I lost a good friend to this. Hope it helps other people.
The meds helped him but he didn't like the side effects so he stopped taking them. Went in and out of homelessness. In the end he thought he had superpowers and could fly. He could fly, but he could not land. It eventually took him.
> M4 and M1 receptor stimulation indirectly rebalances dopaminergic and glutamatergic circuits involved in the symptoms associated with neurological and neuropsychiatric diseases such as schizophrenia and Alzheimer's disease.
> I wanted sort of the opposite of this for opioids - work in the body, not the brain
That's already how some anti-diarrheals work like loperamide. And some anticonstipation drugs like oral naloxone and methylnaltrexone that work as peripheral or locally-acting antagonists
Yes but loperamide doesn't alleviate pain, which maybe just that opioids only alleviate pain if they do reach the brain, but I did see trials for non-bbb crossing ones that were for pain so not sure what's going on there.
It's possible that the analgesic and euphoric effects of opioids are one and the same. In other words, it's centrally dampening the experience of pain, both physical and mental. One is experienced as analgesia and the other as pleasure, but both may share the same mechanism, making one impossible without the other.
Yeah, because it is the high they are after, but not working in the brain would make opioids completely useless for depression and anxiety (for which it really does wonders).
My want is for relieving pain in the body without making me feel high, I actually assumed you want it in the body not brain, as the brain effects are the feel-good effects, but really not sure or familiar with how they work.
"Childhood Trauma is probably the most important environmental factor associated with Schizophrenia. There is evidence of multiple paths between traumatic experiences and psychosis. Mental disorders are systems of interacting symptoms through a framework of networks. Psychotic symptoms in patients with a history of child abuse are more severe, persistent, and refractory to treatment. In developmental years, exposure to neglect and abuse reveals severe adverse effects on the average neurobiological growth, leading to vulnerable neurobiology preceding disadvantageous psychiatric outcomes."
"The guiding principles of trauma-specific care can give you the space to uncover the root of your schizophrenia and trauma. Thus, understanding how your early traumas have impacted you opens the door to dismantling maladaptive coping mechanisms. As you deepen your self-understanding, it encourages you to lean into adaptive coping strategies to process your experiences and life stressors. Furthermore, with support, you can find a path to recovery from schizophrenia and trauma that considers you and your specific experiences."
i'm getting very argumentative on the internet today (under a pseudonymous account because as you might guess from my incessant posting, this issue is personal for me)
trauma (at any time), drug use, other experiences -- all can make schizophrenia more likely in those susceptible. absolutely true.
but it is a biological disease, and healing trauma won't stop its progression. as your source notes, the trauma causes differences in brain development, and once that's done its done.
i don't think coming up with a new drug, the main advantage of which is it doesn't numb you the horrible way existing antipychotics do, is a bad thing.
this is basically a drug that was only created to improve the QoL of people with schizophrenia. if society just wanted to numb them, we already have drugs for that and could just be much more aggressive in violently coercing treatment.
investing in these drugs isn't "looking away", it's putting in a huge investment of many billions of dollars to help the victims live better lives.
"As such, the hippocampus and hippocampal neuroplasticity may also play a key role in resilience and recovery from stress. This is supported by the current finding that hippocampal volume increased following psychological therapy."
I’d like to call you both right on the basis that a working brain at age 40 retired with less than a working brain from age 27 or whenever schizophrenia tends to present.
Outcomes are what we’re hoping to improve. Your data looks like we get brain recovery, which is an improvement to outcomes. Necessary, maybe not sufficient.
All those articles are for PTSD. PTSD is not the same as schizophrenia. Just because psychotherapy helps with PTSD doesn't mean it'll help with schizophrenia. Mental illnesses, and their treatments, are not fungible!
look, if someone has actually have a new drug that works like antipsychotics but doesn't have the nightmare side effects, i am very happy for that person to get filthy rich.
if this pans out the way they hope, by all means give the lead guy a couple yachts or whatever he wants. space tourism, gold statue of himself, whatever. big bonuses all the way down the org chart.
there's the potential to reduce an absolutely staggering amount of human misery here. frankly (again if this pans out) our homelessness crisis would look very different if this drug had existed 20 years ago, when the mechanism of action was discovered.
the people who cared enough and took a huge concentrated risk to do this should just get rich, if in fact it pans out.
> Homeless people are unlikely to pay $20 000 per year which is the price of the drug though.
True, but think about all the people who are fully functioning and productive members of society and got afflicted with this disease. This med will increase the likelihood that they continue to be highly functioning and compliant with the treatment. This will allow them to keep their jobs and cognitive abilities.
