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The Complete Mystery of Madeleine McCann™
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The Political Spectrum: Have Your Say

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Post by Verdi 24.06.21 13:00

A few trillion is petty cash to a trillionaire, his investments probably doubled the philanthropic gift sooner than it was given away.

It's easy to be righteous when financially endowed. A personal wealth in excess a couple of a million is not feasibly spendable so you either stuff it under the mattress or let it sit in investments making even more by the second or you can give it away. A charitable donation is a handy gesture for tax avoidance - they all do it. Leaving a healthy stash for acts of persuasion. Money can't buy love but my my, what a powerful tool of persuasion.

It's not an act of charity, or philanphropy as Gates likes to boast, it's all about controlling the finances, looking after ones own whilst keeping up the pretense of piety.

I wonder how Gates, his associates (I doubt if he's got friends) and legal bastion are going to control Mrs Gates now and in the future. I bet she's got a tale or two to sell.

whisper

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Post by Verdi 24.06.21 13:32

No question - the health industry has got to be the richest on the planet, even over and above the riches of technology.

It's no wonder they want to keep sticking needles in the populace..

Solving the Gene Therapy Cost-Effectiveness Conundrum


By Rich Durante, Managing Director, Pharmaceuticals and Medicines | January 6, 2020

Gene therapy is one of the most exciting new frontiers in modern medicine. Gene therapies have demonstrated their tantalizing potential to successfully address extremely rare and difficult-to-treat disorders. But they are exceptionally costly, and the healthcare system is struggling with their cost-effectiveness and how to price and pay for them. This has reignited the conversation around the need for a shift towards pricing a medication based on its value to a patient and the healthcare system.

Gene therapy is a promising—and costly—field

Gene therapy’s tremendous promise lies both in how it works and its impact on disease. Gene therapy works by targeting the defective gene in the patient’s DNA that is responsible for the disorder or disease, and compensates for or adjusts the genetic abnormality. Once the defect is repaired, the patient can be effectively cured. At the moment, researchers are focused on monogenic diseases, which are caused by a mutation to a single gene; in time, the expectation is that gene therapies will be developed to treat more genetically complex conditions.

Since 2017, the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have approved three gene therapies between them. The FDA and EMA approved Spark Therapeutics’ Luxturna for biallelic RPE65 mutation-associated retinal dystrophy; the FDA approved Novartis’ Zolgensma designed to treat spinal muscular atrophy; and the EMA provided conditional approval for bluebird bio’s Zynteglo for beta-thalassemia.

The FDA has also recently approved two chimeric antigen receptor T-cell (CAR-T) treatments—Novartis’ Kymriah for childhood B-cell acute lymphoblastic leukemia and Gilead’s Yescarta for aggressive B-cell non-Hodgkin lymphoma. These treatments activate the patient’s immune cells in such a way that they recognize and fight cancer cells in the body. They are similar to gene therapies in that they rely on replacing a gene within a cell.

Gene and CAR-T therapies are noteworthy for their steep costs as well as their effectiveness in treating or even curing diseases once considered incurable. Gene therapy costs range from $373,000 for a single dose of the CAR-T therapy Yescarta to $2.1M for Zolgensma. Moreover, these prices are only for the therapies themselves—hospital stays, complications, and other medications can easily increase the overall cost of treatment.

Several factors contribute to the high cost of gene therapies. Pharmaceutical companies make massive investments in gene therapy research and development and, understandably, aim to recoup those costs once the treatment is brought to market. Yet, according to the MIT Technology Review, the market for gene and CAR-T therapies can be incredibly small: Novartis estimates 300 people per year would be eligible for Kymriah, while Spark suggests 1,000 to 2,000 people in the U.S. could be eligible for Luxturna. Gilead’s Yescarta, by comparison, could be used to treat up to 7,500 people. In addition, these therapies are often single treatments, rather than a long-term course of action. In the end, economics weighs in—and the smaller the market, the more costly the treatment.

The other pressure on the cost of gene therapies is what insurers and other healthcare payers are willing to pay for these treatments. Healthcare systems in the U.S.—and other countries—are not necessarily designed to deal with the sort of costly “one-shot” treatments gene therapies represent. It takes time for insurers, governments, patients, and other payers to determine how to fund these expensive therapies, necessitating discussions about the trade-off between a treatment’s cost and its benefits. Given how much gene therapy costs, it does not take long for such conversations to become mired in murky ethical waters: after all, how much is a human life worth?

