Is curing patients a sustainable business model?

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markjo

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Is curing patients a sustainable business model?
« on: April 13, 2018, 07:12:30 AM »
I think that we already know the answer, but is that really the right question?

Goldman Sachs analysts attempted to address a touchy subject for biotech companies, especially those involved in the pioneering "gene therapy" treatment: cures could be bad for business in the long run.

"Is curing patients a sustainable business model?" analysts ask in an April 10 report entitled "The Genome Revolution."

"The potential to deliver 'one shot cures' is one of the most attractive aspects of gene therapy, genetically-engineered cell therapy and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies," analyst Salveen Richter wrote in the note to clients Tuesday. "While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow."

I suppose that's one of the problems with capitalism: what's good for society isn't necessarily good for business.
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Re: Is curing patients a sustainable business model?
« Reply #1 on: April 13, 2018, 08:47:23 AM »
1) This assumes medical/biotech companies have no moral values
2) If you - either as a company or as a researcher - find that 'one time application cure' for some diseases, this will give you a TON of fame, plus you can be certain your company will have more than enough money for the times to come; so even if they had no morals, they'd still do it if they could.
3) Since people get born all the time, more of this product would be needed all the time = sustained cashflow guaranteed
4) There is a nearly uncountable amount of diseases out there. Much of which are not very well known on a genetical level, thus companies would need a loooong time to solve all the issues...
5) Not all diseases are genetically caused, so meds would still be needed anyway = sustained cashflow guaranteed.

--> This article is nothing new, just some old, dumb bullshit.
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Re: Is curing patients a sustainable business model?
« Reply #2 on: April 13, 2018, 09:05:44 AM »
1) This assumes medical/biotech companies have no moral values
Companies do not have morals.  Companies exist to deliver value to shareholders - they are legally obligated to in fact - morality doesn't come into it.

Quote
2) If you - either as a company or as a researcher - find that 'one time application cure' for some diseases, this will give you a TON of fame, plus you can be certain your company will have more than enough money for the times to come; so even if they had no morals, they'd still do it if they could.
This might be true - it really depends on how many customers there are for the cure, vs how much it costs to develop.

We need publicly funded research, as well as private.
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Re: Is curing patients a sustainable business model?
« Reply #3 on: April 13, 2018, 09:12:02 AM »
1) This assumes medical/biotech companies have no moral values
Companies do not have morals.  Companies exist to deliver value to shareholders - they are legally obligated to in fact - morality doesn't come into it.
A company in itself doesn't do anything, there are always humans behind it, which always have morals (although not always to the same degree).
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Twerp

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Re: Is curing patients a sustainable business model?
« Reply #4 on: April 13, 2018, 11:04:28 AM »
Sure, most (if not all) individuals and thus, most (if not all) companies are going to draw the line at some point, based on morality. But is that enough?

Companies may have financial incentive to bring a cure or other solution to the market in some cases but not in others. Perhaps there are two competing cures for the same thing, one is a better cure but the other is more lucrative. The financial incentive in that case would be to market the lucrative one.

A socialistic approach (publicly funded research and development) is kind of a solution.

I would like know if there are any ideas on how to ensure companies are financially incentivised to always market the best solutions.
« Last Edit: April 13, 2018, 11:08:02 AM by Boots »
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Re: Is curing patients a sustainable business model?
« Reply #5 on: April 13, 2018, 12:15:13 PM »
I kind of agree with you there.
But still - in my opinion they will nearly always give you the best treatment (even if just to be better than competitioners) although they might charge a ridiculous amount of money for it.

But anyways, at least where I live you have both, university research groups and industrial research. I think that's a very nice concept.
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Re: Is curing patients a sustainable business model?
« Reply #6 on: April 13, 2018, 12:26:31 PM »
1) This assumes medical/biotech companies have no moral values
Companies do not have morals.  Companies exist to deliver value to shareholders - they are legally obligated to in fact - morality doesn't come into it.
A company in itself doesn't do anything, there are always humans behind it, which always have morals (although not always to the same degree).
The humans may well have morals - but they work for the corporation, which doesn't.  The humans are morally (certainly legally) obliged to deliver maximum return on investment to shareholders. 

If people in the corporation decide to do something that might benefit humanity but that reduces profits, the shareholders could argue that they are in fact acting immorally.

A corporation exists purely for the benefit of it's shareholders, not for the good of humanity, and any moral framework that exists within it will reflect that.

