Personalized treatments may be threatened by drug cost-containment proposals

first_img President Trump has said he plans to issue an executive order to lower what the United States government would pay for drugs to no more than “whatever the lowest nation’s price is.” The proposal is designed to end what he has called “global freeloading,” whereby Americans pay more for drugs than residents of other countries.The executive order announcement follows an earlier proposal by the Trump administration to decrease the price of physician-administered therapies by tying them to an international price index so their prices will not exceed those charged in other countries.These proposals, like others that would cut the costs of drugs, are clearly popular. But if implemented they could have disastrous unintended consequences for existing or future high-value personalized cell-based therapies, gene therapies, and targeted medicines that are reshaping the discovery, development, and delivery of health care.advertisement By Edward Abrahams July 18, 2019 Reprints Adobe Backdoor price controls, like those proposed or suggested by the administration, will likely discourage the pharmaceutical industry from making investments in personalized and targeted therapies that address the root causes of diseases rather than merely treating their symptoms. They would also slow the discovery of treatments for diseases that affect small numbers of patients for whom there are no effective medicines by making it even more difficult for pharmaceutical companies to get returns on their ongoing investments in therapies aimed at subpopulations of patients. Some of these medicines have unprecedented upfront costs to develop and deliver, but they represent breakthroughs that can spare patients from a lifetime of ongoing symptoms and costly hospitalizations. According to one recent study, the pharmaceutical industry is developing nearly 300 treatments that, like Zolgensma, prompt a patient’s own cells to address the biological causes of a disease, facilitating a long-term treatment response. The industry is also committed to developing targeted therapies that can be taken regularly to counteract the effects of genetic mutations for certain cancer patients and those with rare diseases.Recent developments in Europe demonstrate that these investments will be at risk if health care decision-makers do not put individual patients at the center of their considerations or if they abdicate their responsibility to make decisions based on what is best for Americans and allow other nations to set the price of drugs.In 2015, for example, the FDA approved Orkambi (lumacaftor/ivacaftor), a drug made by Vertex Pharmaceuticals for treating cystic fibrosis in patients 12 years and older with two copies of a specific gene mutation. Three years later, this lifesaving drug was approved for treating younger children as well. The United Kingdom’s National Institute of Health and Care Excellence (NICE), whose mission is to get the best bargain even if it means denying British citizens access to innovative medicines it deems as overpriced, has embroiled the country in a bitter dispute over the cost of Orkambi.By applying a methodology for assessing the value of drugs that was developed in the days of population-based medicine rather than those of precision medicine, NICE determined that this targeted treatment is not worth what Vertex wants to charge for it. That judgment, if replicated, will likely deter future investment in innovative medicines that require enormous capital, long lead times, and a willingness to tolerate failure rates of 90% or more. Edward Abrahams Even worse, in addition to the detrimental effects of these proposals on the development of innovative therapies, they would lock patients and health systems into a future in which physicians rely on imprecise, one-size-fits-all daily maintenance medications that fail to help many patients at a time when science is beginning to help us better appreciate human heterogeneity and new technologies, such as next-generation sequencing, are ushering us into a new era that promises better outcomes for patients and increased efficiencies for the health system generally.The Trump administration’s cost-cutting proposals, which fail to consider drug prices in the context of overall health care costs, arrive as the global pharmaceutical industry is deeply invested in creating innovative therapies that carry higher price tags, at least in part because the companies that make them must recoup research and development costs from fewer prescriptions administered to smaller patient populations. These smaller populations are defined by specific biological characteristics known to drive disease or predict responses to therapy. The pharmaceutical industry’s attention to these molecular markers lets physicians target more effective treatments to patients who are almost certain to benefit from them, improving patient care and making the health system more efficient.Recent developments in the U.S. Congress are no less concerning than the Trump administration’s proposed price controls. Also aimed at decreasing drug costs across the board without reference to their value to patients and the health care system, some of these ideas, such as House Speaker Nancy Pelosi’s latest drug pricing plan to arbitrate the list prices of 250 drugs, display no discernible concern for the future.Personalized medicine points to a new future for health care that moves away from treatment protocols based on what has been proven to work for the highest percentage of patients with a given disease in favor of analyzing each individual’s specific biological characteristics. In so doing, this precision approach is designed to increase the value of every dollar spent on health care by making upfront investments to understand everything that can be learned about each patient before prescribing a therapy that can deliver the longest-lasting effect.Instead of blindly reducing list prices for all drugs, we should instead seek solutions that assess every treatment in the context of its value to individual patients and the downstream savings they may facilitate elsewhere.Edward Abrahams is the president of the Personalized Medicine Coalition, a nonprofit education and advocacy organization in Washington. Consider Zolgensma (onasemnogene abeparvovec-xioi), which was approved by the FDA in May 2019 as a single-dose, curative treatment for spinal muscular atrophy (SMA), a rare and debilitating neuromuscular disorder that affects fewer than 25,000 people in the United States. Novartis, the company that developed the drug, defends Zolgensma’s $2.125 million price by noting that patients living with SMA regularly generate costs of more than $5 million over 10 years — while still suffering from this horrible disease.advertisement About the Author Reprints Related: I have spinal muscular atrophy. Critics of the $2 million new gene therapy are missing the point Tracking Washington’s moves on drug pricing [email protected] Related: @permedcoalition First OpinionPersonalized treatments may be threatened by drug cost-containment proposals Tags drug pricingprecision medicinelast_img read more

