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

#291

Post by tgb » Fri, Apr 13, 2018, 5:13 PM UTC

tgb wrote: post #181

aaavl2821 wrote: post #171

Earlier quoted context omitted.

If the US were to make all drug R&D a public service they'd have to basically increase the current NIH budget from ~$30B to probably $150B It may be nice in theory to have government manage drug R&D, but it is not practical. It's simply too expensive

It's not politically practical, but why would you expect that paying for the stuff we already pay for is too expensive?

I'll assume that downvotes mean I wasn't clear: the US is currently spending that much ($150B apparently, I haven't checked) on R&D for drugs. It's just doing it through different means, presumably by paying higher insurance premiums and healthcare costs that end up going to drug companies to fund their R&D. If instead we payed that cost through taxes, then there's no theoretical reason why it would have to cost any more. So why would it be too expensive, given that we already pay that much via a different route? Of course, it's not politically expedient and won't happen anytime soon.

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

#292

Post by entee » Fri, Apr 13, 2018, 5:17 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…

All of these kinds of arguments at least with regards to medicine neglect to understand how drug discovery actually works. It's not like engineering where you can a-priori design your spec, then reliably build the product to meet that spec.

At best in medicine you have a well understood disease mechanism (sometimes you don't even have that), where all the biological culprits are known and easily handled in an experimental context (that's rather rare at the outset of a medical project). Then you try to influence those players, but the process of finding those drugs looks a lot more like throwing darts at a board in the dark than it does like a coherent engineering task.

When you aim for the bullseye cure you often fall short and end up with a maintenance med. If you don't initially shoot for something that's likely to massively affect the disease's course, you're likely to miss the board entirely.

And all this assumes that the disease itself CAN be cured, which is not at all guaranteed. Biology is a wily beast, with insane, complicatedly interacting systems. In many ways, it's amazing we have as many cures as we do.

In other words, when finding drugs you don't really have a choice between cure/chronic use/total failure.

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

#293

Post by rusk » Fri, Apr 13, 2018, 5:22 PM UTC

alistoriv wrote: post #229

psergeant wrote: post #85

Earlier quoted context omitted.

> Creating a public institution with no pressure to make profit is a disaster waiting to happen. This is the model many rich country healthcare runs on, and provides measurably better outcomes for less expenditure than the US.

In addition, the best healthcare system in the world, according the WHO, is in Cuba, where it certainly isn't run on a for-profit basis. Moving medicine away from the private sector allows for a stronger focus on preventative care, which is significantly less profitable. I think that worrying about removing the profit motive entirely misses that fact that not only is the profit motive not the only motive for doing th…

As much as I wanted this to be true it doesn’t really stand up to scrutiny. Yes “day to day” access to healthcare is far superior but it’s very week on the high end stuff. Even Castro in his final hours was treated in a Spanish hospital. Ideally we would want some kind of reasonable alternative that exists between these two extremes ...

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

#294

Post by rusk » Fri, Apr 13, 2018, 5:24 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…

Which is all well and good if you have the money. Poorer countries have to “make do” with profit driven public services where the exchequer simply doesn’t have the money.

In fact I think this is the sad truth behind a lot of privatisation stories in the West... various government running out of cash but rather than admit poverty put on the rich mouth and claim its “better”

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

#295

Post by tonyarkles » Fri, Apr 13, 2018, 5:28 PM UTC

refurb wrote: post #248

tonyarkles wrote: post #169

Earlier quoted context omitted.

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 mak…

Did you include the HST? And gasoline taxes? And the ability to deduct mortgage interest and up to $18K in your 401k? My own person experience was that taxes were much lower in the US than Canada.

No, no, and no, just straight up income tax before deductions. The mortgage interest deduction would be great, no doubt, for people with mortgages.

I also didn't include the monthly health insurance premiums, nor did I include the mandatory 3-week vacation pay, nor the 35-week maternity/paternity leave, etc etc. Nor tuition costs. I'd really love to see the numbers all across the board as a general "cost of living comparison" for sure.

