
Indian Government uses special powers to slash cancer drug price by 97% - Garbage
http://timesofindia.indiatimes.com/india/Govt-uses-special-powers-to-slash-cancer-drug-price-by-97/articleshow/12240143.cms
======
JunkDNA
I worked in the drug R&D business for over 8 years. I still follow the
industry closely. Some things always get lost in these discussions. First,
_manufacturing_ an existing drug is absurdly cheap. Modern industrial
chemistry ensures this for all small molecule drugs (note that this is not the
same case for the "biologics" which are often fiendishly difficult to make).
Almost all the cost in a drug is the manufacturer recouping R&D costs. These
costs have been spiraling out of control for 10 years. They are astronomical.
A recent Forbes analysis pegs the cost of a new drug with failures of drugs in
development folded in anywhere from $3 billion to $12 billion depending on the
manufacturer (excellent context and discussion here:
[http://pipeline.corante.com/archives/2012/02/10/the_terrifyi...](http://pipeline.corante.com/archives/2012/02/10/the_terrifying_cost_of_a_new_drug.php)).

You don't need to be an industry expert to grok that those numbers are wildly
unsustainable. It is not possible to keep spending the amount companies spend
to make new drugs. In the past, companies would inflate the price in the USA
to make up for reduced prices elsewhere. But with all the recent healthcare
reform in the USA, that strategy is ending.

To add insult to injury, the vast majority of the most commonly used drugs
will lose patent protection in the next couple of years. In the industry they
call this the patent cliff. There will not be enough new drugs to offset all
the ones that go generic.

This move by India is a symptom of the wider drug industry problems. There
will be more of these kinds of moves in the future. The industry has been
searching for ways to more effectively make drugs and have it not be so
expensive. But so far they have been striking out for 10 years running. The
current strategy is to lay off most of their r&d workforce and offshore and
outsource this part of the business.

Somewhere out there, a business model is waiting to be found. Whoever cracks
that nut and becomes the Southwest of the drug industry is going to make a
fortune.

~~~
Alex3917
> _Almost all the cost in a drug is the manufacturer recouping R &D costs._

Actually that's not true. Big pharma spends twice as much on advertising as
they do on R&D:

[http://www.sciencedaily.com/releases/2008/01/080105140107.ht...](http://www.sciencedaily.com/releases/2008/01/080105140107.htm)

They also spend a significant amount of money on government fines due to
corrupt practices (i.e. killing people). They are now the single most corrupt
industry, paying significantly more fines per year than the entire military
industrial complex:

<http://www.citizen.org/hrg1924>

~~~
JunkDNA
If you took the time to look at the link I posted that talks about the Forbes
piece, you'd see that they specifically _excluded_ the cost of marketing from
the analysis of how much it costs to put out a new drug. When companies do
marketing, they expect it to more than pay for itself, clearly it is, or they
wouldn't be spending so much on it. I know people don't like to hear it, but
marketing products _does_ lead to more sales.

Trust me, having worked in an R&D organization, there was no want for more
funding. There was an incredible level of funding. If the problem in the drug
industry is simply that not enough is being spent on R&D, that is easily
correctable. Unfortunately for all of us, that's not the problem.

~~~
thwest
Of course one expects marketing mental diseases to be effective! 'Its not your
fault, take a pill and it will all go away' certainly has mass emotional
appeal. However, the article is not too convincing about the methodology of
excluding marketing expenses.

    
    
        First - and I know that I'm going to hear about this from some people - you might assume that different companies are putting different things under the banner of R&D for accounting purposes. But there's a limit to how much of that you can do. Remember, there's a separate sales and marketing budget, too, of course, and people never get tired of pointing out that it's even larger than the R&D one. So how inflated can these figures be?
    

Not particularly powerful evidence here: a vague notion of a limit, and a
rhetorical question. Corporate accounting statements are generally only
accountable to the board of directors, who might be perfectly happy with
pushing the limit on creative accounting while the stock goes up. When aimed
at investors other than the board, and especially when used by citizens
attempting to assess the social value of institutions, accounting statements
are better treated as marketing materials themselves.

We can discuss _evidence_ when the CFOs of these corporations open their daily
work to a public VNC session.

~~~
mahyarm
Mental disease drugs are only a part of industry. The drugs for physical
problems are still marketed heavily too.

