投资医疗保健革命

对于博士分子的剧院区附近，游客可以归功于误认为是技术剧场的交叉基金RA资本管理办公室。一条闪闪发光的白色入口，自由主义使用常设办公和储存良好的公共厨房是研究人员，分析师和设计师的团队的环境，这些人在数量和图表上徘徊。氛围实际上尖叫着“中断”和“创新”。仔细观察大量吹玻璃衬里，走廊揭示了英国艺术家Luke Jerram的个体病毒分子的复制品。有Ebola，大肠杆菌，艾滋病毒甚至禽流感。它们导致一个明亮的会议室，由一个大型屏幕展示幻灯片，幻灯片幻灯片幻灯片，可以持有钥匙来固化这些疾病的次数。

带来思想史蒂文斯皮尔伯格的科幻惊悚片少数派报告，Ra Capital的39岁的联合创始人和投资组合经理Peter Kolchinsky，他有一个博士。在哈佛大学的病毒学中，操纵一个触摸屏，显示蒸馏目前患有乳腺癌，丙型肝炎和亨廷顿疾病等疾病的所有内容的触摸屏。他的公司被投资于针对触发疾病的特定分子机制的各种药物，但Kolchinsky在这些条件下发现的黑色空间中的真正潜力。由于需求和科学创新的汇集，十年前似乎不可逾越的疾病的汇集变成了能够拯救生命，并对合适的投资者提供令人难以置信的利润。

纽约大约200英里，互联网企业家统一状态是在高盛组织前总部的卫生保健技术初创企业中建立了一个小帝国。在85楼的29楼，由Coworking-Space Developer WeWork拥有的一大块舒适的舒适办公室，已经为这是初创健康网络的一部分。自2014年推出以来，该网络已经增长，包括在世界各地50多个城市的117家公司，这承诺通过生物识别来完成从家庭透析治疗的所有透析治疗方法。在一个小家具的房间里，即将成为录音播客的一室公播，Stoakes，网络的联合创始人和总统，讲道创造性的破坏福音。他说，避免医疗保健是唯一的主要行业，除了教育，没有有意义的扰乱和被迫因为新技术而被迫重新创造自己。那是改变的。

Kolchinsky和Stoakes代表双重革命that are propelling health care into a new era of personalized, consumer-oriented, data-driven medicine. At the edges of RA Capital’s maps are the treatments and therapies that will fill health care investors’ portfolios in the months and years to come. StartUp Health’s network comprises dozens of companies ready to change the way doctors and individuals communicate about, monitor and address health concerns. Not all of these companies will succeed, but continuing advances in science, coupled with recent regulatory, cultural and demographic shifts (see “The Silver Tsunami”), have created a convincing optimism that the overwhelming trend is toward more-expedient and successful diagnoses, treatments and cures. For investors interested in capitalizing on this disruption, this means looking beyond hot-button issues like drug prices and a potential biotech bubble to the science and technology that have transformed so much in the sector from empty promise to reality in the past few years.

“你在字面上看到了可能在我们的医疗保健方面改变的各个方面，”Stoakes说。“它不适用于线性路径;它正在展望指数曲线。“

It took 13 years and $2.7 billion to sequence the first human genome. Today it can be done in a few hours for a few thousand dollars. Just three years ago hepatitis C was for many patients a life sentence to immune system–weakening treatments for a chronic disease; now studies of new drugs indicate a cure is possible within three months of treatment. Researchers are learning not only how to identify which genes might be contributing to a patient’s disease and the mechanisms by which they are doing it but also how to edit those genes to alleviate symptoms and implement cures. On November 30 researchers from the San Francisco–based J. David Gladstone Institutes released new findings that show a connection between the BRCA1 gene — a mutation of which is known to increase a patient’s chance of developing breast cancer — and Alzheimer’s. Researchers now know that BRCA1 proteins not only cause cells to multiply, they interact with neurons, which are depleted rather than divided. This could lead to better prevention and treatment for one of the most baffling brain-related diseases.

“We’re just now starting to see the fruits of genomics,” says Michael Ringel, global leader of research and product development at Boston Consulting Group, who is studying ways of valuing new methods and outcomes of health care. “The depth of understanding of disease is opening up whole new avenues of treatment.”

Provider- and consumer-focused technologies that may sound to some like science fiction — helmets that can detect concussions in real time, pill bottles that tell your doctor if and when you’ve taken your medication — are now in use, and scientists have the capability to do even more. At the same time, individual consumers are becoming increasingly interested in and capable of tracking their own health. The implementation of the Patient Protection and Affordable Care Act (ACA) has shifted more of the cost of care onto patients as insurers lean on high-deductible plans, giving a new generation of consumers already caught up in a culture of wellness additional incentive to tune into their own health.

