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Personalized Medicine Conference
Boston | November 6, 2013
Accelerating Medical Solutions
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us …”
We are entering a new
“Golden Age of Medicine.”
Precision Medicine,
Immunology, Stem Cells…
Change in Biomedical Research Spending (2012)
Source: OECD – Government Budget Appropriations or Outlays for Research and Development (2012)
-10%
-5%
0%
5%
10%
15%
20% China India
Brazil Korea JapanGermany
Australia UK
France
US Canada
Overview
The Interaction of Financial, Social and
Human Capital … and Technology
The Promise of Bioscience and Public Health
Where We Have Come From
Accelerating Medical Solutions
Berkeley
1964
Los Angeles Under Siege
P = Prosperity
Ft = Financial Technology
HC = Human Capital
SC = Social Capital
RA = Real Assets
P=SFti*(SHCi+SSCi+SRAi)
Universal suffrage
Rule of law
Education and health care
Police and fire protection
Religious freedom
Cultural resources
Property rights
Protection of creditors
Financial reporting standards
Examples of Social Capital
Human capitalis the largest asset class.
Cost of Raw Materials & Energy
1920’sAutomobile
60% <2%
Today’sMicrochip
Education and skills
Immigration
Health and quality of life
Three Ways to Build Human Capital
Each life is priceless…
but in economic terms, over the past two
centuries, as much as 50% of all economic
growth can be traced to advances in health.
The Value of Health
0
20
40
60
80
1955-1960 2011
Life Expectancy in East Asia
Source: United Nations, Department of Economic and Social Affairs, Population Division (2011).World Population Prospects: The 2010 Revision, CD-ROM Edition
2001 -
2010
11.1%
10.5%
10.3%
8.9%
8.4%
8.2%
7.9%
7.9%
7.7%
7.6%
Angola
China
Myanmar
Nigeria
Ethiopia
Kazakhstan
Chad
Mozambique
Cambodia
Rwanda
2011 -
2015
8.6%
8.4%
8.4%
7.8%
7.6%
7.6%
7.2%
7.1%
7.0%
7.0%
Iraq
China
Ghana
Mozambique
Zambia
Rwanda
Uzbekistan
Congo, D.R.
Nigeria
Cambodia
Source: The Economist; IMF (excludes countries with populations<10 million)
Annual Average GDP Growth
World’s Fastest Growing Economies
$2,255
Source: International Monetary Fund (2011 USD)
Do human capital strategies work?
Per Capita GDP
1960
$2,271
Singapore
Jamaica
$5,526
2012
$49,936
Overview
The Intersection of Financial, Social and
Human Capital … and Technology
The Promise of Bioscience and Public Health
Where We Have Come From
Accelerating Medical Solutions
Between 1870 and 1950, Americans added almost ONE YEAR OF EDUCATION EACH DECADE.
By 1960, the highest average grade level in the U.S. EXCEEDED EVERY OTHER NATION BY TWO YEARS.
Since 1960, we have made no progress and several OTHER NATIONS HAVE SURPASSED US.
Source: Claudia Goldin and Lawrence Katz / The Race between Education and Technology
“I believe we can keep the
promise of our founding —
the idea that if you’re
willing to work hard … you
can make it here in
America.”
- Reelection Night
Source: New York Times 11/7/12
Skilled and Unskilled Jobs in the U.S.
60%
20% 20%
Unskilled Semi-skilled Skilled
15%20%
65%
Unskilled Semi-skilled Skilled
1950 Today
Return
Job Training
Preschool
Programs
School
Return on Human Capital Investment
Source: James Heckman, University of ChicagoAge
Share of Government Spending on Education
0% 20% 40% 60% 80% 100%
Finland
France
United Kingdom
Germany
Australia
Mexico
Greece
USA
Source: OECD
Early Childhood Middle Late
Social Capital
60% of Chinese people with assets over
$1.6 million are thinking about
emigrating to the U.S. or Europe.
Source: U.S. Department of Homeland Security (WSJ 2/22/12 “Plan B for China’s Wealthy: Moving to the U.S./Europe)
1. Harvard University
2. University of Cambridge
3. University of Oxford
4. Stanford University
5. Berkeley
6. University of Tokyo
7. Johns Hopkins University
8. MIT
9. Yale University
10. UCLA
World University Ranking
11. Imperial College London
12. UC San Diego
13. National University/Singapore
14. University of Melbourne
15. University College London
16. University of Toronto
17. University of Edinburgh
18. Kyoto University
19. University of Sydney
20. University of British Columbia
Life Sciences and Medicine
329 Scholars since 1989
87 born outside the U.S.
