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Posted
4 hours ago, Pancho said:

 

Hmm, have you been this detective like over “other” tweets and posts?

this is some peak Surly sand-in-my-vag bullshit. I have seen plenty of tweets related to a whole host of topics criticized on this board for misleading descriptors. I have no idea if Don Johnson commented on any of them, but who the fuck cares? 

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Posted
2 hours ago, Txzen said:

You don't pull the plug going into phase 2 unless the drug had manufacturing issues or something hugely critical at fault. Phase 2 is where you actually start learning if it is 'hitting the target'. And even if it doesn't looks as promising as you hoped, as long as it's not unreasonably toxic, you try to learn what subpopulations of patients might benefit and expand that recruitment...in a phase 3. The complexity of cancer is that if 10 people who have lung cancer, each patient in effect can have a very different disease, and understanding those differences - and what patients stand to benefit - is critical.

If what you're saying is that there's value in every phase of a clinical trial, doesn't that cut against the idea that prices need to be high to offset money wasted on failed research?

Posted
19 hours ago, chainsaw said:

If what you're saying is that there's value in every phase of a clinical trial, doesn't that cut against the idea that prices need to be high to offset money wasted on failed research?

I didn't say that, and I think it's simplistic to think that the costs are to offset the losses incurred with a failed drug. On the contrary, quite a bit of that cost is offset the investment needed to get a drug to the clinic. Whether that is through the expense of the research, the purchase acquisition of a small startup with a promising candidate (who don't have the $$ to take it to the clinic), the length and complexity of the clinical trial, or even the expense and complexity of manufacturing the drug. It's all part of it.

There are other considerations too. There was a huge controversy when the first drugs to treat people with Hepatitis C. Previously, this was a horrible diagnosis - you were going to get liver cancer, and the only 'treatment' would be to manage the disease while waiting for a liver transplant. But, compared to what many are used to for other medications, the cost of new Hep C treatment - about $84k - seems like lunacy. But after 8, 16, or 24 weeks of treatment, 95% of people are cured. In reality, the pricing may be reasonable considering the costs associated with ongoing Hep C disease. It's far more expense to get a liver transplant and live with chronic disease. None of this is easy to unpack.

That last example also flies in the face of 'drug companies don't want to cure people because then they don't have patients anymore'. Again, it's a business, and business can be cutthroat, but everyplace I've worked, the goal - in oncology, autoimmunity and infectious disease - the focus has always been on bringing the best benefit to the largest number of patients. And working for the cure.

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Posted (edited)
4 hours ago, Txzen said:

compared to what many are used to for other medications, the cost of new Hep C treatment - about $84k - seems like lunacy. But after 8, 16, or 24 weeks of treatment, 95% of people are cured. In reality, the pricing may be reasonable considering the costs associated with ongoing Hep C disease. It's far more expense to get a liver transplant and live with chronic disease.

This kind of thinking is problematic, perhaps more so than the thinking that led Luigi Mangione to plan and carry out a murder. You're saying it's okay to charge someone $84k for something that doesn't need to cost more than like $350, and the reason why it's okay is because the only alternative available to the patient would also be expensive. Whatever the distinction is between that and extortion is one, I'd say, without a difference from a morality standpoint.

Edited by chainsaw
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Posted
4 hours ago, Txzen said:

I didn't say that, and I think it's simplistic to think that the costs are to offset the losses incurred with a failed drug. On the contrary, quite a bit of that cost is offset the investment needed to get a drug to the clinic. Whether that is through the expense of the research, the purchase acquisition of a small startup with a promising candidate (who don't have the $$ to take it to the clinic), the length and complexity of the clinical trial, or even the expense and complexity of manufacturing the drug. It's all part of it.

There are other considerations too. There was a huge controversy when the first drugs to treat people with Hepatitis C. Previously, this was a horrible diagnosis - you were going to get liver cancer, and the only 'treatment' would be to manage the disease while waiting for a liver transplant. But, compared to what many are used to for other medications, the cost of new Hep C treatment - about $84k - seems like lunacy. But after 8, 16, or 24 weeks of treatment, 95% of people are cured. In reality, the pricing may be reasonable considering the costs associated with ongoing Hep C disease. It's far more expense to get a liver transplant and live with chronic disease. None of this is easy to unpack.

That last example also flies in the face of 'drug companies don't want to cure people because then they don't have patients anymore'. Again, it's a business, and business can be cutthroat, but everyplace I've worked, the goal - in oncology, autoimmunity and infectious disease - the focus has always been on bringing the best benefit to the largest number of patients. And working for the cure.

Citing a pharma industry media source probably isn’t the kind of unbiased reporting you think it is.

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Posted
20 hours ago, royiv said:

Citing a pharma industry media source probably isn’t the kind of unbiased reporting you think it is.

The citation was to provide the argument from the perspective of pharma. What you make of it is your own opinion.

With regard to the Hep C drug, saying it 'cost more than like $350' - can you explain how you arrived at that valuation?

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Posted (edited)
On 1/9/2025 at 10:54 AM, royiv said:

She’s a surgeon in Austin. Looks like St. David’s in the background.

Correct! She did my wife’s partial mastectomy last year. She is an extremely nice person and a fantastic surgeon.

Edited by SquishMitten
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Posted
1 hour ago, Txzen said:

The citation was to provide the argument from the perspective of pharma. What you make of it is your own opinion.

With regard to the Hep C drug, saying it 'cost more than like $350' - can you explain how you arrived at that valuation?

like most evaluations, the pricing should consider the number of users over a time Period.  If it cost $1 billion to bring the drug to market, then charging $1000 per treatment for the 100 patients who use the drug once a year to cure the very rare disease is unreasonable.   in fact, under that scenario, I very much doubt they would approve the $1 billion effort in the first place.

