Mar 25, 2019

Axios Vitals

Good morning ... I've got almost 900 words for you here today, and none of them are "Robert" or "Mueller." Consider this your shelter from the storm.

Did somebody forward you this newsletter? You can sign up for yourself here.

1 big thing: The grim outlook for Alzheimer's

Illustration: Aïda Amer/Axios

Last week's failure of yet another Alzheimer's drug was just the latest setback in a field that has seen more than its fair share.

  • Differing estimates place the number of failed Alzheimer's drugs somewhere between 150 and 300. And there's not much cause for hope in the pipeline.

What they're saying: "I admit to you, we are getting pretty desperate," Samuel Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center, told Bloomberg after Biogen and Eisai pulled the plug on a once-promising drug that, in the end, did not appear to be working.

Between the lines: Most Alzheimer’s research to date has focused on a protein called beta amyloid, which forms large plaques on Alzheimer's patients' brains. Broadly speaking, the theory was that those plaques cause Alzheimer's, and that an effective treatment would break them up.

  • But with each new failure, more and more scientists are second-guessing that theory. The Biogen failure seems like a tipping point.

What's next: Research into other theories is happening, but most of it still in the earliest stages. And there is no broad agreement about where to go next — no consensus about what will work, only a growing consensus about what won't.

  • Some biotech companies are targeting brain inflammation; others, genetic mutations tied to the brain’s immune system, according to a Wall Street Journal roundup. Another theory is focused on a possible role for infectious agents. A different brain protein, called tau, has also gotten a lot of attention.

The bottom line: Scientists learn from failure; some of these aborted trials are still a form of progress. But as researchers head back to the drawing board to try to figure out how Alzheimer's works, we're likely a very long way from an effective treatment.

Go deeper

2. Eli Lilly says its insulin is getting cheaper

Eli Lilly says it's not making as much money off high-priced insulin as you might think, per the Wall Street Journal.

By the numbers: The list price for Humalog, Lilly's insulin, has risen 52% since 2014. It now stands at $594 per month.

  • But, in newly released figures, Lilly says most of that increase in list prices has been funneled into pharmacy benefit managers' rebates, not its own bottom line.
  • The net price for a month of Humalog — the price after accounting for rebates and discounts — has fallen slightly over the same period. It was $147 in 2014, and is now $135.

Yes, but: This will be cold comfort to the uninsured and people with high deductibles, for whom rising list prices matter a great deal, especially for a drug people depend on to stay alive.

Go deeper: The outrage over insulin prices

3. China's big biotech investments

China is gunning for the U.S.' position as the world leader in biotech, according to a new report by the Information Technology and Innovation Foundation.

Details: The Chinese government has set up more than 110 bioscience research parks, including one in Shanghai referred to as "Pharma Valley." The Ministry of Science and Technology plans to build up to 20 more parks by 2020.

  • Drug companies are eligible for incentives including free or subsidized lab and manufacturing space and a 15-point reduction in corporate income taxes.
  • More than 1,000 government-funded venture capital firms will provide as much as $800 billion in capital.

The Chinese are investing in specific therapeutic areas, including genomics. Chinese researchers are writing an increasing share of the world's academic papers on genomics.

Go deeper: China wants its own pharma industry

4. Where "Medicare for All" gets a shrug

Photo: Alex Wong/Getty Images

As much as it can feel like the defining issue in a political season that's already in hyperdrive, "Medicare for All" isn't actually breaking through everywhere.

Axios' Alexi McCammond recently had the chance to sit in on a focus group of swing voters in Wisconsin — people who had either voted for Barack Obama and Donald Trump, or Mitt Romney and Hillary Clinton.

  • Half of the voters in that focus group had never heard the phrase "Medicare for All" until they walked into the room, Alexi reports.
  • Nine of the 12 participants said they hadn't heard anything about it in the past several months.
  • A majority of these swing voters didn't know which party is pushing the plan, and therefore didn't view it favorably or unfavorably.

My thought bubble: This seems consistent with polling that shows people's opinions about "Medicare for All" can swing wildly when they hear arguments for or against it. Most people simply are not hardcore about this issue, at least for now.

  • The "Medicare for All" debate right now is mainly about appealing to the engaged and partisan Democrats who vote in primaries, who are less likely to be swing voters in the general election.
  • Even so, all the evidence suggests there's still plenty of flexibility in defining "Medicare for All" — that it's not yet the slam dunk Bernie Sanders' fans perceive it to be or the obvious albatross Republicans see.

Go deeper: What Medicare for All could look like

5. While you were weekending ...
  • Nine years in, the Affordable Care Act still isn't out of the woods, HuffPost's Jonathan Cohn writes.
  • Kansas Democrats' effort to expand Medicaid is headed to the state's GOP-controlled Senate, where it will likely face staunch opposition, the Wichita Eagle reports.
  • Via the Louisville Courier-Journal: Kentucky's Democratic attorney general, who's also running for governor, is investigating whether pharmacy benefit managers overcharged the state's Medicaid program.

Thanks for reading, and as always, please share your tips, questions and feedback: