How I Got the $84k Hepatitis C Drug for $1500 by Buying It from India - <AUTHOR> http://www.alternet.org/personal-health/84000-hep-c-drug-only-1500 <comment><USER2> Something to keep in mind is the population that typically has chronic Hep C requiring this drug. It's IV drug users who share needles. Think they have $84K? Nope. Think they have insurance? Nope. Guess who pays for it. Oh that's right, it's Medicaid! It's you, the taxpayers. Where is there a large concentration of people that have Hep C? Prisons. Guess who pays for it then? Still you! The prison systems are obligated to provide health care and treatments in accordance with community standards of care, which they do. They have treated many people already who meet the criteria of disease progression to qualify for it. Still think Gilead should be charging this much for it here and not elsewhere?

<comment><USER3> Actually a significant population in the US was infected by blood transfusion; the US didn't start properly/universally screening blood and taking precautions for hep C until 1992.

This is why there's a spike in infection rate among older people, and why hep C is considered a looming cost crisis for Medicare -- we don't yet know the full extent of the infectious disaster that was unscreened blood, but it's ticking away inside anyone who received a transfusion prior to 1992.

<comment><USER4> There's something rather unsettling about the realization that Jehova's Witnesses had a point about something once..

<comment><USER5> If you're getting a blood transfusion it's usually because you need it. I'd take hepatitis C over death any day.

</comment></comment></comment></comment><comment><USER6> (1) As someone who was following the market when Gilead paid $11 billion for PharmAsset, it was not a sure thing that it would be first to market or a premier drug. They announced $137/share on November 21 for a stock that opened at $65.49 on November 11. People like to point out how much money Gilead made on the deal, but that is Monday morning quarterbacking on something where they easily could have lost billions.

(2) The article claims Harvoni was acquired. That is not really true. Sovaldi (sofosbuvir) came from the Pharmasset acquisition. Harvoni is a combination of sofosbuvir with ledipasvir, a drug discovered at Gilead.

The combination of the two is a key part of the treatment; sofosbuvir was still taken with interferon (and ribavirin) for genotype 1 HCV, the most common form.

Treatment for genotype 1 HCV, without interferon required ledipasvir. The notion that Gilead contributed nothing scientifically to Harvoni is false; they provided a crucial component to the all-oral treatment of HCV genotype 1.

<comment><USER7> _As someone who was following the market when Gilead paid $11 billion for PharmAsset, it was not a sure thing that it would be first to market or a premier drug._

This is a fantastic point. I remember when Gilead announced their acquisition of Pharmasset. They were _ridiculed_ in the press. How could they be so stupid to pay that much? Many people thought that $11B was as good as gone.

That's the risk involved with drug development. It's like VCs, you spend a ton of money on a lot of investments, most of which fail. Unless you get a few huge winners, it's not a feasible business.

</comment></comment><comment><USER8> Gilead has developed the first drug since penicillin to cure a major disease and people think the price tag is too expensive.

In the modern world, it's not ideal to create a drug to cure something. Once people are cured they no longer need your drug. That's why we have so many drugs like Lipitor and Viagra that treat symptoms but do not cure.

The "problem" with Sovaldi/Harvoni is that the patient only takes it for ~90 days, and then they're cured.

The drugs are cheaper than regular treatment of Hep C - which ends in liver transplant. Do people think the price tag was just random? No, it's because this is a price at which the taxpayer saves money by curing the disease vs. blood transfusions, liver transplants, lost economic value, etc.

Not to mention that the waitlist for a liver transplant is getting halved as we cure Hep C.

As we slam Gilead the other really evil pharma companies like Pfizer are taking notes and patting themselves on the back for creating drugs whose end goal is to addict the consumer.

<comment><USER9> I worked for a company that developed some PA criteria for these drugs, I can assure you a lot of debate went into this criteria.. these two specific drugs are probably the most hotly contested drugs. If we sold them at the 84k price tag to anyone that COULD use it, the entire insurance industry would go bankrupt, literally. Not even an exaggeration. While your logic is sound, the drug is cheaper than a liver transplat... not everyone who has Hep C ends up getting a liver transplant. There's a huge gap between the number of people who COULD use the drug (and have a MUCH better quality of life), and the people who are most qualified for it. The drug companies are not doing the government a favor here... sorry.

Another side conversation that's interesting, is who takes the $84k hit. There's sound logic that it's cheaper to give the drug NOW vs paying for surgery LATER... but what if i'm not your insurer when you need it. With obamacare, you can't be denied because of pre-existing conditions... so it's interesting math.

<comment><USER10> Do you have a sense of the production costs?

If they aren't very high, the US government could start making the company look like jerks by offering $50 billion for the patent. I'm pretty sure they would be able to calculate a nice return based on a payment like that.

The math works fine for that, there's ~3 million people just in the US to treat, paying $50 billion would save a substantial amount just treating those patients. Of course, we don't run our government based on math that makes sense, so it's a pipe dream.

<comment><USER11> > the US government could start making the company look like jerks by offering > $50 billion for the patent

Pretend you were in charge of Medicare/Medicaid. The NPV of the lifetime care cost of the HepC symptoms of each HepC patient on your rolls is $X. You want to encourage someone to develop a cure for HepC, so you put out a price bid for what you will pay someone who shows up with a cure. What price do you offer?

<comment><USER10> I offer $Y, the lowest amount I think I can get them to accept.

<comment><USER11> In the hypothetical, you are offering a price before anyone has developed it. "You want to encourage someone to develop a cure."

What price do you offer for someone who shows up with a cure?

</comment></comment></comment></comment></comment></comment><comment><USER12> This is yet another perverse collision of care and market regulation. Other examples abound. Why do we accept this? Do we even dare think of alternatives?

What if western governments stop enforcing drug development intellectual rights? Not going to happen before hell freezes over, but let's have a short thought experiment.

Quality health care for all would probably blossom thanks to more access to affordable drugs than ever. Drug development would probably slow down significantly without compensating measures. But would that be so bad? Medical research is increasingly a game of diminishing returns... Many but the rarest disease puzzles have been solved already. And the huge profit margins show the current drug development system has proven inefficient handling these rare corner cases. Think [https://en.wikipedia.org/wiki/Alexion_Pharmaceuticals](https://en.wikipedia.org/wiki/Alexion_Pharmaceuticals) . With more patents starting to expire, the existing drug development model will only get more inefficient...

Aren't there more efficient ways to incentivise drug research?

Crazy idea... Bootstrap an open source drug with maecenate and/or public funding, or market an existing generic with a sympathetic history. Make it super easy for people to donate something extra on top of the drug price. Think a tip at the pharmacy, directly to the researcher's drug development budget. Their drug cured them or their loved ones! Put a picture of the research team on the packaging. Show people these researchers are heroes.

<comment><USER13> > What if western governments stop enforcing drug development intellectual > rights?

No new drugs. Pretty simple.

Now you ask, is that a bad thing? well yes, yes it is. Right now, we are running out of (or have run out of) top end antibiotics.

Partly from over use (I'm looking at you America.) mostly from using them to get much higher yields in farm animals (yup, thats right, last line antibiotics are being used on pigs, so they can be packed in much higher densities. )

So what I hear you say? Well TB thats what. There is a resurgence in TB, the white death. Now, you might be content with each lung collapsed in turn, in a vein attempt to cure it[1]. However I'm not.

1 in 3 people get cancer. The survival rates are not good. Loads of people are diabetic. (mainly because they eat shit and are fat(unless its type1 which is genetic))

Opensource model is just bollocks. I don't want to be treated by some drug thats only had patchy test coverage. I don't want to be beholden to some amateur who thought it'd be good to reinvent for the billions time penicillin.

Who is going to pay for the time? its not like you can provide charge for support is it?

No, the way forward is actually having a proper handle on insurance. Here in the UK, drugs are purchased nationally[2] but more importantly you only pay a nominal upfront fee. Its not more expensive, in fact its hovering around 6% of GDP compared to 18% for the US (and with much better care too)

[1][http://journal.publications.chestnet.org/pdfaccess.ashx?Reso...](http://journal.publications.chestnet.org/pdfaccess.ashx?ResourceID=2102478&PDFSource=13) [2][https://www.evidence.nhs.uk/formulary/bnf/current/5-infectio...](https://www.evidence.nhs.uk/formulary/bnf/current/5-infections/53-antiviral- drugs/533-viral-hepatitis/5332-chronic-hepatitis-c/sofosbuvir)

<comment><USER14> > No new drugs. Pretty simple.

I doubt that. There's no reason why the same research couldn't be academic research.

Global spending on drugs research is only $77 billion a year. Take the 20 richest countries in the world and that's less than $4 billion a year each. That's less than half the UK's EU rebate.

(EDIT: not enough coffee to add correctly)

<comment><USER15> Bingo. The private profit motive isn't the only way to get things done. Two of the greatest scientific and engineering feats of the 20th century, the atom bomb and landing on the moon, were both government run and funded.

<comment><USER16> Not sure if the war motive is much better than the profit motive, though.

<comment><USER15> To stretch the analogy, lives are being threatened in war as they are also threatened by medical illness.

</comment></comment></comment></comment></comment></comment><comment><USER17> I'm conflicted about this article. On the one hand, the pharmaceutical companies gouging ordinary Americans is abominable. Doing something to circumvent their greed is something to support.

