
Goldman Sachs questions whether curing patients is a sustainable business model - DoreenMichele
https://arstechnica.com/tech-policy/2018/04/curing-disease-not-a-sustainable-business-model-goldman-sachs-analysts-say/
======
PeterStuer
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.

This realization goes beyond medicine, and is key to understanding why we live
in an 'economy' that produces masses of landfill junk while our technology and
manufacturing processes keep on improving.

~~~
brann0
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.

~~~
ramblerman
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.

~~~
psergeant
> 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.

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

~~~
TomK32
It's all multinational these days. Only 4/10 of the big players are in the US
[https://www.tharawat-magazine.com/facts/10-largest-
pharmaceu...](https://www.tharawat-magazine.com/facts/10-largest-
pharmaceutical-drug-companies-world/#gs.BI67Uy0) and that's quite logic if you
remember that the European market is pretty much harmonized and twice as
populated as the US.

~~~
ekianjo
The EU market is far from being harmonized medecines regulation wise. it
always takes longer to get approval across all EU countries vs one approval in
the US. Pricing of drugs is not harmonized at the EU level either and thats a
hard block for any launch.

------
cornholio
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 sorts: a single
company trying to capture more of the market ruins profits for everybody else
by finding a cure; behold, the magic of the free market.

They can only escape it by entering non-compete agreements and collectively
agreeing not to inovate, a substantial claim that requires substantial
evidence.

~~~
xg15
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 every patient will only buy the cure once.

So even then the incentives would probably lead do driving the price of drugs
up significantly. You'd also still have no incentive to actually eradicate a
disease.

~~~
mft_
Drug development is really hard - the odds are stacked against you.

 _Any_ successful drug with half a business case will be launched - no company
can afford to be picky about cure vs. chronic treatment - there just aren't
that many successful drug discoveries to enable it.

------
buserror
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 have a another plastic brush to clean my shotguns of all things (I do a
lot of clay pigeon shooting) -- the construction is _identical_ to a
toothbrush, just perhaps a tad bigger. Doesn't have the fancy colored handle.

Now the brush I'm currently using I've been using for _3 years_ and the brush
is still pretty much pristine, after being used to generously scrub bits of
sharp, grim metal once or twice a week.

Hmmm... How does that work? Better unicorns? Well, think about it, _everyone_
is changing toothbrush on a monthly basis, that is a _huge_ revenue. Even
reducing the lifetime of a toothbrush by 5% would increase the number of
brushes sold by a _huge_ amount.

All the while, it creates fantastic amount of plastic waste. Fancy packaging
and 100% plastic, possibly not even all recyclable.

~~~
dghf
> I also have a another plastic brush to clean my shotguns of all things (I do
> a lot of clay pigeon shooting) -- the construction is identical to a
> toothbrush, just perhaps a tad bigger.

Is it, though? Are the bristles made of the same material, for example? I'm
guessing that bristles tough enough to scrub metal would not be the best
things to use on your teeth and gums.

~~~
stronglikedan
Unless you like the taste of copper.

------
phkahler
When you're a business person or a researcher you want to find the big thing
that's going to fund your retirement. When you're an engineer you make a
career out of building thing after thing. I think this is similar to the
difference between US companies and Chinese companies. In the US they want to
develop a product and ride that wave for as long as possible, while in China
they produce one item and quickly move on to producing the next one in a never
ending cycle. This is also why US companies care so much about IP, they want
to do something once and retire. One could even frame it as a form of
entitlement ;-)

Having said that, I do want people who solve major problems to be reasonably
compensated. I'm not sure what that looks like.

------
jfasi
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.

~~~
danharaj
The Goldman Sachs analysts didn't ask an unreasonable question. What are
absolutely dismal are the conditions that make it a reasonable question. And
what makes them dismal people is that they are totally cool being part of the
system that makes such questions reasonable.

> In the absence of original source material, whatever interpretation you
> apply will inevitably be a projection of your pre-existing views on the
> matter.

