Is there proper incentive for the healthcare industry to cure diseases?

It seems that our pharmeceutical/healthcare industry doesn’t find cures for diseases anymore. Is it because there is more money to be had ‘managing’ AIDS, Diabetes, Cancer, etc. than there is from curing them?

I thought diabetes was curable. If a fasting blood sugar level higher than 126 is considered diabetic why wouldn’t lifestyle changes that lead to a permanent fasting level less than 126 be considered a cure?

Vaccines for AIDS are being worked on right now. Drugs that treat cancer are also being worked on. Its probably more because there is not a cut & dried cure for these illnesses.

Drugs don’t make too much money afetr the patents wear out; there are always more companies willing to undercut all but the slimmest of margins. The money is in new drugs, which can garner fantastic sums.

I think you need to separate the pharmacutical industry from the healthcare industry. Most of the doctors I know (both the ones I work for, and others) would rather “cure” (if possible) that “manage”; unfortunately there aren’t nearly as many cures as people would like to think.

If the best they can do for my asthma is “manage” it, well, I’d rather do that than nothing. Yes, there are doctors out there who would rather prescribe than work, but with a little effort you can find the ones who don’t do things that way.

The insurance companies are an entirely different issue. :mad:

Diabetes will be cured if someone figures out a way to make the body produce the proper amounts of insulin in diabetic people.

Well, stem cells are showing promise:
http://stemcells.nih.gov/info/scireport/chapter7.asp

Unfortunately, some powerful groups - and it is not the healthcare industry - are constantly slowing progress in this field.

That is type I diabetes though. Type II is due to the cells being unable to respond to insulin properly.

Besides they are working on a treatment for type I diabetes. They import Islet of Langerhorn (whatever they’re called) cells into the new body and cover them in some kind of substance that prevents the immune system from destroying the new cells.

Good point.

However, my main point is that altering your lifestyle so that you’re always below a certain blood sugar probably doesn’t work (or isn’t possible) and certainly doesn’t cure the underlying disease. So diabetes hasn’t been cured.

Type II diabetes really can’t be cured. It’s a cellular metabolic defect resulting in insulin resistance in many cells, but primarily fat cells.

Now it can occasionally be managed well enough so that the blood sugars are always normal, via diet, exercise, medications and so forth. But even with the best of results from those modalities, the person is still a diabetic, albeit a superbly controlled one who will most likely avoid the complications of that disease.

Certainly Big Pharma is little interested in researching “cures”. It’s not where the money is. The money, the next blockbuster drug, is in something that someone needs to take every day forever. Cholesterol meds, antidepressents, antihypertensives, etc. The new antibiotic to beat off the next resistant bug is not in the pipeline because people would take it for a few days and be done with it.

Qadgop, I’m not sure if I entirely agree or not. I have a strong family predisposition to Type 2 DM. I am very confident that if I did not keep up with my healthy diet and excercise then I would gain weight and DM would manifest itself. I am also confident that if I then lost the weight again, restarted my healthier lifestyle including diet and exercise, that my blood sugars would be normal again. For the sake of discussion, assume this is true. Am I significantly different now then if I had become obese and returned to my lower weight, diet, and exercise habitst? Am I a superbly treated diabetic now because I have prevented the manifestatiion of diabetes by lifestyle choices?

We’ve been told that some of the effects of Type II manifest even with perfectly controlled sugars. That it isn’t just the blood sugar in itself that causes the problems, but the entire syndrome–that a controlled diabetic still runs a diabetic’s risks, though greatly lessened.

That’s from my husband’s doctor and from, strangely enough, our cat’s vet. Would you disagree?

I would say that it is unknown. The working hypothesis is that it is abnormal blood sugars that causes diabetic complications because the rate of complications decreases as blood sugar control gets better. A controlled diabetic had abnormal sugars already and is usually not “perfectly controlled” to the subtlety that a functioning pancreas-glucose receptor system would control things. To the best of my knowledge saying more than that aiming for normoglycemia dramatically minimizes the risks goes beyond the available data.

Fair enough!

I’ve always been of the (totally wild-arsed, admitted) opinion that the pharmaceutical industry has developed an actual CURE for the common cold.

Think about it…they make squillions of dollars every winter-time, all over the world from a disease that (unless you are really unlucky) won’t kill you, but needs OTC medications to get you through the day. I’m sure they’d go bust without us snivelling, hacking, bleary-eyed suckers to leech off.

That’s my conspiracy theory, and I’m sticking to it. :smiley:

That’s assuming that “Big Pharma” were one monolithic company. But, there are quite a few biotech and pharma companies out there. The one that finally cures a disease will make enough money on that cure to make it worthwhile.

Why does the OP assume that curing a disease is something simple?

