Latest / Making Medicine / Rep. Scott Peters on the Pill Penalty, PBMs, China & America’s Biotech Future

Transcript

Rep. Scott Peters on the Pill Penalty, PBMs, China & America’s Biotech Future · Making Medicine

• 0:00
  Speaker 1: At Making Medicine. We're reporting on the headlines, not making
• 0:03
  Speaker 1: medical recommendations. For personal health questions, always ask your doctor.
• 0:08
  Speaker 1: Nothing in this episode constitutes investment, financial, or legal advice.
• 0:13
  Speaker 1: Consult your own advisors before making decisions.
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  Speaker 2: China has gotten a lot better now they are innovating.
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  Speaker 2: We see that they have read our playbook and they're
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  Speaker 2: doing a pretty good job, and we have to compete
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  Speaker 2: with them again. And the FDA was the gold standard.
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  Speaker 2: I think that under this administration, I hear a lot
• 0:30
  Speaker 2: of complaints from companies trying to get through it about
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  Speaker 2: how it's become an impediment that's got to be focused.
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  Speaker 1: Welcome back to the Making Medicine podcast, where science, policy
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  Speaker 1: and innovation meet. Today we have another special guest joining
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  Speaker 1: from Capitol Hill, California Congressman Scott Peters, who represents San
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  Speaker 1: Diego and the surrounding areas, a major biotech hub, as
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  Speaker 1: we talk about in the episode. The congressman serves on
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  Speaker 1: the House Energy and Commerce Committee and the House Budget Committee,
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  Speaker 1: putting him at the center of healthcare, innovation, and fiscal
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  Speaker 1: policy debates. He was ranked the fourth most independent Democrat
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  Speaker 1: in Congress by the National Journal Building on his reputation
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  Speaker 1: for crossing the aisle to find practical bipartisan solutions. He
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  Speaker 1: recently co sponsored the Epic Act, which addresses a long
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  Speaker 1: standing issue in biotech investment, the pill penalty. We'll talk
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  Speaker 1: about why that was important to him, his district, and
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  Speaker 1: the country. It's a making medicine you don't want to miss.
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  Speaker 1: So let's get into the show. Congressman, welcome to the show.
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  Speaker 2: Great to be here, Thanks for having me. Looking forward
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  Speaker 2: to it.
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  Speaker 1: Well, we should have a great conversation because your district
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  Speaker 1: is ground zero for biotech and truly innovative medicines. You've
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  Speaker 1: put yourself at the center in your political career of
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  Speaker 1: championing that innovation, fighting for life sciences, fighting for new medicines,
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  Speaker 1: things we talk about on this show. I'm curious what
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  Speaker 1: made that such a passion for you to care about
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  Speaker 1: the There's so many things you could care about in Congress.
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  Speaker 1: You've chosen to be a leader in life sciences. Is
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  Speaker 1: that a reflection of the district or is that personal
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  Speaker 1: or is it a little bit of both.
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  Speaker 2: It's probably a little bit of both. I think what
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  Speaker 2: i'd say is, you know, San Diego is powered by
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  Speaker 2: four economies, and you know, the military is a big
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  Speaker 2: part of the Navy, Marines, we're proud part of the
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  Speaker 2: national defense. We're a great place to visit, so we
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  Speaker 2: have a tourism economy that's great. The southern border is
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  Speaker 2: is a place where a lot of trade takes place,
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  Speaker 2: generates tens of thousands of jobs, and all of those
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  Speaker 2: are really important industries. All of us are steady, pretty
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  Speaker 2: steady industries, but not really the high paying industries that
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  Speaker 2: you're not going to make us prosperous in the future.
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  Speaker 2: And I started to get to know what's happening in innovation.
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  Speaker 2: So you know, we have Qualcomm is the is headquartered
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  Speaker 2: in San Diego, so that's telecommunications right now, there's a
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  Speaker 2: lot of defense research and because of the proximity of
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  Speaker 2: the Navy and some of the brain power there. But
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  Speaker 2: biotechnology has always been a real cornerstone for US and
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  Speaker 2: for our future, and there's a lot of reasons for that.
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  Speaker 2: But you know what I learned was, you know, we
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  Speaker 2: have a tremendous investment in the NIH that generates a
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  Speaker 2: lot of talent in our research institutions like the Scripts
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  Speaker 2: and Scripts Institution or SALT or sand Erbert and prebus
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  Speaker 2: cancer or UCSD which has had a meteoric rise, and
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  Speaker 2: now San Diego State, all generating a ton of talent.
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  Speaker 2: And we have a thousand companies that are that are
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  Speaker 2: in life sciences, over eighty thousand people I think directly employed.
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  Speaker 2: Many more people employed than that. And you know, when
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  Speaker 2: it's a thousand companies, you know some of them are
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  Speaker 2: no vartists, which just announced they're investing one point one
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  Speaker 2: billion dollars. That's great, we love that, But a thousand
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  Speaker 2: companies means there's a lot of like small startup companies
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  Speaker 2: trying to solve heart science problems with private risk capital.
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  Speaker 2: And we've tried to keep that going. So the more
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  Speaker 2: i've I've worked on it, I think it's a priority
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  Speaker 2: for the district. But also I'm just inspired by the
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  Speaker 2: things that are invented that are going to make such
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  Speaker 2: differences for patients in the future, preventing preventing bad outcomes
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  Speaker 2: and with better treatments and with cures. I just want
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  Speaker 2: to keep that going. I want to be American and
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  Speaker 2: you know, I want as much of it to be
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  Speaker 2: in San Diego as I can.
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  Speaker 3: Well, I think you're doing the right thing.
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  Speaker 1: From a congressional standpoint to say this is this is
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  Speaker 1: a place to come. You know, it's you've got no artists,
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  Speaker 1: and that is an incredible announcement. And as you mentioned
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  Speaker 1: private risk capital, our own numbers show more than a
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  Speaker 1: billion invested by early stage venture capital last year alone.
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  Speaker 1: Something we're going to celebrate in our upcoming in your
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  Speaker 1: backyard barbecue. And you know it's it has managed to flourish,
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  Speaker 1: and you and the other leaders in San Diego have
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  Speaker 1: built a welcoming environment and gotten to know the issues
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  Speaker 1: that impact what we care about as investors.
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  Speaker 2: May you say one more thing about that? Though?
