Targeted Therapies and Big Cost Savings: Personalized Medicine Coalition President Edward Abrahams on Precision Medicine’s Potential

Edward Abrahams

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Margaret Flin ter : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health policy, health innovation, and technology, and the top
thought leaders who are shaping the health care of the future. This
week , Mark and Margaret speak with Edward Abrahams , president of
the Personalized Medicine Coalition , dedicated to advancing the
adoption of personalized medicine concepts for the benefit of
patients and the health system. He t alks about the growing body of
medicine that will allow truly personalized care , treatment , and
prevention based on one's own personal genomic profile.

Lori Robertson also checks in , the managing editor of FactCheck .org ,
l ooks at misstatements spoken about health policy in the public
domain, separating the fake from the facts.

We end with a bright idea that ' s improving health and well - being in
everyday life. If you have comments , please email us at
chcradio@chc1 .com or find us on Facebook , or Twitter @chcr adio , or
you can also find us on iTunes , Sound Cloud , or ask Alexa to play the
program, Conversations on Health Care .

Now , stay tuned for our interview with Edward Abrahams , president
of the Personalized Medici ne Coalition here on Conversations on
Health Care .

Mark Masse lli: We 're s peaking today with Dr. Edward Abraham s, P h. D . , president of
Personalized Medicine Coalition , dedicated to promoting the
understanding and adoption of personalized medicine concepts,
s ervices, and products for the benefit of patients and health systems.
Previously, Dr. Abrahams was the executive director of the
Pennsylvania Biotechnology Association , where he spearheaded the
state's $200 million investment in the biotech industry. He wa s the
assistant vice president for federal relations at the University of
Pennsylvania and taught health and public policy at Brown University.

Edward, welcome to Conversations on Health Care .

Edward Abrahams: Thank you very much. I appreciate this opport unity to talk about
personalized medicine.

Mark Masselli: Yeah . Let's start right there and take a moment , a s I assume , not
everyone in our audience may fully understand w hat the concept of
personalized medicine truly means . I wonder if you could talk to our
listeners about the basic premise of precision medicine.

Edward Abrahams

Edward Abrahams: Well, actually, that' s a very good place to begin . Personalized
medicine a ctually i s an evolving field , in which physicians use
diagnostic tests to determine which medical treatm ents will work best
for each patient based upon what the individual brings to the
equation . By combining the data from those tests with an individual's
medical history, his or her circumstances, health care providers can
develop targeted treatment and prev ention plans that would lead to
better outcomes for patients and also better outcomes for health
systems that integrate personalized medicine into what they offer.

Margaret Flinter: Well, Edward , your organization has been advocating for the
advancement o f personalized medicine , I think since 2004, which puts
you kind of back in the very early years that people were working on
this . As people started to hear more about accessing one's own
personal genome , and we've had so many people going to
Ancestry .com and 23andMe , then all of this seems to have brought us
to an increase in research for personalized approaches , to treating all
kinds of diseases and conditions, but also to a crossroads where it
may be on the horizon to see this as the norm and not the exc eption.
What do you think about that? Do you think we're at a new era where
it'll move from possibility to a standard part of health care treatment?

Edward Abrahams: Well , f irst, let me say, it already has move d from possibility to in
particular areas stan dard of care. Clearly , the parameters of the new
horizon are becoming more evident every day. The Personalized
Medicine Coalition was, as you note, founded at the end of 2004. Just
before we were founded, the human genome had been mapped . The
mapping of t h e human genome opened the opportunity that we could
better understand patients, based upon their genetic inheritance , and
with that new tool, develop new targeted therapies that would, as I
say, lead to better outcomes for patients , and also improve the
ef ficiency of the health system, which by employing personalized
medicine have become more targeted.

The Personalized Medicine Coalition , recognizing that we had this
golden opportunity , considered what needed to happen to speed up
the movement away from tr ial and error , one - size - fits - all medicine
towards one of personalized or targeted therapeutics. We decided
that the space between the science and the patient really was an d is
determinative , h ow we regulate . How we reimburse, how we educate
physicians and other providers makes a t remendous amount of
difference.

We were founded as an education and advocacy organization to
spearhead the promise of personalized medicine. I think we've made
a lot of progress since then, but still have a long way to go. We know
from a poll we did earli er this year that fewer than 20% of Americans

Edward Abrahams

have any idea what personalized or precision medicine is all about .
Although when we explain it to them, the overwhelming majorit ies
like what they hear .