On the other hand, if the drug will be sold to 1 million people who will use the drug monthly - and be charged the same $1000 - a $1000 retail price would be unconscionable.

naturally, the problem is thinking that a blockbuster billion dollar earning drug will result in voluntary price reduction once it becomes a blockbuster.  That could be seen as a violation of the board’s fiduciary duty to the shareholders.   if they have to choose between shareholders and patients, they will always fuck the patients.  It’s a feature not a bug.

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Posted
2 hours ago, Txzen said:

With regard to the Hep C drug, saying it 'cost more than like $350' - can you explain how you arrived at that valuation?

Let's just go with some fuzzy numbers

<$11 billion to develop a Hep C treatment

Spoiler

 https://www.reuters.com/article/business/gilead-bets-11-billion-on-hepatitis-in-pharmasset-deal-idUSTRE7AK0XU/

Quote

Gilead bets $11 billion on hepatitis in Pharmasset deal

November 21, 20114:03 PM CST

Updated 13 years ago


By Lewis Krauskopf and Anand Basu
(Reuters) - Gilead Sciences Inc struck a deal to buy biotechnology company Pharmasset Inc for about $11 billion in a huge and risky bet on the next generation of hepatitis C treatments.

Pharmasset, which had 82 employees as of its most recent annual report, has three hepatitis C medicines in clinical trials. Its lead candidate, PSI-7977, was recently advanced into two Phase III studies. Gilead expects PSI-7977 to be submitted for U.S. approval in the second half of 2013.

 

4 million with Hep C in the United States

Spoiler

 https://pubmed.ncbi.nlm.nih.gov/38739849/

Quote

Using the PWID adjustment model, we estimated HCV RNA prevalence of 1.6% (95% CI: 0.9%-2.2%), corresponding to 4,043,200 (95% CI: 2,401,800-5,607,100) current HCV infections.

 

50 million with Hep C worldwide

Spoiler

https://www.cdc.gov/hepatitis/global/index.html

Quote

Viral hepatitis worldwide
The World Health Organization (WHO) estimates that during 2022:

  • 1.2 million people were newly infected with hepatitis B virus (HBV).
  • 1 million people were newly infected with hepatitis C virus (HCV).
  • Approximately 254 million people have chronic hepatitis B.
  • Nearly 50 million people have chronic hepatitis C.
  • Chronic hepatitis B and chronic hepatitis C cause 1.3 million deaths each year due to liver disease and cancer.

 

So, big picture here, let's assume that only 80% of the world's Hep C patients are prescribed and can access the drug Gilead bought which we're assuming was $11bn to develop. If we amortize that to 40million patients, the mathematical expression for computing the amount each patient would need to pay for Gilead to break even:

X (each patient's fair share of the amortized R&D cost) = $11,000,000,000 (The R&D cost) ÷ 40,000,000 (The number of patients)

So, each patient's fair share of the amortized R&D cost is $275

Let's remember, however, that not all of Gilead's $11bn acquisition can be fairly apportioned to its portfolio of Hep C treatments. So it's more accurate to say:

Each patient's fair share of the amortized R&D cost is <$275

Of course there are more costs involved when you are producing and distributing Hep C medication, on top of the R&D required for it to have existed in the first place. I don't think that number, per patient, is particularly high.

Whatever the true number is, it's beside the point. What these companies are doing is morally indistinguishable from extortion. It's indefensible.

Posted
On 1/9/2025 at 11:24 AM, Don Johnson said:

Doc not wrong about her actual complaints in her video, which were not about the surgery being called off.

But this tweet was re-tweeted and quoted thousands of times, with many of the the comments similar to ones ITT.  Encouraging/predicting more murders.

All because everyone too lazy to watch a one minute video to fact check.

Xitter sucks, in case you hadn't noticed.

Posted (edited)

Had something of a realization on the patent tangent.  One of the most significant US patent reforms ever is the creation of the Patent Trial and Appeal Board and the Inter-Partes Review proceeding (and to a lesser extent post-grant review).

This provides a forum where challenges to the validity of patents may be brought in the PTO in an adversarial format as an alternative or adjunct to litigation.

One judge famously called the PTAB "a patent death squad."  He wasn't wrong.  In 70% of cases where a proceeding is instituted (it's not automatic that one of these is commenced, there has to be some preliminary merit) all claims of a patent are invalidated. 78% of claims considered are invalidated.  https://ipwatchdog.com/2025/01/12/ptab-70-claims-invalidation-rate-continues-source-concern/id=184956/

However, when the dataset is confined to pharma patents, the invalidation rate is much smaller, 15% of all claims invalidated, 33% of claims considered.  So half or less of the usual rate of invalidation.  It's even smaller among biologics.

This rather belies the notion that a lot of pharma patents are bullshit.  Some of them kind of are, in the sense that they cover minor variations, but they are also very limited in scope/coverage, meaning they are not essential to participating in the market for the drug in question.  That's why, when you drill down into a patent thicket, you'll find a relatively small handful are correlated to "the monopoly."  That is, it is usually the expiration of one or two patents that is regarded as opening up the market.

Edited by TwiceHorn
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Posted

I think the challenge with @chainsaw's approach is that it doesn't reflect the complexity of finance well enough.  

 

A better way would be to calculate the net present value and split the research costs across 10 years, add a discount rate (say 7%) and projected cashflow rate from the sale in years 10-30 (assuming patent protected and monopoly) and then a generic alternative for years 30-40.     If you only generated $1 billion for years 10-30, and .5 billion for years 30-40, you end up with a total revenue of $25 billion on an $11 billion investment.  However, the NPV is negative, meaning you will be in the hole about $2.5 billion.  The IRR for this project is ~5%.    So if the investors only required 5% return, then this is a coin flip of a project.     

Now this excludes the foreign markets were price controls and approvals will vary.    In that case, those 4 million US souls will pay $26 billion over the course of 30 years of being on the market to company X, which works out to about $6500 (very quick and dirty estimate) per treatment.  Assuming no new people get sick.   No inflation is assumed as well.  

