Medicine is probably the second best place after military where we can observe how greed and corruption are literally killing people.<p>I'm living in Russia and recently have been involved in medical devices market here. The local market for cardiology stents (little springs they insert non-surgically into your heart to remove artery clogging and prevent heart attack or stroke) has been long occupied by the three US companies. The Russian company I invested in, made their own stent design and launched a production factory in Western Siberia. Our prices are three to four times lower that prices for the same class of stents from the US competitors and the quality is the same or higher. We fought out 15% or the market for the last two years.<p>I have to say, that almost 99% of all stents in Russia are installed at the cost of the state medical insurance - every person in Russia is covered by this insurance, and that insurance is just sponsored by the state or local budget. The budget allocated to this kind of medical support is fixed, so if the yearly budget is 100M rubles (our local currency) and cost of a manipulation and a stent is 100K rubles then you can install stents in 1000 patients in one year. If the price goes down four-fold, then it will be 4000 patients. And this stent manipulation is a life saver in true sense of this word. So, basically with our stents we can save four times more people's lives, which on a scale of Russia would be tens of thousands of people.<p>Here enters the greed and corruption. One of the US companies approached one of the most powerful Russian oligarchs with good ties in the government. He lobbied a government decree stating that this US company will be single supplier for cardiology stents starting Jan, 2017. So, all hospitals and clinics are obliged to buy stents only from them, at the price they set. Tens of thousands of Russian people will die each year because of the greed and corruption - and we can't do much about it.
The Hackers groups are doing what they can to expose Mylan's (EpiPen makers) Greed which is laudable. What is really needed is also an explainer on why a bit of govt. leverage (socialism if you will) is good in Medicine Pricing as well.<p>Mylan is a really great user of buying legislation.
They leveraged their 90% market ownership of the epinephrine auto-injector market such that<p>[1] It lobbied hard to ensure that all parents of school going kids (or tax payers) paid for EpiPens by making it into a bill that politicians could easily justify.<p>Once the bill passed and schools all over the country purchased these by the boatloads, then they just kept raising the price over and over and milking the profits.<p>When it got too much and they could not ignore the patient backlash they have turned again to purchasing legislation..<p>[2] Now they want to make it so that the patients do not see the copays - instead every one suffers by paying more for health insurance.<p>[1] <a href="https://www.opensecrets.org/lobby/billsum.php?id=hr2094-113" rel="nofollow">https://www.opensecrets.org/lobby/billsum.php?id=hr2094-113</a><p>[2] <a href="http://www.nytimes.com/2016/09/16/business/epipen-maker-mylan-preventative-drug-campaign.html" rel="nofollow">http://www.nytimes.com/2016/09/16/business/epipen-maker-myla...</a><p>With scumbags like these, is it any wonder that the USA has the most expensive healthcare system in the world?
Probably too late to really contribute, but either way -<p>I feel like health is a degenerate case of free markets. In any free market, the price is set by the consumers assessing their utility for the goods or services purchased. In cases of pencils, productivity software, energy, raw materials, etc, consumers compare the methods of resolving the need, or at baseline the cost of not addressing the need.<p>In healthcare, there are lots of situations where the cost is X dollars vs literal death. Of course, death is not an acceptable alternative, so an acceptable X ends up being very, very high for the treatment. Most people would pay their life savings to treat themselves of any life-threatoning ailment.<p>I honestly believe that free markets setting prices is good for most industries, but I cannot see it working in situations where the benefit categorically supercedes any amount of money.<p>It seems like we need to either rethink IP law surrounding healthcare, or have a monopsony (single payer or something else) setting prices.<p>This is a hard thing for me to resolve, as somebody who normally likes a libertarian approach.
The title could be rephrased as "Cheap guys risk the lives of thousands of people by promising savings of a few bucks".<p>The problem is not with the "greedy corporations", but with the poorly dedigned legislation regarding intellectual property rights.<p>The state created the protectionist environment in which companies can become bullies and be sure that they won't be exposed to any economic competition.<p>Of course, the complete lack of IP laws would deter companies from investing in research, but the same effect have too strong IP laws. Why would a company risk their money and do research once they found a cash cow which can be milked for a long time, having the state guarantee it?
