Andrew Lo (MIT) – financial engineering a “cancer megafund”

Via Felix.

http://video.mit.edu/watch/professor-andrew-lo-can-financial-engineering-cure-cancer-11949/

https://lgo.mit.edu/news/articles/lo-cancer-megafund/lo-cancer-megafund.html

In LGO webinar, Andrew Lo discusses “cancer megafund”

By Josh Jacobs, LGO Director of Operations and Partner Integration

Andrew LoAndrew Lo

In a recent MIT Leaders for Global Operations webinar titled “Can Financial Engineering Cure Cancer?” MIT SloanProfessor Andrew Lo described how the same tools that were used to catastrophically inflate U.S. mortgage debt markets could be used to fuel a “cancer megafund” to distribute the risks and rewards of breakthrough research across the vast global bond market.

Lo, who directs MIT’s Laboratory for Financial Engineering and also leads a hedge fund he created in 2003, is noted for applying tools from various disciplines to provide new insights on key issues in finance. In recent years, driven by the impact of cancer on friends and family members, he wondered if the resources of global capital markets could be used to accelerate progress toward solving pressing global challenges in health and energy.

Working from his expertise in financial markets, Lo described his concept for how the greed and financial engineering that drove a six-fold increase in U.S. mortgage debt in the 2000s might be focused to more altruistic aims. Recognizing that a huge global bond market—vastly bigger than the venture capital market—is looking for ways to secure reasonable returns, Lo proposed a $30 billion cancer megafund that would invest in more than 150 promising drug development projects. He discussed his cancer proposal recently with both the Economist and the Boston Globe.

In his March 1 presentation, Lo demonstrated that spreading the typical cost, risk and return on cancer drugs across such a broad range of potential successes would present very attractive potential rates of return to bond investors. This potential fund would address the current negative trend for investment in biotech, driven by very long development timelines as well as dry cancer-drug development pipelines.

While $30 billion is not a very large target in the context of global bond and sovereign wealth investment resources, it’s equal to the current overall budget for the National Institutes of Health—and, more importantly, it would provide a longer-term horizon than venture capital investors now offer for drug development efforts.

In response to a question by an LGO student about the governance procedures that would be needed to prevent a “cancer bubble” along the lines of the housing bubble, Lo said that despite the lessons learned from the housing finance crisis, “the price of innovation may be some false positives.” However, he added, with proper oversight and financial structuring, the net impact of the cancer megafund would be overwhelmingly positive, particularly in light of declining governmental support for such research.

Lo, who was recognized by Time as one of the World’s 100 Most Influential People, is convening a conference this June at MIT on the cancer megafund project with key stakeholders from the biotech industry, government, the investment community, and cancer researchers. More details will be forthcoming soon on his website.

Jeffrey: On millimorts and microlives…

Very good, very interesting piece on risk measurement and reporting…

http://www.jeffreybraithwaite.com/new-blog/2014/11/20/youll-be-dying-to-hear-about-this

You’ll be dying to hear about this

There’s lots of death in the world. Transport is risky, for instance—planes, automobiles, trains and ships can crash, maiming or killing passengers. You don’t have to go much further than seeing the road toll, or hearing about Malaysian Airlines Flight MH17 shot down over the Ukraine, or watching the TV scenes of the Costa Concordia, run aground just off Isola del Giglio near the coast of Italy, to appreciate that death is never far away.

Then there’s infectious diseases. You can all-too-readily catch a cold, or the flu, or TB, or lately, the Ebola virus. And there seem to be never-ending wars and skirmishes in the Middle East; and terror, spread by fundamentalists.

Each of these, depending on fate, can hasten someone’s demise. Wrong place, wrong time, wrong circumstances.

Lifestyle issues can cause problems for your risk profile too—but these are slower, and more stealthy. Think of smoking, drinking too much, eating yourself into a coma or just gross obesity, or the more insidious dangers of sitting at a computer for years on end with little exercise. These can translate over time into heart or lung disease, diabetes, and cancer.