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  Speaker 3: Yeah? Please?
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  Speaker 2: What I learned also just appreciated, is that that geography
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  Speaker 2: of San Diego is amazing because in nineteen seventy four,
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  Speaker 2: then Mayor Pete Wilson decided that instead of dedicating this
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  Speaker 2: city land to housing, he would dedicate it to science.
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  Speaker 2: So the proximity of stuff that you can get to,
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  Speaker 2: it's really it's a geographical cluster as well. I didn't
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  Speaker 2: mention I think I just visited Eli Lilly's one hundred
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  Speaker 2: million dollar campus. I mean, there's really a rush for
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  Speaker 2: the talent in San Diego. So I think we've got
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  Speaker 2: a good future. And one more thing about San Diego
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  Speaker 2: we learned was I think in twenty twenty four we
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  Speaker 2: were the fifth leading destination for a venture capital in
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  Speaker 2: the country, or pretty far far behind like the big ones,
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  Speaker 2: you know, New York, Chicago, San Francisco, Boston, but we're
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  Speaker 2: ahead of the other ones Seattle, Austin, you here talked about.
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  Speaker 2: And what we're seeing now is we're seeing a migration
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  Speaker 2: of financial financial capability becoming local. So it's not so
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  Speaker 2: much people coming from outside of San Diego looking for investments.
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  Speaker 2: Now we have money based in San Diego looking for investments.
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  Speaker 2: I think that you know, there's we'll probably talk about
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  Speaker 2: some of the challenges in the short term in terms
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  Speaker 2: of investment and risk, but long run, I think San
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  Speaker 2: die has got a really bright future in biotechnology. And
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  Speaker 2: I think, you know, obviously we do well as a community,
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  Speaker 2: but I think the country in the world does pretty
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  Speaker 2: well with what we invent.
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  Speaker 1: Well, it's funny you mentioned just the role of decision
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  Speaker 1: back in the seventies for regional geography and co location.
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  Speaker 1: We get asked all the time by economic development professionals,
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  Speaker 1: governor's offices, how do I build what they've got in
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  Speaker 1: San Diego or in Kendall Square, and at some point
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  Speaker 1: it is these decisions that have played out.
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  Speaker 3: Your weather is probably better than Boston too, but.
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  Speaker 1: I need to stay unbiased to But I like every
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  Speaker 1: time I visit San Diego.
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  Speaker 2: It's I think it's spin in the nineties in DC too,
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  Speaker 2: So I do miss it.
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  Speaker 1: It's just that perfect seventy two degrees, probably for the
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  Speaker 1: next eight weeks in San Diego.
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  Speaker 2: Right, that's right, it's looking for it right.
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  Speaker 1: Well, as you know you you couldn't do what you
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  Speaker 1: do if you didn't dig into the issues. And I
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  Speaker 1: do want to start first with your decision to really
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  Speaker 1: tackle one of the thorniest things investors are facing. And
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  Speaker 1: you recently added your name to the Epic Act, which
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  Speaker 1: would address the pill penalty that has led to less
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  Speaker 1: investment in small molecule medicines. What encouraged you to support
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  Speaker 1: this legislation, Why do you see it, what's the problem,
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  Speaker 1: and how is it fixing it? And why did you
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  Speaker 1: want to put your name to it?
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  Speaker 2: You know what? Might I want to go back a
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  Speaker 2: step and talk about the IRA and how that got
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  Speaker 2: created and how the pill penalty came about, because because
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  Speaker 2: actually we were looking at much a much worse potential
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  Speaker 2: outcome than even that in a couple of congresses ago,
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  Speaker 2: when the Democrats took power and when we had the trifecta,
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  Speaker 2: we had the House, the Senate, and the presidency. You know,
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  Speaker 2: Speaker Pelosi had a very good idea with some very
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  Speaker 2: bad features. And the good idea was, let's let's negotiate
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  Speaker 2: prices with Let's let medicare and negotiate prices with with
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  Speaker 2: manufacturers so that we can keep the price for a senior,
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  Speaker 2: we can limit it to two thousand dollars a year
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  Speaker 2: out of pocket. That's a great idea, And the problem
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  Speaker 2: was that part of that, part of that was to
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  Speaker 2: start negotiations on the day that a drug was launched.
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  Speaker 2: And you know, I know, you know, but I knew
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  Speaker 2: from San Diego that it's about a billion dollars to
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  Speaker 2: get a drug to market. It's you know, ninety five
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  Speaker 2: percent of them fail. And if you don't give some return,
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  Speaker 2: non investment to people who made these risky investments to
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  Speaker 2: create these drugs, they're not going to invest in private
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  Speaker 2: drug discovery. And the NIH budget is around forty five trillion,
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  Speaker 2: forty seven trillion. It's up from twenty nine when I started.
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  Speaker 2: But the amount of investment from the private sector is
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  Speaker 2: well over double that. And the private sector is taking
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  Speaker 2: that basic fundamental science that we generate out of government
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  Speaker 2: investment and turning it into therapies and cures. They won't
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  Speaker 2: do that if they can't make a return. And so
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  Speaker 2: all I said was I said, I told the speaker,
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  Speaker 2: I told my committee chair, I can't support this. We
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  Speaker 2: have to create some space for people to make a
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  Speaker 2: return on the investment before the before the negotiation kicks in,
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  Speaker 2: because it's better to have something that costs a lot
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  Speaker 2: for a while than not to have that at all,
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  Speaker 2: which is what we were going to end up with.
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  Speaker 2: We were going to We're not going to end up
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  Speaker 2: with these innovations. So my proposal was to in a
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  Speaker 2: period of time when when you could make a return
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  Speaker 2: before the negotiation kicked in. And it caused quite a
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  Speaker 2: stir I think, you know, generally I only had four
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  Speaker 2: votes here for that position. It's basically all I needed.
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  Speaker 2: They didn't have a vote in the Senate for this
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  Speaker 2: at all. We were able to convince Senator Cinema from Arizona,
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  Speaker 2: if you protected the right those investment incentives that she
• 10:26
  Speaker 2: would join up and we would land this plane because
• 10:29
  Speaker 2: it was going to wasn't going to be an issue
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  Speaker 2: that went away. I voted against my own party's reconciliation.
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  Speaker 2: I did it on video during COVID and oh my gosh,
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  Speaker 2: my poor district staff had to take so much incoming.
