Working with GitHub Actions - <AUTHOR> https://jeffrafter.com/working-with-github-actions/ <comment><USER2> My experience with GitHub Actions has dramatically shifted as of last week. My first attempt at using them was catastrophic, and I decided it would never work for us. Fast forward about 2 months and everything seems to be working perfectly now. Setting up a test build for PRs on a .NET Core solution took ~10 lines of YAML, and we were in business. The ability to monitor the builds in real-time as well as link to specific line #s in each respective action log is an incredible feature. We will definitely be using this to link issues to build failures. Also, the ability to see how a build script will perform scoped to its PR means that you can review and approve not only the code aspect, but also any required changes to the build/deploy pipeline. Atomic commits across source & CI/CD is a very compelling idea.

One final aspect we started investigating was how we could completely eliminate Jenkins from our stack. We have some deeply-customized jobs that run on that box (for handling bundling of build artifacts, managing metadata for final public releases, etc). What we will likely do is write a post-build agent in .NET Core, include it within the same project repository it will be responsible for working with, and then as part of the solution build it would just get taken care of automatically. Then, we simply need to invoke one more command after our initial dotnet build to trigger the package/deployment process, all from GitHub's machines.

If anyone from the GitHub team is browsing here, I was wondering if there were any plans for caching Action state between builds. That is to say, instead of downloading & installing the .NET Core 2.2 runtime every time an action executes, it could load from some cached instance (if available). This is the only downside I see right now - Jenkins can usually turn our check builds around in about 50% the time of the GitHub Actions, but for our purposes right now we honestly don't mind it. PRs don't need to merge every 60 seconds. Once we get to release builds in GitHub Actions, I think that tune might change a little bit.

<comment><USER3> GitHub provides an action which might be the one you're looking for: [https://github.com/actions/setup-dotnet](https://github.com/actions/setup- dotnet)

If you set a specific version, it can use a cached image and is a lot faster than a complete install.

Also have a look at their other `setup-*` actions for similar installations of Node, Python, Go...

<comment><USER2> Yep - This is exactly what we are using right now. It is still a bit slower compared to having it pre-installed on something like a persistent Jenkins instance, but it's such a marginal difference that we will probably overlook it assuming that new caching features roll out eventually.

</comment></comment></comment><comment><USER4> If you are a programming beginner or want a deep dive which teaches a bunch of unrelated topics, this is a great article!

But, it took me longer to skim this article than to setup my first action. This is making things _way more complicated seeming_ than it actually is IMO. All you need is 3 small files :)

<comment><USER5> Sorry in advance for the shameless plug.

If anyone is looking for such a get-started-right-now post, I've written one with a sample build-and-upload-to-s3 workflow [0].

It is indeed simple to get started, and I'm personally quite optimistic for Actions in the future!

[0] [https://tpaschalis.github.io/gh-actions- go-s3/](https://tpaschalis.github.io/gh-actions-go-s3/)

</comment></comment><comment><USER6> The only downside to GH Actions rn is the inability to cache artifacts, but that'll change by November 13th at the latest.

[https://twitter.com/natfriedman/status/1172387801054113793](https://twitter.com/natfriedman/status/1172387801054113793)

</comment><comment><USER7> How do people find Github Actions compared to Gitlab's CI?

I've had a a first look through the documentation, and saw a couple of interesting differences:

Actions allow a job to be broken up into a series of (re-usable) steps

Can be triggered on a broader set of events

</comment><comment><USER8> GitHub actions are pretty easy to get started even for CI beginners. Only few things I feel lacking, 1\. Environment variables can only be defined on steps, they can't be defined at a job level. So the same code has to be repeated in each step. 2\. There's no way to manually trigger a job.

<comment><USER9> > 1\. Environment variables can only be defined on steps, they can't be > defined at a job level

Actually you can define global environment variables with an extra step... here is how I do it. I was quite frustrated until I worked this out!

          - name: Set environment variables
            shell: bash
            run: |
              echo '::set-env name=GOPATH::${{ runner.workspace }}'
              echo '::add-path::${{ runner.workspace }}/bin'
              echo '::set-env name=GO111MODULE::${{ matrix.modules }}'
              echo '::set-env name=GOTAGS::${{ matrix.gotags }}'
              echo '::set-env name=BUILD_FLAGS::${{ matrix.build_flags }}'

<comment><USER8> That actually works! Thank you.

</comment></comment></comment><comment><USER10> I tested our most complex pipeline on Github Actions (the newer version of the beta, which had the YAML specification, though I tried both). Our most complex pipeline, though universally likely not very complex; maybe 8 distinct linters, unit tests, a build step with a typescript compile + docker build, and an image push.

While they're definitely trying out some novel ideas in the CI world, it was _startlingly_ slow. Using as much parallelism as possible on every platform; CircleCI could do this pipeline in ~5 minutes, BuildKite (what we currently use) hosted on GCP n1-standard-1 instances, could do it in about 6, and Github Actions took closer to 10. I believe the main reason why Circle was faster was that I took some extra time to set up their native cacheing systems for things like npm dependencies and build outputs between steps; we don't have this set up on BuildKite, and that might shave off a few seconds (though, I haven't looked into it, but if we're forced to egress these caches from a BuildKite DC, say in AWS, to our agents in GCP, maybe it wouldn't save any time. The tight integration of Circle is a big advantage here).

My theory is that the big slowdown is the downloading of docker images; not necessarily the beefiness of each build container.

On Circle, we avoided the use of docker and went straight native, except in the final steps where we're actually building an image of course.

On BuildKite, we're actively encouraged to use Docker to isolate builds. Given a single agent will be shared between multiple repositories, this makes total sense. But, the agents are still durable; if a tslint step starts with a pull of the node:carbon image, that image will be cached on each machine that has ever ran the build, practically indefinitely (until the machines are recycled). So the P99 off each pipeline can be higher than that 6 minute mark, but the vast majority of builds will go much quicker.

On GHA, every step needs to be in a docker image (which I like!), but there doesn't appear to be any local image caching in the build containers. If they can add this in some capacity, I'd bet the builds would be much faster. Arguably; they _know_ at any time what images may be needed for a given repository, because the pipeline steps are defined statically in the repository, so they could feasibly keep those cached in a pool of workers that are then grabbed for that repo. Plus, I'd bet over 50% of builds start with the top 50 most popular images on docker hub (alpine, ubuntu, node, python, etc). There's no reason why every agent can't have those pre-downloaded and ready to go, beyond cost.

Excited to see the product improve; I could _easily_ see us switching and paying for it one day.

<comment><USER11> I've recently dumped a lot of time into making our CircleCI pipeline faster. I'd love to hear why you switched to BuildKite because we're looking at doing the same thing. My understanding is BuildKite has the following advantages:

\- You can have persistent workers since the build machines run in your cluster.

\- Much better Docker layer cache hit rates. We use custom Docker images and I've never seen a Docker image cache hit on our CircleCI machines.

\- Better download throughput. CircleCI appears to be bandwidth limited to about 15MB per second.