On the other hand, if enough people exploit loopholes like this, and the pharma company actually felt a significant drain in revenue, they may decide not to license the manufacture of these drugs in India at lower prices. If $84,000 seems unreasonably high in the US, imagine how out of reach it will be in India, where the cost of living is much lower.

<comment><USER18> What exactly is "gouging?" The average wedding in the U.S. is almost $30,000. Average new car price is $33,000. Is $84,000 one-time an unreasonable price for a complete cure to a chronic disease?

<comment><USER19> must me nice in your bubble that $84,000 as a one time payment is reasonable. normal people can't get a loan for something like this, and obviously don't have cash stored away for something like this, and like the article mentioned, the op won't get covered by insurance even though he's done his part and paid insurance premiums. he clearly had no other options. glad you drive a $33k car. seems like the op doesn't.

<comment><USER7> Do you think charging $300K for a liver transplant is gouging too? Because that's what this $84K drug just replaced.

<comment><USER20> Yes, $300k is even more unconscionable.

Medicine in the US is wwaaaaaaaaaaay overpriced. Things that are critical for life needs to be priced at a reasonable flat rate above costs, and conducted with the attitude of public service and human actualization. Let big pharma reap their R&D costs some other way

<comment><USER21> > Let big pharma reap their R&D costs some other way

How?! You think they should create a social network for doctors? A billion dollars in ad sales is somehow morally better than a billion dollars from saving lives? They're making their money by saving lives, and being criticized for it. You're effectively saying that they shouldn't do any R&D, like the Indian generic drug companies.

Sorry for the exclamation points. I think that you have a particular system of morality, that is more important than saving lives. To me this is like arguing for abstinence-only sex education, which demonstrably does not work. I wish in general people would be more willing to look at data and outcomes.

<comment><USER20> I'm not in that industry, I'm sure my ideas aren't very good.

* massive step up in grant funding to front-load R&D costs so they're paid by the time the drug is out, or

* worldwide medical R&D fund, bounties for individual re-searchable issues, or

* move private R&D to universities, have profits gained pay back R&D, send any extras to researchers, and shutter R&D aspect of private medicine

At least I'm trying to think of alternatives, and not just trying to shoot other commenters down

<comment><USER21> I don't have a problem with your ideas. I think the vast majority of drug development costs are being borne by industry right now. So when you say "massive step up in grant funding," that might have to be something like a 100x funding increase. And the NIH budget has been flat (when adjusted for inflation) since 2002 [1], so there doesn't seem to be much political will for your suggestions. (And that's bad! Even if you could get your suggestions passed, long-term stagnant government funding for R&D would stall drug development.)

I think your ideas should be implemented first in another country, such as India or somewhere in Europe, so that we can see how well they work before throwing away the baby in the bathwater. Personally, I would prefer more gradual changes here in the US. For example, the cost of running drug trials has been increasing. Big pharma companies _like_ this; going through the drug trial obstacle course is their specialty, and the huge barrier means that small drug companies that do the pre-trial drug research have to go through the big companies to get to market. Reducing these costs would lead to more competition.

[1] [http://www.aaas.org/page/historical-trends-federal- rd#Agency](http://www.aaas.org/page/historical-trends-federal-rd#Agency)

<comment><USER20> Indeed, lack of political will kills many things :/

</comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER22> Eminent domain is not just for land. In extreme cases like this where a profit motive is the only thing keeping us from curing huge numbers of people, the US government should write a single check, take the rights, and start handing out pills.

As far as the company is concerned, that could even be a preferable outcome. Cash now and the marketing benefits to promote its other drugs.

Edit: Just a reminder that eminent domain requires paying the property owner. [https://en.m.wikipedia.org/wiki/Just_compensation](https://en.m.wikipedia.org/wiki/Just_compensation)

<comment><USER7> Let's walk through this. Drug develop is mostly funded with private money. Yes, the NIH funds basic research that often support drug research, but private companies fund most of the bill. It's in the hundreds of billions each year.

Now why would they do that? Well, they expect that they'll give a company $500M and it will turn into $2B or $3B. However, most of those companies will fail and the $500M will turn into $0.

So that would mean that the returns on the drugs that are successful need to be really high. What if they weren't? Well, all that private money would dry up pretty dam quickly.

Look at the money going into cancer research. It's a huge amount every year. It's not just because cancer is a terrible disease and affects everyone, it's because the returns on cancer therapy are _high_.

You could just tell private companies, "stuff it, you don't get to make money" and try and have the gov't do it on their own. Of course you'd need to increase the NIH budget by what? 10x?

Our current system isn't perfect, but it does a dam good job aligning the incentives of people with money and people who need new drugs.

<comment><USER23> Scientists are not profit motivated. Scientists don't work to produce more drugs faster just because the CEO is managing better. This is definitely something that can be funded by the public and should be funded completely by the public on a not-for-profit basis. Then we can no longer make these sort of ridiculous economic arguments.

<comment><USER24> Do they hand out sainthoods with PhDs now? A scientist working in the commercial sector has the same motivations as anyone else.

<comment><USER23> Then why not make any scientist who discovers any very important drug or therapy into a billionaire. If they are motivated the same way corporations are, then that should super motivate them produce more drugs faster. In fact why don't universities work the same way?

<comment><USER24> Scientists at pharma companies who make breakthrough discoveries _are_ well rewarded in stock and bonuses.

</comment></comment></comment></comment></comment></comment><comment><USER25> The pharmaceutical industry is disgusting me. Their goal is no more to cure people but to generate that maximum amount of cash for shareholders. To chose a price point, they don't look at what research has cost, but what people, government aid and insurance are willing to pay for it and choose chose a price that max out the benefit. In developed country it becomes ridiculous.

As a note, when they have to make risky research they put the risk into a spin-off company with investors that share the risk, and this is how you end up with Gilead buying this probably co-founded research company.

<comment><USER26> I give you an A for finally coming w/the right answer.I was falling asleep reading all this liberal blather.

</comment></comment><comment><USER27> OK, let me be a devil's advocate for a minute, before we get the pitchforks once again. Let's remember this:

> Gilead Science was first out the gate, bringing the new hep C drugs Harvoni > and Sovaldi to market in 2014 and 2015, respectively. And they worked great: > More than 90 percent of patients taking the new drugs saw the hep C virus > wiped out in three months, and without the side effects that made interferon > treatments so intolerable.

So, Gilead is exactly the company that created these drugs from the very beginning. I'm looking at it this way: in 2013 (situation A), there was no cure ("cure" is a simplification, of course, but for this kind of analysis it's not an important detail.). In 2016 (situation B), there is a cure, but it costs $86k.

Now, the moral question here is very simple: when you change the world (as Gilead did) from situation A to situation B, is it net good or net evil deed? In which world of these two would you prefer to live?

</comment><comment><USER28> Yes, way to go! There are honest online pharmacies, but finding them is nontrivial. And there are numerous competent generics manufacturers in India. They've captured a large share of the global generics market in recent years.

<comment><USER29> .

<comment><USER30> You should re-read the article.

>Last year, Gilead entered into an agreement with India that would allow Indian pharmaceutical manufacturers to produce generic versions of Harvoni and Sovaldi and sell them in 101 developing countries at "a significantly reduced flat price."

>If you buy Hepcinat from India, Gilead still makes a profit as part of its licensing arrangement, but it doesn't make the unholy profits the U.S. government allows it to get away with.

</comment></comment></comment><comment><USER31> Surprised no-one has pointed to the real culprit here: the patent system, which allows individual companies to own knowledge like this and sell it at any rate it desires... private taxation by and for the rich, on the rest of society.

<comment><USER32> "Gotta have patents and profits, or there's no reason to fund it."

All testing, research, and funding has to be private for some reason.

</comment></comment><comment><USER33> There is obviously something unbalanced in the pharma business, and I think it is one of the corner cases where unbridled capitalism fails - perhaps because it is a need, not a want, so it is not discretionary spending.

My instinct is that pharma development should be carried out by universities (the state), so it's benefits can be shared with all citizens.

<comment><USER34> It sounds more like a lack of real competition.

<comment><USER18> You can't have "real competition" in the drug industry. While the status of patents is debatable in software (where actual copying is rare), the generics manufacturers are always directly copying from the drug inventors. They don't have the capability to do their own R&D, or often even to develop a lot of the ancillary protocols themselves.

So you either have a regulated market, or massive free-riding, neither of which is "real competition."

<comment><USER7> You can't have perfect competition in the drug industry, but you can get close. Gilead dropped the price of Sovaldi/Harvoni by almost 30% when Abbvie launched their HCV therapy.

In fact, one of the best way to introduce competition is through "me-too" drugs. You know, the ones everyone complains about.

</comment></comment></comment></comment><comment><USER35> You Just try "oddway International" For All HCV Medication Like Sofosbuvir , daclatasvir , Ledipasvir , ETC Find All Generic And Brand Medication At Wholesale cost .... Oddway International is an Export House with a strong independent infrastructure which allows us to work in tandem with the needs of our customers across the globe. We directly cater to the needs of large, medium, small enterprises and individuals around the globe. Our aim is only maintaining a healthy, safety and understanding relationship with our customers and, it can be manifested by the excellent satisfaction they feel by being with us. Address : 5A/7, Ansari Road, Daryaganj, New Delhi-110002 (India) icon email@example.com QQ : firstname.lastname@example.com icon Phone : +91-11-43526658 Mobile : +91-9873336444 icon Skype : Oddway2010 WeChat : Oddway2010 icon WhatsApp : Available Viber : Available [http://www.oddwayinternational.com](http://www.oddwayinternational.com)

</comment><comment><USER36> I really think this article is spot on taking on an issue that I believe will become more and more pressing over time as baby boomers continue to retire.

