Goldman Sachs Argues Against a Cure for Hep C

There are not many things upon which my father - whom I love deeply despite the fact that he sang the praises of Margaret Thatcher and Ronald Reagan in my youth - and the socialist professor (and one of my mentors as a young activist) Noam Chomsky would agree. But both of them taught me one very important thing: the best place to get an accurate and unbiased view of the world is by reading the business press.

Try as I may, this is not always a lesson I’ve been able to put into practice. A case in point is that I seem to have missed this very important CNBC article from 2018 entitled “Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’”

The article, in a way, addresses a question that comes up again and again from my clients. “Why,” they ask, “have you been able to help me resolve my issue in a few weeks when I’ve been seeing doctors about this for years? Aren’t doctors supposed to be the experts?”

Not wanting to badmouth doctors, I usually redirect this question to the asker and take myself out of the equation. “Why do you think you’ve succeeded now after years of trying and failing?” Eventually we’ll end up talking about holistic approaches that address root causes as opposed to focussing on symptoms. The implication (though I try not to take the conversation back in that direction) is that doctors know about symptoms - they often don't know how to address root causes.

That said, doctors are highly trained, highly educated, and highly competent professionals. But what are they trained, educated and competent in?

The answer is pretty simple: doctors are mostly trained in whatever the medical establishment is focussing on at the time when they get their training. That's where they learn not only the basics of how to perform their craft, but also what journals to read, who to listen to and who to ignore when they go forward in their professional life. And it’s here where the CNBC article on a Goldman Sachs (GS) report becomes so important.

Goldman Sachs, for those who may not know, is one of the largest multinational investment companies in the world. It is also widely regarded as one of the most competent. Where GS leads, the industry follows.

In this report that was released in April of 2018, GS analysts consider the example of Gilead Sciences which developed a highly successful drug for hepatitis C. Hepatitis C is a serious condition that can lead to liver damage, intestinal dysfunction and even depression. So the fact that Gilead (which trades as GILD on Wall Street) had developed something very close to a cure - 90% of patients experience complete remission - should have been applauded.

But Goldman Sachs was not applauding:

“GILD is a case in point, where the success of its hepatitis C franchise has gradually exhausted the available pool of treatable patients,” the analyst wrote. “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 (eg, in cancer) the potential for a cure poses less risk to the sustainability of a franchise.”

In other words, if a company creates a cure for an infectious disease, they risk reducing the patient pool in the future making their business model less profitable.

While this may seem shocking, it makes perfect sense both from the point of view of Goldman Sachs and from the point of view of Gilead. In a world where medicine is business, illness is good for the bottom line. That bottom line influences research agendas, meaning that drugs that cure disease are less likely to get funded than drugs that just manage disease or even drugs that can lead to addiction (that’s a separate discussion on the opioid epidemic in the USA).

So what are doctors trained in? By and large doctors have one tool: the prescription pad. You go in, you get an examination, maybe you get some blood tests done. You leave with a diagnosis and a prescription for a medication, maybe multiple medications. Those medications all have side effects. Many of those medications are only meant to be used for a few months - I know people who’ve been on Proton Pump Inhibitors (PPIs) or Selective Serotonin Re-uptake Inhibitors (SSRIs) for years. That’s despite a wealth of information documenting that long-term use of these drugs can be dangerous.

Most of the drugs - especially drugs for chronic conditions like type 2 diabetes, high blood pressure or depression - are about “disease management” as opposed to “disease reversal". As the Goldman Sachs report shows, it's hard to tell whether this is because "disease management" is the best we can do right now, or whether we only use "disease management" because there’s more money in managing disease than ending it.

All of this should in no way be construed as an indictment of doctors. Doctors have their role and medication has its role. But patients have to understand the system and its limitations in order to navigate it. If we seek complete disease remission or reversal, we must ask more meaningful questions. When you get a prescription for a statin, for example, what do you think that means? Was your poor health caused by a lack of circulating statins in your blood? Or were there deeper diet and lifestyle issues that you could address in order to optimize your health, with or without the statin?

The system we live in works against us in so many ways. It prioritizes profit over human life at every level. If we keep our eyes open (and if we read the business press) we can even see people openly advocating for an end to effective treatment. That's scary, but once we understand that it leads us to a fundamental truth - in order to thrive we must be willing to take control of our own medical decisions. 

Anyone can do that if they have enough time and resources. But working with a health coach is a great way to get started. As we enter the end of year holiday season, do feel free to reach out and make a plan for taking control of your own health in 2023.