The complexities of determining gene therapies’ cost-effectiveness
Navigating the medical, commercial and ethical issues created by the high cost of gene therapies is not easy. The critical question is how insurers, governments, healthcare decision-makers and other stakeholders determine whether gene therapies are truly cost-effective, especially given the fact that they’re so new.

The Institute for Clinical and Economic Review (ICER), for one, is inclined to think the costs are reasonable. ICER evaluates the value of a medication or treatment through a multistep process that considers several factors:

● Comparative clinical effectiveness—the magnitude of the comparative net health benefit and its level of certainty;
● Incremental cost per outcomes achieved (expressed in cost per aggregated quality-adjusted life year (QALY);
● Potential budget impact—the estimated net change in total healthcare payer costs over an initial two-year time frame;
● Other benefits / disadvantages of the treatment and additional contextual considerations (e.g., ethical or legal issues).

ICER has indicated that, given their benefits, Kymriah’s and Yescarta’s prices fall within common thresholds of cost effectiveness. ICER had a different perspective on Luxturna, suggesting that the price of the therapy needed to be halved to better align with its long-term health benefits.

There does appear to be at least a general sense that treatments for extremely rare conditions, such as those current gene therapies address, should be judged against a higher cost-effectiveness threshold (CET) than “regular” treatments. In the U.S., ICER has explored a range of up to $500,000 per QALY gained; in the U.K., the National Institute of Health and Care Excellence had discussed a threshold of up to £300,000 per QALY, depending on health gains (as reported in JMCP). To put this into context, emicizumab prophylaxis, a breakthrough treatment for hemophilia A, costs $21 million for lifetime treatment, while a heart-lung transplant costs $2.53 million. The cost of Luxturna, on the other hand, is $853,000.

Determining gene therapy’s value: Lessons from oncology
In many ways, the considerations surrounding the value and cost-effectiveness of gene therapies are similar to those involving cancer treatments—which, like gene therapies, can have a dramatic impact on a patient’s quality of life, can mean the difference between life and death itself, and are typically extremely costly.

Because of this, oncologists have long had to balance the trade-offs between medication effectiveness and cost. Our own qualitative research, in which we asked 32 oncologists to identify the minimally acceptable benefits of a hypothetical colon cancer treatment, shed an interesting light on practitioners’ priorities [1].

The exercise deliberately encouraged the participants to actively make trade-offs and think about patient needs in a holistic fashion. Overall effectiveness of the treatment (in terms of overall survival and progression-free survival) was by far the most important feature—but there was a clear “floor” to what they would accept given the significant costs of typical cancer therapies at the time: four months’ additional overall survival was the minimum threshold. Clearly, oncologists were not inclined to proceed with a new treatment without a deep consideration of its actual benefits, its downsides, and its cost.

Traditional “pay per pill” thinking does not suit a gene therapy world
The high costs associated with gene replacement and CAR-T therapies—and questions as to their cost-effectiveness and affordability—are driving renewed interest in changing the paradigm around how we both value and pay for medical interventions.

In a recent interview with Bloomberg, Pfizer’s Angela Hwang discussed this, noting that the traditional, product-focused, “pay by pill” model is a poor fit in a world of costly one-treatment cures. She asserted that an approach focused around determining the value of the treatment outcome, rather than the treatment itself, may well be what is required.

This basic way of thinking about the value of gene therapy is aligned with value-based reimbursement, which is a critical pillar of the 2010 Patient Protection and Affordable Care Act (ACA). The basic premise of this component of the ACA was that healthcare providers should be reimbursed based on the quality and efficiency of the care they deliver and not based on the number of services they provide. A byproduct of this is that many in the healthcare industry are calling for pharmaceutical manufacturers to link drug prices to the value these drugs provide to patients. The advent of gene therapies may speed up the move to this type of pricing model.