Whether you are active or passive, things you do or don’t do can shorten your lifespan, or kill you a little or a lot faster than you would otherwise last. So what levels of risk do you actually, quantitatively, face in your own life?

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Stanford University decision scientist Ron Howard in the 1970s presented a novel way to calculate this risk. He introduced the idea of the micromort, defined as a one-in-a-million likelihood of death.  This is such an evocative unit of measurement that it deserves a little further attention.

If you live in the US or another relatively rich, OECD-style country, with good law and order, legislation that keeps society relatively risk free (such as with environmental and public health issues sorted out, effective building codes, and so forth), a well-educated population, access to health care, and a buoyant GDP, you can expect a micromort of one on any particular day. Another way of saying this is that’s the standard expected death rate for any individual today in any one 24 hour period: a microprobability of one in a million is your index of baseline risk.

These are great odds for you, today, as you read this; you are very likely to get through it. Congratulations if you do.

What circumstances lead to an elevated risk? Say if you do dangerous things or even just live life to the full? How does your micromort level get upgraded?

In the United States, you accumulate an extra 16 micromorts each time you ride a motorcycle 100 miles, for instance. Or 0.7 micromorts are added for each day you go skiing; so go for a week and you’ve added five more.

Or you might decide to do something a little more strenuous. With hangliding, the additional risk of dying equates to eight micromorts per flight; or skydiving, nine per freefall.

They are relatively benign compared to moving up to base-jumping. Do so, and you rapidly earn many more risk points: 430 micromorts per jump, in fact.

Marathon running, anyone? That will be seven micromorts to your debit account for each run. Even walking 17 miles adds one micromort, as does a 230 mile car trip, and add another one for every 6,000 mile train trip. But the puzzle is, it’s not always clear how to treat these: the walking introduces an element of risk (you could be out and about and get run over, or be struck by lightning) but it’s also beneficial (it contributes to improved health).

Perhaps even more interesting, there are microprobabilities associated with accumulated chronic risks in contrast to these other single-shot event risks. These are lifestyle choices and behaviors that incrementally add a little more risk through exposure. They won’t kill you if you have bad luck on a given day, but will slowly have an effect—and may claim you in the end.

Every half a liter of wine exposes you to a micromort because it can accrue into cirrhosis of the liver. Each one and a half cigarettes does the same, but the menace here is cancer or heart disease. Even eating 100 char-broiled steaks, 40 tablespoons of peanut butter or 1,000 bananas sneaks up on you in the form, respectively, of cancer risk from benzopyrene, liver cancer risk from aflatoxin B or cancer risk from radioactive potassium-40.

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Hang on though. I doubt I’ve done much to help anyone.

Because a clear problem is that people aren’t very good at doing these kinds of statistics, or applying them to their own lives—and are even less capable of acting on them. We can readily appreciate that skiing or motorcycling add some risk for the time you are doing them compared to the everyday activities of being at work or hanging out at home, yet many people are undeterred. People even cheerfully find ways of taking on more risk, such as by climbing Everest, driving fast cars, or having unsafe sex.

Everyone knows about that steadily accumulated risk, too: not too many of us are blind to the fact that drinking too much alcohol can lead to liver disease or smoking to lung cancer over time. And although both have been falling for decades, this hasn’t stopped millions of people indulging. There’s 42.1 million US smokers at last count, or 18.1% of the population, and on average each adult US citizen consumes 8.6 liters of alcohol annually.

This is not the best performance internationally but is by no means high by international standards, and Eastern Europeans smoke more heavily, and really give hard booze like vodka a nudge.  Nevertheless, both activities contribute to what public health people quaintly call excess deaths and the rest of us know by “their drinking or smoking (or both) killed them eventually.”

But what does it actually mean that you expose yourself to increased risk if you go out walking regularly or eat bananas?  We need another way of looking at this, because it’s too hard to do the sums.

