

Tecfidera's Price - mhb
http://pipeline.corante.com/archives/2013/04/02/tecfideras_price.php

======
rurounijones
Off-topic: For anyone interested the guy who wrote this post also has a
hilarious section of his blog called "Things I won't work with"
[http://pipeline.corante.com/archives/things_i_wont_work_with...](http://pipeline.corante.com/archives/things_i_wont_work_with/)
which documents various insanely dangerous chemicals along with very humourous
descriptions of their history, usage, what crazy people _tried_ do do with
them and in what ways they have killed people.

You do not need to be a chemist to appreciate it.

~~~
mauvehaus
It looks like there's at least one other fan of stuff blowing up here. I
heartily agree that you needn't be a chemist to get a laugh out of it. Anybody
who has gotten through 2 years of high school chemistry or a year of college
chemistry would probably raise their eyebrows looking at his diagram for
hexanitrohexaazaisowurtzitane [1]. And if you haven't had that much chemistry
background, he'll shortly explain why your eyebrows should be retreating
towards your hairline at maximum speed when you look at it.

[1]
[http://pipeline.corante.com/archives/2011/11/11/things_i_won...](http://pipeline.corante.com/archives/2011/11/11/things_i_wont_work_with_hexanitrohexaazaisowurtzitane.php)

~~~
Retric
I still think this takes the cake.

[http://pipeline.corante.com/archives/2010/02/23/things_i_won...](http://pipeline.corante.com/archives/2010/02/23/things_i_wont_work_with_dioxygen_difluoride.php)

 _The heater was warmed to approximately 700C. The heater block glowed a dull
red color, observable with room lights turned off. The ballast tank was filled
to 300 torr with oxygen, and fluorine was added until the total pressure was
901 torr. . ._ And suddenly O2F2 aka FOOF.

Which as you might guess is just all kinds of nasty. Explosive reaction with
water at 100 Kelvin etc.

~~~
AlexandrB
My favourite is:

[http://pipeline.corante.com/archives/2008/02/26/sand_wont_sa...](http://pipeline.corante.com/archives/2008/02/26/sand_wont_save_you_this_time.php)

 _The compound also a stronger oxidizing agent than oxygen itself, which also
puts it into rare territory. That means that it can potentially go on to
“burn” things that you would normally consider already burnt to hell and gone,
and a practical consequence of that is that it’ll start roaring reactions with
things like bricks and asbestos tile._

------
mauvehaus
This is a bit off-topic, but if you enjoyed his writing on this, I would also
recommend perusing the category "Things I won't Work With"[1], but maybe only
if you have the afternoon free. It's a hilarious compendium of chemicals that
are simply too unpleasant to work with for his tastes. For values of
unpleasant including explosive, smelly, corrosive, or some combination
thereof.

I'm not a chemist, but his tellings of not just how things could go terribly
wrong once you have the substance, but the myriad ways it can wrong merely
trying to _make_ the substance had me in stitches for the better part of an
afternoon.

Then again, I was always the one setting stuff on fire, breaking glassware, or
trying the reaction with more reagents in high school chem lab, so maybe it
only appeals to me...

[1]
[http://pipeline.corante.com/archives/things_i_wont_work_with...](http://pipeline.corante.com/archives/things_i_wont_work_with/)

~~~
lifeisstillgood
As a taster

Yep, [the stable-to-explosion sensitivity was] below the detection limits of a
lab that specializes in the nastiest, most energetic stuff they can think up.
When you read through both papers, you find that the group was lucky to get
whatever data they could - the X-ray crystal structure, for example, must have
come as a huge relief, because it meant that they didn't have to ever see a
crystal again

------
ctdonath
Punchline of old joke:

Hitting engine with hammer - $1

Knowing where to hit engine with hammer - $9999

~~~
redcap
That sounds like a doctor's job - they might prescribe a fairly cheap
medicine, but knowing what kind of medicine to use is a different art
entirely.

Here the only reason why the company is able to charge a large amount of money
is because they've gone through the whole process of tests and clinical trials
to get the drug available for consumption. That's an entirely different kettle
of fish than the expert knowledge $9999 you mention above.

The gist of the article isn't about expert knowledge, it's that a fairly
simple chemical compound (the name itself gives the simplicity away - dimethyl
fumerate is too short to be anything horrendously complicated) is jacked up in
price, and that someone suffering from the disease could presumably get the
drug made themselves for much less than $50,000 per annum.

~~~
epmatsw
The more I've learned about how the medical system works, the more it seems
like the future is going to tend towards replacing doctors with systems like
Watson, concentrating knowledge in a quick, easily updatable form and keeping
doctors around for patient comfort.

~~~
nmcfarl
Living with the doctor, I've come to the conclusion that: yes, quite probably
this is the future – but this future is going to be about as easy to implement
as replacing programmers with Watson.

~~~
epmatsw
Agreed. I don't see it happening for quite a while.

------
Alex3917
Why not just buy it for research use? You can buy a year's supply for $22
bucks online that's at least 99 pure. Then for an extra couple hundreds bucks
you can just put it in a mass spectrometer to make sure that none of the
impurities are going to be dangerous.

