I don't really understand the downvotes and reactions of the other commenters to the gp's post. There's a whole bunch of studies showing there's less incentive to find cures opposed to ongoing treatments under for profit health systems.
On a website where products as a service are discussed regularly i'm confused as to how the parallels between that and profit driven 'healthcare as a service' are ignored or looked at with hostility.
Thanks for pointing that out. Sorry for adding to an offtopic, flamewar inspiring subthread. I hoped providing some sources for the GP's comment might spur on some more productive discussion and i genuinely thought the other commenter was asking in good faith about sources for discussion. I was also genuinely curious as to the harsh reaction
I do see now the flamewar aspect to it and didn't really stop to consider the initial topic of the article when I responded. I was just trying to focus on the actual topic of the commenter's statement and kinda got lost in searching up articles. I was hoping to maybe bring some data and information into the discussion that might steer it in a more productive direction.
It is an issue that could productively be discussed. It seems it didn't end up being the case though and probably wasn't the most appropriate comment thread to do so on.
Thanks—I appreciate that! We all underestimate how provocative our posts will end up being. I struggle with this daily.
I think it's because in our mind, the comment is blended together with the intention behind the comment, which is usually benign. We take our intent for granted and assume it will come across, but of course the people who read it have no direct access to that intent, and often it doesn't come across.
> Is the flamewar tangent part of this the comment on capitalism or "Capitalized medicine"? Doesn't really seem flamie to me but obviously others disagree.
The problem is the generic ideological tangent. You can perhaps (maybe!) imagine a substantive article and thread on the economics of cures vs. treatments. But that would require different initial conditions—primarily an interesting, informative article that brought lots of relevant information. Relevant information is flame retardant.
The situation is different when the topic is "FDA approves first monthly injectable to treat HIV infection" and the comment is swerving generically into "capitalized medicine". Generic tangents, especially when the impetus is snarky or unsubstantive, make threads reliable less interesting, and generic ideological tangents almost always turn into flamewars. The reason is that there's very little specific information to discuss—that's the meaning of "generic".
Off-topic tangents can be great when they're unpredictable and curious, but generic tangents are the opposite of that. They're more like getting sucked into the gravitational field of a much larger body, if not a black hole, that pulls all nearby topics toward itself and renders them all the same. Avoiding repetition is the biggest problem that a forum like HN—dedicated to curiosity—actually has, so it's a big deal: https://hn.algolia.com/?dateRange=all&page=0&prefix=false&so....
I hope this helps explain things a bit. There are lots of past explanations at https://hn.algolia.com/?dateRange=all&page=0&prefix=true&sor... also, but you'll unfortunately—and ironically—have to wade through some generic repetition to find the interesting bits.
If you mean in this case, that may be, but it's certainly not true in the general case.
Moderation comments have multiple functions. If it were just about this specific case it wouldn't be worth spending so much time on it, but they're also opportunities to explain the principles of this site to readers who might not have encountered those principles yet.
For those who do already know this stuff, it's true that such comments are tedious. I'm sorry about that. If it helps at all, they're even more tedious to write than they are to read.
A comment that spawns a lengthy subthread of meta trying to parse out what the commenter actually meant, why precisely they are being downvoted, etc, is bad. As is the subthread of meta.
I am sure there is some evidence on both sides, but at the end of the day, people get into medicine and medical research to heal people, not keep them sick. The USA does not have the only medical system in the world and many countries run their systems with the goal of controlling costs, not increasing them. I don't think this kind of pessimistic conspiracy thinking adds to the conversation.
If there's more money to be made from keeping people sick than outright curing them, that logically is a disincentive from curing them.
It's not conspiracy thinking to look at the incentive structures within systems to predict possible negative outcomes.
Of course, there's a moral incentive to not keep people sick, but history shows that we can not rely on people acting morally. The pessimism is justified.
If we expect companies to provide cures over treatments, we at least must allow them to profit as much or more from a cure as they would from a treatment.
> we at least must allow them to profit as much or more from a cure as they would from a treatment
I think that’s where you go wrong. There are huge profit incentives for a cure. If a biotech company comes up with a cure they will instantly have the business of every afflicted person on the planet. The market for that and price they can charge will be way larger than a slightly different treatment.
Beyond that, there are labs all over the world funded by public dollars to research avenues to a cure, it’s just way more complicated than effective treatment.
There are indeed huge profit incentives for a cure. There are even larger profits to be had from a monthly treatment that the patient has to take for the rest of their lives.
Are you saying people that aren’t taking a monthly biologic injection for example will start coming out of the woodwork for a cure when normally they wouldn’t seek treatment for their malady?
You speak as if there is just one entity making these things. There isn’t, there are hundreds of labs all over the world working on this. If one of them comes out with a treatment alternative like this it may gain some traction but if they came out with a cure they would dominate the global market
> It's not conspiracy thinking to look at the incentive structures within systems to predict possible negative outcomes
It is when one mischaracterizes the system.
