Sheer nonsense. This assumes that all surgeries are a result of poor preventative care which is trivially false.
Why does it seem like the folks criticizing the profit motive of pharmaceutical companies see no such perverse motive in those selling holistic treatments? I don't suppose that "alternative way of dealing with infections" happens to involve spending money regularly on herbs and acupuncture...
However, doctors only contribute slightly to the status quo. The food industry more generally is to blame. As well as the government, for subsidizing unhealthy things.
Worth remembering whenever you see people comparing different healthcare systems based on longevity. Doctors are not always the primary factor in lifespans.
True but that's a considerably diminished claim from the OP's, which was that all surgery is a sign of doctor failure. Also, the unscientific treatments they linked to would do nothing to prevent heart disease, and may even discourage patients from seeking care that can help them.
One reason is to do with scale, and perceived credibility.
A pharmaceutical company is a vast organisation, which is able to invest huge sums of money on advertising, marketing, lobbying, PR, insurance etc, and they have the benefit of being seen as having scientific rigour and government-administered quality assurance as inherent features of their offering.
This all means their products can be sold to many millions of people who trust the recommendation of their physician, even if it offers minimal benefit (e.g., antidepressants or statins prescribed to people who would benefit far more from lifestyle changes) or causes significant harm (see current spike in addictions and fatalities linked to opioid painkillers like Fentanyl).
A natural/holistic health practitioner is a normally an independent small business operator, offering treatment to about 20-30 people per week, most of whom are generally healthy and just want to stay that way by having good nutrition, reduced stress, better muscular-skeletal alignment, etc.
Most natural/holistic practitioners make a comparable income to a contract software developer, and have no intention or ability (or more importantly, stock market pressure) to make any more than that. They rely heavily on repeat business and word-of-mouth recommendations, and therefore must consistently help their clients achieve an improved quality of life.
When people die whilst under conventional medical/pharmaceutical treatment, the general attitude is "that's sad, but hey it was a scientifically validated treatment, so, what else could we do?"
Whereas any natural/holistic practitioner who causes serious harm or death of a patient is subjected to thorough scrutiny by regulators and the media, and indignant sharing on social media. Those found to be negligent are quickly put out of business.
Alternative medicine is a 34 billion dollar industry in the US alone
The crucial difference between the pharmaceutical industry and the alternative health sector is centralisation vs fragmentation.
Due to being vast, centralised entities, pharmaceutical companies can utilise mass marketing, lobbying and the perception of scientific validity and government endorsement to get their products into the hands of customers, and can continue to do so even if their products cause widespread harm [1]).
But every natural/holistic practitioner is an independent operator servicing a small local area, and must work hard to provide a high degree of satisfaction to every customer every day, and face the reality that a single instance of serious harm will put them out of business for good.
The article you cited demonstrating the size of the industry only confirms that for the most part, practitioners are doing a pretty good job.
I'm not arguing that mainstream medicine and pharma shouldn't exist, or should even be dramatically changed. I happily use it, and find it very beneficial. But I also know from personal experience and simple market economics, that the oft-touted-here attitude, that most/all natural/holistic/alternative medicine is useless/harmful snake-oil peddled by charlatans to morons, is misinformed and mostly false.
[1] http://www.livescience.com/57268-fentanyl-overdose-deaths-do...
http://www.statisticbrain.com/health-care-industry-statistic...
You'd think the HN audience would be smart enough to actually look at evidence in regards to medicine, but there's a lot of Steve Jobs types who'd rather pay for a well placebo-ed death. I wouldn't mind if they weren't so insistent on preaching their bullshit everywhere they go and trying to pass it off as having any basis.
It's kinda disheartening to dedicate years and years to studying medicine, only to realize there's more money and satisfied patients to be made in hustling bullshit to new-age fools who will preach your crap right up until they die of an easily treated disease.
But it's true that you are happy to get surgery in case of a grave emergency, with heavy drugs and a strong hopital system. It's also true that the current most used health system is actually very bad at keeping people healthy.