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  Speaker 2: We had a protest at our office that I was
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  Speaker 2: trying to kill seniors. They had to die in at
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  Speaker 2: my district office. They had signs all over like tell
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  Speaker 2: Scott Eaters to get out of the way of drug
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  Speaker 2: you know, drug price reductions. They had one of those
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  Speaker 2: planes that flew over the beach. H that's and they
• 11:01
  Speaker 2: really came after me pretty hard for two months. But
• 11:03
  Speaker 2: we held our ground because it was the right thing
• 11:05
  Speaker 2: to do. We got we got that. We got that
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  Speaker 2: provision in there, and you know, by the way we
• 11:14
  Speaker 2: passed it and every Democrat ran, as you know, on
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  Speaker 2: this as a proud accomplishment. It wasn't like we lost
• 11:20
  Speaker 2: anything because we did get the two thousand dollars cap
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  Speaker 2: for seniors. That was the whole point. We got the
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  Speaker 2: same relief that Speaker Pelosi had proposed in the beginning.
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  Speaker 2: But the negotiation was ugly around that period because it
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  Speaker 2: came out the nine thirteen, so nine for small molecules,
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  Speaker 2: nine years for small molecules, thirteen years for for large
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  Speaker 2: molecules biologics, and you know why it was a better
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  Speaker 2: result than zero as we saw it play out. You know,
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  Speaker 2: you've mentioned we've seen a reduction in investment in small molecules.
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  Speaker 2: There's just like really kind of stuff that's going to
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  Speaker 2: help us with Alzheimer's in particular, and so that needs
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  Speaker 2: to be fixed. And that's why I think the Epicact
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  Speaker 2: makes a lot of sense.
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  Speaker 1: I don't know how to properly applaud what must have
• 12:05
  Speaker 1: been sort of courage in the room on that ian
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  Speaker 1: C vote and having these conversations, if you'll let me
• 12:11
  Speaker 1: pry a little bit, is you know, in those weeks,
• 12:15
  Speaker 1: in the midst of the HR three conversation and not
• 12:19
  Speaker 1: going to what would have been a radical position on
• 12:25
  Speaker 1: drug pricing, you've always had an independent streak, You've always
• 12:29
  Speaker 1: been in that sort of moderate corner of the Democratic Party.
• 12:32
  Speaker 1: What was what was some of the reaction of the
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  Speaker 1: peers And you know how it seems like you've you've
• 12:39
  Speaker 1: kind of built those bridges back up, But was it
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  Speaker 1: a particularly tense time in the caucus as you did that.
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  Speaker 1: I mean, like you said, you had protest, You had
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  Speaker 1: people really lighting you up over this decision to say, hey,
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  Speaker 1: I want new drugs and I want seniors to be
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  Speaker 1: able to afford existing drugs.
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  Speaker 2: Yeah, I mean it was hard. I have to say. Know,
• 13:00
  Speaker 2: the only time I ever got invited in on MSNBC
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  Speaker 2: was during this period. And my you know, my liberal
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  Speaker 2: staffers were excited about it. I said, that's they're not
• 13:08
  Speaker 2: going to make me look good. They had to come
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  Speaker 2: after me. I remember NPR reporter actually said to me,
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  Speaker 2: but why wouldn't you want to lose jobs in your
• 13:16
  Speaker 2: district for something bigger. I mean, that was the kind
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  Speaker 2: of thinking that I saw. You know. You know, look,
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  Speaker 2: I'm a trial lawyer, and the the the people yelling
• 13:27
  Speaker 2: at me that they're going to beat me in an election.
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  Speaker 2: That doesn't bothered me. I mean what I saw was
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  Speaker 2: the evidence in front of me was I had the
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  Speaker 2: right case. I knew that I was right on the facts. Uh.
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  Speaker 2: And and when people make these kind of outrageous claims
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  Speaker 2: and they don't make any sense, I kind of stick
• 13:42
  Speaker 2: with the facts. I want to say first, I want
• 13:44
  Speaker 2: to thank my staff because they put up with a
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  Speaker 2: lot here and you know, we didn't have the we
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  Speaker 2: didn't have a committee to do our work. We you know,
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  Speaker 2: my my legislative staff did this work on their own
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  Speaker 2: and you know, in conjunction with you know, people on
• 13:58
  Speaker 2: the outside helping us with language and everything else. And
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  Speaker 2: then I have to you know, think my district staff,
• 14:05
  Speaker 2: who really I was so proud of my district staff
• 14:10
  Speaker 2: because when when they when the news started to break
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  Speaker 2: that really the reporting was that I was against seniors,
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  Speaker 2: and so we had kind of like a lot of
• 14:20
  Speaker 2: people come call in the office. First was saying like
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  Speaker 2: people who who a lot of people who liked me,
• 14:27
  Speaker 2: but they said, why would Scott do this? They wanted
• 14:29
  Speaker 2: to know kind of what the answer was. There are
• 14:31
  Speaker 2: always people who you know, hate hate me for you know,
• 14:35
  Speaker 2: for other reasons anyway, and they're not going to be satisfied.
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  Speaker 2: But my district staff would be on the phone, these
• 14:40
  Speaker 2: like kids basically out of college explaining the economics of
• 14:43
  Speaker 2: drug discovery to these constituents and they did so they
• 14:47
  Speaker 2: really hung It was really great. I was really really
• 14:49
  Speaker 2: proud of them, and we did get through it, and
• 14:50
  Speaker 2: we did it was the right thing. And I think
• 14:54
  Speaker 2: at the end of the day, we look back and
• 14:55
  Speaker 2: we had a real accomplishment from the Democratic side with
• 14:58
  Speaker 2: this is the first time Medicare couldn't go shaate drugs
• 15:00
  Speaker 2: with manufacturers. I would think that was a big thing.
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  Speaker 2: That's what they wanted. It didn't look exactly like they
• 15:05
  Speaker 2: wanted at the beginning, but yeah, it was. It was hard,
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  Speaker 2: and I think also I probably have paid a little
• 15:10
  Speaker 2: bit of a price with my colleagues here for not
• 15:13
  Speaker 2: just towing the party line. But if you want someone
• 15:14
  Speaker 2: who's just gonna say everything is wonderful, and you know
• 15:19
  Speaker 2: Democrats are right all the time, you don't need me
• 15:21
  Speaker 2: in this job. I think I have a different role
• 15:25
  Speaker 2: and I was. And I think also the argument that
• 15:27
  Speaker 2: people made that I was bought off by Pharma, I
• 15:30
  Speaker 2: was a pharmacrat. People understood that I was standing up
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  Speaker 2: for my district. Now we have biotechnology in my district.
