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Zalicus Inc. Message Board

phakosurgeon 11 posts  |  Last Activity: Feb 6, 2014 9:57 AM Member since: Nov 18, 2008
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  • phakosurgeon phakosurgeon Feb 6, 2014 9:57 AM Flag

    Hugeman, Biogenius, thank you for your kind words. I had thought that this board would be different, but I guess that is just expecting too much from a Yahoo MB. If you wish to further discuss anything, please feel free to email me with this handle at Yahoo mail. Good luck o all.

  • phakosurgeon phakosurgeon Feb 5, 2014 7:33 PM Flag

    Well so much for that wonderful post by biogenius about the decorum and open minds on the board. I guess if anyone disagrees with you that Squalamine is going to be the most lucrative drug in the history of pharma (show me another drug that has 10 billion a year in sales), they must have an evil agenda. You needn't bother putting me on ignore, I will not be posting here again. Good luck with your boards, but do me a favor. Go into research. You are not cut out for patient care.

  • phakosurgeon phakosurgeon Feb 5, 2014 7:07 PM Flag

    You may not know one senior who would forego an eye drop for an injection, but I know tons. Most of them are my patients. I have watched them literally put their life at risk to avoid a $50 copayment. So yes I think a lot of seniors will forego the drops at $200 a bottle. You mentioned in an earlier post you are an investor, not a doctor. I respect that because you think rationally and logically. Everything you say makes a lot of sense, just like what Livermore says makes a lot of sense too. But here's the thing. Patients are NOT rational! Politicians (who set the Medicare rules) are NOT rational! CEO's of insurance company are VERY rational. Unfortunately they don't give a flying fig about doctors, patients, or what is good medicine. They care about the bottom line. So while I agree with most of your logic, I unfortunately must deal with reality. Besides, I am not against you. I think Squalamine will ultimately prove a very lucrative drug. I just think you should hold off ordering the Ferrari yet. We will make nice money on Ohr, and on that I think we pretty much all agree.

  • phakosurgeon phakosurgeon Feb 5, 2014 3:49 PM Flag

    A perfect example Richmando. Patanol is a fantastic drop. Best of the mast cell stabilizers/antihistamines out there. These days it's marketed as Pataday, a once a day formulation. During allergy season I used to prescribe buckets of the stuff. I don't anymore. Want to know why? Very simple. Because United Healthcare, by far the largest insurer in my practice made it a Tier III drug. What does that mean? It means that every 5ml bottle of Pataday has a $65-75 copay (depending on the plan). I and all my colleagues got sick and tired of the phone calls from irate patients screaming "$65 for an allergy drop! Are you crazy?" So Pataday, the best drug out there is losing tons of business. Unfortunately, this is the state of medicine today. It is no longer the patient's best interests, it's whats in the insurance company's best interest.

  • Reply to

    Phakosurgeon, your squalamine pricing assumption

    by hugeman99 Feb 5, 2014 8:29 AM
    phakosurgeon phakosurgeon Feb 5, 2014 1:52 PM Flag

    Whoa! Livermore, 10 billion dollars already? Slow down! First lets get through phase II before you count your billions. As to the speculation that Squalamine will be used in dry AMD patients, not quite. Dry AMD and wet AMD are two very different animals. Dry AMD is caused by gradual loss of pigment epithelial cells. The RPE cells nourish the photoreceptors, and their loss causes the macula to lose most of its photoreceptors. This process is slow, insidious, and permanent. Anti-vegf treatments have no effect on this. In fact, the only trial I know of for Dry AMD right now is being done by ACTC and their stem cell derived RPE cells. Wet AMD occurs when there is a rupture in Bruch's membrane under the macula. This allows new vessels to grow from the choriocapillaris through the breach in Bruch's membrane and under the retina. These new vessels leak, and cause detachment of the macula. Squalamine will not stop breaks in Bruch's membrane. It WILL (hopefully) stop new vessel growth from the choriocapillaris.

