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One of my dad's medications, Lyrica specifically, was $2,000 a month (thank heavens for Washington State's Charity Care mandate, or he couldn't have afforded it before he qualified for medicare). When the patent finally ran out, the price plummeted. We went to pick it up yesterday, and the copay was more than the insurance burden. Totally a whopping $5 between them.
I'm a pharmaceutics PhD student, and this video sums up and expands on one of my core intro classes. Wish it came out a year ago but it's still really helpful now! The historical and societal context really puts the laws and practices into perspective, and I'm glad you're not afraid to point out the issues with evergreening, because sometimes I get vibes from my professors that their mindsets may not be the same. I'll be passing this on to the first year students for sure.
Thanks for the thoughtful comment, I appreciate it. And you nailed it, my goal is to add context so that people can understand how our systems got this way.
Hoping your follow-up vids mention the Colcrys scandal. Colchicine was literally an ancient treatment for gout. It sold for pennies a dose until Takeda took out a patent on it and the price skyrocketed.
@@PatKellyTeachesincidentally, I’d love to see a video on LYMErix. For a very short window of time in the late 90’s/early 00’s, there was an FDA-approved Lyme disease vaccine on the market. Most people have no idea existed, or they’ve largely forgotten. Doesn’t even have its own Wikipedia article. Beecham didn’t take it off the market for safety reasons, and even though the patents expired years ago, nobody has taken the opportunity to make a generic. Just seems like something that would be right up your alley!
The quality of your work is astonishing. Truely the best of the internet. well researched, well explained, beautifully made. can't believe I'm watching this for free. Thankyou patrick!
I work in this area, it’s good pharmaceutical companies make money for doing the chemistry. But the big issue is with the secondary patents and the term extensions they get. Term extensions should only apply to the novel compound or biologic, not the follow on formulation or crystal form which they get now. I would also note that pharmaceutical companies spend a lot more on marketing than they do on science.
I've worked in nursing for 3 years now and thoroughly enjoy watching all of your videos in my free time as I'm very interested in medical history as well as regular old history. Your videos also go a long way to helping understand how many aspects of the medical world today function by understanding where it came from. I particularly love any of your videos directly relating to drugs or pharmaceuticals (I'm a med-tech so drugs are quite a special interest of mine 😅)
@PatKellyTeaches So much more than useful my friend 🙏 As I'm sure you're aware trying to Google or even look up on TH-cam anything "medical history" or specifically "history of pharmaceuticals" generally links you yo some short little useless clips, the occasional interesting news investigation documentary about malpractice, fraud, or patient testimonials about the drug in question w/ very little if any science about how it works, what it's even made from, the people who discovered it etc.....or you find some very dry, but I will admit very interesting medical conferences/lectures. Your ability to be personable and talk so fluently made me assume at first that you must be in the medical community 😅 Your videos while highly educational also help me greatly make it through 12 hr shifts whenever I have downtime.....all morning I was bouncing around rewatching/listening to many of your videos. Thank you again 🙏
Extraordinarily researched video. Thank you so much for making these! I wish new patents could be awarded only for drugs that show actual superiority, not just non-inferiority.
Morality and big pharmaceutical companies do not go together. Of course not everyone involved have bad intentions, but the ones making the most money probably only see dollar signs. I rely on medication to be healthy, so I see the good and bad about large pharmaceutical companies.
Same thing here. I suffered mightily when the only antidepressant that actually works for me (duloxetine) was patented, because I couldn't afford it even with insurance. When it finally went generic, it was a huge relief--but it should have been a generic to start with, IMO.
Astra-zeneca decided to sell their covid vaccine at cost price, because it was for the good of mankind. Biontech and Pfizer sold it at 2500% of cost, and used dirty politicians and dirty tricks to rip the people off. Nice.
I think if patents never expired like Coke, the government could make the argument that you must charge less monthly but you’ll get that money forever. I understand the need for innovation but there are few old products that don’t actively work to retain their market share or, like cars or fashion, innovate to keep customer engagement.
A part of me understands the drug companies completely. The amount of capital plus time to research a drug, test it, and get on the market is massive. So massive that any bust can seriously damage a company. So patents gives incentives to not only investors, but to people themselves in hopes of large profits. Those profits allow huge teams of expensive researchers, and expensive medical equipment to keep on trying to produce new drugs. That is good. Having massive amounts of supported chemist or researchers is good. I don't see much of a way to get around it. THEN on the other hand... I think what pisses me off the most is the fact they can tweak their drugs just a bit, and then renew a patent on them. That is a damn loop hole, and it is one thing having Disney do it. An other thing with life saving medication. Also the amount of time for the monopoly. 7 years MAX. They can tweak it all they want, but it shouldn't do them any good. Insulin and Epipens should be dirt cheap by now. No excuses outside of corruption on why they are not.
your videos have inspired me to pursue microbiology, specifically researching infectious disease. you have made a huge impact on me and my future, and i couldn’t thank you enough. i’m currently in community college on the path to transfer to a UC soon, and then go to graduate school (hopefully for a PhD). i have issues with depression and ADHD that impact my ability to perform basic functions, which makes daily life so draining. but thinking about a future in which i could research ways to mitigate antibiotic-resistant infectious diseases is so exciting and really helps to motivate me to keep going. thank you for creating such informative and engaging videos, i always look forward to your uploads. ❤
This comment absolutely made my day. First off, the CC to UC path is a great strategy that I think you'll be pleased with. It'll let you experience the field of microbio before committing to more years of education. Second, you're a wise person to know what motivates you. The day-to-day of a biology lab can be tedious, but having that focus on your mission is so healthy. Thanks for the kind words. Keep going.
I appreciate your work. Another example: the compelling story of rofecoxib (Vioxx)/Naproxen. While investigating these NSAIDs in GI cancer trials, if I recall correctly, the CV event rate (a safety outcome?) was lower in the naproxen group. Researchers uncritically considered this a potential sign of CV risk reduction rather than the actual cause for the observed difference: increased CV events in the Vioxx arm subjects. Imagine the desperate scramble, spurred by the company's CPAs, to develop a new LA/SR naproxen that they could patent. Eventually, increased CV risk was confirmed and Vioxx was withdrawn from the market in ~2004.
I was a pharma rep when that happened and even though the faxes came out and it was all over the news I remember having to tell a lot of my offices to take Vioxx off their shevels. PS I didn’t promote Vioxx or work for the company. 100% of the offices I informed took the samples and kept them for their own use because “It’s the best thing for menstrual cramps” As a woman I wouldn’t take my chances but…. 😑
The next video in the series is NSAIDs, and I'm struggling with how much time to give the Vioxx incident. On one hand, I want to keep it short and sweet, but on the other, I want to do a 20 minute deep dive since there's plenty of material to cover
speaking of patent medicine i miss my good old gees linctus i want my opium tincture and squill for my cough like it's 1897, they made it prescription only in 2019 in nz 😭😭
I actually had a prescription for opium tincture here in the US! Let me tell you, people look at you weirdly when you are trying to get laudanum from the pharmacy. It was for diarrhea secondary to Crohn's though. It was VERY effective, but I have basically given up hope of ever getting to use it again simply because of the opiate situation here in the US. Nobody wants to dare to prescribe any opiates whatsoever, for any reason. Except for pain management clinics, but they also do everything they can to not prescribe any these days too. But since it isn't FOR pain...that's a no anyway. And my gastro won't prescribe any either, even though it is for a gastro issue. Where I used to live I just had an ANCIENT sole propreitership gastro in his 70s that still saw use in it and wasn't afraid to prescribe whatever he wanted.
@@Boots_293 Yup, it's not often thought about because most cases of diarrhea either resolve on their own or with more obvious first line stuff like loperamide (Which, interestingly enough, is actually a type of opioid! It just is so large it can't cross the blood-brain barrier, and thus no mental effects, just gut effects) but it actually still is approved (Well, grandfathered in due to it being around LONG before actual regulation) for more resistant forms of chronic diarrhea and you are absolutely right, it was INCREDIBLY effective at it's job. But if you take enough of it you could get high, and we can't have that so...no effective drug for me.
im a UW madison student and hearing you mention steenbock was incredibly exciting! ive learned about him in a few of my chemistry and history classes here but hearing you mention my school in one of your videos was very exciting!