Every person I know with this disease has trouble sticking to meds due to side effects, and not sticking to the meds and relapsing multiple times is probably one of the most important reasons that their condition regresses.
"frankly (again if this pans out) our homelessness crisis would look very different if this drug had existed 20 years ago"
Are there numbers, for how many homeless people, are suffering from schizophrenia?
I would assume only a very small number of homeless people has the clinical condition, but those who have it, are just very visible. Most homeless people are hidden usually and avoid attention.
If I were to guess, I would say that while many people may experience bouts of homelessness, the ones with schizophrenia are more likely to be persistently homeless.
this is completely true, but they take up a very disproportionate amount of time and energy from social service providers, people who work in shelters, etc, and make all spaces for homeless people much more chaotic.
the crisis would look very different if it was just a mix of people dealing with drug addiction (but basically lucid and rational) and with poverty.
"drug addiction (but basically lucid and rational) "
Serious drug addicts are seldom lucid and rational.
But I very much do get the point, that solving the schizophrenic problem, would help a lot with everything else. (I am just way more sceptical, that this drug can deliver that)
Bristol Myers Squibb acquired Karuna Therapeutics, the company behind Cobenfy (formerly KarXT), for $14 billion earlier this year so that’s their break even for the drug and presumably what their investors thought was fair. I don’t think Karuna had anything else interesting in trials so they have to recoup all of that from Cobenfy before they’re in the black on the acquisition.
Pharmaceutical companies offload most of the risk onto institutional investors and the public (most biotechs IPO pre-revenue to fund clinical trials) but the flipside is that they have to pay eye-watering sums to acquire promising drugs.
In their last 10-K, Bristol Myers Squibb reported an operating income of $8.4bn on sales of $43.7bn, giving them a gross profit margin of just over 19%.
You shouldn't look at R&D on one product, since lots fail. Would be like saying a record label that funds 100 artists with 1 being profitable should have a strict 20% profit cap on the profitable one. That wouldn't allow ongoing funding of the broader pool of bets.
David Bowie, Mick Jagger and Keith Richards, John Lennon and Paul McCartney. The list of musicians who were “on the dole” to support their music careers before they made it big is huge. It’s almost a cliche at this point. And when they do make it big, their biggest concerts are usually held in stadiums that were heavily subsidized by tax payers.
Besides, Bristol Meyers Squibb acquired this drug for $14 billion which is bigger than the annual budget of the entire NSF. For a single drug. Tax payers weren’t the ones on the hook for that.
Fundamental research slants towards public institutions, advertising and the clinical trials are the main spending the drug companies do, though they have research beyond trials too. Lots of acquiring university spinouts as well.
The gap between "one chemical that targets this thing" and a drug is massive. And basic research might not even end up with the first, just the target idea.
That's fine but even considering that, is 20% only on successes enough to fund the rest of the portfolio that fails? And will it pass the risk free rate of return you can get from money markets or treasuries or whatever?
The US will do anything and everything to solve homelessness as long as it doesn't actually involve building more homes or giving homes to people.
I mean that in a fully genuine way. Just look at how much money gets set on fire cycling the same homeless people in and out of jails and emergency rooms and you can see that nobody actually cares about the amount of money being spent, but only that homes themselves aren't easier to get.
The point of my comment, in response to its parent, is that people in the US are willing to support immense amounts of money being spent on the homeless as long as it doesn't involve housing anyone.
I think the institutional structure of most US states and cities wouldn't blink at spend huge amounts on schizophrenia drugs as long as it doesn't involve any kind of inpatient treatment (forced or not) that would put a roof over anyone's head.
In short, a couple of hundred square feet with decent temperatures, a sturdy lock, and basic facilities. I believe that the de facto illegalization of SROs in US cities is one of the more prominent factors when it comes to both invisibly and visibly homeless populations.
It would cost you $2 with insurance in the US too. It’s a terrible system, it doesn’t make sense, but you have to understand that approximately no one pays the list price for prescription drugs - even people without insurance.
Healthcare in the US is an elite graft, the system will pay the full price. That is actually why prices are so high and hospitals try to keep price tags a secret, because the bill does get paid, and all those executives and investors and even the insurance companies all make off with riches, increasingly paid for by the public. The real crime is setting up indigent people now using drugs on the street to become a massive market for psychiatric medication on the pretense of a pseudo-scientific "disorders" like schizophrenia.
