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. To Jab and Jab Not

A defining narrative of COVID has been that Europe sprang to action while the US buried its head in the sand. Not so! Economics professor Alex Tabarrok reviews Preventable, a new book by CMS Administrator Andy Slavitt, and as Tabarrok pokes holes in Slavitt’s self-serving narrative, he also makes a compelling case for how the US reacted more quickly than either Europe or Canada:

Data from the Oxford Coronavirus Government Response Tracker (OxCGRT) show that the US “sacrifice” as measured by the stringency of the COVID policy response–school closures; workplace closures; restrictions on public gatherings; restrictions on internal movements; mask requirements; testing requirements and so forth–was well within the European and Canadian average…The US fiscal response to the pandemic was among the largest and most generous in the world. An unemployed minimum wage worker in the United States, for example, was paid a much larger share of their income during the pandemic than a similar worker in Canada, France, or Germany.

2. A Postscript to the Aduhelm Saga?

To many, the approval of Aduhelm was the long-awaited climax in an otherwise dismal story about Alzheimer’s. The celebration was brief. But as counterarguments, calls for more data, and political histrionics mar the promise of Aduhelm for people affected by Alzheimer’s, The Economist looks a few decades ahead and sees a happy ending:

During the 2030s something unexpected happened. The change was almost unnoticed at first, but then surprisingly fast, as old people with dementia died, and the incidence of new cases quickly shrank to almost zero. Back in 2020, such an outcome had seemed inconceivable…A surge in funding for dementia research and a growing sense of urgency about the scale of the problem coincided with a tipping-point in neuroscience. The first and most important breakthrough was the development of a simple blood test…Identifying those at risk early meant that existing therapies such as aducanumab, a treatment for Alzheimer’s which had little effect once symptoms were far advanced, could be deployed early enough to make a difference. And a stream of new treatments followed.

3. ARPA, ARPA, ARPA

Nature tracks a growing global phenomenon: the rise of “ARPA-everything.” Trying to replicate the success of DARPA (the US Defense Advanced Research Projects Agency), “governments around the world, including Europe and Japan, have attempted to duplicate the agency within their own borders.” Success may not follow:

Scientists who have studied the DARPA model say it works if applied properly, and to the right, ‘ARPA-able’ problems. But replicating DARPA’s recipe isn’t easy. It requires the managers who build and run an agency’s grant programmes to have the freedom to assemble research teams and pursue risky ideas in promising fields that have typically been neglected by conventional industrial research and development programmes. Critics aren’t yet sure how ARPA-Health, ARPA-Climate and ARIA [the UK’s version of ARPA] will fare.

4. Paper Jam

No aspect of the US healthcare system prompts more hand-wringing and global mockery than its costs. A new academic study offers a gloomy addition to the discussion: the paperwork associated with billing results in both uncompensated visits for HCPs and unavailable appointments for patients:

Observing the back-and-forth sequences of claims' denials and resubmissions for past visits, we can estimate physicians' costs of haggling with insurers to collect payments. Combining these costs with the revenue never collected, we estimate that physicians lose 17% of Medicaid revenue to billing problems, compared with 5% for Medicare and 3% for commercial payers. Identifying off of physician movers and practices that span state boundaries, we find that physicians respond to billing problems by refusing to accept Medicaid patients in states with more severe billing hurdles.

5. Can Clinical Trials Go Virtual?

The problem is obvious: clinical trials are “expensive, time-consuming, and risky for those taking part.” A solution, virtual clinical trials, may be on the way. They are showing early promise by generating evidence that may persuade regulators while also avoiding tricky ethical questions. The researchers of a virtual clinical trial report:

Our findings demonstrate that in-silico trials of endovascular medical devices can: (i) replicate findings of conventional clinical trials, and (ii) perform virtual experiments and sub-group analyses that are difficult or impossible in conventional trials to discover new insights on treatment failure, e.g. in the presence of side-branches or hypertension.