martes, 30 de abril de 2019

More reads

The Readout
Damian Garde

More reads

  • The obscure advisory committees at the heart of the U.S. drug pricing debate. (Reuters)
  • A new Sun Pharma policy on insider trading raises questions of double standards. (STAT Plus)
  • How big tech is struggling with the ethics of AI. (Financial Times)
  • After amyloid failures, it’s time to take a new tack for treating Alzheimer’s. (STAT)

The next biotech IPO might be a tough ask

The Readout
Damian Garde

The next biotech IPO might be a tough ask


Trevi Therapeutics wants to raise $70 million at a roughly $250 million valuation. That money will fund the company’s work to turn a reformulated opioid into a treatment for an itchy skin disease called prurigo nodularis, and a late-stage study is already under way.

What might be problematic to potential investors is that the drug already failed. In a Phase 2 study, neither tested dose of Trevi’s drug outperformed placebo when it came to reducing itch. The company did a post-hoc analysis of the data — which can lead to shoddy conclusions — and decided a modified trial design could make the drug’s next study into a success.

Trevi’s IPO, expected to price this week, will be an interesting barometer of market sentiment for biotech. The nine biotech companies that have gone public this year are trading up on average. But none had Trevi’s combination of potential stumbling blocks — the words “opioid” and “failed Phase 2,” for example — making this week’s pricing one to watch.

What does Daniel O’Day’s voice even sound like?

The Readout
Damian Garde

What does Daniel O’Day’s voice even sound like?


That’s among the things many investors will learn Thursday when O’Day, the new CEO at Gilead Sciences, answers questions for the first time since taking the job earlier this year.

As a genre, quarterly earnings calls tend toward the mundane, but O’Day might actually make news. He has inherited a Gilead whose next big idea, treating the liver disease NASH, has run into serious setbacks this year. The company’s once-massive hepatitis C business has ceased to grow, and its embrace of oncology has moved in fits and starts at great expense. And people are losing their jobs.

All of that makes Thursday’s call, which starts after the market close, into both an introduction for O’Day and a state-of-the-company address for Gilead. When the time comes, you can stream it here.

PhRMA is swarmed over 'Medicare for All'

The Readout
Damian Garde

PhRMA is swarmed over 'Medicare for All' 


The lobbying organization’s nondescript Washington, D.C., headquarters was the site of a protest yesterday not against high drug prices or thwarting generics. Instead, the roughly 200 demonstrators had come to talk about “Medicare for All.”

As STAT’s Nicholas Florko reports, activists accused PhRMA — and the drug industry at large — of standing in the way of the reform effort now gaining steam, much like the insurance industry whose very existence is threatened by it. The rising cost of health care is the “direct result of the greed of insurance and pharma corporations represented by groups like PhRMA,” advocates said.

Coverage of the increasingly popular “Medicare for All” push has largely focused on the world of payers and providers, and so too have activists. But Wall Street, like the protesters outside PhRMA, see a connection to the drug industry, and biopharma stock prices have slumped in recent weeks.

PhRMA, which declined to comment on the protest, happens to be flying about 60 industry researchers to D.C. today for meetings with lawmakers “on their efforts to advance new treatments and cures,” according to a statement.

Read more.

For big biotech, home cooking has its benefits

The Readout
Damian Garde

For big biotech, home cooking has its benefits


The drug industry has long since embraced agnosticism, claiming to consider drugs based on their scientific merits and not whether they were invented in-house or licensed from elsewhere. But a look at recent biotech history suggests the companies that prize their own ideas have fared better.

Analysts at Leerink looked at the eight biggest companies in biotech and found that Vertex Pharmaceuticals and Regeneron Pharmaceuticals had the best rates of pipeline success and the fewest drugs dropping out over five years. That’s interesting because, unlike their more catholic peers, Vertex and Regeneron tend to develop drugs from within their own walls rather than shopping around for external science.