Fiera Capital reports drop in AUM in Q1

first_img Keywords AUMCompanies Fiera Capital Corp. IE Staff “In the context of a first quarter characterized by extreme market volatility, our assets under management decreased by 6.8% — a testament to the diversity and resiliency of our investment platform and to the benefits of our active portfolio management approach,” said Jean-Philippe Lemay, Fiera’s global president and chief operating officer, in the release.Fiera’s AUM saw a year-over-year increase of 9.1%, up from $144.9 billion in the first quarter of 2019. Facebook LinkedIn Twitter Share this article and your comments with peers on social media After significant drops in March, IGM and CI saw gains last month Assets under management (AUM) decreased for Fiera Capital Corporation in the first quarter, according to a preliminary estimate in a press release from the firm on Thursday.The Montreal-based company reported AUM of approximately $158.1 billion as of Mar. 31, 2020, a decrease of $11.6 billion from the previous quarter, or nearly 7%. Related news Businessman check seriously analyzes a finance report investor colleagues discussing new plan financial graph data. bank managers task. Concept business and finance ,Account analyzes planing yozayo/123RFlast_img read more

Is the classic car value bubble about to burst?

first_img Great collectible vehicles still sell — many for good money. But owners are experiencing a changing marketplace with fewer enthusiasts to buy their cars, and not as many younger people entering the hobby. PlayThe Rolls-Royce Boat Tail may be the most expensive new car everPlay3 common new car problems (and how to prevent them) | Maintenance Advice | Driving.caPlayFinal 5 Minivan Contenders | Driving.caPlay2021 Volvo XC90 Recharge | Ministry of Interior Affairs | Driving.caPlayThe 2022 Ford F-150 Lightning is a new take on Canada’s fave truck | Driving.caPlayBuying a used Toyota Tundra? Check these 5 things first | Used Truck Advice | Driving.caPlayCanada’s most efficient trucks in 2021 | Driving.caPlay3 ways to make night driving safer and more comfortable | Advice | Driving.caPlayDriving into the Future: Sustainability and Innovation in tomorrow’s cars | Driving.ca virtual panelPlayThese spy shots get us an early glimpse of some future models | Driving.ca Millennial enthusiasts love these cars Boomers can’t stand ‹ Previous Next › The people who loved these cars when both were younger are crossing the divide. Many collectors in their 70s and 80s are downsizing their garages. Some are selling all their collector vehicles. The collectors who are still buying these cars have become extremely price-conscious. There are bargains to be had.At the same auction last weekend, a rare Canadian-built 1954 Meteor Rideau Sunliner convertible crossed the block selling for $15,900 — that’s unheard of. Ford of Canada built about 400 of these Canadian-only convertibles, and only a handful are left.Created with Raphaël 2.1.2Created with Raphaël 2.1.2A 1954 Meteor Rideau Sunliner that sold at the Toronto auction for $15,900 is reflective of slumping prices for classic convertibles of the 1950s. Collector Car Productions Japanese collectibles, including any Acura NSX model, along with Datsun Z sports cars of the ’70s and early ’80s, have seen prices double in the past few years. There are others.