A Patient Cured Is a Customer Lost: The Economics and Ethics of Modern Pharmaceutica

Why Cures Are Rare and Symptom Management Prevails: A Critical Look at Big Pharma

A friend of mine Mr Hor Meng Yew  asked  this in a WhatsApp group  

"There is much criticism of pharmaceutical companies not interested in researching to produce medicine that cures illnesses. They rather produce drugs that manage symptoms which cause prolonged dependence and generate profit.

I wonder if it is true that no pharmaceutical company can survive if it produces drugs that cures" 

Here is my reply for Mr Hor and others 

Summary Version

Pharmaceutical companies face enormous costs in drug development,  up to USD 15 billion and 10–15 years to bring one drug to market. Because of these risks, they often prefer drugs that guarantee lifelong sales rather than one-time cures. This creates what many call the “refill economy”, where patients return again and again for daily medicines.

The most profitable drugs target chronic diseases such as diabetes, hypertension, high cholesterol, asthma, autoimmune disorders, psychiatric illness, and epilepsy. These conditions are rarely curable with current pharmacology, but they can be managed indefinitely, ensuring steady profits.

Why cures are rare:

1. Scientific complexity, many diseases (e.g., cancer, Alzheimer’s, autoimmune disorders) are difficult to “fix.”
2. Economic incentives,  curing patients reduces revenue, while lifelong management ensures continuous demand.

Yet there are exceptions. Antibiotics cure bacterial infections, hepatitis C antivirals can eradicate infection, and vaccines prevent diseases with only a few doses. Emergency drugs such as adrenaline, naloxone, and clot-busters also save lives, though they are less profitable because they are used infrequently.

Doctors, caught in the middle, can only prescribe what pharmaceutical companies supply. Many recognize the limitations of symptom-based medicine and even turn privately to traditional remedies, dietary changes, or integrative approaches. Indeed, according to the World Health Organization, around 80% of the world’s population relies on traditional medicine, including many highly educated professionals like doctors themselves who were my colleagues. One of them once  told me this:

"If I were sick I will look for other ways to treat myself. I prescribe all these drugs only for my patients" 

If society wants more cures, the path forward includes:

1. Increasing publicly funded research,

2. Supporting integrative medicine, and
Pressuring companies through regulation and advocacy.

Big Pharma operates at the intersection of science and commerce. While genuine cures exist, antibiotics, vaccines, hepatitis C treatments, most drugs aim for control rather than cure. The central challenge remains: ensuring that the pursuit of health takes priority over the pursuit of wealth.

Full Story: Introduction

For centuries, medicine was guided by the principle “to cure sometimes, to relieve often, to comfort always.” Yet in the 21st century, the biomedical industry, dominated by multinational pharmaceutical companies, faces increasing criticism. A common charge is that these corporations, often labeled Big Pharma, prefer producing drugs that manage symptoms rather than discovering cures. The reasoning is straightforward: a patient cured is a customer lost.

This essay explores the economics, ethics, and medical realities behind this assertion. It examines why chronic diseases remain largely drug-dependent, contrasts them with exceptions where true cures or life-saving interventions exist, and considers the broader consequences for doctors, patients, and healthcare systems.

1. The Economics of Drug Development

Bringing a new drug to market is an extraordinarily costly endeavor. Estimates suggest that the development of a single drug requires between USD 2–15 billion and 10–15 years of research and testing. Fewer than 1 in 10 candidate drugs entering clinical trials ever achieve approval.

Given such high costs, pharmaceutical companies prioritize drugs that guarantee long-term revenue streams. A one-dose cure is commercially unattractive; a daily pill or injection for life, however, ensures recurring profits akin to a subscription model.

2. The “Refill Economy” and Chronic Disease Dependence

The profitability of symptom management is best illustrated by chronic, non-communicable diseases (NCDs), conditions that now dominate global healthcare. These include:

• Diabetes Mellitus (Type 2). Patients rely on insulin injections or oral hypoglycemics (e.g., metformin, sulfonylureas, DPP-4 inhibitors) for decades. These drugs lower blood glucose but do not regenerate pancreatic beta cells or reverse insulin resistance.

• Hypertension

Affected individuals often take lifelong antihypertensives: ACE inhibitors (enalapril, lisinopril), beta-blockers (atenolol, propranolol), calcium-channel blockers (amlodipine), or diuretics. Discontinuation causes blood pressure to rebound.

• Hyperlipidemia

Statins (atorvastatin, simvastatin, rosuvastatin) effectively reduce cholesterol but do not correct the root causes of dyslipidemia. Most patients remain on them indefinitely.

• Asthma and COPD

Inhaled bronchodilators (salbutamol) and corticosteroids (fluticasone, budesonide) relieve airway obstruction but do not cure chronic inflammation.

• Autoimmune Diseases

Conditions like rheumatoid arthritis, lupus, or multiple sclerosis require lifelong immunomodulators such as methotrexate, corticosteroids, or monoclonal antibodies. These suppress immunity but do not restore normal immune tolerance.

