
Foreigners turn to India in search of cut-price, life-saving cures - denzil_correa
http://www.japantimes.co.jp/news/2016/03/06/asia-pacific/science-health-asia-pacific/desperate-foreigners-turn-india-search-cut-price-life-saving-cures/#.VtvsXMtX7qB
======
vinodkd
I know the article and the discussion is about access to drugs, but I must
call out that part of the success of medical tourism in India is the lack of
stranglehold control over medical care by insurance companies. In India, I
can:

\- Get an estimate for service _before_ it happens, and plan for it therefore.

\- Pay for the service _at the time of discharge_ with/without insurance

\- _decide by myself_ if i want to get a specific procedure done or not - no
fuss of "does the insurance cover it?". Of course, this is one area where the
costs of service being inherently low helps.

\- get all my medical records _in my hand_

These are basic patient freedoms, IMO, that the insurance industry in the US
has taken away.

I dont know the history of how it came to be this way in the US, but as it
stands, the situation is very geared towards getting mystery service - you
dont know what you're allowed until you're refused, you dont know how much the
service cost you until months later and even then in multiple bills from
various hosiptals, doctors practices and specialists, and you have to ask for
your records because _you_ cannot keep them safe!

I have all my records from every treatment in India, but not one
coherent,collated record of my last physical checkup in the US. There's
something broken there.

~~~
bobby_9x
This is why we need to completely get rid of health insurance in the US. If
Hospitals could only charge the actual value for their services, and not the
inflated insurance prices, the prices would be much lower.

One of my friends is a Doctor. He told me that they need to over-charge for
services because of the insurance companies. If they charge $20 (the actual
cost of the service), they might get $4 back from the insurance company. If
they charge $100, they might get the $20 from the insurance company for the
service. We need to cut out the middle man. It's basic economics.

The drug issue in the US is mostly the fault of the government. It takes
hundreds of millions of dollars and 10+ years to get FDA approval. This
stifles innovation and creates an environment where there are only a few
players (IE: a monopoly). The result is ridiculous prices due to no
competition.

~~~
ocean3
If they charge $100, they might get the $20 from the insurance company - the
remaining 80 goes to the insurance company?

~~~
chimeracoder
> If they charge $100, they might get the $20 from the insurance company - the
> remaining 80 goes to the insurance company?

He's saying they bill for $100, and the insurance company decides to pay $20.

~~~
ocean3
So where does the 80 go?

------
dineshp2
I find the concept of intellectual property and patents ridiculous.

What would be the benefit of granting IP over an invention or innovation to a
corporation or a group of individuals versus releasing the knowledge under the
public domain? Except the corporation or inventor(s) making money off of it, I
can't think of anything significant. Instead, if the knowledge is made freely
available under the public domain, the limitation becomes how well the
innovation is used for the benefit of humanity instead of the limitation being
access to the invention itself and IP.

Maybe the existence of IP and patents was important to get to the present as a
way of rewarding innovation, but it's high time to look for a better model.

I know this is a very complex issue for which there are no simple answers or
solutions, but a good starting point might be to think about a society where
the motivation for innovation is not financial reward.

Taking the example of patented drugs, how is it justified to keep access to
life saving drugs beyond the reach of most people(including people in
developed nations)?

~~~
runholm
The issue is that with medicine, it cost vast amounts of money to develop and
test a medicine. If there was nothing making sure the investment would pay of,
there would be much less money spent developing medicine.

I am not saying the system is perfect, and some companies push the prices to
the ridiculous to exploit people in need, but removing medical patents
altogether would require some other equally strong economic incentive to keep
development rolling.

~~~
crdoconnor
We already have publicly funded research, which is an altogether more
effective way of developing new medicines anyway.

~~~
frozenport
Nonsense, disregarding the pink elephant in the room (reproducibility in
academia) once a method has shown potential it is often spun off into some
sort startup (often SBR recipients). If they keep gaining clout, a bigger
pharmaceutical will buy them out. New medicines are developed 10% by a
university and 90% by industry.

~~~
crdoconnor
Not 90%. 58%. According to JAMA.

[https://jama.jamanetwork.com/article.aspx?articleid=185198](https://jama.jamanetwork.com/article.aspx?articleid=185198)

When the public funds drug research it also doesn't "magically" discover that
its drugs are really effective when they aren't:

[http://articles.mercola.com/sites/articles/archive/2006/06/1...](http://articles.mercola.com/sites/articles/archive/2006/06/10/studies-
funded-by-drug-companies-favor-drugs-80-percent-of-the-time.aspx)

~~~
selimthegrim
You're seriously going to post Mercola on HN?