Since there is no chemical or biological test one can do to confirm a schizophrenia diagnosis, it's a subjective diagnosis by practitioners, treating such subjective diagnosis with powerful brain-chemistry altering drugs. Worse, we do not yet know whether these new drugs will be easy to get off of. Some of the other anti-psychotic type medication is VERY hard to get off of, such as abilify, where most drug treatment centers will not deal with Abilify withdrawals or take on those patients because those are so severe (extreme violence, self harm, etc during withdrawal).
Until Psychiatry can reform itself to become a real science, using the scientific method (repeatable, provable results and not just a "theory of how brain chemistry maybe works sorta but we're not sure"), it will continue to just be a big cash cow for Big Pharma while hooking many patients who do not need these drugs onto them for life, while failing to effect ANY cure on the things they are treating (Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure.)
> Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure.
Some people with acute depression can take the meds, work on the underlying issues and taper off, yes.
People with chronic depression likely need to take the meds for life.
People with type I diabetes can't get insulin one time either. People with allergies often take the allergy meds when exposed to allergens, which is always for some.
That's not big pharma being greedy, that's a chronic condition requires chronic treatment.
We don't have cures for diabetes, HIV/AIDS, allergies, plenty of ailments. Having treatments is totally valid even if they are taken forever.
People with the guidance of their doctor stop taking antidepressants all the time. External factors aren't static and often these can change. (separately or because of the treatment)
You do not need to stop treatment unless you and your doctor have decided it is going to be better for you.
Another point I'd make is that we don't have exact mechanisms for action in other treatments like paracetamol. That doesn't make it invalid treatment.
This is so misguided that it's hard to even know where to begin. People who develop high blood pressure without a known underlying cause take a pill for it every day for the rest of their life. You could say the same thing, they're not cured, but what actually matters is that they get to live a full life, unconstrained by the disease even if we don't know the underlying cause. Of course it would be better if we were more advanced of a civilization and figured it out, but the important thing is that these people get their lives back.
i'm curious what is the longest conversation you've ever had with an untreated schizophrenic person?
it's so obviously a "real disease" even if we don't fully understand the biological basis. it's subjective but honestly, there are just a ton of completely obvious cases.
abuses of the psychiatric system are very bad, but schizophrenia is so so clearly real.
> Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure.
There is no medicine in the world that you can take for a limited time to fix problems forever. That's not how medicine works. That's not how the world works.
An enlarged salience network may be responsible for depression in some patients[0]. Some individuals are pre-disposed to being depressed and it may be a chronic condition, like any other chronic condition. For others, it could "simply" be a chemical imbalance that taking medication for a set period of time resolves (lucky them).
I can't stand this term 'game changer', I started noticing it being used a lot during early covid and then the Ukraine war, all for things which did not turn out to be 'game changers'.
You can see its explosive rise on Google Ngrams. Looks like we're still not quite at the peak
An unfortunate requirement of modern attention/engagement economy. Readers hate this one trick, but for the media outlets, if you don't crank up hype clickbait engine to 11, you're out, or running some very niche business.
> Cobenfy, set to launch in October, will have a list price that would cost about $22,500 a year. The influential Institute for Clinical and Economic Review this year estimated that a price in line with expected clinical benefits to patients should be in the range of $16,000 to $20,000 a year. Bristol Myers Squibb executives say most eligible patients are covered by Medicare or Medicaid and wouldn’t pay the list price.
You're being downvoted for using an easily google-able factoid incorrectly because you're pattern matching on "high drug prices"
What happened was Martin Shekreli purchased patents for existing life-saving drugs and raised the price for them from $1.50 to $30 to cover the cost of the purchasing the patents themselves.
The company paid $14b for the research to bring this drug to market. Like all Americans — and all citizens of the world, apparently — I agree that drug prices in the US are too high, but shouldn't they be allowed to at least recoup that investment?
How can we expect companies like this to continue researching such drugs if not? Especially when, more often than not, the research leads to a dead end or failed trials, and they can't even bring the drug to market?
Legends say that Shkreli was actually trying to rip off insurance companies and left individuals alone, even going as far as to give it away for $1 to people without insurance, but I'm not sure.
The FDA is under regulatory capture by the pharmaceutical industry, and their approval or lack thereof is one of the most unreliable measures of the safety and efficacy of psychiatric drugs in particular. Schizophrenia diagnoses are almost entirely subjective in nature (there's no reliable biochemical or biomolecular or biophysical test for the presence or absence of the condition) - really the whole field of psychiatric care for mental health issues is about as useful as tuberculosis experts were in the 1850s, before Koch's demonstration of the infectious microbial nature of the disease.