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  Speaker 2: I think everyone understood that, and so I don't think
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  Speaker 2: anyone bought that. Can I tell you John the political
• 15:42
  Speaker 2: upshot of this A couple of things. Of course, aft
• 15:44
  Speaker 2: right after this, we got redistricting, and my district got
• 15:48
  Speaker 2: much bluer than it was I had run in a
• 15:51
  Speaker 2: close district, and now I was facing voters in a
• 15:54
  Speaker 2: district that was Biden plus twenty nine. I think, and
• 15:57
  Speaker 2: you know my saying Diego San Diego recognized I got
• 16:02
  Speaker 2: Balbo Park, I got the University of California, San Diego,
• 16:05
  Speaker 2: some of the most most liberal areas, and from the left,
• 16:10
  Speaker 2: they ran a pretty good candidate against me. She had won.
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  Speaker 2: She had run the Biden I mean, she had run
• 16:15
  Speaker 2: the Sanders operation in twenty sixteen. She's a young woman
• 16:18
  Speaker 2: who had a computer science degree from UCSD, made a
• 16:22
  Speaker 2: great presentation, didn't have a lot of money, but knew
• 16:25
  Speaker 2: she was what she was doing and was running a
• 16:27
  Speaker 2: good campaign. And I said to my I said to
• 16:30
  Speaker 2: my political person, Marianne, I said, I'd like to finish first.
• 16:35
  Speaker 2: I'd like to finish about fifty percent in the top
• 16:37
  Speaker 2: two primary that we have coming up. And and she said, well,
• 16:44
  Speaker 2: she said, you know, you just had this battle with
• 16:47
  Speaker 2: Speaker Pelosi. You got forty three percent new voters Biden
• 16:51
  Speaker 2: plus twenty nine. Just hope you finished first and that
• 16:54
  Speaker 2: a Republican finished the second, so you don't have to
• 16:56
  Speaker 2: run against your opponent from the left all year. And
• 16:59
  Speaker 2: that was that was I got fifty three percent, the
• 17:02
  Speaker 2: Republican got thirty five percent, and the Democratic opponent I
• 17:05
  Speaker 2: had got nine percent. So all those threats ended up
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  Speaker 2: falling completely flat. And what I would like to say
• 17:12
  Speaker 2: to my colleagues is that people value independence. They want
• 17:16
  Speaker 2: you to fight for the they want you to take
• 17:19
  Speaker 2: positions where that you believe in and they may i'd
• 17:22
  Speaker 2: agree with you on a specific issue, but they're they're
• 17:24
  Speaker 2: going to respect that you fought for the district and
• 17:27
  Speaker 2: you fought for what you thought was right. And that's
• 17:29
  Speaker 2: what I did, even though I got called a lot
• 17:31
  Speaker 2: of names. And you know, even my mother, by the way,
• 17:34
  Speaker 2: I'll just say who It's like this Swedish lady never
• 17:37
  Speaker 2: criticized me for anything. She's watching MSNBC, because of course
• 17:41
  Speaker 2: he's My parents are are pretty leftists. I love them dearly,
• 17:47
  Speaker 2: still around, but she sends me a text, are you
• 17:50
  Speaker 2: sure you know what you're doing? I was like the
• 17:53
  Speaker 2: harshest criticism I ever got from my mother, But I
• 17:58
  Speaker 2: think she's even she's even come around now.
• 18:01
  Speaker 3: We share that in common.
• 18:04
  Speaker 1: And you know something about this industry and pharma pharmo economics.
• 18:11
  Speaker 1: You got to sit with someone for a while, and
• 18:13
  Speaker 1: so a few things there, your ownsung heroes on your staff,
• 18:17
  Speaker 1: because I don't know that every listener on the show
• 18:19
  Speaker 1: fully understands the phones ring, and people share their opinions
• 18:24
  Speaker 1: with your team members, and I can only imagine the
• 18:28
  Speaker 1: number of times they had to explain, well, you don't
• 18:31
  Speaker 1: understand the drugs don't come out of NIH. It actually
• 18:33
  Speaker 1: takes really long time, and we don't want to disincentimize this.
• 18:37
  Speaker 1: But you said, that's an incredible anecdote about your mom.
• 18:42
  Speaker 1: But you said something else there that I do hope
• 18:45
  Speaker 1: colleagues take note on. But ten years ago, maybe twenty
• 18:48
  Speaker 1: years ago, maybe we have to go further back. A
• 18:51
  Speaker 1: member could stand up in the caucus and say, look,
• 18:55
  Speaker 1: I get there's a pillar of our party that wants
• 18:59
  Speaker 1: to pursue these things, But in my district, where we're
• 19:02
  Speaker 1: inventing new medicines left and right, and we've got this
• 19:04
  Speaker 1: incredible innovation corridor, this doesn't make sense for me. I'm
• 19:09
  Speaker 1: going to stand against it. I'm going to look for
• 19:11
  Speaker 1: a compromise that protects my district's innovation while working on
• 19:16
  Speaker 1: a broader priority of capping seniors out of podcast, which
• 19:19
  Speaker 1: is the right priority, we should be eliminating out of
• 19:22
  Speaker 1: pocket costs. In my view, why doesn't that work in
• 19:25
  Speaker 1: the party anymore? On both sides for someone to just say, look,
• 19:28
  Speaker 1: this is I'm district first, I'm sent here to represent
• 19:31
  Speaker 1: my district.
• 19:32
  Speaker 3: Why doesn't that work anymore?