Mark Masselli: Well, w hile ther e are only maybe 20% of Americans who understand
personalized medicine, certainly the policy makers have been engaged
in this . I'm wondering if we can talk a little bit about the policy side of
the equation. It seems to me that some of the building blocks f or
moving personalized medicine had been put in place i f you sort of
look at the Affordable Care Act , which was designed to put multiple
pieces in place . You had the shift from paper to electron ic health
st
records with the HI TECH Act . You had the 21 Centur y Cures Act . Of
course , we have the All of Us Precision Medicine Initiative , a project
actually t hat we've been engaged in since its inception . How
important are all of these building blocks to moving the needle
forward on personalized medicine and what's missing?

Edward Abrahams: Those building blocks are critical and they provide the foundation that
allows us to put in place the vision that we're trying to articulate , that
is to say the movement towards targeted or personalized medicine. I
agree with you that the Affordable Care Act, the HITECH Act , w hich
encouraged electronic medical records , and especially the All of Us
program , which in the future will provide another research tool that
allows us to better understand the individual variation , because it
incorporates data from hopefully a million people of all different
backgrounds , will yield new insights and therefore better health care .

Personalized medicine is really based on the new information age
reaching medicine. It's not easy, which is why thos e building blocks
are important and why the public policies that will e ncourage
personalized medicine are critical.

Margaret Flinter: Well, I'm really glad to hear you reference the All of Us p rogram . We
also are so excited about this and ha ve been very gr atified by the
eagerness of people of all backgrounds to really grasp how important
this might be , and to consider volunteering to be part of the program.

Mark , as I look back over the roster of people we've had on the show
in the last two years or so , I think the personalized medicine people
have been kind of well represented and maybe almost dominant,
which is another good marker. Eric Topol has been a recurring guest
on our show. Eric has sounded the call repeatedly that this is amazing
and wonderful sc ience , and that these personalized interventions and
therapies are likely going to be very expensive , and therefore likely
not available to all consumers . We have pulled up a quote I think
attributed to you in your 2017 publication, the personalized medici ne

Edward Abrahams

report , that the top challenge in personalized medicine is
reimbursement, reimbursement , and reimbursement.

What are you thinking about the evolving role of pay o rs, both public
and private , in the personalized medicine equation ? Is this something
that you see moving into the sort of essential benefits category, if you
will ? How are we going to rethink business models to pay for it if we
need to or is the volume going to ultimately drive down costs as it has
in other areas?

Edward Abrahams: Well, I think you've identified a major barrier to the advancement of
personalized medicine, which is the emerging perception that
personalized or precision medicine is going to be unaffordable. I
actually disagree with Dr. Topol on that . I think that while some
produc ts may actually cost more, but because they are of greater
value, they will provide better benefit s not only to the patients who
benefit from them, but also the health systems that employ them .
Clearly , we need more evidence to show that a more efficient h ealth
system can also be more effecti ve one.

I 'm pleased to note that there are systems that have studied the
implementation of personalized medicine that shows significant cost
savings by avoiding therapies to patients for whom they will not work.
I rece ntly read a study that said that over $5 00 billion annually could
be saved if we didn't prescribe particular drugs to patients for whom
they didn't work and avoid the kinds of side effects that thereby
occur.

Clearly , we need more evidence that this works and we need more
targeted therapies, but I think we're on the right path. One thing that
could derail it is if payor s just say no instead of work with
manufacturers to figure out how we can get more value for the
money we already spent , getting value and introducing efficiencies
into the system , because you're right . Unless we do that, the promise
of personalized medicine will not take off or at least will be a longer
runway than we would hope for.

Mark Masselli: We're speaking today with Edward Abraham s , Ph . D ., president of the
Personalized Medicine Coalition , dedicated to promoting the
understanding and adoption of personalized medicine concepts,
services , and products for the benefit of patients and the health
system.

Edward, I want to pull the thread o n that thought that you had about
a more efficient system and better health outcomes at more
affordable total cost for the health system . I'm certainly thinking
about the areas of improving prescribing practices. Currently , it seems

Edward Abrahams

to be really a trial an d error . Now , we have pharmacogenomics test ,
which can help determine medication ' s efficacy based on one's
personal genome . I think that's been sort of a r evolutionary
breakthrough and m aybe it is the building block of people
understanding the potential of personalized medicine for millions of
people, avoiding a medication that could not only be of no value to
them, but could put them at risk for greater harm . I'm wondering,
shine a light on this pharmacogenomics area for our listen ers , so they
can understa nd it within the personalized medicine field.

