The World’s Biggest Killers Get An Ear at Davos

In the poorest regions of the earth, there is a particularly pernicious form of malnutrition called kwashiorkor. It’s easy to spot: A child looks utterly emaciated—except for his or her stomach, ankles, and feet, which swell with fluid. The name, “kwashiorkor,” means “the one who was left behind”—and decades ago, when missionary doctors in sub-Saharan Africa first began to characterize this common plague, it was often seen in toddlers who had been weaned too soon from their mothers’ breasts, thanks to the arrival of a newborn sibling.

Today, in the realm of global health, there is always someone being left behind. There is always—by near-universal agreement, it would seem—some urgent health concern that isn’t getting nearly enough attention.

Yesterday, the world’s corporate and political elite communing in Davos, Switzerland, turned their attention to what may be the biggest of the healthcare orphans—an elephantine class of human plagues grouped under the name “non-communicable diseases, or NCDs. These are the deliberate, chronic killers—coronary heart disease, cancer, diabetes, lung disorders, and other slow-cook scourges—that account for nearly 70% of deaths worldwide.

In the quaint late-20th century, these afflictions of middle and old age were considered the bane of rich nations, mostly. But then two things happened. First, we started to make dramatic headway in reducing deaths from infectious disease and other early-life killers—a fact that’s largely responsible for cutting childhood mortality rates in half since 1990. And second, we started counting.

Surprise! As developing nations developed, they too began to inherit the pathologies of wealthier societies. Take diabetes, where the global incidence has quadrupled since 1980. “The diabetes mellitus tsunami” is now worse than the infamous Spanish Flu pandemic of a century ago, according to two researchers writing in the journal Nature Reviews Endocrinology (sorry—this one’s behind a paywall). It’s an expensive plague, this one—costing $1.7 trillion in losses to global GDP, according to one estimate. Nearly half of that hits low- and middle-income countries.

Which brings me back to what happened in Davos yesterday. Twenty-two companies—including pharma giants Novartis, Roche, GSK, Pfizer, and Merck—announced the formation of an initiative called “Access Accelerated,” which will aim to tackle NCDs in developing nations. The companies are seeding the new program with $50 million in investment over three years, Reuters reports.

And that brings me back to kwashiorkor. This terrible disease is caused by a lack of a protein in the diet, and the cure is equally straightforward: putting more protein in the diet. Prevention, for that matter, is even more straightforward. In the 1950s, doctors figured that out by giving starving kids skimmed milk.

Much of what we have to do to fight NCDs in the developing world is the same as what we have to do to fight them here in the West: change diet and lifestyles, focus on preventive care and early diagnosis, end smoking.

You don’t need to go to Davos to learn that.

More news below.

Clifton Leaf

@CliftonLeaf

[email protected]

DIGITAL HEALTH

Former Google employee launches an AI-fueled doctor's office with big ambitions. Adrian Aoun, who worked on artificial intelligence platforms at tech giant Google, has opened up the first offices for his digital health startup Forward. The firm has an interesting payment model. It's a subscription service with a (somewhat steep) $149 per month membership fee that gets you access to Forward's fleet of doctors and high-tech preventative and primary care services (though you still have to have insurance for more involved medical care that might require hospitalization, surgery, etc). For instance, Forward offers rapid full body scans, genomic sequencing to identify genetic risks, and blood tests. Becoming a member also gets you access to Forward's mobile app-linked sensors, which are meant to monitor your biometrics to sense whether or not something might be wrong and to develop personalized health and wellness plans. Aoun says he's been disappointed that the typical doctor's office experience has evolved little in decades, and hopes Forward - which is backed by some serious names like Salesforce chief Marc Benioff and Google's Eric Schmidt, among others - can break the mold with a personalized, digital experience. (Healthcare IT News)

This digital health firm is raising cash to tackle anxiety, depression. SilverCloud has raised $8.1 million in a funding round led by B Capital Group and with other investments from ACT Ventures, Investec Ventures, and AIB Seed Capital. The firm is trying to address mental health issues such as depression, anxiety, and stress through a suite of digital programs that can be accessed via smartphone or any other internet-connected device. There are nearly two dozen different programs that patients can interact with for a variety of behavioral health conditions, and is available under 120 different health organizations throughout the world, according to the firm. "We believe that technology is the enabler to address the biggest healthcare challenge of this century, maximizing clinical delivery while enhancing patient access and choice, through the ability to engage with therapy at a time that fits into diverse lifestyles and through devices that are a part of our everyday lives," said SilverCloud CEO Ken Cahill in a statement. (MobiHealthNews)