------
w1ntermute
Does anyone else find it appalling that the American government and American
companies have the gall to complain about intellectual property violations in
developing countries like China and India? Until the late 1800s, American IP
law _explicitly excluded_ foreigners from IP rights. That's right, forget
about lax enforcement (like you often see in developing nations nowadays) -
you could violate foreign IP rights in public view and _not a thing would be
done about it_.

And that's exactly what Americans and American companies did - they went to
Europe, took the latest IP, brought it back to America, and copied it. Charles
Dickens went on a tour of America to try to get people to buy legitimate
copies of his books, which no Americans were doing at that point. By the end
of his tour, he realized this was a pointless venture, referring to America as
a "nation of pirates". Doesn't sound that different from what contemporary
American industry trade groups call China and India, does it?

And it wasn't just international - domestic IP rights violations were endemic
as well. The reason the movie industry developed in California was because the
movie studios (the _same people_ that are now crying foul about copyright
violations) were trying to escape Thomas Edison and his patents on moving
picture technology. Not only was Edison's lab in New Jersey, distancing them
geographically, but the Ninth Circuit Court of Appeals (which covers
California) took a more "relaxed" view of IP rights.

~~~
ars
No one else finds it appalling that things in the 1800s are not the same as in
the 2000s.

It is a bit appalling that you expect nothing to change in 200 years though.

~~~
w1ntermute
Read my comment here: <http://hackerne.ws/item?id=3699868>

It has nothing to do with the year, it has to do with the position of the US
(as developing or developed) changing its viewpoint vis-à-vis IP rights.

~~~
ars
In the 1800's the US was considered developed in comparison to other
countries. (For example the Cotton gin was invented in the US.)

You can't compare developed vs developing using 2000s definitions and at the
same time using 1800s definitions for IP laws.

You have to be consistent, pick one era and compare everything using the same
definitions.

~~~
w1ntermute
> In the 1800's the US was considered developed in comparison to other
> countries.

Not compared to Europe. There might have been some American inventions, but
those paled in comparison to inventions from Europe. It wasn't until the late
1800s that things started to change.

> You can't compare developed vs developing using 2000s definitions and at the
> same time using 1800s definitions for IP laws.

> You have to be consistent, pick one era and compare everything using the
> same definitions.

For any sort of historical analysis, scientific levels of rigidity are
impractical, because there isn't a large enough data set, so your point is
moot.

------
corin_
I think few people would argue that drug companies' prices are reasonable, and
when it comes to life vs. death I no longer care much about the "they're a
business, they're allowed to make a profit" line - of course it's still true,
and of course they are, but there's a (subjective) line between "making a good
profit" and killing people through greed.

That said, what pricing _would_ be fair? When people claim that these pills
cost bugger all to make, the answer is (perfectly validly) that the second
pill costs bugger all, the first one costs $$$$ in R&D. So I don't know how
cheap they would have to be to be considered a fairer price, and I've no idea
if it's possible for anyone outside the companies to work out - even if you
ignore the fact that what's fair is so subjective.

~~~
leonth
Truth is, clinical trials are mind-bogglingly expensive and takes years for
turnover. Also some newer drugs (I'm not sure about Nexavar) are rightfully
expensive to manufacture due to requirements in equipment, sterile conditions,
etc.

If I were to say anything negative about this it would be that this sets a bad
precedent for any new drugs coming to India -- knowing that the government can
effectively void out drug patents after certain number of years, the big
pharmas probably would not want to set up shop in the country altogether. Does
that sound familiar?

This town is no longer friendly for business.

~~~
Indyan
On principle, you are right. However, Rs 2.8 lakh for 1 month of pills is
inordinately expensive. It's something that no one but aristocrats will be
able to afford. By the standards of the Indian society, I fall in the upper
middle class category, and that amount is almost half of my annual salary
(more than half after tax deductions). To get an idea about how expensive it
is, just think whether you could afford to buy a new car (even a cheap one)
every month. Another point worth noting is that most Indians don't have
medical insurance, since typical healthcare is quite cheap in India.

Under the new forced licensing terms, Bayer will still be making money. In
fact, it might end up making pretty much the same as before, since volume will
increase dramatically thanks to the 97% price cut.

~~~
ig1
Bayer doesn't have a problem with selling cheaper drugs to poor people, they
do have a problem when those drugs go onto the grey market and get purchased
by those who could afford Bayer's regular price.

That's why drug companies don't do differential pricing, because they can't
stop the cannibalization of their wealthier markets.