“这个市场比我能想象的任何公司都大，”天使投资者邓森说，自2007年初以来一直资助与健康有关的企业家。

The U.S. health care market pulls in about $2.8 trillion in annual revenue, according to PricewaterhouseCoopers, and health care indexes have long outperformed the broader S&P 500. Though the ACA has had its stumbles, it has added more than 10 million people to the U.S. health care system through exchanges and an additional 12 million through Medicaid expansion, and the bulk of the changes the ACA has made to the system are likely to remain in place regardless of who succeeds Barack Obama as president. But 2015 was undeniably difficult for health care investors. Stocks in the sector — especially, traditional drug companies and biotechs — had a volatile year, thanks in large part to a growing chorus of objections to drug pricing practices.

In September a young former hedge fund manager named Martin Shkreli became the face of the U.S.’s drug cost problem when his company, New York–based Turing Pharmaceuticals, made headlines for raising the price of an old toxoplasmosis drug by more than 5,000 percent overnight. Hillary Clinton’s response on Twitter, calling the move outrageous and promising a plan to stop such “price gouging,”sent health care stocks tumbling。标准普尔500指数卫生保健指数在一周内下降了5.8％。主要生物科技球员生物罗素药物和生物因均在一天内损失超过6％。

Turing didn’t pull down the market single-handedly. At about the same time, Laval, Canada–based Valeant Pharmaceuticals International came under fire for its own pricing practices and its relationship with a network of specialty pharmacies that allegedly pushed only Valeant’s drugs. The company’s stock fell 71 percent between September 18 and November 17.

Most health care investors, no matter how smart they were, felt the blow from this sell-off. One of Greenwich, Connecticut–based Viking Global Investors’ funds — the Viking Long Fund, which had about 43 percent of its assets invested in health care — lost 7.9 percent in the third quarter. The hedge fund firm owns almost 5 million shares of Valeant. But even those not invested in Valeant felt the contagion: Dublin-based Allergan lost 13 percent in the last week of September, and Teva Pharmaceutical Industries, an Israel-based drugmaker, fell more than 10 percent that same week. In a letter to investors at the end of October,Glenview资本管理创始人和首席执行官拉里罗宾斯那whose hedge fund firm owned both Allergan and Teva, admitted that its health care positions had “failed to protect your capital, and mine.” Glenview, which also was hurt by a drop in shares of Chicago-based pharmaceuticals company AbbVie, was down 13.5 percent for the first nine months of 2015, according to an HSBC Hedge Weekly report.

过去一年的经验表明,即使是一个赌注on a company with solid fundamentals and a pipeline of evidence-based therapies or technologies can be subject to the dips and dives of the volatile market. Investors who remember the biotech bubble of 2000 or got hurt in the recent market stumble may not want to jump into these turbulent waters now. But for those with access to, and a good understanding of, the science just beyond the headlines, the opportunities may be too hard to pass up.

“The ’90s were really a stepping stone,” says Oliver Marti, who manages CCI Healthcare, the team at Stamford, Connecticut–based Columbus Circle Investors responsible for the firm’s $1 billion health care strategy. “Over the past few years, we’ve started to see a lot of the companies whose pipelines hadn’t fully matured entering a new product cycle that I think was underestimated by Wall Street.”

该公司南方山科的Genentech在1980年推出了创建美国Biotech部门的首次公开发行时，其股票从35美元到88美元的股票在不到一个小时内跃升。Investors who had been enamored by Silicon Valley’s electronic innovations had become convinced that the same kind of successful returns could be wrought from a new technology in the medical field: genomics, the branch of molecular biology that focuses on mapping the network of genes in the human body. Since the 1860s scientists and doctors had understood the function of DNA, or deoxyribonucleic acid, the self-replicating molecule that carries genetic information and instructions for proteins such as hemoglobin, which carries oxygen through the blood. In the 1970s researchers at Stanford University successfully took genes from one organism and combined them with genes from another to create recombinant DNA — an entirely new DNA sequence that can function on its own — opening the door to discovering the structure and function of genes that play a part in many diseases.