However, this line felt of out of place:

\- "And then there's Gilead. It didn't even develop Harvoni itself; it made a business decision to pay $11 billion to buy the company that did so it could be first to market and reap the rewards, $26 billion worth. There is something obscene about that. A billion-dollar profit would have been a very respectable return on investment, but Gilead is getting much, much more than that"

I mean, why is that obscene? We have seen crazier returns in [insert latest "stupid" app that made billions]. These drugs are difficult to manufacture AND to market. I am sure that if the return would have certain, then the seller would not have sold the company for that amount and would instead reaped the presumed returns.

I think pharma is entitled to big returns because their business is really risky.

I don't know where the answer is. Maybe it is government-driven pharma (yeah like the federal government is ever going to be good at anything), or a SpaceX for Pharma.

<comment><USER18> Note that a billion dollar profit would be a 3.8% return over the life of the drug (~10 years or whatever is left on the patent). You could literally get better returns with far less risk parking that money in Treasuries.

<comment><USER37> You're doing the math wrong. The suggestion is not a billion dollar profit on 26 billion dollars of costs. Most of the 26 billion dollars is profit. Chopping the cost tremendously would still leave a healthy profit margin.

As to risk, they bought an already-proven drug. That's not the sort of thing that earns massive returns.

<comment><USER18> I did do that math wrong, but to be fair, the article is comparing apples and kumquats. $26 billion is how much Gilead has in cash, which has little to do with Sovaldi at this point. $1 billion profit (let's say that's annual, rather than over the life of the drug) on an $11 billion purchase would be less than 10% annual ROI. That's very low for what was still a very risky investment (unapproved drug).

<comment><USER37> I think in the author's ideal world, the lowered profit for Gilead would mean they aren't rushing to provide Sovaldi a multi-billion dollar profit either. So the price drops well below $11 billion, and you get a solid profit margin without gouging people that need the drug.

</comment></comment></comment></comment></comment><comment><USER38> I was under the impression most Pharma Companies will give it to you for free if you don't have insurance and can't afford it. Maybe it's different if you have insurance and they won't pay for it.

The article is unfair mentioning Shkreli. He has always offered his drugs for free to anyone that couldn't afford them. It has always been his policy and continues to be so.

I think it was the Insurers and their paid for Politicians that created the stink. To this day I still haven't heard of one person that had to pay the $750.00 a pill but just their co-pay and if they had no insurance they got it for free.

Surprised this drug isn't available for free for those without insurance or is it?

<comment><USER39> > _The article is unfair mentioning Shkreli. He has always offered his drugs > for free to anyone that couldn 't afford them._

[citation needed]

<comment><USER40> >We pledge that no patient needing DARAPRIM will be denied access

>If you are uninsured and meet eligibility critera, you can get DARAPRIM for no cost

[http://www.daraprimdirect.com/patients](http://www.daraprimdirect.com/patients)

</comment></comment></comment><comment><USER41> A quick Google search shows that they paid $11 billion for the company that sells the drug(Sovaldi), and earned $1.3 billion off of it[1] in 2016. They make half of that in the US, and something like 10% of it in all places that aren't the US, Europe, or Japan.

That's a 12% return in 2016, which isn't nearly as good as the comments in this thread would have you believe. It's an okay return, but it wouldn't really be a good investment unless they can grow those sales more. It looks like they have had some growth compared to last year, so maybe it will end up working out for them. It's certainly not "100x in profits".

A Google search shows the disease is ultimately hard-to-transmit and preventable[2]. $84,000 seems like a fair price to me for this particular case. Google says the total cost of raising a child is "$245,340", so paying a 30% premium in rare cases doesn't seem unreasonable.

A separate complaint is that the financial industry isn't covering this case well. If you expected your insurance to cover it and they don't, that is an entirely separate issue than the price of the drug. Even if they don't, it seems like there should be a market for people wanting loans to pay for cures: It seems really hard to underwrite such a loan, but it could probably be done.

What does good insurance from a reputable insurance provider that reliably pays out their claims in cases like these cost?

(Edit) I may have misread the earnings report, thinking it was for the previous year rather than the previous quarter. So the percentage is closer to 50%, and a commenter clarified that they also had another product.

[1] Earnings:

[http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol- ear...](http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol-earnings)

Purchase price:

[http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol- new...](http://investors.gilead.com/phoenix.zhtml?c=69964&p=irol- newsArticle&ID=1632335)

[2] Going down the list on one site that lists transmission methods: Don't have sex with weirdos carrying diseases; don't share needles with druggies; go to a licensed upscale commercial tattoo parlor instead of some shady cheap one

<comment><USER42> Or... $11B was a terrible price to pay, and their desire to recoup their shitty investment still shouldn't be allowed to bankrupt people who just want to live.

It's also incredibly obtuse to call $84k a "30% premium" on raising a child. There are so many people who don't (because they can't) spend close to $245k, more that can barely pull it off, and even more that shouldn't have pharma rates kept artificially inflated on their backs.

<comment><USER43> Ultimately if we want companies to do research but not be able to charge prices, then the government should be involved. It's like the case with Turing pharma. Everyone's upset at him for buying a (very old) drug for a very rare condition and raising the prices. Yet... why was he able to buy the drug in the first place? Look there, don't blame the person that found a golden penny.

<comment><USER44> > then the government should be involved.

The government _is_ involved. Most of these drugs would not exist were it not for the NIH.

</comment></comment></comment></comment><comment><USER45> > took the pills for 83 days (saving one for possible testing just in case)

I would try to arrange testing before starting therapy, or at least at the point of starting therapy. There are labs that will run the test for a few hundred dollars (and a lot less if you know someone at a university, it could even be an analytical chemists' bachelor degree project).

<comment><USER30> I guess you could reason they are safe to take regardless. If they are counterfeit, they would likely make them out of sugar or flour not harmful chemicals. It wouldn't be in the best interest of the counterfeiters to make pills that harm or kill the buyer.

<comment><USER46> I wouldn't bet my life on that. In fact, counterfeit drugs are estimated to kill hundreds of thousands of people a year, in many cases directly, not because they don't provide the necessary treatment. See [http://www.cnn.com/2012/07/17/health/living- well/falsified-m...](http://www.cnn.com/2012/07/17/health/living- well/falsified-medicine-bate/)

>Fakes contained chalk, talcum powder, road paint and occasionally dangerous heavy metals, instead of the expensive, hard-to-make medicine.

</comment></comment></comment><comment><USER47> Not sure if there is one in the USA, however in India the law does impose a maximum price for critical and life saving drugs (hypertension, heart related, diabetes etc.). There is ongoing process for adding some cancer drugs too to this list. I think the key here is that businesses should be allowed to make a 'reasonable' profit.

</comment><comment><USER48> Our medical and social systems are ill-equipped to deal with cures for widespread diseases, which is what Harvoni and its related drugs are. We are used to paying for disease on time: relatively small amounts of money for periodic treatments that might last a lifetime, however long that lifetime may be. And we (at least in the US) often think more about the value of the treatment to the patient rather than the value of a healthy person to society.

These questions of cost and value go far beyond HCV. It is a popular, medical, and entrepreneurial dream to cure cancer wholesale with a single easy course of treatment. While cancer isn't a single disease, perhaps we should begin asking now how we could assess the value and pay the price for such a "miracle" should a cure for any of the most common cancers be developed.

</comment><comment><USER49> Guess who can get them for free? those living in civilized countries with universal health care systems.

<comment><USER50> Very few countries offer free prescription drugs. Not even Canada does that.

<comment><USER51> Scotland, Wales and NI do. And England has only a nominal charge.

<comment><USER50> Right, and I think that's it (SK does the "nominal charge" thing).

<comment><USER52> Most western countries do the "nominal charge" thing - which in this context is just about equal to zero.

For instance: German public health insurance buys a course of Sovaldi for EUR40,000 ($46,000), the patient pays a cost of EUR10 ($11.50).

</comment></comment></comment></comment></comment><comment> anne-marie37 I had no side effects either. I did 12 weeks with Ledifos (generic Harvoni), and zero viral load from week 4. I'm SVR4, but still waiting to get SVR12, fingers crossed! :-)

I bought Ledifos in Hyderabad, through med tour agency. The trip cost me just over 2600$, tickets included, and I only paid once in India. The guys are mellow, everything went very smoothly: hotels, doc, prescription, pharmacy, all is done in 3 days (www.cure-hepc.com). I know you can do cheaper if you just buy online, but when you pay online you never know if it's a scam.

</comment><comment><USER53> Ironically, if the rights were owned by Skreli, Smith could've gotten the drugs for free.