@@ohkylie ohh man, Steenbock’s story could’ve lasted another 10 minutes easily. Such an interesting case. I passed it on to my friends who do a medical history podcast called The Poor Historians - they’re all Wisconsinites
I really love these videos, its concise, but in depth. Some of the best medical content on this site. One topic Id really like to see you cover in the future is the history of depression treatment. Its a topic with extensive history of different treatment strategies, and a quite frankly intimidating history of drug development. It also seems like one of the few fields of modern drug development that hasn't just completely stalled.
2nd vote for antidepressants! I was a non-responder to SSRIs, prescribed buproprion several years later while waiting for ADHD assessment, and then found out after a few years and a head injury that buproprion and the beta-blockers I was already on can interact poorly... very interested in the history of depression treatment overall
This incomplete. I heard a speech by Dr Byrd who invented the Byrd respirator. His complaint wasn't the patent System, it was the FDA which takes up to 10 years to approve a new product. He stated that there is no way for startups making medical equipment to start because margins are so low. Only new startup drug companies could survive because of the 16000% markup they can charge at the end to recover the expenses.
I'm a grad student studying technology management. And from the point of view of what I study we can't ask a pharmaceutical company to be not greedy because we can't ask any company to be not greedy. If one company does act less greedy for their long-term value and prestige, that's a noble exception, not a norm. But we still can negotiate with them to make sure they can be rich for saving lives without making even more people's lives miserable. That's what public healthcare system typically does in developed countries. Speaking of Prozac, and away from my professional training, my four weeks' prescription for a set of different psychiatric medications costs about 50 USD equivalent in total, and I paid 15 USD equivalent out of pocket. If some people became rich for inventing the release mechanism for my pills, good for them. I am more productive for longer time through the day and with less side effects like mood fluctuations. I am also thankful for the NHIS for negotiating the price of those pills to what it is and then paying more than half of said price from my family's insurance policy.
2:10 I remember a time not too long ago when people were screaming about how awful a certain vaccine was, and stores had no toilet paper to be found. Humans clearly have our priorities figured out.
There waw a tpilet paper shortage because most people used toilet paper bought from wholesalers for commercial use for a significant amount of their daily use, until they couldn't leave the house. The retail market for toilet paper was overrun with the sudden demand and the wholesalers were not able to sell retail, so they couldn't pick up the slack.
Incredible video, the book “Care and Cure” dives a little into patent issues with medical devices as well as drugs. Similar issue with slightly similar molecules, slightly similar devices could get an abbreviated approval process. But they could cite devices that had an abbreviated approval to get their own abbreviated approval, creating a harmful cycle of slow evolution-like modifications that go untested and have been linked to numerous issues. I think something about cervical meshes is cited in the book? Great read and great video!
Another commenter made the same request! My next video is about NSAIDs and I'll at least mention the Vioxx story, but probably won't devote a ton of time to it
@@PatKellyTeachessuper interested in hearing about this, doctors won’t recommend anything else for my Endometriosis symptoms(even though they’ve never been effective for pain relief and only lead to more issues) but it seems like they’re so afraid of prescribing anything stronger that might actually work
I think this showed up during covid. There were several HIV drugs that showed some promise fighting covid, but pharma wasn't interested in many of them because they had long been off patent and were relatively cheap
This was a well timed video post. Another important subtopic that has become more relevant in the last decade (and is exemplified at the end via the lack of novel patents) is drug repurposement. Can companies/research groups get patents on drug repurposement? I looked this up and it seems like there are royalties split between the inventor of the molecule and the entity that discovered it's repurposement. Is this true? I hope so because repurposement is arguably just as important as novelty and if true, would you happen to know how the profits are split? Been a sub for a while btw. It's been great seeing your channel grow thanks to your thorough and objective story telling of history! Well deserved
Hi Pat Kelly, A series on the development of clinical trials would be interesting. The first I am aware of is Captain Cook and the use of citrus to combat scurvy. But of course there is the horrors of Mengele, the Tusgakee syphilis scandal, the Australian Nobel Laureate who dosed himself with helicobacter pylori to prove the cause of intestinal ulcers, and many many more scandals too numerous to mention.
Get a lobby group, buy a few top-tier lawmakers, let the top-tiers strongarm the lower-tiers, change the rules, make money. Rinse and repeat as necessary. Anyhow... Great video!
Thank you- well done video! I looked at the thumbnail, thinking, "Why do you need 42 minutes to state the obvious?" Glad I tuned in, much more nuanced than I'd thought.
I believe there used to be laws in place that prevented Hollywood studios from owning theater chains. this was supposed to help prevent vertical integration/ monopolization. maybe we should separate research/patent owning entities from manufacturing entities. researchers benefit by licensing patents, and manufacturers can benefit by effective production/distribution
Pharmacy tech from Poland here. Profits and medicine shouldn't go together. I wish it wouldn't be founded by the private sector but from the national budget, instead of military and constant wars, like the US always does, because they always find money to do that. Privatisation of medicine is and always has been a cancer on the societal tissue that's led to poverty. Life should never be a means of profit and human needs such as access to healthcare, food, water and a roof over head NEED to be free, because no one ever chooses being alive
Except that without profit incentives, we would have much fewer drugs. Forcing prices down kills people. Huge budgets funded by government for drug discovery is just much less efficient compared to profit incentives. American consumers essentially subsidize drugs for the entire world.
From the US, and I totally agree. I think it speaks volumes about someone's own attitudes when they say that only profit could possibly drive pro-social innovation
i'd love to see a video on the story of antiretroviral patents (and the activism that combatted it) during the aids crisis ! it's such an important story that i feel is often forgotten and it would be really fascinating to get into it from pharmaceutical, regulatory, and social perspectives
So I didn’t quite hear if a question of mine was answered. Are some people correct when they say “US drug consumers subsidize medicine development for the whole world. If prices in the US weren’t so high, we wouldn’t have nearly as many medicines as we do today”?
You also have to mention that lawsuits against pharmaceutical companies in the US help make pharmaceuticals expensive for all Americans. In socialized medicine countries, you cannot sue them, so they enjoy lower prices. In the UK, you can sue, but you must present evidence that a pharmaceutical company was negligent. In the USA, you don't have to present evidence. They have to prove that they were not negligent, and juries usually side for the poor plaintiff vs the big pharma company. The cost to all of us is extraordinary.
In the EU all medical products that are past their patent are practically 'for free' (I.e. most everything what comes to neurological deceases and diabetes). Products that are 'revolutionary' and have their patents are costly but - the government can come and pay the 'patent' surplus. In Europe mostly all medicine is afordable. In the US, as far as I know, the situation is not the same. I know that in the last 4 years in the US a cap was implemented for some medicine. In the end, it's a matter of choice. All the modern agreements are just voices in the international arena - the EU is pro-consumer, the US is pro-farma. One would assume that as medicine such as Ozempic is from Denmark, EU would be pro-farma but no. Choices.
This makes so many things make more sense to me now! I have an additional question: even when generic versions of a given drug hit the market, at least in my experience, the name brand version of the drug remains much more expensive--for instance, I pay a few bucks a month (after insurance) for generic duloxetine, but the original Cymbalta still costs a couple hundred dollars for the same amount. My insurance won't even cover a name brand if a generic is available. Why doesn't the market competition bring the price of the brand name drug down? Who is even buying the same drug at a hundred times the price? Or does the original manufacturer get enough purchases due to the name recognition that it's worth it to keep the price high? On second thought, maybe this is an economics question and not a history of medicine question...
The channel has a video on the history of generics that might be interesting for you! I think it has to do with consumer trust, basically--in recent years people have come around to generics a lot more than they used to
The answer is corporate greed. Which seems to be the answer to a lot of questions about why the price of everything seems to go up regardless of market forces.
the problem with lawmakers involving themselves in something they really have no way of knowing about is the UNFORESEEN CONSEQUENCES ie: when darvon/darvocet was taken off the market despite being widely used because they had to prove clinical efficacy RETROACTIVELY it left a gaping hole in the analgesic market that was ultimately filled by dangerous highly addictive opioids ☹️
I am so glad I discovered your channel. I don't know how the rabies vaccine History video came up in my interest feed but I'm sure glad I watched it. It was really fun. New fan!
