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Prospective Health Consortium: Development and Assessment of Predictive Tools in Disease Prevention and Wellness Promotion
We are proud to support the launch of a consortium that would develop and evaluate a tool for health risk assessment and treatment selection based on predictive information relatively unique to that individual that can be used to reduce disease and promote wellness in medically underserved communities.
The idea of a consortium is based on discussions held in May at Brookings Institution at a meeting entitled “A Critical Path for Personalized Medicine”. That meeting -- chaired by Dr. Mark McClellan and Sir Michael Rawlins -- discussed ways to demonstrate how predictive or personalized medicine could be used to improve the quality of care and health outcomes. In particular, Ralph Snyderman MD, Chancellor Emeritus of Duke University Medical Center and CEO of Proventys, called for an evaluation of an tools bringing together the latest technologies to predict events and enable intervention before damage occurs. Combining personalized risk prediction and strategic health-care planning will facilitate what Snyderman calls ‘prospective health care’.
"Conservatives blame the sick for being sick, and they fault the poor for being poor. Health care reform must be compassionate, and it must be equitable."
Read more here.
John Dalli, Commissioner-designate for Health and Consumer Policy (SANCO) has pledged new initiatives to break the deadlock on Commission proposals to liberalize controls on the provision of prescription drug information to patients. And we all know how fast Brussels operates.
As Pharma Times reports:
- In the new European Commission, the move of responsibility for the pharmaceutical industry from the Directorate General (DG) for Industry and Enterprise to DG Health and Consumer Safety (SANCO) has been welcomed by consumer and patient groups. One of the reasons holding back progress on the information directive has been concern that it was drafted by DG Enterprise and Industry - whose responsibilities include regulatory and industrial policy for the pharmaceutical industry – rather than DG Sanco, which is concerned with consumers and public health.
While countries including Denmark, Sweden and the UK support the Commission’s proposals, a number of others – including France, Germany and Spain - oppose any move to liberalize controls on the provision of prescription drug information, for reasons including the fact that the draft does not distinguish sufficiently between “information” and “advertising.” They also believe that the industry should have no role in the provision of information to patients and that the proposals would drive up health costs by increasing demand and because of the need to set up monitoring mechanisms.
But – for starters – how about an approach that’s open and transparent.
"There's nothing about Scott Brown's victory that needs to derail health-care reform in particular, or the rest of Obama's 2010 agenda in general. But if Democrats decide to cower and hide, they can end Obama's presidency on Brown's behalf.
That said, I really wonder what the Democratic Caucus thinks will happen if they let health-care reform slip away and walk into 2010 having wasted a year of the country's time amidst a terrible recession. It won't be pretty, I imagine. If health-care reform passes, the two sides can argue over whether it was a success. If it fails, there's no argument."
voices.washingtonpost.com/ezra-klein/
I have heard that petulant "it's all about me" tone before.. It's the gift that keeps on giving to those of us seeking sensible health care reform consistent with the need to sustain job creating biomedical innovation... I hope Klein and others keep pushing Dems to ignore the outrage of the voters... It will produce more Scott Browns.
therpmreport.com/Free/4e767e88-bc84-40e1-871a-4025e307e300.aspx
Saturday, January 16 2010
Teva’s Hedge on Complex Generics
By Michael McCaughan
Generic applications for Lovenox and Copaxone have become bellwethers for the emerging follow-on biologics pathway in the US. Teva is on both sides.
Who says you can’t have your cake and eat it too?
When it comes to the follow-on biologics space, there are plenty of companies who are likely to try. As we’ve written before, the looming new pathway for abbreviated approval of biosimilars opens up opportunities for lots of companies—brand, generic and biotech—to consider whether to play as a true “follow-on” supplier, focus on improved “biobetters,” or do both.
But no one is in quite the same position as Teva. Not only is the company doing that analysis for the longer term biosimilar opportunity (you can read more about its latest thinking in “The Pink Sheet” DAILY here), but it is on both sides of the issue for two near-term decisions on complex molecules that are regulated as drugs.
Teva is one of three companies (along with Momenta and Amphastar) with pending applications to market a generic version of Sanofi Aventis’ enoxaparin (Lovenox). In that case, Teva wants FDA to agree that, while enoxaparin is a relatively complex molecule, it is not too complex to allow for a fully substitutable generic approval.
On the other hand, Teva’s largest and most important product is the branded multiple sclerosis therapy glatiramer (Copaxone). There are two would-be generics pending, Momenta’s and Mylan's.
In that case, Teva is arguing that Copaxone is far too complex a molecule to be copied closely enough to allow for substitutability—and is even suggesting that other manufacturers may have trouble even getting a non-interchangeable product approved without full clinical studies.
