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Comment by dwheeler | Hacker News Reader

> It also suggests that companies be innovative and constantly expanding their portfolio of treatments.

This is the right approach, both for a company and for society. In fact, it's so obvious, that it's weird anyone thought they needed a report to say it.

Even if you only look at the business side (instead of the human side), only developing chronic treatments instead of cures only makes sense if there's no cure on the horizon. Once there is a cure, the people who sell endless treatments will lose money (they'll make basically nothing & they'll have a lot of sunk cost they can't recoup), while those who sell the cure will make practically all the money.

Besides, the people who run companies also have bodies (who knew?)), as well as family & friends with bodies. Eventually they'll want those cures too.

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Alternately:

The right approach for a company is to give up making medicine. Why would you spend billions of dollars on scientists to research a cure and fighting the bureaucracy for its approval, only to have the people and the government turn around and scream at you that they cost too much, and demand you should give them away for free? Heck, just look Biden giving away the coronavirus vaccines — not buying the vaccines (or licenses to the vaccines) and giving them away, which would be eminently defensible and a fine expenditure on foreign policy outreach — just saying it'd be fine if no one enforced the IP rights on these things, giving away someone else's work.

So forget it. If the dollars work out so that the smart investor should spend his money on something else, it will happen. Will this result in fewer cures? Yes, but society has decided punishing people for making money is a more important priority than actually finding these cures, and our democracy operates on the premise that we've made our bed, so we can damn well sleep in it.

(There will of course continue to be a few cures coming out of publicly funded research and academia, but if they need to fight for grants with every other project out there, there's no way they'll have enough money to have the same output.)

>while those who sell the cure will make practically all the money

Why would they release a cure when they could make more money releasing their own chronic treatment instead?

I feel this is a valid question, particularly considering patents.

patents only last 20 years and AFAIK by the time it gets to market it's closer to only 10-15 years.

Because someone else will release the cure at some point.

Someone else might make the cure and they corner the market?

I suspect the answer will be something like "maybe they won't, but their competitors are incentivised to", which naturally ignores the long history of price fixing and collusion.

unlike OPEC, they do not control a commodity.

People will travel to rogue jurisdictions that choose to make money by defecting, some may even invalidate patents like India.

That completely misses the point. The problem is that companies won't do the research to find cures -- because cures don't make money.

You can't go to India for a cure that doesn't exist.

i don't buy there will be no research. no trials/commercialization maybe.

Once there is enough research, you can have grey-ish market commercialization.

cancer immunotherapy works, and at times (maybe even often) is curative. Same with stem cells. Zolgensma, a one time cure that costs 2 million dollars, also exists.

Public goods funding as a thing also exists.

I'm not so pessimistic about it. There is still a profit incentive.

>That completely misses the point. The problem is that companies won't do the research to find cures -- because cures don't make money.

This is only true if a company is confident that all other companies are also not working on a cure. That may be feasible when dealing with a local service or commodity (as you only have to come to a wink wink agreement with other companies in the local area) or when only a few companies control a large amount of a limited resource (like OPEC). That does not work well when dealing with an idea or technology.

Any company anywhere in the world could decide to research a cure. A Nation State-run research group could do it and just give the patent away. It is virtually impossible to get all of them to not research it, and if any of them anywhere find a cure, your treatment profits fall off a cliff. So it makes fiscal sense to sell the treatment, use your market position to get the best data on the condition, and research a cure so you can be first to market and control the distribution of the cure and ensure that the profits go back to you.

Releasing a cure for a condition with treatments in the market already is a much easier sell than releasing yet another treatment that you now have to market to everybody on the current thing. If the first couple players are in a treatment-only business, newcomers are incentivized differently than those initial players were.

The more complicated answer is that if it's something poorly-understood where you came make different-but-similar treatments that will work better for some patients than others, and the current patient base isn't fully covered, there's still lots of incentives for treatment. Look at something like chronic inflammatory/immune stuff, and all the biologics out there.

But then the answer to "why didn't someone just develop a cure" isn't just economics and greed, but also nobody knows how.

In the surgical space, we actually do push expensive procedures over chronic therapy fairly often for things like joint or back issues. Of course, in that case, the economics are obvious - the surgeon and facility make their money that way. So if you can similarly convince the governments and insurance companies that your expensive cure is gonna save money compared to a lifetime of treatment (for surgery, this is being increasingly questioned, even), you can charge a lot for it.

> Why would they release a cure when they could make more money releasing their own chronic treatment instead?

Because the probability of finding a cure, chronic or not, is extremely small.

A non profit-motivated actor might well want to do this just for the societal good it would bring. I think this though underlines a key flaw in the idea that everything ought to be market driven. In some cases you end up driving yourself in contortions working out how to incentivise the market to behave in a certain way. Sometimes it better just to fund the damn thing directly.

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