Preempting severe genetic disease
Around 2% of births come with a genetic disease, often with devastating impact. While some appear de novo (either from germplasm dominant mutations or from chromosoma…
Summary: Over the coming decades, Alzheimer’s disease threatens to become a huge drag on national well-being. To put things in perspective, by 2040, the US may be allocating more resources to the care…
“media attention [is] on lead identification, probably because it sells headlines” – Greg Meyers, Chief Digital and Technology Officer, BMS[1]
The biopharma industry is known for its high risk and po…
The new Humira?
It’s not that often that you see industry-sponsored head-to-head studies of one biologic vs. another, but Abbvie took the plunge comparing risankizumab (Skyrizi) to ustekinumab (Stela…
About the author: Phiona Nabagereka is currently a high school senior attending the Noble and Greenough School. She spent the summer of 2024 with Recon Strategy as a paid intern assigned a project to …
We refresh a prior analysis of two cohorts of oncology development programs: one with first-in-human (FIH) in 2012, and the other with FIH in 2017H2. We use a Kaplan-Meier approach to track whether pr…
The quest for solid tumor CAR-T
For all their success in hematological cancers, the track record of CAR-Ts against solid tumors has been disappointing (though see here for an exception). One key obsta…
What lessons can be drawn from Walmart’s precipitous shut down of its attempt to launch primary care, dental and behavioral health services? The Walmart Health management team (after some mid-stream …
A PDF version can be downloaded here.
One of the major aims of the proposed BIOSECURE ACT[1] is to reduce supply-chain risks for pharmaceuticals, by penalizing firms that contract with China-based “bi…
Hitting reset for the immune system
Every time I get into a new issue of the NEJM, I have a sense of anticipation as in “will this one have an article that blows my mind?” It doesn’t happen very often…
Summary
After challenging conditions in 2022, deal-driven biotech spending appears to have picked up in 2023. To quantify this trend we have systematically reviewed deals announced during this period …
A Chinese study uncovers a new use for an old drug
Bleeding in the small intestine is often due to vascular malformations and is difficult to diagnose and manage because 1) the area is hard to reach w…
PDF here
Summary
The idea of a single blood-test to detect many cancers is attractive, but is it practical? Can an MCED enhance, or even replace, current screening tests?
This paper delves into these …
How the US taxpayer saved 25M+ people
A short piece celebrating the 20th anniversary of PEPFAR, a program that few outside of the field of Global Health are aware of. The world is not always nasty and…
Preparing for the next pandemic: don’t waste the value of waste
During the Covid-19 pandemic, I got in the habit of checking weekly the Boston sewage report, as a reliable, unbiased way of monitoring …
What does Socrates have to do with AI? And what's the Spooky Mountain and why we need to conquer it to get to an AI enabled future?
https://www.youtube.com/watch?v=5V10R6lcIl4…
PDF: Trends and strategy in oncology development
Summary
We review a sample of oncology programs from the past decade and arrive at the following key findings:
The use of expansion cohorts in first-i…
Hypertension?!
Antihypertensive drugs are so 80s and 90s (well, except for pulmonary hypertension) to the point that I cannot recall when I last read research in the NEJM about a new blood pressure dr…
View the PDF here.
The supply chain of pharmaceuticals consumed in the US has become reliant on foreign sources of drug products and intermediates over the last two decades. Growth of generics and bio…
Download a PDF of this article here.
Hematologic cancers account for ~10% of annual new cancer diagnoses and continue to have some of the poorest overall outcomes, particularly for older adults.[1] Ho…
An unusual article on road safety
Motor vehicle accidents are a major share of morbidity and mortality in the young, and as such prevention has long been considered a medically adjacent area (e.g. wit…
A psychedelic for refractory depression
While major depression is awful, treatment-resistant depression (as defined not responding to at least two different courses of therapy) is worse with sufferers…
Back in 2018, I offered a speculation about what Amazon might do in healthcare as part of its now defunct joint venture with JPMorgan and Berkshire Hathaway. The focus was on doing what Amazon is re…
Is Parkinson’s α-synuclein going to be as elusive a target as β-amyloid has been for Alzheimer’s?
Alpha-synuclein aggregates are characteristic of Parkinson’s disease and genetic variants of this prot…
PDF: Trends in oncolytic virus therapeutics: then and now
The idea of using pathogens to treat disease is not new; ranging from phage therapy to malariotherapy (resulting in the only Nobel in medicine…
PDF: Are some of Kaiser’s regional ambitions starting to pay off?
We have produced a new study evaluating developments in Kaiser's regions (outside of California). The report provides an explanation f…
About the author: Alyssa Idusuyi is currently a high school senior attending Miss Porter's School (Connecticut). She spent the summer of 2022 with Recon Strategy as a paid intern assigned a project to…
Download a PDF of this article here.
