Keeping People Sick: a Sustainable Business Model

It was a typical Monday and I was scrolling through my news feed. A CNBC article quickly grabbed my attention: Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’ While this article was directed at the biotech industry in genomic medicine, the question has huge relevance and applicability to chronic lifestyle illnesses that cost the U.S. trillions of dollars and reduce the lifespan (and quality of life) of millions of Americans.

Let’s walk through a fictitious, but all too familiar scenario. A 40-year-old guy named Bob eats the Western-style, standard American diet (SAD). During a routine visit, Bob’s doctor informs him that he has high cholesterol and should eat more of a plant-based diet. Bob nods to her, but then quickly dismisses the idea of changing his diet. He believes his diet is normal and therefore okay. Besides, he was raised with this diet and it’s all he knows. After all, eating meat and lots of it is viewed as manly. Also, he thinks it tastes good.

A year later, Bob goes back to his doctor. His cholesterol is higher. Realizing Bob didn’t take her advice, she tells him to start taking a statin to lower his cholesterol. Bob takes the prescription and leaves. He gets the prescription filled but only takes the statin occasionally when he thinks about it and continues to eat the way he eats: a sausage-and-egg biscuit for breakfast, chicken sandwich and fries for lunch and deluxe pizza for dinner. A few months later, Bob complains of chest pains. After tests are run, he is rushed to the heart catheterization lab, where a balloon angioplasty is performed and the cardiologist places 2 stents into his arteries. Afterward, Bob is sent home with 6 different prescription drugs to take for the rest of his life, and an order to start cardiac rehab.

Now let’s dissect this scenario from a business model standpoint.

First, we live in an environment that encourages and even celebrates a high intake of animal protein and ultra-processed convenience foods. How many times have we scrolled through social media and seen people bragging about eating a steak the size of the dinner plate, or a bacon-wrapped whatever (hot dog, cake…), or snapping that selfie with a frosted cinnamon roll the size of a soccer ball. It’s almost cult-coolness in our society. Money is made because companies know how to design food products that appeal to our innate attraction to calorically dense foods that are often addictive. This fact is eloquently explained by Dr. Doug Lisle and Dr. Alan Goldhamer in The Pleasure Trap.

Second, the cost of a heart attack is estimated to be $1 million over the individual’s life—including procedure(s), prescription drugs, and other indirect costs. This truly is the “razor/razor blade” model learned in business schools across the country. Yes, you sell the razor, but the recurring revenue stream comes from the ongoing sales of the razor blades. The heart procedure is the razor and the ongoing prescription medications would be the razor blades. Eating a poor diet will increase the odds of you participating in this model whether you want to or not.

Knowing this, we all have to ask ourselves whether we want to play in this space or not. It is our choice. Is it more desirable to get wrapped up in the current system that leads to chronic disease, or is being healthy and active into your 90s and 100s more important? Our capitalist system is very enterprising and innovative, so where there is demand for something, products and services will be created to meet that demand, whether it be the food that brings on the heart attack and the $1 million cost outlay, or the food that prevents it. And if we choose to prevent the heart attack, that $1 million could instead be spent on kayaks, “run-cations,” new bicycles (n+1) and hiking trips.