~~~
matwood
Exactly. It's very similar to how content companies try to control the release
of content and pricing around the world (region codes ugh). If any pharm
company sells drug A in the US for $100 and sells the same drug in Africa for
$1 then it's an obvious arbitration opportunity. They are trying to prevent
the 'flat world' from eating sales by simply pricing it the same everywhere.

------
vineetdhanawat
"The Bayer price of Rs 34,11,898 per year ($69,000) is more than 41 times the
projected average per capita income for India in 2012, shattering any measure
of affordability." This is good enough for any govt to act so and rightly done
as well!

Also "6% royalty on net sales every quarter to Bayer" that isnt all unfair

~~~
tomjen3
Bayer is in it to make money, so presumably the reason the Indian government
forced this deal is that Bayer would lose money under it.

So no, it isn't fair.

~~~
Yeroc
Keep in mind that the government did NOT force Bayer to manufacture the drug,
only to license it. I don't believe Bayer had any interest in pursuing the
Indian market whatsoever since it was priced well beyond what the average
person could afford.

On the question of fairness: Is it fair for people to die because they can't
afford a life-saving drug? I'm sure that's what it boiled down to for the
Indian government.

According to my math if Bayer priced the drug over here the same way they did
in India relative to average per-capita income the drug would cost around $1.5
million per year. Would that change your perspective?

~~~
vineetdhanawat
Maybe, who knows. Bayer reported the price as part of Research Costs etc,
maybe true! But at the end Question stands - "Was the price fair?" I dont
think so!

------
tibbon
So wait- am I reading this right? Essentially Bayer didn't sell the drug cheap
enough, so the Indian Gov't gives an Indian company the 'right' to copy the
drug and send Bayer checks for 6% of the proceeds?

And on the flip side of intellectual property, the US is able to extradite a
kid over piracy of TV shows? (<http://news.ycombinator.com/item?id=3699325>)

Neither seems right to me. Maybe they aren't the same thing, but if
ThePirateBay was sending the MPAA checks for 6% of what they made on the site,
and saying "This should make it right, you weren't cheap enough so we
distributed it ourselves" then the US would be trying to seize and detain
people involved.

Hasn't India signed some intellectual property treaty with... well pretty much
the rest of the world? How in the world can they do this?

And totally on the flip side- props to India for sticking it to the man.
Kinda...

------
refurb
This may end up hurting India not helping.

In order to get a drug approved in India, you need to run clinical trial on
Indians. You also need to go to through the regulatory process, which isn't
cheap.

If drug companies fear that the millions they spend on getting a drug approved
in India won't be recouped because the gov't issues a compulsory license, then
they simply won't do it.

I mean think about it... if introducing your product to a new market resulted
in a net loss, would you do it?

~~~
Yeroc
The really simple argument is that at the previous price very, very few people
in India could afford it. So in the end it is more than likely that the
revenue that is gained is higher than it would have been at the very high
price.

~~~
refurb
No, I can't argue that's not true. We don't really know what Bayer's strategy
was here. For all we know they could have told the Indian gov't to shove it.
In that case, they gambled and lost.

Or, they could have offered the drug at 25% of the original cost and the gov't
could have told them to shove it.

------
jensnockert
It would be interesting to see how much money was lost or gained by Bayer
based on this. I assume that usage might go up by at least a factor 20 in
India (and their production costs go down) so those 6% might actually be a
fair deal in the long run.

~~~
rmc
remember that Bayer won't have to manufactor it, someone else does. They get a
cut (6%) without having to do any work

~~~
Tuna-Fish
As others put it, the manufacture of simple chemicals in the quantities
involved in pharmaceuticals is effectively free. As in, give me 100k and I'll
be able to make enough of the drug for the whole world for the next hundred
years. The packaging of most pharmaceuticals is more expensive than the
manufacture of their contents.

The cost is overwhelmingly in R&D -- finding the chemicals, proving it doesn't
kill people, and proving it actually does something useful.

~~~
crusso
Don't forget a huge expense: Battling lawsuits (mostly frivolous) from users
of the drug and potentially paying out huge settlements.

------
x3c
I propose the following solution.

R&D stays in private sector. All successful drugs are bought by the government
at the cost of R&D and a sizable profit. The government, then, distributes it.
Government can control the distribution and Pvt. markets can control the
invention.

Government can then tie up with other govts. and allow sales of the said
medicine in those countries.

