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Brainstorm Health Daily: February 28, 2017

The first case was in a toddler, a boy the age of two, in a remote village of southern Guinea, near the border of Sierra Leone and Liberia. A week later the mysterious illness would claim the child’s mother, grandmother and sister—each, a frightening and rapid decline wracked by fever, diarrhea, and vomiting. Soon, there were fourteen of such deaths in and near the village of Meliandou, in the prefecture of Guéckédou. Seven of the early patients tested positive for cholera at the local hospital, but this wasn’t cholera.

As others were getting sick, the traditional village healers, sometimes called the “secret societies” by outsiders, would attempt to dispel the evil spirits that seemed to cause these hellish symptoms, keeping both the illness and the ultimate deaths shrouded from the rest of the world.

This is what happened in December 2013. “It was pretty much missed by the national authorities in Guinea,” said Dr. David Nabarro, a widely respected public health leader who would later be called upon to serve as the U.N. Secretary-General’s Special Envoy on Ebola. “It was thought by about February 2014 that it had burned out. But all that actually had happened is that it had gone underground. The deaths, when they occurred, were dealt with locally by the secret societies. They weren’t reported.”

Then more and more mistakes followed, said Nabarro at an extraordinary and candid discussion on Sunday morning, graciously hosted by Claudia Gonzalez and Richard Edelman at their home in New York.

When the cases started to build up again in April 2014, it was at last picked up by national authorities in Guinea. But at first, said Nabarro, it was misdiagnosed as Lassa fever, another hemorrhagic illness brought on by a virus.

Then, when it was finally recognized as Ebola, Nabarro recounted, “it just did not sound the global alarm. And, indeed, the NGOs were beginning to say, ‘There is a problem. It is Ebola.’ But it did not switch from being an NGO-identified problem to being a problem that was strongly voiced by the World Health Organization. And we know from email traces that doctors were writing to Geneva from the affected countries in May and in June 2014, and their concerns were not being properly heeded.”

“In June and July 2014, there were quite loud voices coming from the WHO’s regional office in Africa, and then the WHO Geneva office—but by that time, when the alarm was being sounded loud, it had already moved from Guinea into Liberia, and by June/July it was in Monrovia and was spreading with a doubling of cases every three weeks. It was like a wildfire burning out of control.”

So we can see these three escalating steps of failure in the global health response, he said: “One, at the very earliest stage, it was missed in country. It wasn’t identified as Ebola. Secondly, in May, it was identified but not properly voiced in country. And then by June/July, the voice was there, but it was not hitting global opinion.”

The Ebola outbreak of late 2013 to 2015—which may now be a faded memory to many, particularly to those of us in the developed world who understood its distant horror and scale only by the headlines—killed more than 11,000 people. And were the global effort in containment to have been delayed even a few months more, this outbreak could easily have claimed tens of thousands of additional lives, including in the U.S.

So what lessons can public health authorities around the world take away from this episode to ensure that, next time, our global response—and yes, it needs to be a global response—is better and quicker? On Sunday, Nabarro offered three. They are:

1) Always treat reports of clusters of unexpected and unexplained deaths with at least a “high index of suspicion” that the cause may be something of potential global concern.

2) Don’t ever let emailed reports from doctors, particularly those from non-governmental organizations, get buried in inboxes at the WHO (or any public health authority).

3) “Once the alarm is sounded, make sure that it’s sounded at the very loudest pitch possible—because action now is worth 10 or 20 times action in two months’ time.”

Nabarro, who is currently Special Adviser of the Secretary-General on the 2030 Agenda for Sustainable Development and Climate Change (the U.N. is big on long titles), is in contention to be the next Director-General of the WHO—and he is a very worthy candidate in my view. But the WHO and other global health responders can only follow rules No. 1, 2, and 3, if they have ample funding and active support from the rest of the world.