与斯坦福研究人员合作，Genentech于1978年成功地重新创建了胰岛素基因，并于1982年，该公司的首批胰岛素药物管道赢得了美国食品和药物管理局的批准。作为基因后作为基因构建的兴奋被操纵和重复。投资者堆进了Genentech和许多其他基因的生物技术公司，迅速遵循，投注其突破将改变整个医疗保健行业。他们是对的，但它比大多数投资者都需要的时间更长。

Knowing the makeup and function of one gene is useful, but without the larger context of how it fits within the body’s genetic structure, including its DNA sequence, the impact is limited. In 1990 the U.S. Department of Energy and the National Institutes of Health initiated the Human Genome Project, an international effort to identify all of the genes in human DNA. The project was initially scheduled to take 15 years; it was completed in 13. Advances in technology sped up the process, but it wasn’t fast enough for many biotech start-ups and investors.

基因组学IPOS轰炸市场;2000年，美国市场上有46个公开发行，筹集了37亿美元。那一年泡沫爆裂：3月份飙升至1,596时，市场上限加权纳斯达克生物技术指数（NBI）在4月份下跌至1,000以下。Genentech的股票从2000年3月的每股58美元从一年后的每股19美元下降到每股19美元。在开始缓慢的攀爬之前，它在2002年击中了每股16美元的低点。

对于一些投资者来说，Biotech Ipos最近的Uptick看起来很像相似。根据文艺复兴的资本，2014年，美国有71家Biotech IPO，占IPO总量的25％。2015年，10月初有48次，筹集了46亿美元。NBI在7月至7月至10月中旬达到了4,165岁的历史率，而10月中旬的历史最高，主要原因是由于药物价格和缬草的动荡而大部分。IPOS的回应减缓，但在秋季后来开始再次播放，将该部门追溯到另一​​个可能的记录年份。

But the market isn’t just dealing with more start-ups and offerings; it’s also reckoning with more and better science. Several of 2015’s biggest IPOs have been by companies like Austin, Texas–based Mirna Therapeutics that are working on genetically engineered cancer immunotherapies, treatments that bolster a patient’s immune system to battle cancer. Others, such as Vancouver, Canada–based ProNAi Therapeutics, are pioneering ways to interfere with specific pieces of DNA to alter the trajectory of disease.

“The next ten to 15 years will be the period of time that is going to fundamentally change human health, and it’s happening at a pace that’s extraordinary,” says Kevin Starr, partner and co-founder of Boston-based venture capital firm Third Rock Ventures.

STARR担任基于基因组织幸福的时代的马萨诸塞州的千年药物的CFO，然后在Cambridge的COO。He remembers a time in the late 1990s and early 2000s when researchers were working out a way to treat multiple myeloma, a rare cancer of the plasma cells, and they regularly tossed aside as “junk” much of the information in DNA that hadn’t yet been identified. They weren’t alone: Until the mid-2000s few researchers were aware of the epigenome — the compounds that dictate how the genome functions and record changes in DNA. As it turned out, that “junk” held clues as to how DNA is modified by diseases like cancer.

“当我在千禧年时，我们甚至没有知道有一个表观蛋白酶，”斯塔尔说。“现在，我们正在探索全面监管系统，调节多种遗传学疾病，并有一整套新的治疗方法。”

基于Cambridge的Voyager治疗方法具有新的基因治疗帕金森氏病和肌萎缩的外侧硬化，也称为ALS或Lou Gehrig病的临床试验。该公司计划使用病毒作为可以打击可能引发这些条件的基因的蛋白质的载体。由第三岩石支持的航行员在11月IPO提高了7000万美元。另一个第三个岩石公司，鼠尾草治疗方法，筹集了7月IPO的9000万美元，也在剑桥，目前正在进行3阶段对超级难治性状态癫痫的静脉治疗，是导致的罕见，危及生命的疾病的静脉治疗大脑连续抓住。在早期的试验中，71％的患者能够消除麻醉药，然后在没有复发的情况下消除鼠尾草的治疗。

In the 1990s it would have taken 15 years for a product like SAGE’s antiseizure drug, known as SAGE-547, to make it from the lab through clinical trials. Now, from a neon paint–splashed office on Boston’s Newbury Street, Starr is simultaneously keeping track of about 40 different clinical trials for therapeutics, many of which are showing measurable patient improvement with few side effects. These trials are a microcosm of the progress evident across the industry. That’s why, despite recent biotech failures that are fresh in their memories, some asset managers have taken innovative steps to move the sector forward. Those who have watched from the beginning are aware of the challenges ahead but are comfortable enough with the science to believe that this time will be different.

