Monday, July 18, 2016

Dear Mark Cuban: Stick to Basketball and Leave Drug Discovery Alone. Please.

Dear Mr. Cuban:

I want to take a moment and thank you for your recent comments about drug discovery. I know I speak for many former and current members of the science community when I tell you that vague, uninformed expositions about complex economic and technical issues always help both companies and the public.

That is why, after spending a little time thinking about the Dallas Mavericks, I want to use my expertise (1) running my fantasy basketball team to help you improve the squad. Really, the solutions are so obvious that I can’t imagine why you and your executive team wouldn’t rush to implement them right away.

Your goal, of course, is to increase the number of people who are able to see the Mavericks play, just like you want more people to have prescription drugs, so it only follows that you would want to give fans, both rich and poor, the opportunity to attend games.

The easiest way to do that is to let individuals pay the same cost as large organizations that buy blocks of tickets and to charge the same for all seats. You won’t harm the Mavs by charging a flat rate for all tickets because you can offset that by containing your costs. Like drug companies, you are paying for failure and passing that along to consumers. (2)

Here is how your thinking on medication can help your basketball team.

The Mavs won only 51 percent of their games in 2015-16, and lost four out of five games in the first round of the playoffs by an average of an almost supernatural 23 points, so your projected payroll of $103 million for the 2016-2017 season is very high. Just like with drug discovery, you need to know how to tell a winner from a loser, and cut your losses when necessary.

You can start with Wesley Matthews, who will earn $17 million next year while the generic equivalent—the average NBA salary— is $4.9 million. You are really overpaying for a name brand here. This past season, he took 854 shots but made only 38.8% of them. This places him as the third worst among all guards in the NBA who took 800 or more shots. Matthews also played some small forward, a position where he somehow managed to outdo his aforementioned accomplishment. He was second to last among forwards.

Instead of containing your costs so more people could afford to attend games, you then gave Harrison Barnes a four-year contract for about $100 million. Barnes pretty much single-handedly cost Golden State its second straight championship by shooting 10 for 43 against Cleveland, a 23 percent success rate. He is your Vioxx. You should just go ahead and pay that settlement right now.

Given all of this, I cannot think of a single reason to not be astounded by some of the recent quotes about drug companies that you made in STAT news.

For example, you said, “They will be smarter about how they spend their money, but they can’t stop spending because it means they won’t make as much.”

Like $100 million for Harrison Barnes?

You also claimed,“Bad actors don’t typically respond to requests for empathy. But they do respond to the threat of having their margins eliminated through caps and other limits…”

Like the 2+ dozen fines that you have incurred for yelling at referees?

Furthermore, you seem to believe that companies are wasteful: “There is room to make the type of changes suggested in the article and others that would reduce the cost of medications.

Since all pharmaceutical companies have thus far failed to find a way to do so, please enlighten us, and make those Mavs tickets cheaper using the type of changes suggested in this article.

“Do you think a public company CEO is just going to walk away from making money?”

No, but you could if you wanted to. Two court side season tickets cost $30,000. This will pay for enough Harvoni to cure 166 hepatitis C patients (3). It took a collective 25 years (4) of industry research and a ton of money to get the drug to the pharmacy. Sounds like a pretty good deal compared to a $100 million, 42-40 team with shooters who can’t shoot.

Sorry, Mark. Your shot at drug discovery is an airball.

Notes:

(1) This is a blatant lie. I am probably the most inept fantasy basketball player in the galaxy, as evidenced by a recent gift from my brother:fantasy



(2) You can argue that there is a chemistry issue in team success. There is also a chemistry issue in pharmaceutical success. Drugs die gruesome deaths during the 12 years that it takes for something to get from the lab to the drug store. Only one in 5,000 drugs will make it to market, and at will do so with quite a hefty price tag—an average cost of $2.6 billion. You may be able to cut salaries, but companies cannot cut clinical trials, which is where the costs really escalate.
Drug cost

The increasing cost of developing new drugs. Source: Legal Studies Research Paper Series Research Paper No. 16-403

(3) Harvoni, a two-drug cocktail that was discovered by Gilead Sciences, is close to 100 percent effective in curing chronic hepatitis C infections. Patients who have “typical” medical insurance plans will pay about $60 per month for the drug. Uninsured and underinsured patients can apply online for an assistance program that enables them to get the drug with a $5 copay. I have no data on how often this is granted.

(4) Hepatitis C was first discovered in 1989. It is a chronic viral infection that gradually destroys the liver. An estimated 3 million people in the US and 200 million worldwide are infected. It took dozens of pharmaceutical companies 21 years from the time that research began until the first two specific HCV antiviral drugs appeared in 2011. Neither is used today. Exactly one company earned back its R and D costs during that time.

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