This is also overly simplistic, with numbers, strategy, and distribution of costs all pulled from a hat.  

 

 

Posted
2 hours ago, TwiceHorn said:

This rather belies the notion that a lot of patents are bullshit.  Some of them kind of are

In the software/tech world there's a mountain of bad and shitty patents - the Oracle/Google fight over "APIs" springs to mind as a recent example.

Patents by and large have stopped being a mechanism to give inventors a window to profit off their idea, and are now a cudgel used against competitors to drag them down and stop innovation. 

It's not that patents in and of themselves are a bad thing, but they are THE weapon of choice in effectively killing competition in a durable and sustainable manner

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Posted
1 hour ago, Nivek said:

This is also overly simplistic, with numbers, strategy, and distribution of costs all pulled from a hat. 

Always has been. We're merely illustrating an idea here, so it's okay to go with fuzzy math and pulling numbers from a hat. $84k is still an extortionate price when the break-even price is almost certainly less than $1k.

 

Posted
42 minutes ago, chainsaw said:

Always has been. We're merely illustrating an idea here, so it's okay to go with fuzzy math and pulling numbers from a hat. $84k is still an extortionate price when the break-even price is almost certainly less than $1k.

 

Well, I think my example pushes the costs an order of magnitude higher.  ~$7k is strictly for recouping the investment and research of $11 billion, assuming that is all purely company sponsored internally (cash) and not financed through debt/equity or offset by research grants.   The cost of manufacturing should also be included but I have no idea where to even start with numbers here.  But it does seem to indicate that if the costs per treatment were $80k/treatment than that would be pretty absurd in a vacuum.   

I suppose the question is the cost of failures (those never made it out of trial/research) and possibly offsetting costs for research into other diseases which have far fewer patients to spread the costs among.    

 

I simply do not know enough about this industry to give a credible and honest critique.  But like you, I do suspect the industry which also gave us the opioid epidemic might not be so benevolent across the board.

Posted
8 minutes ago, Nivek said:

Well, I think my example pushes the costs an order of magnitude higher.  ~$7k is strictly for recouping the investment and research of $11 billion, assuming that is all purely company sponsored internally (cash) and not financed through debt/equity or offset by research grants.   The cost of manufacturing should also be included but I have no idea where to even start with numbers here.  But it does seem to indicate that if the costs per treatment were $80k/treatment than that would be pretty absurd in a vacuum.   

I suppose the question is the cost of failures (those never made it out of trial/research) and possibly offsetting costs for research into other diseases which have far fewer patients to spread the costs among.    

 

I simply do not know enough about this industry to give a credible and honest critique.  But like you, I do suspect the industry which also gave us the opioid epidemic might not be so benevolent across the board.

I have my doubts that any treatment's break-even price is $7k, even if we're subsidizing or trying to offset a bunch of failed research initiatives. You're correct to observe that even if we make that charitable assumption in favor of big pharma, the ratio of $84k/$7k (12:1) is, to understate things, "pretty absurd."

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Posted
6 hours ago, Captainant said:

It's not that patents in and of themselves are a bad thing, but they are THE weapon of choice in effectively killing competition in a durable and sustainable manner

Well. Walk without rhythm, and it won’t attract the worm.

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Posted
On 1/11/2025 at 3:15 PM, chainsaw said:

Let's just go with some fuzzy numbers

<$11 billion to develop a Hep C treatment

4 million with Hep C in the United States

50 million with Hep C worldwide

So, big picture here, let's assume that only 80% of the world's Hep C patients are prescribed and can access the drug Gilead bought which we're assuming was $11bn to develop. If we amortize that to 40million patients, the mathematical expression for computing the amount each patient would need to pay for Gilead to break even:

X (each patient's fair share of the amortized R&D cost) = $11,000,000,000 (The R&D cost) ÷ 40,000,000 (The number of patients)

So, each patient's fair share of the amortized R&D cost is $275

Let's remember, however, that not all of Gilead's $11bn acquisition can be fairly apportioned to its portfolio of Hep C treatments. So it's more accurate to say:

Each patient's fair share of the amortized R&D cost is <$275

Of course there are more costs involved when you are producing and distributing Hep C medication, on top of the R&D required for it to have existed in the first place. I don't think that number, per patient, is particularly high.

Whatever the true number is, it's beside the point. What these companies are doing is morally indistinguishable from extortion. It's indefensible.

Given your verbiage, I'm not sure that we're capable of a rational conversation here. That said I will agree that when it comes to healthcare, and the pricing of drugs (and services) things get emotional and sticky quickly.

But to think that you'd be able to treat 40m patients is a lark.

That deal was approved in 2011. I can't find more recent numbers, but 6 years later that drug (PSI-7977, sofosbuvir) Gilead had treated 1.4 million patients. Assuming each paid $7-8k for the treatment (and all that money went back to the parent company), I'm not sure that's breaking even as the 11b is only the acquisition cost, not counting clinical trials, manufacturing, marketing, etc. I'm sure it continued to generate revenue, but there were certainly other compounds competing for that market share, including additional approaches within their own pipeline (based on the article).  I do think there's a real question for many of these acquisitions - and this is absolutely not the only example - of simply paying too much or overvaluing the asset or the market.

But I think it's also true that in many cases the goal is not necessarily to even get back the entire cost of the development for the drug, as much as it is for particular companies to try and build a franchise in a particular disease area. Gilead has certainly done so with Hep C, BMS with multiple myeloma, etc.

This is also one of those drugs, given the cost, that really pulled in some questioning regarding public funding for the clinical trials which according to this article was around $60m.

As much hand-wringing as the industry has done over the past year(s) in anticipation of the Inflation Reduction Act, and how it impacts drug pricing, it's clear that change had to start somewhere.

