If Biotech Cannot Make Enough Money from Curing Disease Then Move on to Antiaging

Goldman Sachs analysts asked “Is curing patients a sustainable business model?” analysts ask in an April 10 report entitled “The Genome Revolution.” Goldman was addressing the question of gene therapies that provide complete cures with one treatment.

“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.

Gilead Sciences’ treatments can cure more than 90 percent of hepatitis C patients. Gilead hepatitis C treatments peaked at $12.5 billion in 2015 but are now less than $4 billion in 2018.

Curing infectious diseases (like Hep C) also decreases the number of carriers able to transmit the virus to new patients so complete success means the elimination of the disease. However, cancer has a more constant rate of new patients with the disease that are not based upon infection in almost all cases.

Company Strategy Suggestions from the Goldman Analysts

1. Target large markets: Hemophilia is a $9-10 billion worldwide market (hemophilia A, B) is growing at ~6-7% annually.

2. Address disorders with high incidence: Spinal muscular atrophy (SMA) affects the cells (neurons) in the spinal cord, impacting the ability to walk, eat, or breathe.

3. Constant innovation and portfolio expansion: There are hundreds of inherited retinal diseases (genetics forms of blindness). The pace of innovation will also play a role as future programs can offset the declining revenue trajectory of prior assets.

Nextbigfuture Opinion

Nextbigfuture notes that some biotech companies have a powerful platform for generating many cures. Companies working on RNA interference have a model of rapidly being able to adjust their curing system for the next in a series of diseases. This is similar to the constant innovation but is more systematic.

This problem would not exist for biotech companies focused upon extreme longevity. There would be the need to constantly repeat antiaging treatments as new aging damage is created.

Powerful medicine should be in the age of disease cures instead of the age of slight mitigation or symptom reduction. However, beyond the age of curing heart disease, cancer and other diseases is comprehensive repair of aging damage.

32 thoughts on “If Biotech Cannot Make Enough Money from Curing Disease Then Move on to Antiaging”

  1. Given that now everyone dies of old age at ~100, plus/minus a couple decades, that would simply mean the therapy isn’t fully effective for everyone. But if they get to spend those 120 years in good health, that’s still a win.

    I’m not convinced that we would have that problem though. There are centenarians and other old people with good mental health, so I don’t think there’s a fundamental limit around that age. I think the usual mental deterioration is due to senescence of support cells, accumulation of various junk, inactivity, lack of social contact, etc. All of these can be addressed by the usual aging reversal therapies and other means.

    Furthermore, we’re learning more and more about the brain, and that’ll only accelerate in coming decades. So I’m optimistic that we’ll be able to rejuvenate the brain as well.

  2. Yep. I tried to outline a novel twenty years ago with the working name of “The Pill.” The hook being that, say, tomorrow, one of the big pharmas announces a simple, relatively cheap pill that, taken daily, prevents aging. My problem was that it didn’t lend itself to extrapolation. Take something so simple as life insurance; does it go up in cost or demand, down in cost or demand, or do most people just stop getting it altogether?

    A huge stock market crash is inevitable as entire segments of the market and even entire industries become almost worthless while a few skyrocket. Then too, long term interest rates probably plummet too, as people realize they have more time to get returns on their money. Real estate probably soars. Worse, imagine everyone ending all their retirement saving at once. Just the 401Ks alone cashing out in unprecedented volume would be a disaster, as many or most would be dumping all their retirement accounts even faster than the gov’t would be ending tax protection for retirement plans. It just all gets too crazy too fast.

    Not that I believe it wouldn’t be great in the long term.

  3. I believe it may have been a Zelazny story where the cost of a rejuvenation every fifty or sixty years was one million dollars (like ten million today) or everything they had if they had more than the minimum. Consequently, they would start again, young, but dead broke. Of course, with their contacts, knowledge, expertise, etc. it was often only a matter of weeks, days, or even hours, before they had more than the minimum for another rejuvenation. The great fear, however, was that the time might come when they could not get rich again. The protagonist tried to safeguard against this by finding completely different methods of getting rich each time.