</comment><comment><USER54> I was once prescribed 4 tablets of Albandazole (a drug for worms treatment) just before my health insurance was active on file. The drug was costing over 700$ without insurance and my health center asked if I would like to wait for my student health insurance to show up as active. I said, yes (ofcourse) shocked at the price of the drug (being an international student in US from India). Even after my insurance I paid 35$ co-pay. The same drug costs <1$ in India. Even the co-pay is over 35 times the cost of the drug in India. I was trying to contrast some figures:

Salary ratio: ~5:1 (Software engineer, Google based on Glassdoor); Albendazole drug cost ratio: ~700:1

</comment><comment><USER55> There is an excellent Radiolab piece on this:

[http://www.radiolab.org/story/what-year-life- worth/](http://www.radiolab.org/story/what-year-life-worth/)

</comment><comment><USER56> I see a good opportunity here build a 40-50 patient facility in touristy place like Thailand. It would cost about $250-350k then charge patients $4500 for a 3 month stay including medicine, food and board. Because of cheap labour and food your expenses won't be more than $20k per month. You would me making a profit with 40% occupancy with 85-95% you could recover your investment in under a year.

</comment><comment><USER57> Hey everyone, look!

We're getting ripped off!

Here's how they're doing it!

We're all in this together!

We have the high ground!

Here's what we have to do!

Look another episode of Game of Thrones is on!!

Who's fucking who?

</comment><comment><USER58> > In the United States, there is nothing stopping pharmaceutical companies > from charging whatever they think the market will bear.

That is how it should be. The moment government controls prices, it will slow down overall capital investment in invention of new drugs. I think $80k price is perfectly fair given the scenario.

Until Giliad Science invented that medicine the alternative to the medicine was assured death by cancer. Have you ever paid medical bills for cancer ? $80k does sound like a reasonable amount to pay for one's life in a developed country like USA. In India value of life is much less and I am not surprised Indians are willing to pay much less for their life.

Poor Indians are benefiting at the expense of rich Americans. Indian would prefer to die than borrow and buy a $80k medicine.

I think if Americans can save money by offshoring the cheap call centers to India they can also save money by getting their health treatment in India. The thing to remember here however is that if you die in an operation theater in USA your family might get millions in compensation. In India you have to say bad luck and move on. The pills that you buy from India could be nothing but horseshit packaged in wrappers and you can basically do nothing even if you find it out.

US is at the forefront of drug inventions because markets are allowed to function, surely companies are making ton of profits but I suggest you try setting up a company and invent the same drug and sell it for cheaper price. Inventing drugs is like a startup, a giant number of research projects fail, handful of succeed. People remember Facebook and its obscenely rich Zukerberg they don't remember Bozo inventor of JokerBook, a social network for clowns.

It would be good if Americans learn to appreciate what they have rather than complain about everything.

</comment><comment><USER59> Leaps in technology, finance, and engineering cure man of previously incurable disease. He is pissed.

</comment><comment><USER60> Here is current price for Sofosbuvir in India [http://www.medplusmart.com/compositionProducts/Sofosbuvir-40...](http://www.medplusmart.com/compositionProducts/Sofosbuvir-400-MG/29220)

</comment><comment><USER61> Health insurance in US charges you 10¢ monthly premium, to provide a $100 pill for $10, while it is available for $1 in India.

Dental insurance is as bad. Travel to India + dentist costs are often cheaper than one time treatment costs.

</comment><comment><USER62> Keep in mind that the potential for huge profits was what motivated private investors to fund development for a cure. Without that, Hep C would still be a death sentence, regardless of how much money you had.

<comment><USER10> Pharmasset spent in the ballpark of $1 billion developing the candidate that Gilead decided to buy (I'm taking the annual spend on total operations there, rounding up to $100 million and multiplying by 10 to get the $1 billion).

[https://www.sec.gov/Archives/edgar/data/882095/0001193125113...](https://www.sec.gov/Archives/edgar/data/882095/000119312511331318/d260880dex991.htm)

It sort of looks like they have figured out how to have excellent pricing power when they are willing to bid $11 billion for the company. Part of that is probably that looking just at this drug is a facile analysis of the value of Pharmasset (which did more than develop 1 drug, they built expertise in creating antivirals). Of course, the expertise story implies that they don't need to recover the purchase on just this drug.

I guess some of it is the complexity in the medical payments system.

</comment></comment><comment><USER63> Nobody here is making the pretty obvious point: Yes, it is wonderful to blame the drug companies (who invented the damn cure in the first place!) for greed -- it feels great. But the real important question you have to ask is HOW ON EARTH do they get away with charging $84k for a year of treatment?!?!?!?!

If they are charging this amount of money, it is because someone, somewhere, in some deep and mischievous and evil place inside those big pharma buildings, has crunched a lot of numbers and figured out this is the "correct" price for them to charge for this drug. That is their income-maximizing price. And THAT is what's insane.

Blaming them for "greed" is idiotic. But you have to scratch your head and think of how on Earth the best strategy for them is to sell a product with a price tag that no individual could really afford!!! That's the real mystery, and when you start asking THAT question, perhaps you end up realizing that the answer isn't so clear.

For starters, maybe ingenious strategy devised by our hero in the article, and the Indian government's positions in generic were foreseen by one of the thousands and thousands... upon thousands of lawyers, and business experts, and consultants that these companies hire, so they quickly realized that the name of the game HAS to be that they need to squeeze everything they can out of the U.S. market to make up for the hits everywhere else.

"But wait, no one will be able to afford the drug," exclaimed one novice executive at the pharmaceutical. "Not to worry," the senior counsel said, "we have medicaid in the U.S., and that's where most of our customers will come from. You see, the government will effectively be our client, and since they won't have an option not to offer this treatment, all we need to do is ensure we have amazing terms with this ONE customer and we'll be aaaaaaalllll set." Etcetera, etcetera, etcetera.

Don't blame the pharma companies. We have ZERO competition in many dimensions of healthcare. We have a drug approval process that costs billions of dollars for a single drug to get through, and the academic evidence is quite clear that it is actually killing more people than it is purportedly saving. I had back surgery three years ago, and a line item in my medical bill was "juice - $25." I stayed in the hospital for 19 hours. It cost me $40,000 FOR NO GOOD REASON whatsoever. I also had shoulder surgery overseas, with a Harvard medical-school trained doctor who operates on world class professional soccer players. I was in a phenomenal hospital for two days, in a private room, with nurses checking on me every hour, the works. The sticker price? $7,000. Without a penny of gov't subsidy.

Big Pharma isn't the issue. Our policies towards healthcare are crippling us to no end.

</comment><comment><USER64> We could make pharma companies be government contractors so the "intelectual property" would be a owned by the state. That would probably be a bit better than what we have now.

</comment><comment><USER65> If you remove a bunch of constraints, you can imagine governments paying for country-wide license to the patent, and then individuals just pay enough to cover manufacturing and delivery. I'm not sure if there was any payment that went along with granting India the $1000 price. I know India carries a big- stick of "invalidating" the patent. Sure, they could have just taken the IP for themselves, which basically means Americans just bare a larger share of the overall cost. The fact is that this drug is tremendously valuable for India, so I'm glad they were able to come to some pricing agreement.

Selling those drugs back into the US market clearly goes against the pricing agreement. Based on what I read in those articles about Paul Le Roux, these online drug outfits have _way_ more volume than you might expect, and they apparently can run for a long time before being shut down. This is partly a submarine ad in that sense, even naming sources. You also might expect customs to intercept these packages, but when Le Roux can share the same FedEx account number across all their pill shipments, clearly inspection is expected to be lax. So the result is these pills could actually be pouring back into the country, and hiding within the inventory being sold for consumption actually inside India. It seems like Gilead revenue is strong for now, I don't know if they consider this to be a significant risk.

In some cases insurance will not cover if you are not showing symptoms. But if they do cover it, you will be on the hook for just the out-of-pocket maximum for that year. Any other health care you receive that year will be free, so that could also help justify the cost. But in this case the insurance company didn't want to cover it anyway, so the patient was forced to pursue a gray market purchase. I'm pretty sure Gilead is pushing hard for insurance companies to cover anyone with detectable disease regardless of symptoms, and ultimately that's what we want. There's a huge population that avoided the prior treatments, but would jump on this in a second.

Everyone who has HepC should get this drug. But if we can't afford to cure everyone today, how do prioritize access? And how do you limit access to an FDA approved drug for a diagnosed illness anyway, when the alternatives are _more_ expensive and less effective? Well I guess in some places, like the NY AG is requiring coverage for commercial insurance plans. NYT reports that Medicaid is still denying coverage until the disease has advanced.

We want people to pay the "right" price for this drug, really a miracle cure which is lowering the cost of treatment actually. So how do you price it? The price to the insured patient today will vary based on the financial means of the patient. The revenue to Gilead is negotiated with insurance companies / benefit management companies, and is far below the sticker price.

</comment><comment><USER66> I actually wouldn't expect that Indian prisons provide any effective medication against hepatitis C. You might get it if you buy it yourself, and bribe the prison staff to allow you to have it.

Sorry: this is not based on any real experience or references, just the overall assessment of how India stands currently.

<comment><USER67> > You might get it if you buy it yourself, and bribe the prison staff to allow > you to have it.

> Sorry: this is not based on any real experience or references, just the > overall assessment of how India stands currently.

Jeez, you didn't have time to search but had time to fantasize like a Hollywood script writer hashing out more 3rd world stereotypes? Perhaps we should look at the treatment and hepatitis morbidity rate in our prison system and wonder whether your stereotype may more accurately fit our own prisons rather than Indian ones.

