8 ms·
“Is curing patients a sustainable business model?” asks Goldman Sachs (2018)
- pmoriarty 5y agoWe need to take the business out of medicine.
- carapace 5y agoThis. Medicine and the profit motive do not mix.
- candiodari 5y agoYou do realize this doesn't work, right? Pharma "profit margins are very high", okay, but that means 10% (yes like everywhere there's that one company that does 30% for a while, averages however). So 100% nationalizing them would change the cost of a $300,000 per year treatment to ... $270,000 per year. Nobody is waiting for that. Frankly even a 30% reduction, the top of the line, would not really matter to people. The only thing separating medicine and the profit motive will do is stop the development of new drugs. There's no way in hell the government will invest even 10% of what the private sector invests in new drugs. That would be a 10000%+ budget increase for universities. It's not happening. So drug and treatment development will slow to a crawl. So is it better to die because no-one cares to look at you at all than to die because someone doesn't want to pay for your cure? Apparently it is, according to responses here, but I truly don't understand why. And if that's what you want to do, let people die, then why not just legislate that you can't buy coverage for diseases with <N cases per year? That would avoid all the inefficiency.
- slowmovintarget 5y agoThat's not what the data showed. Doctor-run hospitals, before ACA disallowed new ones and restricted existing ones from expanding, had overall better patient outcomes than state run hospitals. MRI scans, which could sometimes mean the difference between life-saving diagnoses, or a missed diagnosis, were cheaper and easier to come by in the U.S. because clinics could run a scanner at a profit and specialize in MRI scans. Locking them away under government rationing destroys the cycle of signal and response a market can bring. We've seen this in other countries where it is exceedingly difficult to get one when you need one. That doesn't mean there aren't sensible cases for government-funded research. But looking at the current health system with massive government interventions already in place and saying the problem is not enough government intervention seems like a mistaken conclusion.
- pjerem 5y ago> We've seen this in other countries where it is exceedingly difficult to get one when you need one. Well, I don’t know which country you refer to but it’s not the case in France and lots of European countries where healthcare is totally free. Yes you have to wait months for a scheduled PET scan or an MRI but you also can have access to one as soon as you enter the hospital as long as the medical team think it may save your life. It’s just ressource planning. I know it because it saved my life twice and for 0.00€. edit : Just to be clear, I’m not writing this as « US bashing » but to help you consider that free and effective healthcare is totally possible and that working models already exists around the world. Free healthcare IS a solved problem.
- refurb 5y agoAs someone who lives in a country with “free” healthcare, no it’s not a solved problem in the least. There is a constant struggle over budget control and selecting what healthcare is worth funding and what isnt.
- thewileyone 5y agoI live in a country with public and private healthcare. One thing that people don't realize is that the public healthcare system has better equipment because they have a much larger budget than private hospitals. So for MRI or PET scans, it's better to go through the public healthcare system. Now you don't get 5 star service that the private healthcare has like luxury rooms and better food, but that's not the core focus when your life is on the line.
- minikites 5y agoThe cost of healthcare should be borne by society without a profit motive for the exact same reason we do it that way for firefighting services. Many nations other than the USA pay less overall and also receive better care and have better health outcomes, there is no good reason to preserve the current US system.
- exporectomy 5y agoThe US (and Canada) invents more drugs than the rest of the world combined. Maybe Americans are paying the price for all those other countries to get those better outcomes cheaper and without their sacrifice, everybody would lose.
- mistrial9 5y agothe pharma drugs investment sees returns for pharma drugs investors.. USA has the highest prescription medication prices in the entire world, not even close. Who can buy them?
- 988747 5y agoAnd not only drugs, much of the progress in other types of treatments (e.g. surgery) also comes from US.
- curiousgal 5y agoHow many of those drugs are actually used by people outside the U.S. though? I am genuinely curious.
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- jeffwass 5y agoAnecdote - 20+ years ago my colleague told me how his wife worked in the pharma industry. She was studying a potential product to 'cure' some disease or other. Apparently her initial tests on the company's product worked amazingly well, removing all trace of the disease with just a few doses. She was excited to report this success to her boss, who replied "That's Horrible!". The company wasn't interested in a cure that requires only a few doses, but something that requires a longer-term rent-seeking subscription plan.
- lotsofpulp 5y agoThis seems implausible. It’s extremely difficult to find cures in the first place, and in the event a company does, the US is willing to pay a ton for them (see recent Hep C medications). I would need more proof before being able to believe an executive team would throw away a sellable cure for an extremely low probability of finding a longer term rent seeking subscription plan.
- whatshisface 5y agoNot all diseases are bad enough to justify enormous pricetags for a cure.
- lotsofpulp 5y agoI am not aware of any diseases where the US government would not pay for a cure if there is a known cure for it because the price to “how bad is the disease” ratio is too high.