39 countries of origin
245 Scholars have parent(s) born outside the U.S.
106 colleges attended
58 are married
72 children of Milken Scholars
64 Harvard
37 Stanford
28 Yale
24 Berkeley
17 Penn
15 Columbia
14 MIT
10 Princeton
9 Brown
5 Cornell
Sources: Vivek Wadhwa, Duke University
More than half of Silicon Valley’s science and
engineering workforce is foreign-born.
More than 15% of Silicon Valley start-up companies
were founded by immigrants from India.
Another 13% have CEOs from China or Taiwan.
Immigrants in Silicon Valley
Sources: Partnership for a New American Economy
Foreign-born scientists in the U.S. are listed among the inventors on…
• More than five out of six information-technology patents
• Almost eight out of 10 pharmaceutical drug patents
• Three out of four patents in molecular biology and microbiology.
Patents
1900: Countries More Than 50% Urban
> 50%
< 50%
2000: Countries More Than 50% Urban
> 50%
< 50%
34
U.S., Japan, and E.U. Make Up More Than 60%
of the World’s Real GDP
0%
20%
40%
60%
80%
100%
United States
Japan
European Union
Other
(GDP in constant 2005 US$)
Sources: World Bank.
Emerging Market vs. Developing Economies
Source: International Monetary Fund.
30
35
40
45
50
55
60
65
1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018
Share of world GDP (%), based on purchasing-power-parity (PPP)
Developed Economies
Developing Economies
Increase in U.S. Corporate Cash Balances
Source: Bloomberg. Data are for cash and marketable securities
1523
1522
7
25
8 8
145
68
5646
34 34
21 18
-15
5
25
45
65
85
105
125
145
Apple+840%
Microsoft+192%
Google+267%
Cisco+108%
Oracle+380%
Pfizer+32%
Chevron+158%
Merck+120
2007 Q2 2013
$ billions
Increase in Corporate Cash Balances 2005 to 2013Cash holdings of publicly listed companies, percent of GDP
Source: Bloomberg and International Monetary Fund. Note: Includes cash and near cash items.
8%9%9%10%12%
14%
23%23%24%
37%40%
7%
1%3%
6%9%
6%4%
8%
17%
7%6%
0%
10%
20%
30%
40%
Germany$95
Russia$171
Italy$127
Brazil$205
U.S. $826S.Korea$107
Spain$266
France$437
Japan$618
U.K. $747China$3,051
Q1 2013 2005
Japanese Companies’ Cash Stockpiles
Source: Bloomberg.
0
5
10
15
20
25
30
35
40
Toyota Softbank Rakuten Sony Mitsubishi Mitsui HondaMotor
Billion USD
2007
2013
Japanese Corporate Cash Larger Than Spain’s GDP
Source: Bloomberg, World Bank.
Note: Corporate cash includes cash & deposits for nonfinancial private companies.
0
500
1,000
1,500
2,000
2,500
Japan corporate cash U.S. corporate cash Spain GDP
Billion USD
Source: SWF Institute, August 2013.
China $1,300
Norway $810
United Emirates – Abu DhabiSaudi Arabia
$800$700
Singapore $458
Kuwait $386
China - Hong Kong $327
Russia $189
Others $946
Largest Sovereign Wealth Funds By Country
(US$ Billions)
Source: Bloomberg.
Country 3/1/2009 10/30/2013 Increase
U.S. (S&P 500) $6.3 T $16.2 T 156%
U.K. (FTSE 100) $1.3 T $3.0 T 138%
Japan (Nikkei 225) $1.6T $2.9T 79%
Germany (DAX) $558 B $1.2 T 121%
Mexico (Bolsa IPC) $108 B $353 B 228%
Equity market capitalization: 2009 to present
The Nature of Credit
1. Credit is what counts, not leverage.
2. Most loans to real estate are not investment-grade.
3. Interest rates are volatile and unpredictable.
4. Credit research is more than ratings.
5. Sovereign debt is historically risky.
6. Debt values underpin all capital markets
Federal Spending Priorities
FDA CDCNIH
Education
Housing Subsidies
$0
$100
$200
$300
Sources: FDA, CDC, NIH, OMB, Pew Charitable Trusts. Education reflects OMB category “Education, Training, Employment, and Social Services” function. Housing subsidies reflect estimated forgone tax revenues from deductions for imputed rent, mortgage interest and property taxes. All data 2012 except housing, which is estimated for 2010.