Worked for a generic pharma company years ago and was part of a few ANDAs. Once we got it out of the R&D phase we would have to validate them on a mass scale and send that to the FDA. Very meticulous as any mistake would have the FDA not approving and send it back to us. Also an issue with generics that hurts generic producers is wholesale buys over the years combined and forced companies to try and undersell each other instead of the wholesalers fighting by paying more. This made our company cut out our lowest profit margin drugs and I imagine many other companies as it wasn’t worth it. One of those for us was fluoxetine, diazepam, and lorazepam. Along with many others. Unfortunately the wholesalers didn’t pass this on to customers.
It's actually interesting how the patent debate evolved with rapidly changing circumstances, and in many cases, actors on all sides of the debate had good faith arguments for their positions. Still, it seems to me that a way to fix all this, at least in the US, would have been either the government reimbursing or compensating companies and universities for the costs of drug discovery and production as opposed to granting patents or the government creating national R&D labs sooner or perhaps a state-owned drug manufacturer with price caps on drugs and total transparency in process.
All the Blessings to you and your family.. I really like your video❤ i was actually having my vacation and have free time to browse through then I chance upon your channel and omg indeed awesome as your way of delivering the information made me focus more and haven't noticed the time that is really enjoyable this is the first time I came to love listening to history.. truly your voice really adds the flavor to it making it more interesting to listen... ❤Thank you so much for sharing this valuable information... Love from Asia.. PS:I really hope you can make a video on separation of pharmacy and medicine or history of pharmacy perhaps if you have time ❤
Unrelated but you starting the video talking about antidepressants reminds me of how frustrating it is to listen to people preaching about antidepressants and taling meds for mental illnesses. As someone whos struggled with depression for a long time, i'd gladly try anything that works better than antidepressants (dont tell me to just work out and go outside, thats not how depression works) but injavent found anything that helps nearly as much. Like im not joking, if i wasnt taking antidepressants i probably wouldnt be alive right now.
So not a doctor, and definitely would never tell someone to stop taking their medication, but it might be worth getting vitamin levels tested, in addition to whatever you/your doc are currently doing. For a couple years, I've been have symptoms that /could/ have been my depression worsening, but found out I'm deficient in B12 and D (disclaimer: I am also possibly rocking some pituitary dysfunction, but the B12/D dosage my doctor recommended has been immediately helpful)
I wonder if it has some value to think of the US pharma industry and the situation with patents is basically the US jumping on the hand grenade for the world to an extent. The US suffers because of the profit-seeking motive in patenting medicine and it very clearly and directly has led to some of the biggest negative features of American medicine...but at the same time, that profit incentive helped the advancement of medicine as a whole, world wide, as even foreign pharmaceutical companies can use the massive US market and ability to price gouge all they want with a monopoly to recoup investment. The end result is everyone gets more and better medicine, while the US bears the costs associated with the "necessary evil".
Yup! My parents are in pharma so I’ve seen behind the scenes. Reasonable people can disagree about where to draw the line in terms of innovation/cost tradeoffs, but it drives me crazy when ppl try to act like those trade offs don’t exist
Kind of like my ADHD medication unfortunately 😢. Name brand Adderall is $200+ but the generics, that are so pick and choose concerning efficacy , are less than $70 tf. And the name brand WORKS!!!
I've never even had the name brand, but I found out early in the shortages that, for me, while IR = no side effects, XR = terrible side effects. That's one innovation that didn't work out for me 🙃 but I have a friend who is the exact opposite
As you mention in the video on "patent lifecycle management", patents work best when you have a responsible office in government handling the application process to ensure the monopoly power they grant isn't being abused. When companies like Apple can successfully get patents for a rectangular slab with rounded edges or, as you mention, pharma companies start to patent as many secondary things as possible, consumers are the ones to pay the, sometimes ultimate, price. It seems a method to disincentivize companies and individuals from trying to abuse the system is needed. The skeptic in me is doubtful that humanity will ever be responsible with patents due to regulatory capture, but hopefully I'm wrong and we'll figure something out.
Remicade is wildly expensive and makes it really hard to keep jobs if you’re not well established in your career already. The charity application applies to a single dose and is exhausting for the people who need it. It’s the gold standard and it’s understandable that it’s never going to be cheap to make since one dose takes dozens of mice. But $7700 is still a lot for a life saving drug
I just started this video. If you can't patent a medical invention where is the incentive to try'n make new innovations? No one would even try if they knew everyone else could just take it and make money off their invention. (It should obviously be a limited time patent)
34:33 extended release and immediate release have different benefits for a lot of medications, I think it’s usually a good thing to have both available.
there should be more competition by government agencies, hospitals and universities against big pharma companies. Let's create non-profit public entities that can bring new drugs to market. They can focus on creating drugs that are highly needed, but doesn't have the interest of pharma companies. New antibiotics for instance.
How can Auvelity ( detromethorphan and bupropion ) 2 drugs available over the counter and as a generics , respectively, be patented? Auvelity is not available as a generic. This drug is $10,00 a dose, when the 2 drugs the themselves can be bought individually for 0.45 cents a dose. By this logic Tylenol and ibuprofen can be mixed together and patented for some new use.
Not a direct answer to your question, but I looked into a similar situation once and it turned out to have nothing to do with the drugs. The company had a patent on the shape of the lid of the inhaler that the drug combination came in. After looking it over, I agreed it was a better lid. I guess they also combined the drugs as a better selling point since people would be prescribed them together anyway, and who wants two inhalers.
The individual drugs are off patent, but the combination is a novel discovery. Not medical advice, but yes, you probably could. a box of oral syringes + 100mg bupropion and 45mg of dexteomorphan. Ask your dr. Or a compounding pharmacy could combine the two in the corresponding doses and it would still be substantially less expensive.
Honestly? At least it’s patents over some other types of IP law. Imagine if drug formulations were trade secrets. If the expiry of patents could be just a bit better enforced I think it would do wonders.
Surprised not to see Escitalopram as one of the me-too drugs. There's no way a specific chirality is a good enough difference to justify another patent, and it seems likely (to me) that Lundbeck knew the left-handed chirality would be slightly better. I think they just released a slightly less effective drug first then released the slightly better version with a small overlap so they could double the years of profits instead of just releasing escitalopram in the beginning.
The original idea of Letters Patent, 500 years ago, was to protect start-ups from the power of the Guilds, the established businessmen. It wasn't to make the rich richer.
I mean, that's the definition of supply and demand. No one's fault that humanity is greedy by nature. Everyone's fault that we don't overcome that nature
You talk about the amount of revenue that pharmaceutical companies "lost" as a result of patents expiring. This implicitly frames it as if that revenue is something they're entitled to in perpetuity and the patent expiration is doing harm to them. I'm sure their marketing departments are happy with this framing, but your whole video demonstrates that patents are a social contract that gives something for the company that develops the drug - the exclusivity period - in exchange for the cost of developing the drug. It's not a natural right that should last forever. Maybe I'm overreacting to a minor point of language here but I think it would be helpful to resist this framing by saying something like "the company's revenue declined by X" rather than "the company lost X amount of revenue". To me this takes away any implication that the company was owed that excess revenue after the patent expired.
That's a fair critique. After reading your comment and thinking it over, I think the phrasing of "the industry's revenue only hit X dollars, which is a X% decline from the previous year" is less leading. Thank you for the thoughtful feedback.
Hi Trevin. The suggestion you make, “turn over all R&D responsibility to research universities” is a practical impossibility. Universities are not capable of doing the kind of modern research done routinely by pharmaceutical companies; and further; the structure of universities probably would prevent them from doing so, forever. There already exists a fairly tight coupling between universities and industry, with regard to pharmaceuticals and many other innovations, largely because of the severe limitations of university research. It’s difficult to even express the vast gulf in capabilities, if one hasn’t seen pharmaceutical research in both kinds of institutions (universities and companies), but large pharmaceutical companies often have something like 50,000 (fifty thousand) employees, along with major computing and robotic resources, working solely on pharmaceuticals. A typical major research university will employ something like 20,000 employees, spread across 40 departments, with half of these employees assigned to student needs. This implies that universities might dedicate something like 250 (two hundred fifty) employees to pharmaceutical research, that is, something like 200 times fewer employees. Universities simply cannot handle typical full-scale pharmaceutical research and development. There are vast differences in almost any metric you care to examine, in this area. [And of course all of this ignores the notion that universities (apparently) simply don’t want to engage in this kind of research behavior, because academic researchers value their ‘academic freedom’ (and I agree with them).]
