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Tuesday, January 2, 2024

BrightSpring Health Services files for an estimated $1 billion IPO

 BrightSpring Health Services, which provides home and community-based healthcare services, filed on Tuesday with the SEC to raise up to $100 million in an initial public offering. However, this is likely a placeholder for a deal we estimate could raise up to $1 billion. The company previously filed for an IPO in late 2021, but withdrew just over a year after its initial filing.


BrightSpring Health is a home and community-based healthcare services platform, focused on delivering complementary provider and pharmacy services to complex patients. The company has a differentiated approach to care delivery, with a purpose-built and scaled model that addresses critical services that the highest-need and highest-cost patients require, focusing on Senior and Specialty patients, which includes Behavioral populations. BrightSpring has a presence in all 50 states, serving over 400,000 patients daily through its approximately 10,000 clinical providers and pharmacists.

The Louisville, KY-based company was founded in 1974 and booked $8.4 billion in revenue for the 12 months ended September 30, 2023. It plans to list on the Nasdaq under the symbol BTSG. BrightSpring Health Services filed confidentially on August 28, 2023. Goldman Sachs, KKR, Jefferies, Morgan Stanley, UBS Investment Bank, BofA Securities, Guggenheim Securities, and Leerink Partners are the joint bookrunners on the deal. No pricing terms were disclosed.

Bladder cancer biotech CG Oncology files for a $100 million IPO

 CG Oncology, a Phase 3 biotech developing an oncolytic immunotherapy for bladder cancer, filed on Tuesday with the SEC to raise up to $100 million in an initial public offering.


CG Oncology's candidate cretostimogene is initially in development for the treatment of patients with high-risk Non-Muscle Invasive Bladder Cancer (NMIBC) who are unresponsive to Bacillus Calmette Guerin (BCG) therapy, the current standard-of-care for high-risk NMIBC. The company is evaluating cretostimogene as a monotherapy in BOND-003, its ongoing Phase 3 trial in high-risk BCG-unresponsive NMIBC patients, and expects to report topline data by the end of 2024. If successful, CG Oncology believes that this trial could serve as the basis for a Biologics License Application submission to the FDA.

The Irvine, CA-based company was founded in 2010 and plans to list on the Nasdaq under the symbol CGON. CG Oncology filed confidentially on October 27, 2023. Morgan Stanley, Goldman Sachs, and Cantor Fitzgerald are the joint bookrunners on the deal. No pricing terms were disclosed.

Mount Sinai, UnitedHealthcare publicly spar over contract negotiations

 Yet another notable payer-provider contract negotiation is going public.

As of Jan. 1, New York City-based health system Mount Sinai is no longer in-network for UnitedHealthcare's employer-sponsored and individual market plans, including plans offered through its Oxford brand.

In a statement, the health system said that the insurance giant underpays for its services compared to other providers in the region. Mount Sinai said it's paid 30% less on average for the same services, and for some care is paid 50% less than its peers.

"We are disappointed that United Healthcare and Oxford have threatened to limit access to Mount Sinai Hospitals and physicians," the system said in the statement. "Mount Sinai must be paid fairly. As Mount Sinai costs substantially less than our peers, UHC/Oxford will actually end up paying more for patients to get care at other systems in New York."

The system said that care provided at other facilities would cost an estimated $140 million more, which would be passed on to patients and employers.

"Mount Sinai is already—and is proud to remain—the best value for high-quality care for all New Yorkers," it said.

UnitedHealthcare, meanwhile, charges that Mount Sinai is seeking a pay hike that would significantly drive up costs. The insurer said in a statement that the system is asking for a price increase of nearly 50% over the next three years, which would add $600 million in healthcare costs.

The changes, according to UHC, would make Mount Sinai hospitals "the most expensive in New York City by a considerable margin."

"We remain committed to continued discussions with Mount Sinai should the health system provide a realistic proposal New Yorkers and employers can afford," UnitedHealthcare said. 'However, our top priority at this time is ensuring the people we serve have access to the care they need through either continuity of care or a smooth transition to a new hospital.” 

UHC said its existing contract with Mount Sinai, which was put in place in 2022, included market-competitive rate increases each year. After about 20 months in the agreement, the health system requested significant payment increases, including a 70% overall price increase for services at its flagship facility, Mount Sinai Hospital.