It's not an ideal solution, but it has best of both capitalist and socialist
ideologies.

~~~
crusso
So the government then picks "successful drugs" and hands out massive amounts
of money to those companies based on the definition of success as determined
by politicians, bureaucrats, and lobbyists.

Sounds like a nonstarter to me.

~~~
jbooth
I'm not advocating for the proposal necessarily, but it's worth pointing out
that a solution could be all kinds of bad yet still better than the mess we
have today.

~~~
crusso
I don't agree with that.

We could really screw up an industry that has been phenomenally successful at
producing drugs that everyone agrees have provided incomparable and vital
life-saving solutions.

We should be extremely sober and careful about messing with it and mindful of
our ability to destroy the benefits that we already get today. I've seen too
many comments in this thread along the lines of "They make too much money" or
"The Government should take over the industry" or "Something radical needs to
be done right away because 'lives are at stake'".

Statements and positions like those set off my warning alarms.

~~~
jbooth
How about, "they spend more money on ads and sending hot 23-yos to doctors'
offices with free schwag than they'll ever spend on R&D".

Again, I'm inclined to agree with your criticism of that particular proposal.
And I'll agree that there are things that are worse than the current state.
But the current state is pretty bad, and imperfection is not a disqualifier
for "better".

------
suprgeek
Excuse me for not being cut up about how the BigPharma companies will be
pulling in a few less dollars. Thinking about some of the corrupt and
downright unethical practices employed by these companies - this would almost
seem like just payback.

\- They use Drug trials in lightly regulated developing countries to get FDA
approvals for medicines. There was a famous case in India last year I think
where 10-12 children died due to an experimental vaccine. The company involved
was one of the biggest vaccine manufacturers in US. That case got hushed up
quick.

\- Drugs that get banned in US/Europe get dumped in Developing countries where
the science/regulation may not have caught up yet. So even when the deadly
consequences are known, these companies push dangerous medicines.

\- Medical Reps employed by these companies routinely pressure doctors to
over-prescribe expensive medicines. for a uneducated public this ends up
costing them more for the same effects.

Against the backdrop of these practices an occasional such judgement is indeed
good news against these companies.

------
chollida1
Stanford has a set of awesome podcasts called Entrepreneurial thought leaders
(<http://ecorner.stanford.edu/podcasts.html>).

One of the more recent ones was from a serial entrepreneur in the medial
space.

He said the reason that drugs take so long to produce is the FDA process. Now
the FDA is housed by smart people but you have to look at it from their
prespective.

They can accept or reject drugs. If they reject a drug then there is no
serious problem that can come back and bite them.

If they accept a drug, there is no real upside to them.

They get no bonus for accepting the drug, however if the drug turns out to
actually harm people then they are squarely in the cross hairs.

This leads to the question of why would the FDA accept any drug without being
100% sure, and with medicine there is no such thing as 100% sure.

------
yaix
My guess is that this is not so much about saving patients from cancer than it
is about saving polititians during the next elections.

------
digamber_kamat
Government was forced to make such decision because Bayer sold these drugs at
a price unaffordable to most Indians. This to me seems like a very stupid
decision from Bayer's management. The shareholders must act against the board
now.

however because of such decisions companies will find it risky to invest in
life saving drug research. I think government should also take some steps to
win their confidence.

~~~
ttt_
>> _however because of such decisions companies will find it risky to invest
in life saving drug research._

I disagree. That mentality is precisely the reason that they are overpricing
now (and always have done so) as much as they can. People will always need
life saving drugs, and ordinary drugs as well. Terminal and cronical patients
will always try both traditional and new drugs (or the state will provide it
to them in case there is health care). There is absolutely no need to
overprice because any price will eventually give a fair ROI for them.

What they do instead is maximize profit at the cost of human life.

On a different light, a lot of research is funded by government entities
worldwide, and even if pharmaceutical companies do their own research, they
certainly reference other research that is also publicly funded. Thankfully
some states do care a lot about their people and will challenge them. India is
doing so now, Brazil has also broken HIV drug patents (they cover the full
cost of treatment through Health Care) and I hope to hear more of it from
different places.

~~~
relix
You're talking about an infinite timeline where they are the sole seller of a
drug that is used indefinitely.

This is false.

When patents expire the drug is also made by generic drug making companies for
cheap. So upper bound of getting a ROI is the lifetime of a patent (30 years
for drugs iirc, 10 years longer because it takes about 10 years to develop, so
still effectively 20 years).