Annual, in $ billions
(forgone tax
revenue)
Mortgages Guaranteed by the Government
Source: U.S. Census Bureau
1980
$13B
7%
2013
$4T
90%
New Mortgages Backed by FHA
$0
$100
$200
$300
$400
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Source: Inside Mortgage Finance
(billions)
Change in U.S. Home Ownership
Source: U.S. Census Bureau
1980
65.6%
2013
65.4%
45%
50%
55%
60%
65%
70%
Canada UK Denmark U.S. France Japan Germany
Current Home Ownership Rates
Sources: EuroStat, U.S. Census Bureau, AEI, Milken Institute.
Sources: Robert Shiller, Milken Institute / 8-15-13.
Home prices don’t go up forever
WWI WWII
GreatDepression
70’sBoom
80’sBoom
LatestBoom
Change in home prices in 122 years
-20%
-10%
0%
10%
20%
30%
1890 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010
Transaction Cost Comparison
400 shares of AAPL
Value = $212,000
Cost to sell = $9.99
Residential Mortgage
Value = $212,000
Cost to sell = >$20,000Date: 10/24/13
Source: Global Wealth Databook 2013, Credit Suisse
Wealth Patterns in Selected Countries
Country Average Median <$10K >$1M
Australia $403 $219 6.9% 6.8%
France $296 $142 21.7% 4.6%
Greece $103 $54 20.4% 0.8%
Italy $241 $139 20.0% 3.0%
Japan $217 $110 9.2% 2.5%
United Kingdom $244 $112 18.0% 3.2%
United States $301 $45 30.7% 5.5%
2013 wealth per adult in 1,000 U.S. dollars (rounded)
Source: Global Wealth Databook 2013, Credit Suisse
Wealth Patterns in Selected Countries
Country Average Median <$10K >$1M
Australia $403 $219 6.9% 6.8%
France $296 $142 21.7% 4.6%
Greece $103 $54 20.4% 0.8%
Italy $241 $139 20.0% 3.0%
Japan $217 $110 9.2% 2.5%
United Kingdom $244 $112 18.0% 3.2%
United States $301 $45 30.7% 5.5%
2013 wealth per adult in 1,000 U.S. dollars (rounded)
Average Size of American Houses
1,000
1,500
2,000
2,500
1970 1980 1990 2000 2005 2010 2012
Square feet
Source: U.S. Census Bureau
2,5052,434
Home Sizes: U.S. vs. Asia
-
500
1,000
1,500
2,000
2,500
Hong Kong Japan South Korea India China Singapore U.S.
Square feet
Sources: U.S. Census Bureau; CLSA Asia-Pacific Markets
2,505
1,200
33% Housing
18% Transportation
13% Food
11% Insurance/pensions
6% Healthcare
5% Entertainment
4% Apparel and services
23% Food
10% Housing
8% Clothing
8% Other
6% Transportation
5% Healthcare
5% Communication
Consumer Spending
Source: U.S. Bureau of Labor Statistics/CLSA
U.S. Asia
2% Supplemental Education
15% Supplemental Education
P = Prosperity
Ft = Financial Technology
HC = Human Capital
SC = Social Capital
RA = Real Assets
P=SFti*(SHCi+SSCi+SRAi)
U.S. and Fortune 500 Employment
America Goes to Work
60
80
100
120
140
160
180
200
1970 1975 1980 1985 1990 1995 2000
Modern capital
markets begin
New financial technologies
are fully implemented
U.S. = + 62 million jobs
Fortune 500 = minus 4 million
0%
20%
40%
60%
80%
100%
Banks CLOs Hedge, distressed andhigh-yield funds
Prime rates funds, financialand insurance companies
Institutional Investor Base for Non-investment Grade Loans
Sources: S&P LCD / JPMorgan.
Advancing Technology
Cost
Speed
Storage
Access
1975 $10
Cost of a 1-Minute Phone Call from the U.S. to India
Telecommunications cost to business approaches zero.
Today $.01
Download speed
In 2000: 1.2 megabits per second (Mbps)
Today: 14 megabits
… and faster speeds are coming soon.
Source: PC World
IBM System 370/168 in 1976
8 megabytes for
$8 million
Cost per megabyte:
$1 million
Apple iPad Mini
64 gigabytes for $529
Cost per megabyte:
$0.008
By 2014, there will be more mobile phones –
7.3 billion – than people on the planet.
Source: Silicon India 2/28/13
Mobile Device Penetration in Africa
2000
Source: Mike Obel
2%
2012
78%
2015
84%
Source: Mobile Health 2012, iPew internet and California Health Foundation; Burrill & Company, Capturing Value
In 2010, 17% of
cell phone
owners used
their phones to
look up health
information.
In 2012, 31% of
cell phone
owners used
their phones to
look up health
information.
