Peter Kolchinsky Profile picture
Managing Partner, RA Capital Management. We build & invest in biotech companies. Virologist. Author, The Great American Drug Deal.
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28 Mar
Do patient groups perceive drug price controls (HR3) will end progress in treatment of many diseases? Cancer, Alzheimer’s, Parkinson’s... done. HR3 not benign. Price controls always kill investment in risky R&D. No “alternative” economics on that point.…
Some patient advocacy groups I’ve spoken with say “we don’t want to be seen defending drug industry”. And yet, as w/COVID, that’s who develops the treatments- that’s where hope comes from. What’s the point of having standing and pathos if you won’t use it to defend what’s right?
Some say “no, NIH invents drugs.”. They misunderstand. NIH builds foundation but not the product. It makes prototypes at best. But it’s takes the $160B of R&D each year to bring ~50 drugs/year to market... to patients.…
Read 11 tweets
28 Mar
Everything wrong w/ healthcare & drug pricing debate is evident in these slide. Healthcare costs in Massachusetts grew at 4.3% (slide 32). On 33, they report drug spending grew 7.2% gross of rebates. On 34, they show it’s only 3% growth net of rebates.…
Conclusion on slide 55 blames drug prices for Medicare spending growth, yet in footnote acknowledge its “not net of rebates”. Well why not? They clear know net drug spending growth is lower than almost every other aspect of healthcare. It’s clearly hospitals driving growth.
They talk about hospitals, but highlighting drugs is willful misdirection. As for patients’ costs, slide 42 & 47 shows shift towards higher out of pocket costs. So even as drug spending shrinks as a fraction of healthcare spending, Americans afford less & blaming drug costs.
Read 8 tweets
3 Mar
Last Call! Apply by Thu March 4th for Spring 2021 “Business of Biotech” discussion sessions (Wed, 3-5pm ET, March 10/17/24). If can’t make it, our virtual Thinkific materials (listed below) are available indefinitely & more discussions to come. Register at
RA Capital hosts course b/c we are inspired by all that we've seen the biotech industry accomplish for human health, have learned a lot of the past couple of decades, and want to share lessons learned so that biotech can be even better than it has been.
And now more than ever, we think it's important for everyone in biotech to understand and unite around Biotech Social Contract that governs what the public expects of innovators and insurance.
Read 25 tweets
21 Feb
Summary of Clubhouse chat (thanks @BiotechCH)... 5 injustices in a drug NPV model... 1) <100% of patients getting drug they need due to inability to afford out of pocket costs is injustice we mustn’t accept and therefore must push for insurance reforms that lower OOP costs....
2) assumptions of continued high profitability into out-years (eg >15 years) due a drug being hard or impossible to genericize (eg biologics, esp gene therapies) have a far greater cost to society than their contribution to the NPV.
That’s b/c society’s costs are net revenues discounted at 1.5-2%/year but NPV only counts out-year profits discounted at a much higher rate (~8%). So public & Congress is right to challenge drug prices but it’s not that they are too high... it’s that they are high for too long.
Read 25 tweets
10 Feb
This one might tweak your brain. There would be MORE interest in developing new antibiotics if NO ONE needed them today. Huh? Yep... let’s think about it. Today, no one needs drugs for smallpox nor pandemic flu. But those have been developed precisely because... 1/18
...we KNOW that we MIGHT need them in the future. The US contracts through BARDA w/ companies to develop drugs & vaccines (commit to buying a certain number of doses/year at a guaranteed price) b/c it’s buying an insurance policy. Members of Congress understand that. 2/
Media seems to understand that. Academics understand that. Presumably the public understands that. Drugs we don’t need AT ALL today are still worth buying to have in our back pocket JUST IN CASE. Logical. It’s insurance! 3/
Read 19 tweets
4 Feb
Some people think we overpay for only incrementally better medicines. That only home runs deserve high prices. But as in baseball- most are trying as hard as they can & job is to at least get on base. Sometimes, biology allows for a home run, but it’s not the strategy.
However you reward progress, it just takes a certain level of revenues to support industry of certain size, baseball or biopharma. Not paying for singles means paying more for home runs. It means less certain employment since not every disease lends itself to big breakthroughs.
But if you offer little reward for just getting on base in, let’s say, pancreatic cancer or lupus, which are tough pitchers, then no one will bother to step up to the plates against them. Those players will only want to go up against diseases where bigger advances seem possible.
