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2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 1

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 2

• U.S. Defense budget increased to a peace-

time record $74 billion

• DARPA - Defense Advanced Research

Projects Agency

• National Defense Education Act
• $3 billion invested in high schools and

universities throughout the 1960s

• NASA – National Aeronautics and Space

Administration

Source: PC World

1958: America’s Response to Sputnik 1958: America’s Response to Sputnik 1969: “The Eagle has landed.”

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 3

Nixon Declares War on Cancer - 1971 Nixon Declares War on Cancer - 1971 Each life is priceless… but in economic terms, over the past two centuries, as much as 50% of all economic growth can be traced to advances in health.

The Value of Health The Value of Health

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 4

Worldwide Life Expectancy Four million years produced an 11-year increase from 20 to 31.

31 72 1900 2018

118 years produced a 41- year increase.

James Carey: Longevity; United Nations Development Program

• Chicken pox
• Diphtheria
• H. influenza-caused

invasive diseases

• Measles
• Pertussis
• Pneumococcal disease
• Polio
• Tetanus
• Typhoid fever
• Yellow fever
• Smallpox

Source: Discovery Fit & Health

Some Major Diseases Now Mostly Controlled Some Major Diseases Now Mostly Controlled

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 5

• Vastly improved sanitation
• Development of antibiotics
• Implementation of vaccines
• Progress against heart disease
• Investment in bioscience research

What caused the increase?

The National Cancer Summit 1995

The March of Progress

Milken Family Foundation Cancer Research Awards 1970s/1980s CaP CURE PCF 1993 The MARCH in Washington 1998

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 6

Innovation Retreat / NCATS 2011 Partnering For Cures 2009 - current FasterCures 2003 - 2015 NIH Budget Doubles 1998-2003

The March of Progress

Celebration of Science 2012 CDC Conference 2014 21st Century Cures Act 2016 Milken Institute School of Public Health 2014

The March of Progress

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 7

The March of Progress

PCF-VA Veterans Health Initiative 2016 - current Future of Health Summit 2017 - current Giving Pledge Learning Session February 2017

Direct Health Care Costs for Treatment of Chronic Illnesses and Indirect Productivity Losses, 2016 ($ Billions)

Equivalent to 19.6% of GDP

Cost of Chronic Diseases: $3.7 Trillion Cost of Chronic Diseases: $3.7 Trillion

Source: The Costs of Obesity in the U.S., Milken Institute, July 30, 2018

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 8

Condition

Costs (in $ Millions)

Direct Indirect TOTAL

Alzheimer's or Vascular Dementia $73,572 $32,606 $106,178 Asthma $10,564 $16,234 $26,798 Breast Cancer $5,900 $3,669 $9,569 Chronic Back Pain $38,476 $217,291 $255,768 Colorectal Cancer $6,151 $5,425 $11,576 Congestive Heart Failure $5,201 $2,039 $7,239 Coronary Heart Disease $22,700 $39,315 $62,015 Diabetes Type 2 $120,707 $214,500 $335,208 Dyslipidemia $28,619 † $28,619 End Stage Renal Disease $3,716 †† $3,716 Endometrial Cancer $189 $158 $347 Esophageal Adenocarcinoma $970 $92 $1,061 Gallbladder Cancer $22 $17 $39 Gallbladder Disease $26,863 $27,401 $54,264 Gastric Cardia Adenocarcinoma $1,433 $136 $1,568 Hypertension $29,323 $432,230 $461,553 Liver Cancer $87 $67 $154 Osteoarthritis $86,480 $215,303 $301,783 Ovarian Cancer $1,152 $152 $1,304 Pancreatic Cancer $146 $738 $884 Prostate Cancer $1,983 $13,411 $15,393 Renal Cancer $2,254 $559 $2,813 Stroke $14,148 $14,527 $28,674 $480,654 $1,235,869 $1,716,523

Source: The Costs of Obesity in the U.S., Milken Institute, July 30, 2018

Total Costs of Obesity and Overweight, 2016 Total Costs of Obesity and Overweight, 2016

We have entered a new Age of Medicine.

• Immunology
• Precision medicine
• Genomics
• Powerful diagnostic tools

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 9

When robotic surgery is performed by a certified provider with advanced training and skill …

• Less blood loss, less trauma to the body, less

scarring.

• Hospital stays are shorter and recovery times

much faster.

Source: University of Kentucky HealthCare

Minimally Invasive Robotic Surgery

400,000 robotic surgeries were performed in the U.S. in 2012. The rate of robotic surgeries is increasing 25% per year. By 2020, the global medical robotic system market will reach $18 billion; compound annual growth rate will be 12.7%.

Source: Becker’s ASC Review 7/23/15; 11 Things to Know About Robotic Surgery

Robotic Surgery

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 10

• Two highly skilled pathologists

assessing the same slide will agree

• nly about 60% of the time.
• Machine-learning predicted patient

survival times better than the standard practice of pathologists.

Source: Stanford University School of Medicine

Pathologist vs. Computer Sequencing the Human Genome 2003:

• 13 years
• $3 billion

Today:

• A few hours
• Approaching $1,000

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 11

The Origins of Immunotherapy

Reported a major breakthrough in the development of successful gene therapy that for the first time in history harnessed the body's own immune system to shrink tumors.

• Dr. Rosenberg is now chief of

surgery at the National Cancer Institute.

Steven Rosenberg, M.D.

Arie Belldegrun, MD

Commercialization of Rosenberg’s Work

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 12

Milken Institute’s Concept to Commercialization

1. University of Utah 2. Columbia University 3. University of Florida 4. Brigham Young University 5. Stanford University 6. University of Pennsylvania 7. University of Washington 8. MIT 9. California Inst. of Technology

• 10. Carnegie Mellon University

PCF Leverage in New Cancer Drugs

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 13

Impact of PCF Young Investigators Impact of PCF Young Investigators

10 FDA-approved treatments for prostate cancer since 2010.

• Provenge: stimulates tumor immunity
• Xgeva: improves quality of life by reducing side effects
• Jevtana: chemotherapy that kills prostate cancer cells
• Zytiga: reduces testosterone, resulting in longer life
• Xtandi: blocks testosterone’s cancer targets and prolongs life
• Xofigo: results in less medication to control bone pain
• Erleada: treatment for those who fail testosterone reduction
• Zytiga + Prednisone: delays cancer progression by 18 months
• Pembrolizumab: precision immunotherapy for solid tumors
• Xtandi: secondary approval for non-metastatic CRPC

Heritage Provider Network: The Challenge Heritage Provider Network: The Challenge

2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 14

Heritage Provider Network: The Solution Heritage Provider Network: The Solution

“Never doubt that a small group of thoughtful, committed citizens can change the world: indeed, it’s the only thing that does.”

• Margaret Mead