For every drug that is successful, they pour tons of money into drugs that are
eventually considered useless. So the R&D isn't solely for the one successful
drug, but also for the losses.

A competitor might come in 5 years with a drug for the same problem, that
works better. Now the timespan for any ROI has been cut short to 5 years.

Looking at the profits of pharmaceutical companies: sure, most medicine is
probably overpriced. But saying that they can get a good ROI at any price is
false. They will need to recoup the billions spent on R&D.

~~~
ttt_
Ok, I might have exagerated.

The thing is, when a company chooses to manufacture pharmaceuticals, it
shouldn't just be 'business as usual' for them. They must realize that they
have a social responsability to undertake besides making a profit, and that is
even without a proper regulamentory agency or something of the sort.

Most countries have some kind of social welfare, so maybe these companies
could have differentiated deals with those programs and still price whatever
for those can afford it. It would both cover a market they wouldn't otherwise
reach and not jeopardize those that imperatively need treatment and can't
afford it otherwise.

~~~
Symmetry
But surely the social responsibility to help people isn't just limited to
pharmaceutical companies? I mean, if you tell rich people that they don't have
any responsibility to help sick people in India until they invest in a
medicine company, and then suddenly they have to spend huge amounts of their
investment helping those people then I think that's a bit unfair, and more
importantly saying that will cause a lot of people to avoid investing in
medicine.

Ultimately, matters of social responsibility ought to be governed by the
government, using taxation to spread the burden equally among everyone who can
pay.

------
ThomPete
The reason why it's expensive to develop drugs is in large parts because of
the process involved to get the approval.

Couldn't you turn this on it's head?

What if the companies could expense the cost of getting the approval. I.e. the
tax payers pay for drugtesting and approval process.

Wouldn't this make sense? Since it's in the publics interest to get safe
medicin, shouldn't they/we pay for that part.

~~~
nikcub
because drugs are a hit based business. a large number don't get through the
approval process. your proposal would socialize and subsidize the downsides of
an already very profitable drug industry while privatizing the upside

~~~
ThomPete
But the downsides are largely due to government demands of safe drugs no?

The prices of the drug includes the cost of development. So if you remove that
cost you would decrease the price.

------
GuyCall
I have no idea when it was first public knowledge that the Indian Govt were
considering this option and when it was finalised. But since Bayer AG's share
price in part the markets sentiment of their potential future earnings, and
their share price has done reasonable well over recent years, I suspect the
market doesn't see this as a major issue.

Bayer's current market cap is a fairly significant EUR45.93bn. So even with
the "patent cliff" that JunkDNA discusses, it seems people still expect big
pharma to be profitable.

------
senthilnayagam
This is a late stage cancer drug, delays death by 6 months to 5 years for
liver and kidney cancer patient. Even after 97% reduction most Indian
households may not be able to afford it .

Government wants to buy it and distribute through government and aided
hospitals, that is the principal reason behind it.

According to statistics there about 200 Indians using it, even if can save a
additional thousand lives it is worth passing this compulsory licensing

------
arkitaip
Bayer shareholders should hold the senior management accountable for not
caring enough to bring the drug to more than 2% of the Indian market.

~~~
crusso
And if they lower the price drastically in India and then are accused of
gouging their customers in other countries?

When they lower the price of the drug in India, a gray market arises that
resells the drugs to other countries. The presence of the gray market creates
yet more opportunities for scam artists to sell fake versions of the drug,
creating yet more victims.

My point is that this isn't as cut and dry of an issue as you imply.

~~~
Produce
Human lives are at stake, there's nothing more cut and dry than that. We need
to stop trying to make our reality fit our models and start adapting our
models to fit reality. This whole business is backwards.

~~~
crusso
Human lives are at stake if we screw up the drive to discover new drugs that
will save future lives.

Imagine if you had eliminated Bayer's incentive for even creating this cancer-
saving drug in the first place. How many lives would you have ended
prematurely? Imagine all the new drug research that depends upon Bayer's
initial research that will save yet more lives.

Like I said, it's not so cut and dry. The pharmaceutical industry has had
quantifiable and demostrable success at a level that is almost unparalleled in
history. But your claim is that it's backwards.

I think your statement is inherently backwards. The "reality" is that the
pharmaceutical industry produces something that society has found to be
extraordinarily valuable. The people I see warping models that don't reflect
reality are the ones that disregard the cost of keeping the pharmaceutical
rate of discovery going.

I'd love to see improvements to the industry, but "human lives are at stake!
It's all backwards!" along with the "senior management should be held
accountable" just don't seem to be statements that head is a direction of
improvement.

