Tuesday, December 31, 2013

Lloyd Green, Writing in The Daily Beast, Takes Note of the Cure Strategy

This article, full of hope for transformative technology, quotes Jim Pinkerton herein:

Yes, all that will make for great theater in the run-up to November’s congressional elections, and fortunately for the Republicans, health insurance’s implosion is happening on Obama’s watch. But I’m talking about medicine, medical research, and cures. As Jim Pinkerton, a former White House domestic policy adviser to Presidents Reagan and Bush 41, likes to say, “A cure is better than care. It’s cheaper to beat than to treat.”

Sunday, December 29, 2013

Fighting Killer Diseases vs. Fighting Gender Disorientation. Connecticut Makes Its Choice.

Reuters reports that people are dying of new viruses in Saudi Arabia and Hong Kong.  Which is to say, the next round of contagion, this time in the real world, could be just an airplane-ride away. Meanwhile, the state of Connecticut is pushing forward on a different cause--it is mandating that health insurers pay for gender-reassignment.  The Hartford Courant reports:  

The Connecticut Insurance Department is directing all health insurance companies operating in the state to provide coverage of mental health counseling, hormone therapy, surgery and other treatments related to a patient's gender transition.

Such mandates could have something to do with higher "healthcare" costs.  That is, if governments are continue to pile more mandates on the insurance system, of course costs will go up.     So much for "bending the curve."   People should be free to choose their own destiny, but it's not so obvious that the rest of us should pay for it.  

At the very minimum, we should be honest enough to admit that restraining the growth of healthcare costs if not going to be possible if the government continues to unconstrain healthcare costs.  

Meanwhile, people are dying.  

Thursday, December 19, 2013

Peggy Noonan on the Cure Strategy

Peggy Noonan, writing in The Wall Street Journal

There are also the words this year that were most conspicuous by their absence. They're the words we don't use when we talk about health care. Actually we don't talk much about health care, we talk about health insurance. Fox News's Jim Pinkerton says the absent words in the ongoing debate are "medicine," "research" and "cure." Do you want to make a dent in future health-care costs? Cure Alzheimers. That's where the cost will be as the health of the baby boomers falters. Insurance isn't the key. It was never the key. It's a product. Cure and care are the words of the future.

Monday, December 2, 2013

"New Computer-Designed 'Drug" Prevents AIDS From Replicating"

Is this headline true? false?  If it's even a little bit true, then we can see the prospect of a whole new kind of medicine, and whole new industries.  And, of course, a lot of hope for a lot of people.

It certainly seems like a prospect that should entice the interest of DC policymakers.

Tuesday, November 26, 2013

We need more antibiotics--now.

In the words of The Week's John Aziz

"If the problem continues to grow, the U.S. and other countries will have to invest a whole lot more in antimicrobial technologies, or create incentives for Big Pharma to do so. Like the zombie apocalypse, the post-antibiotic world would not be a pretty place to live in."

It sure seems that next-gen antibiotics are not only a public health necessity, but also a good business--creating lifesaving products not only for Americans, but also to be sold to the world.  It's also hard to see how we could "bend the curve" on healthcare costs if there's a big epidemic. 

Saturday, November 16, 2013

Peter Huber's "The Cure in the Code: How 20th Century Law is Undermining 21st Century Medicine"

Peter Huber's new bookThe Cure in the Code: How 20th Century Law is Undermining 21st Century Medicine is both provocative and inspiring.   Once again, the Manhattan Institute scholar shows his extraordinary grasp of both technological and legal issues.  

Huber is certainly correct in arguing that a) laws concerning intellectual property and b) the regulatory procedures of the FDA and the federal government in general are inhibiting medical progress--at least within the current parameters of how medical progress is achieved.  More specifically, the status quo is impeding medical cures--and it's great to see Huber using the word "cure" in the title. 

Why?  Because only the idea of cures fully animates political activity.   In politics, goals drive process.   By contrast, process by itself is kind of a snooze to politicians, and to the public.  In 1962, John F. Kennedy didn't say that he wanted to increase NASA's budget by 84 percent--he said he wanted the US to go to the moon by the end of the decade.  

It was that galvanic message that punched through.   It was that goal that drove not only NASA's budget, but also, of course, America's success in putting a man on the moon.  

Indeed, it's a good thing that Huber sets forth the goal of cures, because only that big and worthy goal will overcome the inertial, even hostile, forces that block progress.    

In particular, Huber identifies two recent US Supreme Court cases, Association for Molecular Pathology v. Myriad Genetics  and Mayo Collaborative Services v. Prometheus Laboratories, which have--incorrectly in Huber's view--dramatically limited the right of private companies to create and defend IP claims.   If companies can't create monetizable IP, Huber reasons, they won't go to the expense of creating it at all.   

As he puts it, "Well-crafted property rights promote the broad and economically efficient distribution of know-how." 

It's a strong argument, but there's also a strong counter-argument.   

In fact, there's a huge constituency in favor of "open source" medical research, as part of the larger open-source movement.  These open-sourcers argue just the opposite of Huber--they argue that the public benefits of open exchange of information far outweigh the benefits of privatizing medical discoveries. Indeed, they would further dispute the very idea that a naturally occurring entity ought to be patented at all.   

We might recall that the open-sourcers seem able to count a majority of the Supreme Court.   In other words, those who vehemently disagree with Huber seem to have the upper hand right now.  

In addition to arguing for a more "robust" IP regime, Huber argues that researchers and companies will need to be able to create data consortia, so that the benefits of Big Data can be fully felt in the medical field.   As Huber puts it, "For well over a century, competing companies have been pooling their patents and interconnecting their telegraph, phone, and data networks, online reservation systems, and countless other information conduits and repositories." 