TIL that an "autoject" is an inexpensive self-injection tool commonly used by diabetics[1] that can be carried safely and used easily. It can be loaded with Insulin, or with any drug whatever. The OP article describes using it to inject epinephrine, stating that<p>> A 1mL vial of epinephrine costs about $2.50... Doses range from 0.01mL for babies, to 0.1mL for children, to 0.3mL for adults.<p>In other words, if your doctor will give you a prescription for the drug itself, you could assemble three epipen equivalents for less than $100.<p>[1] <a href="https://smile.amazon.com/AJ-1311-Autoject-Injection-Removable/dp/B002M3TBUS/" rel="nofollow">https://smile.amazon.com/AJ-1311-Autoject-Injection-Removabl...</a>
(preparing for an onslaught of down votes, but here we go.)<p>It's awesome to see a 'hacker' building a $30 EpiPen. But looking only at the materials cost for a medical device ignores the millions (sometimes billions?) of dollars spent on R&D, IP licensing, and (perhaps most significantly) regulatory compliance.<p>The pricing system for devices and drugs is definitely screwed up in the US, but Mylan's 36% gross margin on the devices doesn't seem criminal.<p>Perhaps they're padding their cost numbers. And perhaps there are IP shenanigans at play that I'm not aware of. But one needs a thorough understanding of the <i>total</i> costs to invent, develop, achieve regulatory clearance for, and market a medical device in order to assess the morality of the pricing.
This doesn't feel like the right platform for DIY. When someone needs an EpiPen, it's because they might be dying. Presumably, a large and well-capitalized organization will have tested their device extensively and can offer better guarantees about it actually working (I should stress <i>presumably</i>). There are a lot of ways in which the hacker mindset can be beneficial to society, but this particular application feels like an ethical gray area.
So "Four Thieves Vinegar" says their DIY auto-injector works probably almost as well as the EpiPen. Sign me up! </s><p>Are we really complaining about an "onerous regulatory process" for a device which untrained laymen need to be able to use in a high stress emergency situation?<p>I'd like to see Four Thieves Vinegar fund the necessary trials to prove their device is safe, gain FDA approval, bring the device to market, and defend themselves against the inevitable lawsuits, and <i>then</i> tell us how they can sell the device with less than 80% gross margins. The marginal cost of making one more pill or one more device is almost entirely irrelevant, and any article that tries to make a case for a medical product being overpriced based on COGS isn't worth reading IMO.<p>The price for EpiPens went up because no one else was able to make a competing product that didn't malfunction or deliver the wrong dose of epinephrine.
I feel like a lot of the commenters here didn't read the article.<p>> Four Thieves Vinegar have created and uploaded the plans for the simple version, called the Epipencil. Also spring loaded, the parts are gathered over the counter. The epinephrine will still need to be acquired with a prescription.<p>This still involves an FDA-approved drug obtained through normal channels; the DIY part is the injector.<p>Creating DIY medical drugs would certainly be something to be concerned about, but I don't see the problem with DIY medical tools.
"Hacking" medicine doesn't really work. See Theranos.<p>First, epenephrine degrades when exposed to light so your epipencil may be ineffective from the start.<p>Second, parents when measured took 2.5 minutes to fill a syringe with epinephrine which is not fast enough in an emergency.<p>The price gouging is terrible. There are cheaper alternatives but Epi-pen has the most well known brand.<p>People buy Tylenol and Advil not Aspirin and Ibruprofen.<p>Drs have appealed to ban drug advertising. Medicine should have no place in capitalism.<p>Source: <a href="http://www.aaaai.org/ask-the-expert/effect-of-light-on-epinephrine" rel="nofollow">http://www.aaaai.org/ask-the-expert/effect-of-light-on-epine...</a>
Michael gave a fantastic talk at Hope this year titled "how to torrent a pharmaceutical" where he made Daraprim on stage for only a few cents. Its defingely worth watching: <a href="http://livestream.com/internetsociety3/hopeconf/videos/130731041" rel="nofollow">http://livestream.com/internetsociety3/hopeconf/videos/13073...</a>
If you are persistent, you can get CVS to order the "generic" epinephrine injector for $5.<p><a href="https://www.facebook.com/barbara.k.hollinger/posts/1285236738177708" rel="nofollow">https://www.facebook.com/barbara.k.hollinger/posts/128523673...</a>
The hack here is simple: this group did not get FDA approval for their device. Greedy corporations have <i>repeatedly</i> tried to make money by competing with Mylan with cheaper Epipens, but they've been prohibited from doing so by the US government (not so in Europe, where the unfortunate Europeans suffer <i>eight</i> greedy corporations trying to drive prices down).<p><a href="http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-chairs/" rel="nofollow">http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-dr...</a>
I just checked and here in China you can buy 10x1mg doses of epinephrine (which is actually adrenalin) over the counter/online for 4元 ($0.6USD) ... <a href="https://world.taobao.com/search/search.htm?sort=price&_ksTS=1474517174609_40&search_type=0&json=on&module=sortList&_input_charset=utf-8&s=0&navigator=all&q=肾上腺素" rel="nofollow">https://world.taobao.com/search/search.htm?sort=price&_ksTS=...</a><p>That means the epinephrine (adrenalin) itself is essentially free. What do they charge in the US/Europe/Australia?
