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Goldman Sachs Analyst Asks Whether Curing Patients Is A Sustainable Business Model

from the better-to-ask-whether-the-traditional-drug-development-model-is-sustainable dept

Wed, Apr 18th 2018 10:39am — Glyn Moody

Pharma companies generally like to give the impression that their business is a win-win kind of thing: you get better, they get sales. But sometimes the mask slips, and the real strategy that lies behind the benevolent exterior is revealed. For example, back in 2014 we wrote about the CEO of Bayer, one of the biggest drug companies in the world, openly admitting it developed medicines for rich patients in the West that can pay high prices, not for those in places like India that need them just as much, but can't afford them.

Now CNBC has spotted another revealing remark that probably reflects what many in the Big Pharma world say privately. It appears in a report called "The Genome Revolution" about a new generation of treatments based on powerful genomic techniques like CRISPR. They hold out the hope that many diseases can be cured permanently, for example by editing the patient's DNA to replace genetic code that is causing the problem. The report asks: "Is curing patients a sustainable business model?" It goes on to explain the issue here:

"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," analyst Salveen Richter wrote in the note to clients Tuesday. "While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow."

That's a fair analysis. Given the choice between creating a product that cures people after one use, and another that requires a lifetime's supply, the rational choice for a company is the latter. The analyst's question, shocking as it is, exposes neatly the tension between what Big Pharma and its shareholders may want -- fat, recurring profits -- and what patients and society desire -- a short course of treatment that results in a complete cure. As genomic medicine continues to progress, that question is likely to be posed more frequently, both behind closed doors, and in public debates. It will also bring with it another one: if curing patients isn't a sustainable business model for traditional pharma companies, why not find other ways to fund the development of genomic treatments?

Follow me @glynmoody on Twitter or identi.ca, and +glynmoody on Google+.

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Filed Under: business models, cures, diseases, gene therapy, genetic engineering, genetics, health, pharmaceuticals, profits
Companies: goldman sachs

66 Comments

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Anonymous Coward, 18 Apr 2018 @ 10:47am

If curing patients is not a sustainable business model then perhaps health care should not be a for profit endeavor.

Obviously, treating the symptoms will be much more profitable than curing the disease, however - what kind of an asshole verbalizes such revolting thoughts. Everyone has dumbass ideas, but most refrain from embarrassing themselves with same.
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hij (profile), 18 Apr 2018 @ 10:47am

The Free Market will decide the value of life
The analyst was not thinking it through. The free market will decide the value of that one shot. When you ask parents how much they will pay for the shot that will save their child, the valuation will be high enough that it will make up for the long term payments of longer therapies. See, problem solved! Unless, of course, you are the one with the sick child and just gave up everything for your kid.

Another advantage of the patent system is that it is not really a free market.
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justok (profile), 18 Apr 2018 @ 10:47am

idk
Insurance companies would like to prevent all diseases, illnesses and injuries. They don't want to pay the medical providers. As long as everyone still pays for insurance, they are perfectly happy with people being healthy.
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Captain Obvious, 18 Apr 2018 @ 10:53am

Duh...
This is not a new revelation.
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Anonymous Coward, 18 Apr 2018 @ 10:59am

Re: The Free Market will decide the value of life
They'll just warehouse the cure until the none cures are unprofitable.
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Anonymous Coward, 18 Apr 2018 @ 10:59am

Re:

what kind of an asshole verbalizes such revolting thoughts..

This story has created a lot of outrage for no good reason. A for-profit company should be investigating the financial effects of new technologies. The report doesn't say people shouldn't be cured—indeed it says gene therapy "carries tremendous value for patients and society", which suggests the opposite. It merely points out the challenge for the business model, as you did; so yeah, maybe health care shouldn't be about profit.
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Anonymous Coward, 18 Apr 2018 @ 11:02am

Re: The Free Market will decide the value of life
Courts and insurers also put dollar values on human lives, the numbers being about 2-10 million US dollars each for developed countries. It's not new.
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Roger Strong (profile), 18 Apr 2018 @ 11:04am

Re: The Free Market will decide the value of life
The customer is always right. Big pharma, insurance and healthcare companies are investment companies. It's the investors, not the patients, who are the primary customers.
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YaTOG, 18 Apr 2018 @ 11:11am

Re: Re:
Assholes, like those in big pharma have known this for years.
It's also why they have not, so far, picked up on any "natural" cures or medicines, because they *can't* be patented so they can choke the lives of patients to pay for it.

One life lost due to a big-pharma "cost" prohibition of the medication should equate to a 1 Trillion dollar fine, payable to the family of the person who lost their lives.

