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Comment by gadf | Hacker News Reader

No money in that, unfortunately. Or, not enough anyway. This might be a false notion, but I'm scared that the economics simply don't work to "cure" a major disease. It's more profitable financially to provide treatment to sick people.

I hate this...yet am scared it's true.

Another notion I hate and are am afraid is true is that: even if corporations were prepared to cure cancer and take the hit, the state would be terrified of increased longevity, at least I think so.

Retirement age people are to the state, probably, what post-reproductive organisms are to evolution: dead weight that they can't "afford" to care about.

In these areas I think the incentives might be wrong, but we can probably too better somehow. No idea how that can be corrected tho... :'(

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You’re verging into conspiracy territory a little too much here. Truth is, there are good economic reasons to cure a disease or cancer: because the cure can be priced according to its (great) value.

Quick examples include:

* Hepatitis C - can now be cured in ~95% of cases. When the various drugs were released, they made many billions for the manufacturers, as the economic case for their use was clear.

* previously-untreated DLBCL (a type of lymphoma) - can be cured in ~2/3rds of patients, and many trials are ongoing (and have been run previously) to try to push this percentage higher. A treatment adding extra cures would be valued highly.

the power of that phrase conspiracy theory is amazing. As soon as I read it I started to doubt my conclusions and I was very open to what you were saying. I think because of its power such a phrase must be regarded with suspicion. I don't think it actually carries any weight in an argument, it's more of a psychological trick... like shaming, like "oh I don't want to be a conspiracy theorist because they are crazy people and if I'm a crazy person then I can't possibly be right so I better agree with what this person accusing me of being crazy is saying otherwise I'll be crazy..." and while I like your points I think the other analysis provided in other comments is also valid.

If you're using that conspiracy theory phrase I think either you're verging a little too much into below the belt territory there or maybe you doubt the point you're making so you are compensating for it with this dirty psychological trick. I'm not saying that's how it is for you that's just how it comes across for me.

If all drug companies were a cartel you'd be right, but If a single company could provide a cure they would wipe everyone out of that market and could charge enormous sums. For example BMS had recently a CAR-T therapy approved by the FDA for myeloma, wich is not a cure yet.

But the list price is $419 000.

https://www.fiercepharma.com/marketing/bristol-myers-bluebir...

Does national insurance pay for something like that in US? Unless this is paid in taxes, the price is exorbitent.

I don't know yet it was approved some days ago, but i guess yes.

Cancer meds are really expensive, a four month cycle in myeloma ( where most of the time 2/3/4 drugs are combined) can cost more than 250k. Revlimid, a maintainance drug often given for years can cost 20k a month (in India it's $150 a month).

The whole premise of the notion is that managing the disease is more profitable than curing it. So it is not the ones who develop a cure that wipe everyone else out of the market but rather the other way around.

Consider a disease has an effective daily pill treatment where each pill costs $.50 to make. Someone comes along with a single pill that costs $1000 to make but cures you. The cure developers have just spent a lot of money on R&D and need to make a profit on the administration of the cure, so they need to price it significantly over their production costs. The established treatment on the other hand has a war chest and can recoup short term losses in the long run, so they can afford to drop their prices or even give it away for free for a limited time. Perhaps some segment of the population will pay a hefty premium just for not having to deal with the hassle of treatment, but most people don't have thousands to spend on such a luxury and will stick with the option they can afford right now, even though it will wind up costing more over the course of their lifetime.

I don't know how it works in the US, but here in Germany i am pretty sure your health care provider has to pay for it.

They can't keep your arm in a cast because fixing it with an operation is top expansive.

This isn't a question of denying someone service, this is a question of what form the service takes. I am certain your health care provider won't pay 1 million dollars for a different cast design that reduces the time you wear it by 1%, nor should it. In the scenario I'm describing, both options are medically adequate, one is just more convenient but also substantially more expensive. Insurance pays for what you need, but it is quite common to deny claims which are not medically necessary.

In the case of this cancer,the maintainance drug is around $1000 a pill so you get to that million pretty quickly.