\- It's much more straight-forward to programmatically generate workflows instead of hard-coding them in multi-thousand line YAML file.

Some of low-hanging optimizations on CircleCI I've used to reduce build time are:

\- Using a shallow git checkout. Reduced checkout time of our 500MB repo from 30 seconds to 2 seconds.

\- save_cache into /dev/shm. This cut our 1GB node_modules (yea, it's huge I know) save_cache and restore_cache from 30 seconds to 10 seconds. The HUGE downside is /dev/shm is mounted as noexec so you can't run anything in node_modules/.bin without some hacks.

<comment><USER10> We never really "switched" to Buildkite; its what we started with, and its been great for us. But I'm always experimenting with other options, which has recently included GHA and Circle.

Buildkite has pros and cons, like any CI platform. Managing your own agents is nice in the sense that you get really fine-grained control over their performance and cost. But, that being said, it would take some engineering to create an agent pool which can match the cost of something like Circle.

If you're running an agent 24/7, on, say, an EC2 instance, but you're not actually using it 24/7, there's some serious cost overhead there where you'd see some nice savings on Circle. The great thing about BK is the flexibility; there's infinite potential to do some really smart things, like build an autoscaling agent pool. In fact, they have an AWS CloudFormation stack which does exactly that (we don't run that, but I've looked into it and its really cool: it essentially has a lambda cron which calls the BK API to determine the number of outstanding jobs, dumps that into a CloudWatch metric, then sets up an ASG which can scale-to-zero based on this metric). As far as I can tell, this is a "one-click deploy", so management should be easy.

We run our agents inside Kubernetes on GKE. We've had some minor issues with this. Docker-in-Docker is never fun. So we'll probably look to switching to that stack (and maybe set it up so, instead of the automated ASG, we just have a timeboxed ASG between 9-5 M-F, scale to 1 instance outside of those hours, as we're pretty timezone-centralized). The advantage of GCP/GKE is that we're using preemptable instances; ridiculously easy to set up on GKE and you get that 70% cost savings. The only downside is that, every once in a while, a build just fails because the underlying instance restarts. At our scale, not a huge deal; just re-run it. Maybe happens once a week.

Again, its trade-offs. You can go with more persistent workers, and get amazing docker layer image caching. Or you can go with an auto-scaling route and save a ton of costs. It shouldn't be impossible to find a balance in there which works for your company, and I like that about BuildKite.

I don't think we'd ever switch to Circle, just because I don't see a huge benefit in doing so. We may, one day, switch to GHA. We already use Github, so that integration is nice. If the performance is looking good and the cost is acceptable, then we'd do it; CI is so fungible that it really comes down to minutia like this.

</comment></comment></comment><comment><USER12> Had anyone switched from Google Cloud Build to GitHub Actions CI? What has the experience been?

</comment><comment><USER13> tldr; The author motivates the solution given in the article, but does not explain the problem which GitHub Actions solve. I would have liked to know what to expect before dumping an article into my brain.</comment>


Facebook Will Ban White Nationalist and White Supremacist Content - <AUTHOR> https://www.buzzfeednews.com/article/ryanhatesthis/facebook-ban-white-nationalist-white-supremacist <comment><USER2> conversation here: [https://news.ycombinator.com/item?id=19503094](https://news.ycombinator.com/item?id=19503094)</comment>


Finding rectangles in images using Haskell - <AUTHOR> http://twanvl.nl/blog/haskell/finding-rectangles

<comment><USER2> Not necessarily on the topic of the article itself, but I found this to be a good concrete example of how to think in Haskell (and functional programming in general?).

I've just started learning by reading Learn You a Haskell. Even though there are plenty of examples in the book, so far, none of them are concrete. I found this article helps with the thought process of how to approach a problem in Haskell. The code snippets are accompanied with some clear explanations, and with some effort, I could figure out what the code does.

If you're a new Haskeller, I would encourage you to take the time to understand what's going on.

</comment><comment><USER3> My immediate thought was to do a hough transform. The equation for rectangles has very few parameters and finding "complete" rectangles at any given point would fast, though slower than this technique in honesty

the bonus of the hough transform approach is that you'd get ALL the complete rectangles. Also you could (optionally) get the biggest rectangle which is almost complete (let's say missing one or two pixels). Which is nice in the practical case when you are looking for shapes because "noise is a bitch"

word.

<comment><USER4> What jumped to my mind is that if you detect the vertical and horizontal lines - O(n) - and call those corners 'm'. You can then just run the O(n^2) bit on m rather than the whole n. Worst case n=m, but usually m will be massively smaller.

[http://stackoverflow.com/questions/289779/calculating-a- boun...](http://stackoverflow.com/questions/289779/calculating-a-boundary- around-several-linked-rectangles/294549#294549)

</comment></comment><comment><USER5> I remember reading about this in DDJ back in the day:

<http://drdobbs.com/database/184410529>

</comment><comment><USER5> "Given a binary image, find the largest axis aligned that consists only of foreground pixels."

I think you mean "axis-aligned rectangle", no?

</comment><comment><USER4> please someone post the APL program to do this!</comment>


All hail the information triumvirate (Web, Google, Wikipedia) - <AUTHOR> http://www.roughtype.com/archives/2009/01/all_hail_the_in.php

<comment><AUTHOR> The key point of the article:

"What's much more likely is that the Web, through its links, and Google, through its search algorithms, have inadvertently set into motion a very strong feedback loop that amplifies popularity and, in the end, leads us all, lemminglike, down the same well-trod path - the path of least resistance."

I couldn't agree more. I hope that a good number of HN readers are working on the next disruptive force rather than continuing to prop up the status quo.

<comment><USER2> Not the same path for all. But there may be rigid clusters of people with the same opinion.</comment></comment>


Linuxserver.io Docker Images - <AUTHOR> http://tools.linuxserver.io/dockers <comment><AUTHOR> They're built correctly, on top of the tiny Alpine image (same image used for most of the official Docker images), and most of these images are for open source projects geared towards self-hosted personal use. I'm having a lot of fun playing with them on an old box.</comment>


Show HN: DocRipper – Scrape .doc|.docx|.pdf|.txt|.sketch with 1 command - <AUTHOR> https://github.com/pzaich/doc_ripper <comment><USER2> Interesting! Apache Tika is the "classic" way of doing this, and it supports many dozens of formats. Is this meant to address certain needs that Tika doesn't?

<comment><AUTHOR> Interesting! I started this project a long while ago and I gradually introduced additional features and formats over time after running into performance issues with other file parsers (not Tika). Tika looks like a great solution if you don't mind the Java dependency.

Here's a JRuby wrapper: [https://github.com/ricn/rika](https://github.com/ricn/rika)</comment></comment>


Hey Paypal, why do you need access to my microphone, camera and photos? - <AUTHOR> http://thepcspy.com/read/paypal-permissions-microphone-camera-photos/ <comment><USER2> As a long term Android user and a mostly happy one at that, let me just say that Android's permissions are terrible and basically not fit for purpose.