That ought to suck the "profit" out of treating instead of curing, or pricing their medication so high that insurance companies (that never pay full price anyway) refuse to pay for it, so their customers can continue supporting pharma's revenue streams on older, less effective, possibly-with-fatal-side-effects medications.
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Anonymous Coward, 18 Apr 2018 @ 11:15am

simple solution for lifetime cash flow
simple solution - copyright the DNA "patch" they are giving people and charge a monthly licensing fee for as long as it remains in a person's body (presumably until death).

Surgical implants can also be licensed rather than sold.
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Anonymous Coward, 18 Apr 2018 @ 11:17am

Re: Re:
I understand that but I'm sure such discussions in the past were held in a less public venue. These healthcare/health insurance businesses know they walk a tight rope. Expressing such concerns is not good PR and they know it but they no longer seem to care about their appearances which is concerning. This means they intend to push their agenda regardless of the public needs/ wants.
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Anonymous Coward, 18 Apr 2018 @ 11:19am

Re: simple solution for lifetime cash flow
Yeah - lol

Not so simple tho - and would led to many hilarious events.
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Anonymous Coward, 18 Apr 2018 @ 11:22am

Re: simple solution for lifetime cash flow
Even better profit initiative: have an end of life for the device inside a person's body. Require a full priced replacement every X number of years.
Also pay for patches. That bandwidth is not free! Want to patch out that zero-day hole that lets any hacker control your pacemaker? That will be $10,000.
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Ninja (profile), 18 Apr 2018 @ 11:22am

"why not find other ways to fund the development of genomic treatments? "

That. Research into it and let the generics use at will. Also, I think we should have some type of universal healthcare provided by the government but that would be too Communist of me (even if capitalist countries all around have such model in place).
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NeghVar (profile), 18 Apr 2018 @ 11:27am

http://files.abovetopsecret.com/files/img/ux56fbd903.PNG
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Anonymous Coward, 18 Apr 2018 @ 11:28am

But there are still diseases whose only treatment is: "do this drug/therapy/lifestyle change and there will be improvement so long as it continues". I doubt we'll cure so many diseases with gene therapy that health difficulties will never exist again.

It's a pretty disgusting thing for the guy to say, considering these cases will always exist. I shouldn't have been shocked, but eh... that's capitalism to the nth degree for you.
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I.T. Guy, 18 Apr 2018 @ 11:35am

The cure will cost hundreds of thousands.

The treatment will cost $500 (or more) a month for the rest of your life.

Needless to say the healthcare is for the rich.
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NeghVar (profile), 18 Apr 2018 @ 11:47am

Re:
Collude with medical insurance agencies to make sure the cures are never covered.
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Anonymous Coward, 18 Apr 2018 @ 11:49am

An example, if a lifetime (say 20 years) of drugs cost $100K, wouldn't a one time cure cost about the same? Maybe even more for the convenience?

What don't people understand about investment chasing return? If I am investing my money, do I want to invest it in something that will generate a lot of money or a little money? What do you choose?

Why are you surprised that this is the way of the world? If you don't like it, why don't you start your own company in order to cure diseases and make very little money?

As for gene editing? This could actually cause the end of mankind. "Of course the wolf has wings"
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YaTOG, 18 Apr 2018 @ 11:51am

Want to cure big pharma prices?
Make it so that Government positions - voted in or assigned by the President, only get what the rest of the country gets.
Medicare/Medicaid
Social Security

Anything above that, has to come out of their salaries, which will be limited to that of the lowest paid Teacher in the country.
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Joel Coehoorn, 18 Apr 2018 @ 12:00pm

Patents
The solution to this is, of course, a healthy patent system. Not the system we have now, but one in which drug patents actually expire when they are supposed to, after a reasonable amount of time, and don't get endlessly renewed because of new delivery mechanisms or alternate uses.

Given such a patent system, the difference in profits between life-time drug treatments and one-time cures is much less pronounced. The drug company can't keep milking the medicine sales for the life of it's patience, because the patient will be able to turn to a low-cost generic.

What if it's a rare disease where there is no low-cost generic? It's patents to the rescue again. The purpose of the patent system is to make an invention available to the public. Patent examiners that are doing their jobs well should reject patent applications that don't contain sufficient information to reproduce the invention (or drug, in this case). At this point, the inventor can, of course, re-appply, but this time they should include the necessary information.

When this system functions properly, the cost to create and market generic drugs should be greatly reduced, thus again expanding the field of drugs available via generic markets.
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Anonymous Coward, 18 Apr 2018 @ 12:08pm

Re: Re: Re:

This means they intend to push their agenda regardless of the public needs/ wants.

