Vas Deferens

So, that didn't take long. Again. In Sunday's NYT Business section is a full page puff piece (each is) on Vas Narasimhan, CEO of Novartis. I considered typing a missive on the piece, but let it go, since the sole significant thought I'd had (scrawled under his photo) was:

Why would you want a McKinsey graduate running a drug company?

McKinsey has the well earned reputation as the capitalist's Social Darwinism wet dream defender. Kind of like a high price defense attorney. Confuse them when you can't convince them.

A few days later, now, we know that Novartis has been playing fast and loose with trial data for a $2 million gene therapy. The notion of "I save your life, give me all your future earnings" is so McKinsey. I guess we know why he's running a drug company.

Here's an Axios piece on Novartis and the faked data drug

The future of medicine is in personalized and scientifically advanced drugs, meaning that Zolgensma's imminent approval is just the beginning of the seven-digit price tag era. While drug companies say the drugs' effectiveness justifies their costs, some experts are pushing back.

Later in the article it is mentioned that the underlying drug tech will be used for other drugs. IOW, Novartis isn't on the hook for the drug's R&D for this one indication. Surprise, surprise. And, of course, no forensic accounting exists, publicly, of that R&D spend.

Here's a report that lays out the scheme

As Novartis' departing CEO Joe Jimenez noted in a November 2016 editorial in Forbes, "We want to be rewarded for the tangible outcomes that our products provide the patient, not for simply selling pills."

Left to inference is the simple question: what's the value of "tangible outcomes" in moolah terms? Two possibilities are at the top of the totem pole:
- avoided costs of alternative, existing therapies
- the net present value of a patient's earnings

The first metric is, generally, not a kerfuffle. The second sure is. If there is a truly orphan population at risk, then only the 1% need apply, since their lifetime earnings are much higher. Not that they'd actually turn over any of it, of course. Only that the bean counters can put said 'amount' in the 'value' side of the equation. Thus justifying that multi-million dollar price.

Finally, a dense and detailed review of the drug by medical professionals.