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Posted
1 minute ago, Txzen said:

Given your verbiage, I'm not sure that we're capable of a rational conversation here. That said I will agree that when it comes to healthcare, and the pricing of drugs (and services) things get emotional and sticky quickly.

But to think that you'd be able to treat 40m patients is a lark.

That deal was approved in 2011. I can't find more recent numbers, but 6 years later that drug (PSI-7977, sofosbuvir) Gilead had treated 1.4 million patients. Assuming each paid $7-8k for the treatment (and all that money went back to the parent company), I'm not sure that's breaking even as the 11b is only the acquisition cost, not counting clinical trials, manufacturing, marketing, etc. I'm sure it continued to generate revenue, but there were certainly other compounds competing for that market share, including additional approaches within their own pipeline (based on the article).  I do think there's a real question for many of these acquisitions - and this is absolutely not the only example - of simply paying too much or overvaluing the asset or the market.

But I think it's also true that in many cases the goal is not necessarily to even get back the entire cost of the development for the drug, as much as it is for particular companies to try and build a franchise in a particular disease area. Gilead has certainly done so with Hep C, BMS with multiple myeloma, etc.

This is also one of those drugs, given the cost, that really pulled in some questioning regarding public funding for the clinical trials which according to this article was around $60m.

As much hand-wringing as the industry has done over the past year(s) in anticipation of the Inflation Reduction Act, and how it impacts drug pricing, it's clear that change had to start somewhere.

The company Gilead had acquired already did this R&D and FDA process. Don't confuse two different things. There's the market (estimated 40M could be more though) and there's the patients who had adopted the treatment in the short time it had been made available. The particulars are less important than the big picture here, which is that people are being extorted.

Posted

Some of y’all’s breakeven price estimates are assuming that each drug captures 100% of the market share, ignoring patients who don’t take medication, stick with competitors’ products, or often cannibalizing sales from one of their own legacy products. 
 

1 hour ago, chainsaw said:

The company Gilead had acquired already did this R&D and FDA process. Don't confuse two different things. There's the market (estimated 40M could be more though) and there's the patients who had adopted the treatment in the short time it had been made available. The particulars are less important than the big picture here, which is that people are being extorted.

In acquisitions, it is common for the acquirer to assume the debt of the acquired company in addition to the purchase price and any future royalties. There could be million$ of r&d, regulatory, and marketing debt that needs to be paid. Every situation is unique. 

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Posted
Some of y’all’s breakeven price estimates are assuming that each drug captures 100% of the market share, ignoring patients who don’t take medication, stick with competitors’ products, or often cannibalizing sales from one of their own legacy products. 
 
In acquisitions, it is common for the acquirer to assume the debt of the acquired company in addition to the purchase price and any future royalties. There could be million$ of r&d, regulatory, and marketing debt that needs to be paid. Every situation is unique. 

Qualifiers were present, there is so much uncertainty around the figures that adding conditions such as some people not having access or a competing treatment option is akin to the Sex Panther efficacy statements.
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Posted

Somebody’s bottom line appears to be affected.  Going after an Austin plastic surgeon and maybe others on social media.  @Ghost of LL and @TwiceHorn and @South Austin and others, thoughts?  It’s the law firm that helped get almost $800 million out of Fox News, so I wonder if this is going beyond one plastic surgeon.

https://news.bloomberglaw.com/business-and-practice/unitedhealth-hires-defamation-firm-to-counter-social-media-posts

UnitedHealth Group Inc. has hired a prominent defamation law firm to counter what it sees as inaccurate and irresponsible social media posts about the company’s practices.

Clare Locke, an Alexandria, Virginia-based boutique law firm, is working for UnitedHealth, the company confirmed. A doctor “is using her social media following to perpetuate inaccuracies, which is irresponsible, unethical and dangerous,” UnitedHeath said in a statement.

The hiring shows the biggest US health insurer is pushing back against public statements it views as false following the high-profile death of an executive. Clare Locke is best known for representing Dominion Voting Systems Inc. in a landmark $787.5 million defamation settlement with Fox Corp.'s Fox News. 

Social media platforms lit up with criticisms and even hatred of health insurers following the Dec. 4 murder of Brian Thompson, the chief executive officer of the company’s UnitedHealthcare unit, outside an investor conference in New York. Luigi Mangione, who had allegedly decried health industry practices, faces murder charges in Manhattan.

Elisabeth Potter, an Austin, Texas, plastic surgeon, claimed on Instagram Jan. 7 that UnitedHealth denied an in-patient stay after surgery related to cancer. “I had to scrub out mid-surgery to call United, only to find that the person on the line didn’t even have access to the patient’s full medical information, despite the procedure already being pre-approved,” Potter said in the post.

One of Potter’s attorneys, Jessica Underwood, said Potter received a Jan. 13 letter from Clare Locke demanding that she correct her posts, apologize to UnitedHealth and condemn threats of violence that the law firm said resulted from the posts.

But Underwood, of the law firm Nix Patterson, said Potter’s statements about the insurer were truthful. “Dr. Potter will not be silenced by UnitedHealthcare’s attempts to threaten and harass her,” Underwood said. 

UnitedHealth said in its statement that it had previously approved coverage of the care the patient received, including coverage of an overnight stay. “Dr. Potter’s claims that she was called out of surgery are false,” the company said. “There are no insurance related circumstances that would require a physician to step out of surgery and it would create potential safety risks if they were to do so.”

Clare Locke’s letter to Potter was signed by Tom Clare, who founded the firm in 2014 with his wife and former fellow Kirkland & Ellis partner Elizabeth “Libby” Locke.

Firm partner Jered Ede also signed the letter. Before joining the firm, Ede served as chief legal officer for Project Veritas, the conservative nonprofit that goes undercover to expose what it sees as wrongdoing.