THOUGH LARRY FEINBERG, founder and managing general partner at Greenwich-based Oracle Investment Management, was the first to focus a hedge fund solely on health care and biotech, he may be an unlikely evangelist for the current craze. At the peak of the 2000 biotech mania, his firm had one of the world’s biggest positions in the sector. When the bubble burst, the humbling experience led to a change in how Feinberg did business. Once an active trader, he now runs Oracle much more like a family office, with longer-term positions. For much of the past decade, that has meant taking advantage of the expansion of the U.S. health care industry through safe bets such as hospitals and established companies. But recent breakthroughs and start-ups with promising pipelines have proved too hard for Feinberg and many other asset managers to ignore.

现在Feinberg争辩旨在以高于和超越市场风险的“科学风险”的必要性，以便在医疗保健中赚钱。这转化为基于北卡罗来纳州北卡罗来纳州的Chimerix等公司的投资，该公司计划向预防细胞核病毒的第一次治疗的第3阶段试验，这是与导致单核细胞多疾病和鸡痘等病症相关的常见感染，2016年初，甲骨文还有几家医疗机器人公司和梅洛公园的太平洋生物科学的职位，首先提供第三代基因测序，提供比其竞争更大的遗传信息。

“我从来没有见过这样的平台ht now in terms of drug development, in terms of results of products in clinical studies and coming to the market,” Feinberg says. “Now I’m breaking my own rules.”

在波士顿，在RA Capital的未来派地图上，由内部研究人员的团队开发，Kolchinsky指出了目前对乳腺癌研究的关键见解，这与许多类型的疾病都是一群不同的突变。肿瘤学是通过靶向和治疗特异性基因突变来识别和解决疾病的比赛中最前面，但最近几个月最讨论的基因靶向突破不是癌症;它适用于丙型肝炎，一种影响肝脏的炎症病毒。“随着我们更好地了解疾病的分子基础并诊断出什么是错误的，它变得更容易说，”这是可以解决这个问题的工具或工具组合，“”Kolchinsky说。

虽然对丙型肝炎的几种新治疗方法是他们的价格，但来自加利福尼亚州的福斯特市的价格为其价格进行了标题，从加利福尼亚州的加利福尼亚州的Gilead Sciences成本约为1000美元 - 它们比以前存在的任何治疗更有效。FDA于2014年10月批准的Harvoni通过抑制复制丙型肝炎病毒的蛋白质，在三个月内有效地治愈了94％的患者，六个月后占患者的近100％。

“People call it expensive, but we’re talking about a cure in eight to 12 weeks, versus prior therapies that often required a lifetime of treatment,” says Marti of CCI, which owns nearly 3.5 million shares of Gilead as of its most recent 13F filing. “And it’s only penetrating a very small percentage of the estimated hepatitis C market.”

As many as 150 million people around the world have hepatitis C, according to the World Health Organization, and curing the virus on a large scale would be one step toward eliminating many cases of liver cancer. The next step: targeting hepatitis B. RA Capital has made at least one past investment toward that end, in Pasadena, California–based Arrowhead Research Corp., which is working on an injection. Finding a cure for this virus has turned out to be much more difficult, but Kolchinsky points to the value of Arrowhead’s research in understanding those hurdles. The important thing to remember going forward, he says, is that these advances are no longer happening in a vacuum; the breakthroughs will continue.

“随着人们欣赏生物技术在黑暗中没有经营并理解遗传医学给我们的蓝图，我们开始看到该行业的显着变化，”Kolchinsky说。“当基因治疗治愈疾病时，你不会恢复到平均值;你不拿回来。“

The problem for some investors is that massive breakthroughs aren’t discovered and implemented overnight, and in the meantime other factors influence the market. Many analysts look at a company like Cambridge-based WAVE Life Sciences, which raised $102 million in a November 11 IPO and is working on DNA therapies for rare diseases, and worry that it isn’t worth its recent $350 million market cap because of what it hasn’t yet produced: earnings and FDA-approved treatments.

“公共市场不适合解析科学数据，”Kolchinsky说，其公司拥有25％的波浪。他规定了基于科学的，而不是基于战略的展望。

RA Capital started out in 2002 as a public-focused fund but has since transformed into a crossover fund, focusing on the science and pipelines behind investment targets, both public and private. The firm has an in-house research group, dubbed TechAtlas, that creates its disease-specific maps. Kolchinsky believes that to take full advantage of current and future biotech developments, investors will have to set aside their loyalties to particular strategies.

“If we come up with a way to cure Huntington’s disease, it won’t matter which bucket your money came out of,” he says, referring to an inherited neurodegenerative malady that affects about 30,000 Americans. “If you’re only a public guy, you need to figure out how to broaden that mandate and invest in that drug. It’s worth figuring out how to get the flexibility you need to be a part of that.”

