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Online Higher Education (1)

US Higher Education

According to The Condition of Education 2019 by National Center for Education Statistics (NCES):

  • Undergraduate Enrollment
    • In fall 2017, total undergraduate enrollment in degree-granting postsecondary institutions was 16.76 million students.
    • Between 2000 and 2017, total undergraduate enrollment in degree-granting postsecondary institutions increased by 27 percent (from 13.2 million to 16.8 million students).
    • By 2028, total undergraduate enrollment is projected to increase to 17.2 million students.
    • Percentage enrolled in any distance education course grew from 30.8% to 32.9%
    • Percentage enrolled exclusively in distance education grew from 12.8% to 13.3%
  • Post-baccalaureate Enrollment
    • In fall 2017, some 3.0 million students were enrolled in post-baccalaureate degree programs.
    • Between 2000 and 2017, total post-baccalaureate enrollment increased by 39 percent (from 2.2 million to 3.0 million students).
    • By 2028, post-baccalaureate enrollment is projected to increase to 3.1 million students.
    • Percentage enrolled in any distance education course grew from 32% to 34%
    • Percentage enrolled exclusively in distance education grew from 15% to 16%

NCES is located within the U.S. Department of Education and the Institute of Education Sciences. Distance education is a broad definition here but is an approximate to online education.

We can see that:

  1. Online education is one of the fastest growing forms of higher education.
  2. Around 1/3 of those enrollments have used online courses.
  3. Online degree programs have grown at least to 13-16% – as many programs will require on-campus immersions to some extent.

Another report by Wiley Education Services said by the 2020/21 school year, online programs are expected to account for 26% of all higher education market share.

It also lays out some headwinds & tailwinds.

Source: Wiley

To be continued

「What’s News In China」Alibaba + Vanguard, First Index Option In Mainland China, China’s Most Valuable Brand

Alibaba (NYSE: BABA) affiliate Ant Financial and Vanguard, the $5.9T U.S.-based asset manager, formed a joint venture to bring a streamlined and broadly available investment advisory service to retail consumers in China. // prnewswire


China’s first mainland stock index options will debut on China Financial Futures Exchange (CFFE) on Dec. 23. The options are tied to the Shanghai and Shenzhen stock exchange-based CSI 300 Index and the minimum account threshold is RMB500K. It is the fourth risk management hedging tool for the mainland stock market. Previous options included CSI 300 Stock Index futures, CSI Smallcap 500 Index futures and SSE 50 Index futures. // YiCai


Moutai/Maotai is the most valuable brand in China. Hurun released its Most Valuable Chinese Brands list on Dec 12 – Kweichow Moutai ranked top with RMB 640 billion brand value. It maintained the title for the second year running. Maotai /Moutai is a brand of baijiu; the company booked over RMB 22 billion revenue and RMB 10 billion net income in 2019Q3. // AsiaTimes

 

Opioids (4)

New Treatments

Nektar Therapeutics (NKTR-181)

  • NKTR-181 is a new chemical entity (NCE) designed to relive pain without inducing high levels of euphoria, minimising the likelihood of addiction and abuse. Due to the potential of NKTR-181 to address the urgent problem of prescription painkiller abuse, the US Food and Drug Administration (FDA) granted NKTR-181 a Fast Track designation for the treatment of moderate-to-severe chronic pain in May 2012.
  • March 20 2017, Nektar Therapeutics announced positive results from the SUMMIT-07 Phase III study testing the efficacy of NKTR-181 in the management of moderate-to-severe chronic lower back pain.
  • Human Abuse Potential of Oral NKTR-181 in Recreational Opioid Users: A Randomized, Double-Blind, Crossover Study
  • May 2019, spinning off into a new subsidiary, Inheris Biopharma
  • July 26 2019
    • FDA Delays Advisory Committee Hearing For NKTR-181
    • Jefferies’ David Steinberg says he now expects a 1-year delay for the entry of the drug and lop off 30% of its peak revenue — trimming that to $350 million.
  • Q3 earnings Call, Nov 6 & Jefferies London Healthcare Conference, Nov 20
    • FDA informed us that they can now reschedule product-specific advisory committee meetings. We now anticipate adcomm for NKTR-181 within the next several months
  • https://seekingalpha.com/article/4303473-nektar-therapeutics-nktr-ceo-howard-robin-q3-2019-results-earnings-call-transcript?part=single

 

Opioids (3)

Oxycontin & Purdue Pharma

Companies at the center of the opioid crisis include Purdue Pharma, which filed bankruptcy in September 2019.

Oxycontin is a modified-release formulation of oxycodone that was initially approved December 12, 1995 as 10 mg, 20 mg, and 40 mg tablets. An 80 mg tablet was approved January 6, 1997, followed by a 160 mg tablet on March 15, 2000, and 15 mg, 30 mg and 60 mg tablets on September 18, 2006. The Applicant (Purdue Pharma) ceased distribution of the 160 mg tablet in April of 2001.

Here is a history of FDA actions, from 1995 OxyContin approval. In 2001, OxyContin label was changed to add and strengthen warnings about the drug’s potential for misuse and abuse.

Abbott marketed OxyContin from 1996 through 2002 — a critical period directly following the approval of the drug by the US Food and Drug Administration.

