Healthy Optimism — April 5, 2017

Well, not much has happened in the past two weeks in the world of healthca…no wait, the complete opposite of that. As expected, as advertised, the new administration is providing plenty of…um, material for discussion around healthcare and the life sciences.

Add to the news about NIH funding a case study on why funding (from somewhere, anywhere, even if not the NIH) is desperately needed, and we have the makings of an interesting conversation around scientific R&D.

Oh, and also, ACA repeal. In fact, let’s start there.

So Many Acronyms, So Little Clarity

A few weeks ago the Congressional Budget office scored the Republican Majority’s ACA alternative. The results led to a prophecy that 24 million people would lose coverage. Granted, the CBO can only score on assumptions within a bill and surrounding economic conditions and, well, we all know about assumptions. Conservative health policy analyst Avik Roy explained the potential problems with the 24 million number (and the CBO’s history with health insurance coverage projections) in a detailed article at Forbes.

There’s been plenty of number crunching to show serious problems with the American Health Care Act, though. Between sketchy, generally negative numbers and the bizarre realities of DC politics — pushback from both sides but for polar opposite reasons — House Speaker Paul Ryan pulled the bill from the floor. But we all already know that. What does it mean?

Great question and, like with so much of DC politics (see above), along with the risks of predicting the future (see above), we’re not going to go out on too much of a limb. There are few people who will, though. Many of these were posted before the bill collapsed, but they provide useful insight for the next attempt (which, Ryan assures us, is going to happen.)

The CBO’s numbers were plenty sufficient for the AMA and several patient advocate groups, which made it clear that a bill leading to reductions in coverage was not going to get a thumbs up. And medical practitioners are getting fed up with dealing with the red tape of insurance, in general. A semi-scientific LinkedIn poll recently showed that almost half of providers would be in favor of a single-payer system, even accepting lower financial reward in return for the chance to get back to spending time with patients. In other words, it appears that the medical community just wants to take care of people. Good idea, that.

People in the health tech space noted that the AHCA would probably not have changed much as far as value-based care and MACRA. Better outcomes for lower costs are popular across the board. As a result, the need for ongoing innovation wasn’t going to change, even if the underlying financial environment did. And there, of course, is a great lesson for all times: keep creating and building, regardless of who holds the gavel.

On the payer side, Healthcare Dive suggested last week that the death of AHCA still leaves a lot of uncertainty around the existing ACA exchanges. Even with the status quo remaining, well, the status quo, it’s confusing enough that some insurers could “bail on ACA exchanges.” This problem ain’t going away, folks.

We could write for hours on ACA vs AHCA, Left vs Right, winners and losers. But, we have a meeting this afternoon and there’s other stuff going on in the world.

No One Accused Him of Being Subtle

…Like funding for research. And you thought we’d be leaving DC behind for the rest of this digest. Hah!

Hard to leave it behind when there are 1.2 billion reasons not to. That’s the $1.2 billion President Trump proposed cutting from the National Institutes of Health budget this year, with almost $6 billion in cuts on the table for next year. The primary target of cuts are indirect costs, which are the funds research organizations take from scientists’ grants to pay for infrastructure. Literally, keeping the lights on. Only the future of research, and future advances in health, are at stake.

As with any budget, it’s Congress who sets the numbers, not the President. But the executive branch sets the tone, and a President’s budget is one of the most powerful ways to reveal an administration’s priorities. In this case, the White House is indirectly (see what we did there?) presenting the NIH cuts as part of the oft-repeated “waste and abuse” mantra.

It continues an interesting question about how funding affects spending. When more money is available to do [x], more of [x] will be done. Are there more efficient ways to do [x]? Maybe, but if the money is there to keep doing it the same way, will people be incentivized to find them? Thus, as STAT points out, proponents of the NIH cuts note private organizations that offer far less for indirect costs in their grants. Additionally, “Given [the size of university endowments], critics say, it makes little sense for taxpayers to foot the bill for lab utilities.”

On the other hand, scientists, science advocacy groups, and university administrations across the board have said that research will be devastated and some programs could shut down if the cuts go through. Someone has to keep the lights on.

As with the ACA/AHCA situation, the Administration is getting and will continue to get significant pushback from residents of both sides of the aisle.

Between the mind-numbingly frustrating overtures to the anti-vaccine community on the part of the Trump Administration (we try to be fair and open around here, but some ideas are just wrong and bad) and the proposed gouging of the NIH budget, scientists have just about had it. Plans are in the works for a massive March for Science on April 22 to remind our government of the importance of research in the pursuit of a healthy world. And yet, as in DC, there’s trouble brewing. According to STAT, the event designed to present unity among the scientific community is anything but unified.

Regardless of policy and funding and marches and advocacy, really, how valuable is basic research? Well…

A Long, Hard Road With a Wonderful Outcome

…Pretty darn valuable, as it turns out. Not every scientific discovery makes it to human trials. In fact, only a tiny fraction of a percent do, according to a recent episode of Genentech’s Two Scientists Walk Into a Bar Podcast. But nothing makes it into human trials if no research is conducted.

We saw an amazing example of this recently when the FDA approved Ocrevus, the first drug built to treat Primary Progressive Multiple Sclerosis. It started in the ’70s, when Dr. Stephen Hauser jumped into research on B cells and showed that they’re involved in the aberrant immune response that causes inflammation and breakdown of the insulating sheath around nerve cells. For years, Hauser’s group carefully built a case for a drug to target B cells in the most severe cases of MS. They started from scratch in the lab, first proving the initial theory in an animal system that in and of itself took a decade to develop. From there, it was a long, slow slog to figure out the biological details and find a molecule to shepherd through the drug development process.

You can read more from UCSF (where Hauser is director of the Weill Institute for Neurosciences, and where much of the research was carried out) and STAT.

It’s an outstanding story to remind us that, regardless of our political preferences, amazing work is going on across health and science and we must ensure that such work continues in an affordable and sustainable way.