But no, all pharma related practice is not a z-serie drug dealer plot. And no, all alternative health practice is not hippie voodoo trying to cure cancer with placing hot stone on your third eye.
Alternative medicine may not all be hippie voodoo but it all has one thing in common: all the data all of its salesmen have gathered before profiting hand over fist has amounted to nothing. All of the data gathered since then has amounted to nothing except the rare fortunate placebo effect, early deaths, and needless suffering. Once every few decades we stumble on a gem like meditation because medicine works by testing and gathering data on everything, including folk remedies.
Our most common treatment for metastaticized cancers is to inject radioactive material into our bodies in the hope that it kills cancer cells faster than healthy tissue! We will clearly do anything so all any "alternative" medicine has to do is prove its effectiveness. There is lots of value to a variety of traditional remedies that utilize the antimicrobial properties of tea and honey or blood thinners in many herbs but that isn't going to make anyone any money except your neighborhood grocery store or ethnic market. The rest of alternative medicine is just a bunch of snake oil salesmen whose livelyhoods depends on rejecting the foundations of evidence based medicine.
There is no way you can judge "all the data" because "alternate medicine" is as big as saying "languages in the world". It's all that is not sanctioned. It includes a lot of things good and bad, crazy and sane.
E.G: calibrated fasting is alternate medicine. Data for fasting has amounted to many things including improving the immunity system response and lowering side effects of heavy drugs. There is nothing magical or mysterious about it.
It is "alternate medicine" because you won't see most doctors recommend fasting to your typical patient. There is no moral judgment in that. I'm not saying it's good or bad, it's just a fact.
You have one vision of "alternate medicine", and it's limited to a stereotype. I understand why. The louder champions of many alternate medicine are using pseudo science, repeated by stay-at-home mothers on facebook. It does make the credibility of many interesting informations crash.
However, dismissing what can be valuable information because of that is missing opportunities. Especially, a lot of chronic diseases have treatments outside of traditional medicine that make living with it much more bearable.
Again, it's not exclusive. You don't have to reject one to get the other. But trying a few things outside of ones own bubble can get some wonderful unexpected results.
I make a point of trying many such things. I'd say 9 times out of 10 it's a waste of my time and money. Sometime it's even unhealthy. But when you do find out something that brings strong benefits, it's usually really worth it.
It's a shame one's have to do it that way. I'd much rather have professionals advice me on those. And it's why it's so important no to close the door.
Given stories like this, I fully expect that whatever turns out to be the next widely-adopted antibiotic treatment, will be something that has long been used in traditional or alternative medicine.
One promising candidate is Pulsed Electromagnetic Fields [2].
[1] https://qz.com/517202/how-traditional-chinese-medicine-final...
[2] https://epjnonlinearbiomedphys.springeropen.com/articles/10....
Yes, of course it took modern medical research practices to convert into a potent form, demonstrate its efficacy and combine it with other agents for maximum benefit against malaria.
But it also took someone - one person - to be willing to go against the tide of vicious contempt towards traditional medicine like that which has been on full display upthread here, and painstakingly study the ancient literature and see where it might lead.
That's one person who I'm quite sure would not ever have said anything like "I wouldn't mind if they weren't so insistent on preaching their bullshit everywhere they go and trying to pass it off as having any basis".
It's all very well to casually dismiss all non-mainstream remedies with "the problem is that overwhelmingly most of the time they don't", just as it's all very well to dismiss every new startup or technological innovation as being highly likely to fail. At least 95% of the time you might be right, but the time you're wrong is when it matters most, when you're talking about a new remedy for malaria, or, perhaps one day, a remedy for antibiotic-resistant bacterial infections.
Please just keep it in mind. Millions of lives saved already, because one person was able to suppress the temptation to sneer and let their curiosity win out.