On the other end of the spectrum, Celgene, which had by far the higher percentage of external projects, had the worst conversion rate. Over the last five years, only 6% of Celgene’s pipeline drugs turned into approved projects.

UPDATE on angiotensin II receptor blocker (ARB) recalls - FDA alerts patients and health care professionals to Teva’s recall and Legacy’s expanded recall of losartan medication due to NMBA - Drug Information Update


FDA is alerting patients and health care professionals to a voluntary recall of 44 lots of losartan potassium tablets manufactured by Teva Pharmaceuticals and labeled as Golden State Medical Supply due to the detection of the impurity N-Nitroso-N-methyl-4-aminobutyric acid (NMBA). The recalled products were made with active pharmaceutical ingredient (API) manufactured by Hetero Labs. Teva is recalling lots of losartan-containing medication that tested positive for NMBA above 9.82 parts per million.

Additionally, Legacy expanded its recall to include one additional lot of losartan tablets made with API manufactured by Hetero Labs.

Manufacturers should contact FDA’s Drug Shortages Staff when their testing of losartan shows levels of NMBA that exceed the interim acceptable intake limit of 0.96 ppm. FDA will determine, on a case-by-case basis, whether lots containing NMBA greater than 0.96 ppm should be released for distribution.

The agency also updated the list of recalled losartan medicines.

What to read around the web today

Morning Rounds
Shraddha Chakradhar

What to read around the web today

  • People are clamoring to buy old insulin pumps. The Atlantic
  • Why your doctor’s white coat can be a threat to your health. The New York Times
  • When measles arrives: breaking down the anatomy of containment. Undark
  • What study findings? Most European universities fail to report clinical trial results. STAT Plus
  • A giant leap for womankind. Nature Medicine

Study supports earlier testing for autism spectrum disorders

Morning Rounds
Shraddha Chakradhar

Study supports earlier testing for autism spectrum disorders

Testing toddlers for autism spectrum disorders at 14 months or older is likely to produce the most consistent results, according to a new study. Most toddlers with ASD are diagnosed and begin treatment at around 4 years old, and the new results open up the possibility of testing treatments at an earlier age. Researchers looked at more than 1,200 toddlers and found that the stability of an ASD diagnosis — the likelihood that future assessments wouldn’t contradict the initial assessment — was weakest at around 1 year of age, but was strongest at 14 months and older. The next challenge, the authors write, is to determine the best treatments and how much of a benefit early detection offers in the long term.

Researchers create potential diagnostic for chronic fatigue syndrome

Morning Rounds
Shraddha Chakradhar

Researchers create potential diagnostic for chronic fatigue syndrome

new study suggests that researchers have found a way to diagnose myalgic encephalomyelitis, also known as chronic fatigue syndrome, a disease that affects up to 2.5 million Americans but is still difficult to detect with a simple test. Researchers at the University of California, Irvine, and Stanford developed a diagnostic to test changes in electrical signals from immune cells in those with ME/CFS and those without the condition. The cells from those with ME/CFS showed a clear spike in electrical signals, indicating a heightened stress response. In contrast, the samples from the control group were fairly level. This diagnostic is still in development, but the “low-cost, rapid, miniaturized, minimally invasive, and highly sensitive” diagnostic could potentially be used in the research and clinical settings, the authors write. 

Inside STAT: Doctors, health officials push to end restrictions on key addiction treatment

Morning Rounds
Shraddha Chakradhar

Inside STAT: Doctors, health officials push to end restrictions on key addiction treatment

Why can’t doctors who prescribe opioids also prescribe drugs to treat opioid addiction? That’s the question on the minds of a group of people that’s looking to expand treatment for those struggling with substance use disorder. The group — which includes 18 state public health directors, a growing group of physicians, and a prominent member of Congress — is pushing to deregulate buprenorphine, which is used to lessen opioid cravings and withdrawal symptoms, but is highly regulated due to fears that it could be misused. But this week, Rep. Paul Tonko (D-N.Y.) will introduce legislation to allow any medical practitioner licensed to prescribe controlled substances to prescribe buprenorphine, he told STAT’s Lev Facher. Read more on the effort here