Esther Dyson希望完全消除对复杂的新药。Dyson在Facebook和LinkedIn上提前投注，最近将她注意与创新技术配对的基本营养信息如何改善健康，并使投资者能够利用越来越大的消费者健康文化。亚慱体育app怎么下载她认为，健康 - 反对卫生保健 - 应该是一个资产课程，她争夺了。“如果你想长期思考并让人们生病，那么回报会对每个人都更好，”她说。

To Dyson, investing in prevention means funding companies such as Omada Health, a San Francisco–based enterprise that provides employers and health insurers with a digital program aimed at preventing diabetes. Omada recently completed a $48 million Series-C round, bringing total funding to more than $77 million.

Dyson has founded a nonprofit known as HICCup that has launched five community case studies to show that a collaborative prevention effort based on individual health data and known science about diet and exercise can create as much value as the latest tech innovation by preventing disease. The project, called the Way to Wellville, is taking place in Muskegon, Michigan; Lake County, California; Spartanburg, South Carolina; Clatsop County, Oregon; and Niagara Falls, New York.

“There’s not a new idea in it,” Dyson says. “It’s implementing old ideas; actually doing it is the new idea.” But the methods of gathering patient data are certainly new, and they are an easier point of entry to the consumer wellness craze for many investors, though hurdles remain.

什么时候Fitbit该基于旧金山的可穿戴活动监视器制造商于2007年推出，是利用个人越来越渴望跟踪个人健康数据的第一科技初创公司之一。随着人们支付更多的口袋供卫生保健，遵守他们自己健康的某些措施的激励。但它很难重视像Fitbit这样的公司，因为消费者和投资者通常不知道如何使用其设备收集的信息。After Fitbit went public in June, opening at $30.40 a share, its stock price steadily rose, topping $50 on August 5. By mid-November, however, analysts’ predictions of a fall had proved true as investors realized Fitbit’s devices didn’t provide much more than a count of steps and calories.

近年来，收集大数据的能力一直是健康技术创新的重点。现在，专家说，下一个任务是弄清楚如何使用该信息。山景，基于加利福尼亚的个人基因组信息公司23andme是这个问题的早期受害者。该公司于2013年击中了障碍，因为FDA命令它停止销售其DNA分析产品，因为消费者将被误报，虚假底片或错误信息所误导的可能性。但禁令将这一秋季提升，据研究公司VC专家的私人举行的公司，私人持有公司的价值超过10亿美元，现在正在销售一个调整的套件版本。

该公司还在与大制药公司锻炼合作伙伴关系，将其数据转化为毒品。In fact, investors who are focused on New York–based Pfizer’s upcoming megamerger with Allergan may be missing the real opportunity at the drugmaker: A year ago Pfizer announced a partnership with 23andMe that gives the pharmaceuticals giant access to more than 600,000 individuals’ data for research purposes. The first study was launched in May with the goal of better understanding and developing personalized treatments for patients with lupus.

“People think it’s the person who owns the data who has the power,” says Belen Carrillo-Rivas, Pfizer’s head of R&D innovation projects. “It’s not. It’s the person who understands the data.”

启动健康’s Stoakes compares the current struggle to get a handle on health data — and the corresponding surge of start-ups attempting to do just that — to the early days of the Internet. Stoakes and Steven Krein, who launched StartUp Health in 2011, began their careers as web entrepreneurs. “To put it in context, I would say we’re at 1994 Internet, when Netscape was going public,” says Stoakes.

In this scenario Fitbit or San Francisco–based information technology provider Castlight Health would be Netscape Communications, blazing a new trail and inspiring a wave of followers. Some of those followers are in StartUp Health’s network, including AdhereTech, which has developed a smart pill bottle that helps track and improve adherence to medication regimens, and Dermio, a virtual dermatological consultation service. Stoakes believes the next generation of health tech start-ups will include devices that can be embedded to measure vital signs and communicate them to doctors, clothes that can measure dehydration and nutrient levels, and skin-patch drug-delivery systems dropped off by drones. If that sounds a little frightening, Stoakes is quick to point out that doctors have been embedding products like pacemakers and intrauterine devices for decades.

真正的医疗保健革命的单个碎片 - 在这种情况下，越来越多的疾病，越来越多的条件，可以用目标个性化方法进行处理 - 用于更好的速度和准确性。下一步将是将它们融合在一起。

“已经完成了很多沉重的举重和努力工作，”Stoakes说。“现在有一个强大的市场来改变，并且在未来五年内会有很大的机会，因为它会很快发生。”

在Twitter上关注Kaitlin Ugolik@kaitlinugolik。