The pharmaceutical industry has delivered substantial health advances to humanity over the last several decades. They have developed medication that has prolonged the lives of your loved ones and helped to reduce the effects of debilitating disease or illness.

However, like any industry, among these heroes there are villains. Martin Shkreli’s 56-fold price increase of Daraprim in 2015, a drug that had been available since 1953, is one example. Although other incidents of bad behavior can be detailed as well, there are two very important misconceptions about the pharmaceutical industry that routinely make the rounds on the internet. One is that the industry has or is aware of a cure for cancer but refuses to develop or release it and the second is that the pharmaceutical industry does not attempt to cure diseases, preferring only to treat the symptoms.

The seemingly logical thinking is that if cancer or another disease is cured, the pharmaceutical industry will lose customers and therefore sales and profits. On the surface, this might seem to make sense, but let’s examine the reality of the business.

When a chemical or biochemical product has the potential to become a drug, no matter how small that chance may be, it is patented. These patents last for 20 years and they ensure that a competing company cannot produce the same drug and reap the rewards from the original company that actually did all the discovery work. Twenty years sounds like a long time but research, development and clinical trials require up to 7 years on average, meaning that once the drug finally hits the market, there are 13 years left on the patent. Now the company will have 13 years to earn back the over $600 million (on average) that it spent on getting that drug to market – and it doesn’t cover the costs of all the other potential drugs that the company invested time and money into but then languished. Some drugs will reach the market with less than 10 years left on the patent due to extra time required during the development and clinical stages. That is one of the primary reasons that some drugs cost so much.

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During this 13 year time period there is a decent chance that this new drug will lose money when it is usurped by a better drug from a competitor that produces fewer side effects or requires a lower dose.

But what if that first drug wasn’t a treatment for a disease but a cure? What would happen then?

Gilead launched Sovaldi in 2013 for the treatment of the hepatitis C virus (HCV). When combined with other existing HCV drugs, it became a cure for people that were infected with certain types of the virus. A cure! Previous treatments could cure only up to 70% of suffers, but with significant side effects. The addition of Sovaldi to the market increased the cure rate well above 90% and has reduced side effects and even offered a shorter treatment time. Sovaldi is now on the World Health Organization’s list of Essential Medicines. When Gilead’s competitors saw the clinical trial results many of them stopped their research projects because they knew that they couldn’t compete with a cure. Not all companies gave up though, and that’s a great thing because it offers hope that in the future a better cure will come along that will treat additional types of HCV thereby curing more people.

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So what happens to the cure producing company in this situation? Gilead quickly captured most of the HCV market, they had few competitors and they started to make billions of dollars selling their new drug. Billions from a cure. So a cure means few, to no, competitors, almost every patient will buy your drug and eventually, hopefully, the disease will be eradicated.

This is different for drugs that treat a disease like cancer whereby incremental advances are the norm and each new drug (depending on the therapeutic area) is under a constant threat of being made obsolete. That’s not to say that there aren’t large amounts of money to be made, there most certainly are and companies do—but that pales in comparison to releasing a cure.

If one talks to the people who dedicate their lives to discovering drugs, they all will tell you how that type of discovery would be the pinnacle of their career. It is something for which they would be forever proud. Every researcher works to find and create the best possible drug that they can. The reality is that discovering a drug that works against a disease without causing too many problems for the patient, is genuinely hard. Humans do not come from an assembly line where each one is virtually identical to the last. Despite all of the really great advances in medicine in recent decades, our understanding of human biology is still very much in its infancy. Our medicine today will likely look as archaic in 100 years as bloodletting does to us now.

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So what about cancer? Knowing what you know now about the HCV cure, let’s add one additional component; cancer can never truly be cured—meaning that it cannot be eradicated from the planet, like smallpox or HCV could be. For the foreseeable future, there will be a need for treatments. While new advancements in immunotherapy indicate that we are getting smarter, cancer is still very complex.

It is not simply one disease, each form is unique—similar but different. It develops within us and each person’s body has the potential of being susceptible throughout their life. A cure for one cancer doesn’t mean the disease will never redevelop in your body again, at least with current technology.

So, if you operate a pharmaceutical company that has a cure for one or even all forms of cancer what would you do? Release it and make billions of dollars and be regarded as a savior to humankind? The moral, ethical and financial goals all align perfectly. Would any for-profit business keep it quiet and face an uncertain future trying to discover and release incrementally better drugs that constantly get one upped without any guarantee of making back the money they’ve invested?

It seems like an easy choice: take the billions, along with the Nobel Prize and your place in history.
Whatever problems the pharmaceutical industry has, it is engaged in developing the very best medicines possible with the current knowledge of human biology. All their goals are in alignment.

Reference:
Prasad V, Mailankody S. Research and Development Spending to Bring a Single Cancer Drug to Market and Revenues After Approval. JAMA Intern Med. Published online September 11, 2017. doi:10.1001/jamainternmed.2017.3601

Michael Little works in analytical chemistry and has almost 20 years experience in the research based pharmaceutical industry. Michael resides in Laval, Quebec, with his wife and three children. Michael has written occasional science articles for GNN since 2007.

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