Michael Milken - Philanthropist, Financier, Medical Research Innovator, Public Health Advocate

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National Cancer Institute Roundtable Summary

Leveraging Multi-Sector Technology Development
Resources and Capabilities to Accelerate Progress
Against Cancer

Luncheon Presentation Summary
Michael Milken--Accelerating Medical Solutions

Mr. Milken, Chairman of the Prostate Cancer Foundation (PCF) and FasterCures / The Center for Accelerating Medical Solutions, presented the Roundtable with some important ideas on how to apply novel funding models to cancer research to simultaneously increase the probability of technology development success and ultimately the rate of financial return. He also called for fundamental systems changes related to the way in which the nation conducts biomedical research and development activities.

What transforms societies? Technology advances, including those that have produced stunning changes in life expectancy. Over the course of the 20th century, worldwide life expectancy more than doubled, whereas life expectancy in the United States rose from 50 to 77 years--an increase of 54%. In 1900 one of every five infants born in the United States died before age 5, a tragedy that 16 of our Presidents have experienced. These incredible advances are largely the result of technology development, ranging from improved sanitation to the development of antibiotics.

Over the past 30 years, new technologies have had a profound impact on everyday life. Financial technologies have dramatically lowered the cost of mortgages, increased the ability of companies to raise money for research and development, and even changed the way we pay our bills. The exponential growth in computing power ushered in the personal computer revolution with its myriad impacts. In biomedicine, technological advances have cut the cost of sequencing a gene from over $100 million per gene in 1974 to $6 today. By 2013 that cost should drop to $0.03 per gene, a rate of improvement that exceeds Moore's Law. But cancer is one area in which the dramatic effects of technology improvement have yet to be significantly felt. This shortcoming is demonstrated by the fact that more people die of cancer annually than the total number of Americans lost in all the wars in the 20th century. We must, said Mr. Milken, focus all of our resources on bringing the power of advanced technologies to bear on cancer.

How might we achieve this goal? To start, he asked the Roundtable audience to consider the remarkable increase in global wealth creation that has occurred over the past 18 months, in which global equity markets have risen by one-third. In the United States alone, the largest 18 companies have increased their market capitalization by over $1.1 trillion dollars. This rise has been even sharper among technology-driven biotechnology companies compared with their more established pharmaceutical company peers, demonstrating the impact that technology can have and the potential for returns to investors who put their money to work in fields such as biotechnology. He said the only threat to the United States' leading position in such technology-driven fields is the dramatic rise in engineering and other technical graduates abroad, particularly in Asia. China alone is turning out over three times as many engineering school graduates as is the United States.

Mr. Milken then discussed some of the key components of how to make major advances in the fight against cancer. First, we must internationalize the war on cancer, which is happening to some extent, but which should be pursued more aggressively. Investing more in cancer research is critical; eliminating deaths from cancer would be worth $46.5 trillion dollars, a potentially astronomical return on investment. Training and recruiting world-class scientific talent must also occur, something that the Prostate Cancer Foundation has emphasized in its efforts. It will also be critical to mobilize patients and their families as active participants in the war on cancer. An organized effort in this area could provide critically needed support for plans to establish an international database of patient medical records. To accomplish this we may need some legislative action to allow patients to choose to be part of a large database development effort for cancer vs. privacy protection. The payoff for such a database would be better information and incentives for patients to join clinical trials. All of these efforts would dovetail nicely with the NIH Roadmap for Medical Research. Finally, we need a "Framingham" lifestyle-type population study for cancer.

He noted that systems changes must also occur, including the creation of new tax policies that encourage biomedical research and development. To accelerate development, we must ensure that medical students and residents receive appropriate training. To speed the development of new cancer interventions, we must increase incentives for patients to participate in clinical trials, streamline the regulatory process through the development of surrogate endpoints, and better define what is needed for approval. We must allow contemporary science to drive a new and flexible clinical trials model. Industry must become a major player in all aspects of conquering cancer. To facilitate this engagement and enable key phases of the development cycle, we must lower risk by providing incentives such as extending the period of patent protection for novel drugs and diagnostics and strategically provide a range of Federal support mechanisms and new partnerships. Mr. Milken emphasized that it is critical that we harness the power of genomics, proteomics, and other advanced technologies to create new diagnostics and therapeutics for cancer with a sense of urgency.

Finally, he spoke of the need for better alignment of for-profit, academic, government, and foundation resources to conquer cancer In particular, he noted that the enormous increase in wealth that has swept the world over the past decade, and in particular over the past 18 months, has created a new generation of potential philanthropists, who are yet to make their mark. Cancer will be important to many of them. One strategy to accomplish the alignment we seek is to couple foundation funds to entrepreneurial activity. We should seek to create "virtuous" cycles of support for research and development tied to a return on investment. We also must provide more innovative funding models for the development of advanced cancer technologies that include venture capitalists, regional entrepreneurial development, and philanthropic models. Finally, we should seriously evaluate the In-Q-Tel model in a demonstration project. Combining a "virtuous" cycle to create return on investment with innovative new funding models will accelerate the development of advanced diagnostics and therapeutics that we need to reach the NCI's 2015 goal.