Literally all interpretation one does about anything is a "projection" of
their pre-existing views on the matter.

~~~
Balgair
> What are absolutely dismal are the conditions that make it a reasonable
> question

I'm a pretty free-market kinda guy, but all systems have flaws. Biotech and
capitalism seem to have a fair few chasms between them, and this GS report
illustrates one of them quite well. Capitalism is not a 'complete' theory,
holes exist in it, as they do in all things. If anything, as the GP states, GS
is pointing this one out. Suggestions for what to do about this 'hole in
theory' are needed though; likely it's government funding (in a 'lighthouses'
manner).

------
ravenstine
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...](https://medium.com/@ravenstine/the-curious-history-of-novamin-
toothpaste-620c6bef8881)

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.

~~~
ZeroCool2u
If you're interested in this check out Jeffrey Hillman's work at Oragenics[1].
Wired wrote about his work in 2002, which is how I found it[2]. SMarT is the
amazing futuristic put dentists out of business almost tech[3], but there's a
current 'ProBiotic' consumer version called ProBiora[4] sold as well, however
that's a continuous delivery version. Far more profitable it would seem.
Unfortunately, they discontinued FDA trials of SMarT for now.

1\.
[https://www.oragenics.com/about/history](https://www.oragenics.com/about/history)
2\. [https://www.wired.com/2002/06/better-teeth-through-
biochemis...](https://www.wired.com/2002/06/better-teeth-through-
biochemistry/) 3\. [https://www.oragenics.com/technology-
pipeline/lbp/smart](https://www.oragenics.com/technology-pipeline/lbp/smart)
4\. [https://probiorahealth.com](https://probiorahealth.com)

------
walkingolof
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".

~~~
emiliobumachar
Good idea, but it takes a lot of cash.

~~~
wiz21c
Once it is in the public hands, it allows for democratic prioritization of the
cash (do we need more solar energy or more cures ?).

~~~
Kalounji
I like to think we need both

------
gpvos
The story goes that in China, doctors used to be paid for keeping you healthy.
When you got sick, they didn't get any money anymore. This sounds to me like a
system with the proper incentives.

~~~
cousin_it
Healthy people are less willing to pay :-(

~~~
kobrad
This is a very narrow view. The usa is not the world

------
cs702
...And there you have it, in seven crisp words: a succinct explanation of why
and how "health-care" becomes "health-exploitation" when it is primarily or
exclusively a profit-seeking endeavor.

In theory, competitors would step in with cheaper, faster cures, preventing
the exploitation of patients.

In reality, many if not most patients find themselves at the mercy of medical
offices and hospitals which are themselves seeking to maximize profit and
therefore have strong financial incentives to prefer expensive, ongoing
treatments over cheap, fast cures.

------
WhompingWindows
I think there's a potential policy play in this. There is already a class of
drugs, known as orphan drugs, which are targeted to rarer diseases that
currently have no gold standard treatment. Companies are incentivized by the
US FDA to make drugs for these conditions. Maybe the FDA could also make a
policy space for "cure incentives" which would provide additional economic
benefits to companies willing to make drugs or protocols which attempt to cure
disease.

~~~
fricat1ve
I found this comment unintentionally hilarious.

------
quincunx
In this sense gene therapy is "disruptive innovation" in the Clayton M
Christensen sense of the word: the incumbents cannot pursue the strategy as
doing so eats into their profits. Does it take smaller, independent, outfits
to pursue this?

~~~
emiliobumachar
I agree that, if one-shots get to be profitable at all, incumbents cannot
smother them for being less profitable than continuous treatment. Somebody
else will do it.

The problem is if searching for one-shots gets to be unprofitable altogether.

------
fiiv
I think perhaps this article's headline is a bit click-baity and it riles up
people. Understandable. I also felt this way.

But then I read further. The report cited in the article suggests that
companies should focus on treatments for things like common cancers, which has
a renewable pool of patients. It also suggests diversifying the portfolio of
cures.

It does not say companies should not bother with curing Hep C like illnesses
since there's no money in it.

~~~
shardis
It does not say "companies should not bother with curing Hep C like illnesses
since there's no money in it."

Critical reading skills and leaving out strawmen/non-existent arguments like
"there's no money in it" are required.

~~~
fiiv
What exactly about my statement was a non-existent argument?

The title is "Is curing patients a sustainable business model?" A non-
sustainable business model cannot sustain a business by definition, therefore
there is no money in it.

------
koolba
> But as more people were cured and there were fewer infected individuals to
> spread the disease, sales began to languish.

I hope for the sake of all humanity that nobody discussed addressing _this_
particular problem directly.

------
javajosh
Wait a sec, Gilead made $12.5B in 2015, $4B this year, on a single drug, and
_that 's not enough_? Gosh, I remember when $16.5B was a lot of money.

