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1:12

Jimmy, nice to beat you virtually. Thank you for

1:14

doing this. It was early in the morning. Thank

1:15

you for having me. I am an early riser.

1:18

What time do you

1:18

get up normally? Four AM.

1:20

Did you always wake up before you? No.

1:23

Actually, for most of my life, I

1:25

barely slept because I had this thing

1:28

cold, insomnia, and then I think me and my

1:30

wife coined when you have so much

1:32

pain that you can't sleep. Why did you have

1:34

so much pain had a disease called

1:36

sickle cell anemia. It's like a succession

1:39

of time bombs because first,

1:41

your split goes,

1:43

then your gallbladder, then your hips,

1:45

and all your organs up in jeopardy. And

1:48

aside from that, there's the cornerstone of

1:50

pain that you have to live with nonstop.

1:53

Lots and lots of pain. Jimmy

1:56

Ola Hair lives in Atlanta where he

1:58

works in e commerce. But he's

2:00

originally from Nigeria, which has

2:02

one of the largest sickle cell disease

2:04

populations in the world at

2:06

around four to six million people. In

2:09

the United States, around one hundred

2:11

thousand people have sickle cell disease,

2:14

so we classify it as a rare

2:16

disease. Most Americans

2:18

with the disease have African ancestry.

2:21

In fact, sickle cell disease occurs

2:23

in around one out of every three hundred

2:26

and sixty five black or African

2:28

American births. It's caused

2:30

by a single mutation in a single

2:32

gene. People with sickle cell disease

2:35

produce red blood cells that are rigid

2:37

and sickle shaped. As a result,

2:40

they can't carry oxygen and

2:42

also clog small blood vessels, causing

2:44

extreme pain episodes known

2:47

as crises like the words Jimmy

2:49

described. Growing up in Nigeria

2:51

at the time, they had no breakthrough

2:53

pain medication. When I'll have my crisis,

2:56

it'll be a menthol rub

2:58

and some advil. Jimmy's

3:00

family moved to the US when he was a

3:02

child so he could get better care,

3:05

but nothing made much of a difference. He

3:07

considered a bone marrow transplant, but

3:10

neither of his sisters were good

3:12

donor matches. Jimmy's pain

3:14

crises got worse as he got older.

3:16

The disease dominated his

3:18

life and eventually his

3:21

wives. Everything we did,

3:23

we had this child called sickle cell

3:25

that we had to do it with. I almost died on my

3:27

honeymoon because of sickle cell. You

3:33

told me that you used to spend lot of time

3:36

in bed with pain insomnia.

3:38

You told me that you now wake up at four

3:40

o'clock at morning energetic and ready to do something

3:43

with your day. How did this all come

3:45

about? This came about by

3:47

something called CRISPR. In

3:49

the fall of twenty nineteen, Jimmy

3:51

got a news alert that changed everything.

3:54

It was about a clinical trial for a

3:56

novel cure that uses CRISPR

3:59

gene editing technology to

4:01

fix the genetic mutation that

4:03

causes sickle cell disease. Jimmy

4:05

reached out to the doctors running the trial,

4:08

and they called him back the next day

4:10

to start the qualification process.

4:13

This all coincided with another

4:15

life altering event for Jimmy.

4:18

My wife has a son December

4:20

fifth twenty nineteen, and

4:22

I think it was a few days before

4:24

Christmas. December twenty something

4:27

they called me and officially told me

4:29

that I qualified. How'd you feel? I

4:31

was really just desperate knowing that I

4:33

was gonna be a father and just how much

4:35

sickle cell can be a demanding companion.

4:38

In January twenty twenty, Jimmy,

4:40

his wife and their newborn moved

4:42

part time to Nashville where the trial

4:44

was taking place. And started

4:47

the lengthy DNA collection and

4:49

transplant preparation process.

4:51

This was no walk in the park.

4:54

He endured blood draws that lasted

4:56

up to eight hours and weeks

4:58

of chemotherapy. Finally,

5:01

eighteen months later, In September

5:03

twenty twenty

5:04

one, it was time after

5:06

going through that long painstaking process.