The QALY-based factors described earlier may be just the starting point for assessing the value of gene therapies in a value-based or “pay-by-outcome” model. “Value of life” or “value of a statistical life” measures can be useful, especially in situations where gene therapy cures a condition that is typically fatal early in life; the U.S. Department of Transportation updated its value of a statistical life to $9.6 million. Decision-makers may also need to factor in such considerations as the severity of the illness, the chance that a therapy would permit a patient to benefit from new treatments in the future, the financial risk, and the patient’s willingness to mitigate that risk. From a broader economic perspective, it may also be worth considering that curing a disease could enable a patient to make a more substantive financial, social, or cultural contribution to his or her society—a contribution that would carry an associated value.

Costly healthcare innovations demand we rethink how we value and pay for medical treatment
We are at the beginning of the gene therapy revolution.

According to MIT’s New Drug Development Paradigms Financing and Reimbursement of Cures in the US team, we could see up to 40 new gene therapies launched in the next five to seven years. In time, researchers will move from monogenic diseases to polygenic conditions—discovering more gene therapies for diseases affecting more substantial patient populations in the process. This will only intensify the pressure on insurers, health systems, governments, pharmaceutical firms, and patients alike to develop a workable framework for determining when to proceed with treatment and how to pay for it. It seems clear that these decisions will require a new way of thinking about disease, treatment, and the value of life—and the movement towards a value-based, “pay-for-outcome” approach to pricing new medications.

We may have little choice but to change.

Contact our healthcare team tp help your organization gain industry insights and trends.

Richard Durante, Don Stark, Michael Feehan, “How do Oncologists Judge Potential Efficacy Thresholds for New Agents in Colorectal Cancer?” PBIRG Perspective, Fall 2013.

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Post by CaKeLoveR 24.06.21 16:27

They have been making monkeys of us for ages.
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Post by Verdi 24.06.21 16:49

It's been building up for decades, slowly but surely indoctrinating people with obsession about their health.

Despite the growing changes and resultant increasing concern about health care generally, for generations people have been advised to rush to the doctor or hospital with every ache and pain or lump and bump

Aided and abetted by the internet and growing fanaticism about healthy eating and fitness. How often these days do you hear people say they go to the gym once twice or thrice a week, they could of course be telling porkies but why the need to mention it? The situation has become like a must have fashion accessory.

Since leaving school I have never been inside a gym, even at school I would find every reason for not being there. Something about the end of play communal shower room didn't inspire confidence.

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Post by CaKeLoveR 24.06.21 17:12

The  communal shower is revolting. I wonder how it works now, in these 'transgender' times?
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Post by Liz Eagles 24.06.21 18:14

[You must be registered and logged in to see this link.] wrote:The  communal shower is revolting. I wonder how it works now, in these 'transgender' times?
When I was a teenager we were required to run naked through a communal shower with the sports mistress fully clothed, whistle in hand to watch over us. 

I refused. I didn't shower naked in front of my own mother.

I protested.

I was taken to the office of the headmistress who gave me tea and chocolate biscuits.

I told her I bathe in privacy in my house. 

No further action

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Post by CaKeLoveR 24.06.21 19:11

Your headmistress was a sensible person, it seems, and I don't like the naked families idea either.
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Post by BlueBag 25.06.21 8:58

[You must be registered and logged in to see this link.] wrote:The  communal shower is revolting. I wonder how it works now, in these 'transgender' times?
A friend of mine went to a Boys only Grammar School in the 70's.

They had to do swimming lessons in the nude.

Not good.
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Post by sequested 25.06.21 13:22

I too went to an all boys grammar in the 70s which had an Olympic size swimming pool (rare in those days). The showers were often the scene of pubescent and growing manhood shenanigans.
On another note, many of the teachers had nicknames and the French master had strange way of admonishing a smack to a naughty pupil. Only years later I found an internet  site, similar to Friends Reunited, where you could look up your old school and past-pupils had added comments. I have to admit to spending probably the most hilarious afternoon trawling through comments, many of which related to the "abuse" meted out by the French teacher. That in itself isn't funny but other peoples recollections and my own memories made for such fantastic reading !!
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Post by CaKeLoveR 25.06.21 13:41

For a year in the 60's I was a boarder at a girl's school for children whose parents were in the forces. We aged from 11 to 18, and there were various nationalities. No allowance was made for anybody when it came to the revolting communal showers. Little girls and grown women  Yuk.
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Post by Verdi 25.06.21 13:50

And everyone knew what was going on but nobody did anything about it - ring any bells?

Institutionalized child abuse.