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Posted
18 minutes ago, atomheartbevo said:

Somebody’s bottom line appears to be affected.  Going after an Austin plastic surgeon and maybe others on social media.  @Ghost of LL and @TwiceHorn and @South Austin and others, thoughts?  It’s the law firm that helped get almost $800 million out of Fox News, so I wonder if this is going beyond one plastic surgeon.

https://news.bloomberglaw.com/business-and-practice/unitedhealth-hires-defamation-firm-to-counter-social-media-posts

UnitedHealth Group Inc. has hired a prominent defamation law firm to counter what it sees as inaccurate and irresponsible social media posts about the company’s practices.

Clare Locke, an Alexandria, Virginia-based boutique law firm, is working for UnitedHealth, the company confirmed. A doctor “is using her social media following to perpetuate inaccuracies, which is irresponsible, unethical and dangerous,” UnitedHeath said in a statement.

The hiring shows the biggest US health insurer is pushing back against public statements it views as false following the high-profile death of an executive. Clare Locke is best known for representing Dominion Voting Systems Inc. in a landmark $787.5 million defamation settlement with Fox Corp.'s Fox News. 

Social media platforms lit up with criticisms and even hatred of health insurers following the Dec. 4 murder of Brian Thompson, the chief executive officer of the company’s UnitedHealthcare unit, outside an investor conference in New York. Luigi Mangione, who had allegedly decried health industry practices, faces murder charges in Manhattan.

Elisabeth Potter, an Austin, Texas, plastic surgeon, claimed on Instagram Jan. 7 that UnitedHealth denied an in-patient stay after surgery related to cancer. “I had to scrub out mid-surgery to call United, only to find that the person on the line didn’t even have access to the patient’s full medical information, despite the procedure already being pre-approved,” Potter said in the post.

One of Potter’s attorneys, Jessica Underwood, said Potter received a Jan. 13 letter from Clare Locke demanding that she correct her posts, apologize to UnitedHealth and condemn threats of violence that the law firm said resulted from the posts.

But Underwood, of the law firm Nix Patterson, said Potter’s statements about the insurer were truthful. “Dr. Potter will not be silenced by UnitedHealthcare’s attempts to threaten and harass her,” Underwood said. 

UnitedHealth saidn in its statement that it had previously approved coverage of the care the patient received, including coverage of an overnight stay. “Dr. Potter’s claims that she was called out of surgery are false,” the company said. “There are no insurance related circumstances that would require a physician to step out of surgery and it would create potential safety risks if they were to do so.”

Clare Locke’s letter to Potter was signed by Tom Clare, who founded the firm in 2014 with his wife and former fellow Kirkland & Ellis partner Elizabeth “Libby” Locke.

Firm partner Jered Ede also signed the letter. Before joining the firm, Ede served as chief legal officer for Project Veritas, the conservative nonprofit that goes undercover to expose what it sees as wrongdoing.

Well, it appears that Susman Godfrey did most of the heavy lifting in Dominion, much of which was discovery related.

It boils down to whether what Dr. Potter said was actually true.  It doesn't seem to be a particularly complicated case.

Nix Patterson is a solid plaintiff's firm.  Not sure how well they'll do at defense.  It's not rocket surgery.

Posted
10 hours ago, atomheartbevo said:

Somebody’s bottom line appears to be affected.  Going after an Austin plastic surgeon and maybe others on social media.  @Ghost of LL and @TwiceHorn and @South Austin and others, thoughts?  It’s the law firm that helped get almost $800 million out of Fox News, so I wonder if this is going beyond one plastic surgeon.

https://news.bloomberglaw.com/business-and-practice/unitedhealth-hires-defamation-firm-to-counter-social-media-posts

UnitedHealth Group Inc. has hired a prominent defamation law firm to counter what it sees as inaccurate and irresponsible social media posts about the company’s practices.

Clare Locke, an Alexandria, Virginia-based boutique law firm, is working for UnitedHealth, the company confirmed. A doctor “is using her social media following to perpetuate inaccuracies, which is irresponsible, unethical and dangerous,” UnitedHeath said in a statement.

The hiring shows the biggest US health insurer is pushing back against public statements it views as false following the high-profile death of an executive. Clare Locke is best known for representing Dominion Voting Systems Inc. in a landmark $787.5 million defamation settlement with Fox Corp.'s Fox News. 

Social media platforms lit up with criticisms and even hatred of health insurers following the Dec. 4 murder of Brian Thompson, the chief executive officer of the company’s UnitedHealthcare unit, outside an investor conference in New York. Luigi Mangione, who had allegedly decried health industry practices, faces murder charges in Manhattan.

Elisabeth Potter, an Austin, Texas, plastic surgeon, claimed on Instagram Jan. 7 that UnitedHealth denied an in-patient stay after surgery related to cancer. “I had to scrub out mid-surgery to call United, only to find that the person on the line didn’t even have access to the patient’s full medical information, despite the procedure already being pre-approved,” Potter said in the post.

One of Potter’s attorneys, Jessica Underwood, said Potter received a Jan. 13 letter from Clare Locke demanding that she correct her posts, apologize to UnitedHealth and condemn threats of violence that the law firm said resulted from the posts.

But Underwood, of the law firm Nix Patterson, said Potter’s statements about the insurer were truthful. “Dr. Potter will not be silenced by UnitedHealthcare’s attempts to threaten and harass her,” Underwood said. 

UnitedHealth said in its statement that it had previously approved coverage of the care the patient received, including coverage of an overnight stay. “Dr. Potter’s claims that she was called out of surgery are false,” the company said. “There are no insurance related circumstances that would require a physician to step out of surgery and it would create potential safety risks if they were to do so.”

Clare Locke’s letter to Potter was signed by Tom Clare, who founded the firm in 2014 with his wife and former fellow Kirkland & Ellis partner Elizabeth “Libby” Locke.

