Metformin is not 8 dollars a day, but 2 cents a day in Indian pharmacies.
Citation needed. Also, the poverty figure I cited is already adjusted for PPP.
As TAME study and adoption will take at least a decade, people will be in general even reacher and can take the drug.
Not by much. Also you assumed that universal drug use would start in 2020, only two years away.
By the way, I’m very confused by the assumption that 5 billion people will be born in 2020. It’s obviously wrong, and I don’t see what predictive value it has.
Moreover, I don’t see how there will be 2.5 billion other people alive in 2100. The claim just isn’t supported.
Metformin has already passed Phaze 1,2 and 3 for many other conditions so its safety profile is well known. It is even known to extend the life of diabetics so they live longer than healthy people.
I don’t know anything about this. It needs to be cited so that it can be verified and contextualized, and included in the original article so as to prevent people from wasting their time. The prospects for Metformin approval are crucial to your argument about its cost-effectiveness. You can’t merely add it as a forum comment to whoever happens to reply.
First, I assume that only half people will take it for whatever reason.
That’s more than perhaps any medication in history.
It is even known to extend the life of diabetics so they live longer than healthy people.
No, it is known to correlate with living longer. But some or all of that correlation seems to be due to the sickest diabetics being switched from metformin to other drugs.
How could it explain that diabetics lived longer than healthy people?
If all of the sickest diabetics are switched to other drugs, then the only people taking metformin are the ‘healthy diabetics’, and it is possible that the average healthy diabetic lives longer than the average person (who may be healthy or unhealthy).
This would give the observed effective without metformin having any effect on longevity.
The model was deliberately oversimplified, as actually these 5 billions will be born the whole duration of the 21 century and will start to take the drug in different ages.
I will add more links on previous studies of metformin, as it probably seems unclear from the article that it is already tested drug for other conditions.
If we speak about fortification of food with useful microelements like iodine, fluoride, and some vitamines it probably has very high reach in developed countries. For some life extending drugs was shown that they could be taken in courses and could have effect on life expectancy.
The problem of constant taking a medical drug is not related to metformin, but to any drug which a person has to take constantly, like hypertension drugs, antidepressant, vitamins etc. This is a different important problem which should be solved to improve public health. There is one possible solution in the form of app (already exist) which records what one has taken and remind to take the drug.
Even if the cost of Metformin is only 2 cents a day, giving to to 5 billion people every day for 80 years would cost about $3 trillion (0.02*365*80*5*10^9). Whilst the cost would (at least potentially) be distributed across the population, it also seems like something that should be mentioned as a cost of the policy.
It was in fact discussed in section 7.1 there we wrote:
The price of a lifetime supply of metformin, 500 USD, will pay for an additional 1-3 years of life expectancy and a proportional delay of age-related diseases.
However, the actual price of the therapy for a person could be negative, because medical insurance companies will be interested that people will start taking age-slowing drugs, as it will delay payments on medical bills. Insurance companies could gain interest on this money. For example, if 100K of medical bills is delayed by three years, and the interest rate is two percent, the insurance company will earn 6 000 USD on later billing. Thus, insurance companies could provide incentives such as discounts or free aging treatments to those who use antiaging therapies.
I more meant it should be mentioned by the $0.24 figure e.g. something like:
“Under our model the direct cost effectiveness is $0.24 per life saved, but there is also an indirect cost of ~$12,000 per life saved from the cost of the metformin (as we will need to supply everyone with it for $3 trillion, but it will only save 250 million lives).”
Noticeably the indirect figure is actually more expensive than current global poverty charities, so under your model buying people metformin would not be an attractive intervention for EAs. This does not mean it would necessarily not be cost effective to fund the trial to ‘unlock’ the ability for others to buy the drugs, since it might be more efficient than e.g. other developed government use of money, but it does hammer home that the costs of the drugs is very non-negligible.
Yes, but 10kg of pure Metformin powder is not much good since it needs to be packaged into pills for easy consumption (since its needs to be taken in sub gram doses). Since you are not able to find pills for less than 2 cents (and even those only in India) I think you should not assume a lower price than that without good reason.