I’m sort of surprised to see someone claiming schizophrenia is subjective. Schizophrenia has extraordinarily pronounced symptoms. It’s like claiming lupus doesn’t exist because there’s no single reliable diagnostic test for it. Schizophrenia has very specific and easily observed symptoms and is specifically affected by medications such as Zyprexa that doesn’t cause similar changes in behavior for people without schizophrenia or psychosis. However that and related medications have horrible side effects leading most patients to avoid taking it. For people who are or have family members ravaged by schizophrenia this is some of the best news you can imagine - a medication with similar beneficial effects on their loved ones but without turning them into zombies. It feels callous to an extraordinary degree to deny the existence of schizophrenia and to not recognize the benefit to a minimal side effect mediation that can give the schizophrenics life back.
I see this take on the internet a lot usually combined with some statement of how Schizophrenics are secret geniuses and were the prophets of olden times. It just doesn't square off with my own observations of schizophrenics in real life. How is the condition subjective when you see the same types of symptoms across people? I've seen it with men and women afflicted by the condition - always the persecutory delusions, belief that they are some king or prophet/chosen one, disorganized thinking, and word salads. Why is it always the same symptoms? You're telling me that's not rooted in any common condition?
No it’s under pressure from people who go to the press saying “the FDA won’t let me use this drug to help me/my family” who ignore “because there’s no evidence it works” as the reason.
The pharmaceutical just has to tell those people that it does work in their particular case and just ignore the studies that say it doesn’t, and the media and politicians uncritically report that as “the FDA is mean, let pharmaceutical companies sell new and expensive snake oil and re-victimise these people”, then in a few years later the same reporters and politicians berate the “ineffectual” FDA for allowing snake oil.
Regulatory capture doesn’t mean the entire of idea of FDA as a safety mechanism is bad… nor does a legitimate reason for their existence mean that capture doesn’t exist
It is good to hold federal agencies with large power to a very high standard. But that’s often not the case as any critiques get dismissed with the “well they have good intentions and can you imagine if they didn’t exist?” hand wave tactic.
https://archive.is/BYzWs
I lost a good friend to this. Hope it helps other people.
The meds helped him but he didn't like the side effects so he stopped taking them. Went in and out of homelessness. In the end he thought he had superpowers and could fly. He could fly, but he could not land. It eventually took him.
It's this https://en.wikipedia.org/wiki/Xanomeline/trospium_chloride
> M4 and M1 receptor stimulation indirectly rebalances dopaminergic and glutamatergic circuits involved in the symptoms associated with neurological and neuropsychiatric diseases such as schizophrenia and Alzheimer's disease.
Whoa. Wonder if that's being evaluated?
Co-administration of an agonist and an antagonist for the same pharmacophore seems like an interesting approach.
Looks like the antagonist is only outside the brain, so it works to counteract the side-effects, pretty cool.
I wanted sort of the opposite of this for opioids - work in the body, not the brain. There's been a few attempts but non that passed trials.
> I wanted sort of the opposite of this for opioids - work in the body, not the brain
That's already how some anti-diarrheals work like loperamide. And some anticonstipation drugs like oral naloxone and methylnaltrexone that work as peripheral or locally-acting antagonists
Yes but loperamide doesn't alleviate pain, which maybe just that opioids only alleviate pain if they do reach the brain, but I did see trials for non-bbb crossing ones that were for pain so not sure what's going on there.
It's possible that the analgesic and euphoric effects of opioids are one and the same. In other words, it's centrally dampening the experience of pain, both physical and mental. One is experienced as analgesia and the other as pleasure, but both may share the same mechanism, making one impossible without the other.
Would the opposite (work in the brain but not the body) also be a healthier alternative for people addicted to getting high on opiates?
Yeah, because it is the high they are after, but not working in the brain would make opioids completely useless for depression and anxiety (for which it really does wonders).
My want is for relieving pain in the body without making me feel high, I actually assumed you want it in the body not brain, as the brain effects are the feel-good effects, but really not sure or familiar with how they work.
Ibuprofen and acetaminophen may already be that option.
https://www.aafp.org/pubs/afp/issues/2018/0301/p348.html
I believe there are other studies besides this that points to these two OTC pain relievers as being 'just as good' as opiates.
[delayed]
The Role of Childhood Trauma in Psychosis and Schizophrenia: A Systematic Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8858420/
"Childhood Trauma is probably the most important environmental factor associated with Schizophrenia. There is evidence of multiple paths between traumatic experiences and psychosis. Mental disorders are systems of interacting symptoms through a framework of networks. Psychotic symptoms in patients with a history of child abuse are more severe, persistent, and refractory to treatment. In developmental years, exposure to neglect and abuse reveals severe adverse effects on the average neurobiological growth, leading to vulnerable neurobiology preceding disadvantageous psychiatric outcomes."
https://www.theguesthouseocala.com/understanding-the-connect...