“If friends and family had listened to me, they would have snapped up every Acura Integra Type RS,” says Nigel Matthews of Hagerty Insurance. “That car sold new for $27,000. Today, they are commanding north of US$60,000.”Any collectible with Carroll Shelby’s name on it is a big seller, particularly the big-block fastback and convertible models from the late 1960s.Full classics including Packard and Cadillac open cars continue to be traded like rare pieces of art, and are holding or increasing their value.Created with Raphaël 2.1.2Created with Raphaël 2.1.2This fully optioned 1957 Chevrolet BelAir convertible brought a winning bid of $74,800 at the Toronto fall collector car auction We encourage all readers to share their views on our articles using Facebook commenting Visit our FAQ page for more information. Created with Raphaël 2.1.2Created with Raphaël 2.1.2 This 1956 Ford Fairlane Sunliner sold at the Toronto collector car auction this fall at the bargain basement price of $17,600.  Collector Car Productions Trending Videos The Rolls-Royce Boat Tail may be the most expensive new car ever This is illustrative of how interest in cars of that vintage is waning as hobbyists who love those cars are fewer in numbers.Auctions are a great appraisal tool to establish collector vehicle values. It shows what the buyer will sell the vehicle for, and what someone will pay for it, at that time and location. Owners can’t expect high U.S.-dollar prices when they are selling their cars in Canada — unless the vehicle is spectacular or has extremely high collectability.It is very hard to define values by looking solely at advertised asking prices and auction results. Many desirable collector vehicles change hands by word of mouth. They never officially come on the market.What’s hot and what’s not? Performance European cars including vintage Mercedes-Benz and Porsche sports cars and convertible examples continue to increase in value.“One of the hottest cars in the marketplace today is the air-cooled Porsche 911, particularly the 1997, the last air-cooled model; and the Carrera cabriolet offered through 1998,” says appraiser and master concours d’elegance judge John Carlson. Created with Raphaël 2.1.2Created with Raphaël 2.1.2There are bargains to be had at classic car auctions in Canada, as values of cars from the 1950s and muscle cars of the 1960s slumpCollector Car Productions Created with Raphaël 2.1.2Created with Raphaël 2.1.2This 1956 Ford Fairlane Sunliner sold at the Toronto collector car auction this fall at the bargain basement price of $17,600.Collector Car Productions Created with Raphaël 2.1.2Created with Raphaël 2.1.2This fully optioned 1957 Chevrolet BelAir convertible brought a winning bid of $74,800 at the Toronto fall collector car auctionCollector Car Productions Created with Raphaël 2.1.2Created with Raphaël 2.1.2This well-restored and highly optioned 1956 Ford Fairlane Sunliner convertible was a no-sale at the Toronto auction with a closing bid of $46,000Collector Car Productions Created with Raphaël 2.1.2Created with Raphaël 2.1.2A closing bid of $352,000 bought this 2006 Ford GT at the Toronto collector car auction.Collector Car Productions Created with Raphaël 2.1.2Created with Raphaël 2.1.2A 1954 Meteor Rideau Sunliner that sold at the Toronto auction for $15,900 is reflective of slumping prices for classic convertibles of the 1950s.Collector Car Productions Created with Raphaël 2.1.2Created with Raphaël 2.1.2This restored 1937 Buick Special convertible sedan sold privately for $36,000 after attracting little interest at the spring Toronto collector car auction.Collector Car Productions Buy It! Princess Diana’s humble little 1981 Ford Escort is up for auction An engagement gift from Prince Charles, the car is being sold by a