I'm going to ignore third party solutions that require root, because those aren't part of the equation for 95%+ of Android users.

Android should have three levels of permissions: Implied (i.e. all apps get these), explicit (at installation), and prompted (user is asked at runtime).

\- Implied ("freebies"): internet connectivity, store data, get a unique device ID (per app?), store the app's own accounts within the accounts API.

\- Explicit (installation): Run in background, use GPS, use the camera, use the microphone, etc.

\- Prompted ("personal information"/"cost you money"): Access your cellphone number, access your contact list, access your calendar, access your email, read/send texts, make calls, etc.

Users in the current Android ecosystem learn to ignore permissions pretty quick as most are for trivial stuff (e.g. internet access, store data on the SD card, store an account, etc).

Worse still a lot of users will skip apps that ask for too many permissions which is bad for both the app developer AND users. Most developers want to offer functionality (e.g. share to contacts) but don't want to do so at the cost of losing users ("Why is this asking to see my contact list?").

Android needs to drop a bunch of "silly" permissions that have no inherent cost to the user. They're clearly created by an engineer who just wanted to slap permissions on every kind of API for no good reason. It benefits nobody.

They then need to take permissions which have a cost (either literally or to user privacy) and set them up rationally so they're either something you get when installing OR something you'll be prompted for.

Lastly Android needs to add a description field to the permissions manifest where the developer can put in a short explanation for why they need permission XYZ. Limit it to 128 characters if you wish. The app store can display these.

I install less apps on Android largely because many ask for too many permissions. If Google makes it really easy for me to protect my personal information (e.g. prompts) I'll literally spend more money on their store because I'll feel more safe to do so. As a developer I'll also offer more functionality to my apps as there is no permission "cost."

<comment><USER3> This is great stuff. I kind of wish they would hire you to run this. Another idea I've had would be for the user to be able to install an app without giving it the perms it "requires" (perhaps by unchecking some boxes in the dialog). Then apps would be responsible for handling a "no you can't see the contact DB" API response. Or they could crash I guess. The point is that users could effectively renegotiate with apps, e.g. "yes I'd like to use NFC to pay, no I don't want you to be able to record everything that's going on around my phone".

<comment><USER4> Actually, you'd want three settings:

Yes, No, and spoof. Otherwise far too many apps would just go "I won't work until you enable the settings I ask for" \- and then we're right back at the current situation.

<comment><USER5> Close. Yes, and spoof.

It is none of the app's business if the "camera" it sees is actually just an animated GIF (in essence).

It is none of the app's business if the "location" information it receives says, Mountain View, California. Wow! Look how many customers live in California. :-P

In short, the app should not even get the yes/no data from the user.

<comment><USER4> That possibly works.

But at the same time, I have a feeling that there would be frameworks popping up all over the place for recognizing spoofed settings. Yes, you'd end up with the same thing with an explicit "no" option, but the segment of users choosing "spoof" would presumably be smaller, and as such presumably the gain of an app adding functionality to detect spoofing would be smaller.

Although I personally think that the best option is, given that Android has the app store, have it part of the verification process that unrelated functionality of an app must work when functions are disabled.

<comment><USER5> Since the spoofed data is an API, your proposed framework to "recognize spoofed settings" must solve the halting problem -- impossible.

The spoofing API actually has only one requirement -- keep the app from accessing real data.

</comment></comment></comment></comment></comment></comment><comment><USER6> You're blaming the wrong people - assuming those are good and valid features (and they are for some users), what do you expect Paypal to do? They can't send you a stripped down app with only some permissions but give me one where I can take a pic of my credit card.

Android needs to support granular permissions at runtime, then you can deny Paypal access to your microphone if it ever tries to run.

<comment><AUTHOR> I completely agree. This needs to be fixed in Android...

But I still find it annoying that I can't install the Paypal app without giving them a free wiretap in return. In my eyes, bloating an application out to a state where it needs all this stuff is almost as harmful because it puts users in situations where they're handing this access out without thinking.

Edit: I've pushed a pretty major edit to the post to give a bit more focus to Android but also to point out that Paypal _could_ be a lot more responsible too. They could (for example) farm out all the privileged code to plugins and package them as separate apps. It's more of a pain for some users, less invasive for others.

<comment><USER7> _I completely agree. This needs to be fixed in Android..._

This is the primary reason I root my Android device and why I buy Nexus devices (I don't do Android development). XPrivacy and other apps allow you to revoke permissions individually, which is what Google should have baked into Android itself, without the need to root.

</comment></comment></comment><comment><USER8> A lot of comments seem to be missing that the issue is less about permission granularity and more about pre-asking for any and all permissions that the app may use. Runtime permissions would solve the issue - using the camera? Ask the user. Then the user can decide to allow once or allow every time. Of course, you'd have exceptions for some common things - store data etc.

The current model is rather like giving a teenager a credit card and hoping they'll be responsible rather than giving them an allowance or having them ask you when they need money. The user has no clue how the permissions are being used after they're forced to allow during installation.

<comment><USER4> Better yet: allow once / allow for <x> period of time / allow in foreground [ ] allow in background [ ].

<comment><USER9> Too complex.

</comment></comment></comment><comment><USER10> Seems the post is less about "why u need camera?", as the author gives reasonable explanations for the "why", but more about why aren't Android permissions more granular? I think the answer to that question is how often should the user be bothered to think about permissions? Android gets it all done up front, at the cost of it being "all or nothing". Apple let's you deny permissions at runtime, at the expense of bothering you each time the app wants to use (say) the camera.

None of which makes the post particularly front page worthy. "Why does $RANDOM_APP need to use my microphone?" Because Android permissions model, which has been rehashed to death; next question.

<comment><USER11> I don't think the solution is to ignore it though. Maybe it needs more calls to change the implementation and fix the core issue.

</comment></comment><comment><USER12> Device fingerprinting is a big boon to fraud prevention. The more data sources that can help uniquely identify a device the better. I know some fraud prevention companies require merchants to include an image (png), javascript and flash file on the checkout pages to profile a customer. Flash can access your microphone, camera and local storage (flash cookies).

Fraud is a big deal for Paypal, although I'm do not know if such permissions are needed in device fingerprinting on apps.

Interestingly from a privacy point of view, more granular permissions to device features might not necessary equate to greater anonymity. If most device users do not care or know about the privacy implications and accept the app's permission request, those who don't accept become the minority.

</comment><comment><USER13> Camera is used for their mobile check deposit feature: [https://personal.paypal.com/us/cgi-bin/?cmd=_render- content&...](https://personal.paypal.com/us/cgi-bin/?cmd=_render- content&content_ID=marketing_us/mobile_check_capture)

Microphone could be used for some kind of dictation feature?

<comment><USER14> Haven't they cancelled that feature? I remember getting an e-mail

[http://consumerist.com/2014/06/16/paypal-discontinues- mobile...](http://consumerist.com/2014/06/16/paypal-discontinues-mobile-check- capture-as-of-um-yesterday/)

</comment></comment><comment><USER15> Their app can also OCR the face of your credit card, for what it's worth.