Huh, I think you may have meant this comment for a different video on the topic. I don't think I made that suggestion during the video, and of course, my name is not Trevin. Thanks for watching
@@PatKellyTeaches Hi Patrick. I meant my comment for one of the commenters named Trevin (I think) who, like so many folks nowadays, believes he knows how the pharmaceutical world should work. But then I decided that the idea that large pharmaceutical companies dwarf university pharmaceutical departments, is a worthy issue for consideration concerning the expense of novel pharmaceuticals. For example, Celltech, a 5,000 (five thousand) employee pharmaceutical company, felt it did not have enough resources to engage in Phase III FDA testing. This is because Phase III testing is exceptionally expensive (as I’m sure you’re aware). So Celltech would pre-engage with ‘Big Pharma’ partners when they expected that new drug candidates had a reasonable chance of getting through Phase I & Phase II. The regulatory burden, and associated financial burden, of Phase III drug trials is obviously quite intense. [I personally strongly agree with the requirements, but most countries require no such burdens for new drugs. Rather, they let the United States shoulder the burden of fully verifying new drugs (when the FDA operates properly).] This of course, contributes to the ‘much lauded’ figure of 1 billion dollars to develop a new drug. [I personally think this figure is low, but that is another matter.] I chose to put the comment outside a ‘reply to Trevin’ because I think the huge expense of drug approval in the U.S. makes drugs expensive. The patent system was designed from its inception to allow individuals and companies to recoup expenses and make a profit. Ignoring the resources and expenses required to find drug target packages, and then push through for a decade or more through FDA phased approval, presents an incomplete picture [at least, I think it does]. But aside from all that, let me join the cacophony to say: I love your vids… and please do continue. Cheers. PS Years ago, I did a vid about Paul Erlich’s contributions to early modern pharmacology, The History of Modern Drug Development (by timeparticle). I would be gratified if you would have a look. If you did your own Erlich video, that would of course, be toast-worthy.
Thank you for such an in-depth comment. I hear what you're saying about folks acting as armchair pharma experts. I'm sure they feel like there's a simple solution when there are millions of interwoven systems, interests, and incentives to navigate. I checked out your Ehrlich video; great work. I mentioned him in my video on Salvarsan, which you can find here: th-cam.com/video/3xxtHTN71jM/w-d-xo.html
@@SystemsMedicine Totally understand why industry might be frustrated with the length/expense of the approval process, but I honestly think that extensive regulation is so important for consumer safety
@@stuffinsthegreat Hi StuffinsTheGreat. I agree with you. It is somewhat frustrating, while also being quite necessary. [The rest of the world relies on the U.S. shouldering the burden, which is also a bit frustrating, but apparently also necessary. Internally, as well as externally, there are occasional attempts to reduce the quality and quantity of FDA requirements (aside from the typical violations), and people have to work hard to try to maintain the FDA quality controls.]
I have no problems with companies making a REASONABLE profit off of the medications and treaments the produce. The problem currently is the extreme price gouging. I rely on medication to not die a slow and agonizing death. The MSRP? Nearly $18,000 *per month*. So I must limit my income to afford a Markerplace plan that makes that medication actually affordable. Which means I can't afford other things I need like physical therapy or traveling out of state to see specialists. Or yanno, food. Our current system is not okay. I know the costs to manufacture my specific medication is less than $300 for my dosage and version. How? Because that's its cost in France without any form of insurance. And that's a high estimate of cost.
There has been a major finding about nitrosamines in a blood pressure medication - interestingly there was no evidence of these poisonous byproducts being present in the original medication. There is obviously far more to safe drugs than just patents. Personally I think the switch to biotech where feasible has been an adequate strategy for the manufacturers to ensure they can continue with their business. Many people are just envious in the well paid jobs at pharmaceutical companies and I get where they‘re coming from. But underestimating the efforts taken to ensure quality is bad practice. The prices of drugs in the USA are strange, they are the result of the US market’s structure.
I understand my comment may come over as incendiary but please don’t underestimate the work done by the pharmaceutical manufacturers to ensure their drugs are safe. I would also like to point to the horrendous pollution in countries like India where generic manufacturers often don’t recycle or incinerate waste and there is also little incentive to ensure the air quality stays at least acceptable. The manufacturers producing drugs here in the West are legally required to do everything in their power to prevent their operations having an impact on life and the environment. I strongly disagree with cheap equals good. Those who‘re wishing for socialism: Guess where many a drug was tested..
yep; patents make new inventions expensive by giving the inventor a temporary monopoly. He can sell for whatever price he chooses. You can keep using unpatented products; or pay his price.
How do pharmaceutical companies get rich well they bright politicians. We don’t have documentaries on that. It’s a court case right now.. if you’re here to be polite about it and explain it in a nice fashion where you think it’s OK for the public it isn’t. Those people are scumbags and they need to be in jail then prison..
commenting Before watching the video: I hate US medical patents as they are, but i do think some level of patents is useful, due to making money back. But it cant prevent others from using/improving on it. maybe something like having a 10 year patent where, if people use your pattented chemical/technology, they have to alert you, and pay 1-5% of their profits to the pattent holder. That way the medicine can proliferate well, while still having a solid money advantage. Definitely would need some hammering out on the details, that is way beyond me, but definitely better than the BS 20 year pattents that hold back medical research so hard
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i'm a pharmacy student and, damn, i love these videos, please keep making them, they are so educational
That means a lot, thank you! Have fun in your studies!
One of my dad's medications, Lyrica specifically, was $2,000 a month (thank heavens for Washington State's Charity Care mandate, or he couldn't have afforded it before he qualified for medicare). When the patent finally ran out, the price plummeted. We went to pick it up yesterday, and the copay was more than the insurance burden. Totally a whopping $5 between them.
I'm a pharmaceutics PhD student, and this video sums up and expands on one of my core intro classes. Wish it came out a year ago but it's still really helpful now! The historical and societal context really puts the laws and practices into perspective, and I'm glad you're not afraid to point out the issues with evergreening, because sometimes I get vibes from my professors that their mindsets may not be the same. I'll be passing this on to the first year students for sure.
Thanks for the thoughtful comment, I appreciate it. And you nailed it, my goal is to add context so that people can understand how our systems got this way.
Hoping your follow-up vids mention the Colcrys scandal. Colchicine was literally an ancient treatment for gout. It sold for pennies a dose until Takeda took out a patent on it and the price skyrocketed.
I wasn't planning to, but I'll definitely spend some time reading about it!
@@PatKellyTeachesincidentally, I’d love to see a video on LYMErix. For a very short window of time in the late 90’s/early 00’s, there was an FDA-approved Lyme disease vaccine on the market.
Most people have no idea existed, or they’ve largely forgotten. Doesn’t even have its own Wikipedia article. Beecham didn’t take it off the market for safety reasons, and even though the patents expired years ago, nobody has taken the opportunity to make a generic.
Just seems like something that would be right up your alley!
@@somerabbit6909 Takeda? Fuck those guys for making Vyvanse $380 per prescription.
@@PatKellyTeaches I would like to hear about this as well.
The quality of your work is astonishing. Truely the best of the internet. well researched, well explained, beautifully made. can't believe I'm watching this for free. Thankyou patrick!
I am a Pathology resident. I really enjoy these videos.
That means a lot, thank you!
I work in this area, it’s good pharmaceutical companies make money for doing the chemistry. But the big issue is with the secondary patents and the term extensions they get. Term extensions should only apply to the novel compound or biologic, not the follow on formulation or crystal form which they get now.
I would also note that pharmaceutical companies spend a lot more on marketing than they do on science.