Teva, of course, is aware that this may sound like trying to have your cake and eat it too. But they don’t see a contradiction. Here is how Teva CEO Bill Marth put it during the Goldman Sachs CEO “unplugged” conference Jan. 6:
“When you think about Copaxone, many people try to equate it to Lovenox. It is
much, much different—vastly more complex—than Lovenox will ever be. We have not characterized it. We don't believe it can be fully characterized.
If one cannot fully characterize Copaxone, I'm not sure how you get it approved without a clinical study since the method of action is not well understood and exactly what the active sequence is. And, by the way, we think there are multiple methods of action, and potentially multiple reasons for that. We think that it is virtually impossible to prove your efficacy without a clinical study. So it really falls into more of that sweet spot of the biologics....
I think it is much different with Lovenox than it is with Copaxone because with Lovenox, the active sequence has been identified by us. It hs been identified by the
innovators. It has been identified of course by Momenta and Amphistar.
So it is defined. It is a sugar. When you look at those sugars and you look at the active sequence, then what you really have to do is understand what is the other stuff or junk that is within your protein or sugar, and there make sure that you don't have improper immunogenicity. They have asked us for immunogenicity testing. We have done that. And it seems to be acceptable so far.”
In other words, Teva thinks it can kept its Copaxone cake and take a huge slice of Sanofi-Aventis’ Lovenox cake too.
But there are other outcomes. From Teva’s perspective, an outright rejection of substitutable Lovenox wouldn’t be so bad, since it would underscore the company’s position that substitutable Copaxone is a pipe dream.
And while Teva would dearly love to tap into the $2 billion Lovenox market, at best it will only get a percentage of a big generic opportunity. With Copaxone, Teva hopes to maintain its own multi-billion dollar brand in something like perpetuity.
How important is that to the company? During its January 7 investor day, Teva’s bullish forecasts for growth for 2015 included what the company called a “conservative” forecast for Copaxone, with sales peaking at $3 billion and then eroding over time to $2 billion in 2015. But the erosion, in Teva’s view, will come only in the face of competition from other MS agents (including Teva’s own oral product)—not from any substitutable generic competition.
So call it a hedge: if generic Lovenox is rejected, Teva’s Copaxone franchise is more secure. If Copaxone can’t be protected, at least Teva will have some generic enoxaparin revenues to fill in the hole.
There’s really only one scenario where Teva loses. If one of the other applicants (Momenta being the most likely candidate) actually has superior technology, it could potentially get approval for generic Lovenox and generic Copaxone, while no one else can.
For Teva, that would be more like a pie in the face.
From the UL newspaper, The Telegraph:
The Government’s drugs rationing body, the National Institute for Health and Clinical Excellence (Nice), has provisionally said that it does not intend to recommend the use of the drug, called Tocilizumab, or Roactemra.Nice claims that the £9,000 a year drug, for rheumatoid arthritis, has not proved that it is cost effective.But patients in Scotland are to receive the treatment after it was recommended by the body which regulates drugs on the Scottish NHS, the Scottish Medicines Consortium (SMC).
The move will reopen accusations of medical ‘apartheid’ within Britain.
It follows an outcry after patients in Scotland were given access to expensive cancer drugs denied on the NHS in England and Wales.
Roactemra has been described as a “life changing” drug because it can be taken after other medications have failed, a common problem in the treatment of rheumatoid arthritis.Patients groups last night said that denying the medication to tens of thousands of patients with the crippling condition in one part of the country was “cruel”.
Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society (NRAS), said: “I have heard patients stories that would make you weep.
“People are virtually suicidal because they have nowhere else to go and yet they know that there are other drugs out there that they could have access to but cannot because of Nice.” She added that it was “ludicrous” that the drug would be available in Scotland “and yet two miles on over the border you can’t get it.”
The drug - the first new arthritis treatment for a decade - is already used in most other European countries, including France and Germany.
It offers another option for patients for whom other treatments have failed or no longer work and is used in combination with a standard anti-inflammatory drug, called methotrexate.Currently many rheumatoid arthritis patients receive methotrexate as a first-line treatment to ease their symptoms. In later years they are offered another class of drugs, called anti-TNFs, together with methotrexate, but even combined the effects of the drugs can wear off.
In combination Roactemra has been found to improve the rates of remission of the illness sixfold in comparison with just methotrexate alone.
The SMC - set up in the aftermath of devolution to make decisions about drugs north of the border - has agreed that the drug can be used for patients suffering from moderate to severe forms of the disease for whom other medications no longer work.
Prof John Isaacs, from Newcastle University, said: “This is fantastic news for people in Scotland who suffer from this disabling, lifelong disease.
“However, it also highlights the disparities in accessing treatments between Scotland and the rest of the UK. “Because Roactemra works in a completely different way to the existing drugs it is likely to be effective in some patients where the other drugs don’t work or have stopped working, providing an extremely important option for these individuals.”
