What are the transformational innovations that will affect the healthcare industry by 2020? This is a question that Merv and I discussed in a recent conversation.
I/ Innovations in Alzeihmer’s Disease (AD)
Merv mentioned Alzheimer’s Disease as an area where there is the potential for a binary outcome by 2020. A number of pharma companies – Merck; Lilly/Astra Zeneca; Biogen Idec/Esai; Roche; Novartis – all have late stage programs for the treatment of Alzheimer’s Disease. All are testing the dominant hypothesis for the cause of AD, the production and accumulation of beta amyloid (ABeta). Attempts to test the hypothesis to date have been unsuccessful in the clinic, either because the drugs were too toxic (gamma secretase inhibitors) or because therapeutic antibodies (such as bapineuzumab) have not shown the level of clearance of ABeta likely necessary for any true demonstration of clinical benefit. If one of the current programs hits, there’s a potential to see a huge change in the way AD is treated. If the drugs show convincing changes in ABeta levels, but no change in disease, then this will be an enormous setback for AD research, essentially negating 20 years of research effort and in a field where the costs of AD exceed on a direct basis $200 billion en route to perhaps more than $1 trillion in 2050. This excludes the equivalent direct and indirect costs for caregivers.
Even if the hypothesis is correct, we do not know at what stage of the disease we will be able to block progression. The consensus, based on the risky game of sub-group analysis in otherwise busted studies, is that earlier is better. Merck’s drug, the lead in the BACE inhibitor class, is now in PIII after passing an important safety hurdle in PII, and after showing 100% clearance of ABeta from the cerebrospinal fluid of patients with AD in PI. In other words, the molecule is good enough to at last test the ABeta hypothesis clinically, according to Merv. In December, Biogen Idec reported sufficiently encouraging data to advance their antibody into PIII also. If either of these drugs show convincing efficacy, the questions will be
- at what price ?
- is the side effect profile manageable?
- at what stage of the disease are they effective ? How early in disease progression must patients start taking them?
These are big, long expensive trials. The Merck study, launched in 2012, targeted 400 patients with mild to moderate disease for a 78 week initial study to establish an efficacious dose; patients completing that go onto a 5 year extension to study outcomes! So unless the study is stopped early by the Data Safety Monitoring Board for safety (bad!) or efficacy (good!), it will be 2020 when we know the answer. The industry has already spent a cumulative $85BN on busted AD research. A Cleveland Clinic study has found a 99.6% failure rate of clinical trials for Alzheimer’s drug candidates between 2002 and 2012. But given the cost figures above, that is why Merv sees this as such a huge pivot point for the directions healthcare takes.
II/ What could disrupt healthcare longterm?
Let us set aside the discussion of genetics and human disease. That has been covered ad nauseam in many other settings.
Healthcare is a highly regulated industry. But the taxi industry was also regulated and yet it is being disrupted by services like Uber. However, healthcare is delivered through a trusted intermediary, the physician, in a healthcare practice or hospital setting. It is not really a part of the sharing economy! So what could disrupt healthcare?
In truth, 90% of healthcare costs are driven by poor behavior and bad personal choices. Lung cancer is caused by smoking; heart disease, Type II diabetes, hypertension, stroke, are all associated with obesity and inactivity – as, indeed are some forms of cancer. To really impact health and healthcare costs, we need to attack the root causes. Reducing obesity would have a colossal impact on the health of the planet.
Merv believes that social media and social media applications could play a huge role in changing the way we all behave. It is well established that our weight correlates with that of our friends ; networking with a group interested in weight reduction improves the outcome of dieting (a model that Weight Watchers is built upon). Furthermore, there is a role for physicians in this. A recent New York Times article reported on a program where doctors provide a “prescription to eat fruits and vegetables” instead of drugs. The results were striking: after just four months in the program 40 percent of participating children lowered their Body Mass Index (BMI). and 97 percent of the children and 96 percent of their families ate more fruits and vegetables after joining the program. More than 90 percent of families shopped at farmers’ markets weekly or more than two or three times a month, and 70 percent understood more about the health value of fruits and vegetables. Merv is Chairman of the Board of a company called PrescribeWell, which is looking to involve physicians in the changing the lifestyle choices of their patients.
For such an approach to « go viral », it would require a shift in agricultural policy, towards subsidizing the production of fruits and vegetables, and away from a corn-based agribusiness which emphasizes the production of animal protein and highly processed snack foods. There is a global concern which could yet help to move us in that direction – climate change. A remarkably interesting recent publication in Nature suggested that a shift to any of three alternative dietary lifetyles – a Mediterranean diet, a diet with a greater emphasis on fish ; or a vegetarian diet could have a stunning impact on global health, on carbon dioxide emissions ; and on land utilization.
Merv doesn’t think a rampant epidemic of Mediterranean diet is likely, but if global agricultural policy changed in response to benefits for health and CO2 emissions, it is possible.
To sum up, key developments in healthcare include :
- the impact of behavioral change on healthcare
- the transformational nature of current Alzeihmer’s programs.
This summarizes my discussion with Merv.
- For the first two parts of this interview, read here and here.
- For a read on the rarefaction of ressources and how innovation can play a role, see this article.
- For a take on electronic health records, please refer to this page.
- For a breakdown of the numerous ways to innovate in healthcare, read this.