------
nonamegiven
Interesting comment from the article's comment thread, from Janne. A patent is
for the commercialization of an idea. Anyone is free to implement any patent
for personal use, as long as you don't sell it. If the use of this common
chemical, and its transformation, is understood well enough for this to become
a home brew possibility, then people could do exactly that. Not that this is
possible or advisable for most drugs, but this particular drug may be one.

~~~
dodo53
That's interesting! I wonder if a charitable company decide to make say AIDS
drugs and give them away without breaching patent law?

~~~
nonamegiven
I suspect "making available" would be treated similar to selling.

But if the law is as described in the ref'd comment, I wonder why there aren't
sites or books that walk you up to the point where you can provide the
invention for your personal use.

------
andrewcooke
that's also a similar price to other MS drugs (eg beta-interferon).

my understanding is that none of these (existing and new MS drugs) is a 100%
applicable fix. they all are effective on only a subset of patients, and they
all have different side-effects (which is still good news as it improves the
chance that any one patient will find something that works (the subset of
affected patients changes with the drug) and is not harmful).

also, fwiw, the govt here in chile pays 80% of the cost. i don't know if that
means it can also negotiate a lower price, but i would suspect so.

and does this also suggest help for other auto-immune diseases (lupus etc)?

[update:] also, talking more about the economics - the market is probably very
inflexible. existing patients with a drug that "works" (and these only work in
some statistical sense - they reduce the chance of outbreaks) is not going to
want to switch, because (1) there's a large chance that you'll start having
outbreaks again and (2) often they take months to become effective.

so the main pressure in lowering prices has to come from either large
purchasers (national health systems, insurers) or from new patients. for new
patients i guess that oral delivery (i think?) is a big win over injections.
that is something people will pay for.

------
ebbv
The blog post seems to frame the issue as:

"Should this company be allowed to make massive profits off of their
investment in clinical trials?"

Any reasonable person would say "Sure they are allowed to make a profit off of
that." I don't think there's going to be much objection to that question.

But that's not the real issue, and I think if the author is honest he knows
that. The real issue is:

"Should MS patients, many of whom are poor, be forced to pay $50k/year for
medication to help with their condition."

The answer to that is obviously no. Now you can say that the insurance company
will take care of it, but that's presuming people have insurance and that the
insurance company isn't going to dump them, they're not going to have a
deductible they can't afford, etc.

When it comes to medicine, ethics have a larger role to play than say, home
decor.

Anyone who doesn't acknowledge that is being disingenuous.

~~~
jerf
Before I could formulate a reasonable answer to that question of whether this
is "unreasonable" (leaving aside the complicated matter of what that exactly
means), I'd be interested in a serious analysis of what the costs are; $50,000
may not be so obscene if their costs were $45,000/possible patient, for
example. What's the floor here?

If the costs are $10,000s of dollars/patient even before the drug company
needs to take profit (and have money to invest in their next drug, after all),
then a full investigation of the "blame" for this very expensive very cheap
drug must also be pointed at the processes that cost that much in the first
place. If it's so bad that MS patients are paying $50,000/year, then perhaps
the real problem (or at least a nontrivial part of it) is that the costs of
certification have greatly exceeded the benefits.

(But people don't like to think in terms of costs/benefits when it comes to
medicine and appear to be willing to incur enormous costs if it allows them to
continue pretending they don't have to think about it....)

~~~
bmelton
And to be fair, the last number I saw on clinical trials estimated the cost at
between 100 million and 800 million dollars per drug candidate, which means
that the sunk cost of any drug that works is going to be pretty high right out
of the gate.

On top of that, you have a VC-like model where the successes must also pay for
the cost of failures as well as the funding of new R&D so that they can keep
making new drugs.

------
lifeisstillgood
This is interesting - as 3d printers mature, and as home brew drug manufacture
improves how the hell will pharma companies be able to enforce this - I mean
at some stage soon we can download a recipie for aspirin, why not dimethyl
fumarate?

To be honest because the DEA will drive such printers underground, which with
54,000 reasons to go underground is an amazingly bad idea

If you are interested in recreational drug legalisation this is the industry
to support - something will change

~~~
potatolicious
3D printing != molecular synthesis. This may be an issue, say, _next century_
, but we're nowhere close to it. If 3D printing an iPhone is going to the
moon, 3D "printing" molecules from elemental sources is like going to Alpha
Centauri.

~~~
pash
The idea is not to print molecules. Instead, you print reagents into a matrix
designed to guide a reaction. The reactor vessel itself becomes a template for
synthesis.

There's a team at the University of Glasgow working on this. They published in
_Nature Chemistry_ last year [0] and garnered a lot of attention in the
popular science media.

0\.
[http://www.nature.com/nchem/journal/v4/n5/full/nchem.1313.ht...](http://www.nature.com/nchem/journal/v4/n5/full/nchem.1313.html)

~~~
spartango
Unfortunately, for much of synthetic chemistry, positioning a bunch of
reagents in a matrix is not sufficient to produce a target molecule. And even
if you do manage to get to your target through a relatively trivial process,
isolating it from other compounds is an enormous challenge. Reactionware has
traditionally made this problem worse, as solvents and reagents tend to
interact with the containers and contaminate the synthesis. There's a reason
that most chemistry is still done in glass.

Further, the reagents and catalysts involved in drug synthesis vary wildly, so
it will take a substantial amount of shopping to even get the raw materials
you would need to setup a viable reaction.

While this is a cool setup, it's best not to overstate it's capabilities.

