> Pharma’s burned billions chasing this as it’s possibly the biggest market imaginable.
To be clearer, Pharma is chasing a nice long treatment plan, that will require expensive drugs till the end. Pharma does not heal - this is not good for business. So there are criteria around what they are searching for.
> To be clearer, Pharma is chasing a nice long treatment plan, that will require expensive drugs till the end. Pharma does not heal - this is not good for business.
This is a trope regurgitated by people who don't know any better. It would imply that pharma are deliberately avoiding research directions that would generate cures, or (even worse) discovering cures and putting them in a dark secret safe somewhere.
The reality is that drug development is serendipitous and really hard, and any company seeing even a sniff of a drug that works will throw everything behind making that drug a success. During the early stages of investigation of a promising new agent, the animal data can't predict much, and certainly can't predict whether something is "curative" - this would only be seen during human trials, after which hiding that benefit would be close to impossible. It's just not how it works.
There are plenty of examples of actual (rather than functional) cures being developed and marketed:
1) Previously-untreated DLBCL (a type of blood cancer) can be cured. CHOP chemotherapy cured ~35-40% of cases. The addition of rituximab boosted that to 60-65%. There then followed a long string of failed phase III studies (probably billions spent, cumulatively) trying to beat rituximab + CHOP, and finally in recent years there has been some success. So: multiple attempts across multiple pharma companies, trying to improve on an already impressive cure rate... not much evidence of an anti-cure conspiracy.
2) Hepatitis C - cures were discovered and marketed from ~2014 onwards; now ~95% of cases can be cured with a treatment lasting only a couple of months. So: multiple treatments, from multiple pharma companies, which offer a hugely effective cure for a pretty unpleasant disease.
From the human perspective, researchers are people, and they do have their incentives. Making a breakthrough, of any kind, is important for them - even if for their career (but many do genuinely care and want to help humanity as a whole).
From marketing and sales perspective, look at what happen to pharma companies capitalization when Ozempic appeared: a relatively small Elly Lily suddenly got bigger then Merck, Novartis, Roche or Johnson & Johnson. You can hardly call it a long treatment plan with expensive drugs "till the end".
Really, there is a lot of bad things going on in healthcare and pharma industry, but the conspiracy theory "they don't want to invent efficient drugs" really makes no sense when you dig deeper.
I agree with you but Ozempic is a bad example here. Part of the reason it is so valuable is that patients usually must take it for the rest of their lives. Its actually the perfect example of “evil” pharma since patients slmost akways regain the weight if they stop taking it. This leads to dependence or people searching for grey market sources.
An example of “good” pharma would be Hepatitis C. We can now cure that. Although, pharma is charging the lifetime equivalent in order to do that (a treatment can run over $100k and insurance balks at covering it)
So pharma will absolutely develop a cure if they can. They however will still charge you as if you had to take a dose for the rest of your life.
> I agree with you but Ozempic is a bad example here. Part of the reason it is so valuable is that patients usually must take it for the rest of their lives. Its actually the perfect example of “evil” pharma since patients slmost akways regain the weight if they stop taking it. This leads to dependence or people searching for grey market sources.
Not really. Note that it's not taking ozempic for life vs taking nothing for life, but actually taking ozempic for life vs taking ozempic and 5 different medications for life when obesity related illnesses bite you in the ass. So generally ozempic still is "good" pharma (and the plot twist is that almost every pharma is good pharma!).
It's ridiculous to say that pharma is "evil" simply because it isn't a one time treatment, especially when you don't know if a one time treatment is even biologically possible. The water company isn't evil for failing to provide me a single glass of water that meets my lifetime hydration requirements.
> Part of the reason it is so valuable is that patients usually must take it for the rest of their lives.
Well yes, Ozempic doesn't solve the habits of a bad diet.
The weight rebound is surely due in little part to removal of hunger suppression as in "hormone rebound", but if you resume eating 5000+ kcal/day because you don't have something that keeps you from doing it, you'll end up in the same situation as before. Ozempic was never meant and is not going to fix your diet. That's a psychological and environmental problem.
Which illnesses have been cured? Diabetes, cancer?
> From the human perspective, researchers are people, and they do have their incentives. Making a breakthrough, of any kind, is important for them - even if for their career (but many do genuinely care and want to help humanity as a whole).
Researchers are people, but they are paid and directed. They can't go off and do what they like. The corporation directs them, and they are paid for their efforts. Researchers (and all working people) aren't doing what is right - they are doing what they are paid to do.
