Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’

I was wondering why this question hadn’t come up before, given recent breakthroughs in medical science: could curing disease actually be bad for business?

Here, a Goldman Sachs exec examines the record of a remarkably effective (90% success rate) medication for Hepatitis C. From the article: “The company’s U.S. sales for these hepatitis C treatments peaked at $12.5 billion in 2015, but have been falling ever since. Goldman estimates the U.S. sales for these treatments will be less than $4 billion this year…”

Apparently, the backlog of patients needing treatment has been substantially reduced. That’s reflected in revenue. Four billion dollars is nothing to sneeze at, but it represents a serious decline in revenue over a relatively brief three year period. Investors will begin to look around for other places to put their money, that have more potential for sustained profits. That directly impacts the value of the company’s shares.

Those big early returns were terrific, but the real prize is a golden goose that keeps on laying a whole lot of eggs.

That’s the attraction of developing drugs for diseases that can be treated but not cured. The patient is required to continue taking the drug “indefinitely”, a medical euphemism for permanently.

Could that include medications for addiction treatment? Take the current “big three”– methadone, buprenorphine, and naltrexone. They’re effective as long as the patient continues to take them, but there’s no real endpoint. Those patients who do stop the meds, even if they’re highly motivated, often return to heroin. Cost is an issue. Methadone is cheap, but the newer drugs are not. And still newer medications, now in development, are likely to be more costly still.

So who’s going to absorb price increases? Say the price of a medication were to go up unexpectedly, as we’ve seen happen over the past few years. What choice does the patient have? Switch to a different medication, provided its price hasn’t spiked as well? Go off the medication entirely?

Given the real risk of overdose fatalities, for some patients it could be a life or death decision.

Can we count on the government to restrain price increases? I don’t know. There’s so much lobbying involved nowadays. I haven’t seen too many cases where a company was made to back down on price increases.

I’d feel better if I knew some in our brilliant science community were working hard on ways to taper patients, if just the most highly motivated, off the medications with a reduced risk of return to heroin. I’m guessing we all know people in longtime recovery who are no longer on these medications and did not return to heroin or other opioids. They tapered successfully, for a variety of reasons.

How did they manage it? I’ve never read a single research article on that subject. I might just have missed them. If so, somebody please forward to me. I know what doesn’t seem to work. I’d like to know what would, at least for some patients.