CEO of ABC Diagnostics Takes a Hint from Allergan's Saunders

Theral Timpson

We found the following wadded up next to a trash can:

CEO Blog: Another Social Contract with Patients

Lately, there has been zero focus on the price of diagnostics.  Damnit.  Drug companies get all the attention.   And the profits.  I’m writing out a new social contract for diagnostics companies. 

It’s often said that 50% of solving a problem is in first of all defining the problem.   This holds true for medicine as well.  If a patient pays $100,000 for a medication, we should get paid $100,000 for the correct diagnosis.  Period.

According to a recent study, 12 million Americans are misdiagnosed each year.  This is water off the drug companies’ backs.  Their drugs will be prescribed anyway.

Unfortunately no one in the diagnostics industry has taken any aggressive, let alone predatory approach to pricing.  Therefore, we will.

There are four principles to the social contract:

1.  Invest and Innovate

As an industry, we risk billions of dollars to develop life saving and life enhancing diagnostics.  Yet we can’t pay our lighting bill.   For similar innovation, our counterparts at drug companies get paid hundreds of millions in salary and bonuses.  I hope I can work there someday.

2.  Access and Pricing

You want access?  Then it’s time we joined the American economy and got some self respect.  We must raise prices.  

Obviously we have approached CMS in the wrong way all these years.

Rather than pulling our pants down and waiting each year to see how much lower they will drop our pricing, we commit to being much more proactive.  As of today, we commit to raising our prices considerably, multiple times per year, and at the least by 100% each time.  These pants are not coming down until I get home to a good glass of wine.

In other words, we will engage in price gouging actions and predatory pricing.

I commit to ending up in a congressional hearing.  With my pants up.

3.  Quality and Safety

It has been said that the diagnostics industry’s low pricing plight is a result of their lack of quality products.   We commit to stop sneaking around the FDA and to stop going direct to the consumer with half baked products all at the price of a bake sale.  Yes we can.

4.  Education

We are committed to educating physicians.   The use of a diagnostic test might result in a drug company selling a single medication to a single patient for hundreds of thousands of dollars a year.  We commit to getting in bed with these drug companies.

There is such unbridled joy in my heart when a Dx company finds itself in the spotlight.  A joy I never experience.  

--John Smith, ABC Diagnostics, Inc.

Five Reasons France Has Become the Number One Anti-Vaccination Nation

Theral Timpson

A recent study shows that the French are, to an alarming degree, against vaccinating.  Huh?  The ultra secular and increasingly atheist, nuclear power dominated, science loving, Voltaire producing French?  It doesn’t make any sense.  According to this study a whopping 41% of the French are holding out against vaccines.  Compare that to just 14% in the U.S.  Which nations are best about their vaccinations?  Those in Southeast Asia and Africa.  They still remember what it’s like to not like polio.

Stunned by this number, we wrote to several people in France asking why almost half the country is against vaccinations.  They offered these five reasons:  

1.  No bonbon, no buy buy.  Michel Macaroon of Aix en Provence told us that any product that doesn’t make it ultimately into a bakery or restaurant is going to do very poorly with the French.

2.  The power not to shower.  According to Helene Sale of Paris, the French are very happy to see that other people around the world finally understand why they do not shower or bathe.  “Our bodies have these amazing natural bugs called bacteria.  They protect us.  When one does not--how do I say--wash them off everyday, like in America, then one is naturally protected from these diseases.  Oui?”

3.  The power that is France.  Jacques Guerre is a capitaine in the French military.  “Are we not known for our Resistance?” he asked.

4.  Le Grande Tragedie.  Audrey Appris, a professor at l’Universite Paris-Sorbonne, wrote in, “Why should we limit the tragically beautiful diverse ways of dying?”

5.  Yes, yes . . . and all that.  The well known chef, Alain Passard had his secretary write back.  “Yes, yes, we’re the country of Pasteur and Voltaire and all of that.  Please don’t bore me.  Really, I ask, what cannot be cured with the finest Chateauneuf de Pape?”

Oui, oui, indeed. 

The All American EpiPen Timeline

Theral Timpson

Millions of years ago - Bees sting humans.  Certain humans eat nuts.  Anaphylactic shock happens.

1973 - Some All American humans are increasingly afraid that other humans will attack on them with chemicals.  The Pentagon asks scientists at a company called Survival Technology, Inc. to develop a quick treatment for when humans are fried by nerve gas.

1977 - All American Shel Kaplan invents the CombiPen.

1998 - All American Heather Bresch claims to receive an All American MBA from West Virginia University.

2004 - Shel Kaplan improves the CombiPen into the EpiPen.  He doesn’t know that Heather Bresch will make millions of dollars from his invention. 

