General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsGoldman Sachs issues report: Curing diseases is a bad business-model.
https://www.dailykos.com/stories/2018/4/13/1756856/-It-finally-happened-Goldman-Sachs-asks-Is-curing-patients-a-sustainable-business-model"The potential to deliver 'one shot cures' is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies," analyst Salveen Richter wrote in the note to clients Tuesday. "While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow."
...
Richter cited Gilead Sciences' treatments for hepatitis C, which achieved cure rates of more than 90 percent. The company's U.S. sales for these hepatitis C treatments peaked at $12.5 billion in 2015, but have been falling ever since. Goldman estimates the U.S. sales for these treatments will be less than $4 billion this year, according to a table in the report.
"GILD is a case in point, where the success of its hepatitis C franchise has gradually exhausted the available pool of treatable patients," the analyst wrote. "In the case of infectious diseases such as hepatitis C, curing existing patients also decreases the number of carriers able to transmit the virus to new patients, thus the incident pool also declines Where an incident pool remains stable (eg, in cancer) the potential for a cure poses less risk to the sustainability of a franchise."
oberliner
(58,724 posts)The better business model is to produce a drug that a person has to use and keep purchasing for the rest of their life.
In terms of cancer, if there was a cure available, it would destroy a huge segment of the health-related economy that is related to cancer treatment and care.
Wounded Bear
(58,773 posts)I have Type 2, and it is fairly managable right now, but I will be taking pills the rest of my life, and will probably have to resort to shots one day. I certainly don't mean to belittle those less lucky than I am that have Type 1, or a more serious form of Type 2, but the economic fact is that companies make tons of money selling drugs to "manage" such conditions and a real cure would stem that money stream.
peggysue2
(10,849 posts)it's enormously expensive. He takes pills and shoots up several times a day. Without insurance, we'd be choosing between food and meds. My father-in-law battled stage 4 colon cancer, a huge outlay of costs. When he would go for his chemo, the ward was chock full of patients receiving similar, astronomically expensive treatments.
The bottom line vs the health and lives of patients in this case is grotesque. The idea that it's better for people to suffer than pinch off the money flow speaks to the worst type of capitalism, a truly parasitic relationship sucking the lifeblood of society. But then, this business model has been affecting pharmaceuticals for years where R&D departments have been replaced with MBA's and bean counters.
We all remember the frenzy over 'death panels' in the Obamacare fight. What Goldman has revealed is the death-panel mindset in the financial industries: sick people are just not a good investment if or when they're cured; prolonging the death cycle is good for the bottom line.
I'm surprised this report was released to the public. That being said, these are the sort of conversations/revelations we'll need to prompt change for the future.
Throck
(2,520 posts)ck4829
(35,096 posts)FarCenter
(19,429 posts)mmbrevo
(123 posts)Such as Chronic dry eye, restless leg syndrome, depression, ADD. Not that these are necessarily invented, but it's easy to make people think they might have them.
Wounded Bear
(58,773 posts)"Ask your doctor" is probably one of the most annoying things people can do.
Aristus
(66,522 posts)In actuality, it is so rare in adults as to be statistically negligible. But I have more patients claiming a diagnosis of ADHD than can be explained statistically. So they were either misdiagnosed by another medical provider, or else they diagnosed themselves, and report it to me as a prior clinical assessment.
It's a little dismaying to have to conclude that for some patients, diagnosis of a particular condition, however rare or improbable, is a key to their identity. I have patients who can't wait to tell me they have fibromyalgia or ADHD, or what have you. And it isn't always in an effort to secure a desired medication. There are patients who have a frantic need to believe that they have a certain disease, even if their medical profile, associated past medical history, or physical exam don't support it.
janterry
(4,429 posts)Perhaps medicine should always be a non-profit endeavor because a for profit company can't make a profit on curing disease.
I think we'd need to read more about their opinion to understand if they want us NOT to cure cancer (for example).
Volaris
(10,278 posts)If you get tax money for medical research, anything you find, discover, cure, etc should belong to the Government for its first patent cycle (so it can be mass - produced for low cost storage and distrubition). I'd even be willing to pay an up - front fee for research hours/time on project, but yeah if we paid for that it belongs to ALL OF US, and we should give it away and Goldman Sucks can go get bent.