    Larry Niven’s Known Space series occasionally included desperate characters who had lost the financial wherewithal to buy “boosterspice” and so were aging against their will.

    Frederick Pohl’s characters in his HeeChee series were all desperate to get enough money to get on and stay on “Full Medical.” This was medical coverage so good they could pluck your body out of the rubble of a disaster after being dead many hours and have you back on your feet in a few days (and not as a zombie) but it cost a million a year (again, like ten million today). At least one short story included a villain willing to do anything to restore his fortunes sufficiently so as to avoid defaulting on his payments.

  4. Then too, suicide rates among people over 120 might rise enormously, especially if the operating systems we call our minds prove unequal to the task of running that long without a reboot.

  5. Suicide is 10th in the US, with 1.6% of deaths. ~43K suicides/year, out of ~325 million population. Not to discount those thousands of people or their families and friends, but statistically that’s just over 1/100th of 1%. I’d call that very few – relatively speaking. Globally it’s not in the top 10.

    Regarding affordability, the thing is, aging reversal is probably the largest possible medical market, but it can’t open up if it’s priced too high. So big pharma have an incentive to lower the price tag to maximize profit. Governments also have an incentive to subsidize it, since that would save them massive expenses on geriatric care. They can subsidize under the condition of delayed pension, so it wouldn’t hit the pension funds too hard (basically, if you’re physically younger than X, no pension for you; go to work). So I doubt it will stay unaffordable for very long. But I can see that happening in the US.

  6. You can save some stem cells. And you can continuously sync your mind to multiple repository. So if you are destroyed you can be restored. Of course you can never be sure its you but maybe it doesn’t matter. As for suicide, check your numbers since suicide is a leading cause of death. In fact almost three times as many suicides as murders.

    Envy will come about when life extension is only affordable by the rich. Who using it will get richer and richer and live longer and longer. While the poor will get poorer and poorer and die younger and younger.

  7. Or as in “I Have No Mouth, and I Must Scream”

    Institutional agelessness: it’s not realistic to change lifespan while extrapolating for everything else staying unchanged, beyond short term.

    No one has lived a normal lifespan with the prospect of centuries+ lifespan (dying early).
    Or likewise but actually surviving centuries or more (personal consequences, character development but also empirical biological evidence of what actually happens).
    Nor has this happened at the scale of a whole society or the whole world (social consequences), while technology also continued evolving…

    Put it all together and it is still immoral to not bring aging therapies ASAP (so people actually have a choice instead of guaranteed deathbed by +-100 years, and illnesses of old age), and still better to have a chance at either changing an unjust state of things (dictatorship or whatever corruption) or moving on to another social group/country/whatever (possibly of their own making – you have centuries to help it happen).

  8. How times change. I believe it was Lex Luthor (maybe in Lois and Clark?) who told his people to suppress a cure for cancer as it would ruin the market for his treatments. The writers did it to show how incredibly evil he was.

    Imagine being held at a certain age becomes incredibly cheap, like the price of a fancy cup of coffee everyday. Now recall a cup of some fancy beverage at Starbucks can easily run five bucks. A lot of people make such a purchase daily. Given that this would work out to two thousand dollars a year, per person, and  the median per-capita household income is $2,920. Most of the world couldn’t begin to afford such a thing. Of course, most poor countries have incredibly corrupt governments (biggest part of the reason why they stay poor), but the elite in almost every country could afford this. Undying corrupt rulers presents a problem but, whether corrupt leaders die of old age or not, it’s already a problem. Meanwhile, the countries with shrinking pops have a big problem solved.