"The guiding principles of trauma-specific care can give you the space to uncover the root of your schizophrenia and trauma. Thus, understanding how your early traumas have impacted you opens the door to dismantling maladaptive coping mechanisms. As you deepen your self-understanding, it encourages you to lean into adaptive coping strategies to process your experiences and life stressors. Furthermore, with support, you can find a path to recovery from schizophrenia and trauma that considers you and your specific experiences."
i'm getting very argumentative on the internet today (under a pseudonymous account because as you might guess from my incessant posting, this issue is personal for me)
trauma (at any time), drug use, other experiences -- all can make schizophrenia more likely in those susceptible. absolutely true.
but it is a biological disease, and healing trauma won't stop its progression. as your source notes, the trauma causes differences in brain development, and once that's done its done.
i don't think coming up with a new drug, the main advantage of which is it doesn't numb you the horrible way existing antipychotics do, is a bad thing.
this is basically a drug that was only created to improve the QoL of people with schizophrenia. if society just wanted to numb them, we already have drugs for that and could just be much more aggressive in violently coercing treatment.
investing in these drugs isn't "looking away", it's putting in a huge investment of many billions of dollars to help the victims live better lives.
> once that's done its done
"As such, the hippocampus and hippocampal neuroplasticity may also play a key role in resilience and recovery from stress. This is supported by the current finding that hippocampal volume increased following psychological therapy."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5943737/
"we found a significant [hippocampal] volume expansion during a 12-week treatment period, which correlated with clinical improvement"
https://www.biologicalpsychiatryjournal.com/article/S0006-32...
Increased hippocampal volume and gene expression following cognitive behavioral therapy in PTSD
https://www.frontiersin.org/journals/human-neuroscience/arti...
I’d like to call you both right on the basis that a working brain at age 40 retired with less than a working brain from age 27 or whenever schizophrenia tends to present.
Outcomes are what we’re hoping to improve. Your data looks like we get brain recovery, which is an improvement to outcomes. Necessary, maybe not sufficient.
All those articles are for PTSD. PTSD is not the same as schizophrenia. Just because psychotherapy helps with PTSD doesn't mean it'll help with schizophrenia. Mental illnesses, and their treatments, are not fungible!
look, if someone has actually have a new drug that works like antipsychotics but doesn't have the nightmare side effects, i am very happy for that person to get filthy rich.
if this pans out the way they hope, by all means give the lead guy a couple yachts or whatever he wants. space tourism, gold statue of himself, whatever. big bonuses all the way down the org chart.
there's the potential to reduce an absolutely staggering amount of human misery here. frankly (again if this pans out) our homelessness crisis would look very different if this drug had existed 20 years ago, when the mechanism of action was discovered.
the people who cared enough and took a huge concentrated risk to do this should just get rich, if in fact it pans out.
> the people who cared enough and took a huge concentrated risk to do this should just get rich, if in fact it pans out.
They already did. Bristol Myer Squibb acquired the company behind this drug for $14 billion earlier this year.
Homeless people are unlikely to pay $20 000 per year which is the price of the drug though.
> Homeless people are unlikely to pay $20 000 per year which is the price of the drug though.
True, but think about all the people who are fully functioning and productive members of society and got afflicted with this disease. This med will increase the likelihood that they continue to be highly functioning and compliant with the treatment. This will allow them to keep their jobs and cognitive abilities.
Every person I know with this disease has trouble sticking to meds due to side effects, and not sticking to the meds and relapsing multiple times is probably one of the most important reasons that their condition regresses.
"frankly (again if this pans out) our homelessness crisis would look very different if this drug had existed 20 years ago"
Are there numbers, for how many homeless people, are suffering from schizophrenia?
I would assume only a very small number of homeless people has the clinical condition, but those who have it, are just very visible. Most homeless people are hidden usually and avoid attention.
It's actually quite high. 10%+ in this meta-analysis, and 21% with some form of psychosis.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880407/
If I were to guess, I would say that while many people may experience bouts of homelessness, the ones with schizophrenia are more likely to be persistently homeless.
this is completely true, but they take up a very disproportionate amount of time and energy from social service providers, people who work in shelters, etc, and make all spaces for homeless people much more chaotic.
the crisis would look very different if it was just a mix of people dealing with drug addiction (but basically lucid and rational) and with poverty.
"drug addiction (but basically lucid and rational) "
Serious drug addicts are seldom lucid and rational.