All the financial upside for pharmaceuticals is in prolonged treatments. It is a 'long sickness' industry. This is perhaps too bitter a pill to swallow for most, so this is where marketing and education come in with the sugar.
I've hung out with a lot of pharma folks, and the business is really complicated. Most of the companies aim to both help people and to make a lot of money, and will choose projects based on some balance of those -- sometimes in dubiously ethical ways (e.g. tweaking formulations of existing products to extend the patent) and sometimes in basically fine ways (e.g. lots of the improvements in diabetes management which have helped a ton of people; at least the targeting is fine here though often not the pricing). Obviously chronic diseases that affect lots of rich people are a prime target to make money, so drug companies make lots of drugs for these, and they usually aren't curative because chronic diseases are hard to cure (but see e.g. Hep C which is now curable). There are also companies with rich investors who want to cure death, or at least cure particular diseases that they fear or have a genetic predisposition to (lots of unethical behavior from a certain now-defunct company that tried to do this).
For cancer in particular, pharmas don't (and mostly can't) just target a drug to chronically treat some cancer over the long term but not cure it. Instead they pick some target that's believed to contribute to development (/ metastasis / treatment resistance / whatever) in whatever cancer, and make a drug to interfere with it or to target an immune response to cells that make it. If it's stable, nontoxic, and looks potentially effective enough they'll take it to clinical trials. During clinical trials they'll find out whether it does nothing, gives you a few extra months, or has a chance at curing the disease. Usually the answer is that it does nothing or almost nothing, or isn't worth the side effects, and then the company wasted its time and money. Drugs with a chance to cure common types of cancer can be enormous successes -- see eg Herceptin.
Cancers are difficult diseases and it's rare to find something that reliably cures them. But drug companies aren't pulling their punches. Like they would never say "oh this drug clears breast cancer too reliably, we should make it less effective so that people will be more likely to die but also might take it for longer".
But researchers are not necessarily paid by corporations, and governments, foundations, and such are generally more willing to hand out grants that forego short-term profitability for long-term gains. And while a company might not be interested investing in research that could undermine one of their core products, that obviously does not apply to competing companies that do not already have corresponding products. What better way to break into a market, than to render your competitors' products obsolete?
> Which illnesses have been cured? Diabetes, cancer?
Chicken pox, polio, hepatitis C, dracunculiasis, yaws, malaria (on the way of it), tuberculosis, syphilis, everything that can be killed with antibiotics, rubella...
Imagine your role is allocating spending on $10B/year of medical research and you are presented with two strategies: spend everything searching for the cure for one poorly understood condition, or allocate to treatments improving standard of care for 100 conditions.
Improving standard of care for 100 is less risky/more profitable because you have more shots at an expensive process with a high failure rate. And it is a lower bar to improve patient care than to permanently fix a medical mystery. But there is another factor. Focusing on treatment/management over cure most likely maximizes the positive impact on patients within the the constraints you work under.
There have been at least three new major treatments for a chronic thing I have that received FDA approval over my lifetime. Those treatments have had a massive impact on my quality of life, ability to have a career, etc. I don't believe that happens for me if we allocate to cures.
I'm genuinely glad you have new treatments and its improving your quality of life.
The point I am making is that you are a/ not getting cured, and b/ paying a lot of money. The reason for this, is this is best strategy for maximising profits. Its really the exact same model as your local heroin/crack dealer.
Please set me straight if those conditions differ in your case.
Profits are what pharma companies want.
The consumer is mostly labouring under the illusion that companies want the best for you. They are not your mum. They want what's best for them. And, most people would do the same - no one is gifting anyone health.
All I'm saying is let's drop the illusions and fantasy and call a spade a spade.
The local illicit drug dealer comparison doesn't apply because you can't simply ignore the development time and cost of FDA approved drugs. My post was about allocating limited capital to pharmaceutical research, and maximizing benefit.
Again, if your choice is improving quality of care for 100 conditions or trying to moonshot your way to curing one disease, more patients benefit from the former even if pharma also profits more.
> Which illnesses have been cured? Diabetes, cancer?
Type I diabetes - no, but this is a condition in which the body attacks the part of itself that makes insulin. So by the time it happens, it's too late. Sadly, we're generally bad at understanding and preventing autoimmune diseases, but this needs more basic research, not drugs.
Type II diabetes - essentially a lifestyle condition. May be functionally cured in some/many cases with strict lifestyle interventions. Ironically, GLP-1s may help move some people towards a functional cure.