Sniffing out the risk of death

Morning Rounds
Shraddha Chakradhar

Sniffing out the risk of death

new study finds that a poor sense of smell is linked with a higher risk of death. We’ve known that our ability to smell diminishes with age, and that a poor sense of smell could be an early sign of dementia. Looking at data from nearly 2,300 older adults who were asked to take a smell test, those who got a score of 8 or lower on a 12-odor smell test had a 46% higher risk of mortality at 10 years after the test and a 30% higher risk at year 13 than those whose sense of smell seemed intact. The scientists also found that these higher mortality rates were associated with other conditions, including dementia and weight loss, but only partially explained the higher rates of death. The results only show an association between smell and mortality risk, and more research is needed to better understand the link. 

Measles cases in U.S. top 700

Morning Rounds
Shraddha Chakradhar

Measles cases in U.S. top 700

The measles case count in the U.S. has climbed to 704, the CDC just announced. This makes 2019 the year with the most cases in nearly 25 years, including since the disease was considered eliminated from the U.S. in 2000. The cases span 22 states, where 66 children have been hospitalized as a result. Most of the infections have been concentrated in New York, where two outbreaks — in Brooklyn and in Rockland County, north of Manhattan — account for 67% of the total cases nationwide. Nearly three-quarters of the people who have been sickened by measles are unvaccinated, according to the CDC. The outbreak in the Pacific Northwest was declared over yesterday; 71 people fell sick in Southwest Washington, in an episode that cost the local county nearly $865,000. 

‘Medicare for All’ and other D.C. health care happenings

Morning Rounds
Shraddha Chakradhar

‘Medicare for All’ and other D.C. health care happenings


SIGNS AND PRINTOUTS OF MEDICAL CROWDSOURCING CAMPAIGNS COVER THE DOORS OF THE PHRMA HEADQUARTERS DURING A PROTEST RALLY. (NICHOLAS FLORKO/STAT) 
It's a busy day in Washington for health care. Most notably, the House Rules Committee is set to hold a hearing on “Medicare For All,” the policy idea that would cover all Americans under a national health care system. The hearing is the first sign that Congress is considering the increasingly popular idea in earnest. Several Democratic presidential hopefuls have already embraced the idea. And yesterday, around 200 progressive activists rallied outside of the Washington headquarters of the industry group PhRMA, accusing drug makers of blocking the policy idea.
Elsewhere on Capitol Hill today, the House Judiciary Committee is going to mark up a slew of drug pricing bills and the health subcommittee of the House Energy and Commerce Committee is also set to hold a hearing on drug pricing in Medicare.

Redesigned Product-Specific Guidances Web Page Features Enhanced Design and Function - Drug Information Update




Today, the FDA published an enhanced version of the Product-Specific Guidances (PSGs) for Generic Drug Development web page. The enhancements add new functionality including text searching for active ingredient or Reference Listed Drug/Reference Standard RLD/RS product, filtering search results, easy-to-follow navigation, and more. This web page update is the latest in a series of FDA efforts to strengthen the agency’s online presence with the latest technologies.

New features for the upcoming version of the PSGs page include:
  • Text search of PSGs by active ingredient, or by the Reference Listed Drug (RLD) or Reference Standard (RS) application number
  • Users can filter search results using a text search box
  • Users can easily export search results in Excel, CSV, or PDF format
  • Search results are now paginated, allowing for faster searching
The redesigned PSGs web page, along with last year’s Drug Shortages and Orange Book website updates, shows the agency’s commitment to developing effective means for the public to access important and useful information.The updated PSG web page can be found on the FDA website at: Product-Specific Guidances for Generic Drug Development

How to Observe STD Awareness Month | HIV.gov

How to Observe STD Awareness Month | HIV.gov

STD Awareness Month

How to Observe STD Awareness Month
Each April, we observe STD Awareness Month as an opportunity to raise awareness about what STDs are; how they impact our lives; and why prevention, testing, and treatment are so important. Take action with CDC's four most popular campaigns...
LEARN MORE

Will 'Medicare for All' bring down drug prices?