2007 - Mylan Pharmaceuticals buys EpiPen product from Merck.  The All American EpiPen is selling for $57.  It injects a dollar’s worth of the generic hormone epinephrine to treat anaphylactic shock.  

2007 - Heather Bresch is Mylan’s COO.  She makes $2.5 million a year.  The All American light goes off in Heather Bresch’s head regarding the EpiPen.  

2007 - After a newspaper calls, All American West Virginia University quickly grants Heather Bresch an MBA degree.  It wasn't granted in 1998 because Heather Bresch completed only half the coursework.   In her All American way, Heather Bresch thanks the newspaper for investigating her,  “I owe you a thank you for pointing out the administrative nightmare around my MBA.”

2007 - Mylan Pharmaceuticals is a major donor to West Virginia University.

2007 - Heather Bresch’s dad is an All American governor of the state of West Virginia.  West Virginia University is one of the state’s largest employers.

2009 - Shel Kaplan, inventor of the EpiPen, dies in obscurity, having made no money in All American royalties.  

2011 - Mylan raises the price of the EpiPen to $198.64.  Heather Bresch is named “Patriot of the Year” by the All American Esquire magazine.

2013 - Congress passes the School Access to Emergency Epinephrine Act.  Mylan raises the price of the EpiPen to $264.50.

2015 - In their All American way, Mylan moves their headquarters to the Netherlands to avoid paying the United States taxes.  Heather Bresch is named one of Fortune Magazine’s “50 Most Powerful Women in Business.”  Her income is $19 million a year.

May, 2016 - Mylan raises the price of EpiPen to $608.61.  Yearly sales of EpiPens are over $1billion.  EpiPens bring in 40% of the company's profits.  Newspapers around the country blow the All American whistle.

August, 2016 - Senators knock on Mylan’s door.  Heather Bresch's dad is now a senator.

August, 2016 - Heather Bresch answers, “Hello Senators. Hello Dad.  Would you like a champagne-bourbon cocktail?  As dad knows, In West Virginia, we call this drink the All American Persephone. . . . Now senators, no one’s more frustrated than me.”   

August, 2016 - Hillary Clinton tweets an All American tweet.  Biotech stock indexes drop sharply.   Mylan says price of EpiPen will remain the same.  Offers some patients some All American assistance.

August, 2016 - Mylan’s stock value drops $3 billion in 5 days as All American investors panic.

August, 2016 - If Heather Bresch gets fired, her All American golden parachute is worth $61.5 million.

10 Genomics Questions for the Presidential Candidates

Theral Timpson has just released 20 science questions for the presidential contenders.  We thought we'd send in our own list of 10 genomics related questions.  Here they are:


1.  Will you get your genome sequenced, and 

   A.  Donald, will you show us what percentage of Neanderthal you have?

   B.  Hillary, will you show us the variants you keep on your private home server?


2.  If Obama could be cloned, should his clone be able to run for another term?


3.  Which of the following would make the best Moonshot:

   A.  A regular genetic screen for all members of congress for 20 intelligence variants 

   B.  Making sure all firewood around the country is non-GMO and gluten free

   C.  Installation of a pipeline from Canada to the US, but for prescription drugs, not oil

   D.  Enable school kids everywhere to sequence their own genomes on the MiniSeq


4.  What is the microbiome? 

   A.  Donald’s private parts

   B.  The chance of Gary Johnson getting into the debates

   C.  Another word for Hillary’s idealism

   D.  Jill Stein’s favorite strain of non-GMO pot 


5.  What’s your position on LDTs?  (Hint, it’s not a drug or a religion or a sexual identity.)


6.  How are you going to one up Obama’s Precision Medicine Initiative?  (Hint:  Put in some actual money.)


7.  What is an exome?

   A.  The genome of one of Trump’s ex-wives 

   B.  The portion of the genome that appears on an X-ray

   C.  The only portion of the genome that Gary Johnson thinks the government should be interested in

   D.  The genome of a voter turned away from the polling station


8.  During the next 4 years a trove of genetic information will come in.  To deal with this onslaught, how important is it that a National Genetic Counselor be the next new cabinet position? 


9.  What is CRISPR?

   A.  GMO bacon

   B.  Part of the refrigerator

   C.  Part of the future

   D.  A national council in favor of stiffer hundred dollar bills

   E.  The New York City dry cleaner where Trump gets his shirts done


10.  If it turns out that we can’t cure cancer in the next four years, how will you break this to the people?

Gene and Tonic, July 8, 2016: 49ers Going into Genetic Testing

Theral Timpson

Just two years at their new home in Silicon Valley and not far down the road from 23andMe, the San Francisco 49ers are offering their fans genetic testing and the chance to donate blood to advance human genome research.

