[Pseudoscience-is-malarkey (OP)]

Whether medication is paid for out of pocket or through one's health coverage, they're very expensive during it's first 10 years of existence. I suppose it has something to do with how much money goes into making the drug. I imagine a small army of highly educated researches that eat, sleep and breathe their work.

[evan_au]

medication ...they're very expensive during it's first 10 years of existence.

When the patent expires, many "generic" pharmaceutical companies start producing the drug, and the price falls significantly.

I suppose it has something to do with how much money goes into making the drug.

I understand that a very small percentage of medications that show some promise in the petri dish actually make it through the FDA (let alone similar regulatory bodies in other countries) to a medication that can be sold to the public (or via prescription). They must show that they are effective and safe and more effective than existing treatments, in a series of trials of rapidly escalating size.

The cost of the process averages around $US10 billion. And this must be recouped before the patent expires!

This is why some charity organisations are targeting "neglected diseases"; diseases that currently have no effective cure and afflict the poorest people in the world who could not possibly afford to pay for standard development and approval processes.
See: https://en.wikipedia.org/wiki/Neglected_tropical_diseases

[chris]

This can be crystallised as follows:

1) Finding the chemicals that will be good candidates in the first place is tricky.

2) Only a fraction of the compounds make it through an initial screen against cells in a dish. Many are too toxic or just don't work.

3) A further tranche fail in animals on toxicity and efficacy grounds.

4) In human trials the cost of proper testing and investigation is extremely high. Few agents make it past phase 2 where the agent is compared in efficacy terms against the existing best practice.

5) Phase 3 trials involve thousands of patients and huge teams of healthcare professionals collecting and analysing data to look for effects, side-effects, interactions and overall safety.

6) Protecting, licensing and marketing the agent adds a further burden once the agent makes it this far.

7) The market lifetime for the agent, while it remains under patent, is short. During this window, the creator must recoup all of the costs invested in the creation of the agent AND simultaneously bankroll the discovery of novel agents.

There are further deterrents against certain classes of compounds such as antibiotics. The risk of bacterial resistance means that the effective revenue-generating lifetime for a drug might be grossly curtailed. Companies are therefore not pursuing risky leads and instead favour targeting chronic conditions like blood pressure, ulcers and cholesterol. So you might die of MRSA infection, but at least you won't have a stroke!

[Pseudoscience-is-malarkey (OP)]

Most of us have our medicine paid for by our insurance or charities, therefore most of us are in ignorance of how expensive they really are. It all just feels irrelevant I suppose. I don't think i've ever paid more than six bucks on a copay in my life.

[chris]

The NHS is the same. Many drugs are subsidised so patients pay the standard prescription charge (less than £10) and may receive drugs costing thousands. The most expensive thing I ever administered was for a patient with a rare blood disorder. It was a synthetic blood clotting factor costing £7000 per tiny phial... My hands shook so much when I got it out of the fridge that I nearly dropped it...

[Pseudoscience-is-malarkey (OP)]

If there's one problem with universal healthcare (such as the NHS, CHA and Medicare/Medicaid), it is that 99.9% of the population are unaware of the costs, as the government takes the bill. The pharm companies can charge what they want without the public asking questions and demanding moral clarification. 

[alancalverd]

It isn't a problem. Everyone who works in a civilised country pays taxes that cover at least part of a state health service, so when we are working we know exactly how much it costs, and when we are sick, we don't have to worry about the cost. Bankruptcy in Europe, Canada and Mexico is caused by poor business practice, not toothache. 

In corrupt, backward countries like the USA, politicians get free healthcare at public expense, and spend a fair bit of time trying to ensure that nobody else does. The reason the USA can deploy a huge professional army has less to do with patriotism than with free family healthcare.   

As far as the UK is concerned, about  90% of healthcare is in the public sector so the NHS can (and usually does) negotiate good bulk deals for common pharmaceuticals and equipment. There is a continuing tension between the Tory party who want to break the NHS into independent privatiseable parts (which would of course increase the profits of the pharma industry and property developers) and common sense, but for the present, common sense seems to be hanging on. 

[Pseudoscience-is-malarkey (OP)]

In corrupt, backward countries like the USA, politicians get free healthcare at public expense, and spend a fair bit of time trying to ensure that nobody else does. The reason the USA can deploy a huge professional army has less to do with patriotism than with free family healthcare.   

Actually, politicians do not get free healthcare. The cost of it is taken out of their paychecks at least once a month, just as it is with me and all other people with private insurance.

[alancalverd]

You are right! Under the new rules, the state (i.e. the taxpayer) only pays 75% of the premium for members of Congress (including "retirees", i.e. politicians who have been sacked by the electorate for incompetence, corruption or laziness) and the premium is related to tobacco use.

The USA is slowly emerging into the 17th century, and I strongly approve of the tobacco loading.

[puppypower]

One of unseen problems is, drug development and drug compliance relies too heavily on statistics. The problems with this is the natural folding of proteins demonstrates that statistics do not apply to the bulk of a cell's configurations used for synthesis. The net result is the wrong tool is being used do the job. It is like building a house with a screwdriver, instead of using a hammer. If we did this, the job can get done, but the costs will go up, since that tool is not the best for the job.

Statistics are preferred, in spite of this technical problem, because you can mass train workers to use a black box procedure. The alternative would require more sight and less blindfold; logic and reason. However, this is harder to mass train. The analogy is, say you can train 1 in 10 workers to use a hammer, but you can train 8 in 10 to use a screwdriver. The screwdriver would better help the industry expand, but the consumer will not best served by the inefficiency and costs. 

In terms of compliance, politicians like polls; statistics, since this oracle helps them make decisions. Polls are where one listens to what the majority says, often based on leading questions, so you can tell them what they wish to hear. This is not about leadership but followers pretending to be leaders by gaming the masses. There is also a lot of inefficiency.