Huber is right, of course, but every one of these arrangements was controversial.  That's why politicians and regulators had to step in to make the system work; back in 1913, for example, the Kingsbury Commitment, for example, encouraged AT&T to create a near-monopoly over US telephone service, and as that monopoly became increasingly controversial, in 1984 it was reversed by the AT&T breakup.  

So, three decades later, is this the time to bring in new kinds of data consortia?   Is this the time to overcome various rules--most obviously, HIPAA--that inhibit, even prohibit, massive data sharing?   Perhaps the correct answer is "yes," but if so, it will take a lot of political and legal muscle to overcome the opposition.  

In fact, it will probably require some updated framework for medical research, one that takes into account a) the imperative of scientific progress, b) the imperative of making sure that the benefits are fairly shared across society, and c) the need to protect privacy.    No doubt there's a way to achieve all three criteria, but the political coalition that's needed does not yet exist.  

And as noted in my earlier post on M.D. Anderson's "moon shot" cancer initiative, the key to developing political energy to move forward is found in the establishing of big and worthy goals--goals such as curing cancer. 

If those goals are established, and supported by the public, then just about anything is possible.  

But if the goals are fuzzy, then the status quo survives.  

MD Anderson's Cancer "Moon Shot"

Earlier today I was clicking around at The Business Insider, and saw this ad, from the M.D. Anderson Cancer Clinic in Houston.  It puts forth a very ambitious vision, summoning up the memory of John F. Kennedy's "moon shot" speech of September 12, 1962--delivered, interestingly enough, in Houston.

Here're some glimpses of the ad:
Indeed, it's nice to see an entity, Anderson, that sets ambitious goals...

... ending cancer: 

This all heartening, of course.  

Curious as to this program, I went to YouTube, and discovered that this spot seems to be derived from a longer spot released by M.D Anderson back in September 2012.   It also has a strong message: 

And it, too, invokes JFK: 

And the space program:

It even details the cancers being targeted: 

Indeed, Anderson even seems eager to eliminate its "business model"--that is, treating cancer. 

This is all great, but I couldn't help notice one little discouraging item--more than a year after its release, the video had less than 18,000 views.  
That's not a crippling concern, if the right 18,000 people are watching.  Or, of course, if Anderson's end cancer message is otherwise punching through.  But so far, at least, it seems that it isn't.

That's not Anderson's fault; it's got all the right ideas, and it's obviously trying hard to get its message out.  The problem--okay, let's be positive here, and call it an "opportunity not yet seized"--is that political leaders have not yet grasped the idea that curing disease is a political winner.  

Let's hope that changes.  

Sunday, November 3, 2013

Of Pindar and the Politics of Longevity: Larry Page, Meet the Hayflick Limit, Henrietta Lacks and the Ironic Secret of Cancer 

Google co-founder and CEO Larry Page is super-smart and super-rich.  Now, he wants to end aging as we know it.  And all of us who are aging should naturally wish him well.   But as Lt. Columbo would say on the 70s TV show, “There’s just one more thing.”

That “one thing” is context.   Specifically, political context.   In the abstract, putting an end to aging may be a scientific mission.  But in the real world—and even megabillionaire tech titans inhabit the real world—a massive new medical-scientific effort will end up being political.  That’s why it’s so important for Page’s effort to be anchored in public support.  

Without a new doubt, Page’s new venture, Calico—an ironically understated  acrostic of “California Life Company"—is aiming big.  As Page said in a September 18 Google press release,

“Illness and aging affect all our families. With some longer term, moonshot thinking around healthcare and biotechnology, I believe we can improve millions of lives.” 

We certainly admire moonshot-type thinking.   Nobody rallied the nation to a great goal better than John F. Kennedy.  Thanks to the firm support of the American people, the space program reached its goal.   So here we are reminded that the Apollo mission was, in fact, a public program.   It endures today as one of the great triumphs of the United States—all Americans can take pride in its success.  

Back to the here and now, Calico has enlisted Arthur D. Levinson, Chairman and former CEO of Genentech, to be an investor-CEO of the new venture.  Genentech under Levinson developed landmark drugs to attack certain kinds of breast, colon, and lung cancers. The Google press release included poignant words from Apple CEO Tim Cook:

“For too many of our friends and family, life has been cut short or the quality of their life is too often lacking. [Levinson] is one of the crazy ones who thinks it doesn’t have to be this way.  There is no one better suited to lead this mission and I am excited to see the results.”

Cooks’s predecessor at Apple, of course, was Steve Jobs, who died of cancer at 56.  So there’s every reason to hope that Calico succeeds.  Indeed, if it does succeed, one can imagine a new longevity business that would make even mighty Google look small.  

Given Levinson’s background, and the lingering presence of Jobs’ example -- life cut short -- you’d think cancer would be a big concern of a life-extending effort.  According to the American Cancer Society, nearly 1.7 million Americans will be diagnosed with cancer in 2013, and more than 580,000 will die of it.  

Yet curiously, in a recent Time interview—the magazine’s cover story asked, “Can Google Solve Death?”—Page seemed to downplay cancer’s importance.  Cancer, Page seemed to muse, as bad as it is, was a sideshow on the road to longevity:

“If you solve cancer, you’d add about three years to people’s average life expectancy.  We think of solving cancer as this huge thing that’ll totally change the world, but when you really take a step back ...  in the aggregate, it’s not as big an advance as you might think.”

Page is looking beyond cancer, or any other single disease.  He is reaching, instead, for immortality.  If so, then surely he is going to seek to tackle the Hayflick Limit, named after the scientist Leonard Hayflick.  The Hayflick Limit describes the number of times a normal cell can divide.  Writ large, it appears to put a time-limit on all of our lives.  