<comment><USER16> The poster's point still stands, though. The user should decide whether to allow that permission on a case-by-case basis.

Sadly, that's a problem with Android, not Paypal.

<comment><USER17> If it's Androids problem and not Paypals, I'm not really sure if it stands, then.

<comment><USER16> Granted, the title and tone is a little sensationalist.

In fact, you're right. The main point is invalid, the author only saves face toward the final paragraphs, when mentioning iOS.

</comment></comment></comment></comment><comment><USER18> If I had to take a guess they're using something like Phonegap/Cordova (i.e., this is a hybrid mobile app -- basically just a browser view with HTML content and JavaScript that can make use of the device's hardware and accounts). A common mistake I've seen is people using the stock Android manifest that comes with Phonegap/Cordova. This manifest enables ALL permissions so all the native functionality plugins "just work" out of the box. However, you're supposed to pare down the manifest to remove permissions for things you don't actually use so you don't end up in this situation.

<comment><USER19> This is PayPal, remember? The likelihood they're using PhoneGap is so low that I'm going to state it isn't, without Googling it. ( _gasp_ ) Did you read the first article?

<comment><USER20> And indeed it isn't (got the latest com.paypal.android.p2pmobile from play store and checked). They do to have _an_ HTML component to their app, a Tour guide found in assets/ ("Pay with PayPal in Stores!").

I'm the same person as above, btw. I have noprocrast on that account. It is working very well for me ;)

They have, however, authored a Cordova plugin for others to use the PayPal SDK easily from their PhoneGap apps [1]

[1] [https://github.com/paypal/PayPal-Cordova- Plugin](https://github.com/paypal/PayPal-Cordova-Plugin)

</comment></comment></comment><comment><USER21> This is a problem with android/ios or the app development process entirely. If permissions could be requested on demand within an app after installation, the the initial permissions sought won't be as intrusive. For PayPal, thier userbase is quite large, and because you don't use a feature, doesn't mean a million users elsewhere don't.

So, imo, the apps permission handling is to blame here

<comment><USER22> iOS has always supported at-runtime permission requests (microphone, camera, camera roll, location, contacts, etc).

</comment></comment><comment><USER23> It is windows all over again. Just block internet access on everything and allow only a few apps to access internet.

</comment><comment><USER24> Why does X need access to Y?

[https://play.google.com/store/apps/details?id=com.dcentral1....](https://play.google.com/store/apps/details?id=com.dcentral1.android&hl=en)

<comment><USER25> For a while, there was an Android app, App Ops, which let you turn off permissions for other apps.

Google took it out. They claimed it would cause "user confusion", when badly- written apps crashed trying to use some feature they were barred from using.

[http://www.cnet.com/news/why-android-wont-be-getting-app- ops...](http://www.cnet.com/news/why-android-wont-be-getting-app-ops-anytime- soon/)

</comment></comment><comment><USER26> A good workaround to having to ask for too many permissions is for the app to explain the intent before the permission pops up. I find this offers a much better experience in general.

</comment><comment><USER27> Yet another example of "Why Smart Phones Aren't". Google it.

</comment><comment><USER27> Yet another example of why "smart" phones aren't.

</comment><comment><USER28> lots of permission managers for cyanogenmod</comment>


Allison Smith: What your company IVR says about your competency - <AUTHOR> https://www.queuemetrics.com/blog/2017/02/01/Allison-Smith-IVR-Competency/ <comment><USER2> This article uses the acronym IVR without defining it.

<comment><AUTHOR> An IVR is an Interactive Voice Response - the "press 1 for..." choices you get when calling a company PBX. Allison is an international talent for IVR voices, being the voice in Asterisk.</comment></comment>


Show HN: Slow.com redirects to Fast.com - <AUTHOR> https://slow.com <comment><USER2> What is the point of this?

</comment><comment><USER3> wow</comment>


Pharma companies continue to raise drug prices at rates well above inflation - <AUTHOR> https://arstechnica.com/science/2019/10/new-drug-pricing-data-shows-stunning-hikes-one-whopping-667-increase/ <comment><USER2> I truly do not understand the purpose of a free market for pharmaceuticals. The demand for these drugs is almost completely inelastic, as it is driven by the statistical incidence of the underlying medical conditions. This makes central planning remarkably easy compared to typical consumer goods. The government already sponsors the vast majority of exploratory, pre-clinical, and early-phase clinical research; all it would take to expand that program to include later-phase clinical trials would be increased funding. A nationalized pharmaceutical industry that provides drugs at cost seems like it would be a tremendous boon to our society, only requiring the "sacrifice" of the opulent lifestyles of the executives and investors profiting off the extortionate practices of our current system.

<comment><USER3> I truly do not understand the purpose of a free market for food. The demand for food is almost completely inelastic, as it is driven by the biological need for sustenance. This makes central planning remarkably easy compared to typical consumer goods.

A nationalized food industry that provides food at cost seems like it would be a tremendous boon to our society. It's time we give Washington full control of our nation's food market.

<comment><USER4> Your sarcasm aside, there _isn 't_ a free market for food. There's tons of intervention.

There's intervention on the supply side, with direct financial subsidies for particular products. There are indirect subsidies like those Snake River dams, which allow farmers in Idaho to cheaply float their crops down to the coast, and which are helping to destroy the salmon population. There are government advice programs like the USDA old "food pyramid" which is pretty much wrong, but shifted demand for foods for decades.

And, of course, there's intervention on the demand side, with food stamps. Essentially, socialized food but only for people who nominally can't afford it.

<comment><USER5> Sounds like the government is already shouldering most of the cost, might as well go full monte.

</comment></comment></comment></comment><comment><USER6> I've worked in pharma for much of my career, but will never go back. At one point I was working for a company that continues to milk profits off of a drug that was developed in the 1950s - the company doubled the price over the span of a few years in the late 2000s, for no reason besides the P in P&L. And that company is generally considered one of the "good guys" in the industry, spending proportionally more on R&D than almost anyone else.

You could argue that the outrageous profits made off a 70 year old drug are funding that research, but (a) that's just not the case, and (b) why should one group of patients and their insurers have to shell out for another? Isn't that what financing is for?

<comment><USER7> What's the company's overall margin?

Everything objective you stated sounds like it could describe either a good company or a bad company, all conditional upon whether the margins are huge or fair.

Any pharma company that spends on R&D will have to rake in profits from somewhere to subsidize R&D efforts. R&D is extremely risky (most drug R&D projects fail) and has a very long time period before payback if it succeeds.

<comment><USER8> Maybe. There are studies which point out some interesting large scale trends. One that private pharma R&D is getting less efficient, creating fewer and fewer drugs per billion dollars. Another is that many current high profit drugs had their early fundamental breakthrough research as government funded R&D, and that todays gov't funding of drug R&D is at a relative low because private industry is theoretically taking care of it all now. Another observation is that private R&D often focuses far more on the development than the research, developing new drug "packaging and delivery", in part to gain IP extensions, instead of fundamentally new drugs.

