The Daily Rise: Thursday, June 30

The Cancer Moonshot Summit

After months of anticipation, Vice President Joe Biden officially kicked off the Cancer Moonshot Summit Wednesday in Washington, D.C.

The moonshot is the Obama administration’s plan to invest $1 billion in research to fight the disease. As part of the national kickoff, the administration coordinated more than 270 events across the country with more than 350 researchers, oncologists and other care providers, data and technology experts, patients, families, and patient advocates taking part at the main event at Howard University.

Among the initiatives being launched:

  • Expediting Researchers’ Access to Cancer Compounds for Research– National Cancer Institute Drug Formulary
  • Making Clinical Research Trials More Accessible to Cancer Patients
  • Strategic Computing Partnership between the Department of Energy and the National Cancer Institute to Accelerate Precision Oncology
  • Creation of an Open Access Resource for Sharing Cancer Data via the Genomic Data Commons
  • Harnessing Big Data to Transform Veteran Health through Precision Medicine
  • Creation of a New Program to Accelerate Cancer Product Regulatory Review
  • Establishment of Fast-Track Review for Cancer Treatment-Related Patents
  • National Institute of Health (NIH) Public-Private Partnership for Accelerating Cancer Therapies

We’ve been somewhat reluctant to herald the “cancer moonshot” as the be-all, end-all to finding more effective treatments for patients with cancer. For starters, a billion dollars is a drop in the bucket when it comes to medical research. It’s less than the average cost for getting a treatment through the FDA approval process and into patients’ hands. Others, such as Margot Sanger-Katz, have questioned whether the moonshot metaphor is the wrong approach.

That’s why we were pleased to hear Biden’s promise to help get government out of the way. He seems to understand that the greatest potential for cures will come through the private sector.

“The impediment isn’t the lack of the gray matter genius [of cancer researchers] and the ingenuity in terms of new drugs and new treatments, et cetera; it’s all this stuff that gets in the way,” Biden said, according to CNN. “The only thing I’m good at in government is getting things out of the way.”

For more on the Cancer Moonshot, check out the White House’s background materials here.

Let’s Do Lunch

“Is your doctor willing to sell you out for the price of a sandwich?”

That’s the question being asked by Bloomberg View columnist Megan McArdle, who reviewed a new study published by JAMA Internal Medicine. The JAMA study found that doctors that receive a cheap lunch from pharmaceutical reps are more likely to prescribe brand-name medications than their cheaper alternatives.

Rather than jump to the conclusion that doctors are being bought off by drug companies, McArdle asks some legitimate questions about this study and its findings. She’s not questioning the validity of the study, but explores potential reasons for a correlation beyond pay-to-play deals.

“Let’s lay out an alternative story,” McArdle hypothesizes. “The prescription drugs are superior to the older or cheaper alternatives in some significant way — perhaps they’re more effective in certain subgroups of patients, perhaps they have a better dosing schedule, perhaps their side effects are more easily tolerated, or they have fewer nasty potential interactions with other drugs the doctors might be prescribing… If a pharma rep could sit down with these doctors and inform them about the benefits of their newer brand-name drug, these physicians would write a lot more prescriptions for it.”

The overwhelming majority of doctors prescribe treatments based on their belief that it’s the best option for that patient. It belies common sense to think that well-paid medical professionals are being bought off by a sandwich.

Even the author of the JAMA study considered this alternate explanation: “If events where industry-sponsored meals are provided affect prescribing by informing physicians about new evidence and clinical guidelines, then the receipt of sponsored meals may benefit patient care.”

ICER Watch: “My” Patients

Our latest installment of ICER Watch features a doctor’s perspective on how value frameworks undercut the doctor-patient relationship.

In a thoughtful piece published at The Hill, practicing pulmonologist Dr. Samuel Louie, Professor of Medicine at the University of California, Davis, says that most physicians are opposed to health insurers efforts to lower costs and reduce patients’ access to innovative treatments. The search for lower prices, Dr. Louie warns, means patient health suffers and breakthrough drugs go untapped.

“And physicians like me lose the ability to make crucial decisions about our patients’ care,” he writes. “No longer “my” patients, these men and women are more accurately under the care of the health insurers who dictate treatment options.”

Dr. Louie rightly identifies ICER as the third-party source that insurance companies will use to deny treatments. As a supposedly independent group, ICER can “effectively give insurers an artificial price point to justify limiting patient access.” And all of this means a decrease in patient health.

He concludes, “ICER, I fear, takes us dangerously to the brink, a tipping point none of us can afford. Artificial price points meant to bully the pharmaceutical industry will instead undermine patient health. Patients will discover that the medicine that is right for them, that they and their physicians choose, is out of reach.”

State Spotlight: California’s Marketplace for All

California could become the first state in the country to allow undocumented immigrants to participate in the state’s health insurance exchange.

Morning Consult reports that the state has applied for a waiver with the U.S. Department of Health and Human Services that would permit illegal immigrants to enroll in Covered California. That waiver request was the result of a new state law signed by Governor Jerry Brown earlier this month.

But, it won’t exactly be smooth sailing to receive HHS approval. Nine members of Congress from California are urging HHS to reject the state’s waiver request.

“This brazen attempt to circumvent the will of Congress adds insult to injury for the millions of Americans who have already been aggrieved and misled by the Patient Protection and Affordable Care Act (ACA),” GOP members wrote in the letter to HHS Secretary Sylvia Burwell and Treasury Secretary Jack Lew. “Additionally, California’s waiver request would raise costs to taxpayers and set an improper precedent for other states that could lead to full taxpayer-subsidized healthcare coverage for individuals who are illegally present in the United States.”

California Republicans that signed the letter opposing the waiver include: Darrell Issa, Tom McClintock, Ken Calvert, Dana Rohrabacher, Duncan Hunter, Doug LaMalfa, Paul Cook, Ed Royce, and Mimi Walters.

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