Edward Abrahams: Well, pharmacogenomics is really a fancy word for the right medicine
to the right patient at the right time. This is an emerging field . One in
four drugs approved by FDA in the last three years have had
biomarker information on their labels , suggesting that FDA wants to
see greater efficacy and safety, which they've determined can only
come about by identifying patients for whom any particular therapy
will work.

Let me give you three examples. In order to prevent breast cancer
recurrence, in t he past, chemotherapy was in variabl y described. Yet
we now know 90% of women will not benefit from that
chemotherapy, which is painful and expensive. A simple genetic tes t
can tell physicians that fact, kno wing who would benefit and who
could avoid chemotherapy. I think you can see the beauty in that and
the c ost savings , by the way, in that , e ven though the test may be
expensive .

Another one is a drug that only works in lung cancer with a certain
ALK rearr angement . That expensive drug will only be prescribed for
those patients who have that particular ALK rearrangement, which
also can be determined by a simple genetic test.

Another one is in cystic fibrosis, a deadly illness where young men and
women die i n their early 30s, can live much longer if a particular
genetic mutation is discovered and a targeted therapy is prescribed.
This is not science fiction. This is happening today.

These are the beginnings of personalized medicine and this field holds
enorm ous promise for patients . What we need to do is align all the
stakeholders around it , so that the research comes online more
quickly , p ayor s, regulators, providers, and also patients who need to
be considered in part of th at discussion.

Margaret Flinter: W ell, I saw another f actoid that there's an estimated 65,000 genomic
testing products on the market today, which I think is completely
astonishing. I think New York Times science writer, Carl Zimmer , when
he was recently with us, he put it this way, that al l this discovery may

Edward Abrahams

require the health industry to just throw out the old training models
and start over . We are very focused on training the next generation
and really ensuring that it doesn't take the 15 years. Historically ,
we've quoted about innovatio ns moving from the lab to the bedside
or the primary care exam room.

What are you thinking about in terms of preparing both the workforce
that's in training today, the ones who will come after them , and most
importantly, that big bolus of people out there in the field today who
need to access this information, understand it , or at least understand
how to connect people to those who do understand it. What's your
organization thinking about that big lift?

Edward Abraham: Well, that is a big lift. The health care providers are slow to adopt new
methods . Education is critical. I would note that as long ago as 400 BC ,
Hippocrates said that ' s it's more important to know which person the
disease has than what disease the person has. What's different today
is that we now have the tools to begin to do that. What w e need to do
though is convince the medical system that it's worth testing in order
to get the right therapy at the right time . The medical system moves
slowly absent evidence and evidence is expensive to de velop. I must
say even when we do have the evidence --

Margaret Flinter: They still don't want to change it.

Edward Abrahams: -- t hey still don't want to change. That's not good for patients or the
health system.

Margaret Flinter: No.

Mark Masselli: Well , the industry may be moving slowly , b ut the pace of discovery in
personalized medicine is really dramatic . The Personalized Medicine
Coalition is holding its annual conference at Harvard in mid - November
and s ome great minds in precision medicine and scienti fic research as
well as policy . Who's coming to grapple with these big challenges and
why you think bringing all these entities together is essential to
ensuring that precision medicine is done right moving forward ?

Edward Abrahams: Sure . Our conference is at Harvard Medical School . We're bri nging
together all of the stake holders with an interest in personal ized
medicine, including policy makers, payor s, scientists, patients , to
consider what's necessary to move the field forward. I'm very hopeful
that we'll be able to develop some solutions to problems that you've
privileged me by giving me a chance to address . That's the purpose of
our conference is to see where the field is at the moment and to
discuss what we need to do to bring it to patients more quickl y , and
how we can overcome the barriers that now exist , and I would say

Edward Abrahams

particularly the barrier of gathering evidence that change people's
minds about investment and adoption of personalized medicine. It
comes across two days . It includes leading proponen ts of the field. I'm
looking forward to a robust discussion.

Margaret Flinter: We've been speaking today with Edward Abraham s , president of the
Personalized Medicine Coalition . You can learn more about Dr .
Abraham s work by going to personalizedmedicinecoal ition.org or
follow them on Twitter @ per medcoalition.

Dr. Abraham s , t hank you so much for your leadership on this really
important movement and for joining us on Conversations on Health
Care today.

Edward Abrahams: Thank you for the opportunity .

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M ark Masselli: At Conversations on Health Care , we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy . Lori Robertson is an award - winning journalist and managing
editor of FactCheck.org, a nonpartisan, n onprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. politics.

Lori, what have you got for us this week?