<comment><USER9> It's important to understand why the efficiency is going down, and it's not because the companies themselves suck more every year. It's because of two main drivers:

1.) The easy targets are mostly gone. All the biology we understand very well either has drugs already, or for some key reason can't be addressed with the drug discovery system we have today (see KRAS, though there are glimmers of home there). This means we have to go after harder diseases that aren't as well understood or have complex etiology. Necessarily that's less efficient.

2.) When you drug something, it eventually becomes incredibly cheap to use that drug, and it becomes the benchmark. (AKA the "better than the Beatles problem") As a pharma company you're competing against the former, better (because you were going after easier biology) versions of yourself all the time. This is also true in software, good software often becomes somewhat commoditized. However, in software we've had exponentially increasing compute capacity for some time, which means the next product can be exponentially better than the previous one simply because new things become actually possible to do when they weren't before. This by and large isn't and can't be true in pharma.

<comment><USER8> I do think some aspect of this is true, but I think how research is directed is systemically off today. You may want to read this overview report (it has footnotes for all the research it cites). But there are quotes in there like:

"While critical medical needs remain unmet, a majority of new medicines developed have no added therapeutic value."

[https://www.ucl.ac.uk/bartlett/public- purpose/sites/public-p...](https://www.ucl.ac.uk/bartlett/public- purpose/sites/public- purpose/files/peoples_prescription_report_final_online.pdf)

<comment><USER10> That's a frustrating article.

Figure 1 shows that recent neuro/psychatric drugs don't have dramatic effects. That's true--but it's not for want of trying. People have been bashing their heads against the brain for _decades_ , but it turns out to be a really hard problem. Biogen lost $18B of market cap on its aducanumab trials early this year. Eli Lilly, AstraZeneca, Roche, Pfizer, Merck, and Johnson & Johnson have all also had big Alzheimer's trials go sideways. I'm not sure that throwing _more_ money at the same amyloid hypothesis will help. Maybe share buybacks—which get taxed and thereby fund the NIH--might not be the worst idea.

The paper also complains about expensive drugs and me-too drugs. The initial HepC drugs were _crazy_ expensive (nearly six figures), but produced quick cures in virtually all of the patients. This was still a massive win over slow, ineffective treatments that still ended with liver cirrhosis/ cancer/transplants for half of the patients. The subsequent "me- too" drugs, which mostly target the same pathway, don't work appreciably better (hard to demonstrate improvement vs a 95%+ cure rate) but have driven the price down by tens of thousands of dollars.

</comment></comment></comment></comment></comment></comment><comment><USER11> I'm sure a lot of folks will pile in here about evil, etc. But I do appreciate the fact that some market incentives (profits) exist to encourage greedy companies to come out with new drugs. I fear lower innovation in its absence.

THAT SAID...obviously a big problem (like software) with the way we handle intellectual property. Just like IBM/x86, there's no philosophical reason why one shouldn't be able to derive a generic and produce it. That's the real issue. We issue "king's crown" (gov't) monopolies on these products. The ONLY advantage I am okay with is first mover advantage. Similar corollary to toll road and broadband concessions...stop protecting these giants and allow REAL PvP competition!

<comment><USER12> > _But I do appreciate the fact that some market incentives (profits) exist to > encourage greedy companies to come out with new drugs. I fear lower > innovation in its absence._

I think of this as a "prayer to innovation", in the cargo-cultism sense. Like tax relief for the wealthy, the prayer goes that "if we can just give these people more money, they'll improve our lives".

Multiple studies have found links between drug pricing and the development of new drugs, but it doesn't work in the obvious way. Large pharmaceutical companies often rely on purchasing smaller startups who do the actual research into developing new drugs [1] but don't have the expertise in bringing the new drug to market and making it successful. The larger pharma companies need financial capacity for this, but since the patents have expired on a lot of other successful drugs before the companies recovered the profits they wanted, they're relying on captive markets for the monopolies they still have in niche pharmaceuticals [2].

These companies are profit-motivated. They aren't working for the public interest. They have no particular desire to "innovate"; their business model instead relies on identifying innovators, buying them, and then selling the product of their research at high prices for as long as possible.

Price controls for pharmaceuticals would ultimately reduce the funding available for the R&D startups, which would limit the creation of new drugs. But it's not clear that allowing big pharma companies to continue charging extortionate rates for life-saving medicines is a good solution to this, nor is it a guarantee for future innovation.

It seems like single-payer insurance and more federal funding for pharmaceutical R&D would be a far better solution than defending predatory drug pricing.

[1]: [https://www.forbes.com/sites/stanfleming/2019/06/20/the- rela...](https://www.forbes.com/sites/stanfleming/2019/06/20/the-relationship- between-drug-prices-and-innovation/)

[2]: [https://www.healthaffairs.org/do/10.1377/hblog20190228.63655...](https://www.healthaffairs.org/do/10.1377/hblog20190228.636555/full/)

<comment><USER13> > They have no particular desire to "innovate"; their business model instead > relies on identifying innovators, buying them, and then selling the product > of their research at high prices for as long as possible.

Isn't that to a great degree how Silicon Valley works too? Google didn't develop Android, for example. It acquired Android, Inc. and then plugged it into the Google ecosystem. Such acquisitions are a fundamental pillar of R&D. They enable startups to do what they do best, and allow big companies to take over when it is time to try and bring a product to market.

<comment><USER12> Sure, but Google and Pfizer (to pick an example at random) aren't exactly equivalent. Few people will die if Google suddenly decides to jack up their pricing on one or more of their services.

The incentives and market pressures are likewise different. Despite the valid criticisms of Google's anticompetitve practices, they have a far less captive market than any large pharmaceutical company does. If Google behaves _too_ badly, they'll become vulnerable; meanwhile, a pharmaceutical company can increase drug pricing for vulnerable people as much as they care to, as long as the company has a patent-protected monopoly on the drug, and people will either find a way to pay it, or they will die.

This business model deserves far more scrutiny than any Silicon Valley darling simply because people's lives and well-being are at stake.

<comment><USER14> To ratchet Rayiner's argument forward to its next step: if the difference between Google and Pfizer is that Pfizer's work is more important, why would it make sense to de-incentivize it by capping its profits? Shouldn't we want drug development to be an attractive industry for entrants?

<comment><USER12> Well, how is this unlike deregulating any other market that has an acute impact on people's lives? Why, for instance, are unregulated ICOs bad, but unregulated pharmaceutical profits not?

Keeping the pharmaceutical R&D market healthy does not necessarily depend on continued predatory pharmaceutical pricing. Let's take a closer look at one example, adalimumab (Humira). Adalimumab was developed initially by a research partnership between Cambridge Antibody Technology Group -- which was publicly funded -- and BASF Pharma, which at the time was a biotech section of a massive German chemical corporation. BASF commissioned Cambridge Antibody Technology to create a tumor necrosis factor-neutralizing agent using some new phage technology [1]. They succeeded, the long and expensive trial process was started, and eventually that section of BASF got picked up by Abbott Laboratories [2], which eventually became AbbVie, which now owns and markets Humira.