Presumably we run into some fundamental price to form, package and ship all the pills? I would be surprised if that could be gotten much below 1p per pill in developed countries. (although around 1p per pill is clearly possible since some painkillers are sold around that level)
It probably should be analysed how the bulk price of metformin could be lowered. For example, global supply of vitamin C costs around 1 billion USD a year with 150 kt of bulk powder.
I also not suggesting buying metformin for people. In case of food fortification, the price is probably included into the total price of food and the manufacturers pay lowerest bulk price.
It probably should be analysed how the bulk price of metformin could be lowered. For example, global supply of vitamin C costs around 1 billion USD a year with 150 kt of bulk powder.
Yes but as I discuss above it needs to be turned into pills and distributed to people, for which a 2 cents per pill cost seems pretty low. If you are arguing for fortification of foods with metformin then presumably we would need to show extraordinary levels of safety, since we would be dosing the entire population at very variable levels.
In general I would find it helpful if you could try and keep your replies in the same comment—this basically seems to be an extension of your other comment about buying metformin in bulk and having it split in two makes it harder to keep track.
Ok. I just have two ideas in different moments of time, that is why there are two comments.
I think that again the problem of expensive pills is not a problem of antiaging therapies, but a more general problem of expensive medicine and poverty. I should not try to solve all possible problems in one article as it will immediately grow to the size of the book.
Most drugs we now consume are overpriced compared with bulk prices; also food is much more expensive in retail. I think it is important problem, but it is another problem.
I’m not saying you need to solve the problem, I’m saying you should take the problem into account in your cost calculations, instead of assuming it will be solved.
In the next version of the article, I will present general equation in which will try to answer all these concerns. It will be (price of the experiment)(probability of success) + indirect benefits of experiment - (fixed price of metformin pills for life)(number of people)(share of adopters)(probability of success of the experiment) - unexpected side effects—growth of food consumption because of higher population. Anything lost?
I’m not quite sure what this equation is meant to be calculating. If it is meant to be $ per life saved it should be something like:
Direct effects:
(price of the experiment)/((probability of success)*(lives saved assuming e.g. 10% adoption))
(Note the division is very important here! You missed it in your comment, but it is not clear at all what you would be estimating without it.)
Your estimate of the indirect costs seems right to me, although in the case of:
growth of food consumption because of higher population
I would probably not include this level of secondary effect, since these people are also economically productive etc. so it being very hard to estimate.
1 rupee is $0.015 not $0.0015 by nominal exchange rates. Sales tax must be included, as well as comparison with the lower nominal incomes in India rather than the global PPP standard that I gave. Other metformin manufacturers seem to generally charge more (https://www.medindia.net/drug-price/list.asp). Presumably they are not available in all locations; presumably there are areas where people simply don’t have easy access to buying these drugs at all. And we are just talking about India, the king of drug IP abuse. I bet if you look at Pakistan or Nigeria then it won’t be so easy to buy these drugs there.
I just don’t understand how it is possible to assume that even half of the people in the world will purchase and use the most effective product regardless of where they live. Have you tried to convince someone in this position to take any kind of supplements? Like, gone to someone who has very low income, and relies on bicycle or public transport, and explained to them why they should add this or that vitamin or OTC drug to their daily routine? If you had, I don’t think you would be making this assumption.
The problem of constant taking a medical drug is not related to metformin, but to any drug which a person has to take constantly, like hypertension drugs, antidepressant, vitamins etc. This is a different important problem which should be solved to improve public health. There is one possible solution in the form of app (already exist) which records what one has taken and remind to take the drug.
Well yeah, but if you want to calculate the expected value then you must go by what is likely to happen, not what you wish to happen.
Apps exist on smart phones, which lots of people don’t have, and most of the remainder won’t bother to install or pay attention to it. Moreover, apps don’t exist in every language.
Citation needed. Also, the poverty figure I cited is already adjusted for PPP.
Not by much. Also you assumed that universal drug use would start in 2020, only two years away.
