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“Is Curing Patients a Sustainable Business Model?” Goldman Sachs Analysts Ask

As reported by CNBC, Goldman Sachs analysts are questioning the long-term profitability of “one shot cures” using gene therapy, gene editing and genetically-engineered cell therapy. In a report titled “The Genome Revolution,” analysts framed a fundamental question about medical care in a way that makes it clear shareholders are more valued than patients: “Is curing patients a sustainable business model?”

Overall, the firm is optimistic about the growth potential of gene therapy stocks. This is not totally surprising; the technology has been moving full speed ahead with few checks, even as the repercussions of gene editing remain largely unknown. Considerable, and perhaps unwarranted, optimism surrounds the ability of modern biotechnology to edit and replace human genes. 

Will investors buy into the vision of genome medicine? Analyst Salveen Richter argued that although one shot cures have a certain level of attraction, “Such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies." Moreover, while creating effective “cures” appeals to patients and society, “It could represent a challenge for genome medicine developers looking for sustained cash flow."

Simply put, a one-shot cure cuts off the consistent revenue generated by chronic diseases. Richter cited the example of GILD and their hepatitis C treatments. "In the case of infectious diseases such as hepatitis C, curing existing patients also decreases the number of carriers able to transmit the virus to new patients, thus the incident pool also declines … Where an incident pool remains stable (e.g., in cancer) the potential for a cure poses less risk to the sustainability of a franchise."

The full depravity of this approach to medicine is almost lost in the analyst’s dispassionate tone. But consider the full implications of what he is saying. This was a moment where the mask slipped and the fact that your long-term health is of no concern to the pharmaceutical companies was clearly articulated. If you ever had any doubt that Big Pharma has your interests at heart, this rare moment of candor is damning. It is hard to believe that anyone would go on the record and openly espouse such an inhumane and pitiless ethos.  

As was the case with genetic engineering of food, the gene editing technology will continue to progress beyond the reaches of regulation and ethics. Even with barriers in place, the creation of a gene-edited person is likely to be attempted, some say “at any moment.” It’s both an exciting and frightening prospect, especially since the technology isn’t perfect and may accidentally hit other parts of the genome. 

If Biotech are concerned about one shot cures cutting into their recurring revenues, a turn towards the next step — genetically engineered embryos may be inevitable. Using CRISPR, researchers successfully altered DNA in human embryos in a way that would eliminate or correct the genes causing certain inherited diseases. If the embryos were implanted into a womb and allowed to grow, the process, which is known as germline engineering, would result in the first genetically modified children — and any engineered changes would be passed on to their own children.
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