February 15th, 2022
Excited to see Estrigenix Therapeutics is now a finalist in the Apis Health Angels pitch competition, competing for $200,000 in funding! Estrigenix is developing therapies to treat symptoms of menopause, including hot flashes and memory decline. The group started with 50 teams initially, and they are now one of 6 finalists – if you have time, please listen in here.
February 8th, 2022
Enjoyed testifying to a Senate subcommittee today on #purplesolutions to #healthcarereform – in particular, on the value of #directprimarycare. Below, and here, is some of what I shared.
Direct Primary Care (DPC) is healthcare received directly from physicians, without the intervention of insurance and without the bureaucracy found in our current system, which was referred to by the former President of the AMA (in my Purple Solutions book) as the medical industrial complex. DPC focuses on the patient-physician interface, delivering medical treatment the way it was many years ago – and how we remember in the idealistic vision and days of house calls. Physicians prefer this also, as they get to spend more time with patients. There’s a reason that 65% of physicians say burnout is a serious problem, due largely to this bureaucracy, and their suicide rate is the highest of any profession. The average patient load in a traditional practice is 2,000, whereas with DPC, a physician may manage 345 patients on average – thus permitting them to give each patient more attention.
For low cost, on average $70/month, patients can call or text their doctors 24/7, and get more in-person time and care with their doctor than is normally the case. So, for less than the cost of a single ER room visit ($1,500 in WI), you get a personal physician – and routine follow-up lab tests, prescriptions, and even imaging for typically nominal extra cost. This is more affordable, accessible and better care for over 90% of the problems people have. It is better for the doctor and better for the patient. The only ones to lose in all of this might be large hospitals and insurance companies who benefit from an opaque reimbursement-driven system that has led to unrelenting increases in healthcare costs in the US, now approaching 18% of GDP.
DPC is taking off across the country, and is going to provide a wonderful supplement to existing insurance-based care, including the ACA. But when payments for the ACA Bronze plan are so unafordable, with a $3,375 deductible in 2021, why not let average people get affordable care at far less than the cost of a copay with insurance – and then only use insurance for more expensive things. This approach was argued by author David Goldhill in his book Catastrophic Care.
According to the American Academy of Family Physicians, 29 states and counting have already adopted DPC legislation. These states have adopted DPC legislation to ensure doctors can continue to provide this care, and not be blocked by the insurance industry, if they are somehow characterized insurance, which DPC isn’t. This is a real fear, since the insurance industry may have much to gain by preventing DPC that delivers care more efficiently without insurance.
Unless you are opposed to providing more affordable, accessible and better care to average people, SB899 will pass – so our next priority for rxthinktank.org will be to explore how to make DPC more available to underserved populations.
January 18th, 2022
To a Happier 2022: A Rational View of Vaccines and Vaccine Mandates?
Don’t expect this from our politicians, or a polarized public that chooses sides as if in a Packers-Bears game, rather than engaging their brains, embracing logic, nuance and civil discourse.
When the AstraZeneca CEO and other pharma CEOs announced in early 2020 that we’d have a vaccine by year’s end, by parallel tracking development and accelerating the typically slow FDA regulatory approval process, (most) Democrats scoffed, threatening to not use the vaccine that was so rushed to approval, via Operation Warp Speed. Now that the vaccine is approved and proven effective, and we have a new party in power, memories of that skepticism and cynicism have been forgotten, just as (many) Republicans choose to support those that now oppose vaccination, or at least vaccine mandates. Interesting how politicians and their often blind followers switch sides and logic so easily.
The truth is, vaccines work, are highly effective, and I think people should get vaccinated. But, it is not at all clear that vaccination is any better than natural immunity, and in fact, the accepted dogma in science – supported by a large and recent study in Israel – is that natural immunity from infection by the natural pathogen is more effective than that from a synthetic mimic, a vaccine. So why pressure previously infected people, like tennis player Novak Djokovic or football player Aaron Rodgers, to get vaccinated? It makes no sense.