- lupire 5y agoWhat do you mean? The US government doesn't buy cures.
- hyperdimension 5y agoIt's called an orphan drug--when it's too expensive to make a profit on it, the FDA (IIRC) steps in and subsidizes it.
- dwheeler 5y ago> It also suggests that companies be innovative and constantly expanding their portfolio of treatments. This is the right approach, both for a company and for society. In fact, it's so obvious, that it's weird anyone thought they needed a report to say it. Even if you only look at the business side (instead of the human side), only developing chronic treatments instead of cures only makes sense if there's no cure on the horizon. Once there is a cure, the people who sell endless treatments will lose money (they'll make basically nothing & they'll have a lot of sunk cost they can't recoup), while those who sell the cure will make practically all the money. Besides, the people who run companies also have bodies (who knew?)), as well as family & friends with bodies. Eventually they'll want those cures too.
- minikites 5y ago>while those who sell the cure will make practically all the money Why would they release a cure when they could make more money releasing their own chronic treatment instead?
- daniellarusso 5y agoI feel this is a valid question, particularly considering patents.
- gruez 5y agopatents only last 20 years and AFAIK by the time it gets to market it's closer to only 10-15 years.
- andix 5y agoBecause someone else will release the cure at some point.
- captn3m0 5y agoSomeone else might make the cure and they corner the market?
- AnIdiotOnTheNet 5y ago
- tibbydudeza 5y agoIf the pharma industry can invent something like Ketracel-white for some dread disease like cancer or heart problems they would do it.
- moshmosh 5y agoBackground: in the Star Trek series Deep Space 9, some of the bad guys are an expansionist empire led by shapeshifters who've bred a race of perfectly loyal super-soldiers whose loyalty is ensured, in part, by an inborn need for a substance called Ketracel-white, which substance is very difficult to synthesize, so they're dependent on their overlords for a consistent supply, else they get sick and die. It's basically the lysine deficiency from Jurassic Park, but for humanoids. There's also an episode of Star Trek: The Next Generation in which one alien planet has hooked a second alien planet's entire population on addictive drugs, having convinced the addicts that withdrawal symptoms are a terrible, incurable disease that the drugs are treating.
- fatjokes 5y agoLove the obscure reference.
- friedegg 5y agoAs a type 1 diabetic, I feel this. It sure seems like there's a lot more money to be made from me selling insulin, testing supplies, pumps, etc, that I'll need to use for life (29 years and counting) than in finding a cure, which perhaps they can sell me once, or maybe yearly. I know there are people working hard to find a cure, but I also know that they struggle with getting funding.
- read_if_gay_ 5y agoSame situation, same feeling. I also don’t have high hopes for disruption from some startup, people seem to underestimate how much harder startups in biotech are compared to tech.
- golemarms 5y agoisn't biotech a kind of "tech"?
- qsort 5y agoAs they say, technically correct is the best kind of correct but also the most useless. Parent's point is well received: it's much harder to be a startup when you need to fund laboratories, complex supply pipelines, diverse and deep know-how, interaction with government agencies etc. It's not like you have AWS for medical doctors.
- golemarms 5y agoAgree with your points. However, parent commenter could have specified they were referring to software tech, not technology in general.
- swiley 5y agoFrom the little I've read manufacturing insulin and testing supplies doesn't seem terribly complex. I'm not too sure why there's so much profit to be made other than regulatory capture.
- tedunangst 5y agoWhat's the difference in cost of a covid test vs covid vaccine?
- ortusdux 5y agoI think it is past time to reform the Orphan Drug Act. It is open to exploitation by bad actors (Martin Shkreli, etc.), and the problem seems to only be getting worse. While we are at it, we should expand the act to try and help address the problem that treatments are less profitable than cures. We also need to start putting in sunset provisions in laws of this nature. Governmental intervention in the economy should have mandated expiration/review dates. https://en.wikipedia.org/wiki/Orphan_Drug_Act_of_1983 https://en.wikipedia.org/wiki/Orphan_Drug_Act_of_1983
- motohagiography 5y agoIf more people learned what "managing," really means, the idea of the business of managing disease instead of curing it would be more intuitive. It seems simple, but only if you know it. Managing means you have at least two factors that form a 'dynamic,' so that there is a differential between them that you can extract variable levels of value out of. Managing a team means you have different people whose work is like cylinders of an engine firing at different times to create continuous motion. Some people have a knack for maintaining the equillibrium that produces power. Managing a product is a dynamic of market demand and feature cadence that produces sales. From this perspective, a disease is a dynamic, however dubiously ethical it may to treat it as one, whether as a business making money or a government effecting policy. However, curing patients is only a business model insomuch as you can produce cures dynamically to create a cure-machine to rent out. From a business perspective, curing diseases is zero-sum and destroys long term value. If you cured covid, the ~$100bn+ of value you created would be a one-off, and it would remove a powerful dynamic from both government and industry, and just be another relatively small capital management problem instead of a long term growth disease mangement problem, like say, periodic booster shots. Solving problems collapses uncertainty and in-effect, destroys opportunity for people who use the dynamic to manage the world. Viewed this way, disease management is not a conspiracy, it's just a lot of people with a certain skill set who respond to the same incentives. It's truly a banal sort of evil. (edited to remove digression)
- refurb 5y agoKind of a crappy article. The example of Sovaldi is a terrible one. Prior to Sovaldi, the best selling drugs were Lipitor, then Humira which made ~$10B per year at peak worldwide (peak being a decade or more post launch). Think about the time value of money when your R&D investment hit peak revenue 10-15 years later. Sovaldi made $12B in its first year full year. What did Gilead make across all its hepatitis C drugs that year? $19B. That blew all records out of the water. And 6 years later it’s pulling in $4B. Note this is in an industry where exceeding $1B at peak is a success. The hepatitis C cures are an absolute blockbuster by any stretch of the imagination. https://www.evaluate.com/vantage/articles/data-insights/hep-c-might-be-fading-it-still-broke-records https://www.evaluate.com/vantage/articles/data-insights/hep-...