By the way, I’m very confused by the assumption that 5 billion people will be born in 2020. It’s obviously wrong, and I don’t see what predictive value it has.
Moreover, I don’t see how there will be 2.5 billion other people alive in 2100. The claim just isn’t supported.
I don’t know anything about this. It needs to be cited so that it can be verified and contextualized, and included in the original article so as to prevent people from wasting their time. The prospects for Metformin approval are crucial to your argument about its cost-effectiveness. You can’t merely add it as a forum comment to whoever happens to reply.
That’s more than perhaps any medication in history.
No, it is known to correlate with living longer. But some or all of that correlation seems to be due to the sickest diabetics being switched from metformin to other drugs.
How could it explain that diabetics lived longer than healthy people?
Anyway, we need a direct test on healthy people to know if it works or not.
If all of the sickest diabetics are switched to other drugs, then the only people taking metformin are the ‘healthy diabetics’, and it is possible that the average healthy diabetic lives longer than the average person (who may be healthy or unhealthy).
This would give the observed effective without metformin having any effect on longevity.
For example, here https://www.medindia.net/drug-price/metformin/diamet.htm one table of 500mg costs 1 rupee, which is 0.0015 USD.
The model was deliberately oversimplified, as actually these 5 billions will be born the whole duration of the 21 century and will start to take the drug in different ages.
I will add more links on previous studies of metformin, as it probably seems unclear from the article that it is already tested drug for other conditions.
If we speak about fortification of food with useful microelements like iodine, fluoride, and some vitamines it probably has very high reach in developed countries. For some life extending drugs was shown that they could be taken in courses and could have effect on life expectancy.
The problem of constant taking a medical drug is not related to metformin, but to any drug which a person has to take constantly, like hypertension drugs, antidepressant, vitamins etc. This is a different important problem which should be solved to improve public health. There is one possible solution in the form of app (already exist) which records what one has taken and remind to take the drug.
Even if the cost of Metformin is only 2 cents a day, giving to to 5 billion people every day for 80 years would cost about $3 trillion (0.02*365*80*5*10^9). Whilst the cost would (at least potentially) be distributed across the population, it also seems like something that should be mentioned as a cost of the policy.
It was in fact discussed in section 7.1 there we wrote:
The price of a lifetime supply of metformin, 500 USD, will pay for an additional 1-3 years of life expectancy and a proportional delay of age-related diseases.
However, the actual price of the therapy for a person could be negative, because medical insurance companies will be interested that people will start taking age-slowing drugs, as it will delay payments on medical bills. Insurance companies could gain interest on this money. For example, if 100K of medical bills is delayed by three years, and the interest rate is two percent, the insurance company will earn 6 000 USD on later billing. Thus, insurance companies could provide incentives such as discounts or free aging treatments to those who use antiaging therapies.
Medical expenses are wayyy lower in the developing world.
At the time when metformin will reach these markets as a life-extending drug, may be somewhere in 2040, these market will develop.
I more meant it should be mentioned by the $0.24 figure e.g. something like:
“Under our model the direct cost effectiveness is $0.24 per life saved, but there is also an indirect cost of ~$12,000 per life saved from the cost of the metformin (as we will need to supply everyone with it for $3 trillion, but it will only save 250 million lives).”
Noticeably the indirect figure is actually more expensive than current global poverty charities, so under your model buying people metformin would not be an attractive intervention for EAs. This does not mean it would necessarily not be cost effective to fund the trial to ‘unlock’ the ability for others to buy the drugs, since it might be more efficient than e.g. other developed government use of money, but it does hammer home that the costs of the drugs is very non-negligible.
Also, Alibaba suggests metformin for 5 USD for kg, which implies lifelong supply could be bought for something like 50 USD.
https://www.alibaba.com/product-detail/HOT-SALE--99-High-Purity_50033115776.html?spm=a2700.7724857.main07.53.2c7f20b6ktwrdq
Yes, but 10kg of pure Metformin powder is not much good since it needs to be packaged into pills for easy consumption (since its needs to be taken in sub gram doses). Since you are not able to find pills for less than 2 cents (and even those only in India) I think you should not assume a lower price than that without good reason.