With Abbott’s help, sales of OxyContin went from a mere $49 million in its first full year on the market to $1.6 billion in 2002. Over the life of the partnership, Purdue paid Abbott nearly a half-billion dollars, according to court records. From late 1996 through 2002, Abbott was paid about $374 million in commissions, according to those documents. Total sales of the drug during that time were nearly $5 billion. From 2003 through 2006, after Abbott had stopped selling OxyContin, it still received a residual payment of 6 percent of net sales, according to the West Virginia court records. It is unclear whether that pertained only to prescriptions written by the Abbott doctors. OxyContin sales during that time were nearly $6 billion.

In May 2007, the company and three of its current and former executives, pleaded guilty to charges of misleading the public about the drug’s risks; Purdue Pharma LP and the executives will pay a total of $634 million in fines. The company’s sales representatives misleading physicians about OxyContin, for instance, said that the drug produced no euphoric feelings for users and that users suffered no withdrawal symptoms when they stopped taking it.

In April 2010, FDA Approves New Formulation for OxyContin.

In 2010, OxyContin was reformulated and an abuse-deterrent version was introduced, leading to an increase in heroin use and subsequent rise in hepatitis C infection rates.

Between the reformulation in 2010 and 2015, there was a more than 40% drop in OxyContin misuse. During the same period, there were sharp jumps in both heroin-related mortality and hepatitis C infections, suggesting that that factors driving the rise in heroin deaths may also be driving the rise in hepatitis C infections, according to the researchers. Prior to the reformulation of OxyContin, hepatitis C infection rates were comparable between above- and below-median misuse states. However, following the reformulation in August 2010, the gap began to widen.

More recently, strategies to reduce the supply of prescription opioids have received scrutiny for the same reason: Opioid users with untreated addictions often turn to riskier illicit drugs.

March 29, 2017 – Trump signs an executive order calling for the establishment of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. New Jersey Governor Chris Christie is selected as the chairman of the group, with Trump’s son-in-law, Jared Kushner, as an adviser.

February 9, 2018 – A budget agreement signed by Trump authorizes $6 billion for opioid programs, with $3 billion allocated for 2018 and $3 billion allocated for 2019.

September 15, 2019 – Purdue files for bankruptcy as part of a $10 billion agreement to settle opioid lawsuits. According to a statement from the chair of Purdue’s board of directors, the money will be allocated to communities nationwide struggling to address the crisis.

Opioids (2)

Prescription Opioid

As a treatment: Prescription opioids can be used to treat moderate-to-severe pain and are often prescribed following surgery or injury, or for health conditions such as cancer.

In recent years, there has been a dramatic increase in the acceptance and use of prescription opioids for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis, despite serious risks and the lack of evidence about their long-term effectiveness.

Image result for Prescription opioid volume peaked in 2011 at 240 billion milligrams of morphine equivalents and have declined by 29% to 171 billion
Source: IQVIA

Prescription opioid usage in the United States increased considerably from the mid 1990’s to its peak in 2011, at 240 billion MMEs (morphine milligram equivalents). It is now declining rapidly with the largest single year change in 2017 with a decline of 23.3 billion MMEs or 12.0%.

The most common drugs involved in prescription opioid overdose deaths include:

    • Methadone
    • Oxycodone (such as OxyContin®)
    • Hydrocodone (such as Vicodin®)

Abuse Deterrent

What is an Abuse Deterrent Opioid: with abuse-deterrent formulation properties that are expected to meaningfully deter certain types of abuse and/or make abuse more difficult or less rewarding.

As a general framework, abuse-deterrent formulations can currently be categorized as follows:

  1. Physical/chemical barriers – Physical barriers can prevent chewing, crushing, cutting, grating, or grinding of the dosage form. Chemical barriers, such as gelling agents, can resist extraction of the opioid using common solvents like water, simulated biological media, alcohol, or other organic solvents. Physical and chemical barriers can limit drug release following mechanical manipulation, or change the physical form of a drug, rendering it less amenable to abuse.
  2. Agonist/antagonist combinations – An opioid antagonist can be added to interfere with, reduce, or defeat the euphoria associated with abuse. The antagonist can be sequestered and released only upon manipulation of the product. For example, a drug product can be formulated such that the substance that acts as an antagonist is not clinically active when the product is swallowed, but becomes active if the product is crushed and injected or snorted.
  3. Aversion – Substances can be added to the product to produce an unpleasant effect if the dosage form is manipulated or is used at a higher dosage than directed. For example, the formulation can include a substance irritating to the nasal mucosa if ground and snorted.
  4. Delivery System (including use of depot injectable formulations and implants) – Certain drug release designs or the method of drug delivery can offer resistance to abuse. For example, sustained-release depot injectable formulation or a subcutaneous implant may be difficult to manipulate.
  5. New molecular entities and prodrugs– The properties of a new molecular entity (NME) or prodrug could include the need for enzymatic activation, different receptor binding profiles, slower penetration into the central nervous system, or other novel effects. Prodrugs with abuse-deterrent properties could provide a chemical barrier to the in vitro conversion to the parent opioid, which may deter the abuse of the parent opioid. New molecular entities and prodrugs are subject to evaluation of abuse potential for purposes of the Controlled Substances Act (CSA).
  6. Combination – Two or more of the above methods could be combined to deter abuse.
  7. Novel approaches – This category encompasses novel approaches or technologies that are not captured in the previous categories.

Opioids with FDA-Approved Labeling Describing Abuse-Deterrent Properties

FDA has approved these opioids with labeling describing abuse-deterrent properties consistent with the FDA’s Guidance for Industry: Abuse-Deterrent Opioids – Evaluation and Labeling:

There are currently NO generic opioids with FDA-approved abuse-deterrent labeling.