Okay, so the insurance company would pay $10 Trillion for one person to receive the cure for that cancer then? Obviously there is a limit.

The fact is that $1000 is not the cost of producing the pill, that is the amount they can charge for the pill while still getting people to pay for it. When there is no competition, and people would die without it, prices get very high very quickly. There is an extremely large barrier to entry for new medicines, and pharmaceutical companies are structured to recoup the massive development costs by charging large sums for inexpensive to produce goods that they have essentially a monopoly over. If it costs billions of dollars to develop a cure, that cure is going to have to be expensive, but a cure administered repeatedly can amortize those costs over many low-cost doses, while a one-time cure can't. Insurance companies are all about spreading costs over time - paying out large sums to large numbers of people all at once is a lot more problematic than smaller, predictable payouts over a longer period of time. It is in their best interest as well for you to manage the disease.

Thank you for this analysis I believe it's making my case more clear.

I think bringing healthcare insurance providers into an argument about whether there's a cartel of pharmaceutical companies artificially keeping up prices it's really not a good idea. It's possibly different in Europe but I think if you have any experience of the US system it's clear that there's some form of rorting and artificially inflated prices where the health insurance providers are in cahoots with all the providers and are somehow gouging the prices there. if you pay cash right now maybe cost you 300 if you put in your insurance the same thing maybe cost 3000 and then there's even a second order incentive effect where "health care professionals" want to give you these extra treatments if it's going through insurance.

I agree that's possible, like a form of payments in installments or debt. Which is very common among a portion of the demographic.

It would be good to see some actual economists weigh in on this.

I'm not an economist I kind of wish I was in this debate but I think the point you make is a hard one to refute.

I think it's a fallacy to say that pharmaceutical financial interests are not aligned with actually effectively curing diseases.

First, when they cure a disease we don't sudenly become immortal, it improves our life quality and expectancy and new diseases become more prevalent at a later stage, so they don't lose their jobs.

Second, even if slowing down research could effectively allow them to benefit longer from existing cures, generally you have competitors and inertia tends to not work well in adversarial conditions.

The argument is that it's more profitable to sell a pill you have to take every day for an extended period of time (or forever) than it is to sell a pill you only have to take once (or a small number of times). Recurring revenue is generally more desirable than a lump sum. There's still a strong incentive to make the disease manageable. It has nothing to do with saving money on research or keeping their jobs.

That's what the second argument answers to. If your competitor produce a one time treatment then he wins the entire market.

That doesn't logically follow. Why would a one time treatment win the market? Lasik is a one time treatment that certainly hasn't eliminated the market for daily contacts. The ability to buy a house hasn't eliminated the market for renting. The one time treatment has to pay for its development in a single dose, the recurring treatment can amortize its costs over many doses. In general, you will have to pay a premium for the convenience of a single dose, and many people can't justify that cost.

That's a really good point about lasik. Great example thank you. But at the same time I guess it cuts both ways because lasik exists. but what I'm specially worried about is that cures might be designed to not be perfect so that maybe you need to buy them again in 15 years or something just like a light bulb they can make perfect light bulbs but they design them to be obsolete so they can sell more. Why would not the same economics operate in the pharmaceutical industry I think it's a tragedy that it might when they should stick with their hippocratic principles.

The first points are really good one. But the second point lost me because I think you can see there's actually a lot of value to be tapped in technology say by keeping software kind of shit for a long time. You end up with lots of consultants and like there's a lot of inertia in the yenterprise software industry where there's also a lot of money.

I don't think that's just because of process. I think some of it is there's profit to me made by artificially holding back innovation because then you can stretch it out over the maximum amount of time through which you can extract value from it.

Just like suppressing advanced technologies. in the public example consider like apple they must have super advanced devices that they're working on and we're not going to see them for a while because why would they bring out that generation now when they can still make a good profit from their existing product lines long into the future.

The incentives for market-based research aren't wrong, but they do have a limit. Investors aren't going to spend ten billion dollars on research to find a cure they expect to make only one billion dollars profit from. They aren't running charities. Many other people are running charities, of course, especially for cancers. If you want to help fund them you can. Many people do. The govt also funds a ton of research.