By the way, I'm not saying this is good, I'm just saying that's the way it works.  I'm always amazed that people don't really know how capitalism really works.
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Pezevenk

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Re: Is curing patients a sustainable business model?
« Reply #7 on: April 13, 2018, 12:33:21 PM »
Um, corporations don't just exist on another plane than humans. People run them. The issue is that often business people are detached from the consequences of their actions and don't realize the impact of what they're doing, or they just have a weak sense of morality, and often businesses that are run by ruthless people are much more competitive.
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Pezevenk

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Re: Is curing patients a sustainable business model?
« Reply #8 on: April 13, 2018, 12:37:52 PM »
you can be certain your company will have more than enough money for the times to come; so even if they had no morals, they'd still do it if they could.
Not true, unless they start charging the shit out of that one cure which would be ethically wrong on another sense.
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Twerp

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Re: Is curing patients a sustainable business model?
« Reply #9 on: April 13, 2018, 12:41:48 PM »
1) This assumes medical/biotech companies have no moral values
Companies do not have morals.  Companies exist to deliver value to shareholders - they are legally obligated to in fact - morality doesn't come into it.
A company in itself doesn't do anything, there are always humans behind it, which always have morals (although not always to the same degree).
The humans may well have morals - but they work for the corporation, which doesn't.  The humans are morally (certainly legally) obliged to deliver maximum return on investment to shareholders. 

If people in the corporation decide to do something that might benefit humanity but that reduces profits, the shareholders could argue that they are in fact acting immorally.

A corporation exists purely for the benefit of it's shareholders, not for the good of humanity, and any moral framework that exists within it will reflect that.

By the way, I'm not saying this is good, I'm just saying that's the way it works.  I'm always amazed that people don't really know how capitalism really works.
Corporate decisions are made by boards which are made up of humans, most (if not all) of which will draw a line at some point, based on morality.
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markjo

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Re: Is curing patients a sustainable business model?
« Reply #10 on: April 13, 2018, 01:21:13 PM »
1) This assumes medical/biotech companies have no moral values
Companies do not have morals.  Companies exist to deliver value to shareholders - they are legally obligated to in fact - morality doesn't come into it.
A company in itself doesn't do anything, there are always humans behind it, which always have morals (although not always to the same degree).
The humans may well have morals - but they work for the corporation, which doesn't.  The humans are morally (certainly legally) obliged to deliver maximum return on investment to shareholders.
This is one reason why I've kicked around the idea that maybe the healthcare industry should be non-profit entities.
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Re: Is curing patients a sustainable business model?
« Reply #11 on: April 13, 2018, 02:35:33 PM »
The thing is, if it's non profit, then the risk of being inefficient and losing the best people gets quite a bit higher.
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Gumwars

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Re: Is curing patients a sustainable business model?
« Reply #12 on: April 13, 2018, 03:58:25 PM »
From what I recall, this article discussed the moral implication and stated that biotech focus away from one shot cures, which have little return on investment once everyone is cured, to more chronic illnesses.  The outcome is evident; business wants to focus on problems that will always be there, not fix things for good.

A possible solution would be to make those one shot cures open source or public domain, like the vaccine for polio.  If they wanted to maximize profit, they could move them to public domain after reaping the cash during the first few years of a cure being available.  Shitty solution, sure, but win-win for the majority.
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markjo

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Re: Is curing patients a sustainable business model?
« Reply #13 on: April 13, 2018, 04:45:38 PM »
The thing is, if it's non profit, then the risk of being inefficient and losing the best people gets quite a bit higher.
Non-profit doesn't mean that the people can't be well paid.
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Twerp

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Re: Is curing patients a sustainable business model?
« Reply #14 on: April 13, 2018, 06:00:11 PM »
A possible solution would be to make those one shot cures open source or public domain, like the vaccine for polio.  If they wanted to maximize profit, they could move them to public domain after reaping the cash during the first few years of a cure being available.  Shitty solution, sure, but win-win for the majority.
Could you explain how this would work in a little more detail?
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Gumwars

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Re: Is curing patients a sustainable business model?
« Reply #15 on: April 13, 2018, 06:39:05 PM »
A possible solution would be to make those one shot cures open source or public domain, like the vaccine for polio.  If they wanted to maximize profit, they could move them to public domain after reaping the cash during the first few years of a cure being available.  Shitty solution, sure, but win-win for the majority.
Could you explain how this would work in a little more detail?

Sure thing.  Jonas Salk, one of the pivotal inventors of the inactive polio vaccine, refused to have the medicine patented.  It was essentially released to the public domain and because of that, anyone with the proper training and equipment can look at the formulation and make their own vaccine. 

So, I have two possible avenues a business could pursue when attempting to bring a cure to market.  The first would be identical to Salk.  They immediately release it, without patent, as an altruistic gesture.  This would net the lowest possible profit for the company but has the greatest positive impact to humanity as a whole.

The second is that they patent it, sell it for profit until the sales peak and then release it to public domain.  This would realize profit for the company until the cure starts to overcome the pool of available customers.  At that point, it could be released as a gift to humanity so as to prevent any resurgence of the disease. 
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Bullwinkle

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Re: Is curing patients a sustainable business model?
« Reply #16 on: April 13, 2018, 08:20:27 PM »
A patent only lasts 17 years.

