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The 'ideal' drug from a business point of view not only not cures the patient long term, it offer a short term mitigation while increasing the risk on relapse a
by PeterStuer 9y ago
The 'ideal' drug from a business point of view not only not cures the patient long term, it offer a short term mitigation while increasing the risk on relapse and thus future recurring consumption of the treatment. At the same time it can be IP protected to block alternatives and has an insured third party collective payment coverage to guard against the treated running out of funds to afford the perpetual dependency.
This realization goes beyond medicine, and is key to understanding why we live in an 'economy' that produces masses of landfill junk while our technology and manufacturing processes keep on improving.
- xg15 9y agoThis. I'd go further and say that a system where innovation is driven by profit is good at perpetually managing problems but very bad at actually getting rid of them.
- PeterStuer 9y agoIf you dig even further, you will find things like 'unhappy people consume more as they try to buy their way out of misery'. Now of course you don't directly sell unhappiness, but you can sell goods of which the consumption benefits the individual that consumes it, but deteriorates the world a little bit for everyone as a result. A car is a perfect example. Great benefit to the buyer, but through noise, pollution, taking up space etc. a bit of a nuisance to all others and making them more likely to also consume a car so as to at least participate in the benefits. This ends up in a situation where everyone gets locked into a net negative system where individual escape (dumping your own car) just makes you worse of as you just forego the individual benefit without any perceptual change in the collective negatives.
- reificator 9y agoI find a motorcycle with lots of storage to be a nice compromise. Cheaper and more fun too. Of course you do need to take a safety course and be aware of the dangers, but at least people acknowledge their danger. Cars somehow get a collective free pass despite their astronomical death tally.
- buvanshak 9y ago> The 'ideal' drug from a business point of view not only not cures the patient long term... There is another one. Vaccines. Or any preventive medicines that does not actually require people to be sick. You just need to inject massive amount of fear of diseases (Statistics is your friend here) into the populace to create a nice, ever increasing demand of your produce...
- dmurray 9y agoVaccines also only get administered once, or a small number of times, per patient. It's hard for them to be as profitable as a drug which is "take this 3 times a day with meals, for the rest of your life, or you die".
- PeterStuer 9y agoI don't agree. Herd immunization is a solid concept. Besides, AFAIK most vaccines do not just work short-term while increasing the likelihood of future vaccination need.
- masklinn 9y ago> There is another one. Vaccines. Vaccines are absolute shit from a business perspective. They're expensive to develop, generally cheap to produce, and their administration is a single or limited event point. Sure you've got breadth but you've got no depth, once an individual is vaccinated they're done, or maybe they'll need an other round years from now. Big pharma companies absolutely hate vaccines, having people pay for repeated treatment is way more business-beneficial. And as other commenters have noted, herd immunity is a well-studied concept, and vaccines have very much proved their worth multiple times over.
- buvanshak 9y agoVaccines provide, a nice, predictable, ever increasing demand. It is even possible to create arbitrary demand in the case of preventive measures such as these. Profit from any normal drug is dependent on chance that a certain number of people will fall sick of the corresponding disease. The company cannot also count on outbreaks since it will have no clue when, where and for which disease the outbreak will occur. The expire date for drugs means that the companies will not be able to stockpile these drugs in hopes that there will be an outbreak some point in future..
- brann0 9y agoSo we agree medicine cannot be managed as a business, right? It's ok if healthcare losses money, in fact it should be ok for all public sevices to operate and not being profitable.
- dominotw 9y agoHow can we tell if the loss if from inefficiencies, corruption and laziness? Case in point: Air India.
- pjc50 9y agoYou need different metrics for that. Nobody has to fly Air India, but people don't have a choice over getting sick.
- PeterStuer 9y agoI'd argue that collectively the 'market' system is incredibly inefficient. Corruption needs policing/regulation just like in the 'private' sector. I'm not sure what you mean by 'laziness' in this context. Could you elaborate?
- ramblerman 9y agoYou are jumping from one extreme to the other. Creating a public institution with no pressure to make profit is a disaster waiting to happen. You can certainly keep a 'competitive' environment which is regulated with incentives. And I do agree healthcare needs this, and shouldn't live purely by the free market.
