Paper short abstract:

I investigate the making of a cure for Hepatitis C as a rare instance in which a medicinal asset ‘eliminates its market’, and the contradictions faced in attempting to value both its population health promise as well as financial return.

Paper long abstract:

Sofosbuvir, a curative therapy for patients with Hepatitis C, presents a rare opportunity to study the consequences of transforming scientific knowledge into an asset that eliminates the very market from which its owners might accrue profit. The regimes of justification and repertoires of evaluation described by Dumit's notion of surplus health - in which patients are economically valuable to companies based on the extent to which they take medicines on an ongoing basis - are re-considered in light of this short-term therapy. I trace the medicine from its origins at a small biotechnology company called Pharmasset, which fulfilled the promise contained in their name and supplied the pharmaceutical asset sofosbuvir to Gilead Sciences for $11 billion in 2011. Gilead Sciences later priced sofosbuvir at roughly $1,000 per pill for its daily regimen. By interpreting a novel data set of private corporate presentations and public transcripts of earnings calls between investment analysts and firm executives, I chronicle a grammar of pharmaceutical forecasting rife with contradictions: on the one hand is the high societal valuation of a therapy that carries the potential to eliminate a disease that affects 170 million people globally. Yet on the other hand this valuation is used to justify a price that defers and diminishes its population health potential. This in-depth case study of a cure can provide insight into both general and exceptional tensions emergent in the creation of biomedical assets, which rely on epistemologies of aggregating and transmuting long-run population-level health risks into short-term economic valuations.