That's very pessimistic. Note that this isn't a pharma employee saying it, it's an investment analyst. Perhaps they raise the problem in the hope of finding a solution. A profitable one, we can assume, but not necessarily an inhumane one; maybe we'll get governments to pay these researchers and make the financial return elsewhere (e.g. lab equipment/tests—or the entire rest of the economy, because fewer workers will be dead or incapacitated).
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Call me Al, 18 Apr 2018 @ 12:15pm

Re: Re: Re:
That is an absolutely brilliant way of getting big Pharma companies to abandon life saving research and just produce varieties of viagra going forwards.
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Anonymous Coward, 18 Apr 2018 @ 12:26pm

Re:

if a lifetime (say 20 years) of drugs cost $100K, ... wouldn't a one time cure cost about the same?

If it's patented, and then only until the patent runs out. Of course, if someone has $100K, they might as well buy a round-trip ticket to some country without pharma patents, and save $90K. (Or if you're looking for a scifi plot: spend the $100K to fly into space and manufacture the stuff outside of Earth jurisdiction, just to spite the phama companies.)
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Anonymous Coward, 18 Apr 2018 @ 12:36pm

Re: Re:
That's counter-productive for insurance agencies. They make money by collecting monthly fees from people. The less they have to pay out in coverage, the more money they make. If one-time cure-all genetic treatment comes out, it would be in their best interest to cover it so that people don't keep claiming insurance payouts for medical expenses. One time payout vs multiple payouts over the insured person's lifetime.
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Anonymous Coward, 18 Apr 2018 @ 12:40pm

Re:

As for gene editing? This could actually cause the end of mankind.

How? Contrary to popular science fiction belief, there are hard limits on how much you can edit genes and DNA. Should we be careful? Yes. Is it going to wipe out all humans in the blink of an eye? Not likely.
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Anonymous Cowherd, 18 Apr 2018 @ 1:10pm

Yet another good reason to nationalize medical research.
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Anonymous Coward, 18 Apr 2018 @ 1:12pm

Re: Re: Re: Re:
Wasn't Viagra found to be able to prevent or battle certain types of cancer recently? Life saving Viagra...?
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anon a mouse that scurries in the dark, 18 Apr 2018 @ 1:22pm

Re: Re: Re: Re:
What life saving research?

The only actual research done by big pharma is scaling for production and modifications to keep the patents live.

Real research is done on the taxpayers dime at hospitals colleges and universities.

Capital decisions that cost lives for profit should have Capital/Capitol punishment.
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anon a mouse that scurries in the dark, 18 Apr 2018 @ 1:27pm

Re:
That's Socialist, not Communist. There is a bit of nuance there. Like the US capitalist system is really corporatism.
Mind I personally think it has devolved into a kleptocracy.
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anon a mouse that scurries in the dark, 18 Apr 2018 @ 1:30pm

Re: Re: Re:
On the surface that would make sense BUT look at how agents and managers get paid as well as the "encouragements" from big pharma. Everyone but the actual person paying the premiums are valued more.
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Call me Al, 18 Apr 2018 @ 1:43pm

Re: Re: Re: Re: Re:
That simply isn't true. There are developments in drugs all the time. Just because they haven't cured everything doesn't mean there aren't improvements in many drugs.
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Roger Strong (profile), 18 Apr 2018 @ 2:00pm

Re: Re: Re: Re: Re:
Just don't take it with iron supplements, unless you want to spin around and point north.
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Anonymous Coward, 18 Apr 2018 @ 2:01pm

Re:
But if we nationalize medial research the eeeeevvvvviiiilllll "commies" win!
What would you rather have: good health and a research program directed by need instead of shareholder profit or the secure knowledge our country is the most awesome because we don't follow others?

I think the choice is obvious and if you don't agree with me you are a traitor. Also when I am personally and troublingly affected by this horrible program I am planting my (awesome!) flag on, It will still be your traitorous fault for letting the system get this bad.

/s
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Chris ODonnell (profile), 18 Apr 2018 @ 2:26pm

"Even better profit initiative: have an end of life for the device inside a person's body. Require a full priced replacement every X number of years. "

You may have been kidding but this is exactly how insulin pumps work, although they are not internal. Yet. As soon as it's out of warranty (4 years for the new Medtronic pumps) it gets replaced with a new $10,000 model. And in the case of the current generation, a new $10K model that doesn't work as well. Being diabetic with a pump costs about $2000 a month at retail, not counting the pump itself.
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Anonymous Coward, 18 Apr 2018 @ 3:00pm

Re: Re: The Free Market will decide the value of life
So they should be slapped with $10 million fees everytime they price something out of reach for patients who die from something, roger that.
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Anonymous Coward, 18 Apr 2018 @ 3:47pm

Re: Re: Re: Re: Re: Re:
right, they add a molecule here, a proton/neutron there which changes the molecular formula allowing them to re-patent the 'new' drug that does exactly what the previous drug did, but now it costs 10 times as much since they had to 'research' how to better screw the public...

