PHARMA DEALS DURING MAY 2014
(Part 2 out of 3)

In May, the deals announced by Big Pharma companies to streamline and rationalise their business operations continued apace with a high level of M&A activity.  The deals mentioned represent the valued deals that were announced during May but there were two major M&A offers that did not materialise in the month. Firstly, the Pfizer bid for AstraZeneca and, secondly, the Valeant bid for Allergan

“When that shark bites with his teeth dear, scarlet billows begin to spread”

The other major M&A rumble was the hostile bid by Valeant for Allergan. In the last week of May, Valeant increased its offer twice to a final eye watering value of $54bn (8.7 x sales, 27 x operating income).  The offer represents an Allergan share price of around $180, a 54 per cent premium over the pre-bid price. According to Reuters, Pershing Square – a Valeant ally and a hedge fund investor holding nearly 10 per cent of Allergan's shares - has called for a meeting to replace the Allergan Board. The question is whether Valeant's primary motive for the bid is strategic or financial.  Valeant is domiciled in low tax Bermuda and in its initial offer claimed there would be a “high single-digit tax rate for the combined company in addition to cost synergies”. Allergan has questioned this and the sustainability of the Valeant business model based on growth from debt-funded acquisitions.

At the end of March Valeant had $17bn of long term debt. Allergan's presentation filed with the SEC claims that growth in the two largest Valeant acquisitions, Medicis and Bausch & Lomb, since Valeant acquired them, has been driven by price increases with loss of volume/market share.  There are a number of companies that have a growth strategy based on acquisitions e.g. in Europe, Meda (rejected bid from Mylan), AMco and previously Nycomed (now owned by Takeda).  The companies funded by debt provided by private equity are usually sold so Allergan's questions about the sustainability of the business model are valid.  Nevertheless during the month Valeant divested its injectable cosmetic fillers for face wrinkles to Nestle (Galderma) for $1.4bn (see table below).  This sale clears potential anti-trust issues if Valeant acquires Allergan with its Botox franchise. In essence, the Allergan product range is a good strategic fit with the Valeant business.

“That's life, that's what all the people say, you are riding high in April and shot down in May”

The traditional Big Pharma business model was continued in the month with Abbott acquiring the Chile-based branded generic company, CFR Pharmaceuticals for $3.3bn (4.3 x sales, 34 x EBIT) to expand its presence in Latin America. Abbott's bid represents a 52 per cent premium on the share pre-bid price. CFR has changed from buyer to seller in 6 months. Last November, its bid for the South African company, Adcock Ingram, was rejected by the Government shareholders in the company. As in France with the GEC bid for Alstom and in the UK with AZ, Governments are increasingly concerned about divestment of local major companies to foreign-owned entities.   

Lundbeck, too, is sticking to its traditional business model. It wishes to continue developing and commercialising innovative neurological products and to expand its US presence. The acquisition for up to $658m (a 59 per cent premium on the pre-bid share price) of the US company, Chelsea Therapeutics, achieves both those goals. Chelsea has the recently FDA-approved droxidopa, the first and only symptomatic treatment for neurogenic orthostatic hypotension ready for launch later this year.

Shire also continues with its well-established strategy to develop and market products for treating rare diseases with its acquisition of the privately-owned US company, Lumena Pharmaceuticals for $260m plus “near-term contingent milestone payments related to ongoing clinical trials”. Lumena develops oral products for treating liver disease and has two oral inhibitors of the apical sodium-dependent bile acid transporter (ASBT) in phase II to improve liver function. The lead product has potentially four potential orphan indications. 

As if one acquisition per month is not enough, Shire also bought another rare disease company, the privately-owned Australian-based Fibrotech, for $75m plus contingent payments based on the achievement of development and regulatory milestones. The company has a novel compound in phase Ib for treatment of diabetic nephropathy. Subject to success, a phase II study will start in the rare indication of Focal Segmental Glomerulosclerosis.  Shire is really motoring. It acquired Viropharma last November for $4.2bn which contributed $93m of sales in the first quarter of this year. Rumours are already circulating that Shire (market capitalisation $34bn) is a target for an acquirer. Apparently Allergan's initial talks with Shire were rebuffed and at the end of April, Allergan was said to be preparing a bid.  Apart from the strategic objectives of a combined company, such a bid could fend off the bid for Allergan from Valeant.  Oh and by the way, because Shire is domiciled in Ireland, where the corporation tax is 12.5 per cent, Allergan would make significant tax savings; a familiar story.         