    Without old age concerns and diseases thereof, a population today would have a half-life of about 1,000 years (half would be dead in 1,000 years, due to other causes). I suspect it might be worse than that, however, as I doubt many people’s minds (their operating system in the brain that is their computer, if you will) might not last that long, regardless of how young and healthy the brain is. Some (many? most?) will likely just fall into mental ruts they cannot get out of.

  9. It’s going to be incredibly interesting to see the countless number and layers of factors shake out. Technologically, socially, economically, etc.

  10. You don’t need utopia for aging therapies to be adopted. And even then it is morally indefensible to delay them.

  11. What if you had to survive for a century or two, to see such a thing – 22 forever and the rest of the world correspondingly well-adjusted to the new conventions of post-aging?

    Would you choose to die rather than survive whatever it took, to see that light at the end of the tunnel? Because once you’re past that transitional period, there’s no predicting what the world will be like.

  12. The thing is that you can’t avoid sci-fi territory.

    1. Technology seems almost undoubtedly set to continue on a quick pace if not an accelerating pace, which along with (healthy, let’s just assume that’s implied) lifespan anywhere beyond a little extended will make it hard to miss the boat: at least a few countries or orgs will pursue aging therapy past its point of no return.
    2. Sci-fi (in general every day real world discussion, not in its own internal realm lingo) is not only explicitly different, futuristic visions, but *any* vision where something is different.

    And curing aging is fundamentally different. In itself and in all of its direct and indirect consequences; it arguably up-ends the world as we’ve known it.

    In freeing people from the scarcity of time, it will further all of the customs and habits that exist as well as new ones. Some people will and others won’t change, some will embrace unaging and others won’t.
    But in a lot of ways it will mark the period where the genie came out of the bottle, thanks to that coincidence of cultural and technological realization of voluntary aging.

    Which exact therapies and financial schemes exist and are chosen is going to be kind of a detail in the grand scheme of every other outdated convention having to accommodate some or most of the world population’s life expectancy multiplying. Even if it takes a generation or two to settle in.

  13. “you need to account for the billions that just the US government spends on the elderly.” Not billions, trillions.

  14. In addition to developing that ‘pill’; you need to account for the billions that just the US government spends on the elderly. Every one of those dollars is attached to a budgetary line item, which in turn supports a bureaucratic fiefdom. In short, the way we budget money provides incredibly strong disincentives for government employees to approve anything that threatens their budget.

    So ,no, they won’t approve of it in a heart beat, it will be approved over their dead, cold bodies after a lengthy review and comment period, multiple lawsuits by third parties and an organized FUD campaign against the technology.

    But I’m just a cynical old barnacle myself; maybe this time they will be the selfless technocrats they believe themselves to be.

  15. If you had some nanobots installed in your head that could keep your brain alive long enough for your body to be regrown, accidents and natural disaster would be much less likely to kill you (you could reinforce your skull as well), and murder would be quite difficult. Suicide is always an option, but very few choose it.

    That kind of tech isn’t on the horizon yet, but it could happen in a century or two. And nanotech is likely to be cheap, because the devices are tiny, would have to be produced on a massive scale for any sizable market (many many trillions of nanites), and may be helped by self-replication of the factories.

    People living longer would certainly take some adjustment, but once it’s mainstream, I don’t see much grounds for envy. At least not directly regarding lifespan.

  16. I would only give up everything I owned if the therapy allowed me to stay 22 forever. 😉 If not, no dice. Lol. Unrealistic ambitions for the win!

  17. Very true. I wonder if there will ever be a flat fee to have your body regressed to a specific age, and keep it that way? xD
    Also, I suppose, should it ever offer economic incentives to companies, aging could be stemmed by a single treatment involving nanobots or DNA machines which can make perfect copies of themselves, repeatedly. I could imagine that kind of therapy, that needs to be administered only once in a lifetime, being VERY expensive and lucrative. Cost effective to manufacture, and something that would rake in the cash.
    Of course, if biohacker folks ever figure out how to do that on their own and open source the methods, biotech companies are sunk, unless governments make home age regression therapy illegal. I’m getting into dystopian sci-fi territory, though. ^_^;;

  18. Target large markets? How about type 2 diabetes. Is there a larger one nowdays, other than old age?
    Not everyone who is an overweight couchpotato develops T2. Not everyone with T2 is an overweight couchpotato. Likely, there is a genetic component.

