Getting Real About Addiction

The U.S. Surgeon General released a remarkable report yesterday, entitled Facing Addiction in America. It’s hard to believe that this is that office’s first-ever comprehensive study of substance misuse in the U.S.—but what the government lacks in response time it has made up for in thoroughness. The report is powerful, candid, and surprisingly well written. (I read about 200 pages of it last night, though admittedly a good chunk was in the form of tables.)

In case it wasn’t obvious from the headlines greeting us everyday: “The United States has a serious substance misuse problem.” And that misuse—66.7 million Americans acknowledge binge drinking in the past month; more than 27 million Americans currently use illicit drugs or misuse prescription meds like painkillers—has a profound cost for the nation. But the SG’s report doesn’t just make a definitive case about the reality and stakes of the crisis, it offers a smart and sober plan forward.

Technology plays a big role in that. Chapter 4 of the report, which delves into tools that are available for early intervention and treatment—has a good (but too brief) section on how emerging technologies, from telemedicine to web-based cognitive behavioral training, can offer inexpensive and timely help for millions.

To the extent that these new approaches catch on, you can thank in large part a slew of new entrepreneurs and the venture capitalists backing them. In recent months, several innovative startups have launched with the aim of convincing potential customers that they need to change their own destructive behaviors (in theory—one would think—not an easy sell). Michael Laskoff’s new digital health offering, Annum Health—which provides a new home-based treatment platform for heavy drinkers—recently raised $5 million in funding. Former Wall Streeter Lauren Stahl has set up Sparkite, an “aftercare platform” built specifically for mobile devices which she calls “addiction support in the pocket.” Pear Therapeutics says it’s “the first prescription digital therapy designed to treat opiate dependence.” And Venrock-backed Lyra Health, cofounded by former Facebook and Genentech CFO David Ebersman, works with employers and insurance providers to coordinate care (and improve outcomes) for employees with regard to behavioral health issues. You can also throw into the mix Workit Health, myStrength, and the Rock Health-backed Lantern, which received a $4 million grant from the National Institute of Mental Health.

Private insurers are becoming much more aggressive about trying to stem this epidemic as well—see, for example, Sy’s write-up of Cigna’s latest effort below.

The Surgeon General calls our response to this public health crisis “a moral test for America.” He is right.

Read on for more. And please be sure and email me with any news, feedback, or a general hello. I would love to hear from you!

Clifton Leaf

@CliftonLeaf

[email protected]

DIGITAL HEALTH

Intel and the Broad Institute strike a 5-year genomic data collaboration. Tech giant Intel and the Broad Institute of MIT and Harvard are teaming up for a 5-year, $25 million partnership that aims to make it easier to sift through the mountains of genomic data which are piling up in labs and academic institutes throughout the world. The hope is that the new Intel-Broad Center for Genomic Data Engineering will be able to create a data "superhighway" that will make it far easier for scientists to access information in disparate cloud networks, including in both the private and public spheres. "The size of genomic datasets doubles about every eight months and, as it does, the challenge of acquiring, processing, storing, and analyzing this information increases as well," said Eric Banks, director of the Data Sciences and Data Engineering group at the Broad Institute, in a statement. "Working with Intel, we plan to build out solutions that can work across different infrastructures to facilitate efficient processing of these growing data sets, and then make these tools openly available for researchers worldwide."

E-cigarettes may yellow teeth just as much as the real things. Electronic cigarettes were meant to be one of the earlier examples of how the digital health revolution could extend into the consumer public health sphere. The products were largely hawked as healthier alternatives to traditional cigarettes and even as a step in smoking cessation, since they don't have some of the more obvious carcinogens in cigarettes. But new research has brought e-cigs' effect on health into question—including suggestions that they may actually be encouraging teens who may otherwise have never used nicotine products at all to smoke. And a new study on 3D human jaw models suggests that the inflammation and irritation caused by electronic cigarette vapor may be just as deleterious for tooth and gum tissue health. (Coins2Day)

Trump's plans to scrap Obamacare are messing with his in-law's $2.7 billion high-tech insurance startup. As President Barack Obama painfully found out over the course of his two terms, major policy overhauls inherently demand tradeoffs. And President-elect Donald Trump's pledge to repeal (or significantly dismantle) Obamacare is no different. In fact, it's already having an effect on one of his relatives' business: Oscar Health, the app-oriented individual insurance company that was co-founded by Joshua Kushner, brother of Trump's son-in-law Jared Kushner. Oscar has set out to streamline healthcare through a combination of its insurance plans and digital offerings that can make it easier to connect with the hugely disparate American health system. The firm has faced some financial troubles since its inception but still recently nabbed a $2.7 billion valuation. But now, as Kushner and his Oscar co-founder and CEO Mario Schlosser write in a lengthy blog post, the future is a bit more uncertain. Scrapping Obamacare's statewide marketplaces, where Oscar does much of its business, would be a big disruption, and the company believes that the problems which have dogged the health law in its nascent years are simply the growing pains of a new and relatively uncharted market. The pair still sounded an optimistic note, arguing that some of the potential changes coming under Trump and GOP-controlled Congress could be good for all consumers. (Coins2Day)