Firm partner Jered Ede also signed the letter. Before joining the firm, Ede served as chief legal officer for Project Veritas, the conservative nonprofit that goes undercover to expose what it sees as wrongdoing.

This looks ripe for a Texas Citizens Participation Act motion to dismiss.  

The TCPA is the anti-SLAAP statute in Texas, and it lets a defendant file a motion to dismiss a suit that arises out of the defendant's exercise of the right to free speech, the right to petition the government, or the right to association.  It's a pretty draconian statute, because if the case is dismissed, then the plaintiff has to pay fees.  And the fees on that kind of thing are always high.

There is a commercial-speech exception, but I'm not at all certain that this would fall under that exception.

Damn--I wish I was on this case.  It'd be fun.

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Posted (edited)
15 minutes ago, Ghost of LL said:

This looks ripe for a Texas Citizens Participation Act motion to dismiss.  

The TCPA is the anti-SLAAP statute in Texas, and it lets a defendant file a motion to dismiss a suit that arises out of the defendant's exercise of the right to free speech, the right to petition the government, or the right to association.  It's a pretty draconian statute, because if the case is dismissed, then the plaintiff has to pay fees.  And the fees on that kind of thing are always high.

There is a commercial-speech exception, but I'm not at all certain that this would fall under that exception.

Damn--I wish I was on this case.  It'd be fun.

So doesn't this, in practical effect, place a higher burden on UHG to prove malice by Potter if any of the statements she made are false or false-ish.*

I have noticed that federal courts give no fucks about placing a high burden of proof of malice at the pleading stage, before discovery is even permitted.

Texas courts, until recently, haven't had much ability to dismiss litigation at the pleading stages and, even if the rules provided for it, judges have been reluctant to do so by tradition and practice, much like the early days of summary judgment in Texas.

TCPA seems to have created sort of an uber-motion-to-dismiss in Texas state courts.  Fun fact, TCPA was drafted by one of my classmates.

(most of this post is for the peanut gallery by way of explanation rather than trying to tell you what you already know, but there is a question in there).

*ETA:  The value, if any, of boutique defamation firms like Clare Locke seems to be in persuasively framing the truth/falsity/opinion issues in defamation litigation to support their clients, that is making what seems like either a clear opinion or a clear fact something else entirely.

Edited by TwiceHorn
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Posted
20 minutes ago, TwiceHorn said:

So doesn't this, in practical effect, place a higher burden on UHG to prove malice by Potter if any of the statements she made are false or false-ish.*

I have noticed that federal courts give no fucks about placing a high burden of proof of malice at the pleading stage, before discovery is even permitted.

Texas courts, until recently, haven't had much ability to dismiss litigation at the pleading stages and, even if the rules provided for it, judges have been reluctant to do so by tradition and practice, much like the early days of summary judgment in Texas.

TCPA seems to have created sort of an uber-motion-to-dismiss in Texas state courts.  Fun fact, TCPA was drafted by one of my classmates.

(most of this post is for the peanut gallery by way of explanation rather than trying to tell you what you already know, but there is a question in there).

*ETA:  The value, if any, of boutique defamation firms like Clare Locke seems to be in persuasively framing the truth/falsity/opinion issues in defamation litigation to support their clients, that is making what seems like either a clear opinion or a clear fact something else entirely.

The TCPA doesn't place a higher burden on the plaintiff to prove malice.  It just creates a procedural mechanism for a defendant to get a quick dismissal and recover fees.  

And theoretically, it shouldn't be that hard for a plaintiff to get past a TCPA motion.  All the plaintiff has to do is show a prima-facie case of every element of its claim.  But in the defamation context--the malice element that you identify is going to be the tough one to show prima-facie evidence of.  I mean, you do get some expedited discovery, but . . . yikes.

I don't know if that answered your question.  

 

I'll also say that I didn't see whether this was filed in federal or state court.  I assume it's in state court.  But I think the Fifth Circuit has decided that the federal courts won't apply the TCPA because it is a purely procedural mechanism (though I could be waaaay wrong on that--beware the old lawyer who says "I think I remember a case that says . . . .").

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Posted
2 minutes ago, Ghost of LL said:

The TCPA doesn't place a higher burden on the plaintiff to prove malice.  It just creates a procedural mechanism for a defendant to get a quick dismissal and recover fees.  

And theoretically, it shouldn't be that hard for a plaintiff to get past a TCPA motion.  All the plaintiff has to do is show a prima-facie case of every element of its claim.  But in the defamation context--the malice element that you identify is going to be the tough one to show prima-facie evidence of.  I mean, you do get some expedited discovery, but . . . yikes.

I don't know if that answered your question.  

 

I'll also say that I didn't see whether this was filed in federal or state court.  I assume it's in state court.  But I think the Fifth Circuit has decided that the federal courts won't apply the TCPA because it is a purely procedural mechanism (though I could be waaaay wrong on that--beware the old lawyer who says "I think I remember a case that says . . . .").

Good points, thanks.  Appears that suit has not been filed.  

And yeah, I didn't mean to imply that TCPA actually creates an increased burden, but I think whether in federal court or Texas court with TCPA, a defamation suit involving a public-figure defendant places a pretty high burden on a plaintiff to produce evidence of malice without engaging in discovery.

And I believe you are correct on federal courts in the 5th Circuit not applying TCPA.

Posted
On 2/6/2025 at 8:38 AM, Ghost of LL said:

The TCPA doesn't place a higher burden on the plaintiff to prove malice.  It just creates a procedural mechanism for a defendant to get a quick dismissal and recover fees.  

And theoretically, it shouldn't be that hard for a plaintiff to get past a TCPA motion.  All the plaintiff has to do is show a prima-facie case of every element of its claim.  But in the defamation context--the malice element that you identify is going to be the tough one to show prima-facie evidence of.  I mean, you do get some expedited discovery, but . . . yikes.