I just wish this was /s

Look up drug patents in the last 5 years and see how many are new in the 'never before seen type of medication' and how many are 'the same medicine we patented last time, but we added polka-dots (at the molecular level)...
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trollificus (profile), 18 Apr 2018 @ 9:00pm

*sigh* I was going to make a snarky post about the government version of the Gell-Mann Amnesia Effect, where you all can see how government handles everything within your area of expertise so badly and then blindly assume it will handle things you know little of just wonderfully...so I would end up preferring the ministrations of a heartless, investor-funded corporation over the magical treatments of placebos, homeopathic tinctures, ginseng and altruism, handed out by the super-efficient bureaucracy.

But really, the mortality rate will hover around 100% in either case so...not very funny.

The comments about a functioning Patent system being the REAL solution for motivating and monetizing medical innovation while also benefiting society are more on point than the "heartless bastards!" outrage posts though.
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The_Jerk, 18 Apr 2018 @ 9:45pm

Re:
I honestly think the current healthcare system is unsustainable. Either we go Socialized or start hanging the bastards from lampposts by their 300-dollar belts. Either way time is running out.
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Peter (profile), 19 Apr 2018 @ 1:20am

They do have a point ...
When scientists discovered that Gastritis is caused by the Heliobacter bacteria rather than excessive acid, the $8bn - acid blocker industry fought the obvious cure - a short antibiotics treatment - teeth and nails to continue selling their acid blockers that merely reduced symptoms.
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Peter (profile), 19 Apr 2018 @ 1:24am

Workarounds available - even if GS has a point
Gilead took a different approach with Hep B - cure: They calculated the lifetime cost of the alternative interferon treatment ($100 K +), and priced their new drug accordingly.

While the discussion on the ethics of selling a $50 - Drug for nearly $100 K is ongoing, Gilead shows that money can be made with new one-shot cures.

And it could be argued that Gilead's approach does encourage investment in drug development and benefits mankind (even if the high prices may be questionable, they will drop sharply when patents expire).
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Dingledore the Previously Impervious, 19 Apr 2018 @ 2:38am

Re: Re:
Socialism vs communism is definitely not best described as "a bit of nuance". They're significantly different.
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Bruce C., 19 Apr 2018 @ 4:52am

Curing patients...
may not be a sustainable business model, but it's certainly more sustainable than not curing patients. A dead patient will never be a return customer.
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Anonymous Coward, 19 Apr 2018 @ 5:00am

Re:
Nationalizing medical research won't "cure" the problem. You'll just have a smaller number of corrupt people making the decisions on what research to conduct.

At least in the current system there are many different people who can attack problems from many different angles.
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Anonymous Coward, 19 Apr 2018 @ 5:03am

Re: They do have a point ...
Exactly how did they fight this "teeth and nail"?

I've never had difficulty getting a doctor to prescribe an antibiotic when my stomach issues flared up.
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Anonymous Coward, 19 Apr 2018 @ 5:33am

Re: simple solution for lifetime cash flow
Funny enough.. they already do that.

Monsanto routinely sues (and wins) lawsuits against farmers that replant seeds that have been cross contaminated with genetic sequences that Monstanto has patented. They get away with it because they force farmers using their seed to sign "hold harmless" agreements before they can purchase their seed. Basically the one on the hook is the poor farmer that plants Monsanto, DuPont, or Sygenta GMOs thanks to contract law. And good luck buying seed that is NOT genetically modified in certain crops like soybeans and corn. Over half the world's agricultural seed is controlled by those three corporations and they are locked up in GMO patents. The problem with GMOs isn't that they are dangerous to humans. It's that they're patented and those patents are viral. They taint all fields genetically compatible within many miles around.

There's plenty of artificial gene sequences already patented. Based on already established case laws, it's entirely possible, even if it sounds absurd, that redistributing any patented gene sequences could result in royalty fees. Want to have that child with your genetically altered spouse? That'll be $10k please for the dominant gene replication royalty.
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Wendy Cockcroft, 19 Apr 2018 @ 5:52am

Get Patents Off Medicines And Medical Appliances, Etc.
Can we do this now, please? The idea of people who think like that actively working against the public interest to fatten their wallets appalls me.

