It wasn't a rhetorical question. I could imagine an entity like the Gates Foundation proving seed funding to bootstrap a non-profit pharmaceutical company. That company could fund R&D through sales of its newly developed medicines. No shareholders. No stock buybacks. But somehow this doesn't seem to happen, at least not on a scale that reduces medical costs for consumers.

Because those researchers could be shareholders of whichever biomedical startup they will create instead of a non-profit.

Because they make more money currently. Why would they choose to make less? Altruism??

I use to believe that. I then discover some private groups of people sharing a disease doing all kinds of trials. Nothing was to absurd. Almost brute forcing the problem. I thought a wiki written by mostly dead people was quite humbling.

There has to be some middle ground between the 2 branches of insanity?

> It's just funding.

And to have funding, you have to attract investors. How to attract investors? By making it quite profitable to invest in the company, i.e. making it profitable for the shareholders.

With enough money, you can do anything big pharma is doing. But how to get that money consistently is another question that have an uncomfortable answer. Plenty of startup and small biotech companies go bankrupt every year. This isn't something you can do in a garage and turn it into a multibillion dollar business like software. Biopharma has too many regulations and rules to follow and it makes the entire field incredibly risky and less likely for a small and unattractive player to succeed, even if they are driven by passion.

CureDuchenne Ventures is a non-profit organization but functions like a VC firm. They provide funding for startup drug companies in exchange for equity, then return the profits back to the parent foundation rather than to LPs.

https://cureduchenne.org/ventures/