good day

Today has been a perfect day.


- Church with my two favorite boys.
- Jonah was GREAT in class (although I still had to stay with him) and he even sat at the table the entire time for the lesson and coloring.
- a BLT for lunch with fresh garden tomatoes (they're finally turning red!).
- I napped when Jonah napped.
- Got my coupons all organized which has been hanging over my head for a long time.
- Got all of our night chores (setting up for dressing change, pulling up tomorrow's meds, loading dishwasher etc.) done early.
- Happy update on Tripp.
- MEXICAN FOOD FOR DINNER!
- A few hands of Rummy with Matt.
- Got my run in. Week 4, Day 3 done. Didn't die.
- Nice relaxing shower.
- Used my new face wash. I like it. 
- Now to bed to read and relax.


GOOD DAY.


Hope you all had a nice and restful day too.


Oh, for those of you who have asked, Jonah's hand is doing much better. We're still keeping it bandaged, but it doesn't seem to bother him when I wash it now, and I'm hoping it will be completely healed by the end of the week. As always, thank you so much for your prayers and for caring about our Sweet Boy. 

jonah's letter sounds

I'm over due for some video posting. I'll try to do better. :) We've recently fallen in love with sesamestreet.org.



And this one is just some overall Jonah-in-his-sunglasses cuteness.

MAPP, week 3

We just got home from our third MAPP class today. It consists of four Saturdays from 9-4, and we have one final one next week. We are getting up at 5:45 to take our showers and get completely ready except for putting on our nice clothes, wake Jonah up at 6:45 for bath and bandage changes, and then Matt and I hit the road for Greensboro by 8:20. We're pretty worn out by the time we get home, but Jonah has been awesome for my mom and Kathryn for three Saturdays in a row now, and has taken long naps each day. We are so thankful he isn't holding it against us. :) He did have a rough time for bandage change last week since we had to drag him out of bed, but I prayed and prayed and this week went much better. He was peaceful and playful and only whimpered a tiny bit when we left. When we came in this afternoon, he chased us with his pet dinosaur and growled at us. I take that as a sign of forgiveness.


I really got a lot from our class again today. We talked during the morning part about the 15 behavior management strategies, and did "case studies" to say what strategies would apply to different children. I really like stuff like this because I don't do well with vague generalizations and do well to really practice... or at least as much as you can practice something like this. We also talked about children who had been sexually abused and they said they estimate that up to 90% of the children they place have been sexually abused at some point, although most cases go unreported and the resulting sexual behaviors are displayed once they get in foster families. It's such a sad statistic and heart wrenching to hear of real cases where these kids have just been forced to do such horrible things - to get fed, to get to go out with their friends, to not be abused.


We watched this video that I thought was especially powerful. (It's pretty straight forward and in-your-face, so you may not want your kids to watch it.)

The head coordinator for adoptions (I don't know her real title) was there today and was actually the one doing the sexual abuse portion. I got a chance to talk with her after lunch about the fact that Jonah is so young and how likely a placement of school age children is for us. I explained our reasons for desiring older children and Jonah's special needs but also expressed my concerns about protecting Jonah. (I want to make it clear here that I'm not trying to judge any child for those kinds of actions or say that all abused children exhibit certain behaviors, but am recognizing that there is always a possibility.) She said that when the approval board met about us, that she had brought up concern about Jonah's age and that she and our social worker had already discussed how selective they would have to be for our family, but that she wouldn't have let us take MAPP and get to this point if she wasn't going to place kids with us. I told her how much I appreciated their being so selective for our family and that that is what we want as well and told her that we know God will show us who our kids are. She said that we would just have to understand and be patient if it takes longer for them to find a child or children that would be a good placement for us, and I said that we totally understood that and were content to wait, pray, and educate ourselves as much as possible in the meantime. 


I will tell you that these classes are not easy. Sometimes I feel like they're just trying to scare the living you-know-what out of you to test you to see if you really know what you're getting into. And maybe that is part of it, but at the same time I'm so thankful for the knowledge and training and how well they try to equip you for your journey. So far I have been very impressed with our agency, our MAPP training, our social worker, and the whole process. I'll be happy to have this step over though and will be ready to move on to the licensure process (which is long and grueling). But I am super thankful for this step and it just makes me eager to educate myself and prepare even more.


I have never been a very compassionate person in many ways (just ask my former high school students) but between this training, discovering where our sweet boys (read: baby girl and a goat) come from, the death of Gabe, and seeing what Jonah lives with every day, I will tell you - God is doing a work on my heart. It's important to remember: "Be kind, for everyone you meet is fighting a hard battle."