• 19:34
  Speaker 2: You know, John, I don't know. I think the evidence
• 19:37
  Speaker 2: is pretty clear that people want they want the government
• 19:39
  Speaker 2: to work. They don't want the government to scream. And
• 19:43
  Speaker 2: one other point of evidence is in twenty twenty four,
• 19:46
  Speaker 2: you know, if you look at the best performing congressional candidates,
• 19:49
  Speaker 2: there's there's an analysis in California of who they were,
• 19:54
  Speaker 2: and I was the second best performing Democrat in California
• 19:58
  Speaker 2: on the ballot Jimmy Panetta, who's who's very much like
• 20:03
  Speaker 2: like me in terms of his profile. I argue, it's
• 20:06
  Speaker 2: unfair he's got the name Panetta. But you know, what
• 20:08
  Speaker 2: can I do? But but you know, there was the
• 20:11
  Speaker 2: it was the screamers and yellers who didn't perform. Well,
• 20:13
  Speaker 2: it's it's the people who are like out there trying
• 20:15
  Speaker 2: to solve problems. That's what people want. I'm really just
• 20:18
  Speaker 2: trying to encourage my colleagues to, you know, to remember
• 20:21
  Speaker 2: why they came. I mean, they know everyone who runs
• 20:23
  Speaker 2: for these really hard races to get into Congress, and
• 20:25
  Speaker 2: they they said they're going to rock the boat. And
• 20:27
  Speaker 2: then they got on the boat and they say, well,
• 20:29
  Speaker 2: it's it's too rocky for me, you know, And I don't.
• 20:33
  Speaker 2: I don't think that's what people want. So my that's
• 20:35
  Speaker 2: been my bet. I've you know, I've taken other battles,
• 20:38
  Speaker 2: you know, on on trade, on a permit reform that,
• 20:43
  Speaker 2: and I try not to take too many at once
• 20:44
  Speaker 2: because you know, the staff, the staff can only bear
• 20:48
  Speaker 2: so much as it has so much bandwidth. But mostly
• 20:51
  Speaker 2: I am a Democrat, I believe, you know, and the
• 20:54
  Speaker 2: democratic principles and opportunity for everyone and civil rights and
• 20:58
  Speaker 2: so this is where I fit it. But also I think,
• 21:01
  Speaker 2: you know, government can't do everything, and I think we
• 21:04
  Speaker 2: have to we should recognize that the private sector, if
• 21:07
  Speaker 2: we can get out of the way, often does the
• 21:09
  Speaker 2: things that we want for our constituents. But people don't.
• 21:13
  Speaker 2: People want problem solvers, I think, and I would love to,
• 21:17
  Speaker 2: you know, convince more people to take that that approach,
• 21:22
  Speaker 2: and I do on the floor. I'm trying to find
• 21:24
  Speaker 2: more people to encourage them. You know, hey, you know,
• 21:26
  Speaker 2: don't worry. You can take this battle. I bet people
• 21:28
  Speaker 2: will appreciate it, particularly because so many people are safe
• 21:31
  Speaker 2: in their elections anyway, and you know they can afford
• 21:34
  Speaker 2: to take a little bit of a fight.
• 21:35
  Speaker 1: We we would like to join us in taking some risk.
• 21:39
  Speaker 1: You talk about people wanting to see things getting done.
• 21:42
  Speaker 1: One of the things you did get done for our
• 21:44
  Speaker 1: community Orphan Cures Act. Sort of a sister problem that
• 21:49
  Speaker 1: an unintended consequence, but our own data says the passage
• 21:54
  Speaker 1: of Orphan Cures Act turned around rare disease investment. We've
• 21:57
  Speaker 1: seen two and a half billion invested, several hundred companies.
• 22:01
  Speaker 1: We've got a tracker, and my team will wish that
• 22:03
  Speaker 1: I had gotten the number right, but the money's flown
• 22:07
  Speaker 1: back into rare because we fix this issue. How are
• 22:10
  Speaker 1: you able to get orphan cures across the finish line?
• 22:12
  Speaker 2: I think within the building, you know, you start with
• 22:15
  Speaker 2: the facts. I tell my staff, let's start with the
• 22:17
  Speaker 2: right answer and build the politics around it. And so
• 22:20
  Speaker 2: we've you know, I think a lot of we obviously
• 22:23
  Speaker 2: took the we didn't know this without input from industry
• 22:26
  Speaker 2: and the innovators that you had this we'd gotten in
• 22:29
  Speaker 2: our own way with orphan cures, and there was an
• 22:31
  Speaker 2: opportunity to like to really unleash a lot of existing
• 22:35
  Speaker 2: technology around orphan cures and and kind of figure out
• 22:41
  Speaker 2: how to make the best use of it. And that
• 22:43
  Speaker 2: was actually pretty easy to propagate. I mean, people understood
• 22:46
  Speaker 2: that in the building, and I think a lot of
• 22:47
  Speaker 2: the folks saw it made sense. I don't believe it
• 22:51
  Speaker 2: was that cost. They don't remember the number on it.
• 22:52
  Speaker 2: But that was just a matter of taking the evidence
• 22:57
  Speaker 2: from the ground that we had and making sure that
• 23:00
  Speaker 2: enough people understood it. And that was pretty easy to
• 23:03
  Speaker 2: to find people to understood it and to make an adjustment.
• 23:07
  Speaker 2: But that was it. It's just like getting getting the facts,
• 23:11
  Speaker 2: making sure you understand with there's counter arguments and that
• 23:14
  Speaker 2: you run those to the ground, making sure that you're right,
• 23:18
  Speaker 2: and then just educating people about it.
• 23:20
  Speaker 1: You're well, we'll do our job of continuing to provide
• 23:23
  Speaker 1: the facts what investors are seeing. And as we remind Congress,
• 23:28
  Speaker 1: we're going to spend money where you have placed incentives,
• 23:33
  Speaker 1: and we're not going to spend money where you place disincentives,
• 23:36
  Speaker 1: and so we're constantly trying to show that it's from
• 23:39
  Speaker 1: the VC perspective. It's not like, Ooh, we love this
• 23:43
  Speaker 1: therapeutic area personally, therefore we're going to invest or this
• 23:47
  Speaker 1: type of molecule or tech versus biotech. It's our job
• 23:51
  Speaker 1: is to storored capital, find risk related return, and bring
• 23:55
  Speaker 1: it back. And Washington's sort of become this lens through
• 23:59
  Speaker 1: which we now need to to look at investments. So
• 24:01
  Speaker 1: we will We'll keep bringing that data. I want to
• 24:04
  Speaker 1: pivot because you mentioned trade and you've always been a leader.
• 24:08
  Speaker 1: I don't know again if this is because you're in
• 24:10
  Speaker 1: San Diego, You're on the West coast. But we can't
• 24:14
  Speaker 1: have a conversation in our community without China coming up.