Read 25 tweets
2 Feb
Fascinated by biotech & good it can do? Interested in how industry works & innovators get funding for their ideas? RA Capital opened registration for its virtual Business of Biotech discussion Spring session. Open to students/professionals... lawmakers.…
This is part of ongoing flipped course that RA Capital hosts with lectures, slide decks, & other materials available for anyone to study online anytime... & periodically we host Zooms w/ small breakouts, case studies, & in this case an optional funding pitch competition.
Note: Lots of reading, including of, since we’ll be talking about insurance, drug pricing, & how innovators & investors would be impacted by price controls.
Read 4 tweets
28 Jan
New data from Novavax vaccine just showed that UK & esp South African variants are more problematic in real world than lab experiments suggested. Implications are profound for 2021 and beyond.…
Vaccine worked well to stop original strain (96%), like mRNA vaccines, but less effective for new strains (86% for UK strain, 60% protective against South African strain). My guess is that if mRNA vaccines were tested now in a clinical trial in South Africa...
...they would show similar reduction in effectiveness. Bottom line, new SA strain has evolved SOME (not total) resistance to current vaccines. Current vaccines still help blunt severity, so worth getting even in South Africa.
Read 19 tweets
17 Jan
This new variant is making a lot of people REALLY nervous. Here’s why it should & shouldn’t. I’ll hit on infectivity, lethality, vaccine effectiveness, & some “what ifs”. Yes, it’s more infectious. That means that w/ comparable carelessness... 1/17 variant will infect more people. Once a person is infected... new variant is not more lethal (though like original strain, it’s bad enough). While not more lethal at level of individual person once they are infected, it’s more lethal at societal level b/c more infectious.
Lethality aside for a moment, not enough attention has been given to what this virus does short of killing. For example, it can rob you of sense of smell, which means taste, for weeks or months. Sound mild until you experience it- it’s a pretty miserable condition. 3/17
Read 18 tweets
24 Dec 20
Does being vaccinated mean you don’t have to wear a mask? Answer: no, mask up, please. B/c vaccine protects you from getting sick if you are exposed to virus, but it doesn’t reliably stop virus from hitching a ride in your nose & jumping to someone else. 1/6
We know the vaccines don’t entirely stop people from getting sick if exposed. They reduce risk by 95% (20-fold). But as people start mingling much more after vaccination, they increase their odds of exposure. 2/6
So think of it this way. Social distancing and masks reduce your risk of being exposed to the virus. And a vaccine reduces your risk of getting sick if you are exposed. But if you stop social distancing, you are way more likely to get exposed. 3/6
Read 6 tweets
25 Oct 20
What would you change US stock market hours to if you could & why? (long on thoughtfulness please, funny is an option, keep puns short)
Here’s another thought. How about introducing newly public companies to market by starting with short trading hours, 3 days a week & then opening up to standard hours after 1-2 years?
What would be ideal public exchange hours from the standpoint of emerging biotech companies (consider their needs) and the funds that provide most of their backing?
Read 5 tweets
24 Oct 20
Once covid vaccines launch, we might trick ourselves into believing they cause everything from colorectal cancer to diabetes to heart disease & lupus. Well-meaning data miners could do real harm. We need to vaccinate ourselves against that. Here’s how. 1/
Consider that many people have avoided going to the doctor for regular checkups during covid. They haven’t gotten preventative care. They haven’t been diagnosed with emergent conditions. They might now have heart disease or cancer and not yet know it. 2/
Here’s a paper showing that cancer diagnoses have gone down during covid. They say “The delay in diagnosis will likely lead to presentation at more advanced stages and poorer clinical outcomes.“… 3/
Read 20 tweets
16 Oct 20
Delays in FDA approval of a vaccine probably won’t change when most of us get a vaccine. PFE says it might be able to seek approval by end of Nov, so Dec approval possible. But will only have 100M doses ready by YE (50M courses). So unless you have...…
So unless you have reason to think you would be among the 50M first up to get vaccinated, what will determine when you get vaccinated is the pace of production. & for most of us, our ticket likely won’t be called until 2Q21. So approval delays of 1-2 months won’t change that.
You might even prefer that the vaccines be vetted more carefully. Of course, the people who would be impacted by delays are those slated to get the first doses. Front-line workers, vulnerable. They too might prefer to know the vaccines are safe and effective.