It's been a good day. I'm tired and thinking a lot. But God is providing every step of the way, and Matt and I have had a couple of really great conversations the last couple of days too. If one of the byproducts of all of this is a more intimate relationship with my husband and a greater dependence on and intimacy with my Abba, I'll take it. 


Apprehensive but excited about what God is going to do through the journey. 

thirty one fundraiser for baby A

Okay, I've been a total slacker as far as Baby A goes, but things are settling down now that the yard sale and spring cleaning/organizing is over, so here I am (again). Ready to fundraise (again)!


I asked V for a breakdown of the costs so here goes:


$375 application fee
$3500 due at time dossier is being prepared
$1925 at time child is matched (after 1st) trip
$900 USCIS
$2500 home study
$600 psych. evaluations
$100 paperwork apostilled
$8,500 Support and service fee
$200- $500 for visas per trip per person. We have to make 2 trips so this will be about $1,600
$1700 Parent medical exam
$1,200 first trip $1500 second trip for transportation
$70 dollars per pick up and drop off from the air port
$150 notarize childs paperwork $6000 air plane tickets
$150 per day Hotel about $3,600 for both trips
$50 per day for meals $1200
$200 for childs medical exam
$120 childs passport
$40 childs photo for pass port
$420 childs visa 


They've raised a lot, but still need $14,000 more. Well, I committed to helping raise the money until A gets home, so we'll just keep on keepin' on. If you don't know Baby A's story, he's an orphan in Eastern Europe with EB whose parents took his healthy twin home but left him abandoned at the hospital. Sad and not fair are understatements.


Anyway, we currently have a Thirty-One fundraiser going on over on A's fundraising site, so CLICK HERE to check it out. 

The fall line is awesome and through August everything is 15% off, and almost all of it is new! Fundraiser ends August 22nd. (And be on the look out next week. We'll be auctioning off some Starbucks coffee!)

Deals of the Week Is On Deadline

Even as summertime drags its lazy weight across the Northern Hemisphere, some among us are feeling the intensity of impending deadlines. Okay, the NFL owners and players' union beat the clock and are on track for an opening night kickoff. But the lack of adult behavior inside the Washington beltway means the Prez and Congress have just four days to decide whether to risk a plunge into another nationwide recession. And though the San Francisco Giants may have welcomed their newest team member (pictured above, though still channeling his 2009 season per his vintage Web site), other teams are still scrambling to move high-value players in exchange for prospects (or vice versa, depending on pennant chances).

Even Deals of the Week itself is feeling the pinch on this summer Friday afternoon.

Not everyone is under the same time pressures, however. If Valeant Pharmaceuticals really has made an approach to buy out Sweden's Meda AB, things appear to be moving along at a snail's pace. The Wall Street Journal reported Wednesday that Valeant, a Canadian specialty pharma with a robust appetite for acquisitions, has made Meda an offer that could range above $4 billion, sometime in the last two weeks.

Meda, for its part, swiftly refuted the Journal's story without explicitly denying that a deal could be in progress, saying only that Meda "has not received an approach of the kind that is described in the article." Maybe they're just waiting for someone to get back from vacation and check his voice mail. It's the slow season, after all.

If the parties are indeed moving toward a deal, however slowly, it wouldn't be out of character for either. The two have joint ventures in Canada, Mexico, and Australia, and Meda has already licensed a couple of drugs to Valeant, taking $76 million up-front for dermatitis cream Elidel (pimecrolimus) and cold sore treatment Xerese (acyclovir/hydrocortisone) in a June partnership. Meanwhile, Valeant has already shown a willingness to spend big this year. It attempted but ultimately failed to buy Cephalon for $5.7 billion this spring, but instead settled for a spree of other acquisitions, among them dermatology units Dermik and Ortho Dermatologics, Lithuanian specialty pharma Sanitas, and generics seller PharmaSwiss.

The Journal story suggests that Meda is open to a sale, but is willing to take its time in finding the right buyer. Some of us, however, don't have that luxury (damn editors). The clock's ticking and time's a-wasting, so let's move it along to...