It may be better than having no epinephrine at hand. But other than that, there are a lot of problems: How sure are you that it will work when you need it? Can you fill the syringe cleanly enough? Will the epinephrine in the syringe degrade, or worse, develop a bacterial growth?<p>It may be a better Idea to look into a syringe+vial combination on hand, prescribed by a doctor. Less convenient, and you need to learn how to use it (and preferably teach those close to you), but this may be a whole lot safer. The downside of course is the problem of self-administration when in anaphylactic shock.
I've had to use an EpiPen twice in my life. Oh my gosh, the terror in your heart when you're self administering it is real. I will never forget the experience for the rest of my life. I don't want to trust some hack with no FDA approval in that moment.<p>I don't give a damn if the product is $50 or $500. I will buy it, it's saved my life many times. Its not awesome to see a hacker point out while the materials are cheap
Wouldn't it be better to focus on the reasons why there is no viable competition for this company even though the business seems to be extremely profitable?<p>The article links to another that lists some of the issues:
<a href="https://www.statnews.com/2016/09/09/epipen-lack-of-innovation/" rel="nofollow">https://www.statnews.com/2016/09/09/epipen-lack-of-innovatio...</a><p>This points out (among other things) that the design is patent protected and FDA rules make it difficult to come up with other designs that don't violate the patent. It is also mentioned that the devices need to go through long and expensive regulatory process.
Regarding the original price hike which motivated this project, I saw an interesting perspective on the matter: <a href="https://www.youtube.com/watch?v=RoMlxVimwiU" rel="nofollow">https://www.youtube.com/watch?v=RoMlxVimwiU</a><p>Now granted Shkreli is a controversial figure, but basically drug companies are businesses, and if you sort of detach yourself and look from a business perspective and value-based pricing, Epipen competes with the ER, and $600 is a bargain vs an ER visit.<p>And of course his ultimate conclusion is that maybe life saving drugs are more like water and power than cell phones and wine? Maybe the government should get involved in making generic drugs available.
Somewhat tangential: I surmise that this title will be subject to editing by HN staff, but I think that "Hacker group creates $30 DIY Epipen to expose corporate greed and save lives" is an exemplary post title for HN and want to see more like it.
Just saw more Epipen Congressional testimony. The actual unit cost of the Epipen (whether branded or "generic") is around $67 USD. Assuming that this cost were not overly inflated beyond actual overhead and unit costs, in order to be sustainable, a reasonable retail price without distributors would be $134 USD... with distributors $200-238.<p>That said, the more downward pressure from competitors (commercial or nonprofit projects), the better for customers; especially where a monopoly existed, it's rational to for customers to band together and attack excessive hegemony.<p>Enteprising folks need to jump on this to sell this as a kit (w/ or w/o the medication).
"3.1.24 The health economics model assumes that people who receive adrenaline auto-injectors will be allocated two epinephrine pens (EpiPens) with an average shelf-life of 6 months. Each auto-inject EpiPen costs the NHS £28.77 (British national formulary 60). This equates to £115.08 per person per year."<p><a href="https://www.nice.org.uk/guidance/cg116/resources/costing-report-136427293" rel="nofollow">https://www.nice.org.uk/guidance/cg116/resources/costing-rep...</a><p>From 2011 - but I can't imagine the cost has gone up by that much.
$30 is way too much, production cost of EpiPen is probably in single-digit dollars, maybe even less. That's not the point, nobody thinks EpiPen costs $300 to produce.<p>The system it built in a very specific and deliberate way in the US - there are patented drugs that are expensive, by design, and the pharma is supposed to finance R&D and FDA testing and so on from that money, instead of financing it through taxation, or venture investing, or other means. Now, one can claim maybe Mylan is abusing the system and the money that were supposed to finance R&D are instead financing lavish salaries or whatever. And one can claim the system should not be built at all like this but should be built other way. Maybe.<p>But completely ignoring the whole design and saying "ah, we've discovered it costs $30!" is useless. Yes, it actually costs even less to manufacture, way less. It's obvious. The reason why Mylan charges more is not because it costs a lot to manufacture. The reason is because that's how patented drugs market in US works. If one wants to change it, it needs to be understood how it works. It's not corruption, it's the design of the system.