As for the motivation to not pursue a profitable cure because you'd rather make more money from treatments, this isn't really the options you get to choose from. The real game they play is to choose either to find and sell the cure if one exists, or to sit back and watch the just-as-smart competition find and sell that cure instead of them. Their profitable treatment loses out either way.

Cancer affects many many people who are healthy otherwise and would have had many more productive years. It isn't just a disease of old age. Especially breast cancer. Either way, elderly folks are the most prolific voters, so there's the incentive situation for the govt.

I'd love to believe in this free market utopia where the end result is always in the best interest of the community. In reality it's well known that companies rely on cartels to protect their shared interests. We can't know if pharmaceuticals are actively holding back any cure but it would be naive to completely trust organizations which only need to answer to their shareholders.

I'd say pretty clearly if you hold back a cure for breast cancer because you can't get investors to put in 10 billion dollars when you're going to make one billion on it but long-term treatments for breast cancer at various stages they're going to make 100 billion on that 10 billion I'd say pretty clearly the incentives are wrong in that case. Because you're enabling research through investment which judges value purely on a monetary basis but it's ignoring the value of human life. So I'd say pretty clear that it's not just a case of the incentives having a limit, the incentives are wrong in that case.

> This might be a false notion, but I'm scared that the economics simply don't work to "cure" a major disease. It's more profitable financially to provide treatment to sick people.

Others have provided nice arguments as to why this isn't necessarily so, but allow me to add one more that is (I hope) more likely to appeal to a cynic.

This is one area where the corporate focus on short-term profits is actually working to the long-term benefit of humans. While it would be more profitable in the long run to sit on a cure and continue to sell therapeutics indefinitely, what CEO could resist the stock-boosting effect of a cure for a major disease? What a time to exercise your options! Long-term profitability is a problem for the next guy.

I agree, I always thought that the idea that "big pharma" would be actively suppressing miracle cure for long term profit is rather improbable.

There's the reason to point out (why pass the opportunity of a huge short term profit?) but also for these types of diseases there's bound to be a high ranking officer within the company who either directly suffers from the illness or has a close family member who does. I doubt that they'd let themselves or their wives die for the sake of getting a nice +3% to benefits ten years down the line.

now I think you're being too naive. In that case they purchase employees corporation with their evil scheme by providing them with the cure of course.

I like that idea that's really good that is a good counter argument thank you.

It is hard to believe that there isn't enough money in it. Breast cancer has a thriving industry of surgeries to remove the cancers plus reconstruction surgery plus a number of treatments associated with these surgeries. They easily run into the tens of thousands of euros a pop (if you go private in Europe, I suppose higher in the US).

I suppose you're right. But I don't necessarily think that's evidence against what I'm saying in fact I think it speaks to what I'm saying which is that curing is inherently not that profitable so there's an incentive to kind of spring up a variety and a proliferation of industries around that so that now you have you know all sorts of support services for you know remission stage or cured breast cancer survivors. I'm pretty sure that's interacting with the fact that a surgery that completely removes and cures the cancer is probably cheaper than a long-term treatment option.

Cancer does not so suitable a target for this, as say, h.i.v. infections.

Cancer is not contagious, and something that is treated in the individual case by curing it. The “cure for cancer” would thus simply be a more effective treatment than what is available now.

This is fundamentally different from h.i.v. infections, where a patient is a lifelong client, and a cure would amount to a type of treatment that would indeed completely cure the patient of the infection, and thus terminate the client.

I think what might be more likely is that if today's terminal illnesses are managed, we'll simply move the retirement age later and keep people working into their 70s.

I'm not sure that's exclusive with what I'm proposing but I definitely think that will happen and is happening even now. I'd be kind of okay with that world where the incentive to cure people is that we can extract more productive work years from them. It's kind of cynical but I think there's a lot of good probably to be had there as well and it's a step perhaps in the right direction anyway. Even if it's not that great on the face of it.

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