# Is there proper incentive for the healthcare industry to cure diseases?
**URL:** https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550
**Category:** Great Debates
**Created:** [June 23, 2005, 4:44pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550 "2005-06-23T16:44:39Z")
**Posts on this page:** 20
**Page:** 1
### Author:  [@quasixote](https://boards.straightdope.com/u/quasixote)
#### Post date: [June 23, 2005, 4:44pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/1 "2005-06-23T16:44:39Z")
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?
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### Author:  [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)
#### Post date: [June 23, 2005, 5:25pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/2 "2005-06-23T17:25:25Z")
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.
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### Author:  [@smiling\_bandit](https://boards.straightdope.com/u/smiling_bandit)
#### Post date: [June 23, 2005, 5:33pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/3 "2005-06-23T17:33:09Z")
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.
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### Author:  [@Indyellen](https://boards.straightdope.com/u/Indyellen)
#### Post date: [June 23, 2005, 5:42pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/4 "2005-06-23T17:42:10Z")
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:
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### Author:  [@dlack](https://boards.straightdope.com/u/dlack)
#### Post date: [June 23, 2005, 5:53pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/5 "2005-06-23T17:53:15Z")
> [@Wesley Clark](#):
>
> 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?
Diabetes will be cured if someone figures out a way to make the body produce the proper amounts of insulin in diabetic people.
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### Author:  [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)
#### Post date: [June 23, 2005, 6:24pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/6 "2005-06-23T18:24:10Z")
> [@dlack](#):
>
> 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](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.
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### Author:  [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)
#### Post date: [June 23, 2005, 6:31pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/7 "2005-06-23T18:31:56Z")
> [@dlack](#):
>
> Diabetes will be cured if someone figures out a way to make the body produce the proper amounts of insulin in diabetic people.
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.
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### Author:  [@dlack](https://boards.straightdope.com/u/dlack)
#### Post date: [June 23, 2005, 6:46pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/8 "2005-06-23T18:46:24Z")
> [@Wesley Clark](#):
>
> That is type I diabetes though. Type II is due to the cells being unable to respond to insulin properly.
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.
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### Author:  [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)
#### Post date: [June 24, 2005, 12:22am UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/9 "2005-06-24T00:22:45Z")
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.
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### Author:  [@DSeid](https://boards.straightdope.com/u/DSeid)
#### Post date: [June 24, 2005, 8:02pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/10 "2005-06-24T20:02:09Z")
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?
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### Author:  [@wonky](https://boards.straightdope.com/u/wonky)
#### Post date: [June 24, 2005, 11:58pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/11 "2005-06-24T23:58:30Z")
> [@Qadgop the Mercotan](#):
>
> 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.
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?
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### Author:  [@DSeid](https://boards.straightdope.com/u/DSeid)
#### Post date: [June 25, 2005, 2:23am UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/12 "2005-06-25T02:23:36Z")
> [@jsgoddess](#):
>
> 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.
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### Author:  [@wonky](https://boards.straightdope.com/u/wonky)
#### Post date: [June 25, 2005, 3:16am UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/13 "2005-06-25T03:16:19Z")
> [@DSeid](#):
>
> To the best of my knowledge saying more than that aiming for normoglycemia dramatically minimizes the risks goes beyond the available data.
Fair enough!
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### Author:  [@kambuckta](https://boards.straightdope.com/u/kambuckta)
#### Post date: [June 25, 2005, 5:16am UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/14 "2005-06-25T05:16:11Z")
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. 😃
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### Author:  [@Fiveyearlurker](https://boards.straightdope.com/u/Fiveyearlurker)
#### Post date: [June 25, 2005, 1:18pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/15 "2005-06-25T13:18:13Z")
> [@DSeid](#):
>
> 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.
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.
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### Author:  [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)
#### Post date: [June 25, 2005, 3:42pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/16 "2005-06-25T15:42:47Z")
**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.
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### Author:  [@edwino](https://boards.straightdope.com/u/edwino)
#### Post date: [June 25, 2005, 3:57pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/17 "2005-06-25T15:57:21Z")
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.
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### Author:  [@DSeid](https://boards.straightdope.com/u/DSeid)
#### Post date: [June 25, 2005, 8:11pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/18 "2005-06-25T20:11:15Z")
[Funny thing about vaccines](http://blogs.cgdev.org/vaccine/archive/2005/06/washington_time.cfm) **Edwino**.
> [@](#):
>
> June 13, 2005
> Washington Times on Vaccine Economics
>
> Gilbert Ross in the Washington Times writes:
>
> ```
> Pharmaceutical companies have fled the vaccine market in droves over the last 40 years. The research and development for vaccines is too expensive and the market too small for drug makers, contrary to the popular image of profit-raking pharmaceutical giants, and this is only worsening.
>
> In 1967, 12 years after the polio vaccine become Page One news around the world, 26 companies were making vaccines. Today there are five. Among the 12 vaccines recommended for infants and children, seven are made by one company. Vaccines given to children over a short timeframe earn much less than "blockbuster" drugs meant to be taken repeatedly over many years, such as statins and heart drugs. Therefore, drug companies can stop making vaccines without any major effect on their bottom lines. In fact, since 1998, shortages have occurred in 9 in 12 vaccines for children.
>
> ```
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.
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### Author:  [@DSeid](https://boards.straightdope.com/u/DSeid)
#### Post date: [June 25, 2005, 8:38pm UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/19 "2005-06-25T20:38:15Z")
And **edwino** , [antibiotic research too.](http://www.sciencemag.org/cgi/content/full/303/5665/1798?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=antibiotics+profit&searchid=1119732416351_2522&stored_search=&FIRSTINDEX=10&fdate=10/1/1995&tdate=6/30/2005)
> [@](#):
>
> The trend is part of an industry-wide hunt for bigger and better prizes. Larger financial returns are needed, companies say, because new products must overcome staggeringly high testing costs to prove that they are safe and effective. For a variety of reasons, the barriers are worse for antibiotics, which are rapidly becoming the stepchild of the pharmaceutical industry. And infectious-disease specialists are sounding an alarm. \ Industry analysts give several reasons for the declining interest in antibiotics R&D; all boil down to money. First, it’s a highly competitive market, filled with products that are typically cheap and effective, says Frank Douglas, chief scientific officer of Aventis in Frankfurt, Germany. Targeting a drug to a resistant organism may not improve its chances. It’s a “tough sell because of the limited market size,” Goldberger says.
>
> Second, there’s a built-in brake on success. Doctors and public health officials are reluctant to use new compounds; they want to save them as a last line of defense against resistant organisms. “Drug companies have to spend a lot of money generating a drug that the medical community wants to hold in abeyance,” says Peter Traber, who became the president of Baylor College of Medicine in Houston, Texas, last year after serving as the chief medical officer for GlaxoSmithKline, the world’s second largest pharmaceutical company.
>
> Antibiotics also buck another trend: They treat acute conditions and work quickly, whereas companies have become more interested in compounds that treat long-term, chronic conditions, such as obesity and high cholesterol. “As a consumer, you want a drug you don’t have to take very long and works very well,” Goldberger says. But that isn’t the most profitable type of drug. He adds that “in some cases the economics and the public health imperative do not match up.”
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### Author:  [@quasixote](https://boards.straightdope.com/u/quasixote)
#### Post date: [June 27, 2005, 12:22am UTC](https://boards.straightdope.com/t/is-there-proper-incentive-for-the-healthcare-industry-to-cure-diseases/309550/20 "2005-06-27T00:22:18Z")
[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.
```
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