I don't know if that answered your question.  

 

I'll also say that I didn't see whether this was filed in federal or state court.  I assume it's in state court.  But I think the Fifth Circuit has decided that the federal courts won't apply the TCPA because it is a purely procedural mechanism (though I could be waaaay wrong on that--beware the old lawyer who says "I think I remember a case that says . . . .").

I was told there would be no Latin.

Posted
On 2/7/2025 at 8:19 PM, SurlyGator said:

I was told there would be no Latin.

prima-facie means the the new CEO of United Healthcare get to sleep with Luigi on his first night after sentencing, before he gets run through in federal pound you in the ass prison.   

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Posted
2 hours ago, Incredulity said:

prima-facie means the the new CEO of United Healthcare get to sleep with Luigi on his first night after sentencing, before he gets run through in federal pound you in the ass prison.   

Thank you for keeping Lobo's spirit alive.

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Posted

I'm not a litigator but I saw the demand letter from Clare Locke posted on social media and thought it was terrible.   Way too verbose, repetitive, unnecessarily aggressive. I read like something I would have written as a first year attorney that would have been ripped to shreds by a partner.

Posted
29 minutes ago, Skipper said:

I'm not a litigator but I saw the demand letter from Clare Locke posted on social media and thought it was terrible.   Way too verbose, repetitive, unnecessarily aggressive. I read like something I would have written as a first year attorney that would have been ripped to shreds by a partner.

seinfeld jackie GIF

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Posted
54 minutes ago, Skipper said:

I'm not a litigator but I saw the demand letter from Clare Locke posted on social media and thought it was terrible.   Way too verbose, repetitive, unnecessarily aggressive. I read like something I would have written as a first year attorney that would have been ripped to shreds by a partner.

Yeah, but did it get clicks and likes and a bunch of fucking losers saying "DUDE, YOU GOT OWNED!" about the recipient?  Because in America 2025, where we are LITERALLY being governed by an unelected billionaire who has temporarily changed his online handle to "Hairy Bolz," that's all that matters.

  • 2 months later...
Posted

In the ongoing clown fiesta that is Luigi's trial, a prosecutor has recused himself after one of his paralegals listened in to a call between Mangione and his attorneys.

https://www.newsweek.com/luigi-mangione-prosecutor-recused-2066624

Quote

Wednesday's letter also amended an earlier letter to Garnett that described the handling of a recorded jail call between Mangione and his attorney, Karen Friedman Agnifilo.

The earlier letter has said that a paralegal at the New York County District Attorney's Office (DANY) had "immediately stopped listening" to the call after recognizing it as an attorney call.

"In fact, the paralegal listened to the entire call, then subsequently informed DANY prosecutors about the identities of the people with whom the defendant spoke," Wednesday's letter said.

"DANY thereafter handled the matter as described in our previous letter. Moreover, DANY notified defense counsel of these facts in an email, dated April 22, 2025, thus, counsel was aware of this information prior to arraignment."

They got their hand caught in the cookie jar

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Posted
4 minutes ago, Captainant said:

In the ongoing clown fiesta that is Luigi's trial, a prosecutor has recused himself after one of his paralegals listened in to a call between Mangione and his attorneys.

https://www.newsweek.com/luigi-mangione-prosecutor-recused-2066624

They got their hand caught in the cookie jar

How, pray tell, does a paralegal at the New York County District Attorney's Office go about inadvertently listening in on a privileged conversation between a defendant and his lawyer? They need to walk us through the steps leading up to that "mishap."

I also wonder how the lie about the paralegal only hearing part of the call was discovered and what actions have been taken to prevent it from happening again. Are there remedies a defense team could seek for this accidental oversight?

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Posted
1 hour ago, bolverk said:

How, pray tell, does a paralegal at the New York County District Attorney's Office go about inadvertently listening in on a privileged conversation between a defendant and his lawyer? They need to walk us through the steps leading up to that "mishap."

I also wonder how the lie about the paralegal only hearing part of the call was discovered and what actions have been taken to prevent it from happening again. Are there remedies a defense team could seek for this accidental oversight?

Wait.  There are some people who think that Luigi was EVER going to get a fair trial?

brian-cox-laughing-at-you.gif

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Posted

Yeah….we live in a purely evil timeline.

https://www.reddit.com/r/news/s/kdzrs6XHx8

A group of shareholders is suing United Healthcare over its reaction to the CEO’s killing.

“The group, which is seeking unspecified damages, argued that the public backlash prevented the company from pursuing “the aggressive, anti-consumer tactics that it would need to achieve” its earnings goals.”

Giant meteor…get here soon.

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Posted
9 minutes ago, Brisketexan said:

Yeah….we live in a purely evil timeline.

https://www.reddit.com/r/news/s/kdzrs6XHx8

A group of shareholders is suing United Healthcare over its reaction to the CEO’s killing.

“The group, which is seeking unspecified damages, argued that the public backlash prevented the company from pursuing “the aggressive, anti-consumer tactics that it would need to achieve” its earnings goals.”

Giant meteor…get here soon.

lionel-hutz-can-you-imagine-a-world-with

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Posted

Any chance this is a plot to get them to admit on the record to pursuing those aggressive anti consumer tactics using reverse psychology? &nbsp

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Posted
On 5/1/2025 at 3:30 PM, Brisketexan said:

Wait.  There are some people who think that Luigi was EVER going to get a fair trial?

brian-cox-laughing-at-you.gif

If the Memphis cops can get a not guilty, why not Luigi? Not that I think he should get a not guilty if he's guilty.

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Posted
On 5/1/2025 at 2:23 PM, bolverk said:

How, pray tell, does a paralegal at the New York County District Attorney's Office go about inadvertently listening in on a privileged conversation between a defendant and his lawyer? They need to walk us through the steps leading up to that "mishap."