Lori Robertson: We looked at ads the Democratic Congressional Campaign Committee
has aired in House races across th e country and found a few that
make misleading claims about health care . For instance, a TV ad in
rd
Iowa misleadingly said that 50% of the non - elderly in the 3 district
have preexisting conditions . Yet Representative David Young " voted
to deny protection s for their health care coverage " . His vot e for the
American Health Care Act would have lessened such protection for
those on the individual market , where 6% of all Iowans get their
coverage.

The 50% figure comes from the liberal leaning Center For American
Progress , which applied Census Bureau population data to an Obama -
e ra Department of Health a nd Human Services Report . That report
estimated how many Americans could be denied coverage charged
more or face d coverage exclusion if they were seeking coverage on
the individual market before the Affordable Care Act ' s protections
went into effect in 2014 .

Those not seeking insurance on the individual market, including those
with employer sponsored insurance, which is where about half of
Americans get their cover age, wouldn't lose their insurance because
of any preexisting conditions. It's true that while the GOP health care

Edward Abrahams

Bill , for which Young voted , wou ld have prohibited insurance
com panies from denying coverage based on health status . It would
have allowed in surers on the individual market to price premiums
based on health status in some cases in states that allowed it.

Two other DCCC ad s said Republican candidates in Colorado and
Pennsylvania cast votes against those with preexisting condition s,
even though the law makers ultimately joined Democrats to vote
against the GOP health care bill in the House . Representative Mike
th
Coffman in Colorado's 6 District and Representative Brian Fitzpatrick
st
in Pennsylvania's 1 were among the 20 Republicans who voted
again st the American Health Care Act .

That's my fact check for this week. I'm Lori Robertson, managing
editor of Fact C heck .org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country ' s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you 'd
like checked, email us at chcradio.com . We 'll have FactCheck.org ' s
Lori Robertson check it out for you here on Conversat ions on Health
Care .

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Mark Masselli : Each week , Conversations highlights a bright idea about how to make
wellness a part of our c ommunities and everyday lives. Students of
public health are often tasked with devising interventions for
ad dressing som e of health ' s biggest challenges. For Harvard T . H. Chan
School of Public Health students , Dan Wexler and Pri y a Patel , their
idea netted an award. The students were tasked with addressing food
insecurity in underserved parts of the world, includi ng neighbo rhoods
in their own backyard. They thought of the current trend of meal or
meal services like Blue Apron and wondered what if we modified that
business model to serve the needs of those living in food deserts .

Wexler and his partner sourced food delivery companies that could
provide prepackaged meal kits with all ingredients included, even
spices, dressings , and recipes. They designed refrigerated kiosks that
could easily be placed in local neighborhoods .

Dan Wexler : I think the biggest change is that ther e is no delivery system door to
door per s e, and that by going and setting up these kiosks in the
community, you can have a very lean design. You don't need a
store front . You don't need to have inbox refrigeration . You are very
much addressing the need of access by physically saying, hey, here is
healthy food. It's convenient because everything you need is in the

Edward Abrahams

box. The directions are very picture based. There's a lot of literacy
issues . J ust really thinking about how can we take all those lean
design pri nciples to facilitate access , t hat really I think make it a
solution that has the potential for impact.

Mark Masselli : They also conducted research with local ethnic groups to create
recipes that would resonate with their families.

Dan Wexler : Then we just went down to the community and did taste testing, talk
to people and said do you like this? What do you want to be able to
eat for dinner? [inaudible 00:23:21] issue is that similar texture s,
similar spi ces. One thing that we found is there's a little bit of
contention between parents who want to eat more traditional foods
and kids who want to eat more American foods. We tried to bridge
those gaps. One of our recipes , for instance, is a Chicken Pot Pie
Pasta . It's kind of fun sounding, but also we use a lo t of traditional
seasonings and spices.

Mark Masselli: Customers can simply walk to the kiosk and purchase their meal kits
with the snap cards or cash . The kiosk will be run by the residents of
the neighborhood, g iving them an opportunity to run them like a
franchise , offering an economic benefit to the community as well.
Their idea earn ed them the Rabobank - MIT Food & Agr i business
Innovation Prize and $15,000 in startup money to launch their
enterprise .

A low - cost portable, healthy meal service placed in p ortable kiosk s in
food desert neighborhoods to address the problem of poor nutrition,
providing an economic opportunity at the same time , n ow that's a
bright idea.

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Mark Masselli: You 've been listening to Conversations on Health Care. I am Mark
Mass elli.

Margaret Flinter: I am Margaret Flinter.

Mark Masselli: Peace and health.

Margaret Flinter : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at chcradio.com , iTunes , or wh erever you
listen to podcast s . If you have comments , please email us at
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