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Post by Verdi 25.06.21 16:00

[You must be registered and logged in to see this link.] wrote:I too went to an all boys grammar in the 70s which had an Olympic size swimming pool (rare in those days). The showers were often the scene of pubescent and growing manhood shenanigans.

And the likes of such folk are now leading the nation under the guise of politicians. It's no wonder child abuse is kept tightly in the closet.

Never trust any of the higher echalons of public service, they are seldom or never appointed on merit or ability. Promotion and appointments of senior staff in the public secteur are always by way of the old school tie network, nepotism, bribery, blackmail and good old fashioned ever reliable kowtowism.

What hope is there?

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Post by Verdi 25.06.21 16:20


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Post by Verdi 25.06.21 16:34


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Post by Verdi 25.06.21 16:37


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Post by Verdi 26.06.21 1:10

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It's probably his sister or the milkmaid or the Amazon home delivery service or the traffic warden or paramedic or bus conductor with a ticket to ride or night nurse ....

whistle2

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Post by Verdi 26.06.21 1:29

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Post by PeterMac 26.06.21 6:45

Just changing the subject slightly, In Re the Batley and Spen Bye-election

Interesting comment today about Labour's campaign

"Three way split, working class, Islamic or woke, whatever appeals to one group will not appeal to the other two."
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Post by BlueBag 26.06.21 8:11

[You must be registered and logged in to see this link.] wrote:Just changing the subject slightly, In Re the Batley and Spen Bye-election

Interesting comment today about Labour's campaign

"Three way split, working class, Islamic or woke, whatever appeals to one group will not appeal to the other two."
The working class need to dump the Labour party.

They hate the working class.
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Post by CaKeLoveR 27.06.21 11:38

Another 'accidental'  loss of top secret military documents, this time found at a bus stop in Kent. They had been carried around in a rucksack, apparently. What could go wrong there?
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Post by Verdi 27.06.21 15:01

Trump mocks 'woke' generals and Biden as he returns to 'save America'

Former US president says Republicans must take 'back America' and hints at a potential comeback in 2024



Watch yer back Joseph and that of your joker cling-on.  Your reign is on the wane.

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Post by Verdi 28.06.21 13:16

Sajid Javid: the man who would be prime minister
3rd August 2018: Financial Times


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Post by Verdi 29.06.21 16:51


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Post by Verdi 01.07.21 13:18

Donald Trump speaks out after visiting southern border in 'Hannity' exclusive


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Post by Verdi 03.07.21 1:13

Oh my gawd - not another one roll , they're going down like flies..

Michael Gove and Sarah Vine split raises Covid distancing questions
Cabinet minister refuses to say whether he broke rules as he announces 20-year marriage will end in divorce

By
Robert Mendick,
CHIEF REPORTER and
Patrick Sawer,
SENIOR NEWS REPORTER
2 July 2021 • 9:31pm

Michael Gove on Friday night became the second senior Cabinet minister in a week to split with his wife as Downing Street refused to say whether any social distancing rules had been broken.

The Cabinet Office minister is one of four people who have been making unprecedented decisions about people's private lives during the pandemic, sparking questions about their own domestic arrangements.

On Friday afternoon, after months of intense speculation and rumour, Mr Gove and his wife Sarah Vine, a prominent journalist, said in a statement that they had "agreed to separate" and were finalising their divorce after almost 20 years of marriage.

The announcement came within hours of the polls closing in the Batley and Spen by-election – a seat the Conservatives had been expected to win but lost, with blame falling on the Government's handling of revelations about Matt Hancock's affair with aide Gina Coladangelo.

Ms Vine wrote a column in a newspaper on Sunday about the scandal, in which she spoke of the difficulties of sustaining a political marriage.

On Friday night, friends of 53-year-old Mr Gove and Ms Vine, 54, insisted nobody else was involved in the split and the couple had simply "drifted apart" over the past two years.

The period covers the entire pandemic and will raise questions about their living arrangements during strict lockdowns.

A Number 10 spokesman declined to comment on the break-up and refused to say whether Mr Gove had broken any social distancing rules during the disintegration of his marriage.

A source close to Mr Gove dismissed any rumours about his private life as "utter nonsense" and "made up" and insisted he was unaware that any social distancing rules had been broken. The source said Mr Gove and Ms Vine remained living at their family home.