5:09

It all amounted to a small syringe

5:11

of DNA that took about thirty

5:14

seconds to infuse. And

5:17

my life changed completely.

5:20

I remember probably two week staff

5:22

that had been infused, I started to notice

5:24

like wow, I actually don't even pain

5:26

medication today because I don't

5:28

feel pain like I used to, that

5:31

pain that just lingers all the

5:33

time, all of a sudden was gone. JB

5:35

no longer lives with sickle cell disease,

5:38

a fate that had seemed impossible. Ironically,

5:41

the cutting edge treatment that made it possible

5:44

relies on something that bacteria evolved

5:47

billions of years ago called

5:49

CRISPR. As

5:52

I explained last week, it consists

5:54

of just two molecules, an enzyme

5:57

that acts as a pair of DNA scissors,

5:59

and a special piece of genetic

6:01

material that tells the enzyme

6:04

where in the DNA to cut.

6:05

Bacteria use CRISPR

6:08

to destroy invading parasites. In

6:11

humans, that same mechanism can

6:13

be used to cut out defective genes

6:16

and even repair them. There

6:19

were gene therapies before CRISPR,

6:21

but they relied on modified viruses

6:24

to deliver new genetic material into

6:27

a patient's cells. CRISPR

6:29

is revolutionary because it allows

6:31

us to edit a patient's genes

6:33

directly. The treatment that cured

6:35

Jimmy sickle cell disease is now the

6:38

first CRISPR based therapeutic up

6:40

for approval by the FDA. Meaning

6:43

it could hit the market as early as

6:45

this year. And what it does,

6:47

one thing is nearly certain. It

6:49

will be very expensive. Last

6:52

year, a gene therapy cure for the

6:54

blood clotting disorder, hemophilia broke

6:57

the record for the most expensive

6:59

drug in the world when it hit the market

7:02

at three point five million dollars

7:04

per treatment. If the CRISPR

7:06

cure for sickle cell disease or

7:08

any other genetic condition comes

7:11

with price tag like that, will

7:13

anyone be able to afford it? From

7:17

the Freakonomics Radio Network, this is

7:19

FreakonomicsMD. I'm Bob

7:21

Pujena. Last week on the show,

7:24

we laid out the pieces of this economic

7:26

puzzle. Today, we'll meet

7:28

an economist who thinks he

7:30

solved

7:31

it. With the right kind of financing, it

7:33

actually ends up accelerating our

7:35

ability to treat these patients.

7:37

And we'll look at how solving this problem

7:40

could have ripple effects across healthcare.

7:43

Thank

7:43

you, rare disease community for showing us the path

7:45

for how to address a much bigger killer.

8:02

Over a seven year period, six

8:05

people that were close to me, including my

8:07

mother, all died of cancer. That's

8:10

Andrew Lowe. He's a professor of finance

8:12

at the MIT Sloan School

8:14

of Management. The more I read about

8:16

what my friends and family were going through,

8:19

The more surprised I was to learn

8:21

that finance actually plays

8:23

a huge role in drug development, sometimes

8:26

too big a role, driving the

8:28

source of scientific discovery rather

8:31

than the other way around.

8:37

There are diseases that have large markets,

8:39

diabetes, high blood pressure, where

8:42

you can expect as an innovator if you develop

8:44

an important treatment that there's a large

8:46

number of people who'll be able to take the drug.

8:49

But for rare diseases that have a genetic

8:51

basis, the market size is very

8:53

small. And so the ability of an investor

8:56

who's thinking about developing treatment

8:58

for that disease is gonna be

9:00

limited by the fact that they're just only a certain

9:02

number of people that they can sell that drug

9:05

to. How does that play out when it comes

9:08

to financial engineering? Very often,

9:10

when you're focusing on just one disease, by

9:13

itself, it may not be economical

9:16

to develop the particular therapeutic But

9:18

if you combine multiple diseases into

9:20

a single financial portfolio, all

9:23

of a sudden the risk reward trade

9:25

off becomes more attractive. If

9:28

you can put together a large number

9:30

of projects that are statistically

9:32

independent, that their success and failure

9:35

have no bearing on the other successes

9:37

and failures, that's the best way

9:39

of reducing risk in our portfolio.