There are 3 epipens in this article.<p>The non-generic at ~$350<p>The generic at ~$150<p>And the homemade at ~$30<p>The homemade is equivalent to the generic and the difference between generic and non-generic is not clearly mentioned so let's talk about the price of the generic epipen.<p>According to the article there is difficult bureaucracy to navigate and very large liability should an epipen fail. On top of that there's distribution and offices that needs a cut or to be paid for.<p>Is 5x markup that horrible?
Ther's an abysmal difference between hacking something together an manufacturing a reliable product at scale that people can bet their lives on. Everything, from R&D to the cost of lawsuits, FDA trials and regulatory frameworks makes these comparisons dumb and ridiculous.<p>I've been manufacturing products for thirty years. It's never simple for good products, not even a cup of coffee at Starbucks.
I am a hacker at heart, and I believe there are definitely some shady dealings with government and industry lobbyists, however, I like to look at things on both sides, since there is always another side.<p>Truth is if it was more than one hacker in this collective making the 'Epipencil' they must have designed, procured materials, fabricated and did this all in less than an hour to say $30, and they would have had to do all of that in less than an hour to meet minimum wage requirements.<p>This does NOT speak to QA/QC, testing, insurance, FDA approval, legal costs or even their hacker lab overhead in equipment and energy to make one, let alone hundreds of thousands of these potentially life-saving products.<p>My guess is that the $150 per Epipen is close to what you need to fulfill all of the above and then some requirements. Far from the $300 or more in pen price hikes, so it was good they did this as an exercise for putting Mylan and government in the spotlight. Bravo, really!<p>My belief is that it is not solely big bad corporations, but big bad government AND big bad corporations. Just look at the moral integrity of our two current POTUS candidates.<p>I am trying to become more financially literate in my old age, and I am trying to teach my children likewise, since financial illiteracy is a deterrent to poor people improving their lives, or hackers making a worthwhile dollar in conjunction with learning and exploration.<p>I tell my kids to think twice when they reactively say or answer:<p>"ASAP" - when is that? Point to a date on the calendar;<p>"It will take 5 min." - It never takes just a minute or five;<p>"It only cost $8 for the materials." - How much is your time worth? Learning is a benefit that cannot be quantified too easily, but for other matters, you need to value your time.
The expected market response should have been a flood of alternatives at 1/100 or even 1/10 the price since the base ingredient costs pennies. But these 'ideal' market scenarios that are in public interest rarely come through.<p>What we often get instead are completely self serving and crafty efforts in collusion with 'ngos' and lobbyists to leech tax payer subsidies and 'force' it onto institutions via legislation.<p>This pattern is repeated so often and widely its predictable. Also predictable is framing it as a capitalism vs socialism issue to trigger and distract while the corruption continues unabated.<p>The problem is healthcare is critical. If your checks and balances and idealised system does not work you risk letting people feed on others desperation and create demons. And these sociopaths then multiply within your society killing it from within. This is the biggest argument for socialized healthcare.
> corporate greed<p>Can we please give blame where it's due? <a href="http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-drugs-vs-chairs/" rel="nofollow">http://slatestarcodex.com/2016/08/29/reverse-voxsplaining-dr...</a>
The original costs about 33€ in Slovenia <a href="http://www.cbz.si/cbz/bazazdr2.nsf/o/208079B7D727DABEC1257C780004AFA0?opendocument" rel="nofollow">http://www.cbz.si/cbz/bazazdr2.nsf/o/208079B7D727DABEC1257C7...</a>
This is an interesting approach. I've been wondering about refilling the things -- once the injectors I have expire, I may disassemble one to see if I can work that out.<p>As long as the needle hasn't been used, and the refill is the same dosage as it came with, I'd expect it to be just as effective as a new injector.<p>(Disclaimer: I am not a doctor, even if I were you're not paying me, this is not medical advice)<p>This may be legal to do commercially as well, since you're not manufacturing new devices that could infringe the patent. Sorting out FDA issues would be the only hard part (though likely very hard).<p>(Disclaimer: Nor am I a lawyer, and you are still not paying me, this is not legal advice)
There are so many reasons the EpiPen costs $318, corporate greed being one of them. One of the huge reasons that no one talks about is that most rarely actually sell for $318. It's priced at that, but insurance companies negotiate a lower (unpublished) price in most/all insurance purchases. It's only those with no insurance or who are buying it without insurance that pay the full price.<p>This is true for nearly all drugs, medical equipment, or medical procedures in the US. This is one of the huge problems with our system. Everyone puts a huge price-tag on their stuff knowing that insurance with negotiate down.<p>To me, this seems like the biggest problem here.
