Selkoe to discuss #amyloid and #Alzheimer’s in wake of another disappointing drug study

A recent story in The Atlantic asks “Is the Leading Theory About Alzheimer’s Wrong?

1905_otto_folin_in_biochemistry_lab_at_mclean_hospital_byahfolsom_harvard
1905: Research at McLean

For years, scientist have been arguing about whether amyloid protein in the brain is a cause,or just a symptom of condition.  Pharma has been confident — or desperate — enough in the science to bet on amyloid clearing drugs, but they haven’t turned out to be very good bets. So far, none has proved effective.

On Tuesday morning, one of the chief proponents of the theory, Harvard’s Dennis Selkoe, will give a talk at McLean Hospital, the storied psychiatric facility in Belmont.  Entitled  “New Insights into the Protein Biology of Alzheimer’s and Parkinson’s Diseases,” it takes place at 11 am in room 132 of at the hospital’s de Marneffe Building.

And, if those in audience have read the Atlantic piece — in which Selkoe is quoted — they may have questions about Merck’s recent decision to abandon test on what was once considering a promising treatment. .

 

 

After Merck’s announcement last week, one neurologist told Bloomberg that “there is mounting evidence—of which this is another piece—that removing amyloid once people have established dementia is closing the barn door after the cows have left.” An advisor to a life-sciences venture-capital firm tweeted, “I’ve been a long-term adherent of the amyloid hypothesis, but starting to feel like this”: “This” was a gif of the Black Knight from Monty Python, arms missing but still adamant he had suffered nothing worse than a flesh wound.

And well, the amyloid hypothesis is not dead yet. Large clinical trials targeting amyloid are still underway—either using new, potentially more powerful anti-amyloid drugs or trying out the previously failed drugs in patients with less advanced Alzheimer’s. These trials will likely affirm the amyloid hypothesis or kill it for good.

From today’s Boston Globe: Partners and Trump, health costs and another expensive drug

STAT News reports that Partners Healthcare CEO Dr. David Torchiana was among the health care executive who met with President-elect Donald Trump Wenesday. 

Torchiana has been among those arguing that repeal of the law could disrupt millions of families who have relied upon it for insurance coverage.

“De-insuring 20 million people, many of whom were probably Trump vPHS_Logooters, is a pretty difficult thing to do politically,” Torchiana said in November, according to the Boston Globe. “Figuring out what the pathway is to altering the ACA and doing so in a way that actually doesn’t increase the cost of health care is pretty difficult. There’s not a simple policy solution to it.”

Torchiana did not reveal what he said about the Affordable Care Act to Trump. Partners spokesman Rich Copp told STAT that Torchiana was invited by the president-elect. “They had a conversation that touched on a wide range of health care policy issues, including affordability, access, quality and biomedical research,” Copp said.

$370,000 drug

Also,  Adam Vacaro of the buiness section reports that Biogen Inc.’s new drug “to treat a rare  genetic disorder in children will be priced at about $375,000 a year per patient — its most expensive medicine ever — the Cambridge biotech company said Wednesday.”

File_000Worth noting that drug companies were once so reluctant to make drugs for rare disease that Congress had to pass The Orphan Drug Act to entice them. It seems that now they just charge a lot of them.  Could it be that these rare diseases the low-hanging fruit for the developers of biologics?

Worth revisiting former Globe reporter Steve Heuser’s 2009 piece on how Genzyme sought out patients around the world with a rare condition and convinced governments to pay the full-price for the drug–  $160,000 a year.

Jose Gonzalez felt indescribably lucky that his little girl, wasting away beneath hibiscus vines in Central America, had been found. But for Genzyme, it wasn’t luck. It was another step in a remarkable business strategy: In countries from Colombia to Taiwan to Libya, the Cambridge firm has compiled an extraordinary track record of searching out patients like Tania, providing desperately needed treatment, and then successfully pressing their governments, even poor ones, to pay full price for the most expensive drugs in the world.

That strategy has helped Genzyme bring in more than $1 billion a year on Cerezyme alone, and to develop an arsenal of similarly expensive drugs for other rare diseases. And Costa Rica would soon learn a lot about Genzyme’s determination to be paid when it considered the cost of saving Tania Gonzalez, how it would drain resources from other patients, and decided that its answer was “no.”…

What (Genzyme)  won’t do is offer a discount. Although discounts are becoming more common on pharmaceuticals sold in lower-income countries, Genzyme follows a “full price or free” model, and works hard to be sure it’s the former.

“If you’re going to give on the price someplace, everyone’s going to ask for a deal, and then you’ve got a massive mess – so from day one, it was one price,” said Alison Taunton-Rigby, a former Genzyme executive who was with the company when it began setting its price policy.

Geoff McDonough, current head of the division that sells Cerezyme, says the policy allows the company to maintain the profit margin needed to research future drugs, while also keeping a door open for the truly impoverished.

“We’ve chosen a way here that’s been consistent across the company, and has met the specific needs and complexities of patients suffering from very rare diseases,” he said.

It is a balancing act, he says, that amounts to an “extreme example” of a discounting policy: the company currently provides the drug free to more than 300 patients worldwide.