Blue_Adept
(6,402 posts)Things that companies have to look at as a business model shifts. Though in corporate side they may try to stem things in in bad ways, like the fossil fuel industry in not shifting to renewables faster to be a part of that project, this is a change that will happen with gene therapy and the one-shot cure angle. As a company, they have to look at and map out those risks as do analysts that look at how it'll impact the health of the company for shareholders.
I can understand seeing nefarious themes in it but at the same time it's often just corporate due diligence.
n/t
Bernardo de La Paz
(49,069 posts)Blue_Adept
(6,402 posts)And I've been around the block a few times, never used "I Totally Agree"
Hortensis
(58,785 posts)expensive research haven't been pursued by business because the product couldn't pay for it, much less turn a profit?
For that we have the National Institutes of Health, which funds its own internal research through the IRP and research labs at places like universities.
TexasBushwhacker
(20,249 posts)and other government research because they think everything can AND MUST be done by for profit businesses. This is just one example of the fault of that kind of thinking. Capitalism works great for some things, but not medicine, public education, etc.
In countries with socialized medicine, they look for ways to improve care and efficiency while minimizing cost. Yes, you might have to wait weeks for a non-emergency MRI in Canada. So what? IT'S NOT AN EMERGENCY!
Hortensis
(58,785 posts)by nature to run modern western democracies of, by and for the people. They can do dictatorships that oppress many to serve a few, but even those tend to fail after a few decades at most. That's after watching them for decades fail to care and/or be able to understand that what allowed people to struggle along enough to produce new generations for 20,000 years before won't keep 300,000,000 people alive.
Liberals get it and moderate conservatives can face it, but I haven't met one strong conservative yet who wondered how THIS for world population below should affect their attitude toward government. 20,000 years of people living basically as we always had, then the industrial revolution with population taking off like a rocket.
Or THIS for growth of life expectancy (which is virtually identical to the first):
Or THIS for productivity, or why we need so many closets and cupboards and big garages now instead of just what we can carry as we follow food around through the seasons.
They agree these are mostly good things for us all but don't get that, without the systems that have been developed in the last second or so of mankind's life to manage new realities, there would be crashes and most of us would die. How many of any of us have watched Puerto Rico and wondered what (IF) we'd be eating or drinking next week if a crash took down the critical support systems of our nation. Such as by pandemic.
Silver Gaia
(4,552 posts)Lochloosa
(16,083 posts)We are always looking 10-20 years down the road to understand what technologies are being replaced.
BTW, there's some cool stuff coming.
First Speaker
(4,858 posts)oasis
(49,480 posts)bronxiteforever
(9,287 posts)A society should assist those who work for cures. As the great Doctor Salk said, public health is a "moral commitment. This value is at odds with the Paul Ryan/Mitch McConnell/Freedom Caucus view of public health.
dflprincess
(28,094 posts)The first being, it PREVENTED, disease - no money in that!
And, Dr. Salk refused to patent it because he wanted as much vaccine made as quickly and cheaply as possible.
shanny
(6,709 posts)DFW
(54,502 posts)A couple of years ago, I had done something to my back, and I was suffering from such excrutiating lower back pain that I had sought out a chiropractor for the first time. I was going to him twice a week, and it wasn't helping much. A couple of months after this started, I was in London where a colleague from Brazil was present. He saw it took me about two minutes to sit down and get up, and he asked me what was wrong. I told him. He took out a film with a few pink pills and said, "here, take one of these before you go to bed tonight." I was desperate, so I did. I was ready to try anything at that point.
So, I took the pill before I carefully and painfully got into my hotel bed.
I woke up the next morning and out of habit slowly started getting up. I noticed it was easy. I also noticed EVERYTHING was easy. My back pain was not only diminished, it was GONE. Like *poof* vanished completely. I thought, oh shit, the pill must have contained some forbidden Amazonian herb and I'm gonna get addicted to them. But I was pain-free overnight, so I didn't care. When I saw my Brazilian colleague at breakfast, I asked how long until his pain killer wore off. He said I was asking the wrong question, as the pill wasn't a pain killer at all, but a muscle relaxer. Not only was I pain-free for the rest of the day, but I was pain-free, PERIOD. After one pill. He gave me the rest of the package (there were three more in there) just in case, but said I might not need them.
