Conference Presentation, Panel
The Promise of Public Health
Milken InstituteMike Klowden, Richard Besser, Nancy Brown, Thomas Farley, Joseph Jimenez, Fred Upton
- Event Scope: The Milken Institute's inaugural Public Health Summit aims to elevate disease prevention to equal strategic importance with medical cures for funders and policymakers.
- Key Upcoming Sessions: A special lunch update on the Zika crisis will be provided by CDC Director Tom Frieden; a dinner event featuring Congressman Upton, Minority Leader Pelosi, NIH Director Francis Collins, and FDA Commissioner Robert Califf is full, though no-show seats may be available.
- Panel Composition: The opening plenary features a diverse group: Novartis CEO Joe Jimenez, American Heart Association (AHA) CEO Nancy Brown, House Energy and Commerce Chair Rep. Fred Upton, and New York City/Philadelphia Health Commissioner Tom Farley.
- Demographic Shifts: Novartis projects a global population increase of one billion over the next decade, with 500 million aged 55+, predicting a surge in chronic diseases requiring advanced technological intervention.
- Public Health Definition: Consensus defines public health as the societal effort to coalesce resources to create environments where populations can thrive, rather than merely treating individual diagnoses.
- Behavioral Policy Success (Smoking): NYC smoking rates dropped from 21.5% to 14% via tax hikes, smoke-free mandates, and counter-advertising, resulting in 400,000 fewer smokers and tens of thousands of lives saved.
- Regulatory Disagreement (Menu Labeling): Rep. Upton argues current FDA menu labeling requirements for complex food items (e.g., pizza toppings, ice cream combinations) are impractical overreach, advocating for streamlined, bipartisan legislation.
- Regulatory Support (Sodium): The AHA supports stricter sodium regulation, noting the average American consumes 3,300 mg daily (exceeding safety limits), driving high blood pressure rates in over 75% of the population.
- Big Data Utilization: NYC Health Department now utilizes anonymous electronic health record data from 3 million patients to monitor real-time metrics like BMI, shifting from five-year lag times to quarterly impact assessments.
- Novartis Business Model Shift: Novartis is transitioning from transactional sales to "conditional reimbursement," where compensation is tied to clinical outcomes, such as the heart failure drug Entresto reducing hospitalizations by 20%.
- Remote Monitoring: Industry partners are developing Bluetooth-enabled scales and blood pressure cuffs to detect early signs of deterioration (e.g., water retention in heart failure), enabling preemptive intervention to prevent hospitalization.
- Data Limitation Warning: Commissioner Farley cautions that early disease detection via technology does not guarantee behavior change, as many patients lack the socioeconomic resources to modify diet or exercise habits.
- Medicare Reimbursement Reform: The Sustainable Growth Rate (SGR) legislation passed with 386 House and 91 Senate votes shifts Medicare provider reimbursement from volume-based to outcome-based metrics.
- Drug Pricing Strategy: Novartis argues high initial drug prices (e.g., Gleevec at $92,000/year) are necessary to recoup R&D investments during exclusivity periods, citing the eventual availability of penn-a-day generics post-patent.
- Venture Capital Trends: Rep. Upton reports a 50% drop in US venture capital investment for biotech over recent years due to return expectations, a trend the "21st Century Cures Act" aims to reverse.
- Legislative Goals (21st Century Cures Act): The bill seeks to accelerate drug/device approval, allow for drug repurposing to treat rare diseases (95% of which currently lack cures), and inject $10 billion into the NIH Innovation Fund over five years.
- Antibiotic Resistance Crisis: Industry faces a broken business model for antibiotics due to low returns and stewardship requirements (limited use), prompting calls for government incentives similar to the Orphan Drugs Act.
- Global Health Request: Commissioner Farley emphasizes the urgent need for R&D investment in Tuberculosis drugs, which are decades outdated despite being a major global mortality driver.
- Prevention vs. Treatment Funding: Rep. Upton notes that while the "Cures Act" focuses on treatment speed, prevention funding remains lower, citing the "Million Hearts" initiative as a model for population-level hypertension management.
- US Health Outliers: US infants are 2.5 times more likely to die in their first year compared to Japan or Finland, and overall life expectancy lags behind peer nations, highlighting a critical policy gap.
- Future Outlook: Panelists predict a public health renaissance driven by the convergence of genomics, big data, and behavioral interventions to address chronic disease on a population scale.