Leave it to a Nobel Laureate to out-quip the famously quippy Noubar Afeyan. It happened while Bob was in the middle of his (probably unnecessary) introductions of the three luminaries who had joined us Tuesday evening to lead a discussion about the future of the life sciences in New England: Flagship Ventures co-founder Afeyan, Harvard-Partners Center for Genetics and Genomics scientific director Raju Kucherlapati, and Phil Sharp, MIT Institute Professor and the aforementioned Nobel Laureate. Bob was reading the litany of companies that Kucherlapati helped found: Cell Genesys, Abgenix, Aveo Pharmaceuticals, and Millennium Pharmaceuticals—and mentioned the latter’s recent $8.8 million acquisition by Japanese pharma giant Takeda. Fingering the lapel of Kucherlapati’s charcoal-grey jacket, Sharp said, “You should have a better suit.”
And with that, the Biogen Idec and Alnylam co-founder set just the right tone for what we had always hoped would be an unusually informal, wide-ranging conversation among some of this area’s best thinkers and key players about what the next two decades hold in store for local life sciences industries. (Indeed, the “three” in the headline is misleading—you could hardly take a step in the airy cafe at Harvard Medical School’s Joseph B. Martin Conference Center without bumping into one of the scientists, doctors, entrepreneurs, investors, or executives who come together to make this area what Sharp called “the epicenter for life sciences and medicine in the world.”) These ninety-odd folks jumped right in with some great questions and challenges for Afeyan, Kucherlapati, and Sharp—and for one another. (And yes, Afeyan managed to fire off some classic one-liners.) As with any great conversation, it’s hard to do it justice in a recap, but some of the highlights for me were…
• Sharp and Kucherlapati each in turn describing what they see as a coming “third revolution” in healthcare—and those revolutions were not one and the same. Sharp’s envisioned revolution is “the integration of engineering into life science at the molecular level.” It’s an idea he has written about on Xconomy as well: “The promise of this third revolution is the rapid translation of new molecular and cellular knowledge into diagnosis and treatment through engineering approaches—and the more rapid advancement of cellular research through new nanoscale quantitative methods and measurements developed by engineers.” Kucherlapati’s third revolution, on the other hand, involves using all the genetic information gleaned in the last few decades “to make people better and improve healthcare.” Kucherlapati is particularly optimistic about the ability of such information to improve preventive medicine—eventually allowing doctors to determine at birth what diseases each of us are at risk for. “If I am susceptible to getting diabetes, the way I should be taken care of by physicians is very different than if I am susceptible to colon cancer,” he said.
• Afeyan’s brutal honesty about what he sees as the difficult economics of the industry. For example: “We invest in companies that discover, develop, and think about commercializing drugs and diagnostics and other tools. Twenty years from now the ones that don’t manage to die will just about be getting their first drugs approved by the FDA, and the ones that make devices will just about be getting profitable.” And later, in a discussion about the colliding forces of declining drug approvals, increasing healthcare costs, and increasing pressure to control those costs, he said: “My worry is it is going to take pandemics and massive increases in some disease in parts of the world for people to say, ‘It can’t all be this way, how we pay for treatment and fund research.’ I feel we are going to head for some form of crisis. That is how change usually happens—absent smooth change, the only alterative is a sudden transition.”
• Former Biogen Idec executive Burt Adelman’s argument in favor of studies that look at real clinical outcomes in patients, rather than relying on biomarkers or animal models. Picking up on Afeyan’s earlier mention of the fact that more than half the prescriptions written are for drugs that don’t work on the people they’re prescribed to, attendee Adelman said: “The evolution of third-party payers is clearly moving toward a greater sense of the value equation for products. The value equation suggests you really have to prove the drugs are clinically useful. In my mind the early significance of biomarkers is helping us dump products that don’t work. Identifying biomarkers that give us enough insight into the clinical relevance of a drug will allow us to not open the Phase III envelope.” Figuring out why a drug works in only 50 percent of patients, and who those patient are, Adelman continued, “will require a very fundamental change in how the medical industry and the pharma industry collaborate and do research. You will never figure it out if the experimental model has a furry tail and cute little ears—you will only figure that out if you study the patients who have the disease.”
• The recurring themes of the proliferation of scientific information and doctors’ and patients’ increasing access to that information. Sharp nicely encapsulated what seemed to be fairly prevalent ambivalence about these trends: “All across society the issue of managing the authority and value of information is rapidly changing. The whole structure of the scientific community in terms of peer review and control over who gets to publish where and what, and how it gets certified, is changing. The idea that selecting treatments is going to get democratized is something we’re going to struggle with for a while. I don’t know who’s got a model that controls that in the sense of being able to direct authority to particular places and benefits.”
• Afeyan’s informal poll of those assembled showing that if it were free today almost all of us would want our genomes sequenced—even in the absence of a medical system that knows (yet) what to do with the information.
• Kucherlapati’s suit. For the record, it was actually quite handsome.
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