I can explain quite simply why curing diseases seems to have stopped. The ones that we’ve cured were the easy ones. Bacterial diseases are simple to cure once we found antibiotics. Antibiotics are brute force drugs that function by shutting down necessary bacterial pathways. We don’t need to know the molecular biology behind exactly how, just that antibiotic X inhibits bacterial translation of RNA into protein (for example).

Fast forward to now. We have cancer. Cancer is not one disease. It is many, many diseases. Even a given type of cancer (breast or colon) is not a homogeneous disease among patients (or even within a patient or even within a single tumor, there are some cancer cells that are different than others, which might allow us to kill one group only to have the remaining 1% return with a vengeance). We need to know the molecular biology and the signal transduction behind how cancer cells work. The tools to do this haven’t been available for more than twenty years, and the good tools to do this have come out in the time it took be to become a scientist (less than ten years).

HIV is a remarkable virus. It’s mutation rate, due to the really shoddy proofreading that reverse transcriptase provides, is phenomenally high. It’s as if HIV can evolve at will. That’s a formidable enemy to destroy. You can vaccinate for it, but it’s likely that the antigens that the immune systems recognizes can simply mutate and become unrecognizable producing escape variants of virions.

These are issues that didn’t have to be dealt with when curing smallpox. All you had to do was shove some vaccinia in there, and let the immune system do the rest.

To say that companies are “little interested” is naive both scientifically and economically.

DSeid, jsgoddess, I don’t have the data right at hand, but I have seen published literature, and have a cousin who is a research endocrinologist. Both have indicated that current theory is that some of the fundamental damage done to both the neurons and the eyes is due to more than just hyperglycemia, but to the molecular changes going on in the diabetic. And while the euglycemic state reduces complications by and large, damage still occurs in certain target organs in euglycemic diabetics at a faster rate than it does to non-diabetics.

Again, apologies for lack of cite, but I’m pressed for time at present.

I dunno, I think that vaccines argue against this line of reasoning. Vaccines are a hugely researched and marketed area, and they do one better than curing a disease, they prevent it.

Kids today don’t get chickenpox and grow up into adults that never get shingles. Kids and the elderly don’t get S. pneumo ear infections and pneumonia. Kids don’t get H. flu epiglottitis and ear infections. We do our damndest against flu. Measles, mumps, rubella, diphtheria, pertussis, tetanus, polio, smallpox, hepatitis A, and hepatitis B are routinely prevented. These are among the most serious of diseases, many of them lethal, some of them leading to a lifetime of complications.

If Big Pharma/Healthcare industry was so set against it, why this big push towards preventive medicine? Towards in hospital weight loss programs? Towards drugs and programs to help to quit smoking?

It is easy to hold up the common cold (actually a constellation of probably hundreds of different viruses) or HIV and ask for a cure, ignoring the fact that no viral illness has ever been cured. All the while, you are ignoring the tremendous inroads in making sure nobody ever gets rheumatic fever again, or drastically reducing the mortality from community acquired pneuomina, where effective antibiotics have been of enormous benefit.

It is easy to point to diabetes, ignoring the thousands of researchers working on it. But you are ignoring acute lymphoblastic leukemia, Hodgkin’s lymphoma, and seminomas (with high cure rates in children, new in the past 25 years). Or new therapies for advanced breast and lung cancers, which used to be uniformly fatal.

We are curing diseases. We wish we were doing it faster. Big Pharma, while obviously lured by a lifetime of profits, is also largely fed by the smaller biotechs and academic researchers, who have no such motivation.

Funny thing about vaccines Edwino.

Despite some new ones on the market there is not really that much work going on. Pharma doesn’t really want to put too much into it. You do remember the flu shot shortage? Part of the problem is that few are in the market because it is just not profitable enough. Prevnar - great vaccine. We went over a year in shortage, rationing or going without, despite the fact they could have sold many more doses if they just invested in the infrastructure to produce it. Malaria vaccine research is only being done because Bill Gates is smart enough to invest his money for philanthropy wisely. Start-ups don’t care about profit? The Hell you say! True they can be profitable with a smaller niche product, but the research has to be paid for first. A venture capitalist needs to beleive that the potential payout is big enough to put it up front. Even academia is falling for the siren - the government funds less and more academic research is with the eye on the prize of owning a bit of that intellectual property.

Qadgop, if you get the cite I’d be very curious. I can’t even imagine what data could be brought to bear on the question. Thanks.

And edwino, antibiotic research too.

[QUOTE=Fiveyearlurker]
That’s assuming that “Big Pharma” were one monolithic company. But, there are quite a few biotech and pharma companies out there. The one that finally cures a disease will make enough money on that cure to make it worthwhile.

Why does the OP assume that curing a disease is something simple?

[QUOTE]

Are you assuming that I'm assuming that curing a disease is simple? I never believed or stated such a thing. I am curious as to the economics of medical/ pharmaceutical progression, not the complexity, per se.