• Psychiatric Disorders

Antidepressants (SSRIs such as fluoxetine), anxiolytics (benzodiazepines), and antipsychotics (risperidone, olanzapine) manage symptoms but rarely cure underlying neurochemical imbalances.

• Epilepsy

Antiepileptic drugs (valproate, carbamazepine, levetiracetam) control seizures but usually do not eliminate the need for treatment.

Hospitals worldwide are crowded not with new diseases but with repeat patients,  individuals living for decades with the same conditions, dependent on medication refills. This snowballing effect generates stable and rising profits for the pharmaceutical industry.

3. Why Cures Are Rare

It would be simplistic to attribute the lack of cures solely to profit motives. Many diseases are biologically complex:

Autoimmune conditions arise from misdirected immunity, which cannot simply be “reset.”

Neurodegenerative diseases (e.g., Alzheimer’s, Parkinson’s) involve irreversible neuronal loss.

Cancer is not a single disease but hundreds of disorders, each with unique genetic and molecular signatures.

Nevertheless, financial incentives shape research priorities. Investment often favors chronic disease management over definitive cures, since the former ensures sustained revenue.

4. Exceptions: Lifesaving and Curative Drugs

Despite commercial pressures, there are notable exceptions where pharmaceutical companies have produced genuine cures or critical, lifesaving therapies:

Antibiotics

1. Penicillin, cephalosporins, and carbapenems revolutionized medicine by curing bacterial infections outright. Yet bacterial resistance now undermines their long-term effectiveness.
Hepatitis C Antivirals

2. Direct-acting antivirals (sofosbuvir, ledipasvir) can completely eradicate the hepatitis C virus in most patients, one of the few true pharmaceutical cures of our time.

3. Vaccines for polio, smallpox, tetanus, measles, and hepatitis B vaccines have prevented countless deaths. Vaccines often involve only a few doses, making them less profitable but immensely valuable to humanity.
HIV Antiretroviral Therapy (ART/HAART)

4. Though not a cure, ART transformed HIV from a fatal illness into a chronic, manageable disease, extending patients’ lifespans dramatically.

5. Emergency and Critical Care Drugs such as: 

Adrenaline (epinephrine): rescues patients from anaphylaxis.

Naloxone: reverses opioid overdoses.
Alteplase (tPA): dissolves blood clots in acute myocardial infarction or stroke.

These drugs illustrate that public health necessity sometimes overrides profit calculations. 

However, such instances are relatively rare compared to the continuous stream of chronic-disease medications.

 

The Doctor’s Dilemma: 

Doctors do not manufacture drugs; they prescribe what pharmaceutical companies provide. They rely on clinical trial data and guidelines often influenced by industry sponsorship. Many physicians are painfully aware of the limitations of these therapies.

Interestingly, even among doctors, there is a strong turn toward traditional and integrative medicine. According to the World Health Organization (WHO), approximately 80% of the world’s population relies on traditional medicine. This includes many educated professionals including doctors who prescribe pharmaceuticals to their patients but prefer herbal medicine, dietary interventions, acupuncture, or qigong for themselves. 

One of my former lady doctor colleagues told us - among ourselves who are doctors - this:

"When I am sick, I will find other ways of treating myself. I prescribe all these chemical drugs only for my patients"  

Moving Beyond Symptom Management

If healthcare is to move away from mere disease management, several strategies must be considered:

Publicly funded biomedical research, less beholden to profit motives.

Integrative medicine, combining pharmacology with lifestyle, nutrition, and traditional practices.

Regulatory oversight and patient advocacy, to ensure companies reinvest in finding true cures rather than perpetuating dependency.

My Concluding Opinion:

The tension between medicine as a healing science and medicine as a business enterprise is undeniable. Pharmaceutical companies, driven by enormous costs and shareholder expectations, tend to favour treatments that generate steady revenue rather than one-time cures.

Nevertheless, history shows that cures are possible,  antibiotics, hepatitis C antivirals, and vaccines prove that medicine can achieve its highest purpose when science and public health align. The challenge ahead lies in balancing profitability with humanity, ensuring that the pursuit of health never becomes secondary to the pursuit of wealth.

References

1. Angell M. The Truth About the Drug Companies: How They Deceive Us and What to Do About It. Random House, 2004.

2. Light DW, Lexchin J. “Pharmaceutical research and development: what do we get for all that money?” BMJ 2012;344:e4348.

3. World Health Organization. WHO Traditional Medicine Strategy 2014–2023. Geneva: WHO, 2013.

4. DiMasi JA, Grabowski HG, Hansen RW. “Innovation in the pharmaceutical industry: New estimates of R&D costs.” J Health Econ. 2016;47:20–33.

5. Alter HJ. “HCV: The beginning, the middle, and the end.” Clin Liver Dis. 2020;16(1):1–7.

6. Fauci AS, Lane HC. “Four Decades of HIV/AIDS — Much Accomplished, Much to Do.” N Engl J Med. 2020;383:1–4.

(My next article or essay I shall be publishing here will be totally different from medicine. It will be about a twin universe or a second heaven I saw twice, and what was also said to be discovered by James Webb Space Telescope (JWST)