Changing small molecule exclusivity rules as a long-term drug price policy play

This piece originally appeared in the Timmerman Report

We’re entering uncharted waters in the US government. I don’t think it’s hyperbolic to say there will be new regulations, new laws that we’ve never seen before. While I don’t pretend to understand the new administration in any way, I do expect there will be more chaos at the level of policy-making than we’ve seen in decades and one thing that chaos does is it increases the likelihood of extreme outcomes.

So here is one speculative policy idea:

I think we should trade the 12-year exclusivity period from biologics to small molecule drugs. Continue reading

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An Open Standard for APIs Could Lead us to Better Health

There’s a parable about the elephant and the rider that’s been used by Chip and Dan Heath, and that originated with Jonathan Haidt, to describe how humans make decisions. A person’s mind can be thought of as consisting of a rider, representing the rational part of human thinking, and the elephant she’s riding, representing emotion. Both of these play a role in how a person decides things, and many of us believe the rider–the rational part–is in charge. The rider taps the elephant with her guide stick, and the elephant obediently moves in that general direction or does a specific task, like carrying lumber from place to place.

Except that’s not how a lot of decisions actually get made. Instead, the elephant sees a bunch of bananas, or a herd of other elephants, or a nice cool river to bathe in, and goes that way instead. And the rider…well, the rider can’t do much about it except, after the fact, rationalize how she always wanted to go in that direction to begin with. Yeah, it was time for a bath, sure

This framing has stuck in my mind for years and it’s a really helpful way of looking at many of the odd things that people do or say, ranging from climate change denial, to believing genetically modified organisms are inherently evil, to smoking despite everything we know about the harms that result, to even saying that Paul Blart, Mall Cop II is really, you know, not that bad–really. And it also speaks to one of the more vexing problems we have in human health. Why do people keep doing things they really probably shouldn’t, and know they shouldn’t, if they want to stay healthy?

I’ve touched before on how the power of digital tools can help make it easier for us to make good decisions. OPower is doing this for power consumption and conservation, and with the advent of tools like Apple’s Healthkit and the proliferation of activity trackers, the time is right to do this for health. Continue reading

Is Opower the model for getting us to wellness and health?

This is a post about nudges. And optimism.

There’s a story I read a long time ago by David Brin. It’s called “The Giving Plague,” and the protagonist is a virologist and epidemiologist who describes his life working on viruses and vectors. The Plague of the title is a virus that has evolved the ability to make infected people enjoy donating blood. Recipients keep giving blood, leading to an exponentially expanding network of people who find themselves giving blood regularly and even circumventing age and other restrictions to make sure they can give their pint every eight weeks.

The central twist of the story is that the protagonist’s mentor, who discovers this virus, realizes people who donate blood also perform other altruistic acts–that the act of giving blood changes their own self image. Makes them behave as better people. And so he suppresses the discovery, for the greater good of society. The protagonist, a rampant careerist, begins plotting murder to allow him to take credit. But before he can act, more diseases strike, the Giving Plague moves through the population, and the protagonist forgets about it in his efforts to cure newer diseases.

And if anyone thinks something like this is too outlandish, I encourage you to read this piece about Toxoplasma gondii and how it makes infected mice charge at cats, the better to be eaten so that T. gondii can spread. Yeah.

But what does this story have to do with the future of wellness and health?

Continue reading

Baseball analytics, arthritis, and the search for better health forecasts

All opinions are my own and do not necessarily reflect those of Novo Nordisk.

It’s Fourth of July weekend in Seattle as I write this. Which means it’s overcast. This was predictable, just as it’s predictable that for the two months after July 4th the Pacific Northwest will be beautiful, sunny and warm. Mostly.

Too bad forecasting so many other things–baseball, earthquakes, health outcomes–isn’t nearly as easy. But that doesn’t mean people have given up. There’s a lot to be gained from better forecasting, even if the improvement is just by a little bit.

And so I was eager to see the results from a recent research competition in health forecasting. The challenge, which was organized as a crowdsourcing competition, was to find a classifier for whether and how rheumatoid arthritis (RA) patients will respond to a specific drug treatment. The winning methods are able to predict drug response to a degree significantly better than chance, which is a nice advance over previous research.

And imagine my surprise when I saw that the winning entries also have an algorithmic relationship to tools that have been used for forecasting baseball performance for years.

The best predictor was a first cousin of PECOTA. Continue reading