- mtgx 9y agoIn a private healthcare system, where the government doesn't directly pay for its own citizens' healthcare issues, the government also lacks an incentive to keep its population healthy - which can go from allowing food companies to put as much sugar as they want not just in sweets, but in meat, sauces, and so on, to allowing companies to pollute the air as much as they want. In a private healthcare system the insurers are also incentivized to pay for as few treatments as possible, hospitals are incentivized to make patients pay as much as possible for all the tests or unnecessary surgeries they make them have, and Big Pharma, as you said, is incentivized to make drugs that don't actually cure people and to price the drugs based on "value provided to the citizen". So if it's something like cancer, the value is a lot, even if the drug costs little to make.
- ransom1538 9y agoAlso* this 'ideal' drug has a difficult time being covered by healthcare. At all possible this drug should not cure the patient, be taken for a lifetime, not be healthcare covered [if possible], needed daily, easily marketable, be IP protected [for as long as possible] AND have the ability to survive even with generics on the market : viagra, propecia, etc.
- branchless 9y agoFrom a _capitalism_ point of view.
- whatisunseen 9y agoThis only works if there are no better treatments or cures. If a competing treatment works better, or might be a better cure, it must be kept out of the market. Sums up the massive web of red tape that we call healthcare.
- ekianjo 9y agoThis is wishful thinking because you never know ahead of time what is going to work and certainly not the pharmacodynamics of your drug. Plus your reasonning is false, even with current chronic conditions like RA many companies are exploring different dosages of bio treatments to drive remission instead of lifetime treatment.
- refurb 9y agoThat's the ideal in a world without any competition from other products. We don't live in that world so what you describe doesn't actually happen. We have more cures being developed now than ever before and it's very lucrative for the companies doing it.
- PeterStuer 9y agoWell, we certainly have exponentially more consumption of treatments for depression, allergies, obesity, pain, attention disorders, ... . That these are very lucrative for the companies supplying them (under a state-covered monopoly agreement) is also correct. Whether those constitute 'cures' is highly debatable.
- refurb 9y agoWe now have a cure for HCV, relapsing blood cancers, genetic forms of blindness, blood clotting disorders (in a year or two). I can give you more examples if you have trouble finding them. And yes, the companies are giving a monopoly on one drug which allows competitors to create others similar to it. And the patent only gives about a decade of monopoly, after which the price drops to ~10% of what it was.
- k_sze 9y ago"The 'ideal' drug from a business point of view not only not cures the patient long term, it offer a short term mitigation while increasing the risk on relapse and thus future recurring consumption of the treatment." One doesn't need to be Sherlock Holmes to figure out that that's just like the narcotics business.
- Bromskloss 9y agoWhat if a competitor shows up and can demonstrate that their treatment is better, for example that it does not lead to relapses?
- EamonnMR 9y agoThe barrier to entry is extremely high. There are regulatory hurdles, hurdles to being taken seriously, etc. You need authorization for human trials, you need to get published, you need to convince insurance companies to pay for your product.
- Bromskloss 9y agoThe same as for the first drug manufacturer, I suppose. And if you really have a superior product, you should be able to take all the customers, assuming that the customers are smart enough.
- celticninja 9y agoThis is only if you treat healthcare as an economic good, it should be considered a social benefit rather than a cash cow.
- cko 9y agoWell, not increase the risk of relapse, since clinical trials usually have relapse or time to some sort of negative event as an endpoint to look for. But to have patients need to take it in steadily increasing doses for life? Yes, that would describe most maintenance medications out there. And encourage patients to have the illusion that “oh, there’s a pill for that” as one of the factors. While I was a pharmacist at a long term care pharmacy, it was not unusual to see patients on more than 20 meds. Some of the meds are to be taken more than once daily. “Pill burden” is the term we use to describe this. What I’ve observed is there is a point of no return in any chronic condition where you can’t diet and exercise your way out of it and you’re relegated to higher and higher doses of diabetic or hypertensive meds. For life.
- andruby 9y ago> it offer a short term mitigation while increasing the risk on relapse and thus future recurring consumption Alcohol? Coffee? Sugar?
- vkou 9y agoSo, the ideal drug from a business point of view is heroin?
- ilyagr 9y agoOr oxycodone.
