Jacob FuchsDirector of Pharmacy at CSC, St. Luke's Health System · Director of Pharmacy

Pharma's Dirty Secret: Why Cures Aren't Profitable

2 Sept 2026 · 4 min

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3:44

In this concise monologue, Jacob—a pharmacist—examines the core incentive problem that drives the pharmaceutical industry. He explains that a cure yields a single payment, whereas chronic treatments generate ongoing, subscription‑like revenue, making the latter far more attractive to investors. Jacob notes that about 90% of R&D funding, according to the CDC, targets chronic illnesses, creating a massive infrastructure of daily pills, monthly refills, and quarterly doctor visits. While a cure would be immensely valuable, it is financially risky because it does not provide continuous returns. Jacob stresses that pharma companies are not inherently malicious; they simply follow the profit incentives built into the system, which rewards disease management over eradication. The true problem, he argues, is a system that financially rewards treating disease rather than curing it.

Chapters

If a company cures you, it gets paid once. But if it creates a treatment and helps you manage a disease for 30 years, it can get paid every month, like a subscription, like Netflix. What business model do you think investors are interested in? I'm Jacob. I'm a pharmacist. I'm asking the hard question. I'm looking at the pharma problem, which is at its core an incentive problem. Now, that doesn't mean pharma companies have a cure for some disease hidden in the basement next to the Ark of the Covenant, It also doesn't mean that they're actively looking for those cures either. The problem starts way before the drug ever hits the pharmacy and lies with incentives for the drug company who pays for all the research. 90% of that, the CDC says, goes to chronic illnesses. Pharma has built a massive machine managing illness. Daily pills, monthly refills, and doctor's visits every 3 months are part of a system that's hard to break. A cure would be incredibly valuable, but financially risky. Pharmaceutical companies are not inherently evil for following the incentives. That's just the way business works. We follow the money incentives. People invest in what they can get returns on, and cures just don't bring returns. The pharma problem isn't that every company is not trying to create cures. The problem is we built a system that financially rewards treating a disease rather than curing it. And that's the true Pharma problem.