> There is lots of value to a variety of traditional remedies that utilize the antimicrobial properties of tea and honey or blood thinners in many herbs but that isn't going to make anyone any money except your neighborhood grocery store or ethnic market. The rest of alternative medicine is just a bunch of snake oil salesmen whose livelyhoods depends on rejecting the foundations of evidence based medicine.
Perhaps we are working from different definitions of "alternative medicine." Wikipedia defines it: "Alternative medicine or fringe medicine are practices claimed to have the healing effects of medicine but are disproven, unproven, impossible to prove, or only harmful." I also have to acknowledge WebMD's definition which is "Alternative medicine is a term that describes medical treatments that are used instead of traditional (mainstream) therapies." I use a middle of the road definition that creates a (perhaps false, perhaps not) dichotomy between evidence based and alternative medicine. Both are broad fields but it boils down to this: when there's enough interesting anecdata or popularity for a therapy that is "alternative," someone eventually pays for a small study to examine it. When enough such studies are done with positive (or at least no conclusively negative) results, metastudies are compiled and eventually the science trickles through evidence based medicine until it hits medical textbooks.
With extended family who are old Soviet trained doctors, I am exposed to a lot of folk remedies, what you would call alternative medicine, but a quick search on Google scholar reveals many peer reviewed studies explaining why many of these remedies work and examining whether there are statistically significant effects. There's not enough profit motive for the pharmaceutical industry to spend nine and ten figure sums on something they can't patent and sell for billions but that doesn't mean we don't know how various tars slow down skin cell replication and help with psoriasis, how antimicrobials in tea, garlic, and honey work, or that many forms of fasting have strong evidence in life extension, let alone general health. This is all evidence based, not alternative, medicine and lumping it all in with reflexology, chakras, faith healing, or magnet therapy is a disservice to our existing scientific knowledge and legitimizes a snake oil industry.
Which illnesses has modern medicine definitevely cured?
Exclude anything that is prevented through vaccination and treated with antibiotics (since even I as a layman know about those).
Someone below mentioned Hepatitis C which is one. What other examples are there?
Obviously no need for complete list just 5 or 10 will do for the purpose or argument.
- Some strokes (if you reach hospital in time)
- some heart attacks (if you reach hospital in time)
- 3rd degree heart block (by way of a pacemaker)
- serious arthritis of the knees, hips and shoulders (by way of replacement joints)
- 80% cure rate of childhood leukaemia, 20-30% cure rate of adult leukaemia
- some forms of childhood brain tumours
- a high percentage of childhood and young adult myelodysplastic syndromes
- pretty much every BCC and almost all SCCs that reach a doctor before they have invaded the whole patient
- early melanoma
- Benign Prostatic Hyperplasia, through either a TURP or what will become the definitive therapy, interventional radiology ablation
- Wolf-Parkinson-white syndrome and other cardiac arrytjmias that consist of accessory pathways
- patent foramen ovale
- Cervical cancer if discovered early through Pap smear
- deep vein thrombosis and it's sequelae, pulmonary embolism
- Cataracts
- about 100 other surgical problems that will be completely cured through surgery
The context of this thread is more about drugs and there's a lot of discussion about pharmaceuticals so that was what I was really asking about.
But I guess radio / chemo therapy is on the list, even though I am uncomfortable with the amount of collateral damage they do to the patient in the process (seen it happen so painful topic)
But that is incredibly disingenuous to medicine. You're removing all the things we do incredibly well - to the point where infectious diseases, for the most part - until we reach this disaster warned about in the article we are commenting on - have ceased to be a major burden of disease in the modern world.
That is just remarkable. The reason people are able to make claims like 'all we do is treat sick people, we don't cure them' is because the things that we do well, we do so fucking well it isn't a major issue anymore.
I know very well that my job in a modern first world country hospital revolves largely around treating people with chronic diseases, and that for the most part, I can't do much for them.