Here: [1] [http://www.delhi.gov.in/wps/wcm/connect/lib_centraljail/Cent...](http://www.delhi.gov.in/wps/wcm/connect/lib_centraljail/Central+Jail/Home/Medical+Care+and+Hospital+Administration)

[2] [http://www.legalservicesindia.com/articles/pri.htm](http://www.legalservicesindia.com/articles/pri.htm)

[3] [http://defensewiki.ibj.org/index.php/Right_to_Medical_Care_i...](http://defensewiki.ibj.org/index.php/Right_to_Medical_Care_in_Prison)

Delhi Prisons have set up an Integrated Counseling and Testing Centre (ICTC) on 10.06.08 in Central Jail Hospital for detecting HIV positive inmates. Targeted intervention for HIV detection in inmates like injecting drug abusers / sexually promiscuous, inmates suffering from STD and inmates suffering from multiple / opportunistic infections. Total number of such inmates, tested for HIV positive test at ICTC from January,2010 to October'2010 were 1399, out of which 27 were tested HIV positive .Further 2254 inmates were tested for HBsAG and out of which 66 were found to be +ve for Hepatitis B.

[4] [https://en.wikipedia.org/wiki/Infectious_diseases_within_Ame...](https://en.wikipedia.org/wiki/Infectious_diseases_within_American_prisons)

While the majority of HCV infections occur outside of prison, the disease is still widespread within the prison system as a result of drug injection.[15] According to one Rhode Island prison study, HCV infection was found in 23.1% of the male prison population.[16] HCV prevention proved to be more challenging than HIV prevention because inmates partake in high-risk behaviors such as "front loading" and sharing spoons to prepare drugs like cocaine.[4] The prevalence of these diseases within prisons is a concern because they pose a potential public health risk.

[5] [https://represent.us/action/private- prisons-1/](https://represent.us/action/private-prisons-1/)

<comment><USER66> Thank you for correction; grant me at least that I knew I'm commenting based on prejudices.

Note however that I don't view the American prison system as "our" ("mine") either (I'm not from the US).

And still, what I read of Indian prison is just way, way worse than what I read about the American system. Overcrowding, horrible delays in trials, abysmal hygiene. I doubt that the HCV treatment there is very good, despite there being a counseling centre.

"In India, overcrowding has aggravated the problem of hygiene. In many jails, conditions are appalling. At the tehsil level jails, even rudimentary conveniences are not provided. Prisoners in India are not even tested for specific infectious diseases, although all prisoners undergo a medical examination when they begin serving their sentence. No studies of the prevalence of viral infections among prison inmates have been done at a national level. India's prison manuals provide for segregation of prisoners suspected of having contagious diseases. A few jails have established informal contacts with medical and social organizations for counseling of inmates to prevent the spread of infections."

<comment><USER68> > way worse than what I read about the American system.

Is it though?

[https://en.wikipedia.org/wiki/List_of_countries_by_incarcera...](https://en.wikipedia.org/wiki/List_of_countries_by_incarceration_rate)

\- the incarceration rate of the United States of America was the highest in the world, at 716 per 100,000 of the national population.

India is 33/100k. We've got 20 times more of our own American citizens behind bars than the typical 3rd wordl country.

<comment><USER66> Your incarceration rate is a different issue from how prisoners are treated (or mistreated), particularly regarding health care in prison.

Over here (Finland), there's a popular meme about "let's put elderly people in prison, so they get a bed of their own, a daily shower, good food and someone to take care of their mental well-being". Even if our old people's care in public institutions is probably one of the better-arranged among nations.

</comment></comment></comment></comment></comment><comment><USER45> The article is already off to a bad start, assuming the existing therapy they're talking about is Pegetron:

> The interferon-based treatments weren't successful half the time, and the > side effects were so debilitating few patients could endure the months-long > punishing protocol.

If the success rate is 50%, I would say that's pretty good, especially since we're talking about treatment, not just managing the disease (as we can only do nowadays with HIV). And from the product monograph: "The most frequently reported adverse reactions were mostly mild to moderate in severity and were manageable without the need for modification of doses or discontinuation of therapy. "

But no doubt, the pre-existing therapy sure has a pile of side-effects.

<comment><USER7> I worked on one of the old interferon drugs before Sovaldi/Harvoni came along.

They sucked.

Patient compliance was low due to the side effects. From what I've heard, it was like having the flu everyday for duration of treatment.

If you any mental health issues (depression, etc) you couldn't take it since the rate of suicide goes way up.

The new HCV drugs are an amazing breakthrough.

<comment><USER69> Does anyone know the prevalence of the most common side effects for Harvoni?

I usually defer to the following site but they don't have info on the drug -- [http://www.healthbee.co/](http://www.healthbee.co/)

<comment><USER48> There are some reports of side effects of varying degree, but in general Harvoni's side effects are extremely mild.

When I did the trial, my physician indicated that in previous trials, patients couldn't reliably distinguish Harvoni from a placebo. My experience aligns with this statement.

While I was on a 24 week trial (longer than most people today) with ribavirin (which is only used with a minority of patients today), I experienced nothing I could directly attribute to the medication. My viral load dropped to undetectable in six weeks, and has remained so since.</comment></comment></comment></comment>


Why are 95% of blogs abandoned? - <AUTHOR> http://postary.com/twitter/mileslennon/why-are-95-of-blogs-abandoned <comment><USER3> 95% of just about everything people try out gets abandoned - relationships, hobbies, jobs. We all have a limited capacity for what we can spend time on in our lives. The only difference with blogs is that (at least for the free ones like blogger/tumblr/posterous), there's no incentive to take them down and they don't decay / disappear on their own.

It's like wondering why 95% of dates don't lead to marriage.

<comment><USER4> Exactly. Imagine for a moment how many novels started were never finished. How many brushes were left to collect dust after a few paintings. Or ab-rollers that never produced any six-pack abs. Or gardens abandoned after a couple salads.

The more amazing number here, in my opinion, is that 5% of blogs stick around. That seems incredibly high for a broadly popular pursuit. Even a 1% follow- through would strike me as a far better success rate than most common human endeavors.

</comment></comment><comment><USER5> Very spot-on description of the mania-to-blah mindset that does in 95% of blogs. I'd also add to the mix:

1) Unrealistic Expectations. Most people have no idea what "success" really looks like for a blog. They assume that, if six months have gone by and they're not getting 100,000+ followers, they've failed. Another unrealistic expectation is what I'd call an overly generous self-assessment: the blogger in question overestimates how much gas he has in the tank on a particular topic. He may get a few great ideas in his head one day, then build a blog around them, then find himself struggling for material on the third day.

2) Lack of Patience. Building a successful following is rarely an overnight journey. Some blogs take years to find their footing, and years more to find their audiences.

3) Insufficient or Non-Strategic Marketing. As folks in the startup world are well aware, you really need to think outside the box -- and occasionally go totally wild -- to get attention in today's crowded marketplace of ideas. You've also got to be clever about building credibility, connections to the right influencers, and paths outward from those influencers to broader audiences. By contrast, most hobby-bloggers take a "write it and they will come" approach -- hoping naively that people will flock to their blogs as if called to them by magic. Or they'll blast notices out to all their friends and family, rather than taking a careful inventory of who might actually be interested, who might be _very_ interested, and who might be so interested that she'll tell her friends (or, conversely, who might not give a flying you- know-what). It's counterintuitive to think that starting out by telling fewer people is preferable to shotgunning everyone you know. But the shotgun approach seldom works. Start surgically.

As it turns out, probably 90% of the work of building a successful blog takes place _outside_ of the blog. Writing great content is the easy part (and it's not easy!); getting folks to notice is the hard part.

<comment><USER6> I disagree with the 90% / 10% thing.

I was a very active blogger in my native language at some point, but I had only like 50 subscribers and maybe 300 page views in a good week.

I then switched to English and wrote only a dozen of articles or so. One of them was hard to write, basically a HOW-TO article who's implementation I had to write and test before I wrote the article. I also work full-time for a living and it took 3 days to write that article (a really long time for most bloggers).

Enough to say that a single well-researched article was more valuable, bringing in more subscribers than my previous shitty blog on which I talked about shitty things in a fire-and-forget style. And this was also kind of depressing, as if you want to be a successful blogger, you need hundreds of these good articles that take a lot of effort to write.

The way I see it - it's the same as with software development - 80% development / 80% polishing / 80% marketing.

<comment><USER7> Strange, you bring up the fact that you switched to English and then completely ignore it as a potential factor in the conclusion.

<comment><USER8> I think it was relevant in that he was starting from scratch with a new audience.

</comment></comment></comment></comment><comment><USER9> It could be as simple as 95% of people expected some sort of reward for blogging. This could be ads from traffic, comments saying how smart you are or just tons of hits to stroke your ego.

I have a half dozen blogs for different things, my favorite is this one where I post my crazy ideas so I stop myself from actually implementing them and can come back to them later if I still like the idea a week/month later <http://ideasfrommydreams.blogspot.com/>

In the six years I have had it there has been a total of 3301 page views and maybe five comments and I am ok with that because that isn't where it provides me with value. If comments or page views mattered I would have abandoned this blog years ago.

<comment><AUTHOR> Ha! That blog is an awesome idea. So may ideas left to die (or...live on?) - <USER2> can completely relate...believe me. If you ever wanted guest contributors to THAT, I think there are probably a few others who can relate who read HN.

<comment><USER9> Hmm interesting idea. If anyone is interested in guest blogging on a blog with such "high traffic" shoot me an email. Or I could spin up an ideaplanet (like <http://planetqt.org/>) to aggregate blogs of such caliber.