    The number of cases that convert from dry to wet AMD is less than 10%, and if caught quickly enough it can be arrested. So no, I don't see Squalamine being used as a preventative. It would not be cost efficient. It is more efficient to closely monitor dry AMD patients and treat when wet AMD manifests. Now if ACTC or some other company comes up with a treatment for dry AMD, that would really be a multi-billion drug!

  • Reply to

    Phakosurgeon, your squalamine pricing assumption

    by hugeman99 Feb 5, 2014 8:29 AM
    phakosurgeon phakosurgeon Feb 5, 2014 10:14 AM Flag

    Hugeman, your last sentence says it all. You are assuming free market pricing. It is not quite that simple. As I wrote previously, Eyelea and Lucentis are bought directly by the retinal surgeon who are then reimbursed by Medicare. The drops are a normal drug, and will be covered by Medicare Part D and by private insurance companies. What does that mean, it means the patient will have to pay for them himself. And if Ohr tries to price the drug at $500 a bottle, Medicare will simply say "that's fine, we will only pay $200, the rest will come out of the patient's pocket as a copay". And guess what, Ohr won't be able to sell too much because every single retiree on a fixed income will say "What, $300 out of my pocket for some lousy drop, give me the darn needle." That's a simple fact of life. Medicare and the insurance companies hold all the power here "It's good to be the King"
    That is not to say that Ohr won't make a ton of money selling Squalamine at $150 a bottle. Remember, the anti-vegf's are biologicals. They are very expensive to produce. It costs quite a bit per dose. Squalamine is a small protein molecule. It will cost a few dollars a bottle to produce. So if Ohr sells it for $150-200, the margins will be huge. Trust me, if Squalamine can deliver on its promise, it will EVENTUALLY be a $1-2 billion drug. And that's great. But it will not suddenly happen overnight when phase II interim results are published. I'll stick with my $40 forecast, maybe even be generous and up it to $50. But when phase III is completed successfully, well that's a different story.

  • Reply to

    Livermore wants total market domination

    by stuartcreekfarms Feb 4, 2014 12:42 PM
    phakosurgeon phakosurgeon Feb 4, 2014 9:01 PM Flag

    Optimist, I am not a retinal doctor. As my handle implies, I am an anterior segment surgeon. However I can tell you about the economics of anti-VEGF injections. A typical dose of Eylea or Lucentis costs from $1500 to $2000. Now here's the interesting part. Medicare does NOT directly pay for the drug. Medicare requires that the retinal specialist buy the drug, and then reimbursed the doctor the exact cost of the drug. So what does a retinal specialist get at the end of the day for injecting the patient? Well he gets about $40 for the injection. Meanwhile, he's got to lay out thousands of dollars for the drug, and hope that he gets reimbursed in a timely manner on all his claims, something that I can assure you doesn't always happen. Trust me, no doctor in this country is getting rich doing anti-VEGF injections. Now as to your calculations. A single injection costs $2000. A bottle of Squalamine will cost $150-$200. The typical patient requires say 8-12 injections of eyelet at $2000 per pop. How many bottles of Squalamine do you think he is going to use even if Squalamine was completely able to replace injections? I highly doubt it is anywhere near 150 bottles.
    Also, when I say $35-40, I am talking about where the stock goes if they announce that Squalamine is showing efficacy in reducing the need for injections in the phase 2 interim look. I am not thinking any further than that right now.

  • Reply to

    Livermore wants total market domination

    by stuartcreekfarms Feb 4, 2014 12:42 PM
    phakosurgeon phakosurgeon Feb 4, 2014 8:03 PM Flag