This brings us to the present day: Abbott paid $6.9 billion for Humira and all of BASF Pharma's other assets. Using the typical market value logic that's popular on HN, let's assume that this is approximately all of the costs associated with developing Humira and getting it to market.

AbbVie made approximately $16 billion off of Humira in 2016 alone. [3] AbbVie's pricing for Humira is massively asymmetrical depending on which country it's being sold in, and as the linked article suggests, appears to be "priced in the United States primarily on the basis of what the market will bear."

The most common defense of predatory pharmaceutical pricing in the United States by far is that we can't regulate these prices because it will hurt pharmaceutical development. So, my question to you, or rayiner, or anybody else exploring that position, is: at which point in that process did predatory United States pharmaceutical pricing help develop Humira?

Was it in the public funding of a UK research group? Or was it in the funds of a massive German chemical company? Or is it that doctors in the US wouldn't know to prescribe the drug without the massive marketing campaign AbbVie has waged, especially in the US, to urge patients to "ask your doctor about Humira"? Or, perhaps, is it in the development of patent "thickets" that AbbVie uses to protect its biggest revenue stream, or in the corrupt kickbacks it was paying out to drive sales? [4]

This is the part where this argument loses me. Whenever I look at the details, I don't see any evidence that pricing in the US has anywhere near a 1:1 correlation with drug development. The NY Times article for instance links to a Journal of the American Medical Association study which found:

"Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices that have been increasing in recent years at rates far beyond the consumer price index. ... Although prices are often justified by the high cost of drug development, there is no evidence of an association between research and development costs and prices; rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear."

To answer your question directly: in this case study, I see no evidence that a _reasonable_ amount of regulation on pharmaceutical pricing in the United States would have had any discouraging effect whatsoever on the development of this drug; it would however have made a _huge_ difference to the health and well-being of many, many people.

[1]: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958567/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958567/)

[2]: [https://www.wsj.com/articles/SB976832374667325423](https://www.wsj.com/articles/SB976832374667325423)

[3]: [https://www.nytimes.com/2018/01/06/business/humira-drug- pric...](https://www.nytimes.com/2018/01/06/business/humira-drug-prices.html)

[4]: [https://www.huffpost.com/entry/opinion-humira-costs- patents_...](https://www.huffpost.com/entry/opinion-humira-costs- patents_n_5bd0c893e4b0a8f17ef3961f)

<comment><USER15> > To answer your question directly: in this case study, I see no evidence that > a reasonable amount of regulation on pharmaceutical pricing in the United > States would have had any discouraging effect whatsoever on the development > of this drug

With the benefit of hindsight? I suspect you are correct. But pharma portfolios operate on the lognormal success model of VCs. Without the blockbusters, you can't fund "development" of the failures that could lead to another blockbuster. (Of course, much if large pharma R&D is by way of strategic partnership and acquisition.)

As to your pricing of the Humira acquisition: I personally would have included some consideration to the existing market exclusivity of the drug. The transaction price is unlikely to be just the "replacement cost".

<comment><USER12> > _But pharma portfolios operate on the lognormal success model of VCs. > Without the blockbusters, you can't fund "development" of the failures that > could lead to another blockbuster._

That was the point of my whole Humira example though: high pharmaceutical prices did not fund its development.

This assertion that drugs have to be expensive or they can't be developed keeps getting repeated, but there's little evidence to support it and even less evidence that they need to be _this_ expensive. This argument is further troubled by little details like drugs being 600% more expensive in the US than in other countries, indicative of more of a "how much money can we extract from vulnerable people" strategy than a "how much will it cost to develop the next great drug" strategy.

For extra credit, take a look at AbbVie's notable products ([https://www.drugwatch.com/manufacturers/abbvie/#abbvie- produ...](https://www.drugwatch.com/manufacturers/abbvie/#abbvie-products)) and see if you can identify any that they developed, or that they funded the development of.

To put this into perhaps more familiar terms, AbbVie's behavior is far closer to Intellectual Ventures than to Y Combinator, and yet people here keep defending it.

<comment><USER15> Fine. Where did BASF get their money from? How much, in your esteemed opinion, should it cost to develop a therapeutic Ab from a drugable target? How should my industry pay for pipeline failures?

</comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER16> I've said it before that the pharmaceuticals, hospitals, and insurance companies are signing their own death warrants. They keep (in my opinion) colluding to charge outrageous prices for life-saving things and at some point we're all going to get fed up with it enough to elect someone that will shoe in legislation that turns them all into state-owned or, at the very least, highly regulated. I personally don't feel like that's what we really want but damn these companies are just being abusive now.

<comment><USER17> didn't we already elect someone like that (Obama vis-a-vis ACA)? and yet the monied interests have undone most of the work.

<comment><USER18> No? What part of the ACA was intended to upend the pharma industry? The ACA was specifically designed to work within the system as it existed in 2008/9.

<comment><USER16> If I recall, originally it was supposed to be more drastic in its changes in an attempt to introduce more efficiencies into the system. But then they realized that they could create a lot of jobs in healthcare (remember, we were smack in the middle of the recession) so they opted to do that instead. That's not any kind of commentary as to whether their decision was good or bad but it does appear to have resulted in making the system less efficient in many ways.

</comment></comment></comment></comment><comment><USER9> There's a huge issue with pricing today. It used to be that drug companies were ethical about the "your money or your life" nature of medicine. Merck once even gave a drug away for free because it was the right thing to do [1].

Nowadays it's about charging what the market can bear. The trouble is that drugs have gotten way more expensive to develop for a variety of mostly scientific reasons. This means a "prize" mentality has developed where each drug is like a lottery ticket, and you best get the most out of that ticket if it wins. There's also a sense across the industry that price controls are going to come, so ramp the prices up now so when the controls arrive they won't gut the industry.

Also sometimes drugs have to cost as much as they do because they're just very hard to make (see gene therapy), but at this point the pharmaceutical industry has squandered all the public trust they had with recent rapacious practices (see insulin, opioids).

Fundamentally there are good reasons drugs cost a fair amount of money, but it's not necessarily clear that costing _this_ much money is justifiable. I believe drug companies can do good while doing well, but that it takes a leadership interested in more than boosting the margins as high as possible. We need a code of ethics for drug and med device companies, maybe something along the lines of the hippocratic oath.

[1] [https://www.nytimes.com/1987/10/22/world/merck-offers- free-d...](https://www.nytimes.com/1987/10/22/world/merck-offers-free- distribution-of-new-river-blindness-drug.html)

</comment><comment><USER19> Everyone wanted to crucify Shkreli for the toxo drug price hike. Where is the outrage for the mentioned 667% hike on generic Prozac? Or did people just target Shkreli because they didn't like his views on other things?