Ex vivo gene-therapies have been a game-changer for aggressive hematologic cancers. These products can effectively cure patients who otherwise had very low chance …
After the $9.7B acquisition of The Medicines Company two and a half years ago, Novartis is eager to demonstrate value with a successful launch of the primary target of the deal, Leqvio. This launch is…
Tirzepatide in pole position
As previously described in this blog, GLP-1 agonists initially designed to treat glycemia in Type-2 diabetes are emerging as powerful weight loss agents in obesity indepen…
There isn’t a bricks-and-mortar primary care acquisition out there that is beyond Amazon’s financial reach. While the announcement regarding One Medical has provoked fresh rounds of speculation about…
Download Here: Troubleshooting GT_Recon Strategy 2022
In the last decade, gene therapies have been a major area of development and interest. What kicked off with the approval of Spark Therapeutics’ Lu…
A cell therapy success against a solid tumor
In CAR-T therapies, T-cells are transformed to express an antibody on their surface that allows them to home in on cancer cells and effect killing. This ap…
A step forward for kidney xenotransplantation
A report on the recent, well-publicized, temporary transplantation of kidneys from genetically modified pigs in two deceased individuals at NYU. The kidne…
The role of artificial intelligence (AI) and machine learning (ML) in healthcare spans a vast range of potential applications. A view of AI development on clinicaltrials.gov helps to focus this landsc…
The opioid crisis and patient abandonment
A perspective from a February issue that I originally missed highlighting the plight of patients who have been on a long-term opioid regimen for chronic pain.…
There’s a major disruption looming in how the site-of-care for infusions is managed which will have repercussions for plan competition, delivery system economics, PE hunting for healthcare opportunity…
Modern drug discovery is largely based on the identification and validation of a biochemical target, and then screening and optimizing molecules that engage that target. Over time, this has given rise…
Gene therapy in beta-thalassemia and sickle cell anemia
Beta-thalassemia and sickle cell anemia are common genetic diseases of hemoglobin (Hb) which manifest themselves in the former through transfusi…
In search of a diagnosis: deploying genomics at scale
A substantial number of children have a disease identified as “rare” without having any kind of causative diagnosis (autism is not a causative dia…
New molecular diagnostics, especially tests based on next-generation sequencing and gene-panels, could revolutionize how diseases are evaluated. But experience shows that insurers won’t cover these te…
Closed vs. open
Hospitals can compete for patient referrals either by exclusively affiliating with a subset of physicians (“closed model”) or by collaborating with as many qualified physicians as poss…
What is revenue cycle management?
Revenue cycle management (RCM) is the process of converting care delivery into cash. At its most comprehensive, services include:
patient intake (scheduling/registra…
UPMC’s decoupling from Highmark exposed a critical vulnerability: economic dependence on its Allegheny County hospitals. In FY11-12,[1] these hospitals provided 70% of UPMC’s overall operating margin,…
What makes an indication especially tough? The combination of a lack of understanding about the mechanism of disease and a lack of clarity on what endpoints would be sufficient for approval of a thera…
The weird world of synthetic biology
In biology 101, one learns about the alphabet that translates DNA/RNA code into amino acids sequences ultimately resulting in proteins. Given that there are 64 pos…
Cancer and mutational complexity
Probably the biggest news in cancer treatment this year is the approval of sotorasib (Lumkras, Amgen) which received accelerated approval in lung cancer with mutated K…
Iora Health was one of the original primary care transformers offering a clinically capable, engagement-focused, and accountability-grounded care model. After an initial foray into commercial, Iora p…
We identify four different business strategy rationales for hospital@home depending on each hospital’s specific market situation and each with clear predictive implications for local markets. These a…
Last week, WMT acquired MeMD, a virtual provider in Arizona. Per the press release, MeMD will “allow Walmart Health to provide access to virtual care across the nation including urgent, behavioral and…
Healthcare is by nature conservative; despite a huge level of interest for artificial intelligence (AI) and machine learning (ML) techniques, significant penetration in standard workflows of care will…
Remodeling to health?
Chronic disease progression is often due to a maladaptive tissue response which leads to remodeling – such as cardiac hypertrophy with hypertension. While most therapeutics focu…
A new approach to schizophrenia
Antipsychotic agents treat schizophrenia by manipulating the dopaminergic system. While they are effective at treating psychosis, they can have major side effects and t…
All that effort for only 0.4% savings
Since 2014, HUM has reported on the performance of primary care in value-based arrangements (“VBA”) vs. traditional contracts (“non-VBA”)[1] in Medicare Advantage…
We can cure Hep C but not immunize against it
Sovaldi and other drugs have made curing chronic Hepatitis C a routine, if expensive, proposition. Still, given how common Hep C infection is, and how it …
Eighteen months ago, WMT opened its first Walmart Health clinic attached to a supercenter in Dallas, GA. The operation combined multiple services – primary/urgent care, dentistry, behavioral health, …
Incremental progress in the fight to treat heart failure
After a decade or more of relative quiescence in the 2000s, a volley of new therapies have come to the forefront in the pages of the NEJM: sacu…
Cardiovascular health – go big or go narrow?