Presumably we run into some fundamental price to form, package and ship all the pills? I would be surprised if that could be gotten much below 1p per pill in developed countries. (although around 1p per pill is clearly possible since some painkillers are sold around that level)
Also, the global market for snake-oil life extension is 300 bn a year, so spending 10 times less would provide everybody with actually working drug.
It probably should be analysed how the bulk price of metformin could be lowered. For example, global supply of vitamin C costs around 1 billion USD a year with 150 kt of bulk powder.
I also not suggesting buying metformin for people. In case of food fortification, the price is probably included into the total price of food and the manufacturers pay lowerest bulk price.
Yes but as I discuss above it needs to be turned into pills and distributed to people, for which a 2 cents per pill cost seems pretty low. If you are arguing for fortification of foods with metformin then presumably we would need to show extraordinary levels of safety, since we would be dosing the entire population at very variable levels.
In general I would find it helpful if you could try and keep your replies in the same comment—this basically seems to be an extension of your other comment about buying metformin in bulk and having it split in two makes it harder to keep track.
Ok. I just have two ideas in different moments of time, that is why there are two comments.
I think that again the problem of expensive pills is not a problem of antiaging therapies, but a more general problem of expensive medicine and poverty. I should not try to solve all possible problems in one article as it will immediately grow to the size of the book.
Most drugs we now consume are overpriced compared with bulk prices; also food is much more expensive in retail. I think it is important problem, but it is another problem.
I’m not saying you need to solve the problem, I’m saying you should take the problem into account in your cost calculations, instead of assuming it will be solved.
In the next version of the article, I will present general equation in which will try to answer all these concerns. It will be (price of the experiment)(probability of success) + indirect benefits of experiment - (fixed price of metformin pills for life)(number of people)(share of adopters)(probability of success of the experiment) - unexpected side effects—growth of food consumption because of higher population. Anything lost?
I’m not quite sure what this equation is meant to be calculating. If it is meant to be $ per life saved it should be something like:
Direct effects: (price of the experiment)/((probability of success)*(lives saved assuming e.g. 10% adoption))
(Note the division is very important here! You missed it in your comment, but it is not clear at all what you would be estimating without it.)
Your estimate of the indirect costs seems right to me, although in the case of:
I would probably not include this level of secondary effect, since these people are also economically productive etc. so it being very hard to estimate.
1 rupee is $0.015 not $0.0015 by nominal exchange rates. Sales tax must be included, as well as comparison with the lower nominal incomes in India rather than the global PPP standard that I gave. Other metformin manufacturers seem to generally charge more (https://www.medindia.net/drug-price/list.asp). Presumably they are not available in all locations; presumably there are areas where people simply don’t have easy access to buying these drugs at all. And we are just talking about India, the king of drug IP abuse. I bet if you look at Pakistan or Nigeria then it won’t be so easy to buy these drugs there.
I just don’t understand how it is possible to assume that even half of the people in the world will purchase and use the most effective product regardless of where they live. Have you tried to convince someone in this position to take any kind of supplements? Like, gone to someone who has very low income, and relies on bicycle or public transport, and explained to them why they should add this or that vitamin or OTC drug to their daily routine? If you had, I don’t think you would be making this assumption.
Well yeah, but if you want to calculate the expected value then you must go by what is likely to happen, not what you wish to happen.
Apps exist on smart phones, which lots of people don’t have, and most of the remainder won’t bother to install or pay attention to it. Moreover, apps don’t exist in every language.
Yes, my typo but 0.015 is still around 2 cents as is said in the article.
About persuasion: it is a problem of marketing, which was successfully solved about vitamins.
The global market of vitamin C is around 1 bln USD, btw. https://globenewswire.com/news-release/2016/08/24/866422/0/en/Global-Ascorbic-Acid-Market-Poised-to-Surge-from-USD-820-4-Million-in-2015-to-USD-1083-8-Million-by-2021-MarketResearchStore-Com.html