For example, when I work in the Emergency Department (Most of my work these days) It is rare for me to 'pick up' a patient that has never had a hospital admission. Most people swing in and out and and out and in and out until one day they don't make it out again. They have chronic diseases caused by a lifetime of either 'just living' or living hard (smoking, drinking, eating too much) and the accumulated damage is BEYOND modern medicine's ability to fix it.
Personally, I think that for many of these chronic diseases, we are beyond any quick fix ever being developed - i envisage a future world where we literally grow someone a new body and attach their head to it so they can go again... the damage occurs on such a cellular (and slightly above that) level - and is so widespread that it is beyond my comprehension how any treatment we are looking at could fix it - although I am an optimist and who would have ever thought we would have the biological treatments we have now for certain diseases, modern miracles that they are.
But we are still WINNING - as pointed out elsewhere in the comments, we now have a cure for Hepatitis C. Hepatitis C is a horrible condition. When I was at med school (graduated 2013) we were taught the 'Rule of 20' for Hep C: 20% clear it, of the remaining 80 20% have no issue, of that remaining 80 20% go on to develop fulminant liver failure. Now we can cure the fucking thing. Absolutely amazing. And there's talk of stem cell injections for damaged cardiac muscle; and since I left Med School the average life expectancy for Malignant Melanoma has risen from <12 months to close to 4 years and growing. This is remarkable. and anyone who says differently doesn't understand the facts, and is being willfully ignorant of the enormous efforts of thousands upon thousands of people who work tirelessly in labs and hospitals all over the world to bring about a better quality of life for the sick
And I would be careful to not make sweeping generalizations about how mainstream medicine makes chronic problems worse. First, most chronic problems are due to population and socioeconomic determinants of health that are often well out of the scope of healthcare providers at least in the inpatient setting. Second, even with chronic problems we have made advances: think about insulin for diabetes, antihypertensives for blood pressure, or statins for heart disease.
The points you made about the causes of those deseases are irrelevant when we talk about treatments. The reasons for a disease are not the reasons for clearly suboptimal treatments. And you certainly can't justify destroying family to lengthen the life of cancer patient for few months, maybe a year, in a general case ?
> ... are willing to take the tradeoff for resolution of acute problem over long term consequences
Meh... majority of acute treatmets have very low long term consequences. AB is not one of those as evidence shows that gut flora may take very long time to recover (or it may never recover) even after single usage (and we know that disfunctional gut flora is bad). But I can probably take a bet that few doses of ibuprofen will not harm me at all. What I am saying is that standard medicine does have many fenomenal things but that people should probably look elsewhere for help about stuff it doesn't handle good at all. This requires everybody to be very well informed, not something most of humans have time or motivation to do.
> We are willing to take those risks because we decide that it is worth it.
No, "we" are taking those risks because doctors tells us its safe and that risks are trivial or non existent (while at the same time bashing supplements as dangerious?!). "First do no harm" should probably be deleted from mission statement. You don't really think that random person knows anything about medicine or that it questions doctor ? Its mostly buisnis only.
Modern medicine not having tools to fix chronic disease says more about the second law of thermodynamics than it does about the state of modern medicine, and thinking that alternative modalities (which have been tried and tested ad nauseum) will do any better is complete madness. But you're welcome to waste your money if you wish.
Now when you get to the price of cancer treatments, fortunately I live and practice medicine in a western country with a universal health system - i don't have to have discussions with patients about whether they will be able to afford a treatment - everyone gets everything they need. The US would do well to introduce a good system here, but apparently that smells too much like communism... even if it does create the horrible situations you allude to
Please don't take it this way - I am in no way diminishing the achievements of modern Western medicine. To say that it has saved the lives of millions of people would be a gross understatement and this fact should rightly be celebrated. I was 'discounting' those things only because they are so obvious that you would frankly have to be dumb not to acknowledge them.
Surgery is a more complicated topic of course - someone gave me an example once of a doctor explaining to a patient due for heart surgery operation that they were saving some veins in their body as donor tissue for when they would inevitably be back for a repeat. So, it's not exactly ideal, right? Yet such surgery is proclaimed as a success.