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Enter the University of Cambridge medical statistician David Spiegelhalter and his colleague Alejandro Leiva who invented the idea of a microlife. This is another unit of risk which has the calculation built in for you. It is half an hour of your life.

If you increase your risk by one micromort, then this shortens your life by half an hour. These calculations apply to people on average, and work out for entire populations, but any one of us might be lucky or unlucky, depending on our individual characteristics. Any particular risk doesn’t convert exactly to the specific individual. But with enough people in the US (beyond 316 million now) and on the planet (7 billion and rising), there’s a relentlessness accuracy about the statistics.

So now let’s do some life expectancy math with Spiegelhalter. Smoke a pack a day? You lose up to five hours a day. Accumulated, that’s up to eight years off your life. Have six drinks a day and that binge costs you one half hour allocation—a shortened life by ten months or so. Stay eleven pounds overweight and you sacrifice half an hour every day you do so (another ten months across your lifespan), as you do if you watch TV for two hours. Your coffee habit at 2-3 cups daily takes away another half hour lot. So does every portion of red meat each day. Another ten months each time.

It’s not all negative. There’s good news. Eat five serves of fruit and vegetables every day and you gain up to a couple of hours each time. You get three years back. Exercise and the first 20 minutes per day earns you a surprising hour (there’s a good investment—a year and a half), and each subsequent 40 minutes adds up to one more half hour bonus to your credit (a bit more work but that seems a pretty good deal, too, to get a ten month return).

If you have a hobby, activity or diet and it’s not been dealt with so far, you can fill in some of the gaps with some good guesstimates. Do you have passive pursuits, akin to watching TV? This is a net deficit. Do you do active, exercise-oriented activities, such as weekly amateur netball, soccer, bowling or basketball—or just walking regularly? Add some lifespan.

These half hour allocations alter somewhat depending on your genetics of course (you can have lucky or unlucky genes) or your socioeconomic status (wealthy people typically live longer than poorer folks) or your gender (women on the whole live longer than men). That said, with this idea you are now able to alter your risk profile by changing your behavior with a tangible, calculable return.

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There’s a punchline to this, and it may be already occurring to you as you reflect on your own lifestyle and lifespan. There are a million microlives in fifty seven years of existence. That, for many of us, is roughly the adult allocation.

Let’s call that your life expectancy baseline. We can assume that you have had a reasonably healthy childhood (not so for everyone, of course, but true for many US children, and true for most readers). Then, from that point on, a large part of your healthy adult life is now measureable.

So: come out of your teens, reach your 21st birthday, and as the “jolly good fellow” and “happy birthday to you” songs subside, imagine you then have 57 years to go. That is, you have an allocation of 78 years in total, maybe a little longer, maybe a little shorter.

Yes, all sorts of unexpected things might happen along the way, but to some degree your lifespan is now no longer vague, but quantifiable. The actual life expectancy in the US indeed hovers around this: it’s 79.8 years overall, 77.4 for males and 82.2 for females. (It’s higher in some northern European countries and Japan, but that’s a story for another day).

However, you might be reading this thinking: Yikes. I’m not 21: I’m a bit older than that. In this case, you’ve already used up a proportion of your time left. Console yourself. At least you got through the riskiest stage of all: being a baby, up to one year of age, and childhood, up to six or so, when many things can go wrong.

But have you used what you were given so far, well? Or do you have a fair bit of regret?

To make an obvious point, however, this isn’t Doctor Who. You don’t have a Tardis to go back in time and fix the past. So stop any lamentations. Look forward.

By now, if you’ve come to value more readily each half hour and especially the cumulative effect of your lifestyle choices to date, don’t listen to me preaching. Feel completely empowered. You know what to do and how to alter your own numbers.

Now, all that’s left is to do the math. You’ll have a much clearer picture of your life and potential death than ever before. It’s your move: what’s next?