• 24:17
  Speaker 1: And I want to take advantage of you being on
• 24:19
  Speaker 1: the show to ask these tough questions of what do
• 24:23
  Speaker 1: we do about China? And it's it's surging dominance in
• 24:30
  Speaker 1: the innovation space. How do you think about it? Seems
• 24:35
  Speaker 1: like they're developing schools of thoughts, making the US more competitive,
• 24:38
  Speaker 1: modernizing the f day. What can we do to outcompete China?
• 24:43
  Speaker 1: But I think there's also a wing of people who
• 24:46
  Speaker 1: who think they're somehow going to cap China's success, And
• 24:51
  Speaker 1: I wonder how you juxtapose those two and how you
• 24:53
  Speaker 1: think about this.
• 24:54
  Speaker 2: Well, I think there's a you know, a number of
• 24:57
  Speaker 2: elements to it. I think, first of all, let's wreck
• 25:00
  Speaker 2: andize that China has gotten a lot better they used to.
• 25:02
  Speaker 2: We used to always say they stole technology, which I
• 25:05
  Speaker 2: think they did, but actually now they are innovating. We
• 25:08
  Speaker 2: see that they have they've read our playbook and they
• 25:11
  Speaker 2: have and they're they're doing a pretty good job, and
• 25:14
  Speaker 2: we have to compete with them. I think you mentioned
• 25:16
  Speaker 2: a couple of things. As one is we have to,
• 25:18
  Speaker 2: you know, we have to make sure we're investing in
• 25:20
  Speaker 2: fundamental research at the NIH and the National Science Foundation
• 25:24
  Speaker 2: UH and make sure that that's being used in a
• 25:27
  Speaker 2: way that's useful. That that really makes the most difference.
• 25:31
  Speaker 2: We've seen tremendous issues at the FDA under this administration.
• 25:34
  Speaker 2: I think it had like a lot of different sections
• 25:37
  Speaker 2: of the of the f I mean, FDA had to
• 25:39
  Speaker 2: be adjusted before, but now we really have to make
• 25:42
  Speaker 2: sure that we're getting out of the way. I hear
• 25:43
  Speaker 2: that there's a lot of scientific conversations that used to
• 25:46
  Speaker 2: happen that aren't happening. And the FDA was the gold standard.
• 25:49
  Speaker 2: I think that under this administration, I hear a lot
• 25:52
  Speaker 2: of complaints from companies trying to get through it about
• 25:56
  Speaker 2: how it's become an impediment that's got to be fixed.
• 25:59
  Speaker 2: And then I think we have to continue to appreciate
• 26:02
  Speaker 2: we have a private economy, enterprise economy that China doesn't have,
• 26:07
  Speaker 2: and we really have to make sure we're taking advantage
• 26:09
  Speaker 2: of it. So I think, you know, the nine thirteen
• 26:12
  Speaker 2: issue and all those incentives, we ought to be constantly
• 26:16
  Speaker 2: looking at the ways to make sure that we're maximizing
• 26:19
  Speaker 2: the benefit that we get out of the risk takers
• 26:23
  Speaker 2: in the private sector. I mean, all that money China
• 26:26
  Speaker 2: has to spend their money directly, we have people who
• 26:28
  Speaker 2: are willing to take risk with private capital that doesn't
• 26:30
  Speaker 2: affect us, and we only win if you lose, too
• 26:34
  Speaker 2: bad for you, But if you win, we win too.
• 26:36
  Speaker 2: So I mean, I think we should just really take
• 26:38
  Speaker 2: advantage of that and let's all agree on that. I
• 26:40
  Speaker 2: think that should be so hard as a national security matter.
• 26:43
  Speaker 2: I do think you have to look at, you know,
• 26:46
  Speaker 2: what we have to have on shore. Okay, So I'm
• 26:49
  Speaker 2: not comfortable with losing one hundred percent of China on anything.
• 26:55
  Speaker 2: I think in particular, this is a this is less
• 26:58
  Speaker 2: of an issue for for the innovators, but I think
• 27:01
  Speaker 2: it's a it's an issue for that we ought to
• 27:03
  Speaker 2: deal with, which is, you know, basically the API, the
• 27:06
  Speaker 2: basic building blocks of of of medicines actually you know,
• 27:11
  Speaker 2: delivering medicines. So much of that is offshore and we
• 27:15
  Speaker 2: can't be vulnerable to that. So just for for the
• 27:18
  Speaker 2: purposes of delivering medicines, we got to make sure that
• 27:20
  Speaker 2: the supply chain is secure and if not on shore,
• 27:23
  Speaker 2: you know, near shore and friends shore. We can't be
• 27:25
  Speaker 2: relying on China for that. We need to make sure
• 27:28
  Speaker 2: we're we're that that are our best universities are continuing
• 27:32
  Speaker 2: to educate people in science and you know, I think
• 27:37
  Speaker 2: you hear a lot of you hear a lot of
• 27:39
  Speaker 2: concern about that here, that we are not educating enough natives.
• 27:43
  Speaker 2: But also I think immigration policy should reflect our interest
• 27:46
  Speaker 2: in having this on shore. We should be aggressively courting
• 27:50
  Speaker 2: brain power from around the world to this country. Uh.
• 27:54
  Speaker 2: And you know, if you can, you can talk about
• 27:56
  Speaker 2: all the big companies and the real major in over
• 28:00
  Speaker 2: the last you know, thirty forty years, such a huge
• 28:04
  Speaker 2: percentage of are done here by people not born here,
• 28:08
  Speaker 2: and that's a huge advantage to us. And the xenophobia
• 28:11
  Speaker 2: that I've seen from the Trump administration is not just
• 28:15
  Speaker 2: directed at dishwashers and bus boys, as it was in
• 28:19
  Speaker 2: my district, but it's also that gun is aimed at
• 28:22
  Speaker 2: brain power. And we see a decrease in applications in
• 28:28
  Speaker 2: our graduate programs from overseas. That's a horrible trend. We
• 28:32
  Speaker 2: need to reverse that too, and I think that we
• 28:34
  Speaker 2: should be welcoming. There's no reason not to welcome the
• 28:38
  Speaker 2: best and the brightest people to our shores to do
• 28:41
  Speaker 2: this work in a place where where they can be
• 28:44
  Speaker 2: free and they can pursue their dreams. And I think
• 28:47
  Speaker 2: we have to get back to that mentality. The immigration
• 28:50
  Speaker 2: policy here has scared off a lot of people, and
• 28:52
  Speaker 2: that's got to turn around.