But I very much do get the point, that solving the schizophrenic problem, would help a lot with everything else. (I am just way more sceptical, that this drug can deliver that)
> a price in line with expected clinical benefits to patients
What would a price in line with recouping R&D and production costs and, say, a 20% profit margin be?
Bristol Myers Squibb acquired Karuna Therapeutics, the company behind Cobenfy (formerly KarXT), for $14 billion earlier this year so that’s their break even for the drug and presumably what their investors thought was fair. I don’t think Karuna had anything else interesting in trials so they have to recoup all of that from Cobenfy before they’re in the black on the acquisition.
Pharmaceutical companies offload most of the risk onto institutional investors and the public (most biotechs IPO pre-revenue to fund clinical trials) but the flipside is that they have to pay eye-watering sums to acquire promising drugs.
In their last 10-K, Bristol Myers Squibb reported an operating income of $8.4bn on sales of $43.7bn, giving them a gross profit margin of just over 19%.
https://www.sec.gov/ix?doc=/Archives/edgar/data/14272/000001...
It may not be fair math. The company may bet on 10 different things and just one pays off. It needs to pay off for the bad bets as well.
> in line with recouping R&D and production costs
That's the "recouping R&D" part.
You shouldn't look at R&D on one product, since lots fail. Would be like saying a record label that funds 100 artists with 1 being profitable should have a strict 20% profit cap on the profitable one. That wouldn't allow ongoing funding of the broader pool of bets.
How much of the record label's music production is funded by tax dollars?
David Bowie, Mick Jagger and Keith Richards, John Lennon and Paul McCartney. The list of musicians who were “on the dole” to support their music careers before they made it big is huge. It’s almost a cliche at this point. And when they do make it big, their biggest concerts are usually held in stadiums that were heavily subsidized by tax payers.
Besides, Bristol Meyers Squibb acquired this drug for $14 billion which is bigger than the annual budget of the entire NSF. For a single drug. Tax payers weren’t the ones on the hook for that.
In what sense are you proposing pharma production is funded by tax dollars?
Selling a product to the taxpayers is not the same as funding.
'Bristol Myers Squibb executives say most eligible patients are covered by Medicare or Medicaid and wouldn’t pay the list price.'
Fundamental research slants towards public institutions, advertising and the clinical trials are the main spending the drug companies do, though they have research beyond trials too. Lots of acquiring university spinouts as well.
The gap between "one chemical that targets this thing" and a drug is massive. And basic research might not even end up with the first, just the target idea.
That's fine but even considering that, is 20% only on successes enough to fund the rest of the portfolio that fails? And will it pass the risk free rate of return you can get from money markets or treasuries or whatever?
> What are "Novel" Drugs?
> "Novel" drugs are new drugs never before approved or marketed in the U.S.
Per wikipedia, wholesale for the drug is $1,850/month.
I think I echo my prior comments on the US health and pharma system: why?
[0] https://en.wikipedia.org/wiki/Xanomeline/trospium_chloride
The audacity of pedaling a drug pricetag of $22,000 to solve someone being homeless when government safetynets won't even offer a fraction of that.
It will probably be sold for $220 in other countries.
But hopefully the compounding pharmacies and anti-pharma hacking collectives will solve the pricetag problem here.
https://www.vice.com/en/article/how-to-make-your-own-medicin...
The US will do anything and everything to solve homelessness as long as it doesn't actually involve building more homes or giving homes to people.
I mean that in a fully genuine way. Just look at how much money gets set on fire cycling the same homeless people in and out of jails and emergency rooms and you can see that nobody actually cares about the amount of money being spent, but only that homes themselves aren't easier to get.
imagine thinking that the "homelessness" crisis is only lack of homes.
go talk to a sample and you'll quickly find out it ain't the lack of home.
The point of my comment, in response to its parent, is that people in the US are willing to support immense amounts of money being spent on the homeless as long as it doesn't involve housing anyone.
I think the institutional structure of most US states and cities wouldn't blink at spend huge amounts on schizophrenia drugs as long as it doesn't involve any kind of inpatient treatment (forced or not) that would put a roof over anyone's head.
What qualifies to you as a home? Is it “nice”? Fully finished? Large? In a nice area? In an area with good weather? In good repair?
In short, a couple of hundred square feet with decent temperatures, a sturdy lock, and basic facilities. I believe that the de facto illegalization of SROs in US cities is one of the more prominent factors when it comes to both invisibly and visibly homeless populations.
We tore down all the slums because they were unhealthy and dangerous, and then shoved all the former tenants onto the streets.
Same basic story as asylums.
