It has always been suspected that pharmaceutical companies would rather keep people sick and on medication than cure them all at once and lose the ability to retain customers.

While the huge motive here is easy to understand, with the industry bringing in over $453 billion in the United States alone in 2017, many people have a hard time considering that these companies don't care interest of their customers.

The idea that these companies would like to keep us sick is dismissed by many as a "conspiracy theory," but let's not forget that these companies and their high-profile investors are there to sell drugs, not to save lives. The point was made openly earlier this month in a memo that Goldman Sachs analyst Salveen Richter sent to the firm's clients about the potential for gene therapy to cure diseases.

Richter estimated that the market size for genetic therapies could reach $4.8 billion because "genes are the basis of all biological activity," according to CNBC. However, he is concerned about how curing illnesses could negatively impact the industry's bottom line.

In the report, “The Genome Revolution,” Richter asks: “Is curing patients a sustainable business model?”

In the memo, Richter said clearly:

“The ability to deliver 'one-shot treatments' is one of the most attractive aspects of gene therapy, gene-engineered cell therapy and gene editing. However, these treatments offer a very different outlook when it comes to recurring revenue compared to chronic therapies. While this proposition has tremendous value for patients and society, it could pose a problem for genetic medicine developers looking for sustained cash flow.”
As an example of how treatments can be bad for business, Richter pointed to the case of Gilead Sciences, a company that developed a treatment for hepatitis C, and which had a cure rate of more than 90 %.

As Richter pointed out, “GILD is a typical case, where the success of its hepatitis C franchise has gradually exhausted the number of treatable patients. In the case of infectious diseases such as hepatitis C, the recovery of existing patients also decreases the number of carriers capable of transmitting the virus to new patients, so the number of incidents also decreases… When a group of "incidents remain stable (for example, in cancer), the potential for recovery poses less risk for the sustainability of a franchise."

It appears that Richter is suggesting that he would prefer people to have hepatitis and that he is not interested in preventing diseases like cancer. Next, he suggested that pharmaceutical companies should only focus on diseases that have a steady stream of new customers, such as the most common hereditary and genetic diseases.

The report proposed three solutions for drugmakers:

“Solution 1: Address large markets: Hemophilia is a $9-10 billion global market (hemophilia A, B), growing at approximately 6-7% per year.
Solution 2: Address high-incidence disorders: Spinal muscular atrophy (SMA) affects the cells (neurons) in the spinal cord, impacting the ability to walk, eat or breathe.
Solution 3: Constant innovation and portfolio expansion: There are hundreds of hereditary retinal diseases (genetic forms of blindness).”
These suggestions seem harmless enough at first glance, as he suggests cures for some very serious illnesses. But at the end of the report, Richter said, “The pace of innovation will also play a role, as future programs can offset declining revenues from past assets.”

Although this statement can be interpreted in different ways, it seems certain that Richter is suggesting that drug manufacturers slow the pace of drug development in order to allow the growth of these new markets to catch up to their current revenue levels.

On a very apparent level it may seem like this is just a toxic manifestation of selfish human nature or an example of the greed that exists in the business world, but there are many more nuances to this situation. Goldman Sachs, like many other Fortune 500 companies, has a very twisted way of looking at the world and doing business, because they achieve their success by lobbying for protection from monopolies or cartels from governments, not by providing value to their customers.

Goldman Sachs analysts and executives at big pharma have a business model that depends on monopolizing markets with patents and keeping innovation in their industries as stagnant as possible, which is why we see a such brutal behavior from companies in these positions, but it doesn't have to be this way.

If businesses were forced to compete to stay relevant and satisfy their customers, instead of simply developing and maintaining government-granted patents and monopolies, innovation would be driven by customer desires, keeping businesses honest. businesses, even if their only intention was to make money.