</comment></comment></comment><comment><USER10> I started blogging about five years ago, more or less in the manner you describe. Wrote an excited post or two or three right away, then maybe another in a week or two, and then... slowly stopped. Then a year later picked it up again, and then stopped.

I tried a variety of blog tools. I first had a blog at MIT, then when they killed that service, I tried several of the hip new services like Tumblr, Typepad, and Posterous. I stuck with Posterous the longest, but most recently moved to Wordpress running on my own virtual server. Along the way, I've kept some of my favorite posts from abandoned services, and deleted others that I no longer felt were worth sharing.

But why not write consistently? In my case, I suppose I feel like I frequently have nothing original to add to a topic. There are lots of things I could write about, but why should I, when somebody else already has?

Does it make sense, though, that a blog ought to be held to the standards of original research and contributions to a topic? It's a _blog_ , not a doctoral thesis. So maybe that doesn't make any sense. What, then, should be the purpose of writing, if not to create brand new thoughts?

Expressing who you are and what you know may be reason enough. I would rather hire a consultant that had displayed their knowledge of their field through writing than somebody who just posted a list of skills they had, and I'm more likely to find somebody who can do a particular task if they have written about it than if they had just done the task and posted it on GitHub.

Blogging can be useful to market yourself as a consultant, to market your products you are trying to sell, to make new acquaintances on the web, to build stronger relations with people you already know, to help you improve as a writer and as a thinker... there are all sorts of benefits to blogging besides making original contributions to exposition of a topic. And even though I realize this, I still get stuck a lot on the non-originality thing.

I imagine that a lot of people do.

And then, there are people who just try blogging, realize they don't like it or have other things they'd rather do, and never delete the first post. That's a lot easier to explain, and probably accounts for way more abandoned blogs. :-)

<comment><USER11> > there are all sorts of benefits to blogging besides making original > contributions to exposition of a topic. And even though I realize this, I > still get stuck a lot on the non-originality thing.

Part of the problem is that many people see blogging as a teaching tool alone. More often than not, it's a conversation starter too, and the blogger ends up learning a great deal of new information in the process.

And even if you wish to be only a teacher with your blog, there is also a bit of Dunning–Kruger effect at play here. You think, what's the point of me explaining X? Everyone knows about X, probably better than me. Others wrote about X.

In truth, you'll find that more often than not plenty of people don't know about X. The way you'd describe and explain X may actually lead people to acquire a new prospective on the subject.

<comment><AUTHOR> Really like the insight you made about conversation starting. The problem is that most people won't believe they can actually attract the audience needed to create a fertile conversation on their blog.

<comment><USER12> Philosophically speaking, doesn't this boil down to having something meaningful to discuss? Otherwise you're just generating web noise but we're all guilty of that.

</comment></comment></comment></comment><comment><USER13> 95% of blogs are abandoned for the same reason 95% of projects never materialize, which in fact is the same reason 95% of life changes remain new year resolutions: _Procrastination_.

The Postary announcement states:

 _Postary - the simplest way to share posts with no strings attached, no obligations and no expectations. Postary reduces the Blog Lifecycle down to step four: if you are inspired to say something, then just post it and share it with the world_

Similarly to suggestions for product landing pages, you do not state _how_ Postary will help me with that, i.e. how the procrastination factor is dealt with. Is there gamification? E-mail reminders? Where is the cheese? Expand on that "simplest way" to sell the idea on me.

Additionally, I will not click-through the "Write a post" button since it requires a Twitter account. Why do I need to login to Twitter, assuming I do have a Twitter account, if you haven't convinced me that there is a reason to waste a couple of minutes of my time?

To sum things up, what differentiates you from, say, Blogspot, Tumblr, Wordpress et al? I can "just post it and share it with the world" over there too.

<comment><AUTHOR> Thanks for the feedback. We did this in 8-10 hours - we left a lot out :)

The difference I guess is that we tried to create a blogging service that isn't a blog you need to maintain to feel good about.

<comment><USER14> I agree on the Twitter thing - open this up to anyone, let them grab a login with Twitter if they want, have a secret admin url if they want or have no editing ability at all - if they want.

</comment></comment></comment><comment><USER15> I've abandoned several blogs. No, I'm not happy about this.

Why abandon a blog that I've put a great deal of time, even years, into?

For me, it comes down to few things, but mainly a work vs reward measuring. Doing a good (or even decent) blog takes a lot of work. I'm honestly not the best writer in the world, and creating a blog that's on topic consistently and creating that amount of rich content is just hard.

I found my traffic was always good if I could blog at least 3x/week, but really 1x/day was the very best. Even if you're doing that by sitting down and queuing up content for the week, that's a _lot_ of effort (generally an entire day) just to blog consistently.

What I always wanted to do, was to get together a group blog with 5-10 friends, which we could all contribute to on some semi-consistent topic (like Mashable, Techcrunch, etc but smaller in scope and goal). Then each person doing 1-2 things a week would be totally sufficient and keep things interesting.

Yet, the reward for this was always pretty low. I didn't like putting ads on my site. Amazon referral links were pretty good on occasion, but if you don't have a product oriented blog (or huge traffic) it still barely paid for hosting. So 1 day/week (15% of your time) for that much coming back to me was pretty low.

</comment><comment><USER16> Because writing well is really hard, and people don't realize that before they start.

<comment><USER17> Not only is good writing hard, but technical writing is even harder. I have a blog with a few articles on technical topics, but it takes a lot of time to write, edit, and make sure everything is correct. To put something up at the quality level I want ends up taking too much time and interfering with working on my projects.

</comment></comment><comment><USER18> Because I realized that 99% of what I want to write about is textual flatulence to the rest of the world, and I got tired of the narcissism inherent in that 99%.

I do keep 3 bloggy things, but 2 only get updated with useful info, and the other is where I mumble about my personal life (which no one but me cares about generally).

</comment><comment><USER19> I think a lot of blog abandonment is a consequence of shifting priorities.

I started my most recent blog back in 2008 to keep track of the projects I was working on and to build a body of work that I could present along with a resume.

A lot of the content I tried to capture was original work I had done; some of it was writing about something I had learned and tried to apply to a proof of concept.

I went with a monthly format and for awhile this worked out well, but as soon as summer would come around- priorities would change and content wouldn't resume until November.

I've gone through that cycle the past four years and this past year I simply haven't had the motivation to stick with it due to projects at work draining me of my enthusiasm and deciding that there are better ways to spend my time than constantly parked in front of a computer.

<comment><AUTHOR> What would make you stick to it? Or am I asking the wrong question: Does it even matter to you that you do stick to it?

<comment><USER19> I'm sure that I'll find myself updating it again. I think if I still had the motivation and focus I did when I was younger, I would be able to stick with it. But when blue skies and mountain calls you, you got to answer.

</comment></comment></comment><comment><USER20> I like this idea, I've had a thing or two I wanted to write on, but didn't want to setup a blog. I've actually thought of building something similar myself.

So, excited about this website, I clicked on "Write a post". Oh, you want to tie to my twitter account. Nevermind.

<comment><AUTHOR> Why not connect your Twitter account? We won't post anything on your behalf...perhaps we should have made that clearer :/

<comment><USER21> I neither have nor want a Twitter account, but even if I did, there's no reason to want to link it to this service.

</comment></comment></comment><comment><USER22> You forgot two points in your lifecycle: \- Irregular posts apologizing for not posting more often. \- Various defeated remarks about "not being read by anyone, anyway".

At least, that's how my personal blog (and a few I tried starting) went, in addition to what you already mention.

I think that it's an awesome ideas, the same way services like "twitpic" offer hosting of free-floating images without the need for a hosting, you offer free-floating blog posts without the setup. I like it!

<comment><AUTHOR> Glad you like it. Feel free to pimp it/use it whenever you want :)

Anyway - if we can find the time, we may release new features in the near-term that will make it even more interesting! Or we might just procrastinate and not do anything...

</comment></comment><comment><USER23> I agree with your diagnosis of the problem, but not sure about your solution. People start blogs because they want their own space to share their thoughts. If they wanted to share their thoughts on someone else's site, they'd comment on a post, use fb, or a million other things. I think you're missing a key piece to why ppl start their own blogs, because it's theirs and they have the freedom to do whatever they want, they have a sense of ownership. I signed up for your service but I won't use it because I want my own space. I'm starting a blog and will probably follow the path you laid out, but at least I'll have my own space.

</comment><comment><USER11> Correct me if I'm wrong but you are essentially offering what Google+ and TwitLonger.com offer already. When a person is inspired, they can post and share with their friends a longer post, with no strings attached.

This will undoubtably work for some, and if you market it properly, you may create a spot for your service; but I'm not sure this is the cure to the 95% of blogs are abandoned problem.

A traditional blog is a lot more work, but it can provide you with an unbelievable degree of rewards and benefits. I think many of these benefits will be lost for those who opt to use your service, at least in its current incarnation.

In my book on technical blogging (<http://pragprog.com/book/actb/technical- blogging>) I provide a different antidote to abandonment syndrome. I suggest a careful plan and road map that can lead virtually anyone who follows the steps to succeed early on.

Careful planning, knowing what to write and when, learning how to deal with writer's block, and achieving a degree of success early on, all contribute to eliminating the abandonment problem.

Who would abandon a blog that is read by thousands, it's making them money, and helping them further their career? Not many, I suspect, despite the weekly effort required to achieve such goals.

