As 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.
> It also suggests that companies be innovative and constantly expanding their portfolio of treatments.<p>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.<p>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.<p>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.
Kind of a crappy article. The example of Sovaldi is a terrible one.<p>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.<p>Sovaldi made $12B <i>in its first year full year</i>. 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.<p>The hepatitis C cures are an <i>absolute blockbuster</i> by any stretch of the imagination.<p><a href="https://www.evaluate.com/vantage/articles/data-insights/hep-c-might-be-fading-it-still-broke-records" rel="nofollow">https://www.evaluate.com/vantage/articles/data-insights/hep-...</a>
I 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.<p>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.<p><a href="https://en.wikipedia.org/wiki/Orphan_Drug_Act_of_1983" rel="nofollow">https://en.wikipedia.org/wiki/Orphan_Drug_Act_of_1983</a>
If more people learned what "managing," really means, the idea of the business of managing disease instead of curing it would be more intuitive.<p>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.<p>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.<p>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.<p>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.<p>(edited to remove digression)
Healthcare 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.
Money should not be The Goal. It is a means to reduce friction in trade and we need to keep it in its place.<p>Historically, many cultures put medicine and spirituality under the same umbrella. A "medicine man" was both a spiritual leader and a healer.<p>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.<p>This needs to stop.<p>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.
When it comes to curing some chronical conditions, I am intrigued by the research of Prof. Roy Taylor of Newcastle University, England.<p>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.<p><a href="https://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation" rel="nofollow">https://www.ncl.ac.uk/magres/research/diabetes/reversal/#pub...</a><p>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.<p>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.
A 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.
The more serious question here is how do you make cures more attractive compared to chronic treatments.<p>Maybe we need to start paying for cures like we do chronic treatments?
This 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
Would shorten the patent expiration on chronic treatment help address the problems? Making chronic trainer competitive and cheap would discourage the tent seeking behavior.
Don't hate the player, hate the game.<p>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.<p>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.
The 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.
Anecdote - 20+ years ago my colleague told me how his wife worked in the pharma industry.<p>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.<p>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.