The first tests of that support, indeed, may come as early as May, when the G20 Health Ministers meet in Berlin. At that meeting, there will be a four-hour simulation of possible pandemics (an extension of one presented at the World Economic Forum at the end of January) that has been organized at the request of German Chancellor Angela Merkel.

“We’ll see how countries react,” said Nabarro. Let’s hope their response is even remotely commensurate with the scale of the danger to the world when the next horrific pathogen emerges. And emerge it will.

More news below.

Clifton Leaf


Kite Pharma will race toward the regulatory finish line with its groundbreaking CAR-T cancer drug. The race to become the first company with a chimeric antigen receptor T-cell (CAR-T) cancer therapy on the market has entered its final leg, and Kite Pharma now appears to have a big advantage. The biotech has been jockeying against main rivals Novartis and Juno to secure a first-to-market advantage with the groundbreaking new medical tech, which turns patients’ immune cells into souped-up, re-engineered cancer killers that are then reintroduced into the body. As with many new biologics-based technologies, there have been a number of clinical setbacks for these companies (for instance, Juno’s trials have been rocked by safety issues). And a big question has been whether or not the technique (which is deployed against blood cancers) would remain effective over an extended period of time or see its prowess wilt. For Kite, six months out, the answer is yes. Approximately a third of patients with aggressive lymphomas that had not responded to other treatments maintained a “complete response” (meaning all signs of the cancer had disappeared) six months out, similar to the rates seen at the three-month mark. The incidence of deadly side effects also declined compared to the three-month data.

A startup wants to use CRISPR gene-editing to treat muscular dystrophy. The world of Duchenne muscular dystrophy (DMD) treatments has been rife with controversy, from the FDA’s decision to approve a Sarepta Therapeutics treatment that has yet to establish efficacy to Marathon Pharma’s decision to sell a steroid that addresses the symptoms (but not the root cause) of the muscle-wasting disorder at an astronomical price in the U.S. even though it’s been around for decades at bargain-bin prices. Well, one startup is seeking to take a very different approach: Exonics Therapeutics, which has secured $5 million in seed funding from CureDuchenne Ventures to see if the revolutionary new CRISPR-Cas-9 gene-editing technology can be used to target the root genetic deficiency at the heart of the disease. If it works, it could be used in a far greater number of patients than Sarepta’s drug, which is approved for a relatively small slice of the DMD patient pool. (FierceBiotech)

Nokia will officially put its stamp on the Withings digital health product suite. Tech giant Nokia took a big step into the digital health space when it snapped up France’s Withings, which has a product suite encompassing everything from activity trackers to smart watches to sleek, high-tech scales, for $191 million last year. This summer, Nokia will officially be putting its name on the franchise, re-branding Withings devices as Nokia ones. (The Verge)


Can drug makers’ transparency ploy actually convince the skeptics? There’s been a new transparency push in pharma after a year that tarnished the industry’s reputation on drug pricing. Yesterday, Johnson & Johnson became the latest pharma giant (after Merck, Allergan, and others) to reveal its price increase strategy. In fact, the drug maker said that its average prices increases have been kept below 10% each year since 2012, and that the average 2016 hike was 8.5% (with a 3.5% net after discounts and rebates). The transparency efforts may be laudable (not to mention good PR) – but as I’ve previously noted, price increases are still extremely common and outpace inflation. To be fair, medical inflation is higher than general inflation, and biopharma companies have the unenviable task of explaining that a gross list price increase isn’t the same thing as the net they’ll take away from that increase after haggling with insurers and pharmacy benefits managers. But if consumers continue to feel a pinch on their pocketbooks in an era of rising deductibles, all the transparency in the world may not resuscitate the sector’s reputation, fair or not. (Fortune)

Perrigo plunges on slew of grim news. Perrigo’s stock fell more than 11% in Tuesday morning trading after the company made several announcements that sent investors fleeing, including a disappointing earnings loss and the departure of yet another key executive. Perrigo CFO Judy Brown is departing the company and heading to biotech Amgen. The firm’s previous chief executive, Joseph Papa, left back in 2016 to see if he could clean up the growing mess at Valeant Pharmaceuticals. Ron Winowiecki will become Perrigo’s acting CFO, and the company will also be selling its royalty stream from sales of the multiple sclerosis medication Tysabri for $2.85 billion to give it a boost in the midst of an earnings crunch.


