Got Cancer? Sorry, There’s No App for That

1/10/13

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investing more money trying to create the medical miracles we’ll wish for when our personal forecast reads mostly cloudy with a chance of death? Fighting disease isn’t just a good investment in our health; it’s also an excellent investment in our economy. Cancer, for example, has a major impact on the American financial system. A recent study showed that some 3.3 million workers are diagnosed with cancer each year, which results in some $7.5 billion in lost productivity.

So how do we incentivize the marketplace to invest more in drug development? As with many aspects of our national fabric, your answer may reflect your political inclinations. Conservatives will look to private industry for answers, while liberals may turn to a government-sponsored solution. Independents might seek salvation in both camps, and libertarians would argue that there’s no need to incentivize anything in a free market. Let’s compare and contrast some different approaches that might serve to increase the number of valuable medicines to see where we stand.

Let’s start with the conservative angle. In our free enterprise system, people with significant financial resources seek out opportunities ordained by the Holy Trinity of capital investment: High yields, rapid returns, and low risk. Investing in early stage biopharmaceuticals is clearly a very risky business. Although it can produce substantial monetary returns (because drug patents lead to monopoly pricing), it is exceedingly difficult to come up with novel drugs that are both demonstrably safe and effective. Only about 8 percent of drugs that enter clinical trials actually wind up being approved by the FDA and marketed. Getting a “rapid return” on invested funds in this sector generally requires an acquisition or IPO event, and IPOs have been tough to come by in recent years. Maybe traditional venture capital funding, as it currently stands, is not the best vehicle for assuring the development of a steady stream of new medicines.

Other private sector options abound. Big Pharma has been investing in a variety of approaches focused on resuscitating their waning fortunes. These include funding their own investment arms as well as establishing a large number of alliances with academic research institutions. They’ve also joined forces recently to form TransCelerate Biopharma, a non-profit organization whose mission is to develop innovative solutions to clinical trial problems faced by all of their members companies. New approaches to tackling dreaded diseases are not just the realm of drug manufacturers. The University of Texas’s MD Anderson Cancer Center estimates that its Moon Shots program to reduce cancer deaths may cost upwards of $3 billion in the first 10 years. Those funds will come from “institutional earnings, philanthropy, competitive research grants and commercialization of new discoveries.” Non-profit charities and disease organizations also remain a force in the voluntary sector, including the Michael J. Fox Foundation for Parkinson’s Research and the Cystic Fibrosis Foundation (who helped pave the way for the new breakthrough CF drug ivacaftor [Kalydeco] in partnership with Vertex Pharmaceuticals).

Let’s turn to the government side of the equation. Federal funding comes from agencies such as the National Institutes of Health, the Defense Advanced Research Projects Agency, and Small Business Innovation Research grants. Most of the money that the federal government spends in this area has traditionally been focused on basic, not applied research, but an increased emphasis is now being placed on translational research programs. Make no mistake: this has been money well spent, for the data generated by the thousands of research grants funded year after year forms the solid foundation upon which most of the applied work that follows has been built. State agencies, such as the California Institute for Regenerative Medicine and the Cancer Prevention and Research Institute of Texas (currently mired in serious charges of political cronyism) have committed billions of dollars to both basic research as well as translational medicine. Traditionally, however, the government has not been the key player in drug development, which resides in the skilled hands of pharma and biotech companies.

John W. Gardner once wrote “The society which scorns excellence in plumbing as a humble activity and tolerates shoddiness in philosophy because it is an exalted activity will have neither good plumbing nor good philosophy: neither its pipes nor its theories will hold water.”

Let me recast this in the light of my current theme:

The society which scorns investing in drug development (because it is both costly and risky) at the expense of investments in mobile phone and social media applications will produce few novel and helpful medicines: its citizens, however, may be too distracted by their electronics to care.”

So how do we go about incentivizing investments in drug discovery? I’ve suggested a few possibilities in the past, including legislation that provides special tax breaks for long-term biopharma investments as well as government funded cash prizes for cures. Others have suggested selling Biomedical Research Bonds to the public as a way of raising funds. Both the public and private sectors need to be involved in this process. With healthcare taking up an increasingly large portion of the nation’s GDP and contributing to our ever-increasing deficit, the government cannot afford to bear this burden alone. I believe a healthy dialogue between all of the interested parties, especially patient advocacy groups, is likely to come up with a wide spectrum of interesting and actionable proposals. Feel free to share an idea in the comments section below.