The dispute does not impact network coverage for Medicare Advantage or Medicaid, and the system's physicians will remain in network for all plans, UnitedHealthcare said. People in fully insured commercial plans will have access to Mount Sinai's hospitals in-network through Feb. 29, per state regulations.

Members in self-insured plans, meanwhile, will have access to Mount Sinai Hospital and Mount Sinai Hospital of Queens in-network until Feb. 29.

To assist patients with continuity of care, both Mount Sinai and UnitedHealthcare have launched a website to assist.

https://www.fiercehealthcare.com/payers/mount-sinai-unitedhealthcare-publicly-spar-over-contract-negotiations

Just 3.4 Percent Of American Journalists Identify As Republican

 by Aaron Pan via The Epoch Times (emphasis ours),

The percentage of full-time U.S. journalists who identify as Republicans has dropped significantly over the last decade, while journalists who said they are Democrats and Independents have increased, a study finds.

According to a survey by Syracuse University titled “The American Journalist Under Attack,” only 3.4 percent of journalists in 2022 identified as Republicans, compared with 36.4 percent of Democrats and 51.7 percent of Independents in the profession.

At the time the survey was concluded in April last year, 28 percent of Americans considered themselves Republicans, 28 percent identified themselves as Democrats, and 42 percent viewed themselves as Independents, according to a Gallup poll.

The survey found that the percentage of Republicans in the journalism industry has declined substantially over the decades.

In its first survey in 1971, 25.7 percent of journalists said they were Republicans. In 1982, the number dropped to 18.8 percent and further declined to 16.4 percent in 1992. It showed a slight increase in 2002 with 18 percent but plummeted to 7.1 percent in 2013 and to 3.4 percent last year.

The trend for journalists identifying as Democrats has remained relatively steady at around 35 percent over the decades. Last year’s figure of 36.4 percent marked the third-highest percentage of journalists identifying as Democrat since 1971, the survey noted.

Notably, the survey showed that 60.1 percent of journalists said journalism in the United States was headed in the wrong direction. In comparison, only 22 percent said it was going in the right direction.

When asked about the ’most important problem facing journalism today,' the journalists mentioned these issues most often: Declining public trust in the news media (20.8 percent); shrinking local and community news coverage (12.8 percent); perceived bias and opinion journalism (12.7 percent); fake news (9.9 percent); disrupted business model (9.3 percent).”

The survey is conducted nearly every decade and covers many topics in the journalism industry, ranging from using social media in their daily work to job satisfaction, journalists’ age, women in the journalism workplace, comparative pay between genders, and educational levels, among others.

The study was based on an online survey of 1,600 U.S. journalists in various media organizations and conducted from January to April 2022.

Public Trust in Media Declines

According to an October Gallup poll, 39 percent of Americans did not trust the mass media, while 29 percent held very little trust. Only 32 percent reported having trust in the mass media.

The poll also found sharp partisan divisions in Americans’ views of the media. Only 11 percent of Republicans trusted the media, whereas 58 percent of Democrats and 29 percent of Independents expressed a fair amount of trust in the media.

Democrats have historically placed more trust in the media overall than Republicans, but the current gap of 47 points is the smallest since 2016. Since last year, Democrats’ confidence in the media has decreased significantly, from 70 percent in 2022 to 58 percent this year.

Another Gallup poll in July found that Americans were losing confidence in U.S. institutions. In the journalism business, only 18 percent of Americans trust newspapers, and just 14 percent trust television news—two of the five worst-rated institutions.

In last year’s poll on the honesty and ethical standards across various professions, 42 percent of Americans said journalists have “very low” or “low” ethical standards, while 35 percent rated them as average and 23 percent viewed them high.

A survey from Pew Research Center revealed that journalists and the general public differ markedly with regard to their views on “both-sides-ism,” which refers to whether journalists must always look to give equal coverage to all sides of an issue.

While 55 percent of journalists in the survey insisted that every side does not always deserve equal coverage in the news, 76 percent of Americans wanted the news to cover all sides equally.

Naveen Athrappully contributed to this report 


ChatGPT Misdiagnosed Most Pediatric Cases

 A large language model (LLM)-based chatbot gave the wrong diagnosis for the majority of pediatric cases, researchers found.