Wait till Europe gets generics, it will cost less than $5 per month. My MS medication would cost me $8k per month in the US, costs me $2 here.
It would cost you $2 with insurance in the US too. It’s a terrible system, it doesn’t make sense, but you have to understand that approximately no one pays the list price for prescription drugs - even people without insurance.
What medication?
Healthcare in the US is an elite graft, the system will pay the full price. That is actually why prices are so high and hospitals try to keep price tags a secret, because the bill does get paid, and all those executives and investors and even the insurance companies all make off with riches, increasingly paid for by the public. The real crime is setting up indigent people now using drugs on the street to become a massive market for psychiatric medication on the pretense of a pseudo-scientific "disorders" like schizophrenia.
> pseudo-scientific "disorders" like schizophrenia.
Are you saying you don’t believe in schizophrenia?
Let's remember it was recently proven that there is little to no evidence that serotonin levels are linked to depression: https://www.nature.com/articles/s41380-022-01661-0
It's pretty much likely to be the same deal here.
Since there is no chemical or biological test one can do to confirm a schizophrenia diagnosis, it's a subjective diagnosis by practitioners, treating such subjective diagnosis with powerful brain-chemistry altering drugs. Worse, we do not yet know whether these new drugs will be easy to get off of. Some of the other anti-psychotic type medication is VERY hard to get off of, such as abilify, where most drug treatment centers will not deal with Abilify withdrawals or take on those patients because those are so severe (extreme violence, self harm, etc during withdrawal).
Until Psychiatry can reform itself to become a real science, using the scientific method (repeatable, provable results and not just a "theory of how brain chemistry maybe works sorta but we're not sure"), it will continue to just be a big cash cow for Big Pharma while hooking many patients who do not need these drugs onto them for life, while failing to effect ANY cure on the things they are treating (Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure.)
> Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure.
Some people with acute depression can take the meds, work on the underlying issues and taper off, yes.
People with chronic depression likely need to take the meds for life.
People with type I diabetes can't get insulin one time either. People with allergies often take the allergy meds when exposed to allergens, which is always for some.
That's not big pharma being greedy, that's a chronic condition requires chronic treatment.
We don't have cures for diabetes, HIV/AIDS, allergies, plenty of ailments. Having treatments is totally valid even if they are taken forever.
People with the guidance of their doctor stop taking antidepressants all the time. External factors aren't static and often these can change. (separately or because of the treatment) You do not need to stop treatment unless you and your doctor have decided it is going to be better for you.
Another point I'd make is that we don't have exact mechanisms for action in other treatments like paracetamol. That doesn't make it invalid treatment.
What is your doubt about paracetamol? This drug's pharmacology is rather well understood.
About the analgesic activity https://pubmed.ncbi.nlm.nih.gov/31734950/
About the antipyretic activity https://pubmed.ncbi.nlm.nih.gov/29738273/
This is so misguided that it's hard to even know where to begin. People who develop high blood pressure without a known underlying cause take a pill for it every day for the rest of their life. You could say the same thing, they're not cured, but what actually matters is that they get to live a full life, unconstrained by the disease even if we don't know the underlying cause. Of course it would be better if we were more advanced of a civilization and figured it out, but the important thing is that these people get their lives back.
i'm curious what is the longest conversation you've ever had with an untreated schizophrenic person?
it's so obviously a "real disease" even if we don't fully understand the biological basis. it's subjective but honestly, there are just a ton of completely obvious cases.
abuses of the psychiatric system are very bad, but schizophrenia is so so clearly real.
> Have you heard of someone getting "better" after taking anti-depressants and being able to come off them? No. They have to take them for life. That's not a cure.
There is no medicine in the world that you can take for a limited time to fix problems forever. That's not how medicine works. That's not how the world works.
Antibiotics (Most of the time) Everything surgery, I would include gene replacement therapy and auto transplants in its viccinity.
An enlarged salience network may be responsible for depression in some patients[0]. Some individuals are pre-disposed to being depressed and it may be a chronic condition, like any other chronic condition. For others, it could "simply" be a chemical imbalance that taking medication for a set period of time resolves (lucky them).
[0]https://www.nih.gov/news-events/nih-research-matters/mapping...
I can't stand this term 'game changer', I started noticing it being used a lot during early covid and then the Ukraine war, all for things which did not turn out to be 'game changers'.
You can see its explosive rise on Google Ngrams. Looks like we're still not quite at the peak
https://books.google.com/ngrams/graph?content=game+changer&y...
Ok, we've unchanged the game in the title above.