9:42

How do I think about risk spreading across

9:45

diseases versus the fact that

9:47

a rare disease, if it's

9:48

successful, will only have a few people who can

9:50

use it? Well, the question that

9:52

you have to answer is, what

9:54

is it worth to those patients

9:56

and to our healthcare system to be able to treat

9:58

them? For example, certain ultra

10:01

rare diseases may seem really

10:03

expensive to treat, but remember

10:05

that those patients are going to have to be

10:07

addressed by the healthcare system one way or another.

10:10

They're going to need medical care and in some cases

10:12

the medical care may be even more expensive

10:15

than the cure. The most expensive

10:17

drug in the world right now is a

10:19

one time cure for rare

10:22

disease called hemophilia. And that

10:24

drug costs something like three and half million

10:26

dollars. And so under this

10:28

framework, help me understand why

10:31

it's so expensive hemophilia is

10:34

a very difficult disease to deal with

10:36

without the cure. The lifespan

10:39

of a hemophiliaic patient is

10:41

fraught with episodes where

10:43

they are going to start leading and they need

10:45

to have treatment and those treatments often

10:48

can lead to infections One

10:50

particular episode could

10:52

cost the healthcare system upwards of

10:54

several hundred thousand dollars. So

10:57

if you think about a lifetime, it

10:59

turns out that three and a half million dollars

11:01

is actually a pretty good deal. In fact,

11:03

United States government, when they make policy

11:05

decisions, they use a concept called the

11:07

value of a statistical life. The

11:10

most recent estimate is about ten million

11:12

dollars. So three and a half

11:14

million dollars is in fact a bargain

11:17

because the value of that life

11:19

lost could be on the order of

11:21

ten million.

11:22

In most markets, prices are determined

11:25

by the supply and not the demand. For example,

11:27

if it's a really hot day and you just

11:29

finish running six miles, you

11:31

might go to the CVS pharmacy and

11:34

buy a bottle of water. You might be willing

11:36

to spend ten dollars for it, twenty dollars for

11:38

it because you're really thirsty, but

11:40

you can buy it for a dollar fifty because

11:42

If CVS tried to charge you three dollars,

11:45

Walgreens right across the street would charge you two

11:47

dollars, and then the gas station right across the

11:49

street would charge you one fifty through

11:52

competition based on the cost

11:54

of producing and distributing that

11:56

water bottle, we get down to a dollar

11:58

fifty. And we generally think of that as being

12:01

good for society. What

12:03

you're describing is price being more

12:05

reflective of the underlying value, which

12:08

in many markets we view as a bad thing.

12:10

The challenge here in innovative markets is you

12:12

want to make sure that innovation enters the market

12:14

in the first

12:15

place.

12:16

There's an added element here that I think is

12:18

worth considering and that's the US patents

12:20

them. You come up with a new drug.

12:22

You get twenty years of exclusivity

12:25

where you are the only person that

12:27

can make you so that idea. In

12:29

the case of drug development, we have to test

12:32

the drug first and the FDA approval process

12:34

generally takes on the order of five

12:36

to fifteen years depending on the

12:38

nature of the disease. So let's call it ten years.

12:41

During that time, you're earning no money.

12:43

You're charging nothing. But

12:45

then, if you get the drug approved, you'll

12:47

have something on average of about

12:49

ten years left of that

12:51

twenty year pattern. After those twenty

12:53

years are up, The idea

12:56

is available to everybody under

12:58

the sun and now the price can

13:00

drop dramatically.

13:04

The pricing of novel cures is one

13:06

issue, but there's another problem,

13:09

one that's stems from how we pay for

13:11

medical care in this

13:12

country. If you're a company that's got

13:15

about a thousand employees, most likely

13:17

you are self insured. That means you're using

13:19

your own money to pay for your

13:21

particular employee's medical needs in

13:23

any given year. With a thousand members

13:26

of your plan, your annual

13:28

budget is about six million dollars.

