EFTA02640664

From: Sent: Friday, August 4, 2017 1:53 AM To: Jeffrey Epstein Subject: so far Ideas for Transforming the Alzheimer Landscape <= class="gmail-MsoListParagraphCxSpFirst">1. Segment the landscape until we have a natural advantage 2. =C240 Opport=nities small enough to win, large enough to matter 3. 4)=A0 Mea=urable points on the board <=>Situation Not a typical disease with a single causal factor / etiology Requires longitudinal investments in health and hard to track What needs to be built — preferably invest in places that can do all thr=e o Institutions - processes, policies o Tools & technologies - validation o Science — exploration - =C24, Downside(s) of creating a new institution from bgc3; difficulty managing "portf=lio" of tools & technologies; exploration challenging to manage </=pan> What is required? $75 million, 3 year WIN-WIN strategy m=naged quietly from bgc3 that will result in 1.=C24> $$ savings to CMS 2.=C24) Improved trial participation</=> 3. Shared data 4. Validated biomarkers 5. $$ savings for caregivers=/p> 6. Global public goods in basic science=/span> 7. =span style="font-size:12pt;line-height:115%">Stronger existing instituti=ns EFTA_R1_01874243 EFTA02640664 8. </=pan>New market deve=opment 9. 4>=A0 Novel fin=ncial product offerings 10.=span style="font-variant-numeric:normal;font-stretch:normal;font-size:7p=;line-height:normal;font-family:"Times New Roman""> New drugs from fail=d ones How - 7 ways, as of today... Underwrite risk for private sector; keep data in the public domain ...$20 million matching fund for private sector (1:2 for government, 1:1 for private secto=) to the AMD-AD ...Outcomes: •=A0 In 3 years, study and trial data for 2016++ pipeline fully public and curated =y NIA • =C24> 10 new candidate drugs put into later stage discovery process Endow a biomarker consortium secretariat = biomarker moonshot ...$10 mill=on to create a "world" secretariat between US & Europe ...Biomarker consortium - 5-20 million per biomarker validation from public-private and partner w IMI to ensure candidate studies are flowing</=> ...Outcomes: In 3 years, 5 validate biomarkers Open and shared trial and registry data Aligned US/Europe regulatory and study processes ...$5 mil=ion to NIA/NIH to RFP and identify gut pre-inflammatory and inflammatory marker= (multiple diseases benefit) consider PPP or matching grant abilities<=span> ...$5 million to ICDDR,B to classify non-pathogenic colonists and create a digital World =ut Library with partners like Danone and Yoplait ...$=0 million to redraw bacterial taxonomy based on genetic criteria to supplement tradit=onal identification and classification (gram + etc) could partner with BMGF 2 EFTA_R1_01874244 EFTA02640665 ...Outcomes Creation of several global goods Bacterial genetic taxonomy is a library for world use, all drug development and food safety would have modern standards based on reality rather than staining (traditional) criteria -=C24> Microbiome non-pathogenic library offers biomarkers for health but also potential prebiotic and endobiotic candidates for food and pharmaceutical industries (monetizable = creates new market) <=p> Computational repurposing of failed candidate drugs ...$20 million (for profit vs. shared profit) for repurposing of top 20 failed candidate t=erapies based on computational models can be done as a special initiative at Schrodinger or within the NIA as part of the AMP-AD =p class="MsoNormal"> =/span> ...Outcomes 20 repurposed medications Creates new market opportunity for failed drugs This experiment could lead to the creation of an institution (for profit most sustainable) Investigate and buil= social biomarkers=/span> ...$1 million for grand challenge-like process managed by NIA to identify social changes directly correlated with aging and dementia ...par=ner with Tesla and/or invest in autocameras or real time digital cognitive (rea=tion time/ocular movement/decision-making) monitors for mobile ...Outcomes Digital biomarkers *=B7 40=A0 Financial and social safety nets for at risk (early detection or red flagging)<=span> 3 EFTA_R1_01874245 EFTA02640666 Bring the financial industry into the conversation ...$1 million to explore Wealthcare, alongside the Federal Reserve (efforts already underway...) and major financial instituti=ns to better understand behaviors and challenges of the senior investors (over age 65) 4>=804>create long term care insurance for caregivers (not just facilities = insure against =ou having to care for someone or to pay you to do it) and relieve burden on lo=g term facility care insurance providers <= class="MsoNormal">*=80410utcomes =C2* =C24> Save massive money for CMS, insurance companies and caregivers =C2* Create a new financial product Create automated checks and balances or financial standards for demented adults or retirees over age 65 with cognitive challenges Share actuarial burden between long term facility care-caregivers </=pan> Reduce CMS facility and hospital admission costs ...$2 million for RAND to shape financial argument for CMS reimbursement for cognitive ho=e health nurses (like hospice nurses) = classify cognition and safety as sk=lled medical needs — currently only covered as: skilled nursing visits, =r physical, speech-language pathology, occupational therapy, or home health aide servic=s ...Outcomes <= class="gmail-MscaistParagraphCxSpFirst">* 4>=A0 Save tons of money =C2* =C24> Reduce hospital admissions Improve trial e=rollment ...$1 million for corporate advocacy and lobbying/awareness campaigns on family leave ...Who enrolls in trials? Spousal-patient dyads but most patients are cared for by adult children who need to work. Family leave act. 4 EFTA_R1_01874246 EFTA02640667 ....orporate leadership. It's unpaid, which often makes taking a leave financial=y impossible. Only 12% of private-sector workers have paid family leave. It o=ly applies to employers with 50 or more workers. So employees at many small businesses are out of luck. It excludes recent hires. To qualify, you must =ave worked for your current employer for at least 12 months and for at least 11=50 hours. It doesn't cover the reasons people often need to take time =ff to care for their parents - under the law's rules, you can't take a lea=e to: shepherd your mom or dad to a doctor's appointment, stay with your parent during = short-term illness or help him or her get resettled after moving from one type of care facility to another. Chronic dementia not considered a "serious med=cal condition." It also doesn't let workers take a leave to car= for their grandparents, in-laws, siblings or adult children. <= class="MsoNormal"> <=span> ...Outcomes Greater ability to participate in clinical trials =C2• Reduced burden on caregivers 5 EFTA_R1_01874247 EFTA02640668