<comment><USER20> Well, Shkreli was an easy target:

1) he repeatedly took us for saps. "People are angry at me because I'm raising the price of this drug when most of them will still pay the same $20 copay". Except we're paying for the full cost of the drug. The fact that the cost is "invisible" because it comes out of our insurance pool was the issue, and he genuinely acted victimized because people could see past that.

2) On at least one occasion, he/his company opposed FDA approval of a new drug. Not on the basis that there was risk/danger/issues of efficacy, indeed, the new drug was less risky and more efficient. It just didn't belong to his company. i.e. if you thought re-patenting drugs was bad, this guy was literally doing the things the worst "Big Pharma conspiracy theorists" were saying - opposing the introduction of new, better drugs for no reason other than "threat to corporate profit".

</comment></comment><comment><USER21> One of the problems is cost of development. We invested in an incredible company called Brightseed that looks at each of the tens of millions of small molecules in our food supply and uses AI to predict how those interact with metabolic networks associated with health. Because everything they discover is implicitly regarded as safe (GRAS) there's the potential to develop products much more rapidly and cheaply. While we may not find something that optimizes on efficacy there's the potential to get very close.

</comment><comment><USER22> I worked at Genentech when it was purchased by Roche. We frequently had Roche execs visit to understand "what it was you crazy californians are doing that makes Genentech our most profitable investment."

One exec said the right way to think about Swiss pharma like Roche is that they aren't in the pharma business, they are wealthy families who invest in pharma because it's a consistently profitable sector.

If you look, all the pharmas in CH are basically co-owned by each other.

<comment><USER23> >If you look, all the pharmas in CH are basically co-owned by each other.

Sorry if I'm missing this, but what is CH?

<comment><USER22> Confederation Helvetique.

</comment></comment></comment><comment><USER24> I like Slovakian approach. Price of drugs can't be higher than average of 5 cheapest EU countries where the drug is being sold. However we face re- exporting and sometimes unavailability. Also we have a new law where distributor will lose licence if the drug is un-available (recent update). [https://www.ncbi.nlm.nih.gov/pubmed/29073987](https://www.ncbi.nlm.nih.gov/pubmed/29073987)

</comment><comment><USER25> So the 'whopping' 667% increase is not on Prozac as a whole, but actually only on a liquid version of the drug. Prozac is a generic medication, so there is competition here.

For example, according to GoodRX, 30 capsules of fluoxetine are $4 at walmart: [https://www.goodrx.com/fluoxetine](https://www.goodrx.com/fluoxetine)

<comment><USER26> Yes, and in the second arm of the scam, the drug companies will send out their army of salespeople to convince doctors and hospitals to prescribe the more expensive version. Because of small differences between the drugs (maybe the liquid version is easier on the stomach) they will decide that the solid generic is not equivalent to the liquid.

Then the patients will all buy the expensive version, as ordered by their doctors, and charge it to their insurers. The insurers will look at the cost going up and will raise insurance rates.

If you have been paying attention to what has been happening to insurance rates for the past several years you can easily see the result.

<comment><USER25> I mean, the obvious answer there is to educate doctors on what is actually scientifically proven. If doctors (who ought to be one of the most scientifically minded professionals engaged with on a regular basis) are susceptible to salespeople selling them false science, then we should probably not allow them to be doctors anymore. The lack of critical thinking in that profession then ought to alarm us, and ought to be the first thing that's fixed.

On the other hand, if it is actually a superior product, then I don't see what the issue is in it costing more. Doctors would know about the cheaper version and prescribe it if the patient wanted it? Of course, given that insurance for everyday needs screws up the pricing dynamics, I do think the alienation of pricing from the consumer, thus reducing demand for the lower priced versions, is a valid criticism.

<comment><USER26> It is not that much about education. Currently there exists a complex system of various incentives to convince doctors to prescribe more pills and to prescribe certain types of pills.

The pharma companies have installed their people in hospital management and various medical boards all over the place, and they are constantly pushing for more drugs and more expensive drugs.

The pharma companies can make it worthwhile for a hospital group to prescribe more drugs. The hospital group management can in turn incentivize their doctors to do it. It is even in the insurance companies benefit, because there really isn't a competitive market for medical insurance. Insurance companies actually welcome higher costs, because they raise their rates accordingly, which actually make their profit dollars go up.

It is only us ordinary users of medical services that are paying the bill.

The underlying problem is that there isn't any mechanism for a cost benefit analysis in the doctor patient relationship. The modern medical insurance system was set up to assure the customer that he would get the best medical care he needs without worrying about cost. It is a perfect system for gouging and everyone has started gouging.

</comment></comment></comment></comment><comment><USER27> This is incorrect and a giant red herring. Pharma is not "raising prices" in the implied sense, and pharma is not the cause of drug prices being high in the US.

Pharma is increasing the "gross price" of a drug in order to increase the rebate going to the PBM (Pharmacy Benefit Manager) so that they maintain their position on the formulary (to be "covered by insurance"). The "net price" of drugs (what pharma makes) is overall growing at the pace of inflation, not above. There's obviously exception cases, and plenty of small biotech firms launch questionable products with high prices that then get covered. But this is a result of this rebate system that prioritizes covering drugs with large rebates (since PBMs monetize rebates), not the most cost effective drug.

</comment><comment><USER28> I'll start by stating the companies who are taking these egregious price increases are only shooting themselves in the foot. They'll end up in front of a Senate committee before long.

That said, profit attracts investment. The rare diseases are a great example. Who wants to spend $50M creating a drug for a disease with so few people you'd only lose money?

Genzyme started the trend of charging a lot, with the caveat than any insurer might have a handful of patients. The cost per member might be $0.10.

Insurers said ok and investment flood the rare disease space. We're talking hundreds of billions. Now some people with a rare disease have treatment.

</comment><comment><USER29> Need to do the following:

        * Eliminate extension patents.
        * Add dual sourcing requirements for drugs
        * Add fiduciary responsibility to insurance co reqs
        * Govt backed non-profit insurance corp
          replacing Medicare, Medicaid, VA Ret medical
          covering federal employees
        * Single-account billing
        * Published rates, rates between payees cannot be more
          than 20% variance in a single calendar year.

Extension patents on medications are generally not great and minimal actual value, in fact, the entire Patent system largely deserves to be broken apart entirely.

Dual sourcing requirements would ensure licensing arrangements and at least _some_ level of competition for drug companies.

Making insurance companies have a fiduciary responsibility in negotiating on client behalf would also help undo the effects of the profit caps from Obamacare without further checks in place.

Gov't non-profit covering those currently covered by federal programs and employees would add a baseline of competition without a profit incentive.

Not seeing a dozen different bills from one visit would help. Localized state billing agencies would help too, but not a fan of this, better than federal level here.

Eliminating the massive difference between insurance and private pay rates is another important step.

Combined would see massive pushback, but all are really needed to bring effective change to the medical care system as a whole, while not significantly effecting federal funding. I've given the above list time and time again, but nobody really seems to listen.