Ironwood/Depomed: Still enjoying the fruits of its 2010 IPO, Ironwood Pharmaceuticals is trying to expand its pipeline beyond its lead program linaclotide, a Phase III constipation and irritable bowel syndrome drug developed with Forest Laboratories that would be its first marketed product. The biotech inked a deal with Menlo Park, Ca-based Depomed on July 27 that will allow Ironwood rights to Depomed’s AcuForm gastric retentive drug delivery technology, which it intends to use with one of its early-stage development programs. The company did not disclose to which program the technology would be applied. The technology works to deliver targeted, extended release drugs directly to the upper GI tract at the desired rate. AcuForm technology is already approved with the use of two other drugs: Santarus’ diabetes drug Glumetza and Abbott Laboratories’ post-herpetic neuralgia drug Gralise. Depomed will receive an undisclosed upfront fee, as well as milestone and royalty payments on any products that result from the collaboration. Ironwood, which raised $188 million in its February 2010 public offering, will handle development and commercialization of the product, but Depomed will help with initial product formulation. – Lisa LaMotta

Trius/Bayer: Trius Therapeutics said Wednesday, July 27, Bayer Pharma has licensed regional commercial rights for the Phase III antibiotic torezolid. For an upfront fee of $25 million, Bayer receives rights to all countries in Africa, Latin America, the Middle East and Asia, except for North and South Korea, where rights are held by Dong-A Pharmaceuticals. Bayer will pay 25% of development costs toward global approval in skin infection and pneumonia, up to $69 million in milestones and double-digit sales royalties. Trius retains all rights in the US, Canada and Europe. Torezolid is one of several antibiotics being developed to treat emerging drug-resistant bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA). Many clinicians say the efforts are not sufficient to head off widespread infection from the new organisms, prompting new efforts to spur development and ease regulatory burden. The deal comes as Trius pushes torezolid toward the regulatory finish line after the FDA spent years rewriting its guidance on antibiotic approval criteria. When FDA issued its new guidance for acute bacterial skin and skin structure infection (aBSSSI) in early 2010, the firm stepped back to revise its Phase III trial and a few months later agreed with the agency on a Special Protocol Assessment. Trius, which soon will begin pivotal trials of an intravenous version of torezolid, hopes to have top-line data for the Phase III study of the orally dosed version early next year. -- Alex Lash

Merck/Astellas - Merck is acquiring North American rights to intravenous vernakalant from Astellas Pharma’s U.S. subsidiary, Merck announced on July 26. The agreement will consolidate its interest in the cardiovascular drug to include worldwide rights to both the IV and oral formulations. Until now, Merck’s ownership included global rights to the oral drug and ex-North American rights to the IV formulation, which is already approved and marketed in the EU, Iceland and Norway under the brand name Brinavess as a treatment for acute atrial fibrillation. Financial terms were not disclosed but Merck will pay Astellas an upfront fee along with potential development, regulatory and sales milestones. As part of the agreement, Merck assumes the responsibilities Astellas undertook in 2003, when the Japanese pharma licensed the IV formulation from the drug’s discoverer, Cardiome Pharma. Cardiome will continue to bear 25% of development costs, while Merck will be responsible for 75% of development costs and all manufacturing and marketing costs. Merck had acquired ex-North American rights to IV vernakalant from Cardiome in 2009, along with worldwide rights to an oral formulation currently in Phase II for prevention of chronic AF and maintenance of normal heart rhythm. For its efforts, Cardiome received $60 million upfront, along with the potential for up to $540 million in milestones and tiered royalties on product sales.—Joseph Haas

Fujifilm/Dr. Reddy's: In its latest step intended to transform itself into a medical and life sciences company, Japan's Fujifilm has partnered with Indian generic drug maker Dr. Reddy's Laboratories for a joint venture that will bring generics to the Japanese market. Ownership of the JV will be split 51%-49% in favor of Fujifilm. The photo supply maker says it will draw upon its own advanced quality control techniques while incorporating Hyderabad-based Dr. Reddy's pharma expertise as a manufacturer and global supplier. Generics account for nearly a quarter of Japanese drug sales by volume, according to Fujifilm; the companies hope to target the country's aging population with generics that fit the overall marketplace. The joint venture is aiming to launch its first products within three to four years. Fujifilm has expanded beyond film in recent years, and now manufactures materials for flat panel displays, graphic systems and optical devices as well as the life sciences industry. - Paul Bonanos

Image of the awesome Carlos Beltran courtesy of Flickr user Keith Allison, reproduced under Creative Commons license.

thankful

HE said to me today:

"Patrice, you don't think you need any water while you are dying of thirst in the middle of the desert."



"Here I am. I AM. You are in me and I'm in you. Cling, Sweet Child, to the the Rock of your salvation. I am Creator, Savior, Friend. I am your Abba. Why don't you come and rest for a while?"

Suddenly I feel your heart in mine...

Let's Fall in Love (With New Business Models)

How does the song go?

Adimab does it / Ablexis does it
Even Stemmer's Amunix has done it
Let's do it / Let's find a new corporate structure that allows us to separate drug discovery from development so that we can sell the assets more easily!

Ahem.

It needs work. Cole Porter's version was a little snappier.

But our toes are tapping because, yet again, an early-stage firm