Peter Kolchinsky Profile picture
Aug 30, 2020 8 tweets 3 min read Read on X
No viruses in this one but it’s still fun. In the spirit of the enemy of my enemy, there was once a time when MALARIA was a dangerous friend worth having in the fight against a deadlier pathogen: SYPHILIS. Like Godzilla vs Mothra, doctors would infect patients dying... Image
...from syphilis w/ malaria to cause them to spike a raging fever. Syphilis is a really nasty bacteria that for millennia was considered incurable, though patients could recover if their had a high enough fever... esp on Saturdays. Image
Malaria was hardly a walk in the park & one might not consider trading malaria for syphilis to be medically ethical, except that there was a drug, quinine, for malaria. So idea was to cure syphilis w/ malaria & cure malaria w/ quinine. Fun fact: quinine glows in black light: Image
Quinine comes from bark of a special tree that was known to help treat malaria for centuries; quinine itself was purified from the bark in early 1800. It took an Austrian psychiatrist in 1917 to connect the dots to come up w/ “malariotherapy” for syphilis. Image
Syphilis is an STD, so why a psychiatrist? B/c although infection shows up initially as lesion on genitals or cervix (sometimes also a rash elsewhere on body), it goes quiet for years, decades even, & then can reawaken in the brain (don’t look below). So called “neurosyphilis”... Image
...would sometimes have psychiatric symptoms, such as mania or dementia, making it logical that a psychiatrist would give thought to use it to induce fever to treat syphilis. Julius Wagner-Jauregg’s discovery of malariatherapy in 1917 won him Nobel Prize for it in 1927. Image
In 1943, penicillin was approved and was a way better cure, so we don’t need Godzilla anymore. That’s good because malariotherapy killed 15% of patients... kind of like Godzilla destroys at least 15% of any city it saves. Image
Of course, there are antibiotic-resistant strains of syphilis on the rise at a time when Congress is talking up price controls on biomedical innovation, making it even harder than before to justify investing in antibiotic companies. Oh well... at least we have malaria. Image

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More from @PeterKolchinsky

Mar 14, 2023
So let's get this right... @statnews elevates someone who would talk the US (as they have other countries) out of paying for a life-saving drug like Trikafta instead of recognizing the courage and intellect of someone like Gunnar Esiason @G17Esiason...
...who has #CF, considers himself fortunate to be able to get Trikafta in US thanks to insurance that hasn't yet totally succumbed to bad math, & advocates for the value of the lives of patients elsewhere, urging other countries not to fall for bad math.
realclearhealth.com/articles/2022/…
Should the staff at STAT recognize that they, like all of us, are or will someday be patients, they might not honor math that undervalues their lives and lives of their readers.
Read 4 tweets
Mar 12, 2023
Some say "urging calm" makes people panic more; stay quiet. I disagree.

The source of panic is uncertainty. People are afraid to talk about risks of a run on their bank in case they give everyone ideas. But everyone already is wondering about their bank. So let's talk.
SVB's failure is not some punishment for tech elite who can handle losing their money... because it's not about the elite and b/c depositors almost certainly won't be losing their money.
Though banks fail all the time affecting individuals and small businesses every year, they tend to be small regional banks. SVB is the largest since WaMu in 2008, and some of the most innovative companies in the US are simultaneously affected b/c that was SVB's specialty.
Read 24 tweets
Feb 24, 2023
One year since Russia attacked Ukraine, don’t take a moment of silence. Give real thought to year 2.

See how aid works in detail by reading @directrelief‘s report. See where money & medicines come from & where they go and how. Let that guide what you do directrelief.org/2023/02/ukrain…twitter.com/i/web/status/1…
Direct Relief is THE MAIN non-profit in the world capable of taking in, storing, and distributing donated medicines & other medical supplies to regions in need during peacetime, war, & catastrophe.
A year ago, some of us in biotech gave to DR to buy generators for hospitals. Several months ago, we donated to enable purchase of ambulances. All the while, @tevapharmeurope, @PerrigoCompany, @novartis, @pfizer, & many others have been donating literally tons of medicines.
Read 9 tweets
Feb 18, 2023
How much do you think ICER math (which Democratic Party often cites) would say US should spend on drugs/vaccines against smallpox in case of outbreak/pandemic?

(I estimate it spends ~$100m/year)

@statnews @SenateHELP @icer_review @IAmBiotech @PhRMA @SchaefferCenter @NPLB_org
Hint: ICER takes a very simplified approach to valuing a medicine that requires that someone be sick so they can be treated and get a measurable benefit in the present to score any value. If no one is sick, there is no benefit (no effectiveness).
So what happens when you divide even $1 by zero? That’s right. The equation breaks. Most people would say “but we are paying for those smallpox medicines/vaccines in case of an outbreak or pandemic”. That’s called risk reduction. It reflects that we value peace of mind.
Read 26 tweets
Feb 17, 2023
M&A is a necessary process of resorting products, cash, & people to where they are most highly valued. Whether the moment feels like sex or autophagy, it's disruptive to people who may wonder what their next job will be. We can help with that.
racap.com/the-right-job#…
There are tons of great jobs across our ecosystem. Many are at companies in the RA portfolio. When a company is going through M&A, at invitation of CEO & HR team, we presented to their team a Talent Briefing of many of the relevant jobs in the RA ecosystem.
And even Talent Briefings aside, if you are interested in learning more about those positions across our portfolio at anytime, here's the spot: open-positions.racap.com/?company=portf…
Read 4 tweets
Jan 13, 2023
Tension among insurance, innovator, & patients w/CF over access to life saving medicine is gutting. B/c Vertex was providing copay assistance, insurance plans stopped covering its drug. So Vertex cut back. Other innovators & their investors watching: what will patients do?
Here's how insurance and innovation are supposed to work together. Can't have most biomedical innovation w/ insurance, and insurance wouldn't be as valuable w/o treatments/cures to pay for. They are intertwined.
Insurance can ignore that value of medicine like Trikafta is much greater than seemingly high price society pays now. In the long run, this medicine will be generic and still saving lives. Vertex has transformed how humanity will think of CF forever. nopatientleftbehind.org/about/value-of…
Read 11 tweets

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