• 28:54
  Speaker 1: It's going to be a conversation that takes nuance, interparty
• 28:58
  Speaker 1: diplomacy to to find to thread that needle both the
• 29:02
  Speaker 1: national security concerns the pro innovation piece. So from our view,
• 29:08
  Speaker 1: it's critically important someone likes you, like you stays at
• 29:11
  Speaker 1: the table. I'm gonna I'm gonna sneak in a bonus
• 29:14
  Speaker 1: question and You've been incredibly generous with your time. We
• 29:18
  Speaker 1: can't meet with a policymaker in twenty twenty six and
• 29:21
  Speaker 1: not prognosticate about the future. So let's let's cast a
• 29:25
  Speaker 1: look down past the midterms. Let's imagine Democrats have been
• 29:29
  Speaker 1: wildly successful. I've taken the House, who knows, maybe even
• 29:33
  Speaker 1: if taken the Senate. What do you think their healthcare
• 29:38
  Speaker 1: agenda is? And taking a tip from you, how do
• 29:44
  Speaker 1: we keep some of those bad ideas that you fought
• 29:47
  Speaker 1: so hard to shelve in the past, And as it
• 29:49
  Speaker 1: relates to drug development and drug pricing, how how do
• 29:53
  Speaker 1: we move a healthcare conversation about affordability forward? Take a
• 29:58
  Speaker 1: look at out of post get costs and reforming insurance
• 30:02
  Speaker 1: and not look backwards at negotiation on day one and
• 30:05
  Speaker 1: things like that. What would what do you think the
• 30:08
  Speaker 1: Democratic Party looks like if they're successful in healthcare well as.
• 30:11
  Speaker 2: A political and policy matter. I just wish people would
• 30:14
  Speaker 2: see that the advances in the IRA were a success.
• 30:17
  Speaker 2: That's yesterday's battle. I mean, we've got to tweak it.
• 30:19
  Speaker 2: I think we have to deal with the pill penalty,
• 30:21
  Speaker 2: as I said, but you know, we've kind of dealt
• 30:24
  Speaker 2: a lot with with with that, I think that the
• 30:27
  Speaker 2: real thing that people don't appreciate yet is what's happening
• 30:31
  Speaker 2: on the insurance side with the PBMs and the lack
• 30:35
  Speaker 2: of transparency and the misincentives, the perverse incentives where you
• 30:40
  Speaker 2: actually have to you have to offer, you have to
• 30:43
  Speaker 2: demand a higher price to get listed as part of
• 30:45
  Speaker 2: the formularea that gets delivered to patients. This is crazy.
• 30:49
  Speaker 2: And when we talk about lowering the cost of drugs,
• 30:52
  Speaker 2: that is the low hanging fruit right now, and I
• 30:55
  Speaker 2: just that we have to be honest about it that
• 30:56
  Speaker 2: it's not you know, you have a lot of manufacturers,
• 31:01
  Speaker 2: obviously the bigger ones who are willing to do discounts
• 31:03
  Speaker 2: and and talk about prices and access, But then the
• 31:08
  Speaker 2: insurance companies are really in the way. And so I
• 31:12
  Speaker 2: don't know that that that's a great constituency for us,
• 31:14
  Speaker 2: and I don't I don't think that they're all bad,
• 31:16
  Speaker 2: but you know, they've got to do their part, and
• 31:18
  Speaker 2: I think that's got to be the next thing we
• 31:20
  Speaker 2: pay attention to. So I think the PBM reform is
• 31:22
  Speaker 2: really important, and you know, there are other things that
• 31:26
  Speaker 2: push up on the cost of insurance right now. The
• 31:31
  Speaker 2: three forty B program has been it's going bigger. It's
• 31:34
  Speaker 2: larger than Part D. It's supposed to be intended, it's
• 31:36
  Speaker 2: intended for its particular populations. And you know, I think
• 31:42
  Speaker 2: hospitals are under a lot of pressure, I know on
• 31:43
  Speaker 2: California in particular, to find revenue anywhere they can. But
• 31:48
  Speaker 2: but that's again those kinds of things increase the cost
• 31:51
  Speaker 2: of insurance for folks, on the cost of drugs kind
• 31:54
  Speaker 2: of side. I think those are two things we autit
• 31:57
  Speaker 2: the next phase. I mean, I think I do believe,
• 31:59
  Speaker 2: and I a lot of manufacturers didn't like it, But
• 32:02
  Speaker 2: I think that negotiating Medicare Medicare negotiating prices was part
• 32:07
  Speaker 2: of the problem, right. I think we've dealt with that,
• 32:09
  Speaker 2: but you know, insurance companies and the bloated three point
• 32:11
  Speaker 2: forty B, I think we've got to deal with that now.
• 32:15
  Speaker 2: And then on the policy side, look, we I'm sure
• 32:19
  Speaker 2: there were reforms that would be appropriate in medicaid, but gosh,
• 32:23
  Speaker 2: the way we have slashed investment in medicaid I think
• 32:27
  Speaker 2: is really really irresponsible and cruel. But apart from the
• 32:32
  Speaker 2: cruel side, you know, it doesn't make sense for a
• 32:36
  Speaker 2: person to have their primary care in the emergency room.
