First in Class Diabetes Drug

I spent two years in the Diabetes Market- Type 2 and I can honestly say it opened my eyes to just how large the diabetes epidemic is today in America. Despite the long list of oral agents from the six different classes, there is no cure or side effect free agent, so there is room for new alternatives in pharma world.  Last week, the FDA approved a new glucose-lowering agent, canagliflozin.  It will be marketed as Invokana by Janssen Pharmaceuticals for the treatment of adult type 2 diabetes in the U.S.

Canagliflozin is the first in a new class of drug, an oral inhibitor of sodium glucose contransporter 2 that reduces the absorption of glucose in the kidney resulting in increased glucose secretion.
*English translation: It will lower sugar levels and aid in weight loss. 
The article doesn't cite the clinical studies, so it's hard to say how significant weight loss or glucose drops will be, but from a safety perspective there is no risk of hypoglycemia, which is a major selling point in the diabetes market space 

Dapafliglozin, which was approved and has been marketed in Europe for over two years now, did not receive FDA approval last year in the U.S. due to a cancer signal, or I would most likely be marketing it today. Canagliflozin does not appear to share that risk, hence its early US approval.  There are several other in class agents waiting for approval, so it will be interesting to see how successful Canafliglozin will be in it's launch mode while they have no direct competition. Let the games begin!

To read more:
First in Class Diabetes Drug

Linking risk factors to Alzheimer's Disease

The Framingham risk score was developed and has been used for years to measure cardiovascular risk factors. It factors in age, lifestyle, and health conditions like hypertension or high cholesterol levels to determine whether a patient is at risk for a cardiovascular event, such as a stroke, heart attack or myocardial infarction. 

The article suggests that two Framingham risk scores are a strong assessment for dementia and cognitive decline. The study, which was published in the Journal of Neurology, compared different elements of the Framingham score system and found that stroke score was strongly associated with 10 year cognitive decline.  If doctors start to use Framingham to identify a cognitive decline score in patients, they may be able to help patients modify lifestyle to eliminate certain risk factors of dementia. 

I think this link will be extremely beneficial to physicians and ultimately their patients.  Since doctors typically utilize the Framingham in a younger patient population when evaluating a patient's cardiovascular health, if they start to recognize deterioration in cognition in these patients and let their patients know that their brain may be at risk too, we are one step closer to closing the gap on dementia and Alzheimer's disease.



To read more about this study, please see link below.
Framingham Risk for Alzheimer's Assessment?

Primary Care Shortage

As more and more medical schools emerge, several are putting a major emphasis on primary care and for good reason.  The article discusses Quinnipiac in Connecticut and the University of California and their goal to double the amount of graduating physicians who choose to practice in primary care setting.  

JAMA published a study in December that found only 21% of third-year residents planned to enter primary care.  That is not nearly enough! There is a major shortage of primary care physicians across the United States.  Considering the Pros/Cons, it is pretty obvious why it is not the most coveted position. They work nonstop, from the office, to hospital rounds, to nursing home visits and typically are underpaid for their services.  On top of this they deal with boatloads of paperwork and kickback from insurance companies.  Sounds like fun right?



Primary care physicians of the future will more often work in multidisciplinary team settings and need to develop management and collaborative skills in addition to receiving and MD or DO. Some schools are even alluding to incentives such as scholarships and tuition reimbursement for those who do pursue primary care.

To read more at medscape: New Med Schools Aimed at Primary Care

Guided Missiles: Drug Conjugates

Drug Conjugates. A new tool for delivering medicines to microscopic targets in the body.  There are two currently being used in cancer treatments, but many more are in the works with drug makers. The article explains it best by stating, "they couple two therapies, and basically work like guided missiles. A toxic warhead is strapped to a missile that homes in on and drops its payload on a specific tumor. Such pinpoint aim has been an important goal for decades, because it could maximize a drug's impact while limiting side effects, such as the hair loss that accompanies chemotherapy's indiscriminate march through the body."

This is a huge breakthrough and could potentially be the next big breakthrough pharma and biotech has been looking for. Several heavyweights like Amgen, Pfizer, and Novartis have drug-conjugate treatments in testing for pancreative, kidney, and other cancers.  Merck is working with Endocyte on a drug-conjugate for ovarian cancer that uses a very small molecule, unlike what has been established so far.

The goal of this is to give oncologists and patients a better shot at fighting cancer.  The approach is to target the specific tumor cells rather than hitting healthy cells as well. This is easier said than done and research dates back to the mid-seventies.

To read more, check out Drug Conjugates

Being Fat in the Workplace

The WSJ released an article today, "When Your Boss Makes you Pay for Being Fat."  The story depicts one example from Michelin North America Inc., but with rising healthcare costs and poor results seen from voluntary company health programs, starting next year we could see a great shift in company health benefits.  Michelin is requiring employees to share their personal health information, which includes BMI, blood pressure, blood-sugar level, and cholesterol.  If employees do not wish to participate  they may face higher premiums or deductibles. 

 Because the cost of healthcare to employers is so dependent on the employees the insure, I completely understand why companies are looking for new ways to motivate their employees to adapt a healthier lifestyle. Studies have shown that people respond more so to potential losses or penalties than they do to expected gains or rewards, meaning it is actually better to ignite a bit of "tough love."  The article states that corporate spending on healthcare is expected to reach about $12,136 per employees this year, which is a big chunk of change.

Employee reward programs will shift sharing additional incentives for employees dedicated to improving their health to a none negotiable.  Some companies would motivate employees with deductibles, like the list below. According to chief medical officer for national accounts at Cigna, companies tie between 5% and 10% of employee premium costs to incentives, which will likely increase in the next few years.

Health Costs

How your shape can weigh on your wallet.

$652

Additional amount that General Electric employees who self-identify as smokers must pay for health care each year.

$1,000

Penalty that Honeywell is adding for workers who get certain types of surgery without seeking more input.

$600

Annual penalty CVS employees must pay if they fail to report their weight, body fat and cholesterol levels to the company's benefits firm.

$100

Monthly penalty that Mohawk Industries charges employees who don't participate in a health-risk assessment.

$1,000

Maximum additional amount Michelin employees with high blood pressure or large waistlines could pay for health care.

Check out article here:

Health Care Costs