Curing Diseases Might Not Be Economically Viable, According To Goldman Sachs

A leaked report has stated what many people in the health industry have whispered privately: there's a lot less money in curing people with a disease than in the long-term management of the disease. This issue was brought into focus by the possibility of a gene therapy which could soon cure various genetic conditions by altering individual units of DNA. The huge potential boon for society, however, could be blocked without changes to how health is funded. Countries with public health systems might be able to reap the benefits of new technologies, leaving America trailing in their wake.

Goldman Sachs analyst Salveen Richter reportedly pointed out the issue in a note to clients; "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."

Somebody who is rich enough might be willing to pay hundreds of thousands of dollars to be cured of a debilitating disease. However, most people couldn't afford this, particularly if their condition affected their earning capacity. Meanwhile, the same person may be able to scrape together tens of thousands of dollars a year to keep the worst aspects of disease at bay, in the long run paying far more than they'd have for a cure. It is a medical equivalent of Terry Pratchett's "boots theory".

Richter refers to the sofosbuvir treatment of hepatitis C marketed by Gilead Sciences. In 2015 it brought the company $12.5 billion, especially in the US, as people suffering liver damage from the virus rushed to buy the new drug. Nevertheless, the therapy cures most patients so thoroughly that they are finished with treatment within 12 weeks. It's more ideal from a social perspective, but it's worse for profits because once treated individuals no longer transmit the virus, thus preventing new infections. This year Richter expects American sales to fall to less than $4 billion.

“While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow,” Richter's note, which isn't online, reportedly concludes.

Unsurprisingly, the report caused outrage after CNBC revealed it. Richter wrote for the investment bank's clients, and it is easy to mock any companies whose profits are threatened by technological changes that will benefit millions. Nevertheless, unless we adjust the economic structures around healthcare the issue she has pointed to could deprive many of the cures they need.

It costs phenomenal amounts of money to invent new medical cures and test them until health authorities deem them safe – usually at least $1 billion. Somebody has to pay. For a widespread problem such as hepatitis C, the issue Richter points to merely reduces mega-profits to very, very large ones. However, for rarer diseases, there might not be enough potential income to justify doing the research and clinical trials financially. MIT Technology Review has noted awareness of this issue might be why GlaxoSmithKline recently sold off its rights over some spectacular cures for very rare diseases.

Public health systems, like the ones the most wealthy countries have, will frequently be willing to pay enough to cure their patients that the cost of the research can be justified. After all, in the long run, the savings will usually outweigh the costs. Only the best American private insurance plans, generally unaffordable to the people who need them most, are likely to see things the same way.

One way around that is to change how trials are run, making it cheaper to bring a new treatment to market. While some ideas propose safely doing this, most of the cost-cutting would come with the danger of another disaster like thalidomide.

Alternatively, we can look beyond profits, funding the development of new treatments with either philanthropic or government money. That's already how most basic medical research is supported, but those sorts of finances are mainly absent from the expensive clinical trial stages. Unluckily, these require governments to make costly investments that will often take decades to pay off.

Reference: IFLScience