<comment><AUTHOR> Regarding, TwitLonger and Google+ - yes, the distinction is not strong. We've built a POC but want to add features that make each post more "special." Because we're divorcing posts from blogs, each post can look different :)

I hear you on the antidote, but I'm not sure it will work for most people. In fact, many people don't have an "expertise" to share and are looking to post thoughts about non-work-related material.

</comment></comment><comment><USER24> And if you want to blog without any strings attached (not even twitter), there's <http://instablogg.com>

<comment><USER12> Oh ya. Here's another blog without any strings attached: <http://pastebin.com>

<comment><USER24> but ... but it has no comments!!

<comment><USER12> Here's a comment response (<http://pastebin.com/rb8jVP5y>) to my original post (<http://pastebin.com/kkAyryLT>)

postery should integrate pastebin as a backend! And then usenet. Or email.

</comment></comment></comment></comment><comment><USER25> I've been blogging for 3.5 years on informational topics, which is to say I share what I learn in my own research on certain topics.

My main blog, which I've had the longest, has 500K hits, with an average of between 12K-16K per month. Am I happy with that? Sure, but it's not a money- maker. From what I've read, one needs to attract upwards of 100K visitors/month to be able to make some money from it. Currently, 130 people subscribe to my main (Wordpress) blog, though I don't believe WP offered the 'subscribe' widget the entire time I've been with them.

In the meantime, I've used the main blog's template, topic-wise, to create around 10 other blogs on other subjects. I eventually got burnt out and consolidated to 3 but then I deleted the least popular and stopped updating the second to last.

At my height, which I sustained for around 3 years, I was posting between one and two posts per day. For the main blog, I also made cards to hand out and tees to sell.

What I essentially did the majority of my time is curation and curation is a lot easier (if you know how to do it) than coming up with original content, which is what I've been doing with the main blog for most of 2011 when I switched gears. 'Coincidentally', this is also when many readers said bye-bye.

People I share links with, who blog on the same topic, usually write personal blogs and a few of them get 20-50 comments with every post. I, on the other hand, am lucky if I get 2-3. Basically, I get more hits but less comments.

All in all, I see my retirement from blogging in the near future because I feel I've mastered the topic (culture, by the way). It is said that it takes 8000-10000 hours of study to become an expert on something (a mark which I passed a few years back). The only problem is I'm a generalist at heart.

</comment><comment><USER26> Frankly, I don't understand why anyone would spend a lot of time on a blog. Well, I take that back. The top .0000001% of bloggers make a lot of money. But for everyone else, well, writing (good writing, anyway) is hard work.

If you just dash off whatever comes to mind nobody will bother reading what you've written, so you're wasting your time. If you put a lot of time and energy into your posts then at some point you've put in the same amount of effort it would have taken to write a book, but you have less to show for it.

I guess if you just enjoy writing a blog it's fine. But like any hobby it will get old eventually, so it doesn't surprise me so many are abandoned.

The blogs that seem to be successful over the long run are either news- aggregation type affairs, where it's mostly just links with a pithy joke or two thrown in, or they're single subject blogs with multiple people sharing the load. It's just too much work for one person to generate enough original content to hold the attention of a regular reader base.

</comment><comment><USER27> This is a great concept... I think where it could differentiate itself is by aggregating posts by topic. If I'm searching some topic on the web, I often come across blogs that are out of date or orphaned, and they might provide me with some of the information or links I am looking for, but not all.

If Postary lets me find several such blogs on its site, organized into blog threads by topic, then it fills a need on both sides: the author gets to broadcast to the web without the pressure of maintaining a blog site or Twitter feed, etc... and the reader is able to find information or commentary on a topic of interest.

It could be almost like a message board, instead of thread topics there are topics (several of which might apply to any given Postary post) and instead of responses to that topic, a threaded view of Postary posts. The threaded view would be composed on-the-fly and would vary depending on what you search for.

To make it more interesting and engaging, each Postary could have the option of being maintained as a blog if the writer so wished... and further, each Postary could allow comments from readers.

So you could post your thoughts about Haskell the day you discover and get really excited by it; and that could be tagged under topics like Haskell, programming philosophy, programming tips, etc. If somebody searched Postary for Haskell, they would see your post along with all others on the same topic, plus comments, plus follow-on posts (if any) by the same author. Threads could be auto-composed based on any number of criteria (newest first, most- responded-to first, etc.)

In this way, the site could serve both the "web archaeology" and "latest and greatest info" niches of search, and could create a lighter, less pressured form of engagement with authors and readers. Isolated, sporadic posting by authors could be organized into a coherent, constantly-updated site on any number of topics.

<comment><USER28> Really like this idea!

</comment></comment><comment><USER29> I'm thinking about rebooting my blog.

For me, the problem is the inherent sense of obligation implied when organizing posts by date. My last post was written April, 2009, which reported that I redesigned and restaged my blog.

Ironic, isn't it?

There are many ways to solve this problem. Postary's picked a really good one, and I'm looking forward to seeing how people responds to using them. But I know it's not the only way to address this problem.

These days I'm rethinking the way I write and publish. I like easy-to-publish. I like self-hosting. I don't want databases - static site generation for me please. I like blending in my activities on other sites (like Twitter). I don't like date-based organization (it doesn't make sense for the way I do my writing).

So I'm looking for (or writing) tools that support folksonomy-based URI navigation (which supports organic site growth), easy-publish, and importing and reformatting data from other social networks. If you have any pointers, send 'em my way.

</comment><comment><USER30> Definitely piqued my interest. I like that it works with Twitter, since it's an obvious "share point." But with this type of system people should have the option of posting their work anonymously.

The other thing I think this type of system should do is to aggregate the content. Encourage tagging and referencing of posts throughout the system, rather than siloing to a single author, and find ways to rank the content. Youtube is a good model. Rationale as follows:

I am often inspired on the spur of the moment to write detailed comments of sizes between a few paragraphs to the length of a short essay. And yet I know that most comments end up buried forever in an old discussion thread, never seeing the light of day again, regardless of their value.

So my thinking is that if we had a system that blurs "comments" and "articles" and tried to facilitate a discussion curated over years instead of hours, more value could be captured.

</comment><comment><USER31> This was one of my smaller ideas - the ease of Posterous combined with the single-designed-page feel of about.me (and others like it). For a long time, I was looking for somewhere suitable to write up a restaurant review or talk about a movie or share something else, without committing to a full-scale blog.

No next or previous post buttons, probably no comments, just a title and body. Then a pool of photos/themes to present your information nicely. No feeling of abandonment or fear of commitment.

Not sure without further thought how this could be taken to the next level, but it's at least a nice side-project worth trying.

</comment><comment><USER32> I have a blog I posted fairly consistently to for 2 1/2 years. I just checked the stats and in that time I have had a total of 1,530 hits. Total. And for my efforts I have earned $2.35. The reason I abandoned my blog is very simple. It never got any traction and I have bills to pay. Perhaps when I get a decent exit I'll give it another try but until then, I have bigger priorities.

</comment><comment><USER33> I wonder how many blog posts are abandoned before they're fully fleshed out. If the percentage is too high it could be a downer for this idea.

Your tool combined with my wondering led to this trolltacular literary masterpiece. <http://www.postary.com/twitter/Detrus/abandoning-a-post>

</comment><comment><USER28> I'm curious as to how people are defining "success" in these comments. It seems to revolve around traffic, and perhaps that implies something (advertising). Me, I guess I define it as having said something that starts/contributes to a conversation, and that an actual conversation happens. But how do _you_ define it?

</comment><comment><USER34> I had a similar weekend project[1] where anyone can write random posts with no setup required.

It's more bare bones (really bare bones, heh) and allows anonymous posts.

Hmm, even _I_ abandoned posting there, though I'm not much of a poster in the first place.

[1]: <http://kodig.com/>

</comment><comment><USER35> Not to diminish the idea (which I like), but I'm most impressed that they were able to get postary.com.

<comment><AUTHOR> +1 to self-indulgent and maniacal domain hunting!!!

</comment></comment><comment><USER36> The site reminds me of squidoo. I kind of wonder why I can't click on someone's username and see everything they've written. What if you feel like writing a lot on postary? Does it just stay disjointed?

<comment><USER37> Seeing an index of all the posts someone made is a good idea, it just didn't make the cut for the first iteration.

</comment></comment><comment><USER38> The two necessary elements of a great blogger: patience and persistence.

Most people don't have either when it comes to blogging since there aren't really instant rewards for blogging and no pain if they don't blog.

</comment><comment><USER39> Has anyone quit because of the Haters/Trolls? I found it shocking to write something I thought might be useful to get feedback like "you're an idiot who shouldn't have a job". Ouch.

</comment><comment><USER40> Glad to see this idea finally come to fruition - I tried getting this exact same thing off the ground last year with no success, but hoping you'll be able to succeed where I failed!

</comment><comment><USER41> I wish more bloggers knew that they could auction off their blog if it's got a bit of traffic and collect a check, rather than abandoning it and letting it die.

</comment><comment><AUTHOR> Would love to hear anyone's thoughts on Postary or blog abandonment in general here! Thanks in advance guys!

<comment><USER42> Is there a list of posts by poster?