  19. Just a note that fixing the aging problem does not guarantee immortality. People died due to accidents, suicide, natural disasters, and murder. Yes, you might live a lot longer but you are going to die anyway.

    And having some people live longer will stress society which will definitely increase the chance of murder. Envy is a dangerous emotion.

  20. The money’s not there yet, probably a lot like it isn’t there to sink the initial expense of a profitable industrial base beyond Earth orbit.
    Most people don’t believe in it, those that believe in it aren’t paid that much and thus aren’t making progress as fast as they could, and if they had, the prospect of inordinately long healthy lifespan would challenge many social conventions in basically the whole world, which all adds up to a substantial obstacle to it happening as fast as it could, in a perfect world.

  21. Especially with time on their side. Humans coming back like zombies to reset their countdown, infinitely.

    On the other hand, those same humans will also have time on their side to figure out how to get free of such a deal, if it happens.

    On the gripping hand, any length of transitional struggle is relatively negligible compared to effectively forever, and technology even without a singularity but merely spurts of mundane acceleration ought to outpace such an artificial constraint on growth of healthy lifespan. Add in the wisdom of a few centuries that humans would have, and the probably inevitable divergence of humans into all kinds of tribes and nations across the solar system, and the initial gouging just can’t last.

    Gouging will fall out of favor with most of the old social conventions from when aging was involuntary.

  22. It’s all about money. I am 71 and have been on SS for 10 years plus. If they could feed me a pill that would take me and everyone else off SS, medicare, and disability, don’t you think they would do it (in a heart beat)? And if it cost me everything I owned to be 22 again, don’t you think I would do it?(In a heart beat 🙂

  23. Maybe they will let you keep your underwear. Nah, they will probably not only take your money, but put you in heavy debt to dig out of…because they can…and people would still take that deal.

    If there is competition though, prices could be much lower. A monopoly on something critical though, could lead to very deep gouging. They would probably even get laws passed that would make doing it outside the country, for less, illegal…and extend their patents decades or centuries.

    The more money they make, the more they can write the laws to make themselves more money.

  24. When just a few drugs can make a massive difference, and your company does not make one, you could be out of business pretty quickly.
    A senolytic that removes all the senescent cells in every tissue with little or no collateral damage would prevent several diseases at once. Similarly, a drug that removes glucosepane would prevent or cure several diseases. Something that refreshes the mitochondria and corrects any mitochondrial damage would also cure many conditions. Reliably extending telomeres by a predetermined amount in all tissues would likely address other conditions including immune system stuff.
    There will probably still be a lot of little things. I suspect there will be lots of money in tailored treatments, for genetic damage. Just getting all your cells to have the same corrected DNA, and similarly getting all epigenetic stuff repaired. For every person the corrections would likely be unique. And I am not even talking about modifying people to have different DNA, just making sure all their cells are on the same page and not drifting into chaos.
    True genetic modification can also be a money maker. There are many organisms out there. Chances are, for every tissue we have, there are improvements some organism has.
    Beyond life extension, we will want rapid and accurate healing from injuries.
    And if you are living long, your teeth will wear out. So you would want some modification to continually grow new teeth.
    And there is cybernetic stuff.

  25. If you can restore me to my vitality I had in my 20s and it doesn’t cost me evevrything I own then maybe I would be interested.

  26. Excellent point. Hard to beat an infinite fountain of cash. They get to be the givers of good news, have their fountain of $$$ plenty, the patients get their lives doing their thing multiplied by centuries. Wins all around.

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