D.C. Diagnosis
Nicholas Florko

'Medicare For All' drives the week

It’s a big week for "Medicare For All"— and though it might not sound like it, that means it’s a big week for drug pricing. Those progressive proposals wouldn’t just shake up the countries’ insurance system, they would also drastically rework the country’s drug pricing system.
At least one witness at today’s hearing on the idea, the Center for Economic and Policy Research’s Dean Baker, told STAT he plans to highlight lower drug prices as a result of Medicare For All as “probably the biggest single area for potential savings.”
If you need more proof of how the fight over drug pricing and Medicare For All are intertwined: See my dispatch from yesterday’s Medicare For All rally outside of PhRMA headquarters, where one popular Medicare For All advocate led the crowd in a chant of: “I hate PhRMA.” The story.

So, how would Medicare for All impact drug prices?  

Both the Senate M4A bill, sponsored by Sen. Bernie Sanders (I-Vt.), and the House version, sponsored by Rep. Pramila Jayapal (D-Wash.), would require the government to directly negotiate with drug makers and ultimately set up a national drug formulary. The bills differ slightly in how they direct the government to set up that formulary: Sanders’ bill simply says that the formulary should “encourage best practices in prescribing and discourage the use of ineffective, dangerous, or excessively costly medications when better alternatives are available,” while Jayapal’s bill directs the government to consider a slew of factors, including: comparative effectiveness, the budgetary impact of covering a drug, the number of alternatives and, strangely enough, global sales and R&D investment for the drugs.
One big difference: I was struck by how the two bills handle a stalemate where the government and drug makers can’t agree on the price paid for a drug. Sanders’ bill would direct the government to just pay the lowest price paid by other government programs like the Department of Veterans Affairs. Jayapal’s bill has a slightly bigger stick: If negotiations fell through the government could let a lower priced competitor come on the market, via so-called competitive licensing. If this sounds familiar, it’s because it’s the same idea behind Rep. Lloyd Doggett's (D-Texas) Medicare negotiation bill.

A floor vote on drug pricing legislation? Before Memorial Day?

The House Judiciary Committee is marking up four drug pricing bills today — bringing House Democrats one step closer to a floor vote on some kind of drug pricing legislation. Both progressive activists and drug lobbyists all told STAT that they expect a floor vote before Memorial Day, with two lobbyists telling STAT they expect a vote within the next two weeks. Buckle up!

The four bills are: The CREATES Act, which is meant to incentivize generic competition; the “Preserve Access to Affordable Generics and Biosimilars Act,” which would ban so-called pay-for-delay agreements; the “Stop Significant and Time-wasting Abuse Limiting Legitimate Innovation of New Generics Act,” which would crack down on abuses of FDA citizen petitions; and the “Prescription Pricing for People Act of 2019,” which would direct the FTC to study the role of pharmacy benefit managers.

Can Ned Sharpless command a room of lawyers like Gottlieb?

Acting FDA Commissioner Ned Sharpless is slated to give the keynote address at the annual confab of food and drug lawyers known affectionately as FDLI on Thursday. It’s one of Sharpless’ first high-profile public appearances since taking the job earlier this month — and it could be a big one. At last year’s FDLI keynote Gottlieb, delivered a more than 5,000 word manifesto that spilled the beans on the administration's plan to eliminate drug rebates (talk about making news.)
What Sharpless will chose to focus on remains to be seen. He’s made it clear that he’s eager to support FDA’s work on nutrition, and has committed to modernizing how FDA regulates dietary supplements, even calling a public meeting on the topic, scheduled for next month. FDA lawyers love debating the gray areas of the agency’s portfolio, so the audience would likely be overjoyed to hear Sharpless’ take on those topics.
But the most important question: Will Sharpless command the sprawling well-dressed conference room like Gottleib once did? Sharpless already seems to have his lawyer jokes honed: During his first address to FDA staff he joked that the “thorny problems” of “electronic nicotine delivery systems (ENDS), gene therapies, CBD oil, genetically modified animals, cell cultured meat (and pet food)” all played a role in why “we have so many lawyers around.” He’s not exactly George Carlin, but it’ll do ...