I also wonder how the lie about the paralegal only hearing part of the call was discovered and what actions have been taken to prevent it from happening again. Are there remedies a defense team could seek for this accidental oversight?

Well, as you probably suspect, all prison phone calls are recorded, and there's usually ample warning that that is taking place.

I believe the best practice with prison calls to attorneys is to make arrangements beforehand that such calls a) are not recorded and b) don't take place "in public," ie common areas of the prison or jail, so there's no issue of invasion or waiver of privilege.  That should be SOP both from the lawyer's standpoint and prison/jail operations.

AFAIK, the prison call recording system keeps a database of all the recordings that prison staff and prosecutors can call up and listen to any/all prisoner phone calls.  The whole prison call thing is a bit scandalous, both as to privacy and cost, and also fairly sophisticated. A call with a lawyer should never be in that database.

So, I'd think a first level of blame would be with Luigi's lawyers for having a call over the standard call system.  And to some degree with Luigi himself.

But, if you're conspiratorially minded, the prison/jail was recording calls it should not have and making those recordings available to prosecutors.

 

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Posted

This is the insane world we live in: Treating consumers badly to boost profits is securities fraud, but treating consumers well and reducing profits is also securities fraud, because everything is securities fraud.

https://www.cnbc.com/2025/05/08/unitedhealthcare-sued-by-shareholders-over-reaction-to-ceos-killing.html

Quote

 

A group of investors sued UnitedHealthcare Group on Wednesday, accusing the company of misleading them after the killing of its CEO, Brian Thompson.

The class action lawsuit — filed in the Southern District of New York — accuses the health insurance company of not initially adjusting their 2025 net earning outlook to factor in how Thompson’s killing would affect their operations.

On Dec. 3 — a day before Thompson was fatally shot — the company issued guidance that included net earnings of $28.15 to $28.65 per share and adjusted net earnings of $29.50 to $30.00 per share, the suit notes. And on January 16, the company announced that it was sticking with its old forecast.

Bloomberg Law adds:

This was misleading, [the plaintiff] said, as it didn’t disclose the company was “no longer willing” to “use the aggressive, anti-consumer tactics” it needed to achieve its prior forecast as it was embroiled in heightened public hostility.

The theory is that Thompson’s murder caused UnitedHealth to become more patient-friendly, which made it less profitable, but UnitedHealth didn’t immediately tell shareholders that, so the shareholders assumed it would continue to be patient-unfriendly and profitable. Here is the complaint, which sort of combines (1) the allegedly patient-unfriendly business practices, (2) the murder and (3) the public statements into one broad critique:

Specifically, Defendants made false and/or misleading statements and/or failed to disclose that: (1) UnitedHealth had, for years, engaged in a corporate strategy of denying health coverage in order to boost its profits, and ultimately, its share price; (2) this anti-consumer (and at times unlawful) strategy resulted in regulatory scrutiny (as well as public angst) against UnitedHealth, which ultimately resulted in the murder of Brian Thompson; (3) animus towards UnitedHealth was such that, subsequent to the murder of Mr. Thompson, many Americans openly celebrated his demise, expressed admiration for his accused killer, and/or otherwise demanded that UnitedHealth change its strategy even if they condemned Mr. Thompson’s killing; (4) the foregoing regulatory and public outrage caused UnitedHealth to change its corporate practices; (5) notwithstanding the foregoing, UnitedHealth recklessly stuck with the guidance it issued the day before Thompson’s murder, which was unrealistic considering the Company’s changing corporate strategies; and (6) as a result, Defendants’ public statements were materially false and/or misleading at all relevant times.

So what was the securities fraud? Was it:

That UnitedHealth “had, for years, engaged in a corporate strategy of denying health coverage in order to boost its profits, and ultimately, its share price,” without telling shareholders that, but that strategy was unsustainable and eventually shareholders realized that (because of the murder) and the stock dropped? Or

That UnitedHealth stopped doing that, without telling shareholders that the change would reduce profits?

 

 

Posted (edited)
33 minutes ago, Vegas64 said:

This is the insane world we live in: Treating consumers badly to boost profits is securities fraud, but treating consumers well and reducing profits is also securities fraud, because everything is securities fraud.

https://www.cnbc.com/2025/05/08/unitedhealthcare-sued-by-shareholders-over-reaction-to-ceos-killing.html

 

Man, this is one of those examples where shareholder suits and class actions in particular are pretty ridiculous. Just about any time a publicly traded company has a price gyration, particularly a drop, they get sued for securities fraud and/or breach of fiduciary duty.

They mostly settle for decent, but not meaningful-in-a-big-way, amounts.  The only real winners are the entrepreneurial lawyers that brought them.

A facile response is to ban such suits.  Most large corporations would be highly in favor of doing so and are probably lobbying intensely for it right now.  Any such action needs to be carefully considered lest we get the "tort reform" result.

But they do, if not often, serve a purpose in regulating corporate behavior in ways that even an effective SEC cannot.  This is the type of suit that kept Elmo from getting his ridiculous comp package.  I'm sure that's a popular result and this may be a popular result.  The actual effect on corporate behavior is, I think, negligible.

Also, this gets into that whole lawyer ethics thing.  The real personal motivation for most of these suits is to make money for lawyers.  But, they follow all the rules and most of the precedents and serve the theoretical reason for their existence (curb corporate behavior) to at least a tiny extent.  And you can find other examples of such suits that serve to compensate the truly defrauded and actually punish or deter bad corporate behavior.

So, should we do something about these lawsuits and lawyers when their motivations and raisons d'etre are quite a bit less than noble, and risk the unintended consequences?  Or just let things chuckle along as usual?  That is a bit of a false choice, as there are tweaks that could be made that reduce the ridiculous, hopefully without also reducing the sublime, but there is always the risk of unintended consequences.

Edited by TwiceHorn
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