But, there are those who have not been infected who still refuse to be vaccinated because they worry about rare adverse effects, or the unknown long-term effects. I think they are wrong, and vaccine benefits far outweigh the potential risks (although perhaps not for children). That is what I think, but I do not know it to be true. No therapeutic or vaccine of this scale has ever been approved with such a short Phase 3 clinical trial to assess safety and efficacy. We know there are rare occurrences of vaccine-induced immune thrombotic thrombocytopenia (VITT) for the AstraZeneca and J&J DNA-based vaccines, and risks of myocarditis for the Moderna and Pfizer mRNA-based vaccines. Do we know what, if any, effects there are 2 or 3+ years down the road? Of course not. I think they will be minimal, but I don’t know that. Some pathologies, like lupus, are thought to be slow-onset autoimmune disorders involving anti-DNA antibodies. I have some experience with this, having developed a diagnostic test for such antibodies in lupus patients 20 years ago. The negatively charged DNA molecule is what also led to the rare thrombocytopenic events in vaccinated patients, due to production of autoimmune antibodies. Who is to say some similar autoimmune reaction could not happen with antibodies against DNA or similarly charged mRNA, leading to some pathology like lupus? I do not think it is likely, but I also do not know. My point is that we should not force people to get vaccinated when they are doing their own risk-benefit analysis, and deciding against vaccination because they fear currently unknown long-term effects. Inform them. Let them decide. It is the whole point of informed consent, thanks to the Nuremberg code.
When well-intentioned yet arrogant and condescending experts ignore and insult this logic, in a paternalistic “listen to me because I know better than you” approach, they actually decrease the likelihood of these vaccination holdouts of joining their team and embracing their logic. Civil and respectful discourse is the way to win people over; and, it is also how science (not politics, lately) works.
In the end, this dilemma may also have to do with two fundamentally different views of governance and social structure. Some want to elect smart competent people to tell them what to do; others want to elect smart competent people to tell them their options, then respect them enough to let them decide.
Another fundamental problem is the challenge of dealing with statistics, and the public’s general disdain of math. It is difficult for us to distinguish individual risk versus societal/public health risk. As a society, we don’t like math and logic! But, let’s give it a shot. The overall risk of death from Covid based on seroprevalence studies, the infection fatality rate, is 0.05%, or 1 in 2,000 for those under 70. Of course, it is much higher as you age: 1000-fold more fatal for an 80 vs. 5-year old. Infection fatality for someone in their 50s is around 0.2% (so, a 99.8% chance of not dying), roughly doubling in risk of death every 7 years after that. Still, those are large numbers when multiplied across our population of 330 million, so can easily overwhelm hospitals – especially since, short of death, severe illness still consumes hospital beds. Why then, when risk of death is 1 in 2,000, and much lower if you are vaccinated or young, was one mother living in such fear that she needed to lock her son in her car’s trunk to avoid her risk of getting infected? Why were Chicago teachers unwilling to go back to in-person teaching, when experts at NIH and CDC agree it is the best thing to do for children? Why in general, other than concern for scarce hospital beds (a valid concern), are we as individuals overly worried about getting infected with a much less lethal Omicron variant? Omicron is straining our hospital resources to be sure, so we must slow the spread, for public health reasons. But, thanks to its higher infectivity, it will run its course and it will infect and immunize most of us – including the remaining vaccination holdouts.
In 2022 we will likely reach a safe level of herd immunity (or endemicity), thanks to some remarkable vaccines and to an incredibly virulent and less lethal Covid-19 variant, Omicron. Let’s then let go of this paralyzing culture of fear, embracing of paternalistic autocracy, and squelching of respectful civil discourse. In other words, Happy New Year!