“I did it my way”

In the same way that Big Pharma is reshaping its business, so are the smaller companies.  This month there were two acquisitions of generic companies. Akorn acquired Versapharm, a privately-owned US company that develops and markets generic dermatology products. The cash price of $440m (debt financed) represents around 4.5 x sales. Akorn is better known for its ophthalmic business where it acquired three products from Merck & Co in November 2013 for $53m. 

Hikma, the Jordanian generic company, acquired the assets of the US-based Bedford Labs (owned by Boehringer Ingelheim), a generic injectable manufacturer, for $300m (16 x sales).  The price consists of $225m upfront and $75m subject to performance-based milestones over the next 5 years. The high sales multiple and a negative EBIDA reflects the manufacturing problems at the site which prompted Boehringer to sell. At least the $225m will go some way towards paying for the $650m settlement of the US Pradaxa litigation Boehringer announced in May.

“Let's face the music and dance” 

Finally, it is a pleasure to report that licensing deals have had a resurgence this month hopefully reflecting the synergistic benefit of partnering between biotech and pharma to develop innovative medicines. In addition to the Xenoport deal reported above, there were six valued deals with an aggregate value of $2.7bn. Top of the list was Ophthotech's commercialisation and co-development agreement with Novartis for Fovista, an anti-PDGF agent, in phase 3 for wet age-related macular degeneration (AMD). Novartis has ex-US commercialisation rights and plans to develop a combination product with a Novartis anti-VEGF agent. Coincidentally two weeks earlier, there was another deal for a product for treating AMD. Regeneron entered into a $653m development and commercialisation collaboration to combine Avalanche's gene therapy vector platform with Regeneron's molecules. Regeneron also has a time limited first right of negotiation to Avalanche's VEGF agent in phase IIa for AMD. 

BMS also entered into a platform deal with CytomX for so-called “Probodies,” monoclonal antibodies that are selectively activated within the cancer microenvironment. BMS has rights for up to four oncology targets. There is a $50m upfront plus $298m per target (Note: only one target has been assumed in the headline value in the table below) plus “tiered mid-single-digit rising to low-double-digit royalty payments” eg 5 per cent to 12 per cent? Why are companies so coy about announcing royalty rates? In contrast to the platform deals by BMS and Novartis, Takeda has taken an option to license from MacroGenics a single product, MGD010 a B-cell targeted monoclonal antibody for treatment of autoimmune disease. Takeda paid $15m upfront and has the option to enter a global licence following the completion of phase Ia. If Takeda exercises the option a further $18m is payable plus up to $469m in milestones plus double digit royalties. 

One year ago AstraZeneca acquired Omthera. On May 7 Epanova, a soft gelation capsule containing Omega-3, was approved by the FDA as an adjunct to diet to reduce triglyceride levels in adults with severe hypertriglyceridemia. On May 14 Omthera announced a $45m deal to license Ligand's prodrug platform for delivery of drugs to the liver. The timing suggests the Ligand deal was in the wings waiting for the FDA approval. As a footnote, Ligand this month licensed to what appears to be a new company called Viking Therapeutics, five of Ligand's small molecule programmes and provided a $2.5m convertible loan to fund the development.  Ligand is to receive a fee in Viking equity at the time of a private or public financing plus milestones and royalties. Ligand described it as a “creative licensing transaction”.

Fuente: PMLive

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PHARMA DEALS DURING MAY 2014
(Part 1 out of 3)

In May, the deals announced by Big Pharma companies to streamline and rationalise their business operations continued apace with a high level of M&A activity.  The deals mentioned represent the valued deals that were announced during May but there were two major M&A offers that did not materialise in the month. Firstly, the Pfizer bid for AstraZeneca and, secondly, the Valeant bid for Allergan

“What's it all about when you sort it out, Alfie”?