Back to Partners, this time on costs

 letter from BU’s Alan Sager on the many confusing interpretations of health that is health care costs in Massachusetts:

David Torchiana,  president and CEO of Partners HealthCare, once again has recited Commonwealth Fund analyses of federal survey data showing that Massachusetts health insurance premiums are a lower share of median income than prevails nationally (“First, do no harm”).

But federal data on actual health spending contradict Torchiana. Massachusetts health spending per person was 36 percent above the US average, the highest in the world. After deducting Medicare and Medicaid dollars, private Massachusetts health costs per person were 40 percent above the US average, an excess of $11 billion over national average costs. Meanwhile, median income here was only 20 percent above the US average.

 

 

 

From Health Leaders: Shame, fear and medical errors

From a recent talk 978-080703330-2at Harvard by Danielle Ofri, MD, author of What Doctors Feel.

Ofri’s talk centered on one emotion, shame, which she said overwhelms many doctors and is a major reason many medical errors go unaddressed.

When errors are not acknowledged, even those without bad outcomes, no one learns from them, she said. And, there is little incentive for doctors to point out their shortfalls. “We want to look like we know what we are doing. When in doubt, pretend. That’s what I learned in my internship. “

Click here for full story from Health Leaders Media 

Should Boston Children’s Hospital expansion go forward? Opponents cite higher costs, smaller garden.

Planned to write a post linking to the wave of endorsements and opposition to the proposed expansion at Boston’s Children’s Hospital, but the Globe columnist Joan Vennochi did it for me. Her opinion piece  links to the various supporters -Gov. Charlie longwood map Globe’s staff editorial endorsing the plan.  BHN is in the reporting, not the endorsing, business. So, FYI.

The need for Children’s to renovate old quarters is not in dispute. But its expansion needs are open to question. Children’s says it will fill beds from national and international referral sources. But it has been working to expand its referral network in Massachusetts. In the past 24 months, Children’s has filed numerous notices of material change about new arrangements to either acquire physicians or become the preferred provider. That suggests the hospital expects to take volume from the current marketplace. At the same time, it will drive up costs, since the hospital has also said it expects to get commercial insurance and Medicaid rate increases every year.

As the Children’s plan moves forward, Massachusetts is under pressure to reduce state health care costs, with spending on Medicaid — the health program for the poor and disabled — already flagged as a trouble spot.

Competitors like Tufts Medical Center and Massachusetts General Hospital — which is part of the Partners network — are also worried that a larger Children’s will dominate the pediatric hospital landscape. To add to the intrigue, Jack Connors, who was chairman of the Partners board from 1996 to 2012, is backing Children’s and essentially undercutting the concerns of MGH doctors. “If you’re successful in business, you grow,” Connors told the Globe.

Ah, business. In the end, is that what this is all about?

Can #Massachusetts tame #health #spending with transparency and oversight?

Stuart Altman, the Brandeis University healthcare economist who has advised presidents from Nixon to Obama, talked to Health Leaders last week. He is capturenow  the head of the Massachusetts Health Policy Commission, which tracks total health spending statewide.  

HLM: How is Massachusetts trying to address high costs?

Altman: First of all, it is the only state that has recognized that it should be involved in total state spending. Some other states that are closer are Vermont and Maryland. But the Massachusetts state government is really acknowledging that it has responsibility for not only what it spends on Medicaid, but that it should be concerned with total spending.

Full story at Health Leaders. 

The New Yorker:#Boston researchers are hunting for a #Zika vaccine — trco201

The August 22 edition of The New Yorker includes a story by Siddhartha Mukhergee on Dan Barouch, director, Center for Virology and Vaccine Research at BIDMC. He’s on the hunt for a Zika vaccine and his work on HIV is informing the effort. From the article, which is not behind the NYer pay wall:

Capture

 

Are two big #hospital groups better than one? #consolidation

At Wednesday’s meeting, the  Massachusetts Health Policy Commission heard a staff report on the proposed merger of Beth Israel Deaconess Medical Center

Capture
From the report. AMC= academic medical center

 In summary, we find that these transactions are anticipated to increase market concentration, solidify BIDCO’s position as the second largest hospital network in the state, and could strengthen BIDCO’s ability to leverage higher prices and other favorable contract terms. However, BIDCO’s market share will remain far smaller than the dominant system in the state for most services.

Member of the commission pondered the impact of having two large hospital systems, instead of just one giant one — Partners. Their conclusion — no one really knows, but it would be worth finding out.  We’ll see where that goes.

From the Globe:

“… commissioners noted that the growth of Beth Israel Deaconess Medical Center and Beth Israel Deaconess Care Organization, or BIDCO, could be a good thing. BIDCO is a network of affiliated doctors and hospitals that negotiates contracts with insurers and gives its members set budgets under which to manage patient care.

“To me, big is not necessarily bad,” said Marylou Sudders, the state secretary of health and human services, who sits on the commission. “Shouldn’t Massachusetts have… a strong competitor to what is the largest and most expensive health system?”

The commission said that by adding MetroWest and the Baptist to its network, BIDCO will solidify its place as the state’s second largest provider network. But it will remain much smaller than Partners, with about 13 percent of all hospital discharges, compared to 29 percent for Partners.