Is curing diseases a sustainable business model?

In many discussions about the (positive) health effects of a ketogenic diet, some people keep demanding proof in the form of published studies and research results.

There are often anecdotes and case studies - more rarely truly large, randomized trials. One reason is that diet is very hard to randomize in a blinded way (except in animals, where you can, for example, test different compositions of kibble). But it is also a result of the profit opportunities: nutrition - especially when it comes to natural foods rather than industrially produced ones - is not very lucrative, and not in the hands of a few large players.

It may sound as though we are getting close to conspiracy theories here, but since there are good sources, we can safely drop the “theories” part:

Goldman Sachs, 2018

Is curing patients a sustainable business model? ⁽¹⁾

In a 2018 report, the analysts at Goldman Sachs examined the economic prospects of revolutionary gene therapies that can permanently cure diseases with a single treatment (so-called “one-shot cures”). In the body of the report, they wrote:

The potential to deliver ‘one-shot cures’ is one of the most attractive aspects of gene therapy […]. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies… While this proposition carries tremendous value for patients and society, it could represent a formidable challenge for genome medicine developers looking for sustained cash flow. ⁽²⁾

Case study: Gilead Sciences

In the report, Goldman Sachs cites a concrete historical example: the company Gilead Sciences⁽³⁾.

Gilead had developed a drug (Sovaldi/Harvoni) that permanently cured hepatitis C with a success rate of over 90%.

From the patients’ perspective: a rescue, ending their suffering.

From the bank’s perspective: a financial catastrophe. In 2015, the drugs generated 12.5 billion dollars in revenue. But because the patients were healthy afterwards, the market shrank rapidly. By 2018, revenues had collapsed to under 4 billion dollars.

Gilead had, quite literally, cured its own market away.

If diet could be prescribed as a pill

Research, along with promising practical experience around and with a ketogenic diet, currently points in an enormous number of directions: from the classic diseases of civilization (e.g. diabetes, cardiovascular disease, obesity, cancer, inflammatory- and auto-immune diseases) all the way to psychiatric diagnoses (e.g. depression, bipolar disorder, ADHD, autism). They all show astonishing results, up to complete remission, in some cases while medication is being discontinued at the same time⁽⁴⁾.

As described above, there is no great profit behind a change of diet, as long as it is not about industrially manufactured artificial foods. So for the foreseeable future we cannot expect studies that come anywhere near the scale of pharmaceutical trials. And from the perspective of a dietary change that favours natural foods, we will not match the marketing budget of the pharmaceutical industry either.

Many people I know who have non-communicable diseases would like to take matters into their own hands. They are interested in self-efficacy, in what they can do themselves to find relief. Those who try it once are shocked to experience, in their own bodies, what an effect nutrition has on health.

In the end, none of this is amazing: it is common knowledge that nutrition plays an important part.

A ketogenic diet, however, is rarely part of that conversation - and from everything I have seen, the usual “better than the standard” is not enough for many people. They need “optimal”. And to get there, both a ketogenic and a fibre-free (possibly carnivore) diet absolutely belong in the toolbox - at least to try out, and as an option.

That is not worthwhile for the economy.

For the individual - as Goldman Sachs already noted - it very much is.