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Comment by pavlov | Hacker News Reader

Gene therapies may cost hundreds of thousands of dollars, or more than $1 million, for one-time treatments. Companies are pouring resources into developing more such drugs, with no real thought to who will pay for them, or how, and no acknowledgement that the current pricing model can't expand infinitely.

I wonder if it's reasonable to expect something like Moore's Law for gene therapy?

A 1980s Cray supercomputer cost over $1 million. Today the same amount of computing power is available in the cheapest Android phone you can find.

If the same trajectory applies for gene therapy, it won't be about finding more million-dollar payers. Only those with the most serious chronic diseases will pay for it now, but in 30 years, all of us will have gene therapy for what today would seem like trivial alterations.

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It's absolutely what will happen (see wind, solar energy or anything that has ever caused market shifts) - in fact, it's pretty incredible that the article doesn't acknowledge this. If the argument was about whether or not prices would drop fast enough, that would have been cogent.

you may not be familiar with how healthcare works. There is, generally, almost no price pressure. In fact, consumers of healthcare, because they aren't paying for it, often equate higher price with higher quality so I wouldn't bet on the prices going down

but with medical tourism becoming more reliable and trusted, as well as companies hq'd in countries unencumbered by our insistence on patents for biology, it's likely this is where another country takes the "top" spot from the US. China, Brazil, and India all seems like good potentials.

Medical tourism doesn't work for chronic disease requiring recurring visits/treatments... unless you move there.

unless you move there

It's a big opportunity for Mexico, then. Already home of the most cost effective first world (OECD) universal health care system, Mexico has good facilities right on the US border in half a dozen cities and is popular for eye and dental procedures for US visitors already.

> There is, generally, almost no price pressure.

That's not actually true. There's tons of price pressure, but it all happens behind the scenes, and in a way that's invisible to patients.

The way payments are structured, downward price pressure on suppliers may even correspond to an increase in the (apparent) out-of-pocket cost to patients. That doesn't mean that the overall amount that the manufacturers are getting paid isn't decreasing, though.

Health consumers are rarely the customers, though; providers' customers are actually the carriers, and the customers make the market in healthcare. The asymmetry in price signaling between patients and carriers causes, as you point out, weird distortions in the market. (It doesn't help that price transparency for patients is basically zero.)

This is changing. In the USA, the increased prevalence of high-deductible health insurance plans tied to HSAs gives consumers a direct incentive to shop around. Of course that only goes so far. Patients with really serious problems tend to hit their out-of-pocket maximum quickly, at which point they no longer feel the price pressure.

The market for computers seems obvious. The market for gene therapy is less obvious.

The market for computers is obvious now because there is a market for computers.

The market for computers 40 years ago was far from obvious. Even 25 years ago, most people weren't really sure if this whole internet thing was going to amount to much. 15 years ago, people scoffed at the idea that the future of the internet was mobile phones.

Predictions are hard. Especially about the future.

I'd have thought the market for gene therapy was blindingly obvious compared with the market for computers 40 years ago: theoretical gene therapies being easier to conceive and more fundamental to human quality and length of life than theoretical everyday uses for calculation devices.

Point mutation diseases impact a relatively small portion of the population. They are trivially addressable if you have a gene therapy that is able to work on arbitrary adult tissue, but it's not that huge a market. I think the largest win is sickle cell anemia, after that cystic fibrosis.

Some way of treating obesity with gene therapy would be a blockbuster financially, but biologically we don't really have that worked out so much.

(research is ongoing: https://en.wikipedia.org/wiki/Sickle-cell_disease#Gene_thera... )

I'm pretty happy with my ~50 year life span. I wouldn't spend a dime on gene therapy ever.

If gene therapy can keep people from dying, I'm pretty sure there will be a market.

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