INDICATIONS

Mallinckrodt settlement shows why pharma isn't afraid to behave badly. On Wednesday, pharma giant Mallinckrodt reached a $100 million settlement with the Federal Trade Commission (FTC) over allegations that the company maintained a monopoly so that it could hike the price of a multiple sclerosis treatment with impunity. But what that settlement really reveals is exactly why some drug makers are largely unafraid to make unethical (and potentially illegal) choices, especially on drug pricing. Mallinckrodt unit Questcor set off the saga when it bought a competitor to its flagship treatment Acthar from Novartis, essentially ridding the marketplace of any would-be competitors. Acthar started bringing in serious money after Questcor set out to raise its price by staggering amounts, eventually leading to a buyout by Mallinckrodt, which was seeking precisely this type of high-priced asset that had cornered the market. Mallinckrodt then continued to hike Acthar's price. Just how much has that price tag gone up? A stunning 85,000% over the past 15 years, according to the FTC. The question is: Why would a $100 million settlement do anything to dissuade Mallinckrodt or drug companies pursuing similar strategies from doing the same thing again in the future? Acthar brought in a third of Mallinckrodt's approximate $3.4 billion in net 2016 sales, dwarfing the $100 million regulatory hit. The company will, however, have to sell off the license for the competing therapy in the coming months.

Patent expirations are about to hit several big pharmas where it hurts. A slew of blockbuster drugs from Novartis, Bristol-Myers Squibb, Merck, and Eli Lilly are falling off the patent cliff this year, portending an inevitable hit to their bottom lines. Merck is taking an especially big blow as four products totaling $3.8 billion in its 2015 sales will lose their IP protection; the single biggest loss, however, is Novartis' Sandostatin LAR, a $1.6 billion-in-sales acromegaly and severe diarrhea treatment. Bristol-Myers' $1.14 billion HIV medicine Reyataz is also falling off the cliff. And, naturally, a host of generic drug companies are already getting ready to launch competitors, including Mylan, Teva, Sun Pharma, and Pfizer unit Hospira. (Coins2Day)

THE BIG PICTURE

Tom Price defends his controversial investments during a Senate confirmation grilling. Donald Trump's HHS Secretary nominee's testimony before the Senate Health, Education, Labor, and Pensions (HELP) committee on Wednesday was filled with thorny questions from skeptical Democratic lawmakers over Obamacare, drug prices, and recently revealed information that Price had invested big money in a number of health care companies that would benefit from a host of legislation that he's championed. While Price has defended his investment in medical device firm Zimmer Biomet by asserting those purchases were made by an independent financial adviser through a broken-directed account, he admitted to ranking Democrat Sen. Patty Murray that his big buys in Australia's Innate Immunotherapeutics were actually his idea. The Innate investments have raised eyebrows since Price was also introduced to the company by fellow Republican Congressman Chris Collins, who is also a director at the firm. Price continued to assist all of his investments were ethically above board and did not sway his support for bills like the pharma-backed 21st Century Cures Act. When it came to the GOP's plans for a post-Obamacare world, Price was considerably more opaque, alluding to "patient-centric" health care that gives everyone "access" to care without a slew of government programs. He also didn't sound particularly enthusiastic about Trump's proposal to control drug prices by allowing direct price negotiations in Medicare, although Price said he would follow the boss's commands. (Coins2Day)

Bill Gates, slew of nations launch new global coalition to "outsmart epidemics." A massive new public health coalition (which has already raised half a billion dollars in funding) was announced during the World Economic Forum in Davos on Wednesday. The Coalition for Epidemic Preparedness Innovations (CEPI) has backing from the Bill and Melinda Gates Foundation, the Wellcome Trust, and the governments of Germany, Japan, and Norway - and it's trying to get even more nations involve, with a goal of raising $1 billion to finance its activities over the next five years. Just what are those activities? Taking a head-on approach to fighting viral threats rather than waiting for an epidemic to already be underway before launching the time-intensive drug development process. The first three parasites that the coalition will target are MERS-coronavirus, Lassa, and Nipah. (Coins2Day)

More than 20 biopharma companies partner to help curb non-communicable diseases in poor countries. Infectious diseases aren't the only ones under the gun in Davos. In fact, about two dozen biopharmaceutical giants including Novartis, Bayer, Bristol-Myers Squibb, Pfizer, and others announced the Accelerated Access initiative, as Cliff reports in his essay above.