There must be a pony in here somewhere.

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Jennifer
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Re: There must be a pony in here somewhere.

Post by Jennifer » 05 Jun 2019, 16:58

Congratulations to Pfizer for giving SHITLOADS of ammunition to the "Big Pharma suppresses cures because there's no money to be made" conspiracy-types: "Pfizer 'deliberately buried' data showing its arthritis drug might also prevent Alzheimer's 'because it wouldn't have made the pharma giant any money'" (I'm linking to the Daily Mail version of the story; the original ran in the Washington Post, but I've reached my free-article limit for them).

https://www.dailymail.co.uk/health/arti ... ailymailus
Pfizer, based in New York, in 2015 found its drug Enbrel may have another use
An analysis found people taking it were significantly less likely to get Alzheimer's
But the company didn't do a trial study and didn't tell anyone what it found
The findings didn't come to light until revealed by the Washington Post
Experts say it is up to scientists, not companies, to decide if findings are useful
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Mo
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There must be a pony in here somewhere.

Post by Mo » 05 Jun 2019, 18:28

I have a good friend who works in the industry (for a competitor) and did a bunch of work on the R&D side of pharma firms. I reached out to him privately to see if it’s a legit criticism or media hype. I suspect a little of column a and a little of column b.
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

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Re: There must be a pony in here somewhere.

Post by Mo » 05 Jun 2019, 18:36

Update: Mostly hype, but they should have published.

“It is a drug that would have patent expired before they could finish what would have been a long, expensive trial with very low likelihood of success. At most the obligation would be to publish and maybe to try and find a larger data set to explore the link. My guess is they did some of that and there wasn’t a strong link. Beyond the fact that there isn’t a great biological rationale to test. Or great animal models to test.”

When asked if he meant that the drug didn’t affect the right physiological areas, he responded:

“Yeah. You’d have to believe that there is something in systemic reduction of inflammation that causes it. Beyond the fact that Enbrel and that class have real side effects. There is a strong ethical argument that a large trial might actually cause more harm. (For people in the trial) So not a fan of Pfizer but don’t see how anyone could rationally expect them to pursue this.”
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

no one ever yells worldstar when a pet gets fucked up - dhex

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Dangerman
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Re: There must be a pony in here somewhere.

Post by Dangerman » 05 Jun 2019, 19:55

That's really interesting, Mo. Thank you.

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Re: There must be a pony in here somewhere.

Post by Aresen » 05 Jun 2019, 20:22

Mo wrote:
05 Jun 2019, 18:36
Update: Mostly hype, but they should have published.

“It is a drug that would have patent expired before they could finish what would have been a long, expensive trial with very low likelihood of success. At most the obligation would be to publish and maybe to try and find a larger data set to explore the link. My guess is they did some of that and there wasn’t a strong link. Beyond the fact that there isn’t a great biological rationale to test. Or great animal models to test.”

When asked if he meant that the drug didn’t affect the right physiological areas, he responded:

“Yeah. You’d have to believe that there is something in systemic reduction of inflammation that causes it. Beyond the fact that Enbrel and that class have real side effects. There is a strong ethical argument that a large trial might actually cause more harm. (For people in the trial) So not a fan of Pfizer but don’t see how anyone could rationally expect them to pursue this.”
If looks like Pfizer had a 'damned if you do' and 'damned if you don't' dilemma. No choice but to opt out.
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Re: There must be a pony in here somewhere.

Post by Mo » 06 Jun 2019, 03:00

They wouldn’t have run into the controversy if they published the data more widely to let others chase down the path. No obligation by Pfizer to go down the path modestly shitty that they didn’t. But no real controversy. The interesting thin is that Amgen holds the patent in the US and Canada and also didn’t see results that warranted going down the path.
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

no one ever yells worldstar when a pet gets fucked up - dhex

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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 06 Jun 2019, 16:58

I can see how animal trials may be of value in determining the possible harm of potential Alzheimer's drugs, but I'm a bit unclear what use they could be in determining their effectiveness. Moreover, given that some level of informed consent is required in human trials of any sort, it's unclear to me how they could get human subjects at all unless and until there is a really reliable method of determining early-stage Alzheimer's.

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Re: There must be a pony in here somewhere.

Post by Mo » 06 Jun 2019, 17:47

I mean I don’t know much about Alzheimer’s, but if I were to throw out an ex rectum guess, I believe there are physiological signs of Alzheimer’s (amyloid plaques in the brain). If inflammation in the skull causes the disease and the treatment works, then the test animals would have fewer amyloid plaques and other physiological signs than the control.
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

no one ever yells worldstar when a pet gets fucked up - dhex

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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 06 Jun 2019, 18:05

Yeah, I'm not saying animal trials would be useless. Medical pharmaceutical research is fraught with all sorts of problems and in the case of Alzheimer's the problem is complicated by the fact that there are so many other causes of memory loss, dementia, etc. of one sort or another in older people. As far as I know, more to the point, Alzheimer's is only definitively diagnosed postmortem, which would make it especially difficult to determine whether a drug is specifically indicated in the disease's early stages.

