Lecture 10 -- Physicians Physician: graduating from an accredited osteopathic or allopathic medical school o Osteopathic: medical schools that developed and based on holistic perspective of healthcare - eastern forms of medicine incorporated into western Allopathic plus Physician residential training o Competitiveness for osteopathic is less Non-USA trained physicians o Educational Council on Foreign Medical Graduates International medical graduates -- have compatible training when they come # If a US citizen goes to a non-US med school -- considered IMGs But international students who go to US med school is not considered IMG Total number of active physicians have been relatively flat Physician Workforce o No consensus that there is a shortage of physicians but may be a shortage of primary care providers o Do alternatives exist? ECON 170 Guest Lecture -- Martin Mackay, Alexion Discovering Drugs for Devastating Diseases 11.10.16
Alexion A focus on devastating ultra-rare diseases -- less than 20 per million -- tiny number
Developing life-transforming treatments PNH - 35% of patients die within 5 years of diagnosis aHUS - 60% of patients die or permanently lose renal function Strensiq -- treatment of HPP Kanuma -- LAL-D -- in young children -- missing enzyme that leads to buildup of diseases in liver Truly used to transform the treatment -- people are willing to pay for the new treatments 2016 - financial outlook o the drugs for this diseases need to be taken every year? Over time so leads to great economic success Robust rare disease pipeline o Preclinical, early clinical development, advanced clinical development, marketed
o Buildup of sulfite in the system as they don't have the enzyme to change sulfite into sulfate -- has a replacement enzyme therapy that may cure this o Cost associated with it
Hypophosphatasia (HPP) Defective bone mineralization Difficulty breathing Seizures Kidney complications Muscle pains and weakness that impacts motor skills Babies can't breathe because do not have ribs Only 25% survive after 5 months Early diagnosis drives better outcomes -- lack of bonestructures Discovered new molecules for the treatment of HPP that replaces TNSALP activity o Human recombinant fusion protein - Adults have multiple fractures every year while living with great pain -- can help them fix it Collaborate with regulatory agencies - FDA approved Strensiq Survival with treatment is much higher - 42 vs. 97
LECTURE 14: DR. EZEKIEL EMANUEL
Key architect of the ACA o There are republican states which are benefiting tremendously from the AcA--will not be that simple to repeal a Republicans have no replacement option o Trump wants to keep: keeping kids under 26 with their parents' insurance, pre-existing conditions exclusion o Other parts of the ACA that are popular Closing the donut hole in Medicare
Affordable Care Act "Overall 22% increase in premiums" Emanuel: ACA has been a tremendous successoCriteria-Access: 20-22 million have been covered, uninsured rate hovering around 10% (some frictional, includes undocumented immigrants who aren't eligible for anything under the ACA) o Problems with the exchanges Adverse selection