- ww520 5y agoWould shorten the patent expiration on chronic treatment help address the problems? Making chronic trainer competitive and cheap would discourage the tent seeking behavior.
- LatteLazy 5y agoThe more serious question here is how do you make cures more attractive compared to chronic treatments. Maybe we need to start paying for cures like we do chronic treatments?
- pasquinelli 5y agomaybe the profit motive is a perverse incentive for taking care of people.
- LatteLazy 5y agoMaybe. But I don't think there are any alternatives right now. And it doesn't seem like a bad for people helping others to be rewarded...
- sudosysgen 5y agoThere definitely are. State run pharma agencies that compete against the private companies and stringent IP restrictions on treatments VS cures can help. Ultimately you're never going to be able to coax the market into valuing 40+ years of rent over a cure.
- LatteLazy 5y agoThe issue with state run pharma is we're not doing it. We cut the budget so morons could pay a tiny amount less a year in income tax. As long as we're reliant on the market, we're reliant on the market sadly...
- twobitshifter 5y agoThis is the problem of planned obsolescence but in a medical context where it’s especially harmful. Why produce a lightbulb that lasts 2000 gotta when you can sell twice as many that lasts 1000 hours
- inglor_cz 5y agoWhen it comes to curing some chronical conditions, I am intrigued by the research of Prof. Roy Taylor of Newcastle University, England. Taylor et al. have been studying effects of short-term fasting on diabetes 2nd type and they claim that they can cure or at least significantly improve the condition by fasting, especially if the fasting therapy is introduced soon enough after the initial diagnosis of T2D. Even NHS England is paying attention to their work. https://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation https://www.ncl.ac.uk/magres/research/diabetes/reversal/#pub... This is about as cheap cure as it gets. Eating nothing for some periods of time does not cost any money and there are no patents/royalties attached. The only trouble is that it might be less comfortable than taking pills. If Taylor is right, we could get rid of a significant part of our disease burden. Fast food producers would fall on harder times, though.
- giardini 5y agoThis was indeed good news. But most obese diabetic people find it nearly impossible to follow such a diet. I have such a diabetic friend who is trying, but even with the Covid quarantine and his daughter policing his diet he has yo-yo'ed in weight, losing 35 lbs only to regain 15, partially due to his cravings for snacks & candy bars that he smuggles into the house or eats while out.
- snicker7 5y agoA possible 'solution' is for governments to offer lucrative bounties on cures, e.g. $50b to cure Thyroid cancer. And then have the cure's IP freely available.
- karmakaze 5y agoDon't hate the player, hate the game. More and more as our capabilities increase we have more options than ever before in deciding what to do and how to do it. In the past, any treatment for any prevalent condition was a no-brainer benefit to society. Now we're heading into territory where our government+economics+capitalism is a solution to an X-Y problem. There will come a tipping point where capitalism is less efficient than alternatives. Healthcare is perhaps the largest, most visible, and pressing one of these. Once we recognize the pattern, more will become apparent.
- DoreenMichele 5y agoMoney should not be The Goal. It is a means to reduce friction in trade and we need to keep it in its place. Historically, many cultures put medicine and spirituality under the same umbrella. A "medicine man" was both a spiritual leader and a healer. You need someone to actually care about you to get you well. When their relationship to your disease is rooted in profit motive, the end result is torturing you so you die slowly. This needs to stop. I don't know how we fix our medical system, but such things exist to serve humanity. Humanity should not be a prisoner or slave to such garbage.
- emrah 5y agoHealthcare is not "business". Well it shouldn't be anyway. Same goes for other essentials that one cannot do without such as food, water, air, etc. But the current system is insufficient (or unwilling to) to model this reality.