In Greek mythology, the three Moirai, or Fates, first spun the the thread of life, then measured it, and then snipped it.  As the ancient poet Pindar wrote, they were “fine-armed daughters of Night…all-terrible goddesses of sky and earth.”   Through the eons, the sorrow of death has a way of eliciting the greatest eloquence, haunting our imagination.  In this more scientific era, the Hayflick Limit is the scientific expression of that doomed inexorability.  

Page is right that we should focus on big medical breakthroughs that might overcome the Hayflick Limit.  

Yet perhaps he is overlooking a key point when he speaks “in the aggregate” and minimizes the value of curing cancer.  

Why?  Because, politically speaking, most people understand that cancer -- even with advances like Genentech medicines -- remains a seemingly random and fearsome prospect; and scientifically, in its own terrible way, cancer is immortality. 

We can see how these political and scientific strands interweave in the life of Henrietta Lacks, an African-American woman who labored in a Baltimore steel mill during World War II, raising five children.  Lacks died some 62 years ago, in 1951, aged 31, the victim of a fast-growing cervical cancer.  

Her poignant story is also instructive.  Though dead some 62 years, Lacks’s cancer lives on.  Her tumor was rare, and, in the right cell culture, immortal.  That’s the scientific value of her example, the connection between cancer and longevity.  However, as described in the 2010 book, The Immortal Life of Henrietta Lacks, there is a political dimension as well.  Lacks’ cancer cells were extracted without her consent and farmed out to cancer researchers worldwide for decades.  Decades later, with genetic screening, some of her descendants’ genetic data was published without their consent.  That’s the kind of personal exploitation that breakthrough medical research must avoid at all costs.  Great science benefits everyone, but it begins by respecting everyone as well.  In Lacks’ case, NIH Director Francis Collins tried to right past wrongs this year, setting new rules with Lacks’ descendants governing how her cells can be used and genetic information can be released.

Once ethical concerns about individuals’ participation in research are reconciled—and those concerns aren’t small, but they are solvable —then we can see that cancer does, in fact, offer us a window of hope on immortality.  If regular cells, in becoming cancerous, can reprogram themselves to be immortal then why can’t other kinds of cells live forever, too?  Like a human body?  

Scientists are making great strides in coaxing regular cells back to their primeval states, to a time before their genetic programs told them to be skin cells or liver cells, or any other cell.  However, once reset, these cells remain subject to aging --  decay, degeneration, and death.  By contrast, cancer causes resilient, hyper-growth tumors.  It may be possible to fuse that which kills us and that which gives us life.  The problem is we just don’t understand it well enough.  Getting to that understanding will require great science, and leadership by scientists and politicians to build widespread support for work that may transform our lives. 

Cancer research holds a second lesson for anti-aging therapies. People with the same cancer treated the same way often have different outcomes.  Some live, some don’t.  Cancer therapies have to be tailored to tumor types and individuals.  Like cancer, anti-aging will need to build on hundreds of millions of data points, each data point representing a person who choses to share their information.  

In law, hard cases make bad law.  Not so in medicine.  Unique cases shed new light on old mysteries.  You never know when another Henrietta Lacks, a rare individual with a uniquely informative situation, may come along.

As an aside, that’s why it was so disappointing to see an October 14 op-ed in The New York Times, entitled, "In Cancer Care, Cost Matters," which denounced new cancer drugs for being too expensive for the health value they offered.  The three co-authors, all MD's, declare that they will boycott these new drugs.  Indeed, they make it plain that they see their boycott as part of a larger effort to curb healthcare costs.  As the trio asserts, "The current level of spending on health care, estimated to be $2.8 trillion this year, is already too high. The growth rate in health spending is unsustainable." Their boycott, they add, "Is a step in the right direction—one of many we need to take."

That Times op-ed was followed by a cover story in New York magazine headlined, “The Cost of Living: New drugs could extend cancer patients’ lives—by days. At a cost of thousands and thousands of dollars. Prompting some doctors to refuse to use them.”  

We can say of both of these pieces, and the many others that followed: In the battle against cancer or aging, we need as many people involved as possible, even long before they get sick or retire.  The cost of cancer drugs is a function of the high upfront cost to determine which drugs might work against which tumors in which people.  Every data point, every person, we involve can lower that cost.   

If some doctors believe that treating cancer on an incremental basis isn’t worth the cost, well, they should be reminded that the history of treating any disease—or, for that matter, the history of any technological advance—is replete with high upfront costs, followed by declining costs, and greater efficacy, as science progresses.  To short circuit that process is a supreme instance of being penny-wise and pound-foolish.  It allows the judgement of comparatively few skeptical researchers to be placed ahead of the collective benefit of great research.  What gives some doctors the right to place their narrow perspective of the possible ahead of the public’s broader right to live longer, healthier lives?

The prototype of anything, we might observe, is ridiculously expensive.  By definition, the new thing has no economic value--it's just a cost-center, someone's obsession.  Yet if the concept proves out, and as production ramps up, prices naturally start to come down, as the product slides down the experience curve.  That's how things that were unattainable at any cost--because they simply didn't exist--go from being, first, expensive luxuries, to second, inexpensive commodities, to third, unrecognizable, because some new innovation has come along to obsolesce the old thing.   That's been the story of the Scientific and Industrial Revolutions over the last four centuries, and it's lifted up not only our standard of living, but also our lifespan.

So if we were to take seriously, as a society, the challenge of curing cancer, then we might consider new financing mechanisms, aimed at rewarding discoverers, innovators, and producers, and yet also making sure that the cancer drugs are widely available.   But that's a topic for another post.  