What else you need to watch this week:

The Energy and Commerce health subcommittee will hear today from Jim Matthews, the head of the congressional medicare advisors known as MedPAC. It’ll be a chance for Matthews to pitch lawmakers on the drug pricing ideas endorsed by his commission, and for lawmakers to get Matthews’ take on the Trump administration’s proposals.

Patients for Affordable Drugs is holding a congressional briefing today at 3:30 about the Trump administration's international pricing index. HHS drug pricing guru John O’Brien is slated to speak, along with drug pricing experts Peter Bach, Avik Roy, and Rena Conti. (The event, sadly, is restricted to congressional staff.)

PhRMA is holding its annual researcher fly-in today, too. The group is expected to fly in more than 60 researchers who will meet with lawmakers to espouse the work being done in drug industry labs. (Good timing!)

For CRISPR nerds, the American Society of Gene & Cell Therapy is holding its annual meeting this week, through Thursday. For those not into reading scientific abstracts, there will be panels on the FDA’s regulation of the technology, as well as discussions on paying for the costly treatments. I’ll be watching to see if there’s any mention of CRISPR babies, given the group just last week wrote to HHS Secretary Alex Azar to urge the administration to support a moratorium on so-called germline editing.

Worth your time

Bloomberg dives deep into the "U.S. Rural Health Network," a two-year-old nonprofit mysterious to rural health officials, funded by dark money, and best known for pushing back against proposals to lower drug prices. — Lev Facher

In state legislatures, Juul claims to support legislation raising tobacco-purchase ages to 21. Public health advocates who've watched them ban cities from restricting vape sells tell a different story, Sheila Kaplan writes in the New York Times— Lev Facher
STAT sat in on a drug pricing debate some 400 miles away from Washington, at Harvard. And the distance wasn’t the only thing that made this one stand out from the typical D.C. conversations. — Erin Mershon
The Atlantic has a fascinating look at “loopers,” biohackers with diabetes who tweak discontinued insulin pumps to largely automate their diabetes management. — Nicholas Florko

Remarks at Health Ministerial Meeting in Lima, Peru in Response to Health Impacts of Forced Displacement in the Region | HHS.gov

Remarks at Health Ministerial Meeting in Lima, Peru in Response to Health Impacts of Forced Displacement in the Region | HHS.gov



Secretary Alex M. Azar II

Remarks at Health Ministerial Meeting in Lima, Peru in Response to Health Impacts of Forced Displacement in the Region

Alex M. Azar II
Peruvian Health Ministerial Meeting: “Strengthening Regional Coordination in Response to the Impacts of Forced Displacement”
 
"Today is one step in the long process of addressing the refugee and public health crisis caused by the Maduro regime, so I look forward to follow-up efforts. I personally commit to all of you that the United States government and my department will remain engaged on this crisis—I suspect, for some time." 
 
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NIST Links Federal Encryption Testing to International Standard for First Time  | NIST

NIST Links Federal Encryption Testing to International Standard for First Time  | NIST

NIST

NIST Links Federal Encryption Testing to International Standard for First Time 

Update to Federal Information Processing Standard aims to help companies get products to market faster.

April 30, 2019
Three white boxes representing the FIPS standard and related NIST pubs are gathered within a boundary, and an arrow points outside the boundary to another white box representing the ISO standard

Electronic device manufacturers should find it less time-consuming to bring their wares to both the U.S. and international markets as a result of new requirements issued by the National Institute of Standards and Technology (NIST), which has updated the Federal Information Processing Standard (FIPS) for testing the effectiveness of a device’s data encryption.