- darawk 9y agoThis sounds cute, but isn't really true. In a competitive market, there is still an incentive to find cures. If company A has a treatment with the properties you describe on the market, and company B comes out with a cure, guess who's going to get all the business?
- andrepd 9y agoNot if both company A and B (correctly) assess that they will reap more profits by investing in chronic treatment even when a one-shot cure is possible.
- darawk 9y agoNo, because that's an unstable equilibrium. If you are company B, you know you can steal 100% of the business by finding a cure.
- andrepd 9y agoYou can theorise all you want, but the world is rife with examples of what I said being true. As always, experiment must trump theory.
- andrewla 9y agoCertainly there are lots of cases of expensive long-term treatments being developed. Do you have examples of situations where cures have been suppressed in favor of expensive long-term treatments? Especially in a competitive environment, where there were multiple players offering competing long-term treatments that were both aware of cures? Preferably this would be something supported by leaked or court documents, but independent investigations would also be interesting. I understand this is a high burden of proof, but everything I've seen seems to indicate that this is an urban myth. I certainly couldn't find any specific cases in a cursory search.
- darawk 9y agoName literally one example of that being true. I'll wait.
- pfarnsworth 9y agoForbid pharmaceutical companies from going public, and give more government support to pharmaceutical companies in terms of liability from trials, etc. If the drug companies behaved more honorably, we could add more protections in case of genuine errors. But they are incentivized to maximize profit for their shareholders. Get rid of those incentives, and instead staff them with well-paid scientists or efficiently run private companies that are beholdened to the country.
- softawre 9y agoSuboxone fits this exactly.
- andrepd 9y ago>This realization goes beyond medicine, and is key to understanding why we live in an 'economy' that produces masses of landfill junk while our technology and manufacturing processes keep on improving. This is the crux of the problem. The current system optimizes for things that are not improving people's lives. It optimizes for waste, unsustainable consumption of resources, wasteful competition rather than cooperation, self-prepetuating inequalities at small and large scale, hyper-optimized psychological manipulation (i.e. advertising) for raw amount of useless shit being sold, etc. We didn't reach the pinnacle of perfection in systems of wealth distribution with 18th century capitalism. We can do better. We can do a lot better.
- pbreit 9y agoWon't a cure beat mitigation in the marketplace every time? It's like selling shorter-life batteries so peolpe have to replace more frequently. Is that better business?
- wintorez 9y agoEvil beyond evil
- entee 9y agoAll of these kinds of arguments at least with regards to medicine neglect to understand how drug discovery actually works. It's not like engineering where you can a-priori design your spec, then reliably build the product to meet that spec. At best in medicine you have a well understood disease mechanism (sometimes you don't even have that), where all the biological culprits are known and easily handled in an experimental context (that's rather rare at the outset of a medical project). Then you try to influence those players, but the process of finding those drugs looks a lot more like throwing darts at a board in the dark than it does like a coherent engineering task. When you aim for the bullseye cure you often fall short and end up with a maintenance med. If you don't initially shoot for something that's likely to massively affect the disease's course, you're likely to miss the board entirely. And all this assumes that the disease itself CAN be cured, which is not at all guaranteed. Biology is a wily beast, with insane, complicatedly interacting systems. In many ways, it's amazing we have as many cures as we do. In other words, when finding drugs you don't really have a choice between cure/chronic use/total failure.
- JoshuaRLi 9y agoWell said.
- jernfrost 9y agoI read about this recently with respect to GMs invention of planned obsolence for cars. They managed to give cars to all Americans which lasted a good time. To continue sales they had to reduce quality and do frequent style changes. I guess it was really just a reinvention of what the fashion industry had been doing for a long time. Get people to throw away perfectly good clothes and biluy new ones because it no longer matched fashion. We really ought to rethink this madness. Companies are already able to make really durable products but there is no economic incentive to do so. How can we change the incentives? I am not sure if that is possible in a regular free market economy, as one kind depend on sort of perpetual growth
- jspreen 9y agoConventional medecine has become a criminal institution that can only be stopped if patient cease listening to dumb doctors who prescribe things like chemo that obviously makes one sick. We should take more care of ourselves and study things like Ryke Geerd Hamer's New Medecine.