So we come back to the lessons of Henrietta Lacks.  Her case reminds us that scientific research does not always have an immediate "business model."  Of course it doesn't: It's science. 

The Lacks case also shows the that the gathering and sharing of human information simply must occur within an acceptable ethical framework.  Most obviously, that ethical framework begins with the sine qua non of informed consent, which is so important that we find a lengthy discussion of informed consent on the American Cancer Society website. 

Yes, it’s easy to imagine human information-gathering outside of an acceptable ethical framework.  But it’s impossible to imagine such research staying secret for very long.  And then there would be hell to pay.  This is a world of social media, Twitter, and Instagram; information wants to be free.  Indeed, even the government’s efforts to monitor all that information seems to quickly become public. 

So the only politically sustainable way to conduct breakthrough research is to explain to each individual the benefits and risks of participating, to create incentives for them to do so, and protections that information derived will not be held against them.     

Perhaps in our big data age computers and algorithms will do most of the work.  That is, ones and zeros will be the new white mice.  That’s great, and will help reduce costs drastically, but sooner or later, any treatment will need human testing.  The pool of human test-subjects could be drawn from desperate patients, or perhaps even compensated volunteers.  But individuals and societies will have to to go in to the exercise with their eyes wide open. 

Who better than companies like Google to get people to share data and crunch it?  No one, except giving tech companies your search history is very different than giving them your genetic data - the essence of who you are.  Refining medicines, too, is much dicier than optimizing software.  Web browsers have “back” arrows; bad code can be undone.  Not humans.  There’s no “Command Z,” or undo, when treatments go wrong.

So even if computers become powerful enough to design drugs without lab work, researchers will need patients’ trust.  Otherwise many who might benefit from trying a drug in a trial will say, “thanks, but no thanks.”  A treatment that might have worked well in some will be written off as a failure, or dismissed by insurers and governments as having little value for the cost.  That’s happening already, as we see in the New York magazine article cited above.

Calico—and other similar efforts that are no doubt already ongoing—need to operate with the support of millions and maybe billions of people, sick and well.  

For big data and big science to work their wonders, each participant must feel personally connected to the research’s goal.  After all, there’s much data that a healthy person could offer between now and when they fall ill that might help scientists detect their condition earlier and treat it better.  

That’s why politics matter.  Every major gain in lifespan has followed a political and cultural shift in support of better science.  This was true for vaccinations, safer childbirth, antibiotics, Franklin D. Roosevelt’s work on polio—the March of Dimes was a spectacularly successful public-private partnership—and recent efforts to cure HIV and eradicate malaria.  Political support will matter even more in fighting age-related disease since effective treatment may have to start long before a condition is outwardly clear. 

Investments in real science, such as Page’s, are a welcome contrast to Washington DC’s belief that health issues can be solved solely by manipulating finance and insurance coverage.  But for billionaire-funded “big science” to have lasting impact, funders must realign their interests with the public interest.  Durable political coalitions rely on shared belief and coordinated action, not top-down brilliance.  Once you earn people’s trust, you can ask them to lend their data, their voice, and eventually their lives; but trust comes first. That’s the enduring lesson of Henrietta Lacks. 

Indeed, we must never lose sight of the real glory that is humanity and human expression.  As Pindar wrote 2500 years ago: 

“Creatures for a day! What is a man?
What is he not? A dream of a shadow
Is our mortal being. But when there comes to men
A gleam of splendor given of heaven,
Then rests on them a light of glory
And blessed are their days.”

Yes, we all are lit by the splendor given of heaven.  And we should all have the right to participate in its glories.  

Today, we know longer fear The Fates, except as a metaphor.    

Yet the common humanity that Pindar described is still with us.  The shared radiance of collective purpose should shine down on all of us.   If it does, we will all live longer, and better.  

Editor's note: This piece was co-authored by Jeremy Shane and James P. Pinkerton.

Thursday, October 10, 2013

A hopeful headline--and a spur to action

"Alzheimer’s treatment breakthrough: British scientists pave way for simple pill to cure disease"--that's the headline in The Independent (UK). 

Then, the fine print, as it were: "Although the prospect of a pill for Alzheimer's remains a long way off, the landmark British study provides a major new pathway for future drug treatments."  

And that should be our spur to action.

UPDATE: Jeremy Shane, a long-time medical observer living in Washington DC, adds these sage comments:

"First, it is critical for government funds to support ideas that seem out of the mainstream where mainstream ideas continue to disappoint.

"Second, figuring out a drug that "works" is only half the battle -- we need funds to figure out how to deliver drugs only to those places where they will be useful and not to places where they cause side-effects.  

"On the first point, Alzheimer's research for decades has focused on two competing causes of neuronal failure -- accumulation of beta-amyloid protein tangles or the malfunction of a neuronal protein called tau.  AD, they agreed, seems to happen when neurons stop "taking out their trash."  

"Then, along come a few out-of-the-mainstream scientists who look at the lack of real progress with either of these approaches, and say, you know, the way AD seems to spread in the brain sure looks like a prion disease, like Mad Cow's disease.  It's fair to say mainstream AD researchers laughed at them.  Certainly advocates of the prion idea got the Rodney Dangerfield treatment when it came to NIH grant applications.  But little by little, the "prion-like" advocates piled up studies until brain imaging studies were able to show that AD spreads from one brain region to the next pathogenically, much like a prion disease (even if the scientists couldn't point to an actual prion protein causing it).  

"So here is this UK article on an AD breakthrough and the two main theories of how AD is caused, theories that have garnered tens of billions of research dollars, aren't even mentioned.  What's more, it suggests to the reader that the prion thesis as a basis for AD research is pretty well established.  