Prof Brian Smith in his book The Future of Pharma describes how pharma companies will evolve to adapt to the changing social and technological environment. He postulates that “the large hierarchical and integrated organisation structures…have run their course as the optimal structural form” and companies will restructure to become more focused in specific business areas such as research ('Genii'), generics ('Monster Imitators'), OTC ('Get Well, Stay Well'), etc. This implies the current conglomerate big pharma companies will narrow down to specialise in certain areas such as research or OTC but not both. 

One company with an uneasy mixture of pharmaceuticals and consumer products is Reckitt Benckiser. In the first quarter 2014 report it says “The strategic review [of the pharmaceutical business] we announced in October of last year continues to progress well.  All options continue to be considered.  A capital markets solution is emerging as a strong option.” The difficulty is that Suboxone (for treatment of drug addiction) sales are being hit by generic competition. In the first quarter sales dropped by 11 per cent and in 2013 operating profit for the division dropped 21 per cent. It is therefore very surprising that this month Reckitt Benckiser announced two deals relating to addiction products: a $145m deal with Xenoport for arbaclofen placarbil at end phase IIa for treatment of alcohol abuse; and a supply and marketing agreement with AntiOp for intranasal naloxone for opioid abuse. What's it all about?

It is certainly the case that Big Pharma companies are currently rationalising their business but most companies seem to be maintaining more than one business area, probably to minimise risk. Why is the rationalisation happening now?  It is driven, we believe, by the short term impact of lower prescription sales and profitability caused by generic competition which are seriously reducing blockbuster product sales as patents expire. Big Pharma companies are seeking to boost short/medium term profitability, and perhaps to simultaneously address the long term environmental changes, by rationalising the business and focusing on key strategic areas. 

“The minute you walked in the joint I could see you were a man of distinction, a real big spender”

Last month we saw Novartis divest vaccines and animal health, acquire more oncology and set up a joint venture with GSK for consumer health. Similarly, this month the top value deal at $14.2bn is the acquisition by Bayer of Merck & Co's consumer health business assets including global brands such as Claritin. According to reports, this will make Bayer the second biggest consumer health company in the world with sales of $7.4bn, of which $2.2bn will come from the Merck products. Bayer seemed to have paid a very high price representing 6.5 x sales and 21 x EBITDA. No wonder Reckitt Benckiser dropped out of the bidding.

According to Reuters, Reckitt Benckiser's chief executive Rakesh Kapoor said "We are a highly disciplined acquirer with strict return metrics which we will not break." Bayer justified the price based on tax savings and cost synergies of $200m by 2017, a familiar story. Perhaps Bayer took comfort from “a related transaction” announced at the same time whereby Merck and Bayer entered into a co-development and co-commercialisation agreement for soluble guanylate cyclase modulators for $2.1bn. One product is approved and the other is in phase IIb.  Bayer will lead the commercialisation in the Americas and Merck will lead elsewhere.

Not content with the Bayer deals, Merck & Co also divested its ophthalmic business (mainly Timolol) in Japan, Asia Pacific and Europe to its licensee Santen. For sales of $0.4bn the price was $0.6bn plus sales milestones. Merck sold its US ophthalmic business in 2013 for 1.5 x sales to Akorn. Similarly, in keeping with the portfolio rationalisation, Bayer sold its interventional device business to Boston Scientific for $0.4bn representing 3.3 x sales.

GSK was also active streamlining its portfolio with the divestment to Pernix of the US rights to Treximet, a sumitriptan/naproxen combination, for $267m representing 3.4 x sales and an estimated 11 x EBITDA. This was a complex deal involving the assignment by GSK to Pernix of the product development and commercialisation agreement for the product developed by Pozen, the payment by Pernix of $3m to an investor, warrants in Pernix shares to Pozen plus royalties of 18 per cent. 

