First Opinion is STAT’s platform for attention-grabbing, illuminating, and provocative articles concerning the life sciences writ giant, written by biotech insiders, well being care employees, researchers, and others.
To encourage sturdy, good-faith dialogue about points raised in First Opinion essays, STAT publishes chosen Letters to the Editor obtained in response to them. You’ll be able to submit a Letter to the Editor right here, or discover the submission kind on the finish of any First Opinion essay.
The story
“Beware elected leaders who would weaken patents,” by Daniel M. Skovronsky
The response
Daniel Skovronsky’s protection of the present patent system overlooks its basic flaws — mainly, the way it disproportionately rewards medication with restricted scientific influence, like Lilly’s donanemab for Alzheimer’s, whereas sidelining low-cost options. Repurposed generics, nutraceuticals, biosimilars, and nonpharmaceutical choices, like dietary and way of life interventions, provide far larger potential for enhancing well being at a fraction of the fee. But our present “blockbuster drug” mannequin below the patent system fails to incentivize these improvements. Patents can yield monumental multi-billion-dollar monetary rewards relative to restricted well being advantages (e.g., in quality-adjusted life years gained).
Nevertheless, as an alternative of merely weakening patent protections, we should always discover revolutionary payer reimbursement fashions that fund R&D for inexpensive therapies utilizing the fee financial savings they generate. This method allows payers to de-risk improvement for cost-effective therapies with out monetary threat, making a sustainable mannequin for medical innovation. For instance, self-funding interventional pharmacoeconomic (IVPE) trials can determine inexpensive options to high-cost therapies, the place the fee financial savings of payers throughout the trial exceed its value, successfully eliminating the monetary threat.
Moreover, mechanisms like advance market commitments (AMCs) and outcomes-based contracts can reward data-driven approaches and algorithms for personalised, low-cost therapies — shifting focus from maximizing drug earnings to maximizing well being. Such a shift would promote value-driven, inexpensive improvements, tackling the unsustainable prices threatening well being care techniques — particularly within the face of an growing old inhabitants. Leveraging applied sciences like AI, which might determine low-cost therapies by way of evaluation of medical data and scientific literature, would additional increase the well being influence of this novel method.
— Savva Kerdemelidis, Public Good Pharma
The story
“It’s time for a brand new medical specialty in asynchronous care,” by Muthu Alagappan, Rishi Khakhkhar, and Ben Kornitzer
The response
I really feel it is a nice possibility in main care drugs — however with guardrails. Major care suppliers are overwhelmed, and affected person portal questions solely add to the burden. Identical to pressing care facilities, asynchronous drugs for affected person queries might be nice, or a catastrophe.
One possibility can be for the affected person’s main care follow to have the choice to reply a question inside 24 hours, with separate reimbursement going on to the responding doc. That method, if attainable, the PCP might be looped in and affected person care can be optimized. If nobody from the PCP group is accessible, the work might be farmed out to a different vetted doc or group in the identical specialty, once more, with separate and assured reimbursement, with a duplicate of stated recommendation going to the PCP. Outsourced recommendation might be evaluated for accuracy and helpfulness to guarantee high quality. It’s time for insurers to pay for separate doctor factors of contact with out counting on main care docs to work free of charge.
— Marc Grella, Massachusetts Basic Hospital
The story
“Beware hospital consolidation,” by Laura and John Arnold
The response
The authors get it proper — hospital consolidation of impartial group practices is unhealthy information for physicians and sufferers. The present unlevel enjoying area is driving physicians out of personal follow and into hospitals, the place they’re usually compelled to make selections which might be finest for the underside line, not the affected person. Whereas physicians report a lack of autonomy when their practices are acquired, the implications of consolidation even have a significant influence on physicians who select to stay impartial.
For instance, I used to be shocked when an area hospital revoked my inpatient oncology privileges after my follow refused a merger with their well being system. Just because I most well-liked to stay locally setting, I immediately discovered myself unable to look after my sufferers who had been hospitalized. Consequently, I’m now compelled at hand them off to unfamiliar hospital-affiliated suppliers at a time when sufferers want an oncologist who has gotten to know them and their situation.
To verify impartial practices can keep not solely operational however aggressive, we’d like site-neutral cost reform — like that proposed within the Decrease Prices, Extra Transparency Act — that closes the yawning hole between doctor and hospital funds. Doing so would scale back the inducement for hospitals to gobble up doctor practices and provides sufferers extra energy to decide on impartial care.
— Moshe Chasky, M.D., Alliance Most cancers Specialists