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Re: There must be a pony in here somewhere.

Post by Mo » 06 Jun 2019, 18:35

But you’re saying you don’t see how they could determine if the treatment was effective. At least one way is by the difference in physiological signs. And yes, all the things you mention is why Alzheimer’s treatments are ridiculously expensive to run. Because they have to span a decade or more before you know if it worked (or more accurately didn’t work).
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

no one ever yells worldstar when a pet gets fucked up - dhex

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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 06 Jun 2019, 19:55

Mo wrote:
06 Jun 2019, 18:35
But you’re saying you don’t see how they could determine if the treatment was effective. At least one way is by the difference in physiological signs. And yes, all the things you mention is why Alzheimer’s treatments are ridiculously expensive to run. Because they have to span a decade or more before you know if it worked (or more accurately didn’t work).
At least one of the many criteria of effectiveness is to note differences in physiological signs, but you're still left wondering if the rats or primates or whatever are experiencing mental deterioration commensurate with whatever their baseline mental states may happen to be and, equally importantly, whether that is sufficiently translatable to make a case for human trials. The fact that you can't dispositively diagnose Alzheimer's in its early stage as being that and not something else, however, is far more problematic.

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Re: There must be a pony in here somewhere.

Post by Mo » 08 Jun 2019, 12:12

This is one heck of a correction.
Correction: This article originally stated that the price of Acthar had gone “from just $40 in 2000 to over $40,000 today.” A spokesperson for Mallinckrodt emailed to request a correction that Acthar actually costs $38,892 today. Gizmodo regrets the error. We also regret that every last one of these guys isn’t in prison yet.
https://gizmodo.com/drug-company-to-pay ... 1835274587
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

no one ever yells worldstar when a pet gets fucked up - dhex

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Re: There must be a pony in here somewhere.

Post by Eric the .5b » 08 Jun 2019, 18:23

Mo wrote:
08 Jun 2019, 12:12
This is one heck of a correction.
Correction: This article originally stated that the price of Acthar had gone “from just $40 in 2000 to over $40,000 today.” A spokesperson for Mallinckrodt emailed to request a correction that Acthar actually costs $38,892 today. Gizmodo regrets the error. We also regret that every last one of these guys isn’t in prison yet.
https://gizmodo.com/drug-company-to-pay ... 1835274587
I'm not clear on the pony aspect. If the accusations are true, I want some punishment laid around, too. If course, any doctors involved would get away with it.
"Better that ten guilty persons escape than that one innocent suffer."
Cet animal est très méchant / Quand on l'attaque il se défend.

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Re: There must be a pony in here somewhere.

Post by Jennifer » 08 Jun 2019, 22:42

Acthar is used for infantile spasms, which afflict roughly 2,000 babies in the U.S. each year, but Mallinckrodt has expanded the use of Acthar for other ailments like rheumatoid arthritis. A 60 Minutes report from May of 2018 raised serious questions about how well the drug actually works for arthritis in seniors, and an expert who spoke with 60 Minutes said that there’s “no evidence” Acthar works for rheumatoid arthritis despite the fact that Mallinckrodt reportedly makes about $500,000 each year for prescriptions treating the condition.

Curiously, there’s a drug called Synacthen that’s identical to Acthar and sells for just $33 in Canada. So why isn’t Synacthen available in the U.S.? Because Mallinckrodt bought the U.S. rights to Synacthen and simply doesn’t make it available to American consumers.
Hey, Big Pharma, do you guys want socialized medicine? Because shit like this is how you get people demanding socialized medicine.
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Re: There must be a pony in here somewhere.

Post by JasonL » 08 Jun 2019, 23:00

Left and right should be able to come together on patent reform and generic shenanigans. They won’t

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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 08 Jun 2019, 23:48

JasonL wrote:
08 Jun 2019, 23:00
Left and right should be able to come together on patent reform and generic shenanigans. They won’t
The left loves regulation and the right enjoys captive regulators. It's a marriage made in political heaven.

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Re: There must be a pony in here somewhere.

Post by Painboy » 17 Jun 2019, 16:47

The Worst Patients in the World

This is an interesting take on things. I wonder if some it has to do with American attitudes on customer service in general. I've heard that there is a much higher expectation of accommodating customer service than here than in other countries.

This also leads me to believe that single payer wouldn't work here as Americans aren't going to accept "good enough" health care when other more expensive options are possible. I've noticed a tendency for socialization advocates to act as if all medical treatment would just be cheaper without any change in the number of medical options out there. The only way you get cheap is if you get rid of all the expensive less common procedures and treatments. No robotic wheelchairs for anyone when two wheels works fine for most people.

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Re: There must be a pony in here somewhere.

