Dear clients and friends: Given your interest in health and medicine, we would like to share with you our collection of the most interesting perspectives on our industry's trends and developments. We are happy to share them with you — and hope you share your thoughts with us.

1. The Next Pandemic: Dice Roll or Late Bus?

Lab coats, data crunchers, and epidemiologists are asking: what’s the chance that H5N1 is the next pandemic? Scott Alexander assesses the best predictions and finds that they range wildly. His latest behemoth of a blog examines the history and potential future of flu pandemics – and it offers a striking metaphor about why predicting pandemics is so tricky:

The forecasters I talked to raised one other point of uncertainty: does the flu work more like a dice roll, or like a bus? Dice rolls are uncorrelated with their predecessors; even if it’s been a hundred rolls since you last rolled a 6, your chance this time is still 1/6. But buses come at fixed intervals; if the buses are hourly, and you haven’t seen a bus in the past 59 minutes, then your chance of seeing a bus in the next minute is very high. It’s been 16 years since the last flu pandemic; these pandemics come (on average) every 20 years. I don’t think anyone has a good sense of how to think about this.

2. Bad Vibes at JP Morgan? 

The annual JP Morgan Healthcare Conference is underway in San Francisco. Barron’s sees a gloomy affair:

Often, the conference is a turning point for investors, when big news draws generalist interest and rescues the sector from the doldrums. This year, however, investors don’t see much hope for a turnaround. The incoming Trump administration brings dramatic policy uncertainty, which, layered on top of shaky fundamentals, is making the industry too unpredictable for investors.

Meanwhile, WSJ wrings its hands over tightened security in the wake of the UnitedHealth CEO killing.

3. We Are the 1%

There’s a popular argument that too many federal dollars are spent on basic R&D. Jacob Trefethen disagrees. His latest post offers five reforms for smarter funding. But the real jaw-dropper is in the opening, when Trefethen outlines the puny scale of NIH and NSF funding: 

Civilian research is only 1% of the federal budget and we haven’t cured Alzheimer’s or depression yet. 1% is the same amount as America spends on dialysis. Dialysis alone…85% of NIH project grant applications on aging will get rejected this year, and 90% on infectious disease will, due to budget limitations. That rejection is for the scientists who stuck around and kept applying. In our current system, many talented people who wanted to work in science and engineering already left to work at investment banks.

4. The War on Cancer Vaccines

As RFK Jr. fans the flames of anti-vaxxer conspiracy, cancer vaccines are having a moment. In its annual “The World Ahead” issue, the Economist shares some good news:

After decades of disappointment, efforts to create vaccines that can stimulate the immune system to fight cancer are showing renewed promise…Personalised vaccines are tailored to a patient’s specific mutations, and aim to train the immune system to recognise and attack cancer cells based on their unique genetic make-up. First comes a biopsy, then the sequencing of the tumour, the identification of mutations likely to generate proteins that would be recognised by the immune system, and finally the manufacturing of a vaccine to target those markers. This can all be done within six weeks.

5. A Less Clinical Clinic

The clinic, with its unpleasant waiting rooms and cold tile floors, can create a barrier to treatment and care. The Thistle, a new legal injection site in Glasgow, offers lessons on how to create a more inviting clinical space to engage the disengaged:

There is no glass barrier at reception. The injecting area is open plan, equipment is not locked away, and the mirrors in the booths are slanted, so the nurses can keep an eye on users without invading their personal space. The interview rooms have been renamed ‘chat rooms’, the treatment rooms ‘health rooms’ and, beyond the recovery room, there’s a bright, comfortable lounge, with tea and coffee. Thanks to input from a lived experience forum, there is also a shower room, a supply of clean clothes and – though they are usually banned at NHS premises – an outside smoking area.