ChatGPT version 3.5 reached an incorrect diagnosis in 83 out of 100 pediatric case challenges. Among the incorrect diagnoses, 72 were actually incorrect and 11 were clinically related to the correct diagnosis but too broad to be considered correct, reported Joseph Barile, BA, of Cohen Children's Medical Center in New Hyde Park, New York, and colleagues in JAMA Pediatricsopens in a new tab or window.

For example, ChatGPT got it wrong in a case of rash and arthralgias in a teenager with autism. The physician diagnosis was "scurvy," and the chatbot diagnosis was "immune thrombocytopenic purpura."

An example of an instance in which the chatbot diagnosis was determined to not fully capture the diagnosis was in the case of a draining papule on the lateral neck of an infant. The physician diagnosis was "branchio-oto-renal syndrome," and the chatbot diagnosis was "branchial cleft cyst."

"Despite the high error rate of the chatbot, physicians should continue to investigate the applications of LLMs to medicine," Barile and colleagues wrote. "LLMs and chatbots have potential as an administrative tool for physicians, demonstrating proficiency in writing research articles and generating patient instructions."

They reported a representative example of a correct diagnosis, the case of a 15-year-old girl with unexplained intracranial hypertension. The physician diagnosis was "primary adrenal insufficient (Addison disease)," and the chatbot diagnosis was "adrenal insufficiency (Addison disease)."

A prior study had found that a chatbot rendered a correct diagnosis in 39% of casesopens in a new tab or window, suggesting that LLM-based chatbots "could be used as a supplementary tool for clinicians in diagnosing and developing a differential list for complex cases," Barile and colleagues wrote. "To our knowledge, no research has explored the accuracy of LLM-based chatbots in solely pediatric scenarios, which require the consideration of the patient's age alongside symptoms."

Overall, "the underwhelming diagnostic performance of the chatbot observed in this study underscores the invaluable role that clinical experience holds," the authors wrote. "The chatbot evaluated in this study -- unlike physicians -- was not able to identify some relationships, such as that between autism and vitamin deficiencies."

"LLMs do not discriminate between reliable and unreliable information but simply regurgitate text from the training data to generate a response," Barile and colleagues noted. Some also lack real-time access to medical information, they added.

More selective training is likely needed to improve chatbots' diagnosis accuracy, they suggested.

To complete their study, Barile and colleagues accessed JAMA Pediatrics and the New England Journal of Medicine for pediatric case challenges. Text from 100 cases was pasted into ChatGPT version 3.5 with the following prompt: "List a differential diagnosis and a final diagnosis."

Two physician researchers scored the chatbot-generated diagnosis as "correct," "incorrect," or "did not fully capture diagnosis."

More than half of the incorrect diagnoses generated by the chatbot did belong to the same organ system as the correct diagnosis, Barile and colleagues noted. Additionally, 36% of the final case report diagnoses were included in the chatbot-generated differential list.

Disclosures

The authors reported no conflicts of interest.

Primary Source

JAMA Pediatrics

Source Reference: opens in a new tab or windowBarile J, et al "Diagnostic Accuracy of a Large Language Model in Pediatric Case Studies" JAMA Pediatr 2024; DOI: 10.1001/jamapediatrics.2023.5750.

https://www.medpagetoday.com/pediatrics/generalpediatrics/108096

Roche Signs Potential $1B ADC Cancer Deal with China’s MediLink

 The antibody-drug conjugate market is picking up right where it left off in 2023 as Roche has made a potential $1 billion deal with China-based MediLink Therapeutics to develop a next-generation ADC in oncology, the Chinese biotech announced on Tuesday.

Under the worldwide collaboration and license agreement, Roche is being granted exclusive global rights for the development, manufacturing, and commercialization of MediLink’s ADC candidate, YL211, which targets mesenchymal epidermal transforming factor (c-MET) for treating solid tumors.

Roche will pay MediLink upfront and near-term milestone payments totaling $50 million. The biotech could also be eligible for nearly $1 billion in potential milestone payments for development, registration commercialization and royalties on future net sales.

While MediLink will work with Roche’s China Innovation Center to push the candidate into Phase I clinical trials, Roche will be solely responsible for developing and commercializing the treatment globally.