<comment><AUTHOR> Not yet but this is something multiple people have asked for.</comment></comment></comment>


Stanford CS 144: Introduction to Computer Networking - <AUTHOR> https://cs144.github.io/ <comment><AUTHOR> OP here. I think the best would be to do the labs in posted link, after watching the great video lectures (which have quizzes but are lacking labs) in the free online Stanford course: [https://lagunita.stanford.edu/courses/Engineering/Networking...](https://lagunita.stanford.edu/courses/Engineering/Networking- SP/SelfPaced/about)

AFAIK this combination would be the best free computer networking course out there, specially if combined with the MIT 6.033 systems engineering videos, to understand complex systems design concepts in a wider context, and how they were applied, in particular, to the internet and the ethernet.

Also, regarding ethernet, there is a realy good old presentation by Metcalfe in youtube: [https://youtu.be/Fj7r3vYAjGY](https://youtu.be/Fj7r3vYAjGY)

<comment><USER2> Where is the link for the lecture videos?

<comment><USER3> Here is the youtube playlist if anyone is interested.

[https://www.youtube.com/playlist?list=PLvFG2xYBrYAQCyz4Wx3NP...](https://www.youtube.com/playlist?list=PLvFG2xYBrYAQCyz4Wx3NPoYJOFjvU7g2Z)

<comment><USER4> Thanks for sharing my curated playlist

</comment></comment></comment></comment><comment><USER5> A good book to accompany this course is TCP/IP Protocol Suite 4th Ed. by Behrouz A. Forouzan which can be found online here: [https://archive.org/details/TCPIPProtocolSuite4thEd.B.Forouz...](https://archive.org/details/TCPIPProtocolSuite4thEd.B.ForouzanMcGrawHill2010BBS)

<comment><AUTHOR> From this course's syllabus: _The optional course textbook is: Kurose and Ross, Computer Networking: A Top Down Approach, 7th edition._

</comment></comment><comment><USER6> In general, I wish the Stanford CS lecture videos were available online to everyone.

<comment><USER7> There seem to be quite a few MOOCs available[1]. edX and coursera have content from big name universities, too

[1] [https://online.stanford.edu/courses?keywords=computer+scienc...](https://online.stanford.edu/courses?keywords=computer+science)

<comment><USER8> Unfortunately MOOCs, including at this point even edX, have really been tightening up on what you have access to for free. By and large, you can still get the videos, at least while the class is running, but not a lot else.

</comment></comment></comment><comment><USER9> I'd started one lab but lost track of them years ago and been looking. All I ever fou d was the Lagunita videos. Definitely will do these when I get time, thanks!

<comment><AUTHOR> OP here, I was in the same situation. The only way I eventually managed to get the labs was by dirbusting this stanford course's url a few months ago (felt a bit bad about this but I was a bit desperate and it did the job, I managed to get the lab pdfs/htmls, zips and even the vm; I also found it a bit ironic that I managed to get network labs from a top university in such a fashion). But this link is the most up to date version, of course. And this time they put the labs in github, just great.

</comment></comment><comment><USER10> Anyone know how I can get a free Stanford account to watch their video?

<comment><USER7> I just signed up to the online course that OP linked to. I assume they're the same videos

<comment><USER10> oh cool. Thank. I got in. Really like this course.

</comment></comment></comment><comment><USER11> I can't see a mention of IPv6 anywhere, and IPv4 is talked about as 'the' IP protocol.

Disappointing and frustrating.

<comment><USER12> Just use getaddrinfo and don't make assumptions about what names/addresses look like.

Really, it's CS so the ideas around building correct systems over a network are much more interesting than how to use a particular version of the sockets API (which just requires reading documentation.) Attitudes like that are how you end up only having electives like "how to build an app in framework x." The whole point of the CS degree is to teach you to read/write documentation so by definition classes that read it for you are a waste of money and time and are the _most_ frustrating.

<comment><USER11> But this course _does_ actually look at IP headers, checksumming, fragmentation, CIDR, discovery protocols and whatnot. Those are also important to understand in the context of IPv6.

</comment></comment></comment><comment><USER7> Could somebody explain why this is news? I'm obviously missing the relevance

<comment><USER13> It's not, just something cool that OP found. This kind of stuff is posted here a lot, along with Wikipedia pages etc

<comment><USER7> Ok, thanks. I wasn't being snarky I was just curious

<comment><AUTHOR> OP here, since you are curious, this is why I decided to post this: as someone else has remarked above, there is a fantastic Stanford free networking course in Lagunita. It is the real thing, full force undiluted highbrow not dumbed down, unlike so many other moocs. Except, frustratingly, unlike the real Stanford course, the challenging labs are missing, so people were missing that necessary balance between theory and practice. But now Stanford has made said labs publicly available, this term. Given that this is AFAIK the best free networking course out there, I thought HN readership might be interested to know that now it's even better (and, as it happens, it was).

<comment><USER7> Great. Thanks for the explanation. I'm not from the US so please forgive my ignorance as to CS 144's significance. That's all I was really asking - when I asked that question there was no accompanying commentary here.

<comment><AUTHOR> No problem. Your remark made me realize that maybe I should have worked harder on the title. I am not from the US either, English is not my first language, but on top of having most of the best universities they also seem to be making great university courses available for free much more than anybody else.</comment></comment></comment></comment></comment></comment>


Favorite Bryan Cantrill (CTO Joyent) Videos - <AUTHOR> http://www.jilles.net/perma/2015/02/27/bryan-cantrill-joyent-smartos/

<comment><USER2> I've been enjoying them. Thanks!

<comment><AUTHOR> You're welcome. It's better entertainment for me than some of the stuff out of Hollywood.</comment></comment>


Codesigning? - <AUTHOR> https://www.youtube.com/watch?v=mwuk0E-tfeg <comment><AUTHOR> Haven't coded against WinAPI for the last 5-10 years, come back to this.

Why is codesigning so painful...

</comment><comment><USER2> First comment describing it as a racket is fairly accurate.</comment>


Will 2014 bring the death of the patent troll? - <AUTHOR> http://projects.aljazeera.com/2013/patent-story/ <comment><USER2> Hah, M-CAM. Anytime an article quotes these guys, I know it's going to have some low quality reporting about patents. (And, yes, this includes the "When Patents Attack" episode [1] on "This American Life", where the very same M-CAM dude claimed there was a "patent on toast".)

I looked through every patent on online backups that M-CAM said "covered the exact same thing" in that episode [1], and found each one to claim something entirely different. Whatever their method of analysis is, it was completely useless then.

I also looked through the first few of the "just 70" out of the 5160 matches M-CAM found in this article, and found nothing really similar to Bobo's patent (or indeed, each other). Sure, there may be some really damaging prior art out there. I just highly doubt M-CAM found it.

But don't take my word for it, others have called these out as well [2, 3].

That said, if Huster can show that she indeed was an inventor, this patent is trivially invalid because she is not named on it. This is the same thing that killed the IV patent in "When Patents Attack Part 2" [4].

1\. [http://www.thisamericanlife.org/radio- archives/episode/441/t...](http://www.thisamericanlife.org/radio- archives/episode/441/transcript) 2\. [http://gametimeip.com/2012/04/13/q-why- was-mdb-capital-right...](http://gametimeip.com/2012/04/13/q-why-was-mdb- capital-right-and-m-cam-so-very-very-wrong-on-aol-patent-value/) 3\. [http://www.iam- magazine.com/blog/Detail.aspx?g=c5c2c5b5-ecf9...](http://www.iam- magazine.com/blog/Detail.aspx?g=c5c2c5b5-ecf9-4b7a-b019-6e72ab6170e5) 4\. [http://www.thisamericanlife.org/radio- archives/episode/496/t...](http://www.thisamericanlife.org/radio- archives/episode/496/transcript)

<comment><USER3> _where the very same M-CAM dude claimed there was a "patent on toast"._

This comes pretty close no? "Bread refreshing method" (US 6080436 A).

[http://www.google.com/patents/US6080436](http://www.google.com/patents/US6080436)

 _Abstract

A method of refreshening a bread product by heating the bread product to a temperature between 2500 are maintained at this temperature range for a period of 3 to 90 seconds._

<comment><USER2> No, because as the claims state, the bread is heated at a temperature between 2500 F. and 4500 F. Toasters generally operate at much, much lower temperatures -- around 300 F. In case this seems like a minor distinction, consider that toasting bread at 2500 - 4500 F does not give you toast :-)

 _" A toaster works by applying radiant heat directly to a bread slice. When the bread's surface temperature reaches about 310 degrees Farenheit, a chemical change known as the Maillard reaction begins. Sugars and starches start to caramelize - turn brown - and to take on intense flavors.

"That's toast.

"With more heating, the sugars and underlying grain fibers start turning into carbon.

"That's burnt toast."_

\- Quote from a Consumer Reports test on toasters, June 1990 (found at [http://www.toaster.org/works.html](http://www.toaster.org/works.html))

I'm not sure what this patent gives you -- heck, maybe it does refresh stale bread -- but it certainly won't give you toast.

</comment></comment></comment><comment><USER4> In deference to Betteridge, I'd say no.

</comment><comment><USER5> No, I don't think so. Like copyright, there is too much money invested in the patent system to allow for any real, meaningful change.

</comment><comment><USER6> Wishful thinking. But we can wish, can't we?</comment>


Ask HN: What are great resources when launching new products during hackathons? - <AUTHOR> Im looking for good resources that can help me and my friends launch products more efficiently during hackathons. <comment><USER2> A good resource to quickly brand your project with a free open source logo is: [http://logodust.com](http://logodust.com)</comment>