2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 1
1958: America’s Response to Sputnik 1958: America’s Response to Sputnik 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 1969: “The Eagle has landed.” 2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 2
Nixon Declares War on Cancer - 1971 Nixon Declares War on Cancer - 1971 The Value of Health The Value of Health 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. 2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 3
Worldwide Life Expectancy Four million years 118 years 72 produced an 11-year produced a 41- increase from 20 to 31. year increase. 31 1900 2018 James Carey: Longevity; United Nations Development Program Some Major Diseases Now Mostly Controlled Some Major Diseases Now Mostly Controlled Chicken pox Pneumococcal disease Diphtheria Polio H. influenza -caused Tetanus invasive diseases Typhoid fever Measles Yellow fever Pertussis Smallpox Source: Discovery Fit & Health 2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 4
What caused the increase? Vastly improved sanitation Development of antibiotics Implementation of vaccines Progress against heart disease Investment in bioscience research The March of Progress Milken Family The National The MARCH CaP CURE Foundation Cancer Cancer Summit in Washington PCF Research Awards 1995 1998 1993 1970s/1980s 2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 5
The March of Progress NIH Budget FasterCures Partnering For Innovation Doubles 2003 - 2015 Cures Retreat / NCATS 1998-2003 2009 - current 2011 The March of Progress 21 st Century Celebration of CDC Milken Institute Science Conference School of Public Cures Act 2012 2014 Health 2016 2014 2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 6
The March of Progress PCF-VA Veterans Health Future of Health Giving Pledge Initiative Summit Learning Session 2016 - current 2017 - current February 2017 Cost of Chronic Diseases: $3.7 Trillion Cost of Chronic Diseases: $3.7 Trillion Direct Health Care Costs for Treatment of Chronic Illnesses and Indirect Productivity Losses, 2016 ($ Billions) Equivalent to 19.6% of GDP 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 7
Total Costs of Obesity and Overweight, 2016 Total Costs of Obesity and Overweight, 2016 Costs (in $ Millions) Condition 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 Source: The Costs of Renal Cancer $2,254 $559 $2,813 Obesity in the U.S., Milken Institute, Stroke $14,148 $14,527 $28,674 July 30, 2018 $480,654 $1,235,869 $1,716,523 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 8
Minimally Invasive Robotic Surgery 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 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 2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 9
Pathologist vs. Computer Two highly skilled pathologists assessing the same slide will agree only about 60% of the time. Machine-learning predicted patient survival times better than the standard practice of pathologists. Source: Stanford University School of Medicine 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 10
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. Commercialization of Rosenberg’s Work Arie Belldegrun, MD 2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 11
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 12
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 13
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 2018 Milken Institute Hamptons Dialogues Precision, Precision, Precision: The Future of Health and Medicine 14
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