~~~
selimthegrim
Yes, go ahead and down vote me for flagging links to a quack's website.

~~~
dang
Please don't post comments about getting downvoted:
[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html)

The comment was unsubstantive and dismissive. If there's something wrong with
a source, it would be better to explain what that is instead of just snarking,
which (a) undermines civility and (b) teaches us nothing.

~~~
selimthegrim
Very well. Joseph Mercola[1] to put it politely, is not burdened by objective
reproduction of claimed results when hawking his alternative remedies.

[1]
[https://en.wikipedia.org/wiki/Joseph_Mercola](https://en.wikipedia.org/wiki/Joseph_Mercola)

~~~
crdoconnor
If you're going to disagree with the source, disagree with the source, not the
website that cited the source:

"Researchers from the Beth Israel Medical Center in New York City examined
four journals: American Journal of Psychiatry, Archives of General Psychiatry,
Journal of Clinical Psychiatry and Journal of Clinical Psychopharmacology.
They found drugs were favored in roughly:"

Is Beth Israel full of quacks?

~~~
selimthegrim
I doubt it, but since Mercola didn't link me to their meta-study I can't find
the reference directly. It's not the JAMA link that was in the OP.

------
abpavel
The problem is not in patents or capitalism, but in perpetual extension of
intellectual property in a Disney-like fashion. The point of "Cyclical" is
that there is a cycle - a life-cycle of development, then intellectual
monopoly and finally general availability. Sovaldi's patent should have
expired in 2012, and Martin Shreli's Daraprim's patent should have expired in
1973. Perpetual extension simply abuses the system, and the stories like in
the original article are just a reflection of system's abuse, not the flaw of
the idea of protecting intellectual property in the first place.

~~~
maxerickson
There's no patent keeping other companies from producing Daraprim equivalents
for sale in the US, it's just that no generic maker had bothered to setup an
FDA approved production process.

There's a few thousand people using it in the US, so there isn't a huge market
for it.

Medicare is a big enough consumer that it should probably be running a program
where it shares risk with generic makers that are willing to produce drugs
that don't cost a lot, as long as the company maintains quality. Basically,
make sure that line start up and regulatory costs aren't preventing $1 pills
for rare conditions coming to market.

~~~
chimeracoder
> Medicare is a big enough consumer that it should probably be running a
> program where it shares risk with generic makers

Perhaps, but Medicare has literally no incentive to do this.

It's one thing to posit that a monopsony or oligopsony _could_ result in
driving prices down. And in a closed system, that might be what happens[0].

But at the end of the day, Medicare has no mandate to ensure sustainability of
reimbursement and payment rates. Since they can't raise revenues (taxes)
without Congress, they balance the budget by driving reimbursements (for
service providers) down below cost. Pharmaceutical companies _are_ actually
affected by this too, but because the big-ticket items are under monopoly
protection (via drug patents), unlike care delivery, Medicare still has to pay
sticker price for those.

The people who end up being hurt by this, by the way, are not Medicare
patients, but uninsured patients and privately-insured patients.

[0] But not always - like a monopoly, a monopsony can choose price _or_
quantity, but not both.

~~~
maxerickson
Medicare the-thing-run-by-Congress has incentive to do it. At least, in
theory, as Congress should be looking to create regulations that are
beneficial to taxpayers (Medicare isn't going away, therefore cost controls
benefit taxpayers).

To the extent that I understand it, I agree that Medicare the-thing-run-by-
statute doesn't currently have much incentive to do it.

I guess I could have said something about federal programs that run huge
public health providers being structured to use market based policies to
reduce costs, but I'm prone to colloquialisms (i.e., the pretense that
Medicare isn't limited to existing statute, it can be amended to act
differently).

~~~
chimeracoder
> At least, in theory, as Congress should be looking to create regulations
> that are beneficial to taxpayers

In theory, theory and practice are the same. In practice, they aren't.

It's one thing to talk about structuring government programs so that they are
obligated to serve the public interest no matter what. But actually
implementing that, in a manner ensured to be robust against creeping scope,
capture, and corruption, is damn-near impossible.

~~~
maxerickson
_In theory, theory and practice are the same. In practice, they aren 't._

If I was naive to that, why would I start the sentence with that caveat?

~~~
chimeracoder
> If I was naive to that, why would I start the sentence with that caveat?

I didn't say you were. I was expanding on the point, naming the specific
challenges to the process.

------
discardorama
Anecdata, size 2, from India:

My uncle (who had a device implanted 4 years ago to regulate his heartbeat)
went into the ER one of the premium hospitals in our city (Fortis). He was
having some weird symptoms, and his blood sugar was off. They strongly
recommended that they upgrade his device to a pacemaker! (A highly expensive
procedure). When my cousins refused, the hospital pumped him full of insulin
and discharged him. He came home and relapsed again. This time he was taken to
another hospital, and the problem was some infection in his kidney.