Announcing a partnership with the company ORIG3N, the 49er Chief Operating Officer, Ethan Casson, says that “this is the first agreement of its kind where a major sports organization can give back to the human genome some of what the genome has given to professional football players.”

ORIG3N CEO said, “it’s an incredible opportunity to show 49er fans just how bad their own sports genes are compared to an average NFL player, to say nothing of warning them of cancer, Alzheimer’s, Parkinson's and anything else that could some day kill them.”

He also said his company name was so bad that they needed a major deal like this to go anywhere.

Scientists who weighed in on the announcement praised the 49ers for their progressive attitude to health, saying that if the 49ers can’t end all the concussions, perhaps they can help out in this other way.

George Church, who has spent years trying to go about collecting DNA samples in the right way, said, “screw it,” and volunteered to be an usher at the games and give tests to the fans.

“We always hear that we are ‘ushering’ in a new era of medicine,” he reminded.

Luke Timmerman reported on his Report that he just got back from the White House where he overheard the Veep expressing some envy of the 49ers deal.

“We have to use this one press room at the White House to get people participating in the President’s Initiative and my Cancer Moonshot,” said Biden. “And they have a stadium!”

There was one lone editor at the San Francisco Chronicle who chimed in with skepticism of the 49ers getting into genetic testing (moving south): “Do we need any more proof to know that there is something wrong with the Silicon Valley water? Whoever drinks it always comes up more thirsty . . . for data."

Gene and Tonic, July 7, 2016: Not the Scientific Method

Theral Timpson

On Monday the New York Times published an OpEd for a guy who wants to take the scientific method away from scientists.

There was immediate outrage from Scientific American. Their executive editor wrote, “I am shocked that in a liberal society such as those who read the New York Times and drive Priuses, a society which prizes itself for valuing the uniqueness of others, that scientists are now being singled out and persecuted in this manner. The next thing you know, scientists won’t be able to use either bathroom. After all we gave you--the moon and Silicon Valley and glowing plants for your cubicles--and we get repaid like this?”

The author of the Times piece tells scientists that they can’t have their method because they can’t use it on themselves. And furthermore, just because poets and philosophers aren't as precise as scientists, reads the article, doesn’t mean they can’t use the method.

Many were in disbelief that the New York Times would run such a piece. In fact new scientific theories were springing up hourly, such as the Subway Theory based on the likelihood of New York Times journalists riding the subway with journalists from The Onion and accidentally dropping and picking up the others’ stories.

The Times spokesperson denies this saying, “anyone who bothers to stay apprised of the media business would known why it’s not true. The numbers just don’t work out. The Onion is down to a staff of two sitting at the table: the editor and the onion. At the Times, those of us left can’t even cook with onions."

Another theory is that a Times journalist and an Onion journalist walk into a bar together. After getting drunk they decide to swap stories and see what happens.

Proponents of this theory think it’s happened many times before.

Update: It’s rumored that the story intended for the Times that went instead to The Onion was a piece by Carl Zimmer saying he was the first journalist to have his genome sequenced. Zimmer denies this, insisting the story was intended for STAT News.

Gene and Tonic, July 7, 2016: Vermont's New Law and the Nobel Laureates

Theral Timpson

On July 1st, Vermont’s GMO labeling law went into effect. All food sold in the state that has been genetically modified has to say so on the label.

While some geneticists are throwing their hands up in the air in total exasperation, others are consulting big food.

“It’s all been genetically modified at some point. So put GM on every piece of food,” reads one consultant’s email. “They’re Vermonters. While you’re changing the labels--which I do understand isn’t cheap--you might as well put, ‘Have a beautiful and pleasant day, Vermont!’”

Still other geneticists are more optimistic, such as Nathan Pearson here on Mendelspod. Put GM on the label, he suggests. The next thing you know, the average shopper will be requesting GM products at their local market.

There was one group of scientists that has been very upset. They all won the Nobel prize, and so they sent Greenpeace a letter accusing them of “a crime against humanity.”

Greenpeace is the leader of the anti-GMO crowd, making them basically the Vermont of non-profits.

A spokesperson for Greenpeace said that the Nobel winners could “go f*** themselves, and gene drive their a**holes out of existence."

Oh, no, we got that wrong.  That wasn’t a spokesperson.   The spokesperson said, “We don’t get spanked by just anyone. Just because these people have a Nobel doesn’t mean they’re qualified to spank Greenpeace like this. How would you feel if you got spanked by over a hundred Nobel prize winners?”

