Making breakthrough cures affordable for all
Science is advancing at dizzying speed. Between our increasing understanding of human biology and our ability to match molecularly targeted treatments to the specific patients who will benefit most from them, cures that have eluded us in the past are within reach. But as Louise Perkins, chief science officer of the Melanoma Research Alliance pointed out, “The cost to create breakthrough drugs threatens to break the innovators who develop them, as well as the institutes who pick up the tab to pull them forward.”
This paradox was the focus of the “Breakthrough Medicine: Will Finding a Cure Be Just the Start of Saving Lives?” panel at the 2015 Milken Institute Global Conference.
“We as physicians want to give new drugs, the best drugs, to everyone, and [we] feel held back,” explained Omid Hamid of the Angeles Clinic and Research Institute. “We’ve always known what’s wrong and why we’re getting these cancers, but we’ve never really known how to take care of that. Now we have the drugs that are able to target them, and target them effectively. But we have to be able to translate these successes to the end user and fix the cost so it is available to all.”
Other panelists shared Hamid’s optimism about the power of precision medicine—treatments matched to an individual’s own tumor mutation—and his desire to better align outcomes and cost. “Our perspective, as we look to the future and seek to drive up quality and drive down cost, is the importance of collaboration,” noted Daniel Hilferty, president and CEO of Independence Blue Cross. “When you get everyone aligned around trying to meet a common goal, progress is much more efficient.”
“The analogy of HIV has been a good roadmap for us,” added Jill DeSimone, senior vice president of U.S. Oncology at Merck. “Advances came about because of collaboration between the advocacy community, the scientific community and the business community. At the end of the day, the North Star is the patient. How do we transform the experience for the patient?”
Gideon Bollag, CEO of Plexxikon, dug into the issue of targeted therapies versus immunotherapies, describing his experience of creating a drug and a diagnostic that moved very quickly from the first in-human clinical trials to approval. “Because the therapy was targeted, and the diagnostic allowed doctors to identify patients with the relevant mutation, there was a very high response rate. However, the reality is that most patients who have success with targeted therapies are relapsing.” In comparison, he pointed out, with immunotherapies, which drive a patient’s own immune system to recognize and reject cancerous cells, “fewer patients respond, but those that do respond very positively.”
Wyatt Decker, CEO of the Mayo Clinic in Arizona, noted the challenge of scaling scientific knowledge so that physicians have the expertise necessary to keep up with new developments. “Our nation’s physicians are not being educated for the future of health care; they’re being educated for the past of health care. That’s got to change.” He went on to explain how Mayo is revamping their schools to address this challenge. “Making the right thing to do for patients the easy thing to do is how we get physicians humming along together.”
This brought the discussion around to big data, and the question of how to take that data and put it through a pipeline to get it back to a patient or caregiver. “Imagine if we could harvest from EMRs how patients get their immunotherapy drug. When? How often? How did it work?” mused Perkins. “What could we learn? What trends would we see? How could it improve the way we treat or make decisions?”
Hamid applauded organizations like the Melanoma Research Alliance for bringing all of the sectors together and reducing the time and pain of forging partnerships. “There’s never been a time like today where we’ve had so many nonprofits working to bring us together. It used to take years to get contracting done, and now [we see] a new partnership announced practically every day. It’s very encouraging for patients.”
In closing, panelists agreed that collaboration, with aligned incentives, would be the path forward for innovative, affordable therapies that improve patients’ “health-spans” as well as lifespans.