Similarly when the 'cure' involves cutting away parts of the body as a lesser evil (or chemo / radiotherapy which is in a way similar) then there is also much room for improvement?
> For example, when I work in the Emergency Department (Most of my work these days) It is rare for me to 'pick up' a patient that has never had a hospital admission. Most people swing in and out and and out and in and out until one day they don't make it out again. They have chronic diseases caused by a lifetime of either 'just living' or living hard (smoking, drinking, eating too much) and the accumulated damage is BEYOND modern medicine's ability to fix it.
This is the real point that I wanted to get to. You can go a long way with correct nutrition and healthy lifestyle and yet there seems to be relatively little attention paid to it (I don't consider some leaflets in the GP surgery, or an article here and there in the press as adequate attention). And as you said in your earlier comment early diagnosis of a condition before it has chance to really set in and cause irreparable damage. This is not a problem for the individual doctors to solve, but it should be something addressed by medicine in general as well as government policy (and consequently a lot more money than is currently being invested into it it seems). Otherwise what you are doing is the same thing as we call 'firefighting' in IT - constantly fixing up the symptoms and not fixing the root cause of the issue.
And it is here that Chinese medicine could have the biggest impact (alongside Western medicine rather than in opposition to it) with it's emphasis on prevention, in-depth and continuous diagnosis, tailoring the treatment to the individual and holistic treatment of the patient (as an interconnected process rather than a collection of individual parts to be treated or removed as necessary). Uneducated people immediately think of acupuncture and herbs as being what Chinese medicine is about but these are only tools and are considered to be 2nd class medicine anyway compared to preventing illness and enhancing health.
That is exactly what medical primary care providers do, up to the point of the magical "holistic treatment", where your definition turns muddy. Clearly, doctors understand that the body is an interconnected process. The only difference is the treatments you pay for are actually studied scientifically to validate their efficacy.
Given the alternative of dying now, it may very well be a success to get whatever time that surgery has granted them even if they'll need repeat surgeries in the future. As the physician you're addressing said- we would love to grow these people new hearts or entire bodies but our medical knowledge hasn't yet reached that point.
As to the bit on correct lifestyle, you're speaking as if this isn't something that all relevant health care professionals are already preaching. The unfortunate reality is that most of our patients would rather slowly kill themselves than adapt the lifestyle changes we recommend. Even without our input they're bombarded daily with nonstop messaging about how they should be slimmer, eat better, and exercise more. Culture is powerful, and a lifetime of overeating and being sedentary isn't going to be remedied in a 15 minute conversation with a physician despite our best efforts.
I agree with you here, you need to incentivise people who would otherwise not plan ahead. We need to design our cities better, we need to get people more active, we need to improve social supports and interactions so that people's mental health is better. Sadly it doesn't look like much of the world is in a hurry to fix these problems.
I do however completely disagree with you in regard to Chinese medicine, which is, from the position of efficacy, utterly worthless.
Show me a well designed study that proves otherwise and I'll eat my hat, but in my years of study and investigation of alternative medicine the only study I am aware of that showed usefulness of Chinese medicine proved that it was 'time with practitioner' that resulted in the improvement, ie. talking to them about your problems, having a sympathetic ear.
This makes sense because so many problems and hospital admissions are psychogenically driven - people derive great comfort from being able to externalise their existential angst. But Chinese medicine is not medicine. Strip the bullshit and hand waving from it and call them therapists, and go to your Chinese therapist - but don't call it medicine because they aren't treating shit
Over there, it's common for (real, medical, certified) doctors to prescribe (as in, write on a sheet of paper and stamp) specific herbal teas. Which are sold in pharmacies. And they do help for sure.
- Hypericum Perforatum [1]
- Ashwhaganda [2]
Please discern the difference. You are a "doctor programmer" in your profile. This is disturbing.
There is a whole field of preventative medicine (also called population medicine) that aims to reduce the burden of disease.