I've worked in nursing for 3 years now and thoroughly enjoy watching all of your videos in my free time as I'm very interested in medical history as well as regular old history. Your videos also go a long way to helping understand how many aspects of the medical world today function by understanding where it came from. I particularly love any of your videos directly relating to drugs or pharmaceuticals (I'm a med-tech so drugs are quite a special interest of mine 😅)
@@lennycampagna734 Thank you! We’ve got quite a few healthcare providers in the audience, and I’m glad the videos are useful to yall
@PatKellyTeaches So much more than useful my friend 🙏 As I'm sure you're aware trying to Google or even look up on TH-cam anything "medical history" or specifically "history of pharmaceuticals" generally links you yo some short little useless clips, the occasional interesting news investigation documentary about malpractice, fraud, or patient testimonials about the drug in question w/ very little if any science about how it works, what it's even made from, the people who discovered it etc.....or you find some very dry, but I will admit very interesting medical conferences/lectures. Your ability to be personable and talk so fluently made me assume at first that you must be in the medical community 😅 Your videos while highly educational also help me greatly make it through 12 hr shifts whenever I have downtime.....all morning I was bouncing around rewatching/listening to many of your videos. Thank you again 🙏
Extraordinarily researched video. Thank you so much for making these!
I wish new patents could be awarded only for drugs that show actual superiority, not just non-inferiority.
Morality and big pharmaceutical companies do not go together. Of course not everyone involved have bad intentions, but the ones making the most money probably only see dollar signs. I rely on medication to be healthy, so I see the good and bad about large pharmaceutical companies.
Same thing here. I suffered mightily when the only antidepressant that actually works for me (duloxetine) was patented, because I couldn't afford it even with insurance. When it finally went generic, it was a huge relief--but it should have been a generic to start with, IMO.
@@aq5426 I'm glad you can afford it now. Take care of yourself.
Astra-zeneca decided to sell their covid vaccine at cost price, because it was for the good of mankind. Biontech and Pfizer sold it at 2500% of cost, and used dirty politicians and dirty tricks to rip the people off.
Nice.
I think if patents never expired like Coke, the government could make the argument that you must charge less monthly but you’ll get that money forever. I understand the need for innovation but there are few old products that don’t actively work to retain their market share or, like cars or fashion, innovate to keep customer engagement.
A part of me understands the drug companies completely.
The amount of capital plus time to research a drug, test it, and get on the market is massive. So massive that any bust can seriously damage a company.
So patents gives incentives to not only investors, but to people themselves in hopes of large profits.
Those profits allow huge teams of expensive researchers, and expensive medical equipment to keep on trying to produce new drugs.
That is good. Having massive amounts of supported chemist or researchers is good.
I don't see much of a way to get around it.
THEN on the other hand...
I think what pisses me off the most is the fact they can tweak their drugs just a bit, and then renew a patent on them. That is a damn loop hole, and it is one thing having Disney do it. An other thing with life saving medication.
Also the amount of time for the monopoly. 7 years MAX. They can tweak it all they want, but it shouldn't do them any good.
Insulin and Epipens should be dirt cheap by now. No excuses outside of corruption on why they are not.
your videos have inspired me to pursue microbiology, specifically researching infectious disease. you have made a huge impact on me and my future, and i couldn’t thank you enough. i’m currently in community college on the path to transfer to a UC soon, and then go to graduate school (hopefully for a PhD). i have issues with depression and ADHD that impact my ability to perform basic functions, which makes daily life so draining. but thinking about a future in which i could research ways to mitigate antibiotic-resistant infectious diseases is so exciting and really helps to motivate me to keep going. thank you for creating such informative and engaging videos, i always look forward to your uploads. ❤
This comment absolutely made my day. First off, the CC to UC path is a great strategy that I think you'll be pleased with. It'll let you experience the field of microbio before committing to more years of education. Second, you're a wise person to know what motivates you. The day-to-day of a biology lab can be tedious, but having that focus on your mission is so healthy.
Thanks for the kind words. Keep going.
Oh heck yeah! Sign me tf up for nearly an hour of Pat explaining patents in medicine
last semester my pharmacology final exam (PHAL221, University of Otago) was to write an essay on exactly this - glad to see i didn't miss too much
@@talpa6969💪💪💪
I appreciate your work. Another example: the compelling story of rofecoxib (Vioxx)/Naproxen. While investigating these NSAIDs in GI cancer trials, if I recall correctly, the CV event rate (a safety outcome?) was lower in the naproxen group. Researchers uncritically considered this a potential sign of CV risk reduction rather than the actual cause for the observed difference: increased CV events in the Vioxx arm subjects. Imagine the desperate scramble, spurred by the company's CPAs, to develop a new LA/SR naproxen that they could patent. Eventually, increased CV risk was confirmed and Vioxx was withdrawn from the market in ~2004.
I was a pharma rep when that happened and even though the faxes came out and it was all over the news I remember having to tell a lot of my offices to take Vioxx off their shevels. PS I didn’t promote Vioxx or work for the company. 100% of the offices I informed took the samples and kept them for their own use because “It’s the best thing for menstrual cramps” As a woman I wouldn’t take my chances but…. 😑
The next video in the series is NSAIDs, and I'm struggling with how much time to give the Vioxx incident. On one hand, I want to keep it short and sweet, but on the other, I want to do a 20 minute deep dive since there's plenty of material to cover
@@PatKellyTeaches Please do. I was once prescribed off-label naproxen for dysmenorrhea and I'd love to see the context.
speaking of patent medicine i miss my good old gees linctus i want my opium tincture and squill for my cough like it's 1897, they made it prescription only in 2019 in nz 😭😭
I actually had a prescription for opium tincture here in the US! Let me tell you, people look at you weirdly when you are trying to get laudanum from the pharmacy. It was for diarrhea secondary to Crohn's though. It was VERY effective, but I have basically given up hope of ever getting to use it again simply because of the opiate situation here in the US. Nobody wants to dare to prescribe any opiates whatsoever, for any reason. Except for pain management clinics, but they also do everything they can to not prescribe any these days too. But since it isn't FOR pain...that's a no anyway. And my gastro won't prescribe any either, even though it is for a gastro issue. Where I used to live I just had an ANCIENT sole propreitership gastro in his 70s that still saw use in it and wasn't afraid to prescribe whatever he wanted.
@@Tinil0I can imagine it was incredibly effective too! I never even considered something like that being used for diarrhoea but it makes perfect sense
@@Boots_293 Yup, it's not often thought about because most cases of diarrhea either resolve on their own or with more obvious first line stuff like loperamide (Which, interestingly enough, is actually a type of opioid! It just is so large it can't cross the blood-brain barrier, and thus no mental effects, just gut effects) but it actually still is approved (Well, grandfathered in due to it being around LONG before actual regulation) for more resistant forms of chronic diarrhea and you are absolutely right, it was INCREDIBLY effective at it's job.
But if you take enough of it you could get high, and we can't have that so...no effective drug for me.
@@Tinil0it’s not just opiates, it’s everything. I went it for agoraphobia and was told to meditate 😂
@@BingusDingusLingus That's so frustrating =\
im a UW madison student and hearing you mention steenbock was incredibly exciting! ive learned about him in a few of my chemistry and history classes here but hearing you mention my school in one of your videos was very exciting!
@@ohkylie ohh man, Steenbock’s story could’ve lasted another 10 minutes easily. Such an interesting case. I passed it on to my friends who do a medical history podcast called The Poor Historians - they’re all Wisconsinites
I really love these videos, its concise, but in depth. Some of the best medical content on this site. One topic Id really like to see you cover in the future is the history of depression treatment. Its a topic with extensive history of different treatment strategies, and a quite frankly intimidating history of drug development. It also seems like one of the few fields of modern drug development that hasn't just completely stalled.
Thanks for the kind words. And totally, antidepressants are on the idea list, but they're such a massive topic that it's a little intimidating
2nd vote for antidepressants! I was a non-responder to SSRIs, prescribed buproprion several years later while waiting for ADHD assessment, and then found out after a few years and a head injury that buproprion and the beta-blockers I was already on can interact poorly... very interested in the history of depression treatment overall
I saw you posted and near immediate decided yeah I can leave late for work to have time to watch this lol
[fist bumps] Hell yeah brother
I signed the John Green petition. He's a legend in advocacy
Consistently brilliant and high quality videos; thank you Patrick!
This incomplete. I heard a speech by Dr Byrd who invented the Byrd respirator. His complaint wasn't the patent System, it was the FDA which takes up to 10 years to approve a new product. He stated that there is no way for startups making medical equipment to start because margins are so low. Only new startup drug companies could survive because of the 16000% markup they can charge at the end to recover the expenses.
hey man I love your videos, they are super thorough, informative and interesting!! Long comment to bump this in other people's feeds. Thanks again!