Further reading

Blastland, Michael and Spiegelhalter, David (2014). The Norm Chronicles: Stories and Numbers About Danger and Death. New York: Basic Books.

Howard, Ronald (1984). On fates comparable to death. Management Science 30 (4): 407–422.

Spiegelhalter, David (2012). Using speed of ageing and “microlives” to communicate the effects of lifetime habits and environment. British Medical Journal 345: e8223.

Spiegelhalter, David (2014). The power of the MicroMort. BJOG: An International Journal of Obstetrics & Gynaecology 121 (6): 662–663.

The Life Insurance Model kick starts in the US

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Michael Doughty, president of John Hancock Insurance, stretches in Boston. Hancock will offer a program that tracks policyholders’ medical data and offers discounts for healthful behavior. CreditCharlie Mahoney for The New York Times

Andrew Thomas’s life insurer knows exactly when he arrives at his local gym. The company is notified when he swipes his membership card, and 30 minutes later, it checks that he is still there, tracking his location through his smartphone.

The insurance company has a vested interest in keeping Mr. Thomas alive and well. In return for sharing his exercise habits, his cholesterol level and other medical information, Mr. Thomas, a 51-year-old medical publisher who lives in Johannesburg, earns points, which translate into premium savings and other perks. By staying in good shape, it is less likely that Discovery, his insurer, will have to pay out his life and disability policies.

“Every Saturday morning, just for playing golf, I get points,” said Mr. Thomas, who said he received about 9 percent back on his life insurance premiums for each of the last five years. “It is trying to make people live a health y lifestyle.”

Now John Hancock will become the first life insurance company to introduce a similar program for American consumers. The program, being announced Wednesday, will apply to both term and universal life insurance policies and is being operated through a partnership with Vitality, a global wellness company that already works with employers and health insurers in the United States.

The concept — which has been used in South Africa, where Vitality is based, Europe, Singapore and Australia — has the potential to transform the way life insurance is priced, at least for consumers who are willing to continually share their health data. But it also raises questions about how that information will be protected — and whether it could be used in ways that ultimately work against a consumer’s best interests.

People who sign up will receive a free Fitbit monitor, which can be set to automatically upload activity levels to the insurer. The most active customers may earn a discount of up to 15 percent on their premiums, in addition to Amazon gift cards, half-price stays at Hyatt hotels and other perks.

John Hancock, a division of Canadian insurer Manulife Financial, says it hopes the program will help reinvigorate life insurance sales, which have stagnated industrywide for decades. Just 44 percent of households in the United States own individual policies, according to Limra, a trade group, a 50-year low. Any product that reminds consumers of their mortality is hard to get excited about, but industry analysts said that financially strained households, changing demographics and increasingly complex and expensive products have led to the decline in sales.

“It has been a slow to no-growth industry for a long time,” said Michael Doughty, president of John Hancock Insurance, based in Boston. “It is crying out for innovation and for someone to try to reinvent the product to make it more relevant.”

The new program also upends the traditional approach to life insurance underwriting, which typically bases its pricing on a detailed but static snapshot of a person’s medical status. Now, John Hancock’s term and universal policies will be priced continuously, at least for consumers who choose the Vitality program.

John Hancock and Vitality, which is owned by Discovery, said the information would not be sold and would be shared only with entities that help with the program’s administration, though the aggregate data could be used to inform the development of new insurance products.

Nonetheless, some specialists expressed privacy concerns.

“All of a sudden, everything you do and everything you eat, depending on which bits of the information they collect, is sitting in someone’s database,” said Anna Slomovic, lead research scientist at the Cyber Security Policy andResearch Institute at George Washington University and a former chief privacy officer at Equifax and Revolution Health.