~~~
perseiden
Bringing new drugs to markets is expensive:

[https://en.wikipedia.org/wiki/Cost_of_drug_development](https://en.wikipedia.org/wiki/Cost_of_drug_development)

(These costs include the other 90% of drugs that have probably failed at some
development stage)

~~~
lultimouomo
So assuming Gilead spent per drug 10% more than the company that spent more in
that list, they recovered the whole development cost in a single year. Most
industries don't come even close to that.

~~~
lotsofpulp
Drugs that have an impact like their Hep C treatment don't come around every
year, or even every decade. It's almost a lottery.

------
minikites
And when you run out of patients to cure, just start making up new diseases to
treat:
[https://en.wikipedia.org/wiki/Herpes_simplex#Society_and_cul...](https://en.wikipedia.org/wiki/Herpes_simplex#Society_and_culture)

> Genital herpes simplex was not always stigmatised. It was merely a cold sore
> in an unusual place until the 1970s. As late as 1975, a study of
> "Psychological morbidity in a clinic for sexually transmitted disease" does
> not mention herpes simplex because at that time, no significant morbidity
> problem (i.e. mental anxiety or illness) was associated with the virus.

> Pedro Cuatrecasas states, "during the R&D of acyclovir (Zovirax), marketing
> [department of Burroughs Wellcome] insisted that there were 'no markets' for
> this compound. Most had hardly heard of genital herpes..." Thus, marketing
> the medical condition—separating the 'normal cold sore' from the
> 'stigmatized genital infection' was to become the key to marketing the drug,
> a process now known as 'disease mongering'.

> Since the creation of the herpes hype, some people experience negative
> feelings related to the condition following diagnosis, in particular if they
> have acquired the genital form of the disease. Feelings can include
> depression, fear of rejection, feelings of isolation, fear of being found
> out, and self-destructive feelings. These feelings usually lessen over time.
> Much of the hysteria and stigma surrounding herpes stems from a media
> campaign beginning in the late 1970s and peaking in the early 1980s.
> Multiple articles were worded in fear-mongering and anxiety-provoking
> terminology, such as the now-ubiquitous "attacks", "outbreaks", "victims",
> and "sufferers". At one point, the term "herpetic" even entered the popular
> lexicon. The articles were published by Reader's Digest, U.S. News, and Time
> magazine, among others. A made-for-TV movie was named Intimate Agony. The
> peak was when Time magazine had 'Herpes: The New Scarlet Letter' on the
> cover in August 1982, forever stigmatizing the word in the public mind

------
mariodiana
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!

------
dschuetz
A healthy person is bad for pharmaceutical business and doctors, yet very good
for health and life insurances.

~~~
pintxo
Not sure about that. Insurances require a certain level of "damage"
probability, else no one would get insurance in the first place. If you could
cure any illness with a $5 pill, I'd guess no one would get health insurance.

This is somewhat different for life insurances, as you could still be run over
by a (self-driving) car and die.

~~~
Broken_Hippo
" If you could cure any illness with a $5 pill, I'd guess no one would get
health insurance."

It is highly unlikely we'll ever get there, especially for genetic disorders
and things like that. But who knows. Nevertheless, people will still get run
over by a car and be injured, along with a multitude of other, very common
accidents. Of course there would still be insurance.

Besides, a good amount of insurance in the world is government-funded. (non-us
countries, medicaid, subsidies for private care). Another portion is at least
partially paid by employers. These folks don't need the certain level of
"damage probability". Employers get an extra bonus with decreased absenteeism,
and they might possibly be able to stop paying for insurance altogether.

------
dynofuz
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.

~~~
sauwan
Do insurance companies really have this incentive? You can (and probably will)
shop around and find a new insurer within a few years.

