[smt88]

"Number of new drugs released" doesn't feel like a good metric for pharma productivity to me.

An ideal metric would be "person-years of increased healthspan per dollar spent by the consumer," and I'd wager that's very low because the profit motive is to create drugs that treat symptoms (and are prescribed for life) rather than cure an illness.

[s1artibartfast]

Most countries do exactly that. determine how much they will pay for a drug based on person years of increased health span. The term you are looking for is quality adjusted life years (QALY). Many European countries will pay up to around €80,000, and sometimes more for cancer treatments. I think France will pay 300k or so for oncology.

Cures are hard. No companies are suppressing cures that would make them tens of billions of dollars out of long term self interest. You take the cash and move on to the next one (or not).

The time value of money means that profits more than 10 years or so into the future are essentially irrelevant compared to money today.

[cogman10]

I disagree. Curing and preventing disease brings in a pretty large paycheck for drug companies. Semaglutide is extremely effective and has made nordisk billions.

Curing cancers also will remain a particularly lucrative trade. Particularly because cancer is a million different diseases which everyone gets if they live long enough.

There is never just one person that gets a disease.

That said, it's definitely true that pharma will never spend research dollars to see if a disease can be treated with a generic drug. Universities and the NIH can and do.

[throwanem]

What does semaglutide cure? What outside the treatment period does it prevent?

[cogman10]

> What does semaglutide cure?

Prediabetes and hypertension. Assuming long term dietary changes, outside of treatment those effects are pretty permanent.

> What outside the treatment period does it prevent?

Again, assuming dietary changes, it'll prevent type 2 diabetes and heart attacks.

[throwanem]

It's indicated as a diabetes medication, but never mind, I'm not going to cavil about off-label use for obesity. What if the dietary changes are made alone?

[nradov]

That rather depends on the patient. Medically supervised ketogenic diets have shown good results for putting type-2 diabetes into remission. But many patients don't stick to the diet long term.

https://www.virtahealth.com/research

[throwanem]

Will you please stop attempting to advertise what I assume to be your portfolio companies in response to comments here?

My point in any case is precisely as you note: People rarely stick to diets. Semaglutide for obesity therefore presumptively is a maintenance medication. That is, if I diet and take semaglutide and lose fifty pounds, and then cease both treatments, I will almost certainly gain back fifty-plus pounds. But - as I understand it, at least - if I only take semaglutide and make no effort at dietary regulation, I will still lose weight, because the medication limits hunger and increases satiation: even with an entirely slovenly eating habit, I won't do myself the damage I would otherwise, but only so long as I remain on the medication. If I stop, I'll minimally gain back weight and likely rebound in the manner of a yo-yo dieter. I have not been "cured." And it is the novel obesity application, not the longstanding diabetes indications, which is the breakout moneymaker. (I said I wouldn't cavil about that, not that it didn't bear talking about.)

I concede I might have a different view of the matter if I had a weight problem, but it is not actually complicated to diet off fifty or sixty pounds to a healthy weight and body composition, and then stay that way. It's only difficult, in that it requires more or less reorganizing one's entire life for years, to support the firm entrenchment of new and healthier habits. That's obviously not something everyone can do. For those unable, I'm glad options like semaglutide also exist. I just don't see any reason to dissemble over what they can actually do and what they cannot.

[cogman10]

They'd probably work. From what I've read, after cessation there is some typical weight gain even with the same diet, but it levels off.

That indicates to me it's doing a bit more than just appetite suppression.

[throwanem]

I don't doubt it is more than merely an appetite suppressant; otherwise I'd expect it to show no significant efficacy over lifestyle changes alone in treating and preventing diabetes, and I understand that it does show such efficacy.

I don't know if that matters, or how much, for the obesity application, where appetite suppression seems plausibly the effect of sole or major interest.