In the last days of May, GSK was reported to have invited private equity companies, presumably those with investments in pharmaceutical companies, to bid for GSK's mature products. This is quite a turnaround from the situation some years ago when a director of one of the UK Big Pharma companies said it did not divest mature products because it got no credit for such disposals in the share price. The fact is acquiring old brands is fraught with operational and contractual difficulties in regulatory, manufacturing and marketing. This has been demonstrated in the past by a number of cases where the only willing buyers of the products were contract manufacturing companies offering low value deals.

“Oh, the shark has pretty teeth dear, and he shows them pearly white”

Judging by Pfizer's bid for AstraZeneca (AZ), it seems the fashion for mega mergers in the pharmaceutical industry is not yet over. The last offer of 45 per cent cash and 55 per cent paper representing £55 per share (45 per cent premium over the pre-bid price) valued AZ at £69.4bn or $117bn equivalent to 4.5 x sales and 32 x operating income. The offer resulted in a lot of hand-wringing by UK politicians about the loss of jobs and research expertise in the UK and perhaps some hand-rubbing at the prospect of additional tax revenues.

In the hearings before the UK parliamentarians, Pfizer made it clear the price could only be sustained based on tax savings estimated by analysts at $1.4bn a year. The UK tax corporate rate will be 20 per cent in 2015 compared to 35 per cent in the US.  The UK also has a 10 per cent tax rate on profits earned from UK patents. The difference in tax rates across the world has driven US companies to accumulate cash overseas, Pfizer is reported to have $69bn offshore.  The loss of US tax revenue also prompted political hand-wringing by some Senators and a threat of legislation against 'inversion' as US companies increasingly move offshore for tax purposes.

AZ rejected the last Pfizer bid as too low which immediately prompted some investors to complain that AZ should have engaged in negotiations with Pfizer. This is the new 'norm', where virtually every M&A transaction creates a storm of protest (and litigation) by investors who want to cash in their chips at the highest possible price. Pfizer may be back in town in six months' time but one can't help thinking its bid is driven more by financial than strategic motives.

Fuente: PMLive

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6 LESSONS FROM THE HealthCare.gov DEBACLE

by David Heitman

There is some irony in the fact that an administration recognized for having run the most digitally savvy political campaigns in history, should now be shipwrecked on the rocks of technical difficulties. One can certainly empathize with the president’s predicament regarding the failures of the new HealthCare.gov website, and there are a number of lessons to be learned here

1. Better to Launch Late Than Launch Badly

Choosing between these two options may feel like a “name your poison” proposition, but business leaders, product managers and marketing professionals occasionally find themselves in precisely this kind of dilemma. As difficult a choice as these situations present, they can be character-defining moments when an organization and its executives are willing to take responsibility for a bad situation. Imagine how much less flak Mr. Obama would have taken if he’d just said, “We’ve done our due diligence, and the site is simply not ready to launch. We’re going to need another six weeks to deliver the quality of product that the American people deserve.” That would have subjected his administration to some short-lived criticism, but not accusations of malfeasance.

Announcing a delay can even have a positive effect if handled correctly. Automaker Infiniti recently announced the postponement of a wireless battery recharging system, scheduled for 2014. The company noted that new advances in technology meant delaying until 2016 would enable them to offer luxury car buyers a superior, highly differentiated product.

2. Placing a Premium on Critical Feedback

Too often, organizational leaders place such a premium on loyalty that the people who work for them are inclined to tell them what they want to hear rather than the truth. It wouldn’t be surprising to learn that this dynamic was at work with the premature launch of HealthCare.gov. In fact, details have emerged that numerous parties knew the website was not ready to launch, but were either unwilling to say anything or were ignored. Great leaders seek out unvarnished truth, because only when dealing with unpleasant facts can they help guide their organizations out of danger.

3. Public and Media Relations Thrive on Transparency

One of the cardinal rules of PR is to be straightforward about the facts. It’s the foundation of building trust with the media and the public. Even embarrassing details are better revealed than obscured. It is always the cover-up that damns and damages political, business and religious leaders. Americans are a forgiving bunch, especially when they feel that people are shooting straight with them. The Obama administration’s seeming inability to be forthcoming with the numbers of visits, inquiries, enrollments and purchases has engendered public distrust. It has even turned otherwise sympathetic news outlets like the Huffington Post, MSNBC The New York Times and even The Daily Show into harsh critics.

