4 days ago
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as someone who may be looking at needing ibrutinib, fuck every single thing about this. recover your R&D costs, sure, but don't price the damned drug out of reach of patients.
Calgary

Evangelism

9 Comments and 13 Shares
The wars between the "OTHER PRIMATES OPEN THEM FROM THE SMALL END" faction versus the "BUT THE LITTLE BIT OF BANANA AT THE SMALL END IS GROSS" faction consumed Europe for generations.
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jprodgers
1 day ago
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I... Uh, wow, so I'm the 3 right most ones. Maybe I am intense...
Somerville, MA
wreichard
4 days ago
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I don’t care whether anyone else believes it, but opening bananas that way is indisputably better. OK, I don’t mind telling people about it.
Earth
popular
3 days ago
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davidedwards
3 days ago
Poor misunderstood Banananus.
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lizamu
3 days ago
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Yes yes yes.
New York, New York
Covarr
4 days ago
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People who insist the eagles could have taken the ring to Mordor are pretty far to the right on this scale. They place badly on the "actually read The Lord of the Rings books" chart, though.
Moses Lake, WA
DaftDoki
5 days ago
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I identify with the rightmost two.
Seattle
Ferret
5 days ago
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Bananas from the other end is the clearly superior method!
alt_text_at_your_service
5 days ago
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The wars between the "OTHER PRIMATES OPEN THEM FROM THE SMALL END" faction versus the "BUT THE LITTLE BIT OF BANANA AT THE SMALL END IS GROSS" faction consumed Europe for generations.
steanne
4 days ago
one of these was useful, but why is there now a second bot doing the same thing?
wmorrell
4 days ago
Because the first bot was offline for some stretches of time. When the second bot arrived, the technical difficulties of the original were also resolved, and now there are two. For some reason, that makes a few people twitchy every third or so comic posting.
cosmotic
4 days ago
Just add a check if another bot commented. How do both bots not properly decode the html entities? As a software engineer, this situation of redundant bots that both malfunction and both being run by complicit lazy admins that don't care about users drives me nuts.
spongbeaux
4 days ago
Why not write your own, and fix the problems that the... ohhhh. https://xkcd.com/927/
cosmotic
4 days ago
;) Also, someone would need to kill the other bots.
WorldMaker
1 day ago
Or you know, don't have any bots at all? It's easy enough to open the page, add the 'm.' to the web address (m.xkcd.com) and get the officially built means to get the alt text in an accessible manner, and give Randall some well deserved ad eyeball traffic in the process. I liked it when people only posted the Alt Text if they had something to add to it. A bot just posting the alt text doesn't add anything interesting to the discussion.
wmorrell
1 day ago
Many people find the bot(s) useful. Just see the, “yay, it’s back!” replies from the previous times they broke. I am glad you have something that works for you. But it’s a mistake to confuse, “I do not find this interesting,” with, “no one finds this interesting,” or even, “no one should find this interesting.”
WorldMaker
19 hours ago
I do not confuse any such thing. Perhaps you mistake my starting my opinion with "or" to offer an option for something other than an opinion? I'm happy to agree that mine might be the minority opinion, but that does not make my opinion invalid.
endlessmike
8 hours ago
MORE BOTS FOR THE BOT GOD
wmorrell
8 hours ago
ALT-TEXT FOR THE ALT-TEXT THRONE
Cthulhux
5 days ago
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Also, Emacs.
Fledermausland
Brstrk
5 days ago
I think you misspelled Vim. It's ok. We forgive you this time.
Cthulhux
5 days ago
You only need ten keys to master Vim: [Esc] [:] [q] [!] [e] [m] [a] [c] [s] [Enter]
firetech
5 days ago
You only need this command to master emacs: `alias emacs='vim'`
taddevries
5 days ago
Meanwhile nano users are in the corner eating glue
c_dave
4 days ago
Tasty tasty glue
tingham
4 days ago
Wow has it been 15 seconds in this conversation already? :)
sfrazer
4 days ago
I know just enough vi so that I can get networking working then I install nano because I've got better things to do with my day :-)
gglockner
3 days ago
About a month after starting to date the woman who became my wife, I asked her a religious question: emacs or vi. Needless to say, we have a mixed marriage.
alt_text_bot
5 days ago
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The wars between the "OTHER PRIMATES OPEN THEM FROM THE SMALL END" faction versus the "BUT THE LITTLE BIT OF BANANA AT THE SMALL END IS GROSS" faction consumed Europe for generations.

Saturday Morning Breakfast Cereal - Potential

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Click here to go see the bonus panel!

Hovertext:
I wonder if my kids will find these more upsetting than the weird sex comics.

New comic!
Today's News:

Signed editions now available!

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vitormazzi
5 days ago
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Brasil
popular
5 days ago
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acdha
5 days ago
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Washington, DC
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jlvanderzwan
5 days ago
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Yesterday, I happened to waste some time thinking about free will, and then that it more or less depends on what it really means to choose something, and then pondered the question of what a choice really is. I tried stripping out everything unnecessary and ask "could you define choice from a pure physics point of view, without anything personal attached to it?"

Then the following sentence bubbled up in my mind: "Choice is when out of all possible futures, one in particular happens"

And I thought.. "Wow... that sounds deep and means absolutely nothing"
vl
3 days ago
Wow, man, that's deep...
jlvanderzwan
2 days ago
Maybe, I don't know if is useful for anything beyond sounding deep though

History

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HISTORIANS: We've decided to trim the past down to make things more manageable. Using BCE/CE, would you rather we lose the odd-numbered or even-numbered years?
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wreichard
12 days ago
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As the economists say, in the end, we’re all dead. Live for the present, because the future probably won’t remember you at all, and you won’t care even if it does.
Earth
popular
10 days ago
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3 public comments
alt_text_bot
10 days ago
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HISTORIANS: We've decided to trim the past down to make things more manageable. Using BCE/CE, would you rather we lose the odd-numbered or even-numbered years?
austinstorm
12 days ago
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Someone send this to Jason Kottke and tell him everything's going to be alright.
Moscow, Idaho
alt_text_at_your_service
12 days ago
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HISTORIANS: We've decided to trim the past down to make things more manageable. Using BCE/CE, would you rather we lose the odd-numbered or even-numbered years?

Saturday Morning Breakfast Cereal - Clowns

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Click here to go see the bonus panel!

Hovertext:
Incidentally, this also explain's my mom's creepy Victorian era doll collection.

New comic!
Today's News:
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popular
16 days ago
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jlvanderzwan
18 days ago
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This makes too much sense.
Levitz
17 days ago
I recommend Dan Carlin's Painfotainment podcast if you're into this line of reasoning :)
jlvanderzwan
17 days ago
That sounds a bit... masochistic
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