Ever seen an advert for exercise? Seen warnings about levels of obesity? Seen an anti smoking sign? Received a vaccination? They are all driven by doctors, who aim to change behaviour to reduce the burden of disease.
There is enough disease and sickness to keep all the doctors of the world employed even if we were actually able to fix all the problems people currently have.
The major problem is, we don't have tools to fix the issues that are major in western societies: they suffer chronic diseases, and the problem with chronic disease is that they are very hard to treat (degenerative bone disorders, arthritis, emphysema and bronchitis, cardiovascular disease, neurodegeneration, diabetes and diabetes-related complications, many many others)
Don't drink the cool aid that has been thrown around... the problem is changing behaviour is hard - no-one wants to do it until they start suffering, and then it's too late. The idea that doctors are sitting there enjoying this windfall from patients they allow to get sick just so they can keep bread on the table is quite frankly extremely offensive and basely ignorant
"Making every contact count", a UK initiative to make sure that doctors[1] use every opportunity to promote smoking cessation, alcohol use reduction, weight loss, and other lifestyle adjustments.
Wow, that's truly the nanny state at work. I like tobacco, I enjoy smoking and I'm working on my weight. I hate it when I go to a physician's office and get offered the standard blurb about how smoking tobacco is apparently only slightly less lethal than mainlining cyanide with an arsenic chaser.
Frankly, that's a major reason why I don't bother going to see one. My body's working well enough, and while it'd be nice to know that my organs are in good condition, I don't want to deal with someone who doesn't respect me.
Why the fuck are you going to a doctor if you don't want advice that will treat your illness?
And this is the point: a lot of health problems are preventable, and it is your doctor's job to tell you how to avoid those health problems.
But then of course my comment was at least in part sarcastic. An advice can always be a good thing; on the other hand, my first reaction at the idea is to think that I'd like my doctor to listen to whatever health issue I have and solve it, rather than giving me paternalistic advice. As if we didn't have enough already.
Edit. Grammar.
You've never heard of preventative care visits? Annual physicals? Baby wellness exams? Vaccinations? I'm incredulous.
[1] http://articles.mercola.com/sites/articles/archive/2015/11/0...
[2] http://edition.cnn.com/2015/10/16/health/annual-physical-unn...
Market size and total profit over the lifetime of the patent is the primary factor that is considered at every step from random screening to clinical trials. Spinning up a clinical trial requires many tens or hundreds of man-years of work by very specialized and hard to find scientists/doctors before you even sign up your first human subject so even the biggest pharma companies have limited bandwidth. This forces them to be very selective, even when they have multiple high-potential targets, and that means choosing to run the clinical trials for drugs with the highest potential ROI and lowest regulatory approval risk. For a variety of reasons, cures are usually much more complex and difficult to develop and get approved than simple drugs that treat symptoms and since the US has a complex, opaque network of insurance companies instead of a single payer, no one is in a position to negotiate prices that maximize healthcare ROI at scale.
There is little incentive for pharmaceutical companies to develop cures for diseases when they can provide a "good enough" quality of life boost for the entire lifetime of the patient and sell it for the exact same price. This means that often times cures won't even be researched past animal testing because the pharma company has a large pipeline of less risky, more profitable drugs to get through the FDA
Second, it's typically the science that limits the effectiveness of therapy, not the potential ROI. The reason why many drugs only treat symptoms is because that's the best science can do right now.
Third, curing a disease can often have a much better ROI than just treating symptoms forever. Look at Gilead's hepatitis C cure. Before it came to market the drug revenue for that disease was maybe $2 billion. The first year that Gilead's drugs were on the market, they sold $12 billion. The cure was way more profitable.
If, just as a thought experiment, it was possible to treat a disease quickly with a cheap drug or intervention, for example a cheap herbal drug that is available patent-free and for mere cents per liter, there would be no business in it, so no company could viably pursue this. The market selects for treatments that give a lot of profit. That always or even merely "usually" automatically somehow translates into the best option from a public health point of view only if you close your eyes and make lots of assumptions about how great the market magic works - in a market with extremely unequal information and very high pressure on customers (when you are sick).