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markjo

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Re: Is curing patients a sustainable business model?
« Reply #17 on: April 13, 2018, 08:52:01 PM »
A patent only lasts 17 years.

Actually:
In most cases, the drug patent is awarded for around twenty years in the United States. The lifetime of the patent varies between countries and also between drugs. Since the company applies for a patent long before the clinical trial to assess a drug’s safety and efficacy has commenced, the effective patent period after the drug has finally received approval is often around seven to twelve years.

Then again, between R&D and clinical trials, new drugs can involve an investment of several billion dollars before they even make it to market.  Then there's the inevitable lawsuits for when the clinical trials don't pick up on some of the less common, but potentially quite nasty, side effects.
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Bullwinkle

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Re: Is curing patients a sustainable business model?
« Reply #18 on: April 13, 2018, 10:17:36 PM »
A patent only lasts 17 years.

Actually:
In most cases, the drug patent is awarded for around twenty years in the United States. The lifetime of the patent varies between countries and also between drugs. Since the company applies for a patent long before the clinical trial to assess a drug’s safety and efficacy has commenced, the effective patent period after the drug has finally received approval is often around seven to twelve years.

Then again, between R&D and clinical trials, new drugs can involve an investment of several billion dollars before they even make it to market.  Then there's the inevitable lawsuits for when the clinical trials don't pick up on some of the less common, but potentially quite nasty, side effects.

Well, fuck me . . .

Quote
Before June of 1995, the patent laws in the United States provided that the term of a utility or plant patent ended seventeen years from the date of patent grant. To comply with Article 33 of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement resulting from the Uruguay Round Agreements of the General Agreement on Tariffs and Trade (GATT), the United States was required to establish a minimum term for patent protection ending no earlier than twenty years from the date the application was filed. Thus, the Uruguay Round Agreements Act amended 35 U.S.C. § 154, and these amendments took effect on June 8, 1995.

I used to freelance drawings for a patent lawyer. I guess it was longer ago than I thought.   :P

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Re: Is curing patients a sustainable business model?
« Reply #19 on: April 13, 2018, 10:53:46 PM »
I think people underestimate how hard it is to create a 'one time cure'...
But be certain, lot's of research is going in that direction.
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Re: Is curing patients a sustainable business model?
« Reply #20 on: March 08, 2023, 01:24:54 PM »
Why do you think doctors can't be businessmen? They can open their own clinics, provide private services, and make money just like other people in the service industry.

Re: Is curing patients a sustainable business model?
« Reply #21 on: March 09, 2023, 02:10:21 AM »
I believe that doctors can make money by starting their own businesses. If they provide quality medical services and successfully manage a group of specialists, that's great. I visit almost only private medical clinics, because I like the level of their service much more than in public hospitals.

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Re: Is curing patients a sustainable business model?
« Reply #22 on: March 09, 2023, 06:06:47 AM »
Those were two weird bots.
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Re: Is curing patients a sustainable business model?
« Reply #23 on: March 09, 2023, 06:49:29 AM »
Currently, we have a cash cow market.

Cash cows in the business sense are repeat customers that you build a relationship with. That would be wonderful except the reason you SHOULD build a relationship with the customer is that the illness is just an excuse, they wanna see you. The hypochondriac customer has a need for love that cannot be cured for instance. The medical industry pushes them aside as troublemakers. Actually, they are your repeat customers. You talk to them about issues, because you can't really cure hypochondria, and you shouldn't try. They like hospitals and they wanna be there. Just give them a back massage or something. What's that you say? Medical professionalism? Bollocks! You can't claim to be professional when it isn't a small few but the majority who are cash cows.

Cash cows are a sign you aren't really treating the problem. Also the drug you give a cash cow needs to be free at your end (why I used back massage as an example, something you don't have to buy). Why? Well, let's say you have a drug that is relatively inexpensive when it is common. But now that you have one thousand people on it, supply has gone down, demand is up because you have treated (but not CURED) patients, and so the price is going steadily up. In fact, the number (and price) will continue to go up because you never bothered to find the root of the problem or at least one by one cure each subject of it. Drug that was $5 dollars is now $250 dollars. Great, you're making big money now! But are you? Generally, no. If you were making $5 for a one-off treatment of 5000 people you'd make $25,000 right on the spot. Even if you didn't address the root of the problem, if you cure them for a year or two, price is under control no matter how many customers you have. But now, with the cash cow overglut, prices are skyrocketing.

They get insurance to pay for it, but even if every tries to have insurance, insurance costs skyrocket. They someone has the idea of tiered insuance. So people pay for insurance but it doesn't cover the drugs or procedures they actually need. Price is out of control!!!

