The focus of the Arnold initiative is limiting the development of and access to the new medicines, particularly those for ultra-orphan conditions, by gaining control over the clinical research process, the measurement of health outcomes and the development of institutions to arrive at and enforce clinical decisions. There is little room for the kind of democratic decision-making and deliberation that characterizes medicine, at least for now.
It is using ICER, funded by Arnold, (and also funded by insurance companies/PBMs) and the Center for Evidence-Based Decision Making at Oregon Health & Science University, to take control of the coverage decisions of Medicaid, Medicare and of course, health plans. Through these entities, Arnold is increasing the power of PBMs and government agencies to limit access to new medicines, guided of course, by ICER recommendations of the value of these treatments (to PBMs and plans). They provide a short window for public input, but there is no mechanism for allowing different communities with different traditions to choose treatments based on what they value.
Value is defined as limiting total drug spending to an arbitrary level. And that level is in turn based on Arnold’s erroneous belief that new drug spending will drive health plans, families and our economy into bankruptcy. But it is a fact, based on evidence that Arnold ignores and would never fund, that new drug spending overall reduces the total cost of treating disease. New drugs do not just compete with old medicines or similar products. They are substitutes for less effective and more efficient forms of treatment. The trend in cancer and other disease is towards less hospitalization, more productivity, better health as we spend more on medicines. As I have noted before, nearly 90 percent of spending on childhood infectious diseases is on medicines. Would we want to turn back to a time when we didn’t? Societies have avoided financial and existential catastrophes by using new medicines to stem the progression and incidence of disease.
This is a calculus that Arnold, with his billions, has purposely rejected. Instead, he has funded sloppy and misleading research about the cost of drug development and the value of medicines. And he spent millions funding a network of groups that are using this twisted evidence to take control over drug coverage decisions
Across the country, ICER and other Arnold funded organizations are packing health technology assessment panels, which are often funded by Arnold or supported by Arnold funded entities to restrict access to new medicines and diagnostics. And they are doing so by justifying these decisions using the same sloppy and misleading research Arnold funds.
In Oregon, a panel tasked by the state’s Medicaid program initially rejected coverage for Foundation One genetic testing to determine which drugs work in treating cancer. The panel was run by the Center for Evidence-Based Decision Making funded by the Arnold Foundation and chaired by Vinay Prasad who is also funded by Arnold. The Center relied on upon input from ICER, Cochrane Library (Wiley Online Library, Medicaid Evidence-based Decisions Project (MED), and the Washington State Health Technology Assessment Program which contracts with ICER to determine the value of new technologies. All of these experts receive Arnold funding.
The Prasad chaired HERC voted against paying for the genetic test and reversed itself only after Brian Druker, who discovered the first truly targeted cancer drug, accused the panel of discriminating against poor people with cancer. The Center has conducted similar evaluations for 23 state health programs.
Last year’s National Academy of Science study on making medicines affordable was underwritten in large part by the Arnold Foundation. In addition, 3 members of the NAS committee guiding the recommendations receive funding from the Arnold Foundation. The key proposals: limiting patient access to new medicines and forcing them to try cheaper drugs first to save insurers money.
And all these efforts, as well as the Arnold funded researchers that sustain them, are reported in Kaiser Health News, ProPublica and HealthNewsReview.org, all with Arnold funding. In addition, all these outlets ensure Arnold funded articles are widely syndicated.
Finally, Arnold is spending nearly $10 million on negative, misleading political ads in New Jersey attacking the Republican candidate for US Senate, former Celgene CEO Bob Hugin. The actual ad buys are being made by Patients for Affordable Drugs Now, a group fully funded by the Arnold Foundation and, when it is not running malicious ads, attacks real patient organizations as pharma mouthpieces in an effort to reduce their influence.
For all the talk about lowering drug prices, the Arnold program focuses on reducing incentives for innovation to reduce the number of new medicines, reducing prices by enriching insurers and PBMs by jacking up rebates and most important, deny the poor, minority communities and people with the deadliest and debilitating illnesses states access to the kind of advances wealthier and more entitled groups will get. Ultimately, the guiding impulse of the Arnold enterpise is that the sickest and most vulnerable people in society aren’t worth spending money on because it comes at the expense of healthier and wealthier people.
In this regard, the Arnold project is similar in approach and purpose used by earlier philanthropic efforts to address the financial burden of spending more and more money on individuals with hard to treat or intractable conditions. In 1930, well-intentioned billionaires supported eugenics to solve the rising cost of health care and social services, arguing that reducing the number of such ‘defectives’ was a better strategy.
Today, the Arnold Foundation, without malice and with the same sense of noblesse oblige, supports reducing the development of, access to and spending on new medicines for people with the greatest health risks. The Arnold Foundation is hell-bent on giving a handful of well-paid elites in academia, business, politics and the media control over technologies that not only determine if we live or die but how we live or die to ensure the economic sustainability of society. This enterprise, like the eugenics movement it has replaced, is more dangerous precisely because it is well-intentioned.