I'm a grad student studying technology management. And from the point of view of what I study we can't ask a pharmaceutical company to be not greedy because we can't ask any company to be not greedy. If one company does act less greedy for their long-term value and prestige, that's a noble exception, not a norm. But we still can negotiate with them to make sure they can be rich for saving lives without making even more people's lives miserable. That's what public healthcare system typically does in developed countries.
Speaking of Prozac, and away from my professional training, my four weeks' prescription for a set of different psychiatric medications costs about 50 USD equivalent in total, and I paid 15 USD equivalent out of pocket. If some people became rich for inventing the release mechanism for my pills, good for them. I am more productive for longer time through the day and with less side effects like mood fluctuations. I am also thankful for the NHIS for negotiating the price of those pills to what it is and then paying more than half of said price from my family's insurance policy.
This is a great video! Also, thank you for providing subtitles. It means a lot for you to put in the effort.
@@Millimallow My pleasure. Since I read from a script, i might as well upload it as captions, then auto-translate it to other languages
2:10 I remember a time not too long ago when people were screaming about how awful a certain vaccine was, and stores had no toilet paper to be found.
Humans clearly have our priorities figured out.
The toilet paper shortages are going to be so strange to explain to the next generation. Like, of all things, why toilet paper?!
@@PatKellyTeaches Was also a nearly worldwide phenomenon. Greetings from Germany (Had a weeks long toilet paper crisis)
There waw a tpilet paper shortage because most people used toilet paper bought from wholesalers for commercial use for a significant amount of their daily use, until they couldn't leave the house. The retail market for toilet paper was overrun with the sudden demand and the wholesalers were not able to sell retail, so they couldn't pick up the slack.
@@clarencejacobowitz640okay this is the first logical reason I’ve seen! And it really makes sense!
Incredible video, the book “Care and Cure” dives a little into patent issues with medical devices as well as drugs. Similar issue with slightly similar molecules, slightly similar devices could get an abbreviated approval process. But they could cite devices that had an abbreviated approval to get their own abbreviated approval, creating a harmful cycle of slow evolution-like modifications that go untested and have been linked to numerous issues. I think something about cervical meshes is cited in the book? Great read and great video!
Can you do a video about the class of COX-2 inhibitors, including celecoxib, the infamous rofecoxib, and the "offspring of Vioxx" etoricoxib ?
Another commenter made the same request! My next video is about NSAIDs and I'll at least mention the Vioxx story, but probably won't devote a ton of time to it
@@PatKellyTeachessuper interested in hearing about this, doctors won’t recommend anything else for my Endometriosis symptoms(even though they’ve never been effective for pain relief and only lead to more issues) but it seems like they’re so afraid of prescribing anything stronger that might actually work
thank you for your work! showing this channel to everyone i can because it blows my mind how underappreciated this channel is
I think this showed up during covid. There were several HIV drugs that showed some promise fighting covid, but pharma wasn't interested in many of them because they had long been off patent and were relatively cheap
Ooooh, a video on the history of HIV treatment and the approval process would be really good (and also infuriating).
This was a well timed video post. Another important subtopic that has become more relevant in the last decade (and is exemplified at the end via the lack of novel patents) is drug repurposement. Can companies/research groups get patents on drug repurposement? I looked this up and it seems like there are royalties split between the inventor of the molecule and the entity that discovered it's repurposement. Is this true? I hope so because repurposement is arguably just as important as novelty and if true, would you happen to know how the profits are split? Been a sub for a while btw. It's been great seeing your channel grow thanks to your thorough and objective story telling of history! Well deserved
Hi Pat Kelly, A series on the development of clinical trials would be interesting. The first I am aware of is Captain Cook and the use of citrus to combat scurvy. But of course there is the horrors of Mengele, the Tusgakee syphilis scandal, the Australian Nobel Laureate who dosed himself with helicobacter pylori to prove the cause of intestinal ulcers, and many many more scandals too numerous to mention.
I'm so excited for the next few videos, i just got caught up/finished the playlist and I'm gonna be joining the patreon to get more videos 🤩
So close to 100K subs! Let's go!
Hopefully in a few weeks!
Congrats Patrick. Almost at 100 K... Always great content thanks mate
Soon! I'll be able to bring the silver plaque to school and flex on all my students
Get a lobby group, buy a few top-tier lawmakers, let the top-tiers strongarm the lower-tiers, change the rules, make money. Rinse and repeat as necessary. Anyhow... Great video!
Thank you- well done video! I looked at the thumbnail, thinking, "Why do you need 42 minutes to state the obvious?" Glad I tuned in, much more nuanced than I'd thought.
yay another good infodump to listen to!! keep it up i love these
I didn't expect *infodump* to be flattering, but I'll take it!
I believe there used to be laws in place that prevented Hollywood studios from owning theater chains. this was supposed to help prevent vertical integration/ monopolization.
maybe we should separate research/patent owning entities from manufacturing entities.
researchers benefit by licensing patents, and manufacturers can benefit by effective production/distribution
That was a court decision, not a law.
Pharmacy tech from Poland here. Profits and medicine shouldn't go together. I wish it wouldn't be founded by the private sector but from the national budget, instead of military and constant wars, like the US always does, because they always find money to do that. Privatisation of medicine is and always has been a cancer on the societal tissue that's led to poverty. Life should never be a means of profit and human needs such as access to healthcare, food, water and a roof over head NEED to be free, because no one ever chooses being alive
Except that without profit incentives, we would have much fewer drugs. Forcing prices down kills people. Huge budgets funded by government for drug discovery is just much less efficient compared to profit incentives. American consumers essentially subsidize drugs for the entire world.
From the US, and I totally agree. I think it speaks volumes about someone's own attitudes when they say that only profit could possibly drive pro-social innovation
i'd love to see a video on the story of antiretroviral patents (and the activism that combatted it) during the aids crisis ! it's such an important story that i feel is often forgotten and it would be really fascinating to get into it from pharmaceutical, regulatory, and social perspectives
So I didn’t quite hear if a question of mine was answered. Are some people correct when they say “US drug consumers subsidize medicine development for the whole world. If prices in the US weren’t so high, we wouldn’t have nearly as many medicines as we do today”?
first part yes, second part no. the prices aren't the only issue. it's the culture which includes the self-destroying desire for profit
You also have to mention that lawsuits against pharmaceutical companies in the US help make pharmaceuticals expensive for all Americans. In socialized medicine countries, you cannot sue them, so they enjoy lower prices. In the UK, you can sue, but you must present evidence that a pharmaceutical company was negligent. In the USA, you don't have to present evidence. They have to prove that they were not negligent, and juries usually side for the poor plaintiff vs the big pharma company. The cost to all of us is extraordinary.
In the EU all medical products that are past their patent are practically 'for free' (I.e. most everything what comes to neurological deceases and diabetes). Products that are 'revolutionary' and have their patents are costly but - the government can come and pay the 'patent' surplus.
In Europe mostly all medicine is afordable. In the US, as far as I know, the situation is not the same. I know that in the last 4 years in the US a cap was implemented for some medicine. In the end, it's a matter of choice.
All the modern agreements are just voices in the international arena - the EU is pro-consumer, the US is pro-farma. One would assume that as medicine such as Ozempic is from Denmark, EU would be pro-farma but no. Choices.
The EUs are rats who exploit American money. Without American prices drug development would collapse
Can you please do a video about SSRI or serotonin more generally?
It's on the list! I just need more time to research and make videos!
This makes so many things make more sense to me now! I have an additional question: even when generic versions of a given drug hit the market, at least in my experience, the name brand version of the drug remains much more expensive--for instance, I pay a few bucks a month (after insurance) for generic duloxetine, but the original Cymbalta still costs a couple hundred dollars for the same amount. My insurance won't even cover a name brand if a generic is available. Why doesn't the market competition bring the price of the brand name drug down? Who is even buying the same drug at a hundred times the price? Or does the original manufacturer get enough purchases due to the name recognition that it's worth it to keep the price high? On second thought, maybe this is an economics question and not a history of medicine question...