</comment><comment><USER30> From the article: "The median price increase overall was 25.8%. Generic drugs, specifically, had higher increases, with a median rise of 37.6%"

Given that the US inflation levels are single digits, this obviously looks egregious but I'd be a lot more satisfied with the article if it gave data on/considered the following:

\- Typically inflation takes into account _goods_. What about the R&D costs which are driven by both goods, people's salaries and other factors? Were they well above inflation?

\- It might be that conditions were favourable for a big increase and the costs will stay flat for a few more years (I won't bet on this!)

\- Finally, any company which prices its goods and services just above inflation is bound to be held in low esteem by its shareholders. After all, if investors wanted returns just above inflation, they'd be buying bonds! The risks associated with equity should be well compensated by the company and this might have prompted the companies to take this course of action.

</comment><comment><USER31> I believe that as always problems like this one may be solved only through erasing privatized monopolies from the market. The civilized way to achieve this is to raise number of competitors on the market. And there's a plenty of available options. E.g. cut subsidies and raise taxes for big pharmaceutical companies, make additional subsidies and cheap loans to small ones, give students extra grants for pharmacology courses at universities (in order to increase number of specialists), abolish or at least change patent laws for drugs, support public pharmaceutical researches funding by government and involved companies with results available to everyone. I guess in modern world one of the primary economic responsibilities of government is providing an environment in which not only large business may start to do high-tech.

</comment><comment><USER32> For those who have pricey prescriptions, look into pharmacy coupon databases like GoodRX. Some drugs are 95% cheaper with these private coupons (pharmacies do not advertise them), and sometimes cheaper than buying them through your insurance.

</comment><comment><USER33> I'm in Bangkok at the moment and there are billboard/bus shelter advertisements from the USPTO encouraging people to 'Only buy from licensed pharmacies'.

I'm not sure exactly what they're targeting. The pharmacies that will sell without a prescription, or the IRL spammers trying to sell viagra by the side of the road.

Regardless, it seems strange for the US patent office to meddle in local food and drug administration.

I shared a pic on twitter: [https://twitter.com/vertis/status/1183986568857440256?s=20](https://twitter.com/vertis/status/1183986568857440256?s=20)

</comment><comment><USER34> Correct me if I am wrong, but the report is talking about wholesale prices.

I would be more interested in the price after the expected discount that the pharmaceutical companies give.

If the price increase is still high then it is newsworthy.

<comment><USER35> This is hitting the nail right on the head. People are blaming "greedy Pharma companies" but at the same time companies are taking lower and lower net prices while the rebates that the purchasers are taking home are absolutely absurd rebates.

I get it, some people don't feel phama companies should still be able to profit on a drug invented 50years ago. But I just can't take any discussion about that serious when we are also in an environment where the purchasers take literally twice the profits on all drug sales without having invested a penny in research or having spent a penny in production distribution or marketing.

They eat up all that money all by abusing their position of "representing the buyers", but at the same time since their rebates are percentage cuts they are just pushing pharma companies to increase prices over and over again.

The American model is rotten and someone has to stop the madness.

<comment><USER26> Nobody is required to give out rebates to pharmacy benefit managers and the like. That is a problem the pharma companies created by themselves. The pharmas can drop their list prices and stop rebates tomorrow if they really wanted.

<comment><USER36> If you where a pharmacy benefits manager, and you where sitting across two different potential drug makers and one says "I'll let you have it at 30$!" and the others says "I'll let you have it at 120$ with a 50% rebate!" which one do you think you'd take?

The forces at play in the pharma/PBM negotiation leads to price increases instead of price competition because the PBM effectively sits on both sides of the table. They want high rebates and they don't care about list-prices as long as they can take back a bit cut of them. This is why you see rebates reaching levels close to 70%. Imagine if you sent a guy to negotiate a car purchase for you, and that guy was looking at taking 70% of the net you pay through rebates from the car dealership. Do you honestly think he would be looking for the cheapest deal?

</comment></comment></comment></comment><comment><USER37> Well, with the GDUFA each genetic manufacturer has to pay the same large inspection fee regardless of how much a drug they produce and they have to pay it far ahead of the time they start selling the drug. This has driven a dramatic consolidation that's resulted in things like the recent bospirone shortage in addition to the recent sudden spike in generic prices.

</comment><comment><USER38> They are raising prices because, uh, wait...what was supposed to stop them from raising prices, again? Oh, that's right. "Nothing".

There's nothing broken here, because there's nothing present to discourage them from raising prices in the first place. No market mechanism, and also no regulatory mechanism. They raise prices because...they can.

<comment><USER39> That's right. The system is working as intended. As guaranteed by lobbyists and big donors having undue influence on public policy.

</comment></comment><comment><USER40> The rest of the world has figured this out, people in the US are just willing to pay more (as in, not protesting en masse to lower costs).

Also, drug spending is proportional to the % of elderly, which is growing faster than inflation as a %.

</comment><comment><USER41> [https://www.youtube.com/watch?v=ylLTMYt24lA](https://www.youtube.com/watch?v=ylLTMYt24lA)

</comment><comment><USER42> Normative: Healthcare should not be subject to the strictures of profit making entities. See insulin prices in the United States vs. elsewhere.

</comment><comment><USER43> Of course they are! They have a captive, increasingly needy market.

Go big I say.

That will force better policy. Hate that idea, but little else has worked.

</comment><comment><USER44> What is inflation? Seriously.

</comment><comment><USER45> Shkreli Did Nothing Wrong

</comment><comment><USER46> But the President says they are the lowest they've ever been.

<comment><USER47> They have been declining if you look at the prescription drug CPI[1], which is more closely related to what people are actually paying, rather than this article which references a document that only lists increases of wholesale prices. I'd like to see a comparison of increases and decreases. If 3 drugs increased an average of 300%, but 10 drugs decreased an average of 300%, for example.

[https://data.bls.gov/timeseries/CUSR0000SEMF01?output_view=p...](https://data.bls.gov/timeseries/CUSR0000SEMF01?output_view=pct_3mths)

</comment></comment><comment><USER48> We've now long reached the point where we can give the market a free hand/carte blanche in pharma matters. Now it's time for Government to act and to do so urgently.

If ethics ever played a role in pharma—which I doubt [remember thalidomide]—then it certainly does not do so now. As health and lives of its citizens are at stake then it's the responsibility of Government to rectify this situation.

After all, the first responsibility of government is to protect the security and well-being of its citizens. If it fails to do so here then it's abrogating its responsibility.

<comment><USER49> I agree. The free-market did not work, time for regulations.

<comment><USER48> Dead on!</comment></comment></comment>


Show HN: I made a recursive kanban board with React - <AUTHOR> http://kanception.io <comment><USER2> The screenshot shows a regular board and I need to sign in to see what makes this recursive. Not going to sign in to check out a product (this is repeated over and over on HN).

Could you describe what makes this recursive and/or update your landing page. Not a whole lot to go by now.

<comment><AUTHOR> I will work on updating the landing page to be more descriptive!

When you click on a card it takes you into that cards kanban board. This way you can break down large tasks into smaller tasks.</comment></comment>