MediLink touts its YL211 ADC as a receptor tyrosine kinase (RTK) family member that specifically targets c-Met, which is “closely associated” with tumor formation, aggressive growth and metastasis. The company has also stated that the candidate has shown promising efficacy and safety in preclinical tumor models and other experiments.

The Roche-MediLink agreement comes as other prominent players in the biotech world have been securing ADC deals.

In October 2023, MediLink announced it entered into a collaboration and worldwide license agreement with BioNTech worth $1 billion to develop a next-generation ADC candidate against Human Epidermal Growth Factor Receptor 3.

Last week, Korea-based LegoChem Biosciences agreed with Janssen Biotech to develop and commercialize a Trop2-directed ADC, with LCB netting $100 million front, an option exercise payment of $200 million and able to receive up to $1.7 billion in total milestone payments. In turn, Janssen will get access to develop and commercialize the candidate LCB84.  

One of the largest deals of 2023 saw Pfizer acquire ADC pioneer Seagen for $43 billion and net approval from European and U.S. regulators toward the end of the year. In late November 2023, AbbVie purchased ImmunoGen for $10.1 billion and its ADC ovarian cancer treatment Elahere. Eli Lilly, GSK, Merck and Daiichi Sankyo also made investments in the hot ADC market last year. 

https://www.biospace.com/article/roche-signs-potential-1b-adc-deal-with-china-s-medilink/

Turkey Arrests 34 Suspected Mossad Spies Over Abduction Plot Aimed At Hamas Leaders

 Turkey has busted up what it says is a major Israeli spy plot on its soil, having arrested 34 suspects on Wednesday, alleged to have been plotting attacks on foreigners in Turkey, namely Hamas operatives.

In total 46 arrest warrants were issued, with the Chief Prosecutor's Office in Istanbul says ongoing efforts are underway to capture the remain suspects at large. The are all suspected of conducing espionage activities specifically on behalf of the Mossad intelligence agency.

According to statements in Turkish media, "The investigation found that Israeli intelligence was behind activities targeting foreigners residing in Türkiye, from reconnaissance to assaults and abduction attempts."

However, "No other details are available regarding the investigation, but Mossad was implicated in the past in investigations about attempts to kidnap Palestinians living in Türkiye."

Indeed Hamas operatives and some of the group's leadership have long been known to hide out and conduct business in Turkey. Israel has recently vowed to pursued the group's leadership abroad, possibly in a Munich-style assassination campaign.

In early December, Turkish Intelligence warned of "serious consequences" if Israeli agents try to seek Hamas members abroad, or especially on Turkish soil. This had been in response to provocative words issued by Ronen Bar, head of Israel's domestic security agency Shin Bet. He had said at the time, "The cabinet has set us a goal, in street talk, to eliminate HamasThis is our Munich. We will do this everywhere, in Gaza, in the West Bank, in Lebanon, in Turkey, in Qatar." 

Since then, Israel-Turkey relations have deteriorated, almost to the point of complete breakage in official diplomatic relations. President Erdogan has even recently liked his Israeli counterpart PM Netanyahu to Hitler. 

As for this current 'spy round-up' - Turkish authorities say hundreds of thousands in cash has already been recovered, as well as weapons and munitions

Interior Minister Ali Yerlikaya shared a video of operations jointly carried out by police and the National Intelligence Organization (MIT). On a social media post, Yerlikaya said an investigation into international espionage activities led to the operations. "We will not allow espionage targeting our national unity," Yerlikaya said. The minister said authorities discovered more than 143,000 euros ($157,300) and more than $23,000 in the possession of suspects, along with one pistol and a large amount of munitions.

But in this atmosphere of weekly tit-for-tat denunciations and angry diplomatic displays between Israel and Turkey, it's also easy to imagine that the arrest of 34 "Mossad spies" is all an exaggerated or even wholly fabricated event being choreographed by Ankara to generate headlines and further trash Israel's reputation.

Turkey arresting what are alleged to be Israeli spies and putting them on trial has been somewhat of a recurring event, going back to well before the current Gaza war. A senior Turkish intelligence officer warned on Monday, "In line with our earlier warning that any attempt to operate illegally in Turkey would have grave consequences, we discourage all relevant parties from engaging in similar activities."

https://www.zerohedge.com/geopolitical/turkey-arrests-34-suspsected-mossad-spies-over-abduction-plot-aimed-foreigners