INDICATIONS

This could become J&J's next blockbuster drug. Johnson & Johnson has submitted an anti-inflammatory medication that it believes could become a massive sales driver for Food and Drug Administration approval. The treatment, guselkumab, is being tested out in conditions like severe plaque psoriasis. So why is J&J so bullish about its prospects? In late-stage trials, the experimental therapy beat out AbbVie's Humira, the best-selling medicine in the world, significantly in a head-to-head match up. Furthermore, guselkumab has shown a lower propensity for producing the kinds of harmful side effects that some of its rivals' own candidates have shown in clinical studies. (Endpoints)

GlaxoSmithKline is consolidating R&D with "smart labs" in Philly. British pharma giant GlaxoSmithKline, which is planning to shift 40% of its worldwide phama R&D workers to Philadelphia by 2018, is pumping $250 million to create what the company calls a new, smarter type of laboratory work space. The "smart space" will be designed to encourage collaboration among Glaxo scientists and to boost safety measures by harnessing technology. For instance, the changing room in the space can notify researchers if they have put on their protective gear properly or need to adjust it. The consolidation of work spaces, powered by new tech, isn't unique to pharma companies; GE Healthcare and Johns Hopkins recently announced a "digital command center" that oversees the entirety of hospital operations and can proactively sense inefficiencies or problems like a shortage of available hospital beds. (BioPharma Dive)

Amgen and Novartis migraine drug could be first-to-market in a crowded field. Amgen and Novartis announced new late-stage trial data this week finding that their experimental migraine treatment erenumab successfully reduced the number of monthly migraine episodes experienced by patients by about 40%. Those numbers set the companies up for marketing approval applications in the U.S. And Europe by next year, which in turn means Amgen and Novartis could be sailing towards a first-to-market advantage among next-gen migraine drugs. But a number of other companies are also actively exploring the space with their own investigational products, including pharma giants Eli Lilly and Allergan.

THE BIG PICTURE

Cigna announces new steps to help stop its customers from using opioids. On the same day that U.S. Surgeon General Vivek Murthy's released an update on the state of the opioid addiction crisis in America, health insurer Cigna announced more details surrounding its ambitious plan to curb its customers' use of opioid addiction by 25% in three years. The company said that its asking the medical care providers under its Collaborative Care umbrella (which resemble Accountable Care Organizations whose mission is to coordinate medical treatment to boost outcomes and cut costs) to sign a pledge to promote non-opioid pain therapy alternatives and watch out for patients who are at risk for abuse and addiction. For its part, Cigna will help teach these providers new Centers for Disease Control guidelines on how to safely prescribe opioids and alert facilities when their prescribing practices run afoul of those guidelines. And the insurance giant believes this could have a wide-ranging effect beyond its own plan holders. "The resources we share with our provider partners will benefit all of their patients, not just those who are Cigna customers," said Cigna VP Dr. Dick Salmon in a statement. "Cigna is committed to reducing the burden of substance use disorders for all Americans." (Coins2Day)

U.S. Still among most unhealthy countries in the world. A new study in the journal Health Affairs finds that the United States continues to lag significantly behind other developed countries like Germany and Australia when it comes to public health. And the survey points to a likely culprit: the sky high cost of medical care in America. In fact, 33% of surveyed adults said they'd either not seek out a doctor or fill a recommended prescription because of cost concerns. That's compared to just 7% of U.K. Adults who said they avoid medical care for financial reasons. (Coins2Day)

Obamacare repeal without replacement could wreak further havoc on marketplaces. Healthcare experts are warning that President-elect Donald Trump's Obamacare repeal ambitions are easier said than done, and that a haphazard repeal without a robust replacement plan would likely wreak havoc on an individual insurance market that's already been on a roller coaster. There's a simple timing reason for this: insurers must prospectively set their premiums before open enrollment begins in the fall based on the costs they incur in the previous year. But that will be considerably harder to do for 2018 insurance rates if they don't know exactly what's coming down the pike, policy-wise. "I would not be surprised by a stampede to exit the market for fear of uncertainty and the strong potential for adverse selection," said Mike Kreidler, Washington state's insurance commissioner, during an event on Wednesday. (Modern Healthcare)