13:31

If one of them ends up developing

13:34

a case of hemophilia, You're gonna

13:36

have to write a three and a half million dollar check. That's

13:38

more than fifty percent of your entire annual

13:40

budget going to one

13:42

patient. And that's a problem.

13:46

It does strike me that absent a

13:48

solution to the problem a

13:50

company doesn't have an incentive to give

13:52

you a one shot cure. In

13:54

fact, they have an incentive to provide

13:57

you a pill that you have to remember to take every

13:59

day that's inconvenient for the rest of your

14:00

life. I couldn't agree with you more. In fact,

14:03

a few years ago, Goldman Sachs looked

14:05

at the economics of these one time cures.

14:07

They looked at the economics of these chronic

14:10

treatments, and they came to the conclusion

14:12

that there is a significant incentive

14:14

for drug companies to develop chronic

14:16

treatments as opposed to cures.

14:20

So how can we make one time cures

14:23

affordable for patients and

14:25

attractive to investors. We

14:27

need to have that conversation sooner rather

14:29

than later. That's after the break.

14:32

I'm Babu Jena, and this is Freakonomics.

14:43

Hi,

14:43

everyone. It's Crystal from The Read podcast

14:45

here. We wanted to let you know about a

14:47

very special up coming bonus

14:50

episode of our show presented by

14:52

State Farm. It was recorded live at the

14:54

Beacon Theatre in New York and is dropping

14:56

soon, so keep an eye out for it on our

14:58

Show Feed, and make sure to check out State

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Farm's personal price plan. You get

15:03

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15:05

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15:54

called Viveczyk. But first, gotta introduce

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and listen to ViveCheck wherever you get your

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16:25

When you decide to buy a home, you're getting

16:27

a lifetime worth of housing.

16:30

And to pay for a lifetime

16:32

worth of housing upfront in

16:34

cash is difficult. So we figured out

16:37

that you can get a mortgage. A

16:39

thirty year mortgage spreads out the

16:41

payment of your value

16:43

of housing over a lifetime

16:45

of thirty years.

16:51

Economist Andrew Lowe published a

16:53

paper in twenty sixteen proposing

16:56

we use a similar payment model to

16:58

finance expensive cures

17:00

for chronic diseases.

17:02

What you're getting for that one time payment is

17:04

a lifetime of health. So why not

17:06

create a kind of a drug mortgage that

17:09

will allow us to spread the payments over

17:11

a number of years?

17:12

It turns out

17:13

there's one big reason why not.

17:15

Remember that in most cases, the

17:17

payer isn't the patient. But

17:20

an insurance provider acting on

17:22

their behalf. And in the US,

17:24

we have a mix of public insurance programs

17:27

private insurance companies, and independent

17:30

employer funded insurance plans

17:32

that make up our multi payer

17:34

system. The problem with these drug mortgages

17:37

is that if you leave that health

17:39

plan to go to another one, then

17:41

you left the first health plan with that

17:43

series of mortgage payments but

17:46

you're not paying that health plan premiums

17:48

as a healthy individual. So

17:50

there has to be a better way to

17:52

be able to make these more affordable

17:54

and that's the current proposal that

17:57

I've been working

17:57

on, which is using a subscription model.

17:59

Before we get into it, I should note

18:01

that Andrew Lowe, co funded the company,

18:04

that would act as a payment platform for

18:06

such a subscription

18:07

model. But he wasn't the first

18:10

person to come up with this idea.

18:12

There is a precedent if you look back a

18:14

few years to the rollout

18:17

of Solvaldi, the drug

18:19

that cures hepatitis c,

18:22

Hepatitis C is not a rare

18:24

disease in the US alone

18:27

as many as four point seven million

18:29

people live with hep C.

18:31

It's a viral infection that spreads

18:33

through the blood and causes liver damage.

18:36

It had always been hard to treat until

18:38

a drug company called Gilead developed

18:41

Sivaldi. The medication was

18:43

approved by the FDA and came

18:45

to market in December twenty thirteen.

18:48

Gilead's original proposed market

18:51

price was eighty four thousand dollars.