Jesus didn't really believe in cash cow. I didn't either, as a computer repair type. But I sucked at my job, and wasn't able to cure anyone. I also had people who wanted tutoring, but I never felt like I got to the point where they could do it well themselves. Those were cash cow, and I was supposed to build a relationship with them, but I was pretty terrible at relationships. I suppose every now and then, I do help people. But I don't have much business. Basically, I suck and I know it. What God seems to be calling me for is writing ( I probably suck there too but I've written a fair amount, so).

Here's how this model works. You repair the problem (computer repair should be a matter of virus removal). The person is impressed, and they recommend you to others. You cure them too, and word spreads.

The thing is, although Jesus could have made a killing, he was running on a "donation only" model. Occasionally some wealthy heiress would be like "You're Jesus? Great, I'm Joanna, have like 10,000 shekels." But his actual customers, he cured one and done. Does this mean had he charged, he would be poor? No, because he drew more people from more towns and moved around to different areas. His people, centuries latter, have still not run out of customers. Though now the church is not about missionary work but itself about cash cow. Asking the same people on Sunday for money. Face it, these people are bored and want a challenge in their life. They want the life-changing experience.

This model is sustainable, because while they suffer from epilepsy no more, they now have a few aches and pains every now and then. Or a bad cold. They are repeat customers, but also they are loyal to you, because you changed their lives. They were a town leper, now you made it so they can go pray in the temple again. Or to put it in modern terms, you do the long slow process of therapy for someone with Tourette's. As long as you are curing them (even though not instantly, like Jesus, but making steady progress), you are building a relationship, you are getting money, and you have a customer who will recommend you. When you finally do get them to stop saying "damn" loudly and uncontrollably, they are a new person. They can go into libraries and train stations again, they can have that job they wanted.

Having most of your patients cured instead of treated is a working model because it keeps prices in control. They will recommend you to others too, just as car mechanics stay in business by curing individual problems, rather than "sorta" fixing the problem and having it recur over and over. People who don't actually cure most of their patients eventually wind up out of business. People go to someone else who will cure their car. And that person treats the problem rather than symptoms.

The problem with biotech is I don't believe in the solution. Tinkering around with people's genes is a good way to accidentally cause cellular collapse or something if you know just enough to do things wrong. I know better than that doctors never make mistakes. That's why they have legal team.
But is it a sustainable model? Well, if you could cure vs making worse, then yes. Goldman Sachs is wrong. But gene therapy and biotech can go very very wrong.
« Last Edit: March 09, 2023, 06:57:33 AM by bulmabriefs144 »

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Wolvaccine

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Re: Is curing patients a sustainable business model?
« Reply #24 on: March 09, 2023, 07:17:56 AM »
blah blah blah But gene therapy and biotech can go very very wrong.

Or it could go very COOL!

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Re: Is curing patients a sustainable business model?
« Reply #25 on: March 09, 2023, 07:25:25 AM »
blah blah blah But gene therapy and biotech can go very very wrong.

Or it could go very COOL!


Well, yeah but for every person bitten by a radioactive spider that becomes Spider-Man, about 50,000 people get spider poisoning or radiation poisoning, and either way die.

Never trust a miracle drug until it has been tested in labs and been on the market with good success.


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Wolvaccine

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Re: Is curing patients a sustainable business model?
« Reply #26 on: March 09, 2023, 07:32:42 AM »
I'd say with gene editing given the fidelity required will always be precarious on each case by case basis.

I have no doubt it will eventually be done. Plenty of states in the world that wouldn't give a fuck to 'go rouge' and do their own thing and not give a damn about what other countries think (eg China).


I also have no doubt that 'transhumans' will eventually be a thing. In fact, given out desire to explore the stars, I'd say it is the only way we could achieve that goal.

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Re: Is curing patients a sustainable business model?
« Reply #27 on: March 09, 2023, 09:16:34 AM »
I'd say with gene editing given the fidelity required will always be precarious on each case by case basis.

I have no doubt it will eventually be done. Plenty of states in the world that wouldn't give a fuck to 'go rouge' and do their own thing and not give a damn about what other countries think (eg China).


I also have no doubt that 'transhumans' will eventually be a thing. In fact, given out desire to explore the stars, I'd say it is the only way we could achieve that goal.

I honestly wonder which one will win out:

Genetic engineering or cybernetic enhancements.
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Re: Is curing patients a sustainable business model?
« Reply #28 on: March 09, 2023, 12:36:50 PM »
Probably genetic engineering. Though cybernetics has its supporters, most people have seen enough films of horrifying robots or cybernetic arms that try to choke their owners and such.

Though viral failure of genetics is a thing (you need a retrovirus to genetic engineer), leading to things like cancer, at the very least, there isn't the chance of third party hacking.


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Re: Is curing patients a sustainable business model?
« Reply #29 on: March 09, 2023, 12:55:48 PM »
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