A journalist familiar with the non-profit and wished to remain anonymous did say that Greenpeace had a tendency towards S & M.

“It’s part of the gig, right? Part of the act is to resist. They’re not the worse S & M pair in the world. In fact, I think they rather do quite well together,” said the journalist.

Gene and Tonic, June 24, 2016: "Best of" . . . this Week

Theral Timpson

Other than sitting by as Great Britain became Petite Britain, how did you enjoy the week? If anyone shares an office--like I do--with someone from the European Union (Austria), then you were allowed to focus on little else. But there were some fun items this week, which I’ve turned into a short “Best of” list.


Best Ad Campaign of the Week

This category has to go to STAT news. Just when they are running out of major stories to cover after six months in publication, they start coming out with some cool social media ads.



Best Ome of the Week

"Thanatotranscriptome: genes actively expressed after organismal death"

“It’s alive! It’s alive!” Scientists at University of Washington, Seattle found that some fish genes remain active up to four days after death. It turns out that death reverts us to a kind of embryonic state where some of our genes get upregulated.   In other words, our genes get the final say.

Think of it as a postscript to our lives:

“PS.  Boy, glad that’s over.” 

“PS.  No, no, no, no!!!”

How about, “PS.  Should have gone to Illumina for that whole genome sequence."

Or probably, “PS.  I lived to see Great Britain fall apart.”


Best Podcast Name of the Week

“Before you pop that Tylenol, tune into this podcast”

Is it just me, or did anyone else find this week’s Signal Podcast with Luke Timmerman and Meg Tirrell to be brilliantly named? It’s all happening at STAT News these days. I only wish I’d come up with this title for one of the Mendelspod shows.

It does inspire some alternate versions:

“If you think you have a headache now, just listen to our show.”

“Podcast, then Tylenol. Podcast, then Tylenol.”

Let's try some other medications:

“Before you pop that laxative, give our podcast a chance.”

“Wait. Do you really need that sleeping pill, when you can listen to our podcast for free from your iPad?”

“Listen to Mendelspod. Take an anti-diarroeahl.  And call me in the morning.”

Gene and Tonic, June 21, 2016: Flatley, Herper, Knoepfler, and the Brexit

Theral Timpson

Flatley on His Way to Sainthood

Not yet out of the corner office at Illumina, CEO Jay Flatley was further canonized today by Business InsiderAs 35th on the list of the BI 100 Top Creators of Value, we learn that Jay created the market for genetic testing from scratch.  

And just in six days.

For fellow lister, Anne Wojcicki of 23andMe, Flatley is known modestly . . .  as "the ruler of this whole universe."

For others, he's known as Jay of Arimathea because he founded the Holy Grail.  

For the upcoming list BI Top Destroyers of Value, Mendelspod wants to nominate John Carreyrou, journalist at the WSJ who took all of Elizabeth Holmes' money from her.  If it hadn’t been for Jon’s timely articles, Holmes might have been listed above Flatley as a Creator of Value--a thought that a year ago would not be so preprosterous.


Not Getting Off Thought Free

Forbes journalist, Matthew Herper, put his career on the line this week when he proposed an original idea.

The idea?  It doesn’t matter.  

“Journalists should not be putting their own ideas out there,” wrote one of a number of disgruntled readers.  “It’s the job of a Forbes journalist to build their brand, first of all, by repeating others, preferably Ayn Rand and, second, by piling up opinions that are free of any original thinking. 

Herper’s proposal, the creation of a government-run fund that would single handedly be able to lower drug prices, reveals a writer willing to risk it all.  

“Matt’s had a tough go of it at Forbes,” said a former mentor who wished to remain anonymous.  “I mean, just standing up for the FDA has already been a huge gamble.  First you become a lone wolf and fall away from the pack here and there, then before you know it, you begin to stumble on to your own ideas.  He obviously tries.  Even though he’s proposing a government program, he did put “market-based” into the headline."


83% of British Scientists Against Leaving the EU

Today we found out the Brexit is pretty much a done deal.  When so many scientists are against something, the majority of the people will certainly be for it.


My Guide for Reading My OpEd

Berkley stem cell biologist and compulsive blogger, Paul Knoepfler, authored an OpEd in the San Francisco Chronicle beating up on CIRM this past week.  Then he turned around and wrote another OpEd on his blog saying that he loved CIRM.

This practice is known outside academic circles as . . . . “being an academic.”

Come on, Paul.  It’s also known as being a waffler.  When you publish an OpEd, at least give your regular blog readers the day off.