Is EpiPen that well known among Americans? I (non-American) never heard of it until all the news about it's price in the US.<p>Does it get prescribed more often in the US than other countries? Why didn't I know about the existence of this thing?
Other big grownup companies have tried to make a precise injector, and not done nearly as well as Epipen. It's not just a needle in front of a spring. (I haven't read the article, it won't load atm.)
it does cost $30 to make an epipen.<p>However.<p>It needs to be proved to work, which is rightly arduous. Unlike in (most)software, you can just fix it later. Defects kill. There needs to be a high bar of evidence to prove that:<p>A) the drug works<p>B) It doesn't cause your face to melt off<p>C) its reliable.<p>All of this is costly, Now, you have two choices, nationalise your drug R&D and charge a uniform cost spread over all drug classes, or through general taxation. Or Sweep away all your regulations on drug prices and start again. (like why the fuck is medicaid not allowed to collectively bargain on price? that's taxpayer subsidy right there...)<p>In the UK there is a thing called NICE, which is semi autonomous and run by people who can understand stats (ie not politicians) its job is to evaluate the cost of drugs, and crucially the effectiveness of all drugs prescribed within the NHS.<p>Is the drug actually effective? (sure 50% more powerful, but it costs 190%, just double up the old one, etc etc)<p>does it provide value for money?<p>is it safe?<p>are all the questions they ask. If a drug fails the tests its either written out of guidelines, or more unusually its banned.
Pretty neat. I wondered why you could just use an autoinjector like diabetics use (answer you need a larger diameter needle). Still easily doable and its all off the shelf made by medical device manufacturers and drug makers so not so much "DIY" as "repurposing existing medical gear to be more versatile".
How much does it cost to get and maintain FDA approval for marketing the EpiPen? What are the financial costs of the legal risks you are taking by selling it to patients? In other words, if it's so lucrative, why isn't anyone else doing it?
Thats like saying pirated software exposes the greed of software companies. I don't think that anybody believes that EpiPens themselves are very expensive at all - just like software, the cost comes from the cost of development, which in this market consists mostly of regulatory compliance and approval. If it were easy to bring an epinephrin injector to market, Teva would have already done so and Sanofi wouldn't have had to recall theirs. If there were more auto injectors on the market, the prices would go down.<p>The outrageous price of EpiPens is not a result of corporate greed so much as a failure of the FDA and Congress - but mostly Congress, the FDA is their subordinate. They failed to promogulate rules that maintained a competitive market for epinephrin auto injectors.
Ok so Mylan can get them made for $30 and sells them (now) for $150. Is a 5X sale price not acceptable? If not why aren't people going after every single product manufactured and sold?<p>Don't get me wrong, I'm not defending anyone here; that whole industry needs some fixing. I'm just tossing out the question.
Url changed from <a href="https://www.minds.com/blog/view/625077755582623755" rel="nofollow">https://www.minds.com/blog/view/625077755582623755</a>, which points to this.
It costs $30 to make an EpiPen at home why dont you create a company and sell it for $50 and solve the problem all ya complaining about ?<p>Mylan deserves our appreciation for inventing EpiPen when none of the other smarty pants who claim to make it in $30 bothered to help the needy.
DON'T POP A NEWSLETTER FORM OVER THE TEXT I AM TRYING TO READ.<p>I'm sure this is an interesting article but the only way we will stop this practice is if we stop giving user-hostile publications our eyeballs.
Watch the video. All described is loading epinephrine into an autoinjector. This is great because it suggests the barrier to competition is relatively low hanging fruit for those already in the drug delivery markets.<p>Also: screw mylan
If the product is so expensive, and someone can make a competing product for less viably I find it hard to believe that it hasn't been done. A more fair comparison would be "medical aid which wasnt subjected to the same regulations and testing is cheaper to make and distribute" aka Corporate greed.
If someone knows how to make a product for $30 that the competition charges $300 for, why not go into business and undercut their price by a huge margin? Millions of users' lives would be instantly improved with dramatically cheaper epipens. That will do far more to combat greed than a blog post.<p>However, I think that if someone were to try this, they'd find there are many more costs involved than the raw ingredients and it might not be quite so simple to massively undercut the competition. But still, they should go for it! Competition is is the best medicine for over priced goods.