This is the “most expensive medicine in the world”: the gene medicine revolution is about to become mainstream.

On Friday, the US FDA gave the green light to Zolgensma, which is already known as “the most expensive drug in the world”. And not for less, since its final price has been set at 2,125,000 dollars. However, if we look only at the price we will be forgetting the most interesting thing about this genetic treatment for spinal muscular atrophy: with dozens of therapies waiting to be approved, its short-term future is also that of gene medicine around the world.

The revolution of gene medicine becomes mainstream

A medicine for SMA. Spinal Muscular Atrophy is an autosomal recessive inherited neuromuscular disease (i.e., both parents must carry the gene responsible for the disease). It affects approximately one in 6,000-10,000 people and manifests itself as a progressive loss of muscle strength caused by the involvement of motor neurons in the spinal cord that prevents nerve signals from being properly transmitted to the muscles (with consequent atrophy).

It is not the only drug available to treat SMA. In Spain, for example, Spinraza was also the subject of controversy a few years ago because of its high price. However, Novartis’ Zolgensma goes one step further because it is presented as the first major gene therapy available to the general public. A therapy that can cure the disease with a single application.

The medicine to come. According to the FDA and if all goes well, in 2025 there will be between 10 and 20 gene therapies in the North American market. Treatments for haemophilia or muscular dystrophy await approval by the highest American authority. Although not only to the approval, of course.

Because the arrival of the Zolgensma opens up many debates, especially regarding the financing of these medicines. Novartis has already started negotiations with US insurance companies to allow payment plans and try to introduce this type of therapy in the clinic at prohibitively expensive prices. Above all, because as has happened again it is reasonable to think that in the next few years the price of these treatments will fall dramatically.

Patients, pharmacists and health systems. In Europe, where the public has a much more important role in health systems, the debate is also open, and we must prepare to deal with it with all the guarantees of transparency and fairness. Last week the BMJ published a report calling into question the close relationship between pharmaceuticals and patient associations in the United Kingdom. The fact that gene medicine is becoming mainstream is great news, but (as we see) in the next few years all the world’s health systems are going to be tested. We need to get down to work.

After a nuclear explosion, these are the foods that become more radioactive

Many of us are currently involved in the extraordinary television series Chernobyl, starring the unsurpassed Jared Harris. So it’s not trivial to wonder what food would become more radioactive as a result of an exposure to radioactivity?

The easiest way to find out is to explore some studies conducted in the “City of Survival,” a fictitious city built in the desert of Nevada, United States, where hundreds of atomic bombs were detonated.

Beware of cod

Project 32.5, a fifteen-page report published in 1956, was intended to test the resistance of frozen foods to a nuclear explosion. To carry out the study, they covered themselves with ice and buried themselves in shallow trenches, 387 and 838 metres, respectively, from the place where a 29-kilometre bomb was to detonate, as well as storing other supplies in freezers in the houses of the city of survival, 1.4 kilometres from ground zero.

29 kilotons, to give you an idea, is twice the power of Hiroshima. So it was more than enough to cover it all with radioactivity. But not all food absorbed it equally, after waiting two and a half days before digging up the food, as Pierre Barthélémy explains in his book Experiments of Improbable Science:

Cod loins turned out to be the most radioactive, ahead of peas. Strawberries had no anomaly. (…) An analysis showed that the nutritional properties had not been reduced, except for a decrease in the vitamin B9 levels of frozen French fries. A team of volunteers also ensured that there were no noticeable differences in taste, texture and appearance from the control foods.

What about food in freezers? There was no sign of radioactivity. However, the report warns that the consumption of food exposed to radiation “should be vitalized as much as possible during the first two weeks, except in case of urgent need.

When Patents Democratized the World of Technological Innovation

During the 19th century, the United States became the most technologically and economically innovative country in the world thanks to the patent system, which protected the property rights of ideas.

This, in turn, allowed people starting from an unfavourable economic and social situation, using exclusively the power of their good ideas, to climb in an unprecedented way in the history of humanity.

Climbing socially
As Daron Acemoglu and James A. Robinson explain in their book Why Countries Fail: The Origins of Power, Prosperity and Poverty:

Between 1820 and 1845, only 19 percent of U.S. patent holders had parents who were professionals or from large, known landowning families. During the same period, 40 percent of patent holders had only primary education or less.

Ideas, good ideas, simply competed in a level playing field. Or at least a much greater level playing field. Even if you were poor, if you had a good idea, you could get a patent on it, a procedure that was not too expensive.

Later, that idea could be sold to another person or company that paid with it, which allowed you to earn money and prestige. Thomas Edison, for example, invented the phonograph and light bulb extraordinarily well, and registered 1,093 patents in his name in the United States and 1,500 worldwide.

But if you had few ideas or just one, then the best way to make money was to start a business. That, in turn, required capital. But the patent system was joined by another flattering circumstance in such a context: the banks were willing to lend you the money, because there was a rapid expansion of banking and financial intermediation.

“While in 1818 there were 338 banks in operation in the United States, with total assets of 160 million dollars, in 1914 there were already 27,864 banks, with total assets valued at 27,300 million dollars. Potential inventors had easy access to capital to set up their businesses. In addition, intense competition between banks and financial institutions made capital available at fairly low interest rates.

Thus, while economic institutions are critical in establishing whether a country is poor or prosperous, it is politics and political institutions that determine the country’s economic institutions.