The channel has a video on the history of generics that might be interesting for you! I think it has to do with consumer trust, basically--in recent years people have come around to generics a lot more than they used to
The answer is corporate greed. Which seems to be the answer to a lot of questions about why the price of everything seems to go up regardless of market forces.
As opposed to socialist thievery?
the problem with lawmakers involving themselves in something they really have no way of knowing about is the UNFORESEEN CONSEQUENCES ie: when darvon/darvocet was taken off the market despite being widely used because they had to prove clinical efficacy RETROACTIVELY it left a gaping hole in the analgesic market that was ultimately filled by dangerous highly addictive opioids ☹️
The minor little problem is that Darvon in fact did not do diddly squat as far as pain relief.
Really awesome video!!!
one of the best videos on youtube
I am so glad I discovered your channel. I don't know how the rabies vaccine History video came up in my interest feed but I'm sure glad I watched it. It was really fun. New fan!
Worked for a generic pharma company years ago and was part of a few ANDAs. Once we got it out of the R&D phase we would have to validate them on a mass scale and send that to the FDA. Very meticulous as any mistake would have the FDA not approving and send it back to us. Also an issue with generics that hurts generic producers is wholesale buys over the years combined and forced companies to try and undersell each other instead of the wholesalers fighting by paying more. This made our company cut out our lowest profit margin drugs and I imagine many other companies as it wasn’t worth it. One of those for us was fluoxetine, diazepam, and lorazepam. Along with many others. Unfortunately the wholesalers didn’t pass this on to customers.
It's actually interesting how the patent debate evolved with rapidly changing circumstances, and in many cases, actors on all sides of the debate had good faith arguments for their positions.
Still, it seems to me that a way to fix all this, at least in the US, would have been either the government reimbursing or compensating companies and universities for the costs of drug discovery and production as opposed to granting patents or the government creating national R&D labs sooner or perhaps a state-owned drug manufacturer with price caps on drugs and total transparency in process.
Incredible video. I've learnt so much
All the Blessings to you and your family..
I really like your video❤ i was actually having my vacation and have free time to browse through then I chance upon your channel and omg indeed awesome as your way of delivering the information made me focus more and haven't noticed the time that is really enjoyable this is the first time I came to love listening to history.. truly your voice really adds the flavor to it making it more interesting to listen...
❤Thank you so much for sharing this valuable information...
Love from Asia..
PS:I really hope you can make a video on separation of pharmacy and medicine or history of pharmacy perhaps if you have time ❤
Unrelated but you starting the video talking about antidepressants reminds me of how frustrating it is to listen to people preaching about antidepressants and taling meds for mental illnesses. As someone whos struggled with depression for a long time, i'd gladly try anything that works better than antidepressants (dont tell me to just work out and go outside, thats not how depression works) but injavent found anything that helps nearly as much.
Like im not joking, if i wasnt taking antidepressants i probably wouldnt be alive right now.
So not a doctor, and definitely would never tell someone to stop taking their medication, but it might be worth getting vitamin levels tested, in addition to whatever you/your doc are currently doing. For a couple years, I've been have symptoms that /could/ have been my depression worsening, but found out I'm deficient in B12 and D (disclaimer: I am also possibly rocking some pituitary dysfunction, but the B12/D dosage my doctor recommended has been immediately helpful)
I wonder if it has some value to think of the US pharma industry and the situation with patents is basically the US jumping on the hand grenade for the world to an extent. The US suffers because of the profit-seeking motive in patenting medicine and it very clearly and directly has led to some of the biggest negative features of American medicine...but at the same time, that profit incentive helped the advancement of medicine as a whole, world wide, as even foreign pharmaceutical companies can use the massive US market and ability to price gouge all they want with a monopoly to recoup investment. The end result is everyone gets more and better medicine, while the US bears the costs associated with the "necessary evil".
Yup! My parents are in pharma so I’ve seen behind the scenes. Reasonable people can disagree about where to draw the line in terms of innovation/cost tradeoffs, but it drives me crazy when ppl try to act like those trade offs don’t exist
Yet another amazing video!
Thank you. Well done as always!
Kind of like my ADHD medication unfortunately 😢. Name brand Adderall is $200+ but the generics, that are so pick and choose concerning efficacy , are less than $70 tf. And the name brand WORKS!!!
I've never even had the name brand, but I found out early in the shortages that, for me, while IR = no side effects, XR = terrible side effects. That's one innovation that didn't work out for me 🙃 but I have a friend who is the exact opposite
As you mention in the video on "patent lifecycle management", patents work best when you have a responsible office in government handling the application process to ensure the monopoly power they grant isn't being abused. When companies like Apple can successfully get patents for a rectangular slab with rounded edges or, as you mention, pharma companies start to patent as many secondary things as possible, consumers are the ones to pay the, sometimes ultimate, price. It seems a method to disincentivize companies and individuals from trying to abuse the system is needed. The skeptic in me is doubtful that humanity will ever be responsible with patents due to regulatory capture, but hopefully I'm wrong and we'll figure something out.
🌈🌞🌺 I just love your knowledge drops in all of these vids ~ really great work 👍
Remicade is wildly expensive and makes it really hard to keep jobs if you’re not well established in your career already. The charity application applies to a single dose and is exhausting for the people who need it. It’s the gold standard and it’s understandable that it’s never going to be cheap to make since one dose takes dozens of mice. But $7700 is still a lot for a life saving drug
I just started this video. If you can't patent a medical invention where is the incentive to try'n make new innovations? No one would even try if they knew everyone else could just take it and make money off their invention. (It should obviously be a limited time patent)
34:33 extended release and immediate release have different benefits for a lot of medications, I think it’s usually a good thing to have both available.
there should be more competition by government agencies, hospitals and universities against big pharma companies. Let's create non-profit public entities that can bring new drugs to market. They can focus on creating drugs that are highly needed, but doesn't have the interest of pharma companies. New antibiotics for instance.
Medical research in general needs this, so many under-researched conditions
How times have changed! It's so few and far between to hear of any drug even being studied without there being a potential huge payoff in the end.
How can Auvelity ( detromethorphan and bupropion ) 2 drugs available over the counter and as a generics , respectively, be patented? Auvelity is not available as a generic. This drug is $10,00 a dose, when the 2 drugs the themselves can be bought individually for 0.45 cents a dose. By this logic Tylenol and ibuprofen can be mixed together and patented for some new use.
Not a direct answer to your question, but I looked into a similar situation once and it turned out to have nothing to do with the drugs. The company had a patent on the shape of the lid of the inhaler that the drug combination came in. After looking it over, I agreed it was a better lid. I guess they also combined the drugs as a better selling point since people would be prescribed them together anyway, and who wants two inhalers.
The individual drugs are off patent, but the combination is a novel discovery.
Not medical advice, but yes, you probably could. a box of oral syringes + 100mg bupropion and 45mg of dexteomorphan. Ask your dr.
Or a compounding pharmacy could combine the two in the corresponding doses and it would still be substantially less expensive.
Honestly? At least it’s patents over some other types of IP law. Imagine if drug formulations were trade secrets. If the expiry of patents could be just a bit better enforced I think it would do wonders.
try this for expensive.... Keytruda, 88,000$ for 1 mg
Now consider doing a bit on how the lack of IP protection prevents the development of new drugs.
Change the incentive, change the world.
Surprised not to see Escitalopram as one of the me-too drugs. There's no way a specific chirality is a good enough difference to justify another patent, and it seems likely (to me) that Lundbeck knew the left-handed chirality would be slightly better. I think they just released a slightly less effective drug first then released the slightly better version with a small overlap so they could double the years of profits instead of just releasing escitalopram in the beginning.
love your vids
With all of this how come insulin is so expensive in the USA?
PS: yes i think your videos are quite good and informative 👍
Really fascinating. I never knew the role the Civil War played in the development of Big Pharma.
The original idea of Letters Patent, 500 years ago, was to protect start-ups from the power of the Guilds, the established businessmen. It wasn't to make the rich richer.