We should ban all patents on medicines and medical appliances forthwith and fund it via taxes. That would quickly put a stop to profiteering and guarantee that medicines actually work as intended.

A girl can dream.
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Wendy Cockcroft, 19 Apr 2018 @ 5:56am

Re: Re: Re: Re:
Or maybe just get patents off medicines and medical appliances, etc. Do that. The companies can still make money by making the products. They can even brand them and make out that "Hedicure" is the best headache pill on the market if they really, truly want to. I just don't want them getting in the way of actual advancements in medicines because it might not make them rich enough.
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Wendy Cockcroft, 19 Apr 2018 @ 5:58am

Re: Re: The Free Market will decide the value of life
Where we're going wrong here is that the market should not be the arbiter of who lives or dies. It ought to be our servant, not our master.
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Wendy Cockcroft, 19 Apr 2018 @ 5:59am

Re: Re: simple solution for lifetime cash flow
I'm still not seeing the case for patenting medicines or medical appliances beyond "$$$$$!!!"
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Wendy Cockcroft, 19 Apr 2018 @ 6:03am

Re: Re: Re:
True, but Communists routinely confuse the two.

You're thinking of the liberal socialism adopted by European governments following the Second World War.

I don't mind socialism as long as it's of the classically liberal variety, i.e. it allows for and enables private enterprises to flourish. It's when it becomes oppressive to the individual and to society that it's a problem, but that's the same for any philosophy including capitalism.
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Anonymous Coward, 19 Apr 2018 @ 6:48am

This is "common law"!
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Anonymous Coward, 19 Apr 2018 @ 7:19am

Re: Re: Re: Re:
Agents and managers get paid out of income made by people signing up and paying monthly insurance fees and premiums. This supports my argument, not yours.

As far as "encouragements" from big pharma, you'll have to be a bit more specific as I don't subscribe to tinfoil-hattery nonsense and insinuations.
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Anonymous Coward, 19 Apr 2018 @ 7:52am

Re: Re: Re: Re: Re: Re:
I am interested in any examples you can provide.
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Anonymous Coward, 19 Apr 2018 @ 7:55am

Re: Re: Re: Re:
"That's very pessimistic."

Maybe - but it is based upon observed events rather than corporate propaganda.
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Anonymous Coward, 19 Apr 2018 @ 7:58am

Re: idk
"they are perfectly happy with people being healthy."

.. and seemingly they also are happy when you just hurry up and die.
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Anonymous Coward, 19 Apr 2018 @ 7:59am

Re: Re: simple solution for lifetime cash flow
Sorta like Blade Runner?
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Anonymous Coward, 19 Apr 2018 @ 8:01am

Re: Re: simple solution for lifetime cash flow
"There's plenty of artificial gene sequences already patented."

Oh - well, that makes it ok then

It's not nice to patent mother nature
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Anonymous Coward, 19 Apr 2018 @ 8:09am

Re: Want to cure big pharma prices?
This is a god idea that will never be implemented.

Make them eat their own cooking.
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Wendy Cockcroft, 20 Apr 2018 @ 2:23am

Re: Re:
Citation? Is there any evidence that you're correct?
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Anonymous Coward, 20 Apr 2018 @ 7:46am

Re: Re: Re: Re: Re:
And the health insurance corps do not get a fee or percentage of each and every transaction?

I find that hard to believe.
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Anonymous Coward, 20 Apr 2018 @ 7:50am

Re:
"Nationalizing" things does not work, history shows this to be true. The other side of that coin, "Privatizing" things does not work. Does the elusive "solution" lie somewhere in between or is there no solution?
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Anonymous Coward, 20 Apr 2018 @ 9:18am

Re: Re: Re: Re: Re: Re:
Why would they? Since the health insurance corps have to PAY OUT for those transactions, not receive money in.

Do you understand how insurance, of any kind, works?
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Anonymous Accountant, 22 Apr 2018 @ 1:48am

What is implied is even worse: Roundup Ready people. The "one shot cures" may even be freely available once their new business model demonstrates recurring revenue.
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elronaldo (profile), 22 Apr 2018 @ 2:13pm

What about competition
Sometimes free enterprise does accidentally obtain and when this happens, the competitor who provides the cure can obtain a competitive advantage over the vendor with the inferior product.

Survival of the fittest.

But that wouldn't be fair, would it? We need government regulation to make sure that the inferior competitor is not injured by competition. Because... shut up.
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Anonymous Coward, 23 Apr 2018 @ 8:57am

Re: Re:
That was a joke and the line about the wolf with wings was from a Rock movie.
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