Post by Aresen » 17 Jun 2019, 17:03

Painboy wrote:
17 Jun 2019, 16:47
The Worst Patients in the World

This is an interesting take on things. I wonder if some it has to do with American attitudes on customer service in general. I've heard that there is a much higher expectation of accommodating customer service than here than in other countries.

This also leads me to believe that single payer wouldn't work here as Americans aren't going to accept "good enough" health care when other more expensive options are possible. I've noticed a tendency for socialization advocates to act as if all medical treatment would just be cheaper without any change in the number of medical options out there. The only way you get cheap is if you get rid of all the expensive less common procedures and treatments. No robotic wheelchairs for anyone when two wheels works fine for most people.
One of the constant pressures here in Canada is refusal to pay for certain procedures the powers that be decide are 'experimental' or 'not cost effective.' The proximity to the USA makes this worse than other countries simply because people in Canada hear about them. (I am guessing that Europe's separation by an ocean from the USA reduces this pressure somewhat.)

Painboy is right. There is going to be a huge backlash against single payer after the US implements it and people discover they can't demand à la carte health care and get 'one size fits all.'
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Re: There must be a pony in here somewhere.

Post by JasonL » 18 Jun 2019, 06:38

I kinda suspect one of the things people get out of single payer is the externalizing of hard choices. If I have to choose extra care for granny I feel bad if cost enters the decision. If everyone like granny gets x and no more, well we by definition did the right amount of care. If I don’t like it, I can get mad at big forces out of my control but not the man in the mirror.

On that theory people will get really shitty about one size fits all in areas where choices seem trivial but will be happier when it’s a big decision.

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Re: There must be a pony in here somewhere.

Post by Jennifer » 18 Jun 2019, 12:58

JasonL wrote:
18 Jun 2019, 06:38
I kinda suspect one of the things people get out of single payer is the externalizing of hard choices.
Another big thing would be predictability -- your taxes would be much higher in a single-payer state, but you know in advance just how much tax you have to pay; there would not be any surprises a la "My doctor told me the procedure would cost $800 but when the bill came it was over $80,000."
"Myself, despite what they say about libertarians, I think we're actually allowed to pursue options beyond futility or sucking the dicks of the powerful." -- Eric the .5b

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Re: There must be a pony in here somewhere.

Post by Andrew » 18 Jun 2019, 14:19

JasonL wrote:
18 Jun 2019, 06:38
I kinda suspect one of the things people get out of single payer is the externalizing of hard choices. If I have to choose extra care for granny I feel bad if cost enters the decision. If everyone like granny gets x and no more, well we by definition did the right amount of care. If I don’t like it, I can get mad at big forces out of my control but not the man in the mirror.

On that theory people will get really shitty about one size fits all in areas where choices seem trivial but will be happier when it’s a big decision.
If my experience with the criminal justice system is any indication, people love the externalizing of hard choices when it's done to other people. It's far less fun when one is the target of that externalizing.
We live in the fucked age. Get used to it. - dhex

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Re: There must be a pony in here somewhere.

Post by JasonL » 18 Jun 2019, 14:49

Andrew wrote:
18 Jun 2019, 14:19
JasonL wrote:
18 Jun 2019, 06:38
I kinda suspect one of the things people get out of single payer is the externalizing of hard choices. If I have to choose extra care for granny I feel bad if cost enters the decision. If everyone like granny gets x and no more, well we by definition did the right amount of care. If I don’t like it, I can get mad at big forces out of my control but not the man in the mirror.

On that theory people will get really shitty about one size fits all in areas where choices seem trivial but will be happier when it’s a big decision.
If my experience with the criminal justice system is any indication, people love the externalizing of hard choices when it's done to other people. It's far less fun when one is the target of that externalizing.
This is one of my Things I Find Hard to Articulate. Dangerous Idea maybe. I used to think that an incidental feature of wealth in society was centralization of decision making and that this was largely driven by a demand for security of a life threatening nature with sudden bursts at key events like world wars, great depressions and 9/11s. I kinda think now that maybe it's not incidental but the whole thing of civilization and it's not a reaction to existential events but a constant pressure to make tomorrow as predictable in every way as today. I think that risk aversion, fear of variance, comfort with status quo collectively determine the paths of modern civilizations. I think this effect becomes dominant very soon after "i'm not worried about starving to death", and I think it portends the end of growth.

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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 18 Jun 2019, 22:27

Wait! You mean medical care would still be rationed under single-payer?

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Re: There must be a pony in here somewhere.

Post by Aresen » 18 Jun 2019, 22:48

D.A. Ridgely wrote:
18 Jun 2019, 22:27
Wait! You mean medical care would still be rationed under single-payer?
From this side of the 49th parallel*, your sarcasm is not appreciated.
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Re: There must be a pony in here somewhere.

Post by Warren » 19 Jun 2019, 09:39

D.A. Ridgely wrote:
18 Jun 2019, 22:27
Wait! You mean medical care would still be rationed under single-payer?
WAIT! You mean medical care is already being rationed?
THIS SPACE FOR RENT

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