Source: Juniper Research; Burrill & Company, Capturing Value
In 2012, there
were 44 million
healthcare app
downloads.
In 2016, there
will be an
estimated
142 million
healthcare app
downloads.
Price Volatility Increases
Alternative-Fuel Investment Risk
10
30
50
70
90
1975 1980 1985 1990 1995 2000 2005
2000/$barrel 2000/$ gallon
3.0
2.5
2.0
1.5
1.0
Retail Gas
Crude Oil
Defending the Persian Gulf from 1976
to 2012 cost America more than $8 trillion.
Source: Stern, R.J., United States cost of military force projection in the Persian Gulf, 1976–2007.Energy Policy (2010), doi:10.1016/j.enpol.2010.01.013
Aircraft carriers
War on terrorism
Wars in Iraq/Afghanistan
Maintain troops overseas
Foreign aid
Intelligence operations
Oil price volatility
Homeland security
Source: U.S Energy Information Administration.
Major Shale Basins Around the World
Note: Fossil fuels include oil, natural gas and coal. Source: U.S. Congressional Budget Office
Technology Game Changer
Total fossil fuel reserves, % of world total
U.S. now has the largest energy reserves in the world
17 16.6
8.3
5.7 5.5 5.44 3.7 3.2 2.9 2.4 2.4 2.3
1.2 0.9 0.8 0.7 0.7 0.7
PUSH
PULL
Crisis: Deepwater Horizon Oil SpillApril 20, 2010
Crisis: Deepwater Horizon Oil Spill
Oil flowed unabated – 53,000 gallons a day
180,000-square kilometer area
Time needed to cap the well: 5 months
Create a $1.4 Million Prize
7 teams exceeded the previous industry-best recovery rate
Team Vor-Tek: A Top 10 Finalist
Fred Giovannitti
Source: Cowen
Life Sciences Outperforms Indices
1998 to present
627.9% NBI
139.8% NASDAQ
89.2% DJIA
74.7% S&P500
• Challenge: Predict how many days a patient will spend in a hospital in one year
• Prizes: $3 million Grand Prize
Improve Healthcare - Win $3,000,000
www.heritagehealthprize.com
• 1,385 teams
• 23,443 entries
• 39,000 participants from 39 countries
Improve Healthcare - Win $3,000,000
www.heritagehealthprize.com
Overview
The Intersection of Financial, Social and
Human Capital … and Technology
The Promise of Bioscience and Public Health
Where We Have Come From
Accelerating Medical Solutions
• Prevention
• Treatment
• Research
Three Areas of Healthcare Spending
The U.S. spends $0.90 of every health dollar on
treatment...
… and just a dime on prevention and
research.
Health Initiatives: Initial Estimates vs. Reality
Medicare hospital insurance $9B $67B 7.44 to 1
Medicare (entire program) $12B $110B 9.17 to 1
Medicare ESRD program $0.1B $0.23B 2.23 to 1
Medicaid DSH program $1B $17B 17 to 1
Medicare home care benefit $4B $10B 2.5 to 1
Medicare catastrophic coverage $5.7B $11.8B 2.07 to 1
Massachusetts Health Reform $0.725B $0.869B 1.2 to 1
Sources: U.S. Congressional Joint Economic Committee Session (July 2009); Eye on the Market (10/17/13)
Benefit Est. Cost Actual Cost Ratio
U.S. Economy$15.9 trillion
Lifestyle Makes a Difference
Sources: Centers for Medicare and Medicaid Services / CIA World Factbook (2012)
70% of health-care spending –about $2.5 trillion – is spent on lifestyle-related diseases.
30% is spent on hereditary diseases.
> 15%
< 15%
Obesity Prevalence Among U.S. Adults 1991
Sources: Trust for America's Health and the Robert Wood Johnson Foundation
25-30%+
30%+
<25%
Obesity Prevalence Among U.S. Adults 2013
Sources: Trust for America's Health and the Robert Wood Johnson Foundation
“Eating too much has overtaken undernurtrition as a leading risk
factor for illness.”
The Global Burden of DiseaseInstitute For Health Metrics and Evaluation
University of Washington
“18.2% of premature deaths in the U.S. are associated with excessive
body mass.”
Columbia University StudyAmerican Journal of Public Health
August 2013
Only in America
“All member nations of the OECD
have witnessed greater
prevalence of obesity in their
populations over the past two
decades, but the United States
tops the list.”
20022005
Source: World Health Organization / Estimated obesity rates for people aged 15 years and older / 2005
1.5%
1.9%
6.6%
20.4%
24.2%
41.8%
1.8%
1.6%
7.8%
20.9%
21.6%
36.5%
Japan
China
France
Germany
U.K.
