Sent: Friday, August 4, 2017 1:53 AM
From:
Sent: Friday, August 4, 2017 1:53 AM
To: Jeffrey Epstein
Subject: so far
Ideas for Transforming the Alzheimer Landscape
<= class="gmail-MsoListParagraphCxSpFirst">1. Segment the landscape until we have a natural advantage
2. =C240 Opport=nities small enough to win, large enough to matter
3. 4)=A0 Mea=urable points on the board
<=>Situation
Not a typical disease with a single causal factor / etiology
Requires longitudinal investments in health and hard to track
What needs to be built — preferably invest in places that can do all thr=e
o Institutions - processes, policies
o Tools & technologies - validation
o Science — exploration
- =C24, Downside(s) of creating a new institution from bgc3; difficulty managing "portf=lio" of tools & technologies;
exploration challenging to manage </=pan>
What is required?
$75 million, 3 year WIN-WIN strategy m=naged quietly from bgc3 that will result in
1.=C24> $$ savings to CMS
2.=C24) Improved trial participation</=>
3. Shared data
4. Validated biomarkers
5. $$ savings for caregivers=/p>
6. Global public goods in basic science=/span>
7. =span style="font-size:12pt;line-height:115%">Stronger existing instituti=ns
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8. </=pan>New market deve=opment
9. 4>=A0 Novel fin=ncial product offerings
10.=span style="font-variant-numeric:normal;font-stretch:normal;font-size:7p=;line-height:normal;font-family:"Times
New Roman""> New drugs from fail=d ones
How - 7 ways, as of today...
Underwrite risk for private sector; keep data in the public domain
...$20 million matching fund for private sector (1:2 for government, 1:1 for private secto=) to the AMD-AD
...Outcomes:
•=A0 In 3 years, study and trial data for 2016++ pipeline fully public and curated =y NIA
• =C24> 10 new candidate drugs put into later stage discovery process
Endow a biomarker consortium secretariat = biomarker moonshot
...$10 mill=on to create a "world" secretariat between US & Europe
...Biomarker consortium - 5-20 million per biomarker validation from public-private and partner w IMI to ensure
candidate studies are flowing</=>
...Outcomes:
In 3 years, 5 validate biomarkers
Open and shared trial and registry data
Aligned US/Europe regulatory and study processes
...$5 mil=ion to NIA/NIH to RFP and identify gut pre-inflammatory and inflammatory marker= (multiple diseases benefit)
consider PPP or matching grant abilities<=span>
...$5 million to ICDDR,B to classify non-pathogenic colonists and create a digital World =ut Library with partners like
Danone and Yoplait
...$=0 million to redraw bacterial taxonomy based on genetic criteria to supplement tradit=onal identification and
classification (gram + etc) could partner with BMGF
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...Outcomes
Creation of several global goods
Bacterial genetic taxonomy is a library for world use, all drug development and food safety would have modern
standards based on reality rather than staining (traditional) criteria
-=C24> Microbiome non-pathogenic library offers biomarkers for health but also potential prebiotic and endobiotic
candidates for food and pharmaceutical industries (monetizable = creates new market)
<=p>
Computational repurposing of failed candidate drugs
...$20 million (for profit vs. shared profit) for repurposing of top 20 failed candidate t=erapies based on computational
models can be done as a special initiative at Schrodinger or within the NIA as part of the AMP-AD
=p class="MsoNormal">
=/span>
...Outcomes
20 repurposed medications
Creates new market opportunity for failed drugs
This experiment could lead to the creation of an institution (for profit most sustainable)
Investigate and buil= social biomarkers=/span>
...$1 million for grand challenge-like process managed by NIA to identify social changes directly correlated with aging
and dementia
...par=ner with Tesla and/or invest in autocameras or real time digital cognitive (rea=tion time/ocular
movement/decision-making) monitors for mobile
...Outcomes
Digital biomarkers
*=B7 40=A0 Financial and social safety nets for at risk (early detection or red flagging)<=span>
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Bring the financial industry into the conversation
...$1 million to explore Wealthcare, alongside the Federal Reserve (efforts already underway...) and major financial
instituti=ns to better understand behaviors and challenges of the senior investors (over age 65)
4>=804>create long term care insurance for caregivers (not just facilities = insure against =ou having to care for
someone or to pay you to do it) and relieve burden on lo=g term facility care insurance providers
<= class="MsoNormal">*=80410utcomes
=C2* =C24> Save massive money for CMS, insurance companies and caregivers
=C2* Create a new financial product
Create automated checks and balances or financial standards for demented adults or retirees over age 65 with
cognitive challenges
Share actuarial burden between long term facility care-caregivers </=pan>
Reduce CMS facility and hospital admission costs
...$2 million for RAND to shape financial argument for CMS reimbursement for cognitive ho=e health nurses (like hospice
nurses) = classify cognition and safety as sk=lled medical needs — currently only covered as: skilled nursing visits, =r
physical, speech-language pathology, occupational therapy, or home health aide servic=s
...Outcomes
<= class="gmail-MscaistParagraphCxSpFirst">* 4>=A0 Save tons of money
=C2* =C24> Reduce hospital admissions
Improve trial e=rollment
...$1 million for corporate advocacy and lobbying/awareness campaigns on family leave
...Who enrolls in trials? Spousal-patient dyads but most patients are cared for by adult children who need to work.
Family leave act.
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....orporate leadership. It's unpaid, which often makes taking a leave financial=y impossible. Only 12% of private-sector
workers have paid family leave. It o=ly applies to employers with 50 or more workers. So employees at many small
businesses are out of luck. It excludes recent hires. To qualify, you must =ave worked for your current employer for at
least 12 months and for at least 11=50 hours. It doesn't cover the reasons people often need to take time =ff to care for
their parents - under the law's rules, you can't take a lea=e to: shepherd your mom or dad to a doctor's appointment,
stay with your parent during = short-term illness or help him or her get resettled after moving from one type of care
facility to another. Chronic dementia not considered a "serious med=cal condition." It also doesn't let workers take a
leave to car= for their grandparents, in-laws, siblings or adult children.
<= class="MsoNormal">
<=span>
...Outcomes
Greater ability to participate in clinical trials
=C2• Reduced burden on caregivers
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[Image 1] The image appears to be a photograph of a document with text. The document seems to be a list or notes related to a discussion or presentation about the financial industry. The text includes bullet points with topics such as "Create a new financial product," "Share a new budget report," and "Create a new financial product." There are also references to "CMS," "CMS," and "CMS," which could be acron
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