Another cousin: had a severe pain in his stomach area. Went to a hospital,
they injected him with a painkiller and let him go. Pain continued: he went to
another, same deal. Finally he got to a third hospital, and they diagnosed the
problem: kidney stone.

There's caveat emptor for Indian hospitals. Be careful.

~~~
vinodkd
This is true. The big "chain" hospitals do have pushy tactics, doctors with
lab prescription quotas etc. Similarly, but at the other end of the spectrum,
there are hospitals in smaller towns that mistreat you or send you off with
painkillers.

Clearly, your mileage will vary, so you have to do research, ie, talk to
people you trust, much like everything else in India :)

~~~
lake99
I've had good experience with big "chain" hospitals, be it Apollo, Columbia
Asia, Wockhardt, or whatever else. I never found them pushy. One of the docs
from there quit and opened his own clinic. He doesn't even charge me for
consultation. Don't know why.

Of course, doing your own research is critically important. Many doctors are
dangerously ignorant of anything that doesn't come under their specialty.

------
DanBlake
Im curious what is stopping some other countries (even micro-nations) from
instituting a policy that forfeits all patents on medication.

Lets say you take the country of Saint Lucia- Could they not spur the economy
(among the lowest in the world by GDP) by saying any company can manufacture
any existing drug and sell it? I feel like the medical tourism for that could
be extreme, especially since there is still many treatments india still does
respect the patent for.

If the country put it in their constitution that all drugs should be a human
right, could a legal action be taken against the country itself? I imagine the
only recourse would be the pharma companies trying to force legislation in
other countries to bring sanctions, but I think that would be a hard sell.

~~~
benjamo
Such a country wouldn't get admission to the WTO and would have a very hard
time trading with the other countries in it.

It would also amount to state endorsed IP theft.

~~~
linuxkerneldev
> Such a country wouldn't get admission to the WTO

As opposed to what we do when we invade and bomb/drone other countries? As
opposed to what we did when we engineer coups in resource rich countries? Come
on. Let me guess, you're buying into the idea that generics hurt RnD. Let me
assure you, having worked briefly in a pharma RnD lab, the bulk of big pharmas
expenditures are on marketing and bribes, NOT RnD. Here's a recent headline:
[http://www.statnews.com/pharmalot/2016/02/22/novartis-
south-...](http://www.statnews.com/pharmalot/2016/02/22/novartis-south-korea-
bribes-doctors/)

You'll find similar bribery cases with GSK, Pfizer, etc.

~~~
sangnoir
>> Such a country wouldn't get admission to the WTO

> As opposed to what we do when we invade and bomb/drone other countries?

I don't think the parent supports the action, but merely stating the likely
outcome, _realpolitik_ and all. S/he is answering gp's question: _" What is
stopping some other countries (even micro-nations) from instituting a policy
that forfeits all patents on medication"_

The answer, in short, is leverage: smaller countries can be pressured into not
even considering it - because of the consequences. India can do this because
it is better able to withstand the hypothetical political pressure.

------
hudibras
The economist Dean Baker has been vocal for years about the benefits of free
trade on medicine. [0] (of many)

But while the powers-that-be are fine with free trade for cars, cheap
clothing, electronics, etc. or exporting American manufacturing jobs overseas,
it's a different tune all the sudden when you try to do the same thing to
powerful industries, like doctors or lawyers.

[0][http://www.cato.org/publications/cato-online-
forum/doctors-d...](http://www.cato.org/publications/cato-online-
forum/doctors-drugs-promoting-growth-equality-through-free-trade)

~~~
jpatokal
Are you claiming that the American car lobby is _not_ powerful? You might need
a history refresher on how (for example) "voluntary export restraints" came to
be a thing:

[https://en.wikipedia.org/wiki/Voluntary_export_restraints#19...](https://en.wikipedia.org/wiki/Voluntary_export_restraints#1981_Automobile_VER)

But they've been fighting that battle for close to 50 years and losing.

------
awongh
Feels like there should be some kind of website or service that tracks these
drug price arbitrage / differences.

------
horsecaptin
Don't have to go all the way to India if you live in the US. Mexico is close
by. And soon, Cuba will be even closer for some.

~~~
puissance
People wer exporting them from Canada, but big pharma lobbied for bans
([http://news.healingwell.com/index.php?p=news1&id=526618](http://news.healingwell.com/index.php?p=news1&id=526618)).
Anywhere close to US mainland, especially Mexico, I am afraid, will meet with
the same fate.

Cuba's a different story as they just tell US lawmakers to fuck off.