Princess Di “superfan”center_img But restored Chevy and Ford convertibles from the 1950s and muscle cars from the 1960s, with a few exceptions, are abundant and have been over-valued in the past. The market is flat for these cars, although some very special models will always draw top money.Project vehicles have really taken a hit. It may be a nice vehicle when restored but, if it’s a basket case, un-restored or a work-in-progress collectible, it will be very hard to sell.Collectors are gun-shy – with soaring costs of labour and materials – to rebuild vehicles at a time when standards for restoration have increased substantially. Trending in Canada RELATED TAGSFlexClassic CarsClassic Cars & TrucksNew VehiclesFlex See More Videos COMMENTSSHARE YOUR THOUGHTS These are the 9 classic cars Millennials most want to buyAs someone who has been a keen observer of the hobby for the past four decades, I have never seen a more challenging market for collector vehicles in Canada. They still sell, and many for decent money. But there are fewer buyers, cars stay on the market much longer and some owners have had to be extremely realistic regarding what they will sell their vehicles for.An example is a recently sold 1937 Buick Special four-door convertible. The Ontario owner did a very nice restoration on the classic, which had been completely disassembled and then put back together with rebuilt mechanics, genuine leather upholstery and wide whitewall radial tires.At the spring auction, the bidding didn’t come anywhere near to the owner’s expectations of more than $50,000. Certainly, much more money must have been spent on the car. The rare Buick subsequently sold privately for $36,000 — a very good buy.Created with Raphaël 2.1.2Created with Raphaël 2.1.2This restored 1937 Buick Special convertible sedan sold privately for $36,000 after attracting little interest at the spring Toronto collector car auction. I don’t know if this was a good car or a made-up car from parts of others. But it sure looks like a bargain for some lucky buyer.On the other end of the auction results, an extremely collectible 2006 Ford GT in red brought the auction hammer down at $352,000. And a well-restored and highly optioned dusk rose 1957 Chevrolet Bel Air convertible drew a winning bid of $74,800.I believe these are still bargains, because the above-mentioned top sellers at Canada’s most recognized classic car auction would likely draw the same money at sales south of the border — in U.S. funds. Buyers could earn up to 30 per cent on their money, simply by adjusting the geographical location for the next sale of the car.However, one must factor in transportation, auction fees and other costs. So a big profit isn’t a slam dunk.RELATED Collector Car Productions Classic cars are, believe it or not, much like real estate in major Canadian cities: Asking prices are still high, but sales are much slower than you’d think. The fall auction held mid-October in Toronto by Collector Car Productions shows both strength and weakness in the marketplace.For example, a desirable 1956 Ford Sunliner convertible that looked to be in decent driver-quality condition sold for $17,600 with the 10-per-cent buyer’s fee. A much better restored Sunliner with lots of options and upgrades including modernized power steering and disc brakes was a no-sale at a high bid of $46,000.I have watched similar cars at this same auction sell in past years for up to $85,000. The market is changing. The Ford Sunliner sales tell the story. advertisement Collector Car Productionslast_img read more

