Goldman Sachs questions whether curing patients is a sustainable business model • Hacker News Board

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

#151

Post by PeterStuer » Fri, Apr 13, 2018, 12:33 PM UTC

dominotw wrote: post #70

kdelok wrote: post #67

Earlier quoted context omitted.

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…

As far as I remember flu vaccines work by looking at the origins of the yearly epidemic (in the east, typically china etc.), predicting which strains will become the dominant ones and then starting to cultivate neutered forms of those (in eggs) on a mass scale to have the vaccines ready by the time the epidemic hits 'the west'. Some years the predictions of the strain are wrong and the vaccines less useful as most people will get another strain.

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

#152

Post by GiorgioG » Fri, Apr 13, 2018, 12:33 PM UTC

ramblerman wrote: post #78

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.

You 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.

> Creating a public institution with no pressure to make profit is a disaster waiting to happen.

We seem to have no problem with throwing $700 billion per year on the military and nobody is pressuring them to make a profit. Is that a disaster? No? "But that's different!" It's only "different" because that's what we've been led to believe.

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

#153

Post by mariodiana » Fri, Apr 13, 2018, 12:34 PM UTC

I encourage people to read (or re-read) this Ars Technica article, especially the second to last paragraph (the one that begins: "To get around the sustainability issue overall[…]") and put your prejudices aside when you do so. There is nothing "broken" about the pharmaceutical industry being described here.

The Goldman guy's opinion is that the industry should focus on treating the conditions that affect the greatest number of people, double down on innovation, and turn their focus towards improving the lives of the elderly—which we're all counting on being, once the promise of gene therapy cures the maladies younger and middle aged people suffer from.

Oh, the horror!

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

#154

Post by solatic » Fri, Apr 13, 2018, 12:36 PM UTC

The difference between a one-shot cure and a chronic treatment is that the former is sold to customers and the latter turns customers into exploitable assets. If I own a cow, and I milk the cow for all the cow is worth so that I can sell the cow's milk in the market, is the cow my "customer"? Because I give the cow feed and a barn in exchange, whatever it needs so that it can keep giving me milk?

A free market works when players have information symmetry and can make free decisions of sound mind. We otherwise resort to regulation, for example to rein in natural monopolies. Regarding chronic treatments, there's nothing the government can do (within this narrow focus) to reduce demand - but the government can set the rules. Specifically, the government can regulate that pharmaceutical companies must balance their research spending between chronic treatments and one-shot cures, rather than going all-in on chronic treatments. The government can set a lifetime cap on revenue from an individual patient for a given drug, such a cap being formulated on the basis of the cost of development and the number of expected patients (i.e. market size - larger markets will have more patients and a lower cap per patient needed to recoup the cost of development), with production guarantees (since the per-unit cost of doses is trivial) for after the lifetime cap is reached. Indeed, such a production guarantee could be met with a publicly-owned-and-funded company tasked with producing generic versions of drugs for patients who have hit their lifetime cap - essentially, a generic drug company prohibited from selling to customers who haven't proven that they have paid more than the lifetime cap, which produces generic versions of drugs still protected under patent, which is now re-defined not as the exclusive right to manufacture but the exclusive right to manufacture and sell without restriction.

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

#155

Post by refurb » Fri, Apr 13, 2018, 12:37 PM UTC

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…

That'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.

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

#156

Post by PeterStuer » Fri, Apr 13, 2018, 12:37 PM UTC

TeMPOraL wrote: post #93

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.

I think it's totally ok, and it should be accepted. Public services are meant to be cost centers. If they bring in profits, they do so indirectly (e.g. better health of citizens -> better GDP -> more money in taxes). The trick is to still find ways to apply pressure so that a service gets better and more efficient in time, instead of attracting parasites that'll use it as money drain. Like a lot of healthcare-related…

"parasites that'll use it as money drain" sounds remarkably like shareholders.

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

#157

Post by k_sze » Fri, Apr 13, 2018, 12:38 PM UTC

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, 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.

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

#158

Post by refurb » Fri, Apr 13, 2018, 12:44 PM UTC

arnoooooo wrote: post #103

spydum wrote: post #87

Earlier quoted context omitted.

I may be ignorant on this, but don't many of those countries benefit by the r&d funding happening in the US?

Most R&D, in the US as elsewhere, make massive use of public funds.

No, that's not true. Private R&D is almost 10x what public R&D is, at least in biotech.

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

#159

Post by aldoushuxley001 » Fri, Apr 13, 2018, 12:44 PM UTC

brann0 wrote: post #54

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…

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.

No, that's an extraordinary leap to make. Private medicine still manages to provide diagnostic services in a much better way than governments.

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

#160

Post by sametmax » Fri, Apr 13, 2018, 12:48 PM UTC

slater wrote: post #150

sametmax wrote: post #139

Earlier quoted context omitted.

This is where traditional Chinese medicine got it right : they have a culture of trying to keep people healthy. You are supposed to go to the doctor to not become sick. It's maintenance. Not that I think it's better, but economically, you suddenly have the same goal as your clients. And that more sane.

Too bad the medicine part of TCM is junk science

Well it's essentially eat right, drink water, get some rest, etc. Not the mumbo jumbo you see in Hollywood movie.

I can't think of any scientific experiment that would conclude: burn out, eat junk and drink mostly beer.