Read 6 tweets
29 Sep 20
It seems @icer_review’s heart is showing a little in today’s report on essential compassion & fairness of proper insurance w/ low OOP costs for medicines. But they still have a lingering attachment to math that’s been rightly criticized as racist...… 1/ patient advocate @SuePeschin in this short, incisive piece.… I wonder if it’s a bit uncomfortable for policymakers ICER claims to have influenced w/ its math. After all, #badmathkills 2/
.@icer_review says if medicines for kids w/ sickle cell disease don’t make the cut according to their math (which @SuePeschin has pointed out is deeply flawed), insurance should make those meds unaffordable to them (w/ high OOP costs) as leverage over drug companies. Harsh.
Read 9 tweets
30 Aug 20
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
Read 8 tweets
28 Aug 20
With each new drug, patients w/ lung cancer live longer. If first one hadn’t been rewarded, all rest wouldn’t have followed. Only insurance makes all affordable. Eventually they go generic; society saves money & humanity forever enjoys longer life span. Biotech Social Contract! Image
Flagging here for a few thought leaders in or soon to be Washington as they consider how healthcare should work. @Tcardenas @ngoroff @StefFeldman @JoeBiden
Here’s the whole paper, from folks at FDA, who are fortunate to see the totality of the constant effort to push back against the threat of disease that weighs upon us all.…
Read 4 tweets
26 Aug 20
For RA Capital’s next Business of Biotech course, I could use some advice. Do students learn as effectively listening to an audiobook as when they read the actual book? If you’ve taught and grappled with this, please add your comments.
I’m thrilled that is available as an Audiobook, though I’m wondering whether old school is better for teaching.
Internet is filled with advice. Here’s a thoughtful piece. But lately I’ve been getting all my peer-reviewed scientific analysis from twitter so figured I would come back for more.…
Read 4 tweets
11 Aug 20
Aptly named Sputnik V, Russian “approved” vaccine is like old Soviet rocket tech that only got cosmonauts into orbit but lacked the sophistication to get them to the moon like US could.…
It’s a two vector adenovirus vaccine, like taking a shot of Cansino’s vaccine (Ad5) followed by a shot of JNJ’s (Ad26). Not much data b/c only did Phase 1. Cansino’s data were really weak. AstraZeneca & Oxford also have a weak adenoviral vaccine, even after 2 shots.
Russia says their breakthrough is using different adenoviruses for the shots. Maybe, but they don’t show much data and the 100% protection they refer to is not based on the large protection studies needed to make such a claim.
Read 6 tweets
9 Aug 20
Not since HIV have viruses & bacteria been this ANGRY at a new member. They are so disgruntled by SARS2, they’re helping make vaccines against it. Pathogens are a Mafia- they have a Pathogen Bad Guy Code. What’s the Code? Who’s askin? Don’t tell humans! (Oh, I’ll tell you...)
The Pathogen Bad Guy Code is to never really, truly scare HUMANS! You can be bad, you can be gross, and you can even be a bit deadly, but don’t ever be so bad, gross, or deadly that humans stop hanging out together. B/c that wrecks it for everyone!
Just look at flu! It’s having a really bad year. “Business is way down”, said flu. “COVID has humans isolating, masking up! They ain’t shaking hands, even.” Fortunately, flu has a decent side biz in animals so it’s getting by & ready to make a comeback.…
Read 17 tweets
4 Aug 20
Here's an ALMOST GREAT explainer of why drugs cost more in the US than other countries. The one thing I would change is to reverse the logic of who subsidizes whom. Many think US subsidizes other countries' access to medicines. But in truth...
...other countries pitch in for cost of funding the drug industry to make drugs Americans need, reducing America's costs. We can wish for those countries to pay more, but it would be counter-productive to deny them access unless they pay more...
...b/c European countries are willing to deny their citizens access to new medicines & so they might just end up paying nothing at all. Trump's strategy of demanding US drug prices=EU drug prices, as with many things, is akin to threatening to cut off our nose to spite our face.
Read 15 tweets
29 Jul 20
Calling all diagnostics innovators and tinkerers - is offering XPrizes for a range of screens/diagnostics to help bring an end to the Covid-19 pandemic. Please submit your proposal & help save the world. The judges are world-class dx experts.
In support, an RA Capital team led by Parker Cassidy has just released a map of in-development & marketed COVID-19 tests as a companion to our therapeutics/vaccines map. These are only some of the chess pieces there are to work with - submit yours!
RA Capital & our peers also launched the Covid Apollo Project, a company co-funding the X-prize & helping w/ assessment. Goal is to assemble an integrated testing paradigm w/ a sustainable business model to enable some reopening even before a vaccine.
Read 12 tweets