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

#296

Post by ravenstine » Fri, Apr 13, 2018, 5:31 PM UTC

This might be going a bit off topic, so I apologize if this isn't allowed here, but I recently wrote an article about a chemical used in dental health that was bought by GSK and pulled off the shelves in the United States. I was just reminded by the topic of this post.

Because it's an effective product in treating tooth sensitivity(by occluding exposed dentin tubules), but it is also effective in preventing tooth decay when used with fluoride, I can't help but speculate what the motivation was for pulling it off the shelves.

https://medium.com/@ravenstine/the-curious-history-of-novami...

The conspiracy theorist in me wonders if they calculated the potential financial impact in the U.S. of people getting fewer dental caries and realized they'd be making less money overall from related treatments.

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

#297

Post by dominotw » Fri, Apr 13, 2018, 5:32 PM UTC

bluGill wrote: post #273

dominotw wrote: post #70

Earlier quoted context omitted.

> 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…

That is for 2011. The effectiveness of the vaccine is different every year. Some years it gets close to 80% (from memory and probably wrong), some years it is only 10%. The average across all years tends to be 40%.

Do you have references to numbers your are quoting? I searched for 60-80% number quoted by GP but found nothing even close.

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

#298

Post by dominotw » Fri, Apr 13, 2018, 5:34 PM UTC

bonzini wrote: post #76

dominotw wrote: post #70

Earlier quoted context omitted.

> 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…

That's a 0.4/8.9 reduction, about 5%. However, flu vaccine isn't useful to the general population. In many countries is usually administered to people that are most likely to develop complications such as pulmonitis.

> However, flu vaccine isn't useful to the general population.

CDC makes no such distinctions in USA.

https://www.cdc.gov/vaccines/hcp/vis/vis-statements/flu.html

Any references to your claims?

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

#299

Post by danans » Fri, Apr 13, 2018, 5:36 PM UTC

dynofuz wrote: post #140

The industry is being defined too narrow. The full industry includes insurers. Insurers have every reason to cure patients. Cured patients live longer. The longer you live the more years you pay premiums. The more premiums the higher your profits. So insurance is incenivized to put the money in the hands of those who cure rather than those who require insurance to fork up a fixed amount on an ongoing basis.

> The longer you live the more years you pay premiums. The more premiums the higher your profits.

The longer you live, the more that the cost of your medical care exceeds the premiums that you pay, because the body naturally starts to fail, most acutely and expensively, toward the end of life. This is a big reason why the ACA individual mandate existed, because there is little incentive to pay for care for those who are expensive to care for if healthier people aren't part of the system.

It also demonstrates to why for-profit incentives don't work very well for health insurance at a national scale.

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

#300

Post by jfasi » Fri, Apr 13, 2018, 5:38 PM UTC

How do we interpret this heartless-sounding statement? In the absence of original source material, whatever interpretation you apply will inevitably be a projection of your pre-existing views on the matter. If you want to knee-jerk your way to the standard "Goldman Sachs is Evil" view, help yourself to the rest of the top-level comments in this thread. If you're still reading, I think I have a worthwhile point to offer:

Let's not forget, Goldman Sachs and its biotech brethren are businesses. All business involves long-term strategic planning, often behind closed doors, to answer the question of "what application of our existing money will make us the most money in the future?" When viewed through this lens, Goldman's statement can be polished up to "of all the biotech investment options we're weighing, investment in outright cures for infectious diseases is less profitable in the long-term because curing people has a nonlinear effect on the patient population." It's a simple statement of fact.

OP's summary, and I strongly encourage you to actually read it if you haven't, goes on to say that Goldman's research suggests long-term research and product investment would be best applied to medical conditions like cancer and aging, for which a cure for an individual doesn't result in a diminishing market.

This isn't nearly as evil-sounding as the article aims to make it sound. At worst, it highlights something we already know: market-based solutions tend to be flawed, and if we want investment in treatments for infectious diseases we need to turn to forces that are exempt from market forces (i.e. government research funding). At best, it's an indication that we can expect more investment to go into things like cancer and age-related diseases.