Stewart Lyman is Owner and Manager of Lyman BioPharma Consulting LLC in Seattle. He provides strategic advice to clients on their research programs, collaboration management issues, as well as preclinical data reviews. Follow @

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  • David Doherty

    Hi Stewart,

    Thanks for sharing this interesting point of view.

    “in 2004, U.S. businesses spent around $250 billion on software development, far greater than the approximately $100 billion spent on all biomedical research”

    Could you imagine if you could somehow leverage the opportunity we now have because of the billions being spent (or in your view wasted!) on software development for the benefit of citizens?

    I see this already happening all over the world and think it’s only going to increase. Here are a few good examples:

    The 1 million + Kaiser Permanente patients that can now communicate with their carers, access their lab results, etc, via a secure mobile website.

    The low cost mobile connected smoke alarm or the care monitor in my neighbours home (she is blind and wishes to continue living alone/independently)

    The pedometer app that runs natively on the Raku Raku mobiles of millions of senior citizens in Japan (it works like a fitbit and motivates you to exercise!).

  • http://twitter.com/brianreid Brian Reid

    Stewart –

    While you’re absolutely right that the industry needs to keep the VC spigot going if we want tomorrow’s great biopharma technologies to actually arrive, I feel compelled to defend the over-caffeinated coders, because they’re going to play a major role in changing health care for the better. Some of the most interesting stuff I saw this week at J.P. Morgan was coming from computer programmers, and it went a good deal further than Farmville or compliance apps.

    One company I talked to is working on a game that will allow patients to improve — and neuroscientists to monitor — cognitive function, which has the potential for better patient outcomes in an increasingly abandoned therapeutic category. Another seeks to reshape the economics of rehabilitation by using Kinect-style video capture to provide real-time, remote physical therapy that has the promise to get more people more healthy — more quickly and more cost-effectively — after hospitalization.

    No, it’s not a cure for cancer, but it’s progress toward better, smarter and cheaper health care. And that’s something worth throwing dollars at.

    — Brian

  • Stewart Lyman

    Brian and David, Thanks for you for taking the time to comment. Let me reiterate that I have nothing against coders or software development; they do good work and make very valuable contributions to society. The examples you brought up are good ones to illustrate the point I was trying to make. In terms of enhanced communication via apps, I now can access my “medical records” via the Internet. Unfortunately, the system that was set up (1) doesn’t allow access to my actual test results, only what my doctor had to say about them e.g. “looks good” and (2) there is also no way to contact my doctor: no email replies allowed. This system is nearly useless to me as the end user. It provides very limited information and only one-way communication. An old-fashioned phone call from my doctor would work much better for me. I’m
    sure others have better products for staying in touch with their doctors, but
    the one I have is pretty bad. However, it will allow my insurance provider to
    advertise that you can access your medical records 24/7.

    I have seen a presentation several times from one of the
    companies (I think there are several) working on developing a Kinect-enhanced approach to physical therapy. I had serious concerns about both the basic business model as well as the lack of IP, but most of all, was dismayed to see no data to support the idea that PT patients who use this device get well faster than patients with similar problems who didn’t use it (maybe they have that data now?). It is a cool idea, and it may be more fun for the user, but at the end of the day, people needing PT can get better without this product and have been doing so for years. Let’s contrast this to folks who show up in their doctor’s office with a diagnosis of ovarian cancer or amyotrophic lateral sclerosis (ALS). They are in serious need of a new drug and without it they are going to die. They will not get better without one. To put this in business terms, I see a new drug for a cancer patient as “mission critical”, whereas the software products mentioned above are more in the “nice to have” category. This is why I am suggesting that maybe we need different mechanisms (for reasons stated in the article) to fund research and product development for drugs vs. software products.

  • sam

    It’s arguable whether pouring more money into biomedical research is the right way to approach tackling issues in cancer, etc., given the # of marginally more effective and copycat drugs out there. In fact, without slashing the $1 billion+ development cost per drug, you’re just pouring money down the sink.

    A two-pronged approach, one for incurable diseases like ALS and cancer, and another relying on health IT and behavior changes for obesity and lifestyle diseases makes sense. But both seem necessary.