~~~
dynofuz
yes youll shop around for the one that'll keep you alive the longest

------
solatic
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.

~~~
jovial_cavalier
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.

------
jimhefferon
Rest of us ask, "Is having such people sustainable in out society?"

------
tynpeddler
This is such a nothing story. A quote from the article itself:

>To get around the sustainability issue overall, the report suggests that
biotech companies focus on diseases or conditions that seem to be becoming
more common and/or are already high-incidence. It also suggests that companies
be innovative and constantly expanding their portfolio of treatments. This can
“offset the declining revenue trajectory of prior assets." Lastly, it hints
that, as such cures come to fruition, they could open up more investment
opportunities in treatments for “disease of aging.”

In other words, Sachs is saying that just because you cure a disease, that
doesn't mean you can sit on your ass. You have to keep finding diseases to
cure. O, the horror.

------
jimjimjim
this is why can't have nice things.

why doesn't goldman sachs just grow humans and harvest their organs?

~~~
chopin
How do you know they don't?

~~~
draugadrotten
Is harvesting human organs a sustainable business model?

~~~
croon
As long as you don't cure other people (with money) and they keep needing new
organs, sure.

------
scotchmi_st
Since we're discussing nationalisation of drug development, one more less
extreme idea that I think needs more air-time: The creation of government-
issued prizes for drug discovery.

Here's how it goes- Government X issues a prize of $10B to whichever company
comes up with a new drug for, say, blood pressure. (10B being about as much as
a company would get in revenue for a blockbuster drug.)

Companies submit their drugs, which are then tested independently (see
[http://www.alltrials.net/](http://www.alltrials.net/) if you want to know why
that's important), and if they are found to have passed the requirements in a
strictly yes/no manner, they get the money.

The IP for the drug then passes to the government, which can then manufacture
and sell it at generic rates.

Like everything there are down-sides to this method, but it would sidestep a
lot of the issues around companies' incentive alignment with healthcare.

------
padobson
This is just bad business, only particularly egregious because it's in
healthcare.

No great product mind I've ever studied sacrificed making a great product for
a more profitable, adequate product.

In the long run, the company that makes the best product always wins. Apple
was never worried about cannibalizing the iPod to make a better product in the
iPhone. You won't find anything in Amazon's leadership principles[0] that
could justify this kind of thinking. Even Wal-Mart, after pressuring their
suppliers for lower costs, doesn't keep the difference as profits. They push
their prices lower and build trust with the customer.

Curing patients is _absolutely_ a sustainable business model, and only the
most small minded, short-sighted Wall Street suit would think it isn't.

[0][https://www.amazon.jobs/principles](https://www.amazon.jobs/principles)

------
perpetualcrayon
I wonder if diseases are patentable. That would probably be a hugely
profitable market. If a company obtained the patent on the disease they'd
almost certainly be the first to market with a patent for the cure.

------
userbinator
Essentially planned obolescence applied to health. Rather unsettling.

------
ako
And that is why healthcare should not be a for profit business.

------
fadzlishah
How is this even a question? It's entirely logical that curing disease
effectively decreases the prevalence. Did it really take a big bank to point
that out?

------
nfriedly
I wonder if insurance companies do anything towards funding cheap
"unsustainable" cures? Seems like it'd have a high ROI for them.

~~~
teddyh
Companies don’t actually want profit if it would also benefit every competitor
equally. A cure for a disease would benefit _all_ insurance companies, so
there is no _competitive_ advantage for an insurance company to develop one.

~~~
nfriedly
Yea, good point. I can imagine ways where it works out well (e.g. the insurer
that found the cheap cure patents it and charges some expensive price that's
still significantly cheaper than a lifetime of non-curing treatments.
Everybody wins, but the insurance company that owns the cure wins the most.)

~~~
teddyh
If they did that, they would no longer be an insurance provider, but a
pharmaceutical company, and at that point there’s no reason to develop cures
when short term mitigations are even more profitable.

------
smoyer
If you're in medicine, you should be more concerned with improving the human
condition. I think that most doctors truly want to help others, and we
obviously need support companies like drug manufacturers. But there's a huge
industry built up around maximizing profits in other ways - I'm not sure how
this can be reconciled.

------
MistahKoala
What a depressing way to spin what are otherwise reasonable questions and
comments seemingly addressed by the report. Just as depressing is to see that
a microbiology PhD is making her living by recycling clickbait content written
by someone else (Mole's article is more or less a facsimile of the original
CNBC article).

------
sebringj
Imagine a corporate AI trained with empathetic traits as its primary goal and
with its secondary goal, profits. I wonder if it would decide vaporizing
certain individuals at Goldman Sachs would be more empathetic overall to
humanity while improving their corporate image and stock evaluation.

------
paulie_a
The next time Goldman Sachs has to be bailed out they shouldn't be cured.

