There are two things that I would really like researchers to figure out: how to cure psoriasis, and a road map for how to avoid getting psoriasis. I’d also like them to figure out how to resurrect mammoths and dinosaurs, but in the realm of psoriasis, these two things will suffice. As a researcher myself though, I am hyper attuned to the phrase “follow the money.” Sometimes this means bias in research studies, but it also relates to what research there is funding for. What does this mean for a possible psoriasis cure?
The cost of psoriasis
It’s been estimated that many of us with psoriasis or psoriatic arthritis spend more than $2,500 per year in out of pocket expenses.1 With almost 8 million people living with psoriasis in America alone, that’s a multi-billion dollar business from us (let alone the reimbursement costs for our medications, which far surpass out of pocket expenses). Would a cure for psoriasis bring in billions of annual dollars? I doubt it.
Conspiracies and cover-ups
Do I think that there is a global conspiracy to hide a psoriasis cure from us? No. But I do think that businesses have to make money. Research moves forward, and it would be hard to suppress something as ground-breaking as a cure, but if I pay you to dig for gold in Alaska, no one’s going to find gold in Texas. Likewise, the money is there for research that aims to develop new treatments for symptoms, not cures for underlying causes. There is even less money available to determine those underlying causes! It has always bothered me that very little of the funding dollars given to our biggest charities go toward preventing disease. Statins are important, for sure. But how can I avoid getting cardiovascular disease in the first place? Who would even make money off that initiative?
Maybe the cure isn’t a drug
Consider the possibility that the “cure” for psoriasis isn’t actually a drug. If that’s true, then pharmaceutical companies will never find it, not because they’re digging in the wrong place but because they don’t even have the right tools. I think it’s just as likely that the cure (or, what seems more likely to me, the prevention) would be something like proper nutrition in childhood to foster a healthy relationship between the gut microbiome and the immune system, or preventing strep and other infections, or minimizing prescription antibiotics and other medications that trigger immune dysregulation. Maybe the cure/prevention is a lifestyle that is filled with sunshine and is stress-free. Of course environmental controls can only overcome genetics so much of the time, but consider that in Norway, 3-11% of the population has psoriasis (depending on the year and the region), whereas many Asian and African countries have incidences less than 0.5%.2 Is this difference due entirely to genetics? If it was, then identical twin studies wouldn’t show that 25-40% of psoriasis susceptibility is attributable to non-genetic factors.3 There are lots going on behind the scenes, and there may be factors that pharma simply can’t address.
The research just isn’t there yet
Autoimmune diseases are incredibly complex. In my opinion, the reason we don’t have a cure yet is because we don’t have enough information. I think the reason for this is two-fold.
First, the majority of the money that’s available for psoriasis research is geared toward finding drugs to help manage the condition (and, if you ask me, I don’t think a drug cure will be found in my lifetime. It hasn’t yet been done for any other autoimmune disease that I know of; to date, we’ve really only cured infectious diseases with drugs).
Secondly, there are certain areas of research that are just not popular enough yet to get the funding they need. The study of the interactions between the microbiome and the immune system is still in its infancy, the study of how our immune system develops is still in its infancy, and the immune system itself is so incredibly complex that no one knows how it all works together (so how can we know what causes it to become dysregulated?). If developing a strong immune system was found to be fostered by a diet rich in fruits and vegetables and low in processed sugar and dairy products, consider all the big interests that would steer the narrative in the other direction.
Of course, these are just the musings on science and lobbying from one scientist! What about you? Do you think a cure will be found in your lifetime, and what do you think that cure would look like?