I had an appointment with the chiropractor the next week, which I almost canceled but I figured I'd go see what he said. When I got there, he asked how I was doing, and I said, great, pain-free. He said, yeah right. I insisted I was serious. He told me to lay down and started feeling up and down my back. He then asked, noting that all tension was, as I said, completely gone, how in the world did you do THAT? I said I took a Brazilian pill. He asked how many. I said one, and that was four days ago. He said he had never heard of anything like that before, and asked me to send him the ingredients on the package. They were in Portuguese, of course, but he said it didn't seem like anything overly exotic.
Now, I know there are dozens of pills sold in pharmacies all over Europe and the USA that are supposed to help with back pain, but they really don't do much, at least not for me. Here, on the other hand, is a pill sold all over Brazil that cures muscular back pain with one dose and no side effects. We have given them out to some of our friends in Germany, and they all said the same thing. They cost the equivalent of $1 each. No wonder the pharmaceutical industry in the USA and Europe doesn't want anyone in their markets having knowledge about this pill (much less access!). After all, if they are going to sell you medicine for back pain, they want to sell you a hundred pills for $250, not one pill for $1.
Duppers
(28,132 posts)Yet another great example of just how f'd up this country's attitude toward health care is.
We lived in England in the late 80s to the mid 90s, long enough to greatly appreciate "socialized medicine" and to counter every dumbassed rightwing we've encountered in a discussion of the subject. My then 2yo son became very ill and had to be hospitalized in Addenbrooke there in Cambridge. I was awestruck by the compassion, knowledge, and attention of the physicians and entire staff. The only thing coming close in this country that we've experienced was when my hub's cancer was treated at the renowned Johns Hopkins, but with a price tag, of course.
DFW
(54,502 posts)His pancreatic cancer was too far advanced.
But he remained vigilant to the end. A few months before he died, he noticed there was a suggested bill to reduce the amount of outpatient cancer treatment covered by Medicare from 95% to 85% (this was summer 2000). From personal experience, he knew what this would mean. He was able to arrange a conference call, weak as he was, between himself, Senator Moynihan's office and the Clinton White House, laying out for them that if outpatient coverage were reduced, patients would check themselves into hospitals for the higher degree of coverage for in-patient treatment--at far greater cost to the government. Both Moynihan and the White House did a simultaneous "oh my God, you're right," and the measure was abandoned.
Duppers
(28,132 posts)Yet another one of your amazing stories.
Am very sorry about your father. My sincere condolences. My uncle and a good friend also died of pancreatic cancer, one of the most fatal and difficult to cure cancers of the body.
On edit: I confess to a bias re: JHU. My son has a couple of degrees from there.
DFW
(54,502 posts)His colleagues have asked me in the past why I didn't follow him into journalism. After all, with his contacts, I would have had a head start most journalists could only dream of. The trouble was, he was SO good and SO well-respected, there was no way I would fill his shoes. Actually I DID end up writing some of the songs used at Gridiron Club events after he died, but officially that never happened, as songs used at Gridiron shows are supposed to be ones penned exclusively by Gridiron Club members.
But he was one of the most respected (if not THE most respected) correspondents from a one-horse town ever stationed in Washington--a one-man bureau. When he hit 75, his idea of retirement was going into Washington (we lived in Virginia) four days a week instead of five. When he was told of his diagnosis, he turned to my mom and commented "so much for clean living."
I'll give you an idea of the caliber of man he was. This is his last column, a farewell to his readers after 50 years at his tiny paper in upstate New York, to whom he remained loyal despite numerous offers to join more prestigious outlets. He was gone less than ten days after it appeared:
Published: November 19, 2000
Page: 9
November 19, 2000
Copyright (c) 2000
BAD NEWS CAN'T NEGATE A WONDERFUL LIFE< FROM WASHINGTON
By (DFW's father)
This is a column I was hoping not to have to write, especially this soon. Readers of this space know that I have been under treatment for pancreatic cancer for about nine months.
The treatment, mostly medication, plus chemotherapy infusions at an oncologist's office, was part of a study program approved by the Food and Drug Administration and involved chemo applications whenever the blood counts were adequate to sustain it.
It was designed for three treatments, one in each of successive weeks, followed by a week of "rest," during which the cells would have a chance to recover.
For me the treatment went in fits and starts. Only once did I complete a three-week cycle. Every six weeks a laboratory radiological office took X-rays to measure what was happening to the cancer, although pancreatic cancer is extremely difficult to read on X-rays.