"So, this is a good reminder that even science -- among scientists -- is political, and that consensus can -- must -- change when facts change.  Facts win.  So it is incumbent on funders, especially government funders, to create systems that allow unpopular ideas to get tested especially in areas like AD where time and again, consensus ideas yield paltry results.  (NIH does have a EUREKA grants program that is supposed to fund these out of the mainstream ideas, but its funding is quite small in the larger scheme of things).

"Second, discovering new drugs -- like discovering new explosives in the military -- is a necessary first step.  But they are of little value if you can't reliably deliver them on target without collateral damage.  This work on AD reinforces that challenge -- for researchers and funders.  This compound was delivered orally and was able to the brain.  Great, but it also messed up other parts of the body.  Drug delivery in AD -- finding new ways to deliver drugs directly into the brain and only the brain -- will be as important to a treatment's success as the active ingredient." 

Saturday, September 21, 2013

Friday, September 20, 2013

"Google vs. Death" and the Hamiltonian Framework

The headline in Time magazine is certainly bold enough: “Google vs. DeathHow CEO Larry Page has transformed the search giant into a factory for moonshots. Our exclusive look at his boldest bet yet--to extend human life.” 

Yes, this is very interesting, and exciting, what Google/Calico has in mind.  It’s great to see someone focusing on what really matters most in healthcare, which is medical cures.  Insurance  for sickness is great, but getting and staying healthy is greater.   

And the G/C folks may be so smart, so rich, and so focused that they can simply blow past all the obstacles that have stymied others. 

But if G/C doesn't deal with public policy concerns about equity and economy, then it could well, too, end up stymied.  For example, Gregory Ferenstein and Rip Epson of TechCrunch raised some sharp questions in a piece bluntly titled “WTF Is Calico, And Why Does Google Think Its Mysterious New Company Can Defy Aging?”  

The authors made it clear that they support, say, curing cancer, but at the same time, they questioned the use of resources, including fiscal resources (entitlement costs, for example),  ignoring the poor, and the general perception of elitism, if not James Bond villain-ism.  If those perceptions are not dealt with, then this effort will never achieve broad political support, except among a few eccentrics.  And if it doesn't achieve broad political support, then I'm skeptical that it will never achieve its potential.   The NGOs, trial lawyers, Naderites, and bureaucrats will all be lying in wait, waiting to ambush. 

Right now, G/C is being positioned as what it, in fact, seems to be: A few billionaires wanting to live forever.  That’s all great--progress in the world often depends on visionaries, and egocentrism is a part of vision.  

One could only wish that the late Steve Jobs, for example, had devoted more of his energy to the issue of longevity.  Not only did Jobs himself have much to offer, but as Apple the company demonstrated, it’s perfectly possible to translate bold innovations and mass-distribute them into the larger consumer arena.  Then we are all better off.

Yet questions of life-and-death are so important that they have to be answered in ways that don’t shock the conscience of the public.   Otherwise, the public/human instincts of egalitarianism, jealousy, suspicion, paranoia, and crab-bucketism will kick in, as countervailing forces.  And they will be powerful countervailing forces.  

After all, perhaps the last form of human solidarity left is the equality of the grave.  So yes, if the “peasants” sense a huge rupture in the social-moral order, they could once again grab their pitchforks, light their torches, and head up the hill to Dr. Frankenstein’s laboratory.  

Once again, if they can do this all on their own, then the lack of political cover won't matter. But in this hyper-pluralistic world, it's hard to pull off a big project without a lot of political involvement.  

Indeed, ever since Hamilton, big projects--from the canals to the railroads to the telephone network to Apollo to the Internet--have always needed political support.  

And I suspect, in the end, G/C will be no different.   Just as Google found itself deeply entwined with the government within a decade of its creation, so G/C will find itself entwined, too.  The difference is that G/C has gotten off on the wrong foot.  

So it will still need what every other big project has needed: a political shield, which can be described as the “Hamiltonian Framework.” That is, the system of political acceptance that allows the project to go forward.  G/C will need that Framework eventually; it’s just that now it will have have to work harder to get it.  

Sunday, September 8, 2013

Sunday, August 25, 2013

Mike Huckabee Talks Cure Strategy

On his "Huckabee" show on Fox News just now, Mike Huckabee said that we need an Apollo Program against disease, or a Manhattan Project.   He didn't shy away from the issue of federal involvement--saying that yes, the government would have to invest more.   But at the same time, he emphasized that if such investment--coupled with tort reform and other streamlining--could lead to health breakthroughs, it would pay for itself.  After all, just about anything is cheaper than spending $1 trillion a year on Alzheimer's Disease by mid-century.

Speaking of illnesses such as Alzheimer's and diabetes and their costs, he asked, "Why don't we try to eliminate them?... It would be a magnificent effort. Not just treat disease, but eliminate it."   Inspiring words.  

He added of such an effort, "Think about what it could do for the economy."   That is, not just saving money for the government, health insurers, and individuals, but also creating jobs in new industries. 

To be sure, the whole hour of the "Huckabee" show was devoted to much more than just the Cure Strategy.  The former Arkansas governor offered a broad-ranging critique of the status quo, citing his own experience as executive of his state's Medicaid and other public health programs.

He sharply critiqued the Affordable Care Act, aka, Obamacare, and he emphasized the importance of healthier personal behavior and prevention.  All important issues, to be sure.

But most notably, he also introduced a new concept--a new concept, at least, to the political and policy world of Washington DC--and that is, cures.   A cure is better than care.  The Cure Strategy.