On the other hand you are right that symptom treatment usually is the best we can do. The body is built during the early years and from then on it's maintenance, also what the body itself does and not just the doctors (it does not regenerate most structures, only repair). Just more and more ever more horrible hacks, workarounds and kludges and patches delaying the long decline more or less well. Or as most drugs do, don't even repair anything, just push levers and buttons in the body, but it doesn't do anything structural unless the body does it on its own. So if the structures don't regenerate the button-pushing drug has to be take lifelong.
That is so fundamental to complex life forms that current medicine simply cannot work against it. Maybe never, because replacing a structure in the grown body is much more difficult than growing it with everything else. For example, the difficulty of finding the path for new axons after a spinal injury is much greater than building everything together during very early development. Medicine would not just have to achieve what nature already does (when the body is assembled) - it would have to become far better! Repairing something often is much more difficult than starting from scratch.
At that level of cheapness, individual patients can buy it themselves. If it became popular enough, somebody would research it. That's already happened with many Traditional Chinese Medicine herbs. Of course, they turned out to be ineffective but one of them might have worked.
I wonder how low the average HN reader IQ has gotten lately that my insightful comment got downvoted and that I have to deal with crap like yours. Way too many total little teenagers and idiots on this site now.
Either you're using a wildly different definition of "biotech companies" than the vast majority of people in the life sciences industry or we're talking about entirely different things. Comparing biotech ventures to established pharmaceutical giants and their research pipelines is like comparing a seed stage social network startup to Google: it's a nonsensical and uninformative exercise. The entire biotech industry exists because the pharmaceutical conglomerates are willing to pay hundreds of millions to billions of dollars for a single promising patent acquisition as long as VCs, LPs, and Joe Shmoe's pension shoulder the 99% failure rate. When you're a biotech, you're not afraid of cannibalizing existing revenue or wasting precious resources better allocated elsewhere and pharmaceutical companies are perfectly willing to let everyone else light their money on fire. The successful biotech investors that have decades of positive returns most certainly look at market potential when deciding where to invest but even they have to make wild shots in the dark because they lack the massive amount of data that pharmaceutical companies work with.
Oh and "typically the commercial viability of a drug isn't examined until about phase 1" is downright false unless "until about" means years in advance. Any biotech company that hasn't figured out whether to treat their potential targets as normal or orphaned drugs by the time they get to animal testing has no business developing medicine and spending other people's money in the process. That most basic step necessitates analyzing the market potential of drugs.
> Second, it's typically the science that limits the effectiveness of therapy, not the potential ROI. The reason why many drugs only treat symptoms is because that's the best science can do right now.
That's obvious, given that ROI doesn't effect biochemistry. There is a whole universe of molecules but which ones we actually find out about and bring to market is dependent on a complex equation balancing luck, science, and a bunch of actuaries. Biotech companies can ignore that last one because it's not their cash that is going up in flames.
> Third, curing a disease can often have a much better ROI than just treating symptoms forever. Look at Gilead's hepatitis C cure. Before it came to market the drug revenue for that disease was maybe $2 billion. The first year that Gilead's drugs were on the market, they sold $12 billion. The cure was way more profitable.
I don't think you could have chosen a worse example to make your case. Sofosbuvir was a once in a lifetime discovery made by a biotech startup, Pharmasset, that resulted in the largest pre-approval acquisition and one of the fastest FDA approvals for a major drug in the history of medicine. That company was started in the late 90s with the express purpose of curing hepatitis C and the second it was clear that Sofosbuvir was on the road to breakthrough therapy designation by the FDA, every single pharma company was scrambling to acquire it. The only way to get such a designation is if the existing treatments had a high toxicity, caused many unbearable side effects, and weren't that effective in treating chronic infections with a rapidly oncoming patent cliff. For all intents and purposes, there was no consistently effective treatment for hepatitis C, let alone a cure, before Sofosbuvir.