God that combined with medical commercials are one of many reasons the USA is twisted
I mean, that's the definition of supply and demand. No one's fault that humanity is greedy by nature. Everyone's fault that we don't overcome that nature
The freedom to doom which people are denied is mixing abusing deadly substances with alcohol and calling it a psychological curative tincture
You talk about the amount of revenue that pharmaceutical companies "lost" as a result of patents expiring. This implicitly frames it as if that revenue is something they're entitled to in perpetuity and the patent expiration is doing harm to them. I'm sure their marketing departments are happy with this framing, but your whole video demonstrates that patents are a social contract that gives something for the company that develops the drug - the exclusivity period - in exchange for the cost of developing the drug. It's not a natural right that should last forever.
Maybe I'm overreacting to a minor point of language here but I think it would be helpful to resist this framing by saying something like "the company's revenue declined by X" rather than "the company lost X amount of revenue". To me this takes away any implication that the company was owed that excess revenue after the patent expired.
That's a fair critique. After reading your comment and thinking it over, I think the phrasing of "the industry's revenue only hit X dollars, which is a X% decline from the previous year" is less leading. Thank you for the thoughtful feedback.
Good thing I keep all my secret nostrums to myself.
No, you can't have any, go away. It's mine.
I'd love to see a discussion on how much stock market shareholder profits raise the price of medications and medical devices.
I notice one yhing each created drug has in common ..Massive PROFITs for the "inventing"" Company! What about the actual INVENTOR?
Hi Trevin. The suggestion you make, “turn over all R&D responsibility to research universities” is a practical impossibility. Universities are not capable of doing the kind of modern research done routinely by pharmaceutical companies; and further; the structure of universities probably would prevent them from doing so, forever. There already exists a fairly tight coupling between universities and industry, with regard to pharmaceuticals and many other innovations, largely because of the severe limitations of university research.
It’s difficult to even express the vast gulf in capabilities, if one hasn’t seen pharmaceutical research in both kinds of institutions (universities and companies), but large pharmaceutical companies often have something like 50,000 (fifty thousand) employees, along with major computing and robotic resources, working solely on pharmaceuticals. A typical major research university will employ something like 20,000 employees, spread across 40 departments, with half of these employees assigned to student needs. This implies that universities might dedicate something like 250 (two hundred fifty) employees to pharmaceutical research, that is, something like 200 times fewer employees. Universities simply cannot handle typical full-scale pharmaceutical research and development. There are vast differences in almost any metric you care to examine, in this area. [And of course all of this ignores the notion that universities (apparently) simply don’t want to engage in this kind of research behavior, because academic researchers value their ‘academic freedom’ (and I agree with them).]
Huh, I think you may have meant this comment for a different video on the topic. I don't think I made that suggestion during the video, and of course, my name is not Trevin. Thanks for watching
@@PatKellyTeaches Hi Patrick. I meant my comment for one of the commenters named Trevin (I think) who, like so many folks nowadays, believes he knows how the pharmaceutical world should work. But then I decided that the idea that large pharmaceutical companies dwarf university pharmaceutical departments, is a worthy issue for consideration concerning the expense of novel pharmaceuticals.
For example, Celltech, a 5,000 (five thousand) employee pharmaceutical company, felt it did not have enough resources to engage in Phase III FDA testing. This is because Phase III testing is exceptionally expensive (as I’m sure you’re aware). So Celltech would pre-engage with ‘Big Pharma’ partners when they expected that new drug candidates had a reasonable chance of getting through Phase I & Phase II. The regulatory burden, and associated financial burden, of Phase III drug trials is obviously quite intense. [I personally strongly agree with the requirements, but most countries require no such burdens for new drugs. Rather, they let the United States shoulder the burden of fully verifying new drugs (when the FDA operates properly).]
This of course, contributes to the ‘much lauded’ figure of 1 billion dollars to develop a new drug. [I personally think this figure is low, but that is another matter.]
I chose to put the comment outside a ‘reply to Trevin’ because I think the huge expense of drug approval in the U.S. makes drugs expensive. The patent system was designed from its inception to allow individuals and companies to recoup expenses and make a profit. Ignoring the resources and expenses required to find drug target packages, and then push through for a decade or more through FDA phased approval, presents an incomplete picture [at least, I think it does].
But aside from all that, let me join the cacophony to say: I love your vids… and please do continue. Cheers.
PS Years ago, I did a vid about Paul Erlich’s contributions to early modern pharmacology, The History of Modern Drug Development (by timeparticle). I would be gratified if you would have a look. If you did your own Erlich video, that would of course, be toast-worthy.
Thank you for such an in-depth comment. I hear what you're saying about folks acting as armchair pharma experts. I'm sure they feel like there's a simple solution when there are millions of interwoven systems, interests, and incentives to navigate.
I checked out your Ehrlich video; great work. I mentioned him in my video on Salvarsan, which you can find here: th-cam.com/video/3xxtHTN71jM/w-d-xo.html
@@SystemsMedicine Totally understand why industry might be frustrated with the length/expense of the approval process, but I honestly think that extensive regulation is so important for consumer safety
@@stuffinsthegreat Hi StuffinsTheGreat. I agree with you. It is somewhat frustrating, while also being quite necessary.
[The rest of the world relies on the U.S. shouldering the burden, which is also a bit frustrating, but apparently also necessary. Internally, as well as externally, there are occasional attempts to reduce the quality and quantity of FDA requirements (aside from the typical violations), and people have to work hard to try to maintain the FDA quality controls.]
I have no problems with companies making a REASONABLE profit off of the medications and treaments the produce. The problem currently is the extreme price gouging.
I rely on medication to not die a slow and agonizing death. The MSRP? Nearly $18,000 *per month*. So I must limit my income to afford a Markerplace plan that makes that medication actually affordable. Which means I can't afford other things I need like physical therapy or traveling out of state to see specialists. Or yanno, food.
Our current system is not okay. I know the costs to manufacture my specific medication is less than $300 for my dosage and version. How? Because that's its cost in France without any form of insurance. And that's a high estimate of cost.
¡Great video!
There has been a major finding about nitrosamines in a blood pressure medication - interestingly there was no evidence of these poisonous byproducts being present in the original medication.
There is obviously far more to safe drugs than just patents.
Personally I think the switch to biotech where feasible has been an adequate strategy for the manufacturers to ensure they can continue with their business.
Many people are just envious in the well paid jobs at pharmaceutical companies and I get where they‘re coming from. But underestimating the efforts taken to ensure quality is bad practice.
The prices of drugs in the USA are strange, they are the result of the US market’s structure.
Biosimilars are not generic because they are not a product manufactured with the specific cell line used for the original biologic.
I understand my comment may come over as incendiary but please don’t underestimate the work done by the pharmaceutical manufacturers to ensure their drugs are safe.
I would also like to point to the horrendous pollution in countries like India where generic manufacturers often don’t recycle or incinerate waste and there is also little incentive to ensure the air quality stays at least acceptable.
The manufacturers producing drugs here in the West are legally required to do everything in their power to prevent their operations having an impact on life and the environment. I strongly disagree with cheap equals good.
Those who‘re wishing for socialism:
Guess where many a drug was tested..
I thought the title said patient, not patent, so i got halfway through this video, and i was so confused 😂😂
yep; patents make new inventions expensive by giving the inventor a temporary monopoly.
He can sell for whatever price he chooses.
You can keep using unpatented products; or pay his price.
Does that explain the price of diabetic medicine in the US and not in Canada. Follow the money.😊
ok i subbed bro
That's why patent lawyers are so rich
How do pharmaceutical companies get rich well they bright politicians. We don’t have documentaries on that. It’s a court case right now.. if you’re here to be polite about it and explain it in a nice fashion where you think it’s OK for the public it isn’t. Those people are scumbags and they need to be in jail then prison..
Patents should be illegal
Its so sad patrick kelly shot and stabbed himself 40 times and then jumped infront of a moving car so soon after posting this 😢
commenting Before watching the video:
I hate US medical patents as they are, but i do think some level of patents is useful, due to making money back. But it cant prevent others from using/improving on it.
maybe something like having a 10 year patent where, if people use your pattented chemical/technology, they have to alert you, and pay 1-5% of their profits to the pattent holder.
That way the medicine can proliferate well, while still having a solid money advantage.
Definitely would need some hammering out on the details, that is way beyond me, but definitely better than the BS 20 year pattents that hold back medical research so hard
Without patents drug would be much cheaper and most of them would not exist.
Me watching this while recovering from spinal herniation surgery 😅