18:54

And from an economist point of view, that was

18:56

a bargain. But the problem is Given

18:58

the number of people that have hepatitis c

19:00

at the time, if every one of them

19:02

had to pay eighty four thousand dollars, that

19:04

would have easily blown the budgets of

19:07

state Medicaid plans and many independent

19:10

insurers that had to pay for these costs.

19:12

And so the state of Louisiana developed

19:14

an interesting approach they agreed

19:17

to pay Gilead a certain

19:20

amount of money per member

19:22

per month. And in exchange

19:24

for that subscription fee, Gilead

19:27

agreed to treat anybody and everybody

19:30

in the state of Louisiana that needed

19:32

the drug. It provides drug

19:34

companies with cash flows

19:36

immediately based upon the

19:38

number of members and the per member

19:40

per month fee and it provides

19:43

the state of Louisiana with as much

19:45

drug as they'll ever need. And

19:47

I think that that would apply very directly

19:50

to rare diseases. Imagine

19:55

that you've got a company with a thousand employees,

19:58

they're self insured, and

20:00

they are worried about getting hit

20:02

with one of these rare diseases that could wipe

20:04

out their budget. They can go

20:06

to the drug manufacturer now

20:09

and say, let's enter into

20:11

an agreement where we

20:13

will pay you fifty cents

20:16

per member per month. You

20:18

agree that if we develop any

20:20

of the rare diseases that your

20:22

company covers, you will treat

20:25

our employees for free.

20:27

It's not really for free because

20:29

the

20:29

payer, in this case, the employer, is

20:32

paying the small monthly premium. This

20:35

payment plan operates sort of like

20:37

insurance, but instead of being

20:39

provided directly to an individual by

20:42

a traditional insurer, It's provided

20:44

to the traditional insurers by

20:46

the drug companies themselves.

20:49

For the drug makers, it offers the prospect

20:51

of predictable recurring payments

20:54

rather than big sporadic

20:56

purchases. That change is

20:58

especially popular with investors.

21:00

As soon as they get their drug approved and

21:02

are ready to deploy that drug, they

21:04

will start getting payments per member

21:06

per month, so it turns a

21:08

very lumpy cash flow

21:11

into a relatively smooth and

21:13

steady stream. And that is

21:15

a lot less risky and from Wall

21:17

Street's perspective lot more

21:18

attractive. It also solves

21:21

a problem for insurance providers. Today,

21:23

the three most expensive drugs in the

21:25

world are all treatments for

21:27

rare genetic diseases, all

21:29

approved within the past few years. And

21:32

we know that more multimillion dollar

21:34

drugs like the CRISPR cure for

21:37

sickle cell disease, or on the horizon.

21:39

Those costs are a challenge for payers

21:42

from private insurance companies to

21:44

Medicaid, to employers with independent

21:47

plans. But providing those

21:49

drugs on a subscription basis would

21:51

effectively create a single payer

21:53

system for that particular

21:55

drug. With a single payer system,

21:57

everybody is part of that

21:59

risk pool. You've reduced the level

22:01

of risk across as many people

22:03

as you possibly can. From

22:05

a purely economic efficiency point

22:07

of view, that is the best outcome. We

22:10

have a very, very complex multi payer

22:12

system but we do have the chance

22:14

right now to focus on a single

22:16

payer system for rare

22:17

diseases. One of the big problems

22:20

for these types of diseases is that they go

22:22

under or undiagnosed for

22:24

many years, do you think that

22:26

having, a, the technology to

22:29

be able to treat more of these as these as and

22:31

b, financial model to be able to pay

22:33

for these treatments might also create

22:36

an incentive

22:37

to diagnose these diseases earlier

22:39

without a doubt. I've spoken

22:41

to a number of pancreatic oncologists who've

22:44

told me that they feel more like morticians than

22:46

oncologists or doctors. They're not healers. Because

22:49

they have very little in their toolkit to heal.