An unfortunate requirement of modern attention/engagement economy. Readers hate this one trick, but for the media outlets, if you don't crank up hype clickbait engine to 11, you're out, or running some very niche business.
Readers hate this one trick, click to find out why!
At $22.5K/yr it'll be more money changer than game changer.
In the early days just before and just after AGI, all of a sudden a lot of games will be changed in a short period of time.
"Double down" has a similar chart, another annoying phrase.
> Cobenfy, set to launch in October, will have a list price that would cost about $22,500 a year. The influential Institute for Clinical and Economic Review this year estimated that a price in line with expected clinical benefits to patients should be in the range of $16,000 to $20,000 a year. Bristol Myers Squibb executives say most eligible patients are covered by Medicare or Medicaid and wouldn’t pay the list price.
Didn't some bro from the pharma industry get mercilessly shat upon for charging so much for a life saving drug?
You're being downvoted for using an easily google-able factoid incorrectly because you're pattern matching on "high drug prices"
What happened was Martin Shekreli purchased patents for existing life-saving drugs and raised the price for them from $1.50 to $30 to cover the cost of the purchasing the patents themselves.
This is an entirely different.
How people feel about facts is much more important than the facts themselves.
The perception of the drug price increase much more than the details, along with other asshole things he did made him an easy target for outrage.
What is the cost of mass producing this new drug? How much profit should the company be allowed to make? Where's the outrage?
The company paid $14b for the research to bring this drug to market. Like all Americans — and all citizens of the world, apparently — I agree that drug prices in the US are too high, but shouldn't they be allowed to at least recoup that investment?
How can we expect companies like this to continue researching such drugs if not? Especially when, more often than not, the research leads to a dead end or failed trials, and they can't even bring the drug to market?
Legends say that Shkreli was actually trying to rip off insurance companies and left individuals alone, even going as far as to give it away for $1 to people without insurance, but I'm not sure.
If the FDA was truly interested in game changing it would lead. As it is, it's a sock puppet for Big Pharma.
https://michaelpollan.com/books/how-to-change-your-mind/
The FDA is under regulatory capture by the pharmaceutical industry, and their approval or lack thereof is one of the most unreliable measures of the safety and efficacy of psychiatric drugs in particular. Schizophrenia diagnoses are almost entirely subjective in nature (there's no reliable biochemical or biomolecular or biophysical test for the presence or absence of the condition) - really the whole field of psychiatric care for mental health issues is about as useful as tuberculosis experts were in the 1850s, before Koch's demonstration of the infectious microbial nature of the disease.
I’m sort of surprised to see someone claiming schizophrenia is subjective. Schizophrenia has extraordinarily pronounced symptoms. It’s like claiming lupus doesn’t exist because there’s no single reliable diagnostic test for it. Schizophrenia has very specific and easily observed symptoms and is specifically affected by medications such as Zyprexa that doesn’t cause similar changes in behavior for people without schizophrenia or psychosis. However that and related medications have horrible side effects leading most patients to avoid taking it. For people who are or have family members ravaged by schizophrenia this is some of the best news you can imagine - a medication with similar beneficial effects on their loved ones but without turning them into zombies. It feels callous to an extraordinary degree to deny the existence of schizophrenia and to not recognize the benefit to a minimal side effect mediation that can give the schizophrenics life back.
I see this take on the internet a lot usually combined with some statement of how Schizophrenics are secret geniuses and were the prophets of olden times. It just doesn't square off with my own observations of schizophrenics in real life. How is the condition subjective when you see the same types of symptoms across people? I've seen it with men and women afflicted by the condition - always the persecutory delusions, belief that they are some king or prophet/chosen one, disorganized thinking, and word salads. Why is it always the same symptoms? You're telling me that's not rooted in any common condition?
> Game changer in treatment of disease we can't even define
Doesn't quite have the same ring to it, now does it?
No it’s under pressure from people who go to the press saying “the FDA won’t let me use this drug to help me/my family” who ignore “because there’s no evidence it works” as the reason.
The pharmaceutical just has to tell those people that it does work in their particular case and just ignore the studies that say it doesn’t, and the media and politicians uncritically report that as “the FDA is mean, let pharmaceutical companies sell new and expensive snake oil and re-victimise these people”, then in a few years later the same reporters and politicians berate the “ineffectual” FDA for allowing snake oil.
Regulatory capture doesn’t mean the entire of idea of FDA as a safety mechanism is bad… nor does a legitimate reason for their existence mean that capture doesn’t exist
It is good to hold federal agencies with large power to a very high standard. But that’s often not the case as any critiques get dismissed with the “well they have good intentions and can you imagine if they didn’t exist?” hand wave tactic.