    Livermore, I appreciate your answer to my post. I understand what you are saying, and I agree with you. AMD seems much more linear than cancer, or even the common cold. You are right. Logically speaking, the mathematical models say that Squalamine is a slam dunk. But a funny thing about patients and their diseases - they don't understand math. Not one bit. That is something that 30 years of clinical experience has taught me. If every patient followed the mathematical models, I would have the easiest job in the world. I do not know what specialty you are pursuing, but if you are doing clinical practice, I am sure you will learn quickly enough. Medicine is as much art as science. And a doctor who only practices using logic will not succeed. (Isn't that what Bones and Spock used to argue about all the time? )
    It would be great if we could always be sure that disease and treatment followed our logic. In the case of Squalamine, I sure hope it does. But remember, patients are not abstract mathematical problems, and neither are diseases.
    Again, I wish you luck with your boards. I know, the memorization is not fun, and 75% of the stuff you will be asked on the boards you will probably never see in real life. But like in many other fields, it is a rite of initiation one must get through. Hope you knock it out of the park!

  • Reply to

    Livermore wants total market domination

    by stuartcreekfarms Feb 4, 2014 12:42 PM
    phakosurgeon phakosurgeon Feb 4, 2014 7:28 PM Flag

    Djohnson, Squalamine does not need to eliminate all anti-VEGF injections to be successful. If it manages to decrease the need for injections by 25%, it will be a major success. I do not think that Squalamine, will make this a $200 stock, but if it gets to $35 or $40, I consider that quite lucrative.
    Hugeman, I have no arguments with what Livermore is saying about Squalamine's mode of action. I also have no doubts as to its effectiveness. Genaera's trials have already proved effectivity. The only real question that needs to be answered is does the drop deliver enough Squalamine to the posterior pole to be therapeutic? If the answer is yes, we win. If the answer is no, we lose. That's it, plain and simple. Like all the others here, I am betting the answer is yes. Good luck to all.

  • Reply to

    Livermore wants total market domination

    by stuartcreekfarms Feb 4, 2014 12:42 PM
    phakosurgeon phakosurgeon Feb 4, 2014 3:29 PM Flag

    I am good friends with one of the chief investigators in the phase II trial. I have been sending him retina patients for over 25 years. While he would NEVER tell me directly how the trial is going (and I would never ask him directly), I have detected a certain excitement in his voice when Squalamine is mentioned. But even though he seems fairly positive about Squalamine, he does not think that it will replace anti-VEGF injections. I hope you are right and he is wrong. I hope Squalamine proves to be everything you think it will be. If it is, I will be glad to share a Mai-Tai with you on the beach, my treat. But please, let's try to keep this in some perspective.
    Good luck to you on your boards. I remember mine all too well, as my daughter was born the day of my orals. It was quite an experience needless to say!

  • Reply to

    Livermore wants total market domination

    by stuartcreekfarms Feb 4, 2014 12:42 PM
    phakosurgeon phakosurgeon Feb 4, 2014 3:14 PM Flag

    Livermore, I applaud your enthusiasm for this drug, and I'm sure you believe every word you are writing. But I wish you would take it down a notch. You seem to think that Squalamine is a slam dunk. The drop will be so successful in the Phase II interim look, that the DSMB will immediately recommend moving directly to Phase III. It might happen, but the odds are against it. You are all but convinced that the drops will totally obviate the need for anti-VEGF injections., and completely render Lucentis and Eylea superfluous. Again, possible, but highly highly unlikely.
    Look, I agree with you. I think the chances of a successful trial are high. But high choroidal concentrations in Belgian rabbits do not necessarily translate to high choroidal concentrations in humans. If I had a dollar for every "wonder" drug that cured cancer in a laboratory animal but did not work in humans, I'd be sipping Mai-Tais in Tahiti right now.
    Yes, the scientific evidence all points to the potential for success. But unfortunately when it comes to a typical wet AMD patient, the human body doesn't care about ionic attraction, dipole-dipole interactions, Brownian motion, feedback loops, transport equations, Nernst potentials, or Nitric Acid levels. It will respond or not respond to a drug based on a lot of things besides theory. Yes, the science is very sound. But in over thirty years of practice, I have often found that results defy our expectations both good or bad.
    This does not mean that I think that Squalamine will be a failure. Quite to the contrary. I think the trials will ultimately be successful, and I think that my investment in OHRP will be quite lucrative.

    CONTINUED

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