President Trump met with big health insurance CEOs. President Donald Trump continued his streak of high-profile executive meetings on Monday with a gathering of prominent health insurance executives. Among the attendees were the CEOs of UnitedHealth, Aetna, Cigna, Humana, Anthem, Blue Cross Blue Shield, and Kaiser Permanente (Health and Human Services Secretary Tom Price was also there). The main topic of conversation was, naturally, the future of Obamacare. And Trump assured the chief executives that they’ll be getting a “fantastic” replacement to the health law. “A very competitive plan, costs will come down, health care will go up very substantially. People will like it a lot,” he said, adding that upcoming reform would be “special.” Those are fairly lofty claims (health care costs don’t really come down in tandem with improving care quality). But for now, the insurance industry is staying pretty diplomatic about some of the administration’s and Congress’ proposals. “The Administration has taken several recent steps to demonstrate its commitment to a stable, effective transition that works for consumers, and we look forward to Congress taking additional, much-needed action soon,” said the health insurance trade group AHIP in a statement. (NBC News)

What will Trump say about health care in his first address to Congress? President Trump will deliver his first address to a joint session of Congress this evening. It’s sure to be a blockbuster event. But what will he actually tell lawmakers about his plans for Obamacare, Medicare, and other entitlements? It’s a bit difficult to game out considering the notable mixed message coming from Trump, Congressional leaders, and more conservative lawmakers. For instance, Trump has previously asserted that there will be insurance for “everyone” under a replacement plan; but that’s at odds with the current draft legislation in Congress, which would roll back Obamacare’s Medicaid expansion and shift the ACA’s benefits structure. Furthermore, he’s expressed support for the ACA’s guaranteed coverage provisions for people with pre-existing conditions, but potential plans to nix Obamacare’s mandate that everyone carry insurance and the introduction of high-risk pools for the sick could result in an exorbitantly expensive system for people who already face massive medical costs. And then there’s the possibility that the president could make another stunning statement about an entire industry, as he did with drug makers he said were “getting away with murder” on prices. The exact content of the speech is anyone’s guess. But it’s probably a safe bet that he’ll continue to blast Obamacare as a total failure.

A cardiologist shares which foods (and fads) are actually good for your heart health. My colleague Laura Entis spoke with Andrew Freeman, the director of cardiovascular prevention and wellness at National Jewish Health in Denver, about which health fads are actually effective in heart health – not based on marketing, branding, or hype, but actual science. And as often happen with actual science, Freeman says that a lot of the vaunted public health conventional wisdom (gluten-free diets, antioxidants in “superfoods) isn’t actually supported by the data. “It’s not sexy, but the research shows that the key to heart health isn’t revolutionary: eat lots of fruits, vegetables, whole grains, and legumes, and a moderate amount of nuts, lean meats, vegetable oils, and low-fat dairy products,” writes Laura. “Despite dramatic headlines and the marketing efforts of Big Food and supplement companies, there is no “superfood” magic bullet that will erase the effects of an unhealthy diet or lead to weight loss on its own. Instead, healthy eating is about moderation, says Freeman.” (Fortune)


McDonald’s Is Exploring a New Menu Item: Sustainable Beefby Beth Kowitt

Uber Exec Resigns After Sexual Harassment Allegations Surface From His Time at Googleby Polina Marinova

Warren Buffett Hints Bank of America Could Be His Next Big Investmentby Shawn Tully

Alphabet Sues Uber Over Alleged Stolen Intellectual Propertyby Fortune Editors

Produced by Sy Mukherjee

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