In my nearly 50 years on this planet, I have yet to see a year as surreal as 2016. In fact, Merriam-Webster quite fittingly designated “surreal” as the word of the year. With attention-grabbing headlines on everything from growing political/racial tensions and the continuing conflict in Syria to the deaths of some of our most beloved celebrities and hordes of scary clowns, this past year has indeed been eventful.
And in a year of big news headlines, the health care industry managed to make some of its own. Let’s take a look at some of these stories as we consider what the future of health care will look like.
• CRISPR-Cas9 really stirred the imaginations of science-minded folks in 2016. It’s a technology that carries the potential to treat medical conditions by editing genes. Currently, CRISPR-Cas9 is the simplest, most precise way out there to manipulate genes. But some, scientists and nonscientists alike, are concerned about the ethical ramifications involved. For example, if genetic engineering can be used for good purposes, can’t it also be used for evil purposes (think bioweapons)? Furthermore, if a genome is in fact edited for the “greater good” (say, getting rid of disease-carrying organisms), how might that disrupt the ecosystem at large? And where exactly does one draw the line? Are we headed towards a world where designer babies are the norm? Regardless of these concerns, researchers have already had a field day with CRISPR-Cas9, accomplishing such tasks as stopping cancer cells from multiplying, reversing blindness-causing mutations, and developing fungi-resistant crops. Startups specializing in developing CRISPR-Cas9 therapies are going public and/or partnering with such bigwigs as Bayer and Regeneron Pharmaceuticals. So wherever the breakthrough technology takes us, count on there being lots of money in the picture.
• Another big story in 2016 was the backlash against Big Pharma and its widespread practice of raising the prices of its medicines. Such go-to villains as former Turing Pharmaceuticals CEO Martin Shkreli (who famously raised the price of antiparasitic drug Daraprim from around $14 to $750 per pill) and Mylan (which raised the price of its EpiPen allergy-reaction injector by a factor of six over the course of seven years) raised the ire of the public and politicians. Companies such as Pfizer, AbbVie, and Biogen also got in on the action, raising prices on multiple therapies to drive revenue growth. What’s more, the byzantine pricing system for drugs is complicated and opaque, with discounts and rebates for some (e.g., powerful buyers such as pharmacy benefit managers) driving up costs for others (e.g., individual consumers). All of this negative attention paints pharma and biotech companies as greedy and insensitive to the well-being of patients. Drug wholesalers took it on the nose too, with declining stocks for such giants as McKesson, AmerisourceBergen, and Cardinal Health. The jury is still out as to what new regulations will be imposed on Big Pharma, but it will certainly be interesting to see how this issue plays out in 2017.
• The election of Donald Trump has caused quite a stir, as the world waits to see what kinds of changes are ahead. One area of great uncertainty is what the future president will do with health care. Trump has promised to dismantle Obamacare, and swiftly, but lately he has hinted at amending the law rather than repealing and replacing it. A longtime proponent of universal health care, which is decidedly unpopular among Republicans, Trump may be forced to go an entirely different route. His controversial nominee for secretary of the Department of Health and Human Services, Congressman Tom Price, is even more opposed to Obamacare than Trump; he has been proposing alternatives to the act since it was signed into law. He also differs from the president-elect in proposing that insurers should no longer be required to cover pre-existing conditions. In other news: Republican leaders are looking to cut federal Medicaid spending, leaving it up to the states to either expand or reduce the program. Other items on Trump’s agenda include establishing drug pricing transparency (see above) and allowing consumers to buy imported drugs from other nations. It looks like major changes are afoot with the incoming administration.
• The US opioid epidemic is perhaps most tragic among health care news stories this past year. Drug overdose deaths have bypassed auto accidents as the leading cause of accidental death in the country. On average, 91 people die from opioid-related overdoses each day. These deaths have more than quadrupled since 2000. Some 80% of heroin users started out by abusing prescription painkillers; most often, these users find heroin to be less expensive to buy and easier to obtain. What’s worse is the flooding of counterfeit painkillers on the market. Fentanyl, which is primarily being smuggled in from China via Mexico, is an extremely dangerous and potent drug that is often being cut into heroin. (It is so powerful that an amount the size of three grains of sugar is lethal to an adult.) It was recently reported that three-fourths of opioid overdoses in Massachusetts are fentanyl-related. So how do we fight this epidemic, which has been called the worst in our nation’s history? Certain programs have been put in place to monitor physicians and their prescribing practices. Incoming president Trump has promised to crack down on the flow of drugs coming in from Mexico. But to address the epidemic, there needs to be a broader implementation of solutions. Government agencies and organizations that focus on public health and family welfare need to focus on prevention, intervention, treatment, and recovery. Big data needs to be harnessed to understand and track opioid use and abuse. Innovative programs such as long-term treatments for addiction need to be encouraged. It will take cooperation and determination, plus a new and more forgiving lens through which we look at addiction, to battle this crisis.
• Zika took many by surprise. Spread by a certain breed of mosquitos, the virus can be passed from pregnant women to their babies, which can then cause severe birth defects. Moving past Asia and Africa, where it had existed in years past, Zika first reached the Americas in 2015. Dire predictions about the infection’s potential damaging effects were floated by specialists at the beginning of the year, but numerous folks pooh-poohed those predictions, even categorizing them as “boy who called wolf”-type scare tactics. President Obama asked Congress for money to prevent the transmission of the virus in the US and to study its effects. Not very surprisingly, Congress got caught up in partisan debates and ultimately granted what I consider too little too late. (For the record, Congress provided $1.1 billion, eight months after the funding bill was introduced.) As of mid-2016, 442 US women with possible Zika infections had given birth, with 6% of those babies (26 total) being born with Zika-related birth defects, primarily microcephaly. Today, the first experimental vaccine is set to begin clinical trials in humans. Perhaps next year will bring a real solution to the problem.
Diane Ramirez has been a member of the D&B editorial department for more than a decade. She currently covers the health care and insurance industries for Hoover’s.