The Cure Strategy portions of the show appear at about 35 minutes into the hour--the show reruns tonight, Sunday, at 11 pm ET.   And clips should soon be available on the Fox News site.

Saturday, August 24, 2013

Alzheimer's Dementia Time Bomb--How 'Bout a Proactive Strategy of Treatment and Cure?

If the ravages of Alzheimer's Disease are a humanitarian and financial "time bomb," as UK Health Secretary Jeremy Hunt suggests, then perhaps it would be worth a national/international focus on better treatments and cures.   No matter what sort of financial arrangements are made, the impact is going to be catastrophic.  A cure is cheaper--and, of course, better--than care.

These points, from The Telegraph article, do, indeed, paint a dire picture.  But the strategy of helping workers rearrange their work schedules to deal with eldercare issues seems inadequate to the overall challenge.

We should be striving to do to AD what we did to polio: make it go away.  That's an argument that is sadly unheard in political circles. 

Tuesday, August 20, 2013

"The Immortality Financiers: The Billionaires Who Want to Live Forever"--But Just One Thing

The tech billionaires listed in this Daily Beast article--including Larry Ellison, Sergey Brin, and Peter Thiel--might find more success in their quest for immortality if that quest were more realistically defined.

That is, rather than shooting for the moon on immortality--with all the infinite moral and ethical quandaries that emerge therefrom--they might focus on a war against disease, including the as-of-now-invincible Hayflick Limit, which casts a dark pall on any bright hopes for significantly longer life. 

If so, then the optics of the struggle would shift from private to public.  That is, the better-health/longer-life issue should shift from private vanity to public policy.  And that's good news, ultimately, for all concerned. 

While a billionaire-boutique effort might be better than nothing--and as argued here many times, the drying up of the medical-cure pipeline is a serious and budget-busting issue--a true public-private partnership and a national or international mobilization beats everything else.   

The bigger the better.  Scale is your friend.  

The billion-and-first iPhone is better--and certainly more reliable--than the prototype of something different, no matter how grand its ambitions. 

As we were reminded with Mitt Romney's Orca get-out-the-vote program, one doesn't want to be the first to use something complicated and technical.  I would feel safer riding in a plane from Boeing--backed by a century of R&D, much of it financed by the Pentagon, as well as many millions of pilot hours--than in some contraption that just came out of the skunkworks.   Thrill-seekers and would-be record-breakers can get in anything they want, of course, but they know the dangers. And the statistics confirm that such dare-devilry is, indeed, dangerous.  

If Ellison, or any of these others, is willing to be the very first person to try the new potion, well, that's okay.   But the moment that he gets into testing it on anyone else--be it duped Third World peasants, unwilling Chinese prisoners, or even highly paid volunteers--that's when the trouble will come.   Issues of right aside, this is an NGO world, and an NGO world with cellphone cameras and Twitter.  

So billionaires are best off learning from the successes of the past.  If they study history, they will realize that the best way to truly get this done is the way the railroads got their way in the 19th century, or AT&T got its way in the early 20th century--or the polio vaccine in the mid-20th century.  That is, by building a robust political framework around their enterprise, shielding them from liability, rent-seekers, etc.    

That's the time-tested way to get this done.  I argued this historical point here, on August 2. 

Sunday, August 18, 2013

George Will on the Cure Strategy

George Will writes:

For Francis Collins, being the NIH’s director is a daily experience of exhilaration and dismay. In the past 40 years, he says, heart attacks and strokes have declined 60 percent and 70 percent, respectively. Cancer deaths are down 15 percent in 15 years. An AIDS diagnosis is no longer a death sentence. Researchers are on the trail of a universal flu vaccine, based on new understandings of the influenza virus and the human immune system. Chemotherapy was invented here — and it is being replaced by treatments developed here. Yet the pace of public health advances, Collins says, is being slowed by the sequester.

He entered federal service to oversee decoding of the human genome, which he describes as “reading out the instruction book for human beings.” We are, he says, at the dawn of the era of “precision medicine,” of treatments personalized for patients’ genetic makeups.

This will be, Collins believes, “the century of biology.” Other countries have “read our playbook,” seeing how biomedical research can reduce health costs, produce jobs and enhance competitiveness. Meanwhile, America’s great research universities award advanced degrees to young scientists from abroad, and then irrational immigration policy compels them to leave and add value to other countries. And now the sequester discourages and disperses scientific talent.

In the private sector, where investors expect a quick turnaround, it is difficult to find dollars for a 10-year program. The public sector, however, with its different time horizon, can fund for the long term, thereby drawing young scientists into career trajectories and collaborations impossible elsewhere.

We might note in particular the point that "Other countries have 'read our playbook,' seeing how biomedical research can reduce health costs, produce jobs and enhance competitiveness." 

Sunday, August 11, 2013

3-D Printing: "Robohand" and the Future of Prosthetics

A visit to the Makerbot retail store in Manhattan is an eye-opener, even for those who have been following the rise of 3-D printing over the last few years.  One can see--and touch--the dimensions of new breakthroughs in prosthetics (to say nothing of any other gave of physical object that might be manufactured).

Makerbot, headquartered in Brooklyn, has been around for a while, but it has chosen to create a showcase for itself in the East Village.    That's good, because now more people will see the potential of 3-D printing, including its potential for medical devices. 

Take a look at this "Robohand," or prosthetic hand, for example, pictured below:

The basic design was created by a man who had lost his hand, and, well, wanted another one.  So here it is: all the parts here were made by a 3-D printer, except for the bolts (which could be made by 3-D), and the cords.   It's functional and capable of grasping.   