Sheriff’s office to open range to hunters for sighting in their rifles

first_imgThe range, located at 2955 Old Plain Dealing Road in Plain Dealing, will be open on these dates and times: Although you do not need to register, you can always contact the Bossier Parish Sheriff’s Training Academy at (318) 965-3525 for more information.  Perfect-Dating.comAre You Ready to Meet Cool Guys in Tung Chung?Perfect-Dating.com|SponsoredSponsoredUndoTheTopFiveVPNThe Secret Netflix Doesn’t Want You To Know To Unblock RestrictionsTheTopFiveVPN|SponsoredSponsoredUndoAspireAbove.comRemember Abby from NCIS? Take A Deep Breath Before You See How She Looks NowAspireAbove.com|SponsoredSponsoredUndoNews gadgetThis watch takes the whole country by storm! it’s price? Ridiculous!News gadget|SponsoredSponsoredUndoTheTopFiveVPNThe Trick Netflix Doesn’t Want You To Know To Unlock RestrictionsTheTopFiveVPN|SponsoredSponsoredUndoCelebsland.com9 Celebrity Before-And-After Plastic Surgery DisastersCelebsland.com|SponsoredSponsoredUndo “Opening up our range to the public allows hunters to sight in their rifles in a safe environment with a highly-qualified range staff on scene,” said Sheriff Whittington.  “As an avid hunter myself, I know residents here in Bossier Parish are looking forward to this time of year when they can enjoy ‘the hunt’.”  The range features 12 shooting lanes with targets at 100, 200, 300 and 400 yards.  Shooters will need to bring their own rifles and ammunition, as well as eye and ear protection.  Basic targets will be available at the range.  The Bossier Sheriff’s Rifle Range will open to the public on three Saturdays in September so hunters can sight in their rifles.     The Rifle Range is located just south of the Bossier Parish Sheriff’s Training Academy on Old Plain Dealing Road approximately 12 miles from the town of Benton. Sept. 14, 8 a.m. – 4 p.m.Sept. 21, 8 a.m. – 4 p.m.Sept. 28, 8 a.m. – 4 p.m.last_img read more

European, South American refs for WCup last eight

first_imgMOSCOW (AP):FIFA has picked European and South American referees to handle the World Cup quarterfinals that feature only teams from their regions.The Uruguay versus France game will be refereed by Nestor Pitana of Argentina tomorrow in Nizhny Novgorod. It will be his fourth assignment, including the opening game.Also tomorrow, the Brazil versus Belgium game in Kazan will be handled by Milorad Mazic of Serbia. He handled the Champions League final in May.FIFA says that Brazilian referee Sandro Ricci will work Russia versus Croatia on Saturday in Sochi. He handled Croatia’s first group-stage game against Nigeria.The Sweden versus England quarterfinal in Samara on Saturday will be the fourth game refereed by Bjorn Kuipers of the Netherlands.last_img read more

Vector Security Welcomes Shoppers to New Storefront

first_imgVector Security hosted festivities to mark the opening of a new retail storefront here on May 21. The location is the third to feature a hands-on customer experience concept, joining the company’s existing retail storefronts in Canfield, Ohio and Ft. Mitchell, Ky.Visitors to the retail outlet are provided the opportunity to touch, feel and demo mobile security and home automation solutions offered by Vector Security.A customer experience area features products such as security control panels, indoor and outdoor video cameras, doorbell cameras, lights, thermostats, among other smart home devices. Real windows and doors show how sensors and contacts work, as well as how alarms can be triggered… Security Sales & Integration- Sponsor – Stay UpdatedGet critical information for loss prevention professionals, security and retail management delivered right to your inbox.  Sign up nowlast_img read more

Missouri process to certify minors as adults challenged

first_img(AP) – A 16-year-old is challenging how Missouri certifies minors as adults in the face of criminal charges.The minor’s public defender argued to Missouri Supreme Court judges Wednesday that the state’s process for certifying juveniles as adults is unconstitutional and discriminatory.Court records only identify the black 16-year-old as D.E.G. He was certified as an adult in Jackson County and is charged with first-degree assault and armed criminal action.His lawyer cited 2017 court data that show black minors were close to six times more likely to be certified as adults compared to white minors.D.E.G’s attorney added that he might turn 18 before he’s able to appeal his certification as an adult under Missouri’s current process.An attorney for Jackson County’s juvenile officer says the certification process provides due process.last_img read more

Azzurri to break records in Bosnia?