U.S.MEN
WOMEN
34.3%
24.0%Mexico
Obesity Rates: U.S. vs. World
Failure to address chronic
diseases adequately costs
the U.S. economy more than
$1 TRILLION annually.
After 20 years of supporting medical
research, I heard these words:
“You have cancer.”
Ca = Cancer
P = Prostate
CURE = All diseases
Cancer = C Change
Prostate = Prostate Cancer Foundation
All diseases = FasterCures
Richard KlausnerDirector, NCI
1995 - 2001
Helene BrownPioneer in cancer
education
National Cancer Summit - 1995
The MARCH: September 1998
National Institutes of Health Budget
Source: National Institutes of Health
0
5
10
15
20
25
30
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
$200 billion
An organization dedicated to shortening the
time to find cures and better treatments for
all life-threatening diseases
Partnering for Cures
Patients Helping Doctors
TRAIN
Philanthropy Advisory Service
Philanthropy Advisory Service
Engages with philanthropists, family offices, wealth advisors, and foundations to facilitate
strategic and informed philanthropic investment in biomedical research.
National Institutes of Health Budget
Source: National Institutes of Health
$0
$5
$10
$15
$20
$25
$30
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Inflation AdjustedBillions
Celebration of Science - 2012
DNA Pioneer James WatsonFrancis Collins, NIH
Margaret Hamburg
U.S. FDA
The NIH’s Tony Fauci and Earvin
“Magic” Johnson
Elias Zerhouni, President,
Global R&D, SanofiU.S. Energy Secretary Steven Chu
Overview
The Intersection of Financial, Social and
Human Capital … and Technology
The Promise of Bioscience and Public Health
Where We Have Come From
Accelerating Medical Solutions
One of every five American babies born in 1900 did not live to celebrate a 5th birthday.
Worldwide Life Expectancy Growth
Source: United Nations Development Program
1820 1900 1950 2013
+5
+18
+21+39
26Years
31Years
49Years
70Years
Improved sanitation
Development of antibiotics
Progress against heart disease
Investment in bioscience research
What caused the increase?
Chicken pox
Diphtheria
Invasive flu
Measles
Pertussis
Pneumococcal disease
Polio
Tetanus
Typhoid fever
Yellow fever
Smallpox
Source: Discovery Fit & Health
Deadly Diseases Controlled in the 20th Century
Take precautions . . . no one is immune
“Iron lung hotels” projected to cost billions.
A Grim Outlook
April 12, 1955
“The Salk Vaccine is safe, effective, and potent.
Polio is conquered.”
Elvis gets his shot to promote immunization 1956
Eradicating Disease
1955: The Salk polio vaccine was introduced.
Since then, the vaccine saved the U.S. nearly $1 trillion, avoided 160,000 deaths and prevented one million cases.
Solving Medical Problems
Source: Thompson & Radboud, “Retrospective Cost-Effectiveness Analyses for Polio Vaccination in the United States”
Polio Cases in the U.S.
Source: Centers for Disease Control
-
10,000
20,000
30,000
40,000
54 55 56 57 58 59 60 61 62 63
Elizabeth and
Ariel Glaser
“Research studies now project
that one in five—listen to me,
hard to believe—one in five
heterosexuals could be dead
from AIDS at the end of the next
three years. That’s by 1990.
One in five.”
- Oprah Winfrey
1987
November 7, 1991
With AIDS pioneering researcher Tony Fauci
at Celebration of Science
Earvin “Magic” Johnson at
Global Conference
We are entering a new
“Golden Age of Medicine.”
Precision Medicine,
Immunology, Stem Cells…
National Center for Advancing Translational
Sciences (NCATS)
Transforming the translational
science process so that new
treatments and cures for disease
can be delivered to patients faster.
Christopher AustinDirector
Sequencing the Human Genome
2003:
13 years
$3 billion
Today:
A few hours
Approaching $1,000
3-D Printing
Replicating human body parts
j
Jack Andraka
Jack Andraka@ 15: invents inexpensive diagnostic tool for pancreatic, ovarian and lung cancers that is more than 90% accurate
@ 15: wins $75,000 Intel InternationalScience Award
@ 15: forms Andraka Technologies,and files several patents
Lori Milken and her mother Robin
Mike Milken and his father Bernie and his mother Ferne
Thank you!
Thank you!
Thank you!
Thank you!
Create a legacy that relegates cancer
and other life-threatening diseases to our
children’s history books.
Personalized Medicine Conference
Boston | November 6, 2013
Accelerating Medical Solutions