22:51

If we can provide doctors with therapies

22:54

that will save patient lives, they

22:56

will absolutely go out there and

22:59

try to diagnose every single instance

23:01

of this disease because their goal

23:03

is to save as many lives as possible

23:06

With the subscription model, the health

23:08

plans that are paying these premiums are gonna

23:10

wanna make sure that they get their money's worth by identifying

23:12

every single patient that's out there.

23:16

This brings us back to the conversation I

23:19

had last week with the physician and

23:21

computer scientist, Gaurav Cengal.

23:23

He talked about the role artificial intelligence

23:26

could play in diagnosing rare

23:28

genetic diseases at scale.

23:31

But his vision had an economic hurdle.

23:34

The payer is caught in a bind here because

23:36

if we screen more for rare conditions, we

23:38

identify more patients who will need

23:40

to have expensive treatments. If drug

23:42

companies entered into subscription agreements

23:45

with

23:45

payers, their incentives would realign.

23:48

As Andrew described. That's one of the

23:50

reasons I'm so excited about this financing. Without

23:53

it, financing ends up being tremendous

23:55

roadblock, but with the right kind of financing,

23:58

it actually ends up accelerating our

24:00

ability to treat these patients.

24:07

So

24:08

what are the barriers? What are the challenges to implementing

24:10

this sort of subscription model? Really the

24:12

challenges are cultural. Many health

24:14

plans are not set up to be

24:16

part of subscription models.

24:18

So we're gonna need to see changes

24:21

in certain state legislation to allow

24:23

state Medicaid plans to engage in these

24:25

kinds of contracts. Certainly, the state

24:27

of Louisiana was a pioneer, but other States

24:29

have followed suit. And so

24:31

I suspect that it's just really a matter of

24:33

time. There are some challenges this proposal

24:36

has to overcome. For one thing,

24:38

who determines the subscription fee?

24:41

And what about the nearly thirty million

24:43

Americans who don't have any health

24:45

insurance? They're left out of this

24:47

picture entirely. These

24:49

issues don't mean that the subscription model

24:52

won't work. The problems it

24:54

aims to solve are just really complicated.

24:57

One solution isn't gonna fix

24:59

everything. What innovative ideas

25:01

like this one get us closer.

25:04

What I think will drive all of these innovations

25:06

is need. Once we start getting

25:08

gene therapies for more common

25:11

treatments, then we'll have no choice, but

25:13

to think more seriously about these payment models

25:15

because the healthcare system cannot

25:17

deal with a broad gene therapy

25:19

for large indication like macular

25:22

degeneration or heart

25:23

disease, but those gene therapies are on

25:25

their way. Dr. Peter EARNoff,

25:27

the geneticist I spoke with last week,

25:29

also sees CRISPR having a much

25:32

broader impact on the

25:33

horizon. Many of

25:35

the medical advances that we

25:37

have today that are widespread. Did

25:40

not start as big endeavors to make a huge

25:42

impact. Statins are great example.

25:44

Over two hundred million statins

25:47

prescriptions are filled in the US

25:49

each year. They're used to lower

25:51

cholesterol and reduce the risk

25:53

of heart disease and stroke. But

25:55

they didn't start out that way. The

25:57

scientists who developed statins in the mid

25:59

nineteen eighties were hoping to cure

26:01

our genetic disease called familial

26:04

hypercholesterolaemia, where

26:06

people have persistently high cholesterol

26:08

levels. It's not a rare disease

26:11

but the most serious form of it is.

26:13

And the pharma companies that were building

26:15

these statins said, uh-huh, this works in

26:17

genetic heart disease, could it work in common

26:19

heart disease and guess what it did. And then

26:21

they said, wow, this is doing

26:24

such good to the patients. Then

26:26

I'm wondering if we can just, you know, give it as

26:28

preventative measure. And that's what

26:30

happened. So as more and more

26:32

examples of CRISPR's safe and effective

26:35

use for these rare diseases come

26:37

to light, then I'm really hopeful

26:39

that pharma will realize that

26:41

CRISPR potentially could be deployed

26:44

in diseases that are lot more

26:46

prevalent. And say, thank you rare disease

26:48

community for showing us the path for how to address

26:50

a much bigger killer.