Siddharta Mukherjee's Writing Career Just Got Dealt a Sucker Punch

Theral Timpson

Siddharha Mukherjee won the 2011 Pulitzer Prize in non-fiction for his book, The Emporer of All Maladies.  The book has received widespread acclaim among lay audience, physicians, and scientists alike.  Last year the book was turned into a special PBS series.  But, according to a slew of scientists, we should all be skeptical of his next book scheduled to hit book shelves this month, The Gene, An Intimate History.

Publishing an article on epigenetics in the New Yorker this week--perhaps a selection from his new book--Mukherjee has waltzed into one of the most active scientific debates in all of biology: that of gene regulation, or epigenetics.

Jerry Coyne, the evolutionary biologist known for keeping journalists honest, has published a two part critique of Mukherjee’s New Yorker piece.  The first part--wildly tweeted yesterday--is a list of quotes from Coyne’s colleagues and those who have written in to the New Yorker, including two Nobel prize winners, Wally Gilbert and Sidney Altman, offering some very unfriendly sentences.

Wally Gilbert: “The New Yorker article is so wildly wrong that it defies rational analysis.”

Sidney Altman:  "I am not aware that there is such a thing as an epigenetic code.  It is unfortunate to inflict this article, without proper scientific review, on the audience of the New Yorker.”

The second part is a thorough scientific rebuttal of the Mukherjee piece.  It all serves as a great drama about one of the most contested ideas in biology and also as a cautionary tale to journalists, even experienced writers such as Mukherjee, about the dangers of wading into scientific arguments.  Readers may remember that a few years ago, science writer, David Dobbs, similarly skated into the same topic with his piece, Die, Selfish Gene, Die, and which raised a similar shitstorm, much of it from Coyne.

Mukherjee's mistake is in giving credence to only one side of a very fierce debate--that the environment causes changes in the genome which can be passed on; another kind of evolution--as though it were settled science.   Either Mukherjee, a physicisan coming off from a successful book and PBS miniseries on cancer, is setting himself up as a scientist, or he has been a truly naive science reporter.   If he got this chapter so wrong, what does it mean about an entire book on the gene?

Coyne quotes one of his colleagues who raised some questions about the New Yorker's science reporting, one particular question we’ve been asking here at Mendelspod.  How do we know what we know?  Does science now have an edge on any other discipline for being able to create knowledge?

Coyne’s colleague is troubled by science coverage in the New Yorker, and goes so far as to write that the New Yorker has been waging a “war on behalf of cultural critics and literary intellectuals against scientists and technologists.”     

From my experience, it’s not quite that tidy.  First of all, the New Yorker is the best writing I read each week.  Period.  Second, I haven’t found their science writing to have the slant claimed in the quote above.  For example, most other mainstream outlets--including the New York Times with the Amy Harmon pieces--have given the anti-GMO crowd an equal say in the mistaken search for a “balance” on whether GMOs are harmful.  (Remember John Stewart’s criticism of Fox News?  That they give a false equivalent between two sides even when there is no equivalent on the other side?)

But the New Yorker has not fallen into this trap on GMOs and most of their pieces on the topic--mainly by Michael Specter--have been decidedly pro science and therefore decided pro GMO.

So what led Mukherjee to play scientist as well as journalist?  There's no question about whether I enjoy his prose.  His writing beautifully whisks me away so that I don’t feel that I'm really working to understand.  There is a poetic complexity that constantly brings different threads effortlessly together, weaving them into the same light.  At one point he uses the metaphor of a web for the genome, with the epigenome being the stuff that sticks to the web.  He borrows the metaphor from the Hindu notion of "being", or jaal.

“Genes form the threads of the web; the detritus that adheres to it transforms every web into a singular being.”  

There have been a few writers on Twitter defending Mukherjee’s piece.  Tech Review’s Antonio Regalado called Coyne and his colleagues “tedious literalists” who have an “issue with epigenetic poetry.”  

At his best, Mukherjee can take us down the sweet alleys of his metaphors and family stories with a new curiosity for the scientific truth.  He can hold a mirror up to scientists, or put the spotlight on their work.   At their worst, Coyne and his scientific colleagues can reek of a fear of language and therefore metaphor.  The always outspoken scientist and author, Richard Dawkins, who made his name by personifying the gene, was quick to personify epigentics in a tweet:   “It’s high time the 15 minutes of underserved fame for “epigenetics” came to an overdue end.”  Dawkins is that rare scientist who has consistently been as comfortable with rhetoric and language as he is with data.

Hats off to Coyne who reminds us that a metaphor--however lovely--does not some science make. If Mukherjee wants to play scientist, let him create and gather data. If it’s the role of science journalist he wants, let him collect all the science he can before he begins to pour it into his poetry.

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