~~~
todayiamme
<http://en.wikipedia.org/wiki/Jonas_Salk>

~~~
crusso
I don't want to make assumptions. What's your argument?

------
MaggieL
Why not just do what the Greeks did? Pay for all the drugs with government
bonds that are worth nothing. That'll work just as well.

------
Shivetya
Special powers? They mean by force or arms. There is nothing special about
theft except when a government does it they are pretty much immune to counter
actions.

This is little different that Greece having passed laws allowing them to
retroactively change bond agreements and then implement said changes they
claimed were now legal under their laws.

Now if India decided to pay a reasonable fee to Bayer for the ability to have
a national drug company manufacture them then I would see little issue here.

Instead they are simply passing the costs to other countries. As in, let those
"rich" countries pay for the development of medicines and countries like India
will simply steal what they want with impunity. How different is that from
what the Chinese do to manufacturers of cars, electronics, and other
technology not developed at home.

The cost is simply borne by people they don't have to see or care about. Yes I
know the drugs are expensive but development of new medicines is not a cheap
endeavor. To have government arbitrarily decide who can charge what and when
will simply trade a few lives today for a potentially larger number in the
future, that larger number arises because potential treatments may be deemed
to risky to research under the threat of confiscation.

------
tuxguy
Related NYT article with some more facts & insights

[http://www.nytimes.com/2012/03/13/business/global/india-
over...](http://www.nytimes.com/2012/03/13/business/global/india-overrules-
bayer-allowing-generic-drug.html)

------
robmcm
Perhaps making drug companies non proffit to ensure all money went back into
developing new drugs and perhaps less proffitable drugs (i.e. Drugs targeted
at the developing world).

------
sanderoak
finally atleast 1 government has the common sense i was waiting for!

------
bradharper
That "special power" is commonly referred to as _theft._

~~~
bradharper
Would love for any down-voters to tell me how I'm wrong...

------
ck2
$5500 a month per person? Bayer are scumbags, serious, serious scumbags.

Do they think cancer is just going to stop happening so their profit will dry
up?

Kudos to India for doing the right thing, I think the 6% royalty is a nice
offering.

------
urza
_Bayer said it was "disappointed" and would "evaluate options to defend
intellectual property rights" in the country._

Down-vote me if you like, but I get sick to my stomach when I read sentences
like this. If someone is able to deliver and sell the anti-cancer drug by 97%
cheaper than you, then in my eyes you have no right to interfere. I am
starting to dislike the whole concept of intellectual property and patents and
copyright. These are tools of greedy people and bring nothing to the table for
the wider audience. No one creates anything just by himself. You are always
building on the work of others and merely deriving, combining, changing and
mutating it. Whether you do it consciously or unconsciously. It is the
principle of cultural evolution and it is why we are where we are. If
intellectual property was always practiced the way it is today, I fear we
would still be in the Middle Ages.

~~~
gaius
_If someone is able to deliver and sell the anti-cancer drug by 97% cheaper
than you, then in my eyes you have no right to interfere_

... Provided that that "someone" also bears their fair share of the cost of
discovery and clinical trials. THAT is the issue here.

~~~
man1sh
also don't forget that for these companies the poor people in India are the
subjects of clinial trials.

The mindset of these companies of treating the poor people as Guinea pigs is
also disgusting

671 _reported_ deaths [http://www.business-standard.com/india/news/human-
rights-pan...](http://www.business-standard.com/india/news/human-rights-panel-
seeks-reportclinical-trial-deaths/447641/)

There is no count of no of people who get disabilities but don't die due to
trials failing. Who will pay for these? These pharma companies are steered by
greed

~~~
gaius
I am referring to FDA trials, in the US, which can take over a decade and cost
8- or 9-figure dollar sums. These are required before the drug even comes to
market.

~~~
ekidd
US clinical trials often involve a second, parallel clinical trial in India,
because it's easy to find lots of poor patients in desperate need of
treatment. I think that, at least in some cases, this probably works out well
for everyone except the control group.

But if poor Indian patients are going to test these drugs, the GP can
certainly argue that poor Indian patients should be able to afford them.

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true_religion
I think the recruitment rules are just more lax in India, than in the US.