January 15th, 2022
To assist those of you interested in raising venture capital, I have started a video Podcast series raising venture capital, to learn valuable insights from prominent venture capitalists in the region. The first in that series is with John Neis at Venture Investors. Here is some of what we discussed (and you can view the first video here):
Raising venture capital (VC) in Wisconsin is a challenge, especially for capital-intensive startups in the complex and highly regulated healthcare sector. VI is the go-to VC firm in Wisconsin for healthcare startups, and really the only firm that has enough dry powder (available funds) to do the large $5-15 million Series A rounds that these companies need. John Neis, the name and face behind VI for almost 30 years, shares stories from VI and a bit of wisdom for entrepreneurs in healthcare. So, please take a listen!
By way of background, VI has been around 40 years ago, with first investments made in 1984. These included investments in iconic biotech companies like Promega Corporation . John joined in 1985, and helped make impressive investments in companies like like Third Wave in 1992, with Kevin Conway – who went on later to start Exact Sciences, another huge success. VI has grown beyond Madison, now with offices in Milwaukee and Ann Arbor. Half of their deals are University spinouts. Other successful investments included NimbleGen and NeuWave Medical, and even some Ophthalmology companies, one of which was sold for $800 million.
John shared some of what he looks for in investments, included a founding team with a proven track record. This mitigates one of the biggest risk factors in startups. Although, sometimes he said it is fine to have a talented scientist run the company in the early days, with a later hand off to an experienced CEO when it is time to scale or grow. He recommends surrounding yourself with great advisors and board members, and to be open to bringing in other talent to fill gaps as needed. A Series A funding round of $6-8 million is common for therapeutics, to get to an IND filing to get your drug into clinical trials, and then a larger Series B to do Phase 1 and 2 clinical trials. Encouraging news for startups is that 2/3rd of drugs moving forward in clinical trial started in venture-backed startups, so that is perhaps the end game of choice for healthcare startups – license/sell to pharma after Phase 2 trials, when you have a Phase 3 ready drug lead. Who can fund something like this in the Midwest? Large funds like ARCH Venture Partners in Chicago can do very large deals like this, to get therapeutic-based startups going – but besides VI, there is nobody else in Wisconsin. These fundings are typically done by a syndicate of at least 2-3 firms, so you still will need to go out of the region to complete the funding syndicate.
December 15th, 2021
Excited, honored, and humbled that Bridge to Cures won the Wisconsin Inno Blazer award in the nonprofit category! There are so many incredible nonprofits doing great things for Wisconsin’s entrepreneurial ecosystem, and we are blessed to work with and alongside them. Click here: https://www.bizjournals.com/milwaukee/inno/stories/awards/2021/12/15/2021-wisconsin-inno-fire-awards-blazer-winners
November 17th, 2021
Tired of the lack of civil and productive/respectful discussion about Covid and our Covid response in America? Should people ever be forced to be vaccinated? Is Aaron Rodgers being treated unfairly – and how do we balance public policy and individual liberties? Are minority voices in the scientific community with differing perspectives on unapproved medical treatments (e.g. Ivermectin) dangerous, or being unfairly blocked? Hear Dr. Jay Bhattacharya speak as part of our Liberty, Faith and Economic Summit. Jay, a Stanford physician and epidemiologist, is author of the Great Barrington Declaration and presents his views of a more targeted response to Covid, based on epidemiology. He also talks about the difficulty being a non-mainstream voice and the impact of cancel culture on civil discourse. Jay is a frequent guest on Fox News and CNN and author of multiple WSJ articles. Click here to watch: https://blog.cuw.edu/lfe-summit/
June 23rd, 2021
Excited to have landed the #2 spot in the Wisconsin Governor’s Business plan competition life sciences category, for Estrigenix Therapeutics, Inc. – the company I co-founded with colleagues Karyn Frick at University of Wisconsin-Milwaukee and William Donaldson at Marquette University. Although, the reason we won was because of the awesome pitch and business plan presented by my student Kylee Marks, as part of her Master of Product Development thesis project! What a great team – focused on addressing women’s health issues – initially on advancing our drug lead for treating hot flashes and dementia in menopausal women. Click here to learn more: https://govsbizplancontest.com/2021/06/04/estrigenix-bpc2021/