4. Respect Your Audience

The selective statistics that HHS and the White House have provided to the media are disingenuous at best and intentionally misleading at worst. It’s insulting to the intelligence of their audience. In today’s digital ecosystem where every move on the Internet is tracked, analyzed and sorted in real-time, precision and integrity of data should be givens. For example, while HHS boasted that 15 million visits demonstrated the popularity of HealthCare.gov, Pew Research found that 70% of those visitors already have insurance and are just curious “tourists,” not serious shoppers.

5. Business Leaders Are More Beholden to Their Technical Experts Than They’d Like to Be

It would be unfair to blame Mr. Obama per se for the technological failures of the website. Every CEO has felt this same kind of helplessness at one time or another. The IT director walks in and says, “We need to spend another $500,000 on network upgrades.” The CEO really has no way to evaluate the merits of the request. Is it really mission-critical, or is the IT department just bored with their old equipment? Technical experts wield an increasingly large share of influence in most organizations. And since most CEOs don’t have the time to learn how to write code, they have to trust their technical people, while still possessing the insight and judgment on how to integrate their advice.

6. Failure in the Details Threatens the Larger Vision

The biggest setback for the Obama administration is the movement of the conversation from the merits of healthcare reform to that of a dysfunctional website. The website has become a synecdoche for the entire healthcare issue, and as a result, tarnished the larger vision with a feeling of incompetence. This is perhaps the biggest issue of all in the HealthCare.gov failure.

The lessons: Quality before deadlines. Respect your audience’s intelligence. Truth over spin. Seek out bad news, rather than demanding loyalty. Don’t let failure in the details undermine the vision.

Fuente: ChiefExecutive.net

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BIOTECHS RAISING PROFILES IN DEALMAKING, BUT BIG PHARMA FIRMS ARE STILL TOP DOG

by Jennifer Boggs

As the tag line for the upcoming Allicense meeting in San Francisco suggests, this year's focus is on the "next generation" of dealmaking. But that isn't just an industry buzzword.

There's been a cataclysmic shakeup of the sector in the last several years, from big pharma mega mergers to a recession to increased regulatory and pricing pressures. While the biopharma industry that has emerged from those macro events is a stronger one – perhaps, as some analysts have suggested, even bubble-proof – today's dealmaking is a different ballgame, one that features more players than ever.

"In the old days, if you were looking to partner, you had a list of 10 to 15 firms to call," said Laura Vitez, analyst at Thomson Reuters Recap. "Today, you're not doing yourself justice if you just look at those 10 to 15."

She and fellow Recap analyst Vinay Singh conducted a marketplace analysis, looking to identify the major players in dealmaking – licensing and M&A pipeline-filling deals – in 2013. Their working hypothesis was that smaller companies were encroaching on what had largely been big pharma's territory, in some areas even taking over the lion's share of dealmaking activity.

But that wasn't exactly the case.

Instead, the list of top dealmakers still leads with the same familiar names. It's just that "the list is a lot longer," Vitez said.

Roughly one-fourth of licensing deals in 2013 were done by the top 20 firms – calculated based on total annual pharmaceutical revenue – but in-licensing dollars from the top 20 comprised 56 percent of the total $20 billion spent. Still, that means deals by smaller companies totaled an impressive $9 billion.

Celgene Corp., in particular, inked a series of significant deals in 2013. Though not among the top 20, revenue-wise – Celgene places at No. 26 on the list with $6.4 billion in revenue – the Summit, N.J.-based firm shelled out $165.5 million in up-front money for rights to Morphosys AG's multiple myeloma antibody in a potential $818 million deal in July. Only a few weeks later, it offered $100 million up front for HDAC inhibitors discovered by Acetylon Pharmaceuticals Inc., in a deal that could bring Acetylon up to $1.1 billion in milestones and comes with a buyout option. (See BioWorld Today, July 3, 2013, and July 29, 2013.)

An analysis of M&A deals for the year tells "a similar but somewhat separate story," Singh said. The top 20 firms did 15 percent of the M&A deals for therapeutic assets, representing about one-fourth of the total $60 billion spent on those assets in 2013.

