For big pharma, the perfect patient is wealthy, permanently ill and a daily pill-popper. Will medicine ever recover?
Just a few years ago, infection with the hepatitis C virus guaranteed a slow and certain death for many. Available treatments were effective in about half of all patients, and the side effects could be awful. Things changed in 2014, when a new medication called Harvoni was approved to treat the infection. With cure rates approaching 99 per cent and far fewer side effects, the medication became an instant blockbuster. Sales topped $13.8 billion in 2015.
But then an odd thing happened – sales began to drop precipitously. Harvoni, in conjunction with four other hepatitis C drugs, is projected to generate only $4 billion this year, a three-fold decline in as many years. Part of this decline is due to new competitors entering the market. But according to analysts at Goldman Sachs, another reason could be that the drug’s cure-rate erodes its own market.
In a private report leaked to news outlets in April 2018, the Goldman Sachs analysts caution against investments in pharmaceutical or biotechnology companies aiming to develop outright cures, and cite Harvoni as a case study. It’s a simple point to make – if profit is your goal, then a product that eradicates its own demand might not be a wise investment.
Though it sounds bad, it’s not a nefarious perspective. The overwhelming majority of pharmaceutical development occurs in the United States or other market economies abroad, where private industry is the force majeure that drives progress. And industry, as much in pharmaceuticals as in any other business, is at the game for revenue rather than the greater good. Much benefit can and has come from this arrangement, but it’s something of an externality to the powerful incentive to make money.
The predominance of the market in US healthcare has taken plenty of flak for promoting profit over quality, and for crescendoing costs.
But there’s a deeper set of issues surrounding how the market influences – or distorts, maybe – the very bedrock of healthcare and medicine. In a system driven primarily by profit, certain diseases or treatments must languish simply because they’re not lucrative. And how can such a system do other than favour revenue over patients?