Oh, and what happened next? Gilead lost almost half of its market cap from its 2015 peak after missing quarter after quarter of earnings estimates and downgrading revenue projections for its entire antiviral portfolio. If competition continues chipping away at their hep C products, their 2011-2015 gains (80+% of their peak market cap) will be wiped out. That's what a cure gets you: a shrinking market and brutal competition that wants to cash in before the well runs dry.
1. Yes, companies will target certain diseases based on their economic viability. However, the work they do is about 5% of what's required for a fully vetted molecule. Take the number of patients and multiply by some price pulled out of the air and they can slap "a $5B potential market" on their pitch slides. Until they actually have some clinical data and start to dig into the pricing/reimbursement environment, those numbers are just wild-ass guesses. How do I know? My old job was doing commercial assessment for in-licensing and phase 2 molecules. Even the big companies had to shut down programs post-phase 1 because their initial commercial assessment was way off the mark. To say that hundreds of clinical programs never make it past screening because their don't have a good ROI isn't true. Companies just don't have enough data that early to make those kind of calls.
2. Sure Gilead lost almost half their market cap in 2015 since they were missing estimates. But that was simply because they missed some pretty ridiculous earnings goals. The fact remains the company made tens of billions of dollars over a couple years based on selling a cure. Both of their HCV drugs sold more in two years than most drugs sell over their entire lifecycle. They were simply a cash cow.
Sure we have a lot of drugs related to Morphine, but most of them are not significantly different from Morphine as to be worth high prices. When viagra goes generic at the end of the year the hurdle for the next male 'enhancement' drug ratchets up.
The other problem is that in a fee-for-service model, health care providers get paid a lot more for major procedures than minor ones, and they may get paid again to fix any complications that arise. So, there isn't a good incentive structure to reward fixing problems quickly and cheaply. Whether single payer fixes that problem will depend on how it's implemented. (I think there was an experiment done awhile back where Medicare stopped reimbursing hospitals for patients who were re-admitted due to infections following surgery. The result was rate of surgery complications went down.)
I kind of wonder if maybe there should be a bounty program for fixing minor problems before they turn into major problems. Just this last week, I had an adenoma removed from my colon. I haven't seen the bill yet, but it was a pretty routine, minor procedure. If I hadn't had it removed, it would have probably become cancerous within the next year or two (according to the doctor that removed it), and if it were any bigger it might have required a much more invasive procedure to remove. So, fixing it now saves a whole lot of medical expenses down the road and saves me a whole lot of unpleasant experiences. It seems kind of a shame that the doctor who removed my adenoma isn't rewarded (except in the knowledge of a job well done) for that.
If patients can switch insurers at any time, then an insurer that spends a lot of money on preventative care only sees a small fraction of the benefit; they lose it whenever the patient switches away. And if you spend 'too much' money on preventative care, you'll probably end up losing customers to cut-rate insurance providers with lower premiums.
If instead we could measure health perfectly, then you could set up a system where if a person is made unhealthier by an insurer, then the old insurer has to compensate the new insurer whenever someone switches. But we don't really know how to measure health, if by 'health' we mean having a low probability that a person will become sick in the near future; we usually can only notice once a person becomes sick.
This assumes there's only one drug company. If company A's medicine heals me an company B's medicine does not then I chose company A's and company B's goes out of business.
So no, a drug company does not have an incentive to keep me sick.
That's not to say there aren't improvements that can be made: All Trials [1][2] is one campaign to improve the system.
A second thing your statement supposes, is that people prescribing drugs in first-line care have the same agenda as people doing medical politics, or at least are not concerned about the well-being of their patients. Every profession has its black sheep, but I think you severely underestimate the drive docs have to see their patients do well, and the self-esteem hit we get when things go wrong.
Maybe there's an alternative way to fund them, or an alternative way to deal with infections in the first place.