Much of that came from the $10.4 billion buyout of Onyx Pharmaceuticals Inc. by Amgen Inc., which landed as No. 12 on the top 20 list, with revenues of $18.2 billion. Also cracking the top 20 was fellow big biotech Gilead Sciences Inc., with revenues of $10.8 billion, putting it at No. 18. (See BioWorld Today, Aug. 27, 2013.)

When it comes to in-licensing and acquiring promising assets, biotechs are holding their own against the deep pockets of big pharma. "Companies like Amgen and Celgene are entering competitive bidding situations, and they are winning," Vitez said.

BIG PHARMA STILL ON TOP

Still big biotech isn't likely to supplant big pharma as the top dealmakers any time soon. Despite massive restructurings, revenue lost to the dreaded patent cliff and a continued decline in R&D productivity, big pharma continues to contribute the most money by far to biopharma dealmaking, mostly by virtue of simply being so big.

The mega mergers of recent years have widened that gap. Since 2000, Pfizer Inc., for example, has snagged Warner-Lambert, Pharmacia, Wyeth and King Pharmaceuticals Inc. – all companies that had grown via their own earlier merger activity. That puts New York-based Pfizer at the top of the revenue list, posting 2013 pharmaceutical revenue totaling a whopping $51.6 billion.

To put that into perspective, one of biotech's biggest growth stories, Celgene, recorded revenue of $6.4 billion. So it's no surprise that big pharma's bandwidth for dealmaking still far outstrips big biotech.

Astrazeneca plc, for instance, "announced 42 deals in at least nine different therapeutic sectors in the last three years," Vitez said. "No matter how hard the guys at Biogen Idec work, they're not going to come close to that."

Not that Cambridge, Mass.-based Biogen's dealmaking efforts have been too shabby. It made it onto Recap's list of the top 12 most active dealmakers of 2013 – figures are based on deals where terms are disclosed – as the fifth most active, putting it up there with big pharmas such as London-based Glaxosmithkline plc and Whitehouse Station, N.J.-based Merck & Co. Inc.

Topping that list were Astrazeneca and Johnson & Johnson, each of which announced 16 deals last year, followed by Roche AG with 12 deals, Pfizer with 10 and smaller firms Celgene and Merck KGaA both disclosing seven deals.

Interestingly, big pharma's overall internal R&D spend was down year over year in 2013, noted Singh, a sign that those firms might be acknowledging that smaller biotechs are more adept at earlier-stage discovery and R&D.

A report published earlier this year conducted by the EMA, for example, looked at the 94 novel drugs approved in Europe from 2010 to 2012 and found that, while 87 percent of those approvals were granted to pharma firms, more than half of the products started out in biotech labs. (See BioWorld Today, Feb. 4, 2014.)

With partnering and acquisition proving more lucrative strategies for big pharma, its dealmaking activity is unlikely to wane.

"Going in [to the analysis], we had expected to see a more distinct role reversal" in dealmaking, Singh said. But while the smaller biotechs are "stepping into the territory, those same 10 to 15 [big pharma firms] are not falling off by any means.

"They're still getting deals done and still spending a lot of the money," he added.

Another plus for the industry is the trend toward early stage deals. Of the total 111 discovery-stage deals in 2013, the top 20 players were responsible for 46. They inked 16 of the 50 platform technology in-licensing deals.

The big firms also did 23 preclinical-stage deals, 16 clinical-stage and four deals for approved drugs. (See chart below.)

That there were fewer late-stage deals isn't surprising; there are simply fewer assets out there. But the rise in discovery deals is good news for innovation.

"It looks like science is back," Vitez said. "People aren't afraid of science right now."

Editor's note: Allicense 2014: The Next Generation of Dealmaking will be held in San Francisco, April 29-30. Visit Allicense.com to register or to learn more information about this year's meeting.

Fuente: BioWorld

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CARDIOBUZZ: MORE MONEY NEEDED FOR HEART RESEARCH

by  Todd Neale

The NIH dedicates a lot of money for research into heart disease and stroke, but it still might not be enough, a new study suggested.