first_img Watch Serie A live in the UK on Premier Sports for just £11.99 per month including live LaLiga, Eredivisie, Scottish Cup Football and more. Visit: https://subscribe.premiersports.tv/ Italy can write history against Bosnia-Herzegovina tonight as they have already equalled the record of nine consecutive wins set by Vittorio Pozzo in 1939. Never have Italy won 10 matches in a row, but tonight the possibility presents itself at the Bilino Polje stadium in Zenica. This Azzurri can also pick up their sixth successive victory away from home – another feat never to occur in the history of the Italian national side. The last time an Italy team managed to win five consecutive matches on the road was 56 years ago, in 1963. On this spectacular run, Mancini’s side have kept eight clean sheets in their last 11 games, five of the eight coming in European qualifiers. Winning nine on the trot also means they will have found the net in each of those fixtures, as only a 0-0 draw with Portugal in the Nations League stops them embarking on a run of 11. They may even prolong their streak of scoring at least two goals in their eight last matches, given Bosnia have conceded at least twice in their previous five. Finally, it’s worth bearing in mind that Federico Bernardeschi could become the first player to score in three consecutive matches since Eder performed the feat in 2017.last_img read more

AFC Cup: Bengaluru FC beat Abahani Limited Dhaka 1-0 in opener

first_imgBengaluru FC started their AFC Cup campaign on a winning note after a Daniel Lalhlimpuia strike (72th) gave the Blues a 1-0 win over Abahani Limited Dhaka (Bangladesh) in their Group E game at the Kanteerava Stadium on Wednesday.With the focus firmly on Saturday’s Indian Super League (ISL) final against Chennaiyin FC, Albert Roca handed first starts to three players in Lucas Perez, Asheer Akhtar and Robinson Singh. Joyner Lourenco and Zohmingliana Ralte were in the centre of a defence that saw the return of Nishu Kumar from an injury lay-off.In a rather quiet first half where chances were at a premium for both sides, Lalhlimpuia had a couple of tries from distance at goal, but nothing dangerous enough to ruffle the ranks in the Abahani defence.The Blues win their opening match in the 2018 AFC Cup. #BENvALD pic.twitter.com/A0S1qU6nbOBengaluru FC (@bengalurufc) March 14, 2018Bengaluru started the second half with a lot more intent and the dominance in possession had Abahani defending in numbers. Akhtar was a threat with his overlapping runs and dangerous crosses in the box which Thongkhosiem Haokip and Perez failed to connect cleanly in quick succession.Roca’s second change on the hour mark saw Daniel Segovia come on for Robinson, adding more teeth to the Bengaluru attack. With Abahani under pressure, the Blues eventually got the breakthrough in the 72nd with both the Daniels combining.Alwyn George, with ball on the right, did well to hold on to possession before sending in a cross that Segovia headed down for Lalhlimpuia. The striker smashed his take on the bounce, leaving Sahidul Alam with no chance.advertisementMinutes later, Segovia had a chance to make it two-nil but shot on the run from an angle went straight to the Abahani keeper. Roca then handed another youngster, Leon Augustine his first appearance for the senior team, bringing him on in place of George.Abahani threw numbers in attack towards the end of the game in a bid to get an equaliser but the Bengaluru defence did well to hold fort and take all three points on the night.Aizawl FC on the other hand lost their opening match 3-1 to New Radiant SC from Maldives.(With Inputs from IANS)last_img read more

10 months agoNewcastle boss Benitez tells Klopp: I had to sell at Liverpool to buy

first_imgAbout the authorPaul VegasShare the loveHave your say Newcastle boss Benitez tells Klopp: I had to sell at Liverpool to buyby Paul Vegas10 months agoSend to a friendShare the loveNewcastle United boss Rafa Benitez has taken aim at Jurgen Klopp ahead of their clash with Liverpool.The Spaniard won the Champions League in his first season at Anfield in 2005 but could not return a first league title since 1990.”When I was there we had to sell to buy,” he said ahead of his return to Anfield.”Now, I think is they have a better squad because when you spend money you bring in better players. “So when they sign Fabinho and Naby Keita, yet they keep Jordan Henderson and Gini Wijnaldum, the squad is better and that means competition and you always have a strong team on the pitch.” last_img read more