Medical research is not an oligopoly. It is oligopolistic within some domains, but as we've seen with the Covid vaccine, there are at least four nation-state domains (e.g. Russia, China, India and "the West") operating competitively, and within those domains, there are varying degrees of competitiveness (e.g. Pfizer vs. Moderna vs. AstraZeneca).
If you have a cure to something everyone else can only treat, you'll make a money selling the cure and taking your competitors' market share. Because if you don't, they will. It's a classic cartel / prisoner's dilemma problem with the added explosive of a multi-decade patent-protected monopoly for the first mover.
I'm not sure every claim is worthy of debate. Setting aside all the private investment and philanthropy dollars going towards a cure, governments spend billions annually on HIV research.
Yes, they spend billions on developing the exact types of treatments that this article is about. Their business model depends on maximizing revenue so any treatment cannot cure the patient and it cannot kill the patient. Sad, but true.
> I'm curious what evidence there is on either side of this claim
Looking at the list of the most deadly non-tropical infectious diseases [1], most can be vaccinated against and/or cured. The standouts remain lower respiratory infections, e.g. influenza, and HIV/AIDS.
When confronted with a novel coronavirus, it took a few months for the world's medical systems to devise various treatments and a vaccine. Neither of those are recurring revenue streams.
Most damning to this conspiracy theory is the recent Hep C cure. That's a real disease. It was profitable to treat. But it's more profitable to cure. Those incentives remain elsewhere. A cure for HIV is worth billions.
Dealing with mortality and sickness is difficult. It's more comforting to some to imagine an evil cabal holding back medicine, and I don't need to take that from them. But if you're entertaining these thoughts as anything more than a coping mechanism, the last half century--or even decade--of progress in curing, not treating, curing a variety of medical issues has been under-reported (lots of niche illnesses) and breathtaking.
The Hep C cure wasn't all that profitable, from what I understand. On paper it was a clear win-win - the cure would save the various healthcare services lots of money compared with treatment, whilst still raking in boatloads of money. The trouble is that healthcare services everywhere balked at buying it regardless of their structure and despite the fact that not doing so would cost them money in the long term, and even at those rejected prices it wouldn't have been nearly as profitable as a long-term ongoing treatment because it eliminates its own customer base.
I came here to post about the Hep C cure. You did a great job.
Only thing I would embellish on is that, much like software - when something is wrong its easier to treat the symptoms than to fix the problem a lot of the times. So it's really no wonder alot of treatments are amelioration rather than cures.
I recently did a major refactor at work to fix database and caching problems in our backend. It took months but only yielded 50% scaling improvements. Past teams just kept stacking shit and adding hardware and we can all understand why.
You needn't use your real name, of course, but for HN to be a community, users need some identity for other users to relate to. Otherwise we may as well have no usernames and no community, and that would be a different kind of forum. https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...
Well not sure if it is "evidence", but in terms of marginal preventing people in the US from getting HIV, lowering the cost of Truvada from $2,000 out of pocket and publicizing it would likely have a much larger impact than this once a month shot.
The claim logically holds together. There is even evidence on its side.
But one reason for the downvotes may be that it might be too narrow-minded. For one thing, it completely neglects to consider the relative difficulty of treating symptoms versus being fully curative. Secondly, it half undermines itself by lumping vaccines into the same bucket as symptomatic treatment. Clearly the economic incentives for vaccine, versus symptom management, versus cure depends on the disease being treated.
Finally, while it carefully uses the word "incentive" instead of talking in black and whites, it doesn't explain why "big pharma" makes cures at all. A lot of the the supporting material for "pharma makes more money on symptom treatment" references Gilead's experience with Hep C. But the economics of how that drug would have worked was clear as day before Gilead spent resources of it. So why would Gilead have gone to market with a cure at all?
The claim doesn't logically hold together: it assumes a monopoly in medicine. It might not be profitable for the company with a treatment regimen to develop a cure. But for the company without the treatment regiment to develop a cure and take away all of a competitor's business and capture a significant part of it as their own? That's extremely profitable. You can charge far more for a cure than for a regular preventative treatment (per dose) so margins are far higher even if volume over time is lower. Suffice it to say cures are sufficiently profitable to enough of the actors in the system that they are worth exploring. And there is evidence of cures being researched successfully as referenced in the comment above. Also, I don't think all pharma companies are perfectly 'rational' actors in this sense. They are composed of people who got into medicine with the interest to help people, and those people know both cures and vaccines help more than just symptom mitigation. The motivation of the actors in the system to do good leads to even more research of cures and vaccines than the non-zero amount that is sufficiently incentivized (even if cures are less profitable than symptom mitigations).