So how much did it cost?   The machine to make it, from Makerbot, is $2200.  The material, the filament, is about $2.  The CAD/CAM software is free, one of thousands of such free programs from Thingiverse

We might ask: What will this same project look like a year from now?  And how much will it cost?  We all know the answer--if we allow this new technology to advance.

And of course, that advance is vital for many, including our Wounded Warriors, to whom we owe so much.  President Obama recently announced an additional $100 million for medical research and treatment; 3-D printing of prosthetics helps us see how that money could make a difference--not just for the benefit of Wounded Warriors, not just for anyone else in need of prosthetics, but also for the huge new industry now on the horizon.   Doing good and doing well--that's the magical combination of the industrial revolution and mass production.  

Here's another picture of another prosthetic device, alas, not as clear.  

And here, for what it's worth, is a picture of the description of the process by which this "Robohand" was made.   

Much more, of course, to be found on the Makerbot websites. 

The future is, indeed, bright.  

Thursday, August 1, 2013

The Needed Framework for Cures

Gillian Tett's thought-provoking article in the FT points to a looming problem--the public could be losing confidence in "Big Data"-ish strategies, even when they have nothing to do with the National Security Agency.

In particular wide-scale biomedical research will be caught in the downdraft of public anxiety over spying and privacy.

It's an interesting point, and Tett cites two possible solutions: private data centers, in which the data is anonymized, and popular subscription campaigns.

Both are worthy suggestions, but it's clear that nothing will work amidst public cynicism, skepticism, and even hostility.

It's going to take political leadership--backed up by leadership from other sectors across all of society--to reinstill public confidence.

That is, it's going to take a framework, not unlike that which the federal government created around infrastructure projects, such as canals and railroads, in the 19th century.  Or around the telephone, television, and Internet networks of the 20th century. 

"The disaster of the last decade of FDA regulation of antibiotic development..."

From David Shlaes' blog on antibiotics: "We explore the disaster of the last decade of FDA regulation of antibiotic development, the recent record of FDA antibiotic approvals and the state of antibiotic resistance in the US. In short, the FDA now realizes that their oversight of antibiotic development over the last 10-15 years has, in part, led to a dangerously thin pipeline of new antibiotics."

One might think that this would be a big issue in DC. 

Here's an earlier chart illustrating the dire situation: 

Tuesday, July 30, 2013

A Computer Mouse That Fits On Your Finger--Next Stop: Telepathy?

As this article by Keith Wagstaff notes, the next step beyond a tiny mouse is direct control of physical objects via the mind.

What’s next, you ask: telepathic devices? Don’t laugh. Philip Low of NeuroVigil is currently working with Stephen Hawking to perfect his iBrain, a helmet that can identify brain signals that are indicative of conscious intent, meaning Hawking could one day communicate with the outside world just by thinking. Don’t be surprised if your great-great grandchildren browse YouTube solely with their brains.

We might note: Not only would such innovations be great for the medical and humanitarian benefit of patients, but it's easy to see a whole new industry being created on the basis of such projects as iBrain. 

Thursday, July 18, 2013

Dr. Andi Shane on the FDA's rules on Fecal Transplants

Dr. Andi Shane, MD, of Emory University writes:

"This study further confirms what anecdotal evidence has shown for some time--this treatment works.   So why is the FDA asking that it be kept from those who need it the most by requiring consent forms and lengthy approvals?"

Good question! 

Sunday, July 7, 2013

The Obama White House, Thinking Bigger

Last year--it would appear that the date was April 2012--Thomas Kalil, Deputy Director of the The White House Office of Science and Technology Policy (OSTP) released a report entitled, boldly and hopefully, "Grand Challenges." The document covered many important areas, from digital education to self-driving cars.

But here on the Cure Strategy front, we can focus in on Slide #15; and in particular, take note of Point 2. below:
The text of Point 2. reads,

Regenerative medicine routinely replaces damaged tissues or organs–ending the agonizing wait for an organ transplant.  

That's a great idea; unfortunately, progress toward that goal by the Obama administration seems to be invisible.

In the meantime, of course, in June of this year, the Sarah Murnaghan case erupted into public consciousness, and the administration ended up looking like the heavy, in saying no to little Sarah's lung transplant--the administration was soon overruled.

In fact, on June 19, I wrote an opinion piece for The American Conservative in which I took note of the Sarah Murnaghan case, arguing hat the only long-term viable solution to the medical and ethical issues surrounding Sarah's case was technological.  That is, figuring out how to mass-produce organs, thus alleviating the shortage.

As I wrote: 

Both parties could work together on a post-scarcity healthcare vision in which innovation and abundance go hand in hand. The two parties could start by working jointly to expand the supply of lungs and other organs. More organ-donors would be great, but even greater would be a new biotech industry of organ production, through non-embryonic stem-cell cloning, maybe, or 3-D printing.

Is all this the stuff of science fiction? Not any more. It can be real, if we as a nation want it to happen. New medical science is the stuff of human hope, and it’s also the basis of new jobs and industries here in America.

And yes, it’s even the basis of a politically winning healthcare agenda—for one or both parties.

Yes, it's still a politically winning healthcare agenda--for one or both parties.

And the Obama administration just took a step in the right direction--a year ago.  Since then, in the Murnaghan case, it has seen what happens when officials don't push technological abundance--they get gored on the horn of "austerity."   As I argued in that AmCon piece, austerity has its place, but it is simply not popular when applied to the life of a 10-year-old.

By contrast, if the Obama administration had energetically followed Kalil's lead, it would have had a much better message on the Murnaghan case.

So now, in 2013, we'll have to see which leader, and which party, takes the next step, and the next, and the next.

H/T Jeremy Shane.