• 32:39
  Speaker 2: And I talked to a doctor recently she said that,
• 32:42
  Speaker 2: you know, since Obamacare passed, she hasn't had to intubate
• 32:45
  Speaker 2: a kid for asthma because they were getting that care
• 32:49
  Speaker 2: as primary care that would prevent that kind of thing,
• 32:52
  Speaker 2: and she's now we're going to see that again. And
• 32:54
  Speaker 2: that's a huge cost for us. First of all, for
• 32:58
  Speaker 2: all those people who can't get can off primary care
• 33:00
  Speaker 2: and then lose their healthcare because it's too expensive, I mean,
• 33:03
  Speaker 2: it's it's tragic for them. But for those of us
• 33:06
  Speaker 2: who are not in that situation, you know, we're gonna
• 33:10
  Speaker 2: see hospital access go down, hospitals at risk of bankruptcy,
• 33:15
  Speaker 2: and insurance rates go up to cover the extra cost
• 33:18
  Speaker 2: of care because we're not doing primary care. And I
• 33:21
  Speaker 2: think that's terrible. So I think, you know, let's let's
• 33:24
  Speaker 2: be rational at that. At the front end as well,
• 33:26
  Speaker 2: I'm hopeful that diagnostics. The other thing I would say
• 33:30
  Speaker 2: is I think that advances and diagnostics are really promising,
• 33:35
  Speaker 2: and you know, the Alzheimer's is going to bankrupt the
• 33:39
  Speaker 2: country if we don't deal with it. And we're seeing
• 33:42
  Speaker 2: we're seeing more and more technologies around figuring out how
• 33:45
  Speaker 2: to deal with that early. I took a test recently,
• 33:48
  Speaker 2: a blood test for cancer that I think is an
• 33:52
  Speaker 2: amazing kind of advance. We've got genomics. Uh, there's a
• 33:55
  Speaker 2: lot of things where we ought to be able to
• 33:57
  Speaker 2: look at those someday providing not just but or outcomes,
• 34:00
  Speaker 2: but more cost effective outcomes for patients. And innovation is
• 34:03
  Speaker 2: not a dirty word. I think it could be really helpful.
• 34:08
  Speaker 2: And I guess I'm excited too about the movement to
• 34:11
  Speaker 2: personal control of your own health information. To the extent
• 34:15
  Speaker 2: that we can get we can deploy that out to
• 34:17
  Speaker 2: people so that they make better choices. I think that
• 34:20
  Speaker 2: could help us as well. But from your perspective, though, John,
• 34:22
  Speaker 2: I'd say to your folks, the most important thing you
• 34:25
  Speaker 2: could do is be an educator. There's four under thirty
• 34:27
  Speaker 2: five members of Congress. Each of us has a different background.
• 34:31
  Speaker 2: My background we haven't talked about. I did environmental law.
• 34:34
  Speaker 2: You know, if you want to talk about a super
• 34:35
  Speaker 2: fun cleanup or a subtitled decompliant municipal solid waste landfill liner,
• 34:40
  Speaker 2: we could do that peer to peer. But I had
• 34:43
  Speaker 2: to learn about this from folks like you and from
• 34:45
  Speaker 2: investors from scientists, so you need to be teachers. And
• 34:49
  Speaker 2: I would just say the encouraging thing is on the
• 34:51
  Speaker 2: democratic side, we've got a lot more people now who
• 34:54
  Speaker 2: understand this and who aren't afraid of it, of talking
• 34:58
  Speaker 2: about it in an honest way, and just you know,
• 35:01
  Speaker 2: educating the angry populism. You know that we get that.
• 35:05
  Speaker 2: You know, actually, this is how it works, and this
• 35:06
  Speaker 2: is how it's better, and this is what we have
• 35:08
  Speaker 2: to protect. And this is where hands off is better
• 35:11
  Speaker 2: than hands on. And I think the more we can
• 35:13
  Speaker 2: find those people, the better off we are. So have
• 35:17
  Speaker 2: your companies invite their local congress member to come for
• 35:19
  Speaker 2: a visit. You know, I don't have to go to DC.
• 35:22
  Speaker 2: They want to hear from you at home. But if
• 35:24
  Speaker 2: you're in DC, just think of yourself as an educator
• 35:27
  Speaker 2: and then don't be offended when you meet with a
• 35:31
  Speaker 2: staff instead of the member, because those are the people
• 35:33
  Speaker 2: we talked about who will tell me, you know, four
• 35:36
  Speaker 2: months down the line, remember that twenty meeting you John,
• 35:39
  Speaker 2: and he told you this to established those relationships and
• 35:43
  Speaker 2: you know, just get the word out. I think that's
• 35:45
  Speaker 2: the best thing you can do. And if you know
• 35:47
  Speaker 2: someone running for president, see if you can get fifteen
• 35:50
  Speaker 2: or twenty minutes with him or her to explain this
• 35:52
  Speaker 2: as well, because the president makes a big difference.
• 35:56
  Speaker 1: I think if there's one headline to the last sixteen
• 35:59
  Speaker 1: months and even the forty eight months before that is
• 36:01
  Speaker 1: the president does make a big difference, and we need
• 36:03
  Speaker 1: to be that education. I'm actually gonna clip this part
• 36:06
  Speaker 1: of the episode and when we're doing our mini fly ins,
• 36:09
  Speaker 1: I'm gonna say I'm not going to talk to you
• 36:11
  Speaker 1: about coming DC. Listen to Congressman Peter's talk about you
• 36:14
  Speaker 1: coming to DC, because that's exactly right and what we'll
• 36:17
  Speaker 1: be trying to do here. Incredibly grateful for the time.
• 36:21
  Speaker 1: I'm still am going back to the story about your
• 36:23
  Speaker 1: mom texting you. There is no doubt that you have
• 36:27
  Speaker 1: been both a champion for San Diego but also a
• 36:29
  Speaker 1: champion for our broader community. So I would be remiss
• 36:32
  Speaker 1: not to say thank you. We hope to see the
• 36:35
  Speaker 1: epic act over the finish line, and we'll look forward
• 36:38
  Speaker 1: to having you back on the show next Congress and
• 36:41
  Speaker 1: we'll see what we're working on.
• 36:42
  Speaker 2: Then. Great congratulations. As everyone is out there inventing things
• 36:46
  Speaker 2: and saving patients and money, appreciate it.
• 36:49
  Speaker 1: That wraps up this episode of the Making Medicine Podcast.
• 36:52
  Speaker 1: Another huge thank you to Congressman Peters for joining us
• 36:55
  Speaker 1: today and for his leadership on addressing the pill penalty
• 36:58
  Speaker 1: through passage of the Epic Act. Be sure to subscribe
• 37:01
  Speaker 1: on YouTube and follow us on other channels so you
• 37:03
  Speaker 1: don't miss upcoming conversations. If you have thoughts on anything
• 37:06
  Speaker 1: the Congressman said and how it may impact your portfolio
• 37:09
  Speaker 1: or your company, let us know and we might feature
• 37:12
  Speaker 1: your comment in next week's episode. Thanks for listening, and
• 37:15
  Speaker 1: as always, keep innovating.