~~~
Bartweiss
...are they wrong about this?

It feels very much like a "shoot the messenger" response. GS isn't saying this
is a good outcome, or even that gene therapy companies don't deserve
investment. They're just claiming that the existing revenue model for drug
companies won't lead to success here. The obvious defense of that claim is "if
it's true, saying it isn't a sin".

I mean, I'm not sure Goldman is _intending_ to make an argument for public
healthcare and state-funded medical R&D, but in practice that's what this is.

------
crawfordcomeaux
Systemic mechanisms in the culture of capitalism are in direct conflict with
the Hippocratic oath.

Capitalism breeds inequality and so it does harm.

------
_bxg1
This is possibly the most dystopic headline I've ever read.

------
ropable
I am perfectly cool with health care being a cost center.

------
dingo_bat
This is the phase where capitalism turns evil. The mere act of thinking like
this is a crime. I hope these people don't suffer from a degenerative disease
in their old age, or they will quickly understand their folly.

------
jernfrost
It is an excellent example of why health care is fundamentally at odds with
capitalism.

Now I don’t see this as black and white. The free market is a useful tool one
can use in healthcare WHERE it makes sense.

However that is not nearly as many places as the conservative free market fan
club thinks it is.

This ought to be a reminder that more market does not equal better. More
market thinking in health care is to the contrary going to bring worse
results.

It is an extremely difficult problem to solve which means they only way to
deal with it is through experimentation, tinkering and data gatering. Not
through ideological silver bullets.

------
sunstone
How to win friends and influence people.

------
anovikov
In theory, market will drive things so the cost of one-shot cure will become
equal to the capitalized cost of life-long therapy. Either by making the
former more expensive, or the latter cheaper. Until the latter becomes a
direct money loser.

~~~
fwdpropaganda
In theory, theory coincides with practice. In practice, it doesn't.

I've long been of the opinion that "free market fundamentalists" are more than
anything intellectually lazy people.

EDIT: Just to be clear, I'm not attacking you personally. I wouldn't think
that a single post on HN sums up the entire thought process of a person,
obviously. But that are people for which that observation is entirely
applicable.

------
emiliobumachar
This is one of the downsides of mobbing, shaming and regulating away
outrageous prices. If pharma companies can't charge you in the ballpark of a
lifetime's earnings for a one-shot, one-shots will be less compelling to them
compared with treatments you have to take twice a day for the rest of your
life.

~~~
watwut
That assumes monopoly. Competition should solve that.

~~~
andybak
Remembering basic human moral values might help as well.

~~~
emiliobumachar
I don't develop cures for diseases at all. Is this moral? If I may go out on a
limb and speculate, you don't develop cures for diseases at all either. Is
this moral?

If someone is going to dedicate their careers to searching for cures to
diseases, but only if they can earn a competitive salary doing so, are they
more or less moral than us?

For the equivalent case for investment, start with "I don't pay people to
search for cures to diseases at all. Is that moral?"

~~~
andybak
Grandfather comment was:

> This is one of the downsides of mobbing, shaming and regulating away
> outrageous prices. If pharma companies can't charge you in the ballpark of a
> lifetime's earnings for a one-shot, one-shots will be less compelling to
> them compared with treatments you have to take twice a day for the rest of
> your life.

Companies are run by human beings. Ignoring the stuff about "fidiciary duty"
(mainly because I think it's highly contentious to infer that it overrides
moral choices and partly because that is a highly complex topic in it's own
right) - people can make choices that involve making less profit and saving
lives. If you're not high enough up the food chain to make these decisions
then you can choose to leave your job in protest.

Therefore companies can choose to take the "less compelling" but more moral
option. And I can judge them on their choices and so can you. And they can
choose to disagree with our judgement. That's how morality works. Shades of
grey and difficult choices...

I think in addressing the GP comment I have hopefully addressed yours too. We
all make our own moral decisions and we all make our own moral judgements.
Just because these processes are complex and reasonable people can disagree
doesn't mean that morality is meaningless. It's just means that it's hard.