In recent years, public funding for cardiovascular research has topped $2 billion annually, more than is spent on the other diseases on the nation's list of top killers, according to the NIH.

But when you weigh the disease burden against the amount of research funding received, cardiovascular disease appears to be getting short-changed.

Chris Stockmann, MSc, a PhD student in the departments of pediatrics and pharmacology/toxicology at the University of Utah Health Sciences Center, told MedPage Today that he wanted to look into the issue after reading a study published last year detailing the leading causes of death and disability in this country.

Cardiovascular disease -- including ischemic heart disease and stroke -- was at the top, both in 1990 and 2010. Rounding out the list of 10 were breast cancer, diabetes, cirrhosis, lower respiratory tract infection, colorectal cancer, Alzheimer's disease, lung cancer, and COPD.

As Stockmann and his colleagues reported in the International Journal of Cardiology, the NIH dedicated $6 billion to those conditions combined in 2010. Ischemic heart disease got the biggest chunk ($1.56 billion) and COPD got the smallest ($133 million). Considering ischemic heart disease and stroke together, cardiovascular disease received $2 billion.

Dividing those figures by the number of deaths caused by each condition, however, moved cardiovascular disease far down the ranking. Breast cancer received $19,342 in research funding per death, whereas cardiovascular disease received a comparatively meager $2,659 per death.

A similar trend was seen for hospitalizations: breast cancer received $10,653 per hospitalization, Alzheimer's disease received $4,698, and cardiovascular disease received just $878.

"Regrettably, we -- as members of the medical community -- have failed to articulate the need for public funding into the basic causes of cardiovascular disease and the clinical trials needed to understand how best to treat and prevent it," Stockmann said in an email to MedPage Today. "Although heart disease and stroke kill nearly one out of every two Americans and consume one out of every $6 spent on healthcare in this country, we have underestimated the challenge in understanding the basic pathophysiology of these diseases and in helping the public to understand how to live and enjoy the benefits of a heart-healthy lifestyle."

Joseph Hill, MD, PhD, chief of cardiology at UT Southwestern Medical Center and co-chair of the American College of Cardiology’s Academic Section Advisory Council, said in an interview that he wasn’t surprised by the findings, and pointed to a couple reasons why cardiovascular research might not get as much funding -- relative to disease burden -- as some other conditions.

First, he said, the significant reductions in heart disease mortality in recent decades might have left some people with the impression that the problem has been solved. "That, of course, is far from the truth."

And second, a perception that heart disease is a self-inflicted disorder -- caused by eating poorly, becoming obese, and smoking, for example -- might result in some people thinking that not as much funding needs to go into understanding its causes.

"There certainly is a lifestyle component that contributes importantly, but half of the problem is out of people's control," Hill said.

While admitting her bias as a cardiologist and the president of the American Heart Association, Mariell Jessup, MD, of the University of Pennsylvania also agreed that cardiovascular research is under-funded and said that it's not clear what goes into the NIH's decisions about where its money should go.

The solution to the funding problem, she told MedPage Today, is to increase the overall NIH budget rather than to advocate for money to be taken from one disease and moved to another.

"If there's a single message," she said, "it's that we as a country -- if we want to keep our place in the world as the fountain of research and as the originator of major medical strides -- have to fund to a higher level all research from the NIH – in addition to cardiovascular disease and stroke research."

Hill pointed out that the current study was a snapshot of funding from 2010 and that NIH funding has been declining for the past decade. At the same time, some other countries around the world have been increasing their investment in medical research.

"We are pulling back when many other countries are ramping up," he said. "And so the historic advantage and lead that we have had in this country is diminishing."

The study did not take into account funding from industry or foundations, and Stockmann noted that metrics other than those used in the study could be used to guide decisions about how to allocate funds for research.

"Our hope in publishing this study is to spark a national dialogue on the funding of biomedical research and to provide information that may be useful as a starting point in the discussion of how to fund biomedical research in the years to come," he said.

The NIH did not respond to a request for comment.

Fuente: medpage TODAY

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