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Goldman Sachs questions whether curing patients is a sustainable business model

arstechnica.com

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

#161

Post by refurb »

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…

It would still require that the company that develops the cure could make more profit off it than it would make with chronic treatments.

No it doesn't. Why? Because there are multiple companies.

If company X is making $10B per year on a poor treatment, there is still an incentive for another company to create a cure, even if it only makes them $1B.

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

#162

Post by refurb »

ekianjo wrote: post #141
_lbaq wrote: post #2

Thats why "we the people" need to have large part in developing new drugs and the care of people, this is nothing that can be left to the "market" in some hope that it will "work out".

You dont seem to be aware that public universities are already heavily involved in drug development. Looking at the facts is helpful before building a narrative.

I would rephrase that to "basic science that could lead to drug discovery".

Public universities can do some initial poking around, but are utterly incapable of actually developing a drug. They've tried and failed many times.

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

#163

Post by Can_Not »

tscs37 wrote: post #96
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?

R&D doesn't happen in non-profit government corporations either (atleast not largely). Most R&D comes from the manufacturers where the state (or relevant institution) buys the drugs from. However, in a single payer or similar systems, if a drug company decides to hike the price, the state (or institution) can swallow the cost and continue medical services to citizens until the situation is resolved (either by legisla…

Another thing is that people want to measure success in profit or less taxes paid. A proper healthcare system should have it's success measured in how many citizens are able to be productive because they're not chained down with accommodatable disabilities, curable chronic illnesses, and extreme medical debts.

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

#164

Post by nailer »

aldoushuxley001 wrote: post #159
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.

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

Could you both be correct?

Yes, managing healthcare 'like a business' with an emphasis of profit over results produces bad outcomes for patients.

But managing healthcare 'unlike a business' with no emphasis on results also produces bad outcomes for patients.

Managing healthcare for the benefit of healthcare workers also produces bad outcomes for patients.

Healthcare should be managed in terms of producing results. Metrics would be a good discussion, eg "good quality of life hours added to life" "hours in acute pain reduced" or similar.

Point is, we need something to measure, the primary measurement shouldn't be profit.

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

#165

Post by jovial_cavalier »

solatic wrote: post #154

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…

Your solution is needlessly complicated and overreaching. How about you just make it illegal for doctors (as in the people who actually write the prescriptions) to interact in any way with pharmaceuticals companies? Outside, of course, of simply reading specifications on drugs and seeing what they do.

If the people who administer the care have their incentive disconnected from the amount of time the patient spends in treatment, that seems to solve the problem.

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

#166

Post by tootie »

buserror wrote: post #131

The health industry has no reason to cure patients. On the contrary, they have reasons to create new patients. And it's across the board. I tell myself exactly that when I look at my toothbrush. A toothbrush lasts about ~3 weeks before needing replacing. I'm sure someone in the industry will tell me that it's because it's made of unobtainium unicorn hair specially designed to make my teeth whiter and all that. I also…

They earn less money off of a cure than a palliative, but not everything the health care industry does is treating disease and the health care industry isn't one company. If one company owns the patent on a popular AIDS treatment, that would not at all stop a competitor from offering a cure if they had one. It's not company A's best interest, but it is in company B's.

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

#167

Post by rectang »

GiorgioG wrote: post #152
ramblerman wrote: post #78

Earlier quoted context omitted.

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.

The US military is spectacularly inefficient, and the US military-industrial complex is a parasitical behemoth per Eisenhower's critique. It's not like the problem is unknown; the issue is that the state has to have a monopoly on violence, so we live with the inefficiency. Encouraging a marketplace of competing militia would not a viable approach. :)

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

#168

Post by ianai »

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.

What about a system that provides individuals with “medical endowments”? Ie in the event you’re diagnosed with a disease the government will pay out $x to cure you or $(x/720) per month for a management treatment. People would still have the ability to chose providers.

But yes, I still think healthcare needs to be out of the market, ultimately.

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

#169

Post by tonyarkles »

ekianjo wrote: post #145
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.

Why is that ok if a private actor can do it better and cheaper? Most cases for public services are not really based on any good justification. On the contrary accepting that they lose money from the get go will drive soviet style inflation of resources and bankruptcy in the long run. Its been tried.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

Canadian here :). By that list, our per-capita healthcare costs are about half of what our neighbours to the south pay. I don't have it handy, but I've worked out the currency conversions and things before with various tax estimators, and in my province (Saskatchewan), we pay approximately the same overall income tax (Provincial + Federal) as someone making an equivalent salary in California (State + Federal). But included in that is all of our health care and some pharmaceutical coverage.

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

#170

Post by moccachino »

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…

To quote your quote of my response:

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> > 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.

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This is why I also said:

>So assuming that the flu vaccine is harmless and the cost is not too great, it can make sense to get it even if the effectiveness rate is low.

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