Saturday, June 29, 2013

Bob Hugin of Celgene on the need for--and the benefit of--action Alzheimer's

Bob Hugin, Chairman and CEO of Celgene, and also chair of PhRMA calls for new push to improve treatment of Alzheimer's Disease.  

Hugin writes

"The Alzheimer’s Association reports that without new disease-modifying treatments, by 2050, at least 13.5 m
illion Americans will have developed Alzheimer’s disease, costing this country $1 trillion per year – a crushing expense. A new therapy that delays the onset of Alzheimer’s by five years would reduce by nearly 45% the number of people with the disease by 2050, and save $447 billion per year. We cannot afford NOT to invest in the discovery and development of such a potential treatment today."

This blog post is a heartening indicator that the whole pharma industry is eager to be a part of the anti-Alzheimer's effort, and is equally determined to argue that such an effort would not only be a humanitarian win for America and the world, but also an economic and budgetary win. In other words, a win-win-win!

Thursday, June 27, 2013

House Majority Leader Eric Cantor Shifts the Paradigm on Healthcare--From Cuts to Cures.

House Majority Leader Eric Cantor (R-VA) said on Wednesday:  "If you cure disease, you no longer have to spend dollars towards treating the symptoms ... of those diseases."

Bingo.  Of course, cures are cheaper than care.  It's cheaper to beat than to treat.  That was the lesson of polio.  A cure is cheaper than care.

If we want to "bend the curve" on healthcare costs--and we all do--this is the right way to do.  Also the only humane way.

But let Russell Berman of The Hill tell the story

“We believe in medical research and discovery, and we believe that pediatric medical research is and should be a national priority,” Cantor said. Joining him at the event were Reps. Tom Cole (R-Okla.), Renee Elmers (R-N.C.) and Susan Brooks (R-Ind.), all co-sponsors of the bill.

The proposal, known as the Kids First Research Act, is part of Cantor’s “Making Life Work” agenda that he laid out earlier this year in a rebranding effort for Republicans. 

The backing of federal support for medical research is not so much a reversal for the Virginia Republican as it is a bid to get away from a singular GOP focus on spending cuts.

“In times of fiscal stress especially, we are called upon in Congress to set priorities,” Cantor said in describing the bill. “It’s also the right thing to do because research in this country of ours has proven to be a tremendous boon to our economy.”

Yet in defending the proposal against critics who say the elimination of presidential campaign funds should go only to deficit reduction, Cantor echoed the arguments that President Obama and other top Democrats have made in favor of government spending for research. 

The funding, he said, would promote economic growth and help reduce the deficit in the long term.

“Ultimately, we all know that the driver of our debt and deficit are the unfunded liabilities connected with the entitlement programs,” Cantor said at a press conference. 

“There’s been a lot of disagreement about how to address that. This money can actually be translated into addressing that through cures. If you cure disease, you no longer have to spend dollars towards treating the symptoms ... of those diseases.”

In fact, Cantor has been advancing this idea for a while.  Back in February I noted that the GOP leader's speech to AEI contained a refreshingly positive vision of scientific transformation.

If Cantor can inspire Republicans, and Rep. Rob Andrews can inspire Democrats, then there's the real prospect of a genuine transformation of American healthcare policy.

Next year, interestingly enough, marks the centennial of the birth of Jonas Salk, the man whose work epitomizes the once and future potential of the cure strategy.  

Sunday, June 23, 2013

All jokes and suspicions about Anna Chapman aside, who in the DC policy world is thinking like this?

Anna Chapman in The Financial Times

"Let me be clear on this one: whether we are dead or alive after 60 is dependent on the state of biotechnology in [Russia]. If we start growing bio-artificial organs in the next 10 years, it will add 20 years to the average lifespan. I won’t mention what gerontology research can do. Sergey Brin, founder of Google, in 2008 underwent a genetic study that found by the time he reaches the age of 70 there is a 50 per cent chance he may develop Parkinson’s disease, which affects his mother. That is, the disease is hereditary, and can threaten not only Brin, but also his children. Since then, he has spent more than $130m on research for the development of drugs for Parkinson’s disease."

Saturday, June 1, 2013

Mitt Romney and the Cure Strategy--in 2013

From The Wall Street Journal, describing a forthcoming event on ideas, featuring, among other guests, Obama campaign strategist David Axelrod: 

"Mr. Axelrod and his wife, Susan, will tell of their daughter's struggles with severe epilepsy and talk up their support for finding a cure."

The Axelrods have long been involved in CURE--Citizens United for Research in Epilepsy--on behalf of their daughter, and all those who suffer from epilepsy. 

So this is a wonderful instance of Mitt Romney being both bipartisan and forward-looking--that is, reaching across the aisle and thinking about the ultimate potential of medicine; which is, of course, curing disease and thereby promoting better health.  

I suggested, last September, that Romney make curing disease--in particular, Alzheimer's, because it is so widespread and so costly--a key part of his campaign platform.  

Now, in 2013, the idea of curing disease is gaining more play.  Of course, such an emphasis on the Cure Strategy would have been more helpful to Romney's political fortunes if he had emphasized it last year, during the presidential campaign.  

Tuesday, April 2, 2013

New Brain-Mapping Initiative Would Be Even Stronger If It Were Linked to Urgent and Tangible National Goals

This scientific effort is completely meritorious on its own, but it would be even stronger and more sustainable if it were linked to urgent national goals, such as curing Alzheimer's and healing Wounded Warriors.  And other maladies, too, of course.

In the meantime, from the point of view of protecting this program from would-be budget-cutters and other critics, this is not a strong articulation:

It is different, however, in that it has, as yet, no clearly defined goals or endpoint. Coming up with those goals will be up to the scientists involved and may take more than year.

[Emphasis added]