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FDA posts lists of product-specific guidances under development or revision to provide increased transparency and support complex generic drug product development and approval



The U.S. Food and Drug Administration (FDA) today launched a new web page, Upcoming Product-Specific Guidances for Complex Drug Product Development.

In January 2018, the U.S. Government Accountability Office (GAO) publicly released a report entitled “Generic Drugs: FDA Should Make Public Its Plans to Issue and Revise Guidance on Nonbiological Complex Drugs.” In preparing the report, GAO studied a number of issues related to the FDA’s assessment and approval of complex drug products. The report contained a single recommendation for the FDA – that the agency publicly announce its plans to issue or revise guidance for these drug products.

This new web page provides information about FDA’s plans for issuing new or revised product-specific guidances (PSGs) in the coming year for complex products as defined in the Generic Drug User Fee Amendments Reauthorization (GDUFA II) Commitment Letter.  The web page will be updated each time FDA issues a new quarterly PSG batch.  Each update removes the posted PSGs and adds additional PSGs under development or revision.  The information on this web page is anticipated to help generic drug companies better plan their development of complex generic drug products.

For more information on PSGs and the new web page, please visit: Product-Specific Guidances for Generic Drug Development.

RIC Resources for Culturally and Linguistically Competent Long-term Services and Supports (LTSS)

From Our Partners

RIC Resources for Culturally and Linguistically Competent Long-term Services and Supports (LTSS)

LTSS are a vital part of care for many dually eligible beneficiaries. LTSS include nursing facility services, adult day programs, home care, and personal care services. Individuals from minority groups often experience disparities in access, quality, and outcomes in LTSS. To help address these disparities, providers and plans may look for ways to meet the cultural and linguistic needs, values, and preferences of diverse individuals.
Resources for Integrated Care (RIC) invites you to explore the resources linked below that contain promising practices relevant to a wide variety of LTSS settings, and case studies demonstrating these practices in action.

This webinar describes strategies plans and providers can use to identify LTSS preferences, values, and needs of members from diverse cultural backgrounds. It addresses effective approaches for providing LTSS and training the LTSS workforce.
This webinar is also available as a set of podcasts on the SoundCloud page. A supplemental resource guide and Q&A document are also available.
This spotlight describes culturally competent LTSS programs at Keiro Northwest, including assisted living and skilled nursing facilities, and home care and adult day programs. It highlights how they incorporate architecture, décor, food, activities, and community connections to meet participants’ needs and preferences.
This resource compendium is intended for providers and health plans interested in enhancing capacity to provide and coordinate culturally competent LTSS. Resources include reports, guides, tools, and trainings applicable to a range of settings.
More than one million older adults self-identify as LGBT. Providers may not always know how to best support LGBT individuals in ways that meet their needs and preferences. This compendium offers resources to providers interested in enhancing their capacity to provide culturally competent LTSS for LGBT individuals.

Register for May 9 Webinar on Advanced APMs

Centers for Medicare & Medicaid Services
Quality Payment Program

Join CMS on May 9 for the Advanced APMs Webinar

CMS is hosting a webinar on Thursday, May 9 at 2:00 PM ET to provide an overview of Advanced Alternative Payment Models—one of the two tracks of the Quality Payment Program.
During the webinar, CMS subject matter experts will discuss:
  • Alternative Payment Models (APMs)
  • Criteria for Advanced APMs in 2019 (Year 3)
  • Qualifying APM Participant (QP) Status
  • Resources and Technical Assistance
Attendees will also have the opportunity to ask CMS subject matter experts questions at the end of the presentation.
Webinar Details
Title: Advanced APMs Webinar
Date: Thursday, May 9, 2019
Time: 2:00 – 3:00 p.m. ET
The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. CMS will open the phone line for the Q&A portion. If you cannot hear audio through your computer speakers, please contact CMSQualityTeam@ketchum.com.