Neil Betteridge, chief executive of Arthritis Care and vice president of the European League against Rheumatism (EULAR), said: "There are a number of treatments for RA currently available but they simply don't work for everyone. "There are people who are most severely affected by this debilitating condition – living in intense pain, unable to work, often struggling even to walk – who have been failed by existing treatments, and it's for them that tocilizumab could provide real hope.” He called on Nice to follow the lead of the SMC and approve the drug for use in England and Wales.
Up to 37,000 patients across Britain would be eligible for the drug.
But local health care trusts do not have to pay for drugs which have not been approved by Nice.
In December Nice took the unusual step of challenging Roche, the drug’s manufacturers, to provide more evidence of that the drug was cost effective.
A final Nice appraisal of the drug is expected later this year. Around 646,000 people in Britain are though to suffer form rheumatoid arthritis, in which their own immune systems start to attack their joints. The condition can be extremely painful and debilitating. Around half of sufferers are too disabled to work within a decade of the disease taking hold. The direct and indirect costs of the disease are estimated at £3.8 billion to £4.75 billion a year in the UK alone.
Nice has previously come under fire for refusing drugs which have been approved by the SMC.
Herceptin, a £21,000-a-year drug for breast cancer, was initially turned down by Nice but available in Scotland, which has its own health budget.
A climb-down, ordered by Patricia Hewitt, the then health secretary, allowed the drug in England and Wales. Patients in Scotland also had access to Tarceva, a lung cancer treatment, which costs about £1,700 a month, two years before the rest of the country. Nice also provoked outcry by turning down Lucentis, a £20,000-a-year treatment available in Scotland for wet age-related macular degeneration, one of the most common causes of blindness, although it later also reversed that decision.
Thanks Ezra.
Part of Klein's contribution to Democrat demise is perpetuating the belief that all people cared about was the total cost of the bill, which he once again argues, is really not so big when you consider say, what it would cost to build the entire fleet of Starships for the Federation. Well, okay, maybe not that much but here is Klein at his misleading and misinformed best:
"by the standards of the health-care system, it's not that big at all. It goes two-thirds of the way on covering the uninsured. It makes a courageous, but insufficient, start on cost control. This is the beginning, not the end, of reform.
Let's begin by breaking down the numbers. The $900 billion price tag is repeated with the regularity of a rooster's crow. That's a shame, as the number is, somewhat impressively, misleading in both directions.
On the one hand, that $900 billion is stretched over 10 years. But people don't think in 10-year increments. They don't pay taxes once a decade. Put more simply, the bill will cost an average of $90 billion a year.
But that number is meaningless without context. Ninety billion is a lot more than you probably paid for, say, your house. But is it a lot of money in the context of national health-care spending? Not really. In 2008, we spent $2.3 trillion on health care. Ninety billion is about 4 percent of that. In other words, a drop in the bucket."
voices.washingtonpost.com/ezra-klein/
I know that The Economist named Klein "minds of the moment" (there is a joke in that but I'll resist) but isn't there a difference between what we choose to spend on health care and what government will force us to spend? Put another way, that $90 billion a year drags along the rest of the spending by forcing people into Medicaid, choose only government approved plans with government approved benefits, paying taxes (not if you are a union member) for higher cost plans that you have no say in shaping which in turn will force you to spend money for premiums, deductibles, etc you may not want to pay or might have to if the services you really want are not covered.
Here is what Michael Cannon, who is a lot smarter and has done a lot more original research than Klein has said about this $90 billion scam:
"The CBO explains it will not count mandatory premiums as federal revenues if the individual mandate leaves consumers with what the CBO considers a "sufficient" or "meaningful" or "substantial" degree of choice among health plans. That rule is both amorphous and arbitrary. (For example, it presumes that the freedom not to purchase health insurance — which an individual mandate would eliminate — is not "meaningful." Millions of Americans would disagree.) More important, evading that rule doesn't make an individual mandate any less compulsory, or any less costly. It just hides those costs by pushing them off-budget.
In Massachusetts, which has enacted what is essentially the Democrats' health plan, mandatory premiums account for about 60 percent of overall costs, according to the Massachusetts Taxpayers Foundation. On-budget government spending is just 40 percent. By my count, mandatory premiums accounted for a similar share of the Clinton health plan's projected cost.
So while the CBO estimates that the coverage expansions in the House Democrats' legislation would trigger about $1 trillion of new federal spending over ten years, the actual cost of those coverage expansions is more like $2.5 trillion."
www.cato.org/pub_display.php
Actually, that $2.5 trillion over 5 years or so. Which is $5 trillion over ten years, both which equal $500 billion a year or so. Not to mean the loss of freedom and the dumb central planning involved to make this all happen.
Regular people -- amateurs -- get this. Experts like Klein who talk to other experts in DC do not. Their detachment from what we, the little people, can feel and perceive, formed by either arrogance or Economist-induced self-regard is stunning. And contributory to the growing sense across this nation that Democrats actually believe that health care is a system established to serve Washington interests instead of a series of human relationships that should sustain our lives and well-being.
Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.