Of course, buying any life insurance policy requires customers to share detailed medical histories upfront. But consumers participating in the Vitality program must be comfortable providing enough information continuously to meet certain thresholds that will convert into worthwhile savings. That might include the frequency of workouts, reporting a physical exam or answering sensitive personal questions: During the last 30 days, how often did you feel so nervous that nothing could calm you down? Hopeless? Depressed?

“You do not have to send us any data you are not comfortable with,” Mr. Doughty said. “The trade-off is you won’t get points for that.”

Participants need to amass 3,500 points to achieve silver status, 7,000 to reach gold and 10,000 for platinum. Nonsmokers automatically earn 1,000 points, and people with in-range cholesterol, glucose and blood pressurewill receive 1,000 points for each. A “verified” standard workout three times a week, or an advanced workout twice a week, provides another 3,120 points over the course of a year. Flu shots, 400 points. The clock is reset each year, though 10 percent of points may carry over.

All customers participating in the program will start by paying a premium priced at the gold level. That is a discount of about 9 percent for a 45-year-old man who bought a $500,000 term insurance policy that covered a 20-year period: He would pay $750 annually, compared with the $825 it would cost outside of the Vitality program.

So what if he does everything right, but breaks his leg? Or worse, gets a serious disease like cancer? While those conditions would not directly affect his rate, if he could not maintain gold status for any reason, he could see premium increases of 1.1 to 1.6 percent each year. But if he reached platinum status, his premiums would fall by about 0.30 percent each year.

The program may attract healthier people who have already engaged in these activities on their own. The strategy also tries to tap into the way humans are naturally wired: There is generally no immediate tangible benefit to life insurance, but this program is structured to try to change that.

“People respond far more to immediate gratification than delayed gratification,” said Dr. Kevin Volpp, director of the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute. (He has performed research sponsored by Vitality.)

The number of points assigned to a particular activity is determined by how it will influence a person’s longevity, based on Vitality’s internal findings — and its level of difficulty. “Stopping smoking is more valuable than one session of activity,” explained Alan Pollard, chief executive of Vitality. “If something is a complex behavioral change, it will attract more points.”

Vitality’s research has found that Americans are generally five years older than their actual age, after taking into account various health and wellness factors. All participating policyholders will be given a “Vitality age,” which will help the program set personal guideposts.

“The people who have the time to devote to jumping through all the hoops are likely to be better off than average, and those healthy enough to do wellness activities may be unrepresentative of the chronically ill,” saidFrank Pasquale, a professor at University of Maryland Carey School of Law. “I believe that is one reason why there is empirical research severely questioning the value of wellness programs.”

John Hancock, which operates in all 50 states, said the universal life program had been approved by insurance regulators in 30 states, while the term program is available in 20 states; more states are expected to be announced throughout the year. It said no regulators had declined to approve it yet.

“It changes the paradigm of life insurance,” Dr. Volpp said. “In some sense, it tries to change your insurance into less of a passive vehicle that pays the bills if something happens, into a more active vehicle to get people to lower their risk.”

Harvard Business School/Harvard Medical School – Healthcare Innovation

 

Peter Orzack (citi) on the economics and financing of health. Gave interesting insights into potential unintended consequences of transparency (aside from reduced variation), could get collusion.

Drugs and devices require RCT level evidence to be enacted, but health financing policy can be done from the hip.

Risk adjustment will be improved by clinical (EMR) level data. At present, claims-based risk adjustment can predict only 10% of future spending whereas clinical data + SES data can predict 40%

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Note “Micro Kale” on the menu:WP_20150415_013

Mark T. Bertolini, CEO of Aetna, presenting one of the most powerful speeches on health care reform and renewal of corporate america I’ve every heard.

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WP_20150415_015Also had an extended conversation over dinner with Ceci Connolly (MD, PWC Health) spoke with Halle Tecco (CEO, Rock Health) and Luc Sirois (Hacking Health, coming to HISA’s HIC 2015), Dr Paul Tang (Paolo Alto Medical Foundation) and Kaiser Permanente (polypill work).