26:54

Why the price of a drug is so high that

26:57

certain patients are going to die because

26:59

they can't afford

26:59

it. Those are not economic questions.

27:02

Those are ethical questions. That's

27:04

economist Andrew Lowe again.

27:06

We need to have a national all

27:08

stakeholder conversation about

27:11

these various lifesaving therapeutics and

27:13

how we're gonna be able to afford

27:14

them. We need to have that conversation sooner

27:16

rather than later. In

27:20

the case of sickle cell disease, we need

27:22

to have that conversation now.

27:24

As I mentioned at the top of the episode, the

27:27

CRISPR based treatment that cured Jimmy

27:29

Ola hair is now up for

27:31

FDA approval. And the

27:33

ethical questions around its affordability

27:36

are compounded by the fact that sickle

27:38

cell disease affects mostly black

27:41

and African American people who

27:43

experience higher rates of poverty in

27:45

the US. And have a

27:47

long history of being mistreated or

27:49

overlooked by our medical system. If

27:52

our drug financing landscape doesn't

27:55

change, The cure will remain

27:57

out of reach for many patients

27:59

who need

28:00

it. It weighs significantly on

28:02

me this survivor's guilt.

28:05

That you feel because I've obviously

28:07

talked to lot of people that have sickle cell

28:09

and even have friends that have sickle

28:11

cell that will never get to experience

28:14

this. And in

28:16

a way that kind of detaches you

28:18

from them, you know, a lot of people reach

28:20

out to me particularly in the sub

28:22

Saharan parts of Africa where only

28:25

god knows how soon this is gonna get there

28:27

messaging me about how they get access

28:30

to something like it's not just for themselves but to even

28:32

save their children.

28:36

Cyclacel disease is also a good reminder

28:39

that this economic puzzle is

28:41

not an American

28:42

issue. It's a global issue. What

28:45

comes next being an ideal order would be really

28:47

easy. Globalization of this technology.

28:50

If every American did a hundred thousand

28:52

plus that suffer from the disease get cured,

28:54

we haven't even touched a fraction of

28:56

the population that suffers

28:58

from this disease. I know it's

29:01

gonna be difficult. Obviously, it's

29:03

no small feet but I feel like there are lot

29:05

of smart people working on it.

29:07

Imagine a future where organizations and

29:09

governments across the globe collaborate

29:12

to eradicate sickle cell disease everywhere.

29:15

Like they pledged to do with polio, thirty

29:18

three years after an American scientist

29:20

developed the first successful vaccine,

29:23

a national future where the world comes

29:25

together to eradicate all

29:28

genetic diseases. That future

29:30

is still a fantasy. But

29:32

as far as technology goes, the

29:34

pieces to make that possible are coming

29:37

together. And Maybe even

29:39

some of the economic pieces too. Do

29:41

you think we'll get there in our lifetimes? Ever?

29:45

don't know. But we have to try

29:48

That's it for today. I'd like to thank my

29:50

guests this week, Jimmy Ola Hair,

29:53

Andrew Lowe, Gaurav Single,

29:55

and feed our earn off. And

29:57

thanks to you, of course, for listening. Let

30:00

me know what you thought about this two part episode.

30:03

I'm abapu at freakonomics dot

30:05

com. That's BAPU

30:07

at Freakonomics dot com. We'll

30:10

be off next week but back

30:12

in two weeks with an all new episode.

30:14

The replacement player situation gave us

30:16

this really interesting natural experiment where

30:19

you had people that wouldn't have been in the NFL

30:21

otherwise play a couple games.

30:24

In nineteen eighty seven, the NFL Players

30:26

Association held strike. Thirty

30:29

years later, my friend, Athena and I,

30:31

did a study that used that

30:33

strike as a natural experiment to

30:36

try to figure out is playing

30:38

professional football good or

30:40

bad for your health. That

30:42

survival advantage is not actually something

30:45

that materializes when you have a more fair

30:47

comparison. We'll talk about our

30:49

findings and also some other unconventional

30:51

ways you could try to answer this

30:53

question. That's coming up in two

30:55

weeks on the next episode of

30:57

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