Mr Gove and Mr Hancock were part of the "quad" of four senior ministers, including Boris Johnson, who were in charge of the key lockdown decisions.

Mr Gove along with Mr Hancock and Dominic Cummings, Mr Johnson's former chief adviser, were the most strident advocates of a strict lockdown, with the latter two both subsequently found to have broken the rules.

The Prime Minister will be concerned that Mr Gove's separation sparks a hunt for the cause of the breakdown, given the difficulties of maintaining strict Covid rules.

Mr Hancock was forced to resign as health secretary on Saturday, a day after video images emerged of him kissing Ms Coladangelo in his private office, breaking social distancing rules which he had put in place.



Mr Gove's separation from Ms Vine appeared inevitable after she failed to testify to the strength of their partnership when writing last week about Mr Hancock. She wrote in the Mail on Sunday that the former health secretary's "behaviour may be shocking, but given the context it is entirely predictable".

In a podcast, released Thursday, Ms Vine spoke about how men let their "egos destroy their families". And of Mr Hancock's affair she added: "I can see how it happens... it's a heady atmosphere in those corridors of power, you are master of the universe."

Mr Gove, one of Mr Johnson's most influential ministers, has been married to Ms Vine, a columnist for the Daily Mail and Mail on Sunday, since October 2001. They had first met two years earlier.

In a statement, a spokesman for the couple said: "Michael and Sarah have agreed to separate and they are in the process of finalising their divorce. They will continue to support their two children and they remain close friends. The family politely ask for privacy at this time and will not be providing any further comment."

A friend of the couple said: "This is a difficult and sad decision for Michael and Sarah after 20 years of marriage. It is an entirely amicable separation and there is no one else involved. They have drifted apart over the past couple of years but they remain friends. Their absolute priority is the children."

A spokesman for Mr Gove, himself a former journalist, denied that the divorce announcement was a pre-emptive move before compromising news breaks about him.

Asked whether the amount of responsibilities assigned by Mr Johnson to Mr Gove, who took on a wide Brexit brief before being tasked with reviewing the possibility of using Covid vaccine passports for mass events, had played a part in the split, the spokesman said: "Mr Gove continues to get on with the job."

In her column on Sunday, Ms Vine wrote on Mr Hancock's affair: "Climbing that far up Westminster's greasy pole changes a person. And when someone changes, they require something new from a partner. Namely, someone who is as much a courtesan as a companion, one who understands their brilliance and, crucially, is personally invested in it."

The column further fuelled the Westminster rumour mill. Diane Abbott, the Labour MP, already posted on social media in the wake of Mr Hancock's resignation: "Some people on Twitter seem to think that Michael Gove is poised to take over from Matt Hancock. But are they confident that Gove's private life is beyond reproach? Maybe Sarah Vine can shed some light on this."

Ms Abbott was criticised for the post but Ms Vine replied on Twitter on June 26: "I'm too busy watching Eric and Ernie on telly."

Some Labour MPs believe Mr Gove will be under pressure to come clean about his living arrangements to prove he has not broken any rules. One said: "The Cabinet Office, which Michael Gove is responsible for, co-ordinates the whole of government, so you can't be a rule-maker and a rule-breaker.

"Michael Gove is even more central to decisions on Covid restrictions than Matt Hancock was, so people have a right to know if he has broken any rules."

Mr Gove and Ms Vine were seen by neighbours leaving the house at different times on Friday in the hours before the official statement.

Shortly after 8.30am, Mr Gove, dressed in a suit, left the house in West Kensington, London, carrying not only his red ministerial box but also two heavy-looking cases which his Whitehall driver loaded into his car. Later, Ms Vine was seen loading several bags and cases into a grey SUV and leaving the house.

While Mr Gove remained at the house in recent days, Ms Vine, according to her social media, had spent the past few days in Wales with their two teenage children. She returned with the children on Thursday night, immediately dispatching Mr Gove to buy some provisions after her week away for what appears to have been their last evening together before the announcement.

It is not known where either Mr Gove or Ms Vine are planning to spend the next few days, although there is speculation that he may have use of Admiralty House, in Whitehall – which has a number of ministerial flats – and she has written in the past about the joys of staying at secluded boltholes in Cornwall and Wales.

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