About 10 days ago I got the bad news from the oncologist. The chemo treatment, which had been interrupted three times for infections and, most recently was accompanied by a substantial swelling of body fluid, had done about all it could to stem the tumor growth and stabilize it.
One other alternative he had held out was to switch to a different chemo protocol, but he determined that, not only was that treatment less effective than the one just halted, but might well have made me sicker.
He said I had put up an amazing fight and he would never have expected me to last as long as I had.
I was fully aware that the odds on stabilizing the cancer - it could never be cured - were tiny, but I had hoped I might have been in the small minority of those who survived. Ironically, my predecessor in writing politics for (his newspaper), died of pancreatic cancer.
In the course of recent treatment my feet had become so swollen they could hardly fit into shoes or slippers, particularly when I was wearing socks; my legs began to look like a linebacker's, as opposed to my normally skinny appearance, and my belly had grown to a point that made me look as if I were pregnant. It was not unlike the famed Demi Moore magazine cover.
Medication I had taken to get rid of some of the fluid was not working.
And that left: Nothing.
In other words, treatment, except for medication to ease various problems - luckily I have been virtually pain-free during the whole procedure - provided no solution, and all that we could do was prepare for the end.
The obvious question was the length of time I had remaining, and the oncologist volunteered, "It could be weeks, it could be months."
If I had my druthers, naturally, I would choose months, but that is not up to me.
We have already had three visits from specialists from The Hospice of Northern Virginia: an overall supervisor, a nurse and a community affairs expert. This organization is a marvel.
It pays the full cost of prescription drugs - when our company insurance policy was subordinated to Medicare B, the drug coverage my wife and I had enjoyed at 70 percent of cost was eliminated - as well as the rental of a wheelchair. The drugs are delivered to the house.
Signing up for drug coverage for my wife under the AARP schedule would have been too expensive - the highest premium and only a small percentage of drug costs covered.
The Hospice people are on call 24 hours a day, have a small place where patients can stay if their spouses or significant others are exhausted from caring for their loved ones and offer expert medical advice. The swelling in my lower legs and feet, surprisingly, has already gone down with the experimental use of a diuretic drug, generic name aldactone, three times a day, rather than one or two.
The symptom to watch out for is dizziness, and, so far, happily, I have had none.
The inevitability of the situation, however, means (his wife) has had to consult with accounting and legal firms to make sure all the necessary papers are up to date. I have to think about getting rid of mountains of clothes - dressing well was a weakness I never overcame - and piles of books and newspaper clippings and letters from VIPs. If that all sounds suspiciously like the angst Frank Augustine described in his throwing out a lifetime of correspondence, it should.
The family has already put in a bid for photographs, from college, from Army service in World War II, from journalistic trips around the world and superb color photographs of us with Presidents Reagan, Bush and Clinton and Sen.-elect Hillary Rodham Clinton.
There are all the drafts of lyrics I wrote for 25 years of Gridiron Club shows, notes from the president, members of Congress and diplomats, virtually every one of which is destined for the round file.
With my continuing columns I remain the "dean" of the New York news media in Washington, as well as the correspondent with the longest stretch of news reporting of any newspaperman in the capital.
That must now come to an end, though not immediately, and, of course, I shall fight to push the envelope as far as I can, with the wonderful support I have received from relatives, friends, colleagues and neighbors. They have held us in their prayers, and we are tremendously grateful.
Hearst columnist Marianne Means and her husband, columnist James Jackson Kilpatrick, gave us an orchid plant about three weeks ago, and, in a small miracle, it is still putting out creamy white buds and flowers long after it should have succumbed.
It could be a sign, but we are realistic enough not to bet the farm on it.
There is a line in the song "A Nightingale Sang in Berkley Square" that insists, "The age of miracles hasn't passed."
Only time sets the parameters. Until the body gives out (for the spirit never will), then I will have to call it a life.
The hour for feeling sorry for myself has passed. I envy those, like the 90-year-old woman profiled by John Golden in the Times recently; like my erstwhile partners on the tennis court and fellow performers at Gridiron rehearsals.
The incoming Gridiron president, Andrew Glass of the Cox Newspapers, wants me to serve as the club treasurer until my physical capabilities tell me, "Enough." Then a successor can be named.
I could complain that fate had dealt me a less-than-optimum hand, but that would serve no purpose and would ignore the many problems of those less fortunate than I.