Cancer - yes, where possible. The open secret is that the best way to fight cancer is to not get it in the first place, or failing that to catch it very early, but these are issues of lifestyle and public health policy - both of which we're currently very bad at optimising, as a species.
> All the financial upside for pharmaceuticals is in prolonged treatments.
Even without understanding pharmaceutical research, your claim to understanding business strategy is braindead: there is not 1 pharmaceutical company. And many pharmaceutical companies work on treatments for the same conditions and diseases.
Why would any competitor sit on a cure for a condition there opponents can only treat when in the short term you'd post amazing next quarter profits, and in the long term you'd financially diminish that competitor in the market place even if we grant the position that you are somehow able to find treatments that aren't cures (others have explained ably why this isn't how it works).
Everything looks like a conspiracy when you don't understand anything.
They want something that actually works, foremost. If the thing they sell doesn't work, then when someone figures out something that does work the thing that works will be preferred by the doctors.
to put a finer point on it, to be able to gouge sick and slowly-going-crazy people for lots of money you have to have something that actually solves the problem.
can't mark-up snake oil, not in ways to shift the stock price for Fortune 100 tier companies -- too many lawsuits and visibility
Isn't it funny that we're so used to the misuse of language (ie lies) that this isn't even a point? I'm talking about software flags to represent your choices, that are merely an 'aspirational intention' and don't actually correlate with reality.
In my world, it shouldn't be possible to override 'turned off automatic downloads'. 'Off' shouldn't be a pacifier for the user, while Apple, Google or whoever can continue installing whatever they like. This isn't what words mean. There isn't actually a choice, but it misleads you into thinking there is. I'm sure there are legal words around this in the "ownership" contract, but "off" can't really mean "on".
hEDS - Hypermobile Ehlers-Danlos Syndrome, I think. "Hypermobile Ehlers-Danlos syndrome (hEDS) is a heritable connective tissue disorder that causes generalized joint hypermobility, joint instability, and chronic pain."
HSD - Hypermobility spectrum disorder. "Hypermobility spectrum disorders are a group of heritable connective tissue disorders where joints are flexible enough to cause problems such as instability and pain."
In practice HSD was an evolution away from benign hypermobility so it’s generally considered not to cause issues beyond the physical discomfort.
hEDS is considered too rare and to actually diagnose someone with it would mess up their health insurance for a condition doctors don’t believe can be treated. So they avoid diagnosing it which creates prevalence data that feeds back into the initial assumptions.
My view of HSD is that it is just a milder hEDS and all the other problems still exist even if most are not detectable. Most people spend their lives being told nothing specific is wrong with them and how are they to know better, after all doesn’t everyone get tired from time to time. Because I’m good at stats I was able to figure out that either I’m the unluckiest person ever or there is a common cause.
My opinion (probably an unpopular one) is that tracking for advertising is merely the excuse to justify widespread surveillance. I don't think all the advertising revenue that is purported to be in play stacks up. I personally do not think advertising directs my purchasing. I don't think it directs others either.
I get that this is Google's business, but perhaps a large amount of their 'business' is actually from the government system (directly or indirectly) - they merely have to pretend to be running an advertising business.
I'm saying that the whole point of advertising was surveillance from the beginning.
The difference is the intention. A corporation maybe tracking. The same data, once given to the governance surveillance teams, is then used to surveil. Same info and mechanisms.
But you could pour water at the fire from across the room!
Lower gravity is giving the defender an advantage over the elements... at least until it gets low enough for things to start floating, when this flips around. In microgravity, water turns into floating blobs, but fire turns into actual floating fireballs.
Water blobs vs. fireballs. Pretty sure there's a nice videogame idea hiding in there somewhere.
It’s not like those scientific definitions are particularly consistent or stable, though. In a large part it’s still a matter of convention when it comes to non human species as well
Science, or you, can make up whatever definitions they wish. The question is not if a definition is "true", but what it's useful for.
Sure, you - or scientific authorities, whoever they might be - can declare that there are multiple modern human species. The question is, what are you intending to use that definition for?
That applies to other branches of the tree of life, too. There's not some objective genetic distance measure which says what's a species and what is not. It can vary widely on different parts of the tree. But it's driven by pragmatism - sensible biologists will not waste time arguing whether some mushrooms should be one species or two, if they otherwise agree on the facts.
If you can't say plainly and clearly what the purpose of your delineation is, and it's in your own part of the tree, of course people are going to have their suspicions.
To be clearer, Pharma is chasing a nice long treatment plan, that will require expensive drugs till the end. Pharma does not heal - this is not good for business. So there are criteria around what they are searching for.
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