The Integrative Stream

Complications of the Health Care System

Excellent article on diabetes care in the New York Times today (registration required). Casual inspection shows that the system in the US for care of chronic disease is broken: critical, acute care is far more expensive than preventive care (and preventive care is better for patients), but the public health and insurance systems are biased towards addressing clear symptoms after the fact.

The article gives a nice introduction to both the need for preventive care and the negative incentives in the insurance business. As an insurer, you save money by proactively treating your chronic patients. But by providing better treatment, you attract sicker patients.

In the Treatment of Diabetes, Success Often Does Not Pay – New York Times

Live vaccine against bird flu (in birds)

China develops first live vaccine against bird flu. It can be delivered orally, nasally or by injection. It can also, apparently, be sprayed.

I am not a virologist; in fact, I’m not anything even remotely like a virologist. So I have to wonder: is spraying a weakened version of H5N1 all over the place a really good idea?

Kids These Days

Just bought a latte at my local Starbucks. The customre ahead of me tendered a $2 bill for payment. The teenager behind the register had never seen one before, and wanted to know if it was real. She consulted the twenty-something behind the other register, who didn’t know either. Finally, they consulted me, and I authenticated the bill for them.

Although, to be fair, I haven’t seen any $2 bills in a long time, so it’s now entirely out of the question that a teenage cashier wouldn’t have seen them. There are so many more currency options than when I was a kid, anyway. As a teenager, I paid cash. Now, not only have credit and debit cards worked their way down to the tweens, it seems that every major retail chain has launched a swipe card program. There’s enough economist in me that I never saw the point of those things. After all, they’re just like cash – but worse.

McDonald’s in Moscow

And to call out a particular post from this weeks Carnival of the Capitalists, on the status of McDonald’s in Russia. I visited the original Moscow McDonalds in 1994, a few years after it opened. On the same trip I was–I believe–one of the first Americans to use an ATM machine in Russia.

Interested-Participant

So beer is good for you…

From MedGadget, a fun read for a Sunday afternoon:

“Medical Beer” and Prohibition

University Tech Transfer

Interesting article from Nature on the downsides of technology licensing offices at universities.

news @ nature.com – The technology trap

Update, 10/18: This article is now protected by nature.com’s subscription service, and isn’t accessible anymore. Sorry! I try not to post references to things which will go away, although I will continue to post links to NY Times articles and other resources which are accessible after a free login.

Nanotech Cancer Screening

Nanowires for detecting molecular signs of cancer.

This is really cool. If it’s cheap enough you could screen large populations and potentially detect cancers before any symptoms manifest. And the technology is applicable to any disease that leaves trace elements in the blood (and I’d think that’s just about everything).

More Vioxx Commentary

On why the Vioxx verdict creates a public health risk. From Richard Epstein writing on OpinionJournal. The author is, like me, in the industry, but I believe his points are quite solid. My initial take on the subject is here.

To balance out my reporting, I’ve been looking for a good editorial commentary praising the verdict, but I haven’t found anything that isn’t absolute lunacy. One article, from a health “news” site found via Google which I will refrain from linking to, makes the totally unsubstantiated claim that Vioxx has killed tens of thousands of people. The same site also promotes a book promising a homeopathic cure for cancer that “they” don’t want you to know about. And it just goes downhill from there.

So if you’ve got an alternate take, let me know.

Personalized Medicine

BusinessWeek has a nice, non-technical overview of the development-to-date of personalized medicine: Drugs Get Smart.

Biotech MBAs

Just came across an article in Nature entitled Making it in the biotech business, discussing some of the rationale for doing a biotech/pharma/healthcare focused MBA, including MIT’s BEP program.

Vioxx Verdict

There are two very good articles in today’s Wall Street Journal (link here if you happen to have a subscription to the online version) detailing the jury process that went into the Vioxx ruling. I haven’t followed the case all that closely, but what I’ve seen is worrysome. In particular, the jury seems to have effectively tuned out the scientific evidence presented by Merck in favor of rather more emotional arguments by the plaintiff’s attorney–such as wheeling in 146 boxes of regulatory documents to imply that Merck had deluged the FDA with data to cover up defects. Every drug approval requires huge volumes of documentation; making a big stack in front of the jury means nothing.

Whatever the specifics, it’s pretty clear the case was not tried on its merits, and that’s a bad sign.

Business education shifts toward life sciences – The Boston Globe

Perfect timing; for my first day at Sloan, the Boston Globe has a short interview with the dean, Richard Schmalensee:
Business education shifts toward life sciences.

How appropriate.

Do you want a new drug?

NPR’s Morning Edition on Thursday devoted a lot of time to the final report of the space shuttle Columbia accident review board. It’s quite clear that we’ve changed our standards for space exploration. Without the Soviets to compete against, we’ve changed our safety expectations; the clear goal being to take the risk entirely out of space travel. Even with the Columbia tragedy, the shuttle program has a 98% safe return ratio, which is probably better than any series of exploratory ventures in history. Apollo, by contrast, opened with the Apollo 1 disaster and was punctuated by Apollo 13. That’s an 83% success rate, but Apollo 13 was followed by Apollo 14 in less than seven months. NASA in the 1960s may have been a more dynamic and aggressive organization than today, but public attitudes have clearly changed; risk, even risk that the crew might happily accept, is out of the equation.

Which brings me back to Thursday morning. I heard the Columbia report on the way to an MIT Center for Biomedical Innovation forum titled “New Medicines: Can Innovation and Safety Coexist?” The issue was more or less the same, just with drugs rather than spaceships. How do we balance the need to provide safe and effective medicines with the risk associated with developing innovative treatments? If even a small percentage of negative outcomes triggers a backlash as large as yesterday’s Vioxx Verdict, will it be possible to develop novel treatments without setting aside billions for lawsuits?

It’s almost impossible to conduct a clinical trial large enough to identify all the potential side effects of a drug. In the case of Rotarix, a rotavirus vaccine marketed by GSK, a 75,000 person trial was conducted, and even that might not have been sufficient to determine whether the incidence of certain complications was statistically above the background level. The vaccine still isn’t available in the US; GSK launched it internationally, and will likely try to bring it to the US market based on post-marketing surveillance of foreign patients (MIT’s Technology Review has an excellent article on the development of the Rotavirus vaccine, and one of the principals from GSK’s biotech partner, Avant, participated in the CBI conference).

I don’t see much difference between giving a drug to a hundred thousand people in a clinical trial setting and giving a drug to a hundred thousand people with a reasonable level of post marketing surveillance. Many people, myself included, try to avoid taking anything that hasn’t been on the market for a few years anyway. We treat new drugs as intrinsically risky. So why not create a probationary category? Start with smaller clinical trials and an expedited approval process. Then, for several years, require the same disclosures as for a clinical trial, and create patient registries to track everyone who is taking the drug – and include the rest of their medical histories, too. Give drug companies the opportunity to release new products through the current system or the new one, and give patients the opportunity to decide what risk/benefit profile they’re willing to accept.

Careful readers will notice that the proposal above requires complete patient registries for probationary drugs, and will likely comment that the infrastructure to deploy those registries in an efficient manner across all participating doctors would be hideously expensive and difficult. And the careful reader would be right. Requiring entry of a patient’s entire medical history, which would be required to properly screen for negative drug interactions, into a separate system for each probationary drug would be extremely time consuming. So the proposal doesn’t work without standardized electronic medical histories, which come with a host of practical and privacy concerns.