I'm still here, and I want to write until the keyboard fails to respond to my fingers and my voice can no longer draw information from those to whom I speak on the telephone.
I don't know how near the end is, nor will I spend time worrying about it. It has been a wonderful life, personally and professionally, and the recognition of that from so many whom I love and respect leaves no room for regrets.
So, agree with what I write or not, don't stop reading. Each day has to bring a new miracle with it.
-----------------------------------------------------------------------------------
THAT is where I come from. An impossible act to follow, but one HELL of a role model, wouldn't you say?
Duppers
(28,132 posts)What a legacy you have to follow!!
Ever thought of doing a screen play?
I always look forward to your posts, btw.
Sorry to be short now but I must ready for a long trip - am leaving in an hour.
DFW
(54,502 posts)And my TFT songs and videos, of course....
DFW
(54,502 posts)I'm constantly on the road, myself, so I appreciate the situation. I'm actually taking the weekend off here in Washington, but Tuesday, the real world starts up again.
Nay
(12,051 posts)like herbs, etc?
What was it called in Portuguese? (I have a Brazilian SIL and will send her on a mission when she goes back home.)
DFW
(54,502 posts)But doctors that saw the ingredients said there was nothing unknown or controversial in there. Maybe it was the proportional make-up that had some miracle ideal effect? The medication is called Tandrilax. It costs about $30 for a box of 30 pills.
Nay
(12,051 posts)BadgerKid
(4,561 posts)Makes you wonder if someone's funding the anti-vaccination movement.
ehrnst
(32,640 posts)Prilosec, which was the long term treatment ($60 a month) to block stomach acid went over the counter as a heartburn medication.
Bob Loblaw
(1,900 posts)And ended up selling it for this very reason. It wasn't making me any money. I loved what the company was doing but couldn't afford to leave my investment in it for a 2.5% yearly dividend. I told my financial advisor their ability to actually cure something was undermining their viability.
Duppers
(28,132 posts)The nature of too many humans.
ck4829
(35,096 posts)Money certainly isn't natural, it only exists as a shared agreement, it's just paper otherwise.
Stocks? They're an abstract concept.
There has to be some way to fight this, we are told that sociopathy of those in power is "normal", it's time to wake up.
Lucky Luciano
(11,267 posts)If the price of the stock is too low, the company can be taken private in the cheap to get the cash flow if (abstract) money. So stocks are only abstract in the sense that money itself is.
Bob Loblaw
(1,900 posts)You don't have enough knowledge to make such a determination.
ck4829
(35,096 posts)Our healthcare system, government ties to it, and many institutions involved with it are always looking for ways to exclude people (Like the poor, GLBTQ, uninsured, people with pre-existing conditions, and 'wrong' people from the profession itself), to blame the victim for their illness or injury, to delegate morality, to attack public healthcare while the people making these attacks receive it themselves, to separate the poor off from everyone else, to actually create differences in race, class, and gender, to coerce people to do work and accept inferior conditions, and more than, you know, actually treating people.
http://tpalladium.freeforums.net/thread/19/intro-evidence
Xipe Totec
(43,892 posts)In fact, there are many cases where a good product can destroy it's own market.
That is why there is a certain class of problems that require government intervention for the good of the public. This is one of them. From the point of view of the people, the return on investment would be enormous; a little bit of tax expenditure to develop a cure for a disease, a little more to deliver the cure, and the problem goes away forever.
CDC should be in the business of developing permanent cures for diseases. In fact, it should be renamed CDE; The Center for Disease Eradication.
BadgerKid
(4,561 posts)Where there is a public interest and where companies wouldn't otherwise go because of cost.
Martin Eden
(12,885 posts)My first thought when reading the OP was this proves that health care must not be left in the hands of for-profit corporations.
mountain grammy
(26,666 posts)Turbineguy
(37,412 posts)war!
Just make money of that!
floWteiuQ
(82 posts)It came out. This involves market manipulation. Obviously, they don't give a rat's butt about patients. However, It's more insidious in that they are promoting biotechnologies they are probably betting against. Besides, the pricing scheme for what is in effect a cure has not been hashed out.
BootinUp
(47,211 posts)On that stupid report?
HopeAgain
(4,407 posts)Snackshack
(2,541 posts)Healthcare should be non-profit. We need a healthcare program like many other developed nations have. Englands NHS is a very good example.