A follow up on the development of evinacumab (Regeneron), an inhibitor of ANGPLT3 (see this opinionated take from 2017), confirming the safety and LDL red…
Small but real progress in ALS:
Despite enormous public attention and significant effort, ALS remains a disease for which the development of new therapies has been challenging. Animal models showed po…
OptumCare’s acquisitions usually make headlines. But what happens when the reporters leave? How is clinical capacity managed? What role do micro-acquisitions, recruiting and retirements play in advan…
Summary:
We conducted a comparative analysis of the referral networks of orthopedic surgeons in King County (the area around Seattle, WA) and Miami-Dade County.
Similarities
Bigger systems are better…
PDF: An ADC renaissance: a resurgence of antibody drug conjugates for cancer
Summary:
Antibody-drug conjugates (ADCs) have seen a record number of approvals in 2020. This comes after a first era of i…
A cheap, low tech intervention for a common Achilles’ heel
When I am out and about, for instance at the grocery store, I am always surprised at the number of people I see with swollen legs. About half…
Stunting and the microbiome
Stunting (low growth for age) affects > 20% of children across the globe and has major impact on the brain, on health, and on opportunities for success in life. The prec…
What’s your blood type?
The first report of a genome wide association study of Covid-19 severity on approximately 4000 patients and controls conducted in Spain and Italy identifies a locus on the 3rd…
COVID-19 has accelerated the adoption of AI in healthcare. AI based tools and solutions can work quickly, be deployed at scale, and respond to the dynamic nature of the crisis. Use-cases span all face…
Remdesivir works… but not enough to change the public health perspective
The eagerly awaited results of the remdesivir NIH trial are out, and it’s solid but not smashing, although this is a partial re…
Summary
NaviHealth is a leader in post-acute care management; since it manages but does not provide care, its impact is constrained by quality of available providers
By aligning with Optum clinical a…
Among Covid’s many repercussions, the recession shock will drive a sustained degradation of provider payer mix. I estimate that each 5% added to unemployment will incrementally reduce hospital[1] ope…
Health Affairs has put out another study – this one by Skopec and team (subscription access) - comparing post-acute care (PAC) among Medicare Advantage (MA) vs. traditional Medicare (FFS). And, once a…
Hydroxychloroquine does not seem to help much in Covid-19 (with caveat)
There has been significant attention to the use of the antimalarial hydroxychloroquine in Covid-19, but data on impact has been …
Preamble
A recent post from Recon Strategy outlined the longer-term strategic implications of Covid-19 on 12 healthcare sectors. This post highlights the opportunity to redeploy corporate strategy ass…
Even as our priority today is dealing with the Covid crisis, healthcare organizations would do well to start thinking about the longer-term implications for their strategies. In some instances the mar…
A first Covid-19 interventional study – unfortunately negative
The first of what promises to be a series of many interventional studies for acute Covid-19 disease to appear in the Journal. Lopinavir i…
Keeping up with COVID-19
It’s not easy for a refereed weekly print periodical to keep up with an epidemic that evolves on a daily basis, but the NEJM is doing its best and all articles are free on-lin…
The loneliness of the patent-less drug
Colchicine is a very old drug commonly used in gout with an anti-inflammatory mechanism of action that is not well defined. It is a generic (although in the US, …
A triumph for cystic fibrosis patients (and for Vertex)
Phase 3 confirmation that the benefits seen in early trials from triple-combination therapy of elexacaftor, tezacaftor, and ivacaftor, are susta…
Genomic applications and scalability
Two very different papers about applications of genomics, one for a very common clinical scenario, the other for an ultra-rare disease.
It is well known that while…
Best care vs. good care
In wealthy countries, the recommended standard of care can often lead to complex medication regimens requiring frequent follow-ups: this can be very challenging for people who …
Last month, Warburg Pincus closed on previously announced plans to acquire a major multi-specialty practice in northern New Jersey (Summit) and combine it with an urgent care network centered in the N…
Is the lack of new (non-viral) antibiotics a market failure?
A lament about the lack of success in getting the biopharma industry to invest sustainably in the development of new antibiotics against h…
MSFT’s pathbreaking alliances in healthcare services are impressive and well designed to grow adoption of their Azure cloud over the medium term. But if MSFT wants to be at the forefront of change an…
Huntington’s disease: light at the end of the tunnel?
The awful thing about Huntington’s is that in most cases, people know they are going progressively lose their mind at an early age, but there is …
A clinical vignette: the cases of Jane and Joe
Imagine if you will two individuals both at age 50. Jane is a project manager whose recent health care has focused on managing menopausal symptoms, a kn…
Summary
The Capital Region of Pennsylvania is shifting in “real time” from traditionally separate plan vs. plan competition and provider vs. provider competition to integrated vertical plan/provider …
TAVR for all?
TAVR has become the standard of care for patients who need an aortic value replacement but are at high/medium surgical risk. But what about those at low-risk? Two studies answer that qu…
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