Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Goldman Sachs questions whether curing patients is a sustainable business model

arstechnica.com

Post reply on HN
Print view View original

61–70 of 376 posts

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#61

Post by shardis »

fiiv wrote: post #23

I think perhaps this article's headline is a bit click-baity and it riles up people. Understandable. I also felt this way. But then I read further. The report cited in the article suggests that companies should focus on treatments for things like common cancers, which has a renewable pool of patients. It also suggests diversifying the portfolio of cures. It does not say companies should not bother with curing Hep C l…

It does not say "companies should not bother with curing Hep C like illnesses since there's no money in it."

Critical reading skills and leaving out strawmen/non-existent arguments like "there's no money in it" are required.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#62

Post by igravious »

cornholio wrote: post #42

Sure it is. Gilead made 100 billion dollars curring Hep-C with seed research investments that were probably much less than 1 billion. So as long as this strong differential and potential for profit exists, drug companies feel competitive pressure to produce better treatments, irrespective of the fact that "milking" the pathology would yield them trillions collectively. It's effectively a "tragedy of the commons" of s…

Is it just me or does anyone else think that "tragedy of the commons" is overused as an explanation?

While I'm at it. Also overused (not as an explanation) but just as an expression is, "onboarding".

Also, "Dunning-Kruger effect"

Sorry for veering off-topic but I was triggered.

I imagine a HN Bingo app game where each player is randomly assigned HN-y phrases and expressions from a fixed database at the start of the day. As the day progresses the app monitors comments of posts on the front page for matches. First to get a line is the winner!

Incidentally I agree with the commenter @cornholio, curing the unwell is incentive enough as there is plenty of profit to made and to live means to suffer from ill health at some point in one's life. As you were…

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#63

Post by pjc50 »

dominotw wrote: post #57
brann0 wrote: post #54

Earlier quoted context omitted.

So 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.

How can we tell if the loss if from inefficiencies, corruption and laziness? Case in point: Air India.

You need different metrics for that. Nobody has to fly Air India, but people don't have a choice over getting sick.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#64

Post by kobrad »

cousin_it wrote: post #56
gpvos wrote: post #39

The story goes that in China, doctors used to be paid for keeping you healthy. When you got sick, they didn't get any money anymore. This sounds to me like a system with the proper incentives.

Healthy people are less willing to pay :-(

This is a very narrow view. The usa is not the world

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#65

Post by PeterStuer »

dominotw wrote: post #57
brann0 wrote: post #54

Earlier quoted context omitted.

So 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.

How can we tell if the loss if from inefficiencies, corruption and laziness? Case in point: Air India.

I'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?

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#66

Post by pjc50 »

buvanshak wrote: post #34
PeterStuer wrote: post #24

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…

> 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...

Vaccines are one of medicine's great discoveries that free humanity. The only reason people aren't terrified of disease and think they can get away with lying about vaccination is that we've driven it into the corners.

Unpreventable diseases are quite capable of creating their own fear, like the AIDS epidemic.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#67

Post by kdelok »

dominotw wrote: post #59
masklinn wrote: post #43

Earlier quoted context omitted.

> 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 p…

> administration is a single or limited event point. What about flu vaccines? Even govt runs ads urging people to get their flu shots, even though they have been shown to be useless.

Flu vaccines aren't useless, but they also aren't 100% effective. The CDC reckoned they reduce the risk by about 40-60%.

Flu is a variable pathogen, which means that it evolves to look different from an immune perspective over time. It follows clustered patterns, where the flu strain will look pretty similar (and vaccines will be more effective), then it "jumps" to a new cluster every few years or so (and the vaccines will likely be less effective). There's a whole bunch of work goes into predicting what flu strains make most sense to use for the vaccine in a given flu season.

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#68

Post by azernik »

xg15 wrote: post #48
cornholio wrote: post #42

Sure it is. Gilead made 100 billion dollars curring Hep-C with seed research investments that were probably much less than 1 billion. So as long as this strong differential and potential for profit exists, drug companies feel competitive pressure to produce better treatments, irrespective of the fact that "milking" the pathology would yield them trillions collectively. It's effectively a "tragedy of the commons" of s…

It would still require that the company that develops the cure could make more profit off it than it would make with chronic treatments. So if you went purely for profit, you could only develop a cure if: - you could price it higher than the price of the chronic therapy over the full lifetime of a patient. or - you could sell it to more patients than you could have sold the chronic treatment. A lot more, because ever…

The third case is:

- you control only a fraction of the ongoing-treatment market, and the windfall you could get as a monopolist in the short-lived cure market is worth losing out on that steady cash flow

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#69

Post by [deleted] »

mft_ wrote: post #52
xg15 wrote: post #48

Earlier quoted context omitted.

It would still require that the company that develops the cure could make more profit off it than it would make with chronic treatments. So if you went purely for profit, you could only develop a cure if: - you could price it higher than the price of the chronic therapy over the full lifetime of a patient. or - you could sell it to more patients than you could have sold the chronic treatment. A lot more, because ever…

Drug development is really hard - the odds are stacked against you. Any successful drug with half a business case will be launched - no company can afford to be picky about cure vs. chronic treatment - there just aren't that many successful drug discoveries to enable it.

[deleted]

Re: Goldman Sachs questions whether curing patients is a sustainable business model

#70

Post by dominotw »

kdelok wrote: post #67
dominotw wrote: post #59

Earlier quoted context omitted.

> administration is a single or limited event point. What about flu vaccines? Even govt runs ads urging people to get their flu shots, even though they have been shown to be useless.

Flu vaccines aren't useless, but they also aren't 100% effective. The CDC reckoned they reduce the risk by about 40-60%. Flu is a variable pathogen, which means that it evolves to look different from an immune perspective over time. It follows clustered patterns, where the flu strain will look pretty similar (and vaccines will be more effective), then it "jumps" to a new cluster every few years or so (and the vaccine…

> CDC reckoned they reduce the risk by about 40-60%.

curious, Do you have a link to this by any chance?

According to this

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693492/

After looking at "328 households with 1441 members, including 839 children," for an entire year (2011) these authors determined that there was a difference of 4/10ths of one percentage point between those who received flu vaccine and those who didn't.

The infection risk was 8.5% in the vaccinated and 8.9% in the unvaccinated.

According to this CDC study https://academic.oup.com/cid/article/64/5/544/2758477

"We observed decreasing vaccine effectiveness with increasing time. Maximum vaccine effectiveness was observed shortly after vaccination, followed by a decline..... Vaccine effectiveness remained greater than zero for at least six months for influenza A(H1N1) and influenza B and at least five months for influenza A(H3N2) viruses."

They say "greater than zero" , far cry from 40- 60% :D

Cannot post more replies atm, but for people saying 5% is still something.

> Going from 8.9% to 8.5% is a 5% reduction in flu cases. If this translates to 5% fewer sick days during the flu-period and a 5% reduction in doctor visits that are due to flu symptoms (some people go to the doctor for everything), that can absolutely be a reason for the government to want people to get their flu shots.

This line of reasoning assumes that there are only positive effects from vaccines. There are many many side effects of flu vaccines.

Just to quote one,

http://journals.plos.org/plosone/article?id=10.1371/journal....

"Hospitalizations were slightly more common among subjects who were vaccinated than among the others"

"hospitalizations for pneumonia and influenza, that were 47% more likely among subjects who received the tetravalent vaccine as compared with those who were not vaccinated."

Post reply on HN