On the occasion of a documentary about living with cystic fibrosis and the drug that turned his life around, Gunnar Esiason reflects on his personal struggle, the roles of patients and their caregivers in drug development, and the scientific struggle we so rarely see publicly depicted.

Last week’s publication in the Forum for Health Economics and Policy of Valuing the Societal Impact of Medicines and Other Health Technologies: A User Guide to Current Best Practices is a watershed moment for the field of health economics and outcomes research. 

Today, AbbVie announced it is acquiring Aliada for $1.4 billion, motivated by the potential for ALIA-1758, Aliada’s lead program, to be the best-in-class for the treatment of Alzheimer’s disease, and by the potential of the BBB-crossing platform to enhance its discovery and development efforts for other difficult-to-treat neurological diseases. As we congratulate the Aliada team, we wanted to share a bit more of the story behind the second significant acquisition from our Raven incubator this year and the first full-circle acquisition of a company we built with technology spun out from a larger company.

Policies favored by both parties’ leadership – who find it politically easier to battle made-up bogeymen than tackle real issues – threaten to undermine our national health security and eviscerate America’s world-leading innovative drug development industry.

The link between environmental sustainability and health outcomes — now a hallmark of planetary health — builds on a foundation of public health, which brings a systems-level approach to health issues.

A LinkedIn discussion about “crossover” financing rounds deepened my sense that we’re not all saying the same thing when we’re saying the same thing. And that’s a challenge, if not necessarily always a problem, in an industry that’s only becoming more scientifically and financially complex as it matures. Because to understand one another and avoid unnecessary hiccups it helps to have a common language.

Whether you enjoy air travel or not, it’s increasingly common and persistently bad for the environment. Almost three million passengers fly in and out of US airports each day and global demand for air travel is expected to double by 2050. In addition to emitting pollutants that lower air quality, aviation is recognized as a hard-to-decarbonize sector and accounts for ~3% of global CO2 emissions. Airlines have recently announced commitments to switch to "green" fuels, but as of today 95% of jet fuel is produced from fossil fuels. Why is that? 

Many people who dedicate their lives to discovering, developing, and making new, lifesaving drugs don’t understand the extent to which the drug industry has failed to communicate its value proposition to society and to inspire its customers to pay for that value. That is to say, when the public and even legislators representing our biotech innovation hubs focus on the price of a breakthrough drug without a sense of its value or how it came into being and insist that innovators should not only invent medicines but pay for them, too, that’s a self-inflicted wound. Vertex’s Trikafta, one of our industry’s greatest success stories, provides an example.

It’s fairly typical for companies to share confidential data with investors of their choosing before completing financing transactions, before publicly disclosing the data or the financing. How is this fair? Shouldn’t everyone get a chance to see the data so that no investor gets a better deal than anyone else? Peter Kolchinsky and Sarah Reed break down what’s allowed, what’s common, and what’s logical.

As a pioneering PDAB takes its first baby steps in Colorado, we’re getting the impression that we’re watching the rules being made up as it goes along. Fortunately, we’re also witnessing the power of organized and impassioned patient advocacy to slow, reverse, and maybe someday reshape misinformed public policy.

A year ago we published the first “Semper Maior” piece, making the case that biotech was on firm ground and ready for a reboot. We put out the second piece last summer, when it felt like the rebound was underway. Had the year ended in October or even November… well, you know. But here we are after a general market and XBI surge feeling like biotech is now truly recovering from its prolonged downturn. So let’s mine the data, as we have before, to get a sense of what happened in 2023 and what lessons to take with us into 2024.

Let’s talk about something everyone produces but nobody really likes – trash. People produce billions of tons of waste annually. While there are many ways to reduce the amount of waste we produce, it is not possible to stop it entirely. Waste is, quite literally, inevitable. The disorder (entropy) in the universe increases with time, which just means that things will always break and there will always be some amount of waste. Once our things become our trash, we have two options: we can dispose of them or we can try to reclaim them as a resource. From a planetary health perspective, there are a lot of reasons to want to reclaim wastes as resources. Unfortunately, it is not easy to do so economically.

Our mission at RA Capital Management (RACM) is simple: to improve the health of each and every person in the world. Staying true to RACM’s mission, the Planetary Health team invests in profit-seeking companies that benefit people by improving the health of the planet.

European central planners should stop trying to talk the US out of incentivizing the development of better medicines that then also help Europeans and the rest of the world. It’s one thing to argue that any one country can’t afford to pay more for new drugs. It’s another thing entirely to put new drugs in jeopardy for everybody by exporting that thinking to the one country whose market-based system has underpinned the last several decades of pharmaceutical advances.

The technological renaissance in covalent inhibitor technology over the past decade is impressive. Relatively recent advances in structure-based drug design have unlocked the tantalizing opportunity to engineer covalency into small molecules. Now, RA Capital has incubated and seeded Hyku Biosciences to unlock histidines, tyrosines, and lysines for covalent modification to greatly expand the druggable proteome.

Silverback Therapeutics’s wind-down and reverse merger process can serve as a template for other companies when their clinical trials fail. The company’s response to its setback also teaches us about scenario planning, the importance of moving quickly when a key program doesn’t deliver hoped-for data, and why we should look ahead to a biotech ecosystem that anticipates the consequences of – and opportunities stemming from – its inevitable clinical setbacks.

Our January 2023 analysis Semper Maior: Time to Reboot Biotech argued that the development-stage biotech industry had found its footing, following one of the sector’s most sustained and painful drawdowns. Now, in our first update to that analysis, we’re happy to report that development-stage biotech remains on solid ground. In the first half of 2023, biotech investors harvested considerable gains from M&A and have already partially redeployed that capital back into what is now a smaller, slightly more highly valued set of promising development-stage companies.

Clinical trials can fail, regulators change their minds, manufacturing might run into an unsolvable glitch, and venture capital might dry up. Given all the risks small biotech companies face that are outside of their immediate control, might it be safer to just work for a more stable, revenue-generating company? Maybe! But before you rule out jumping into a small biotech, consider the pros and cons.

It’s long been assumed that as long as NICE-like cost-effectiveness analyses stay on the other side of the ocean, our US biotech ecosystem will be fine. But in recent years, toxic math has begun to make its way to US soil. Peter Kolchinsky sat down with Jayson Dallas to get his take on NICE’s tactics, their increasingly global reach, and how biopharma can fight back.

The treatment of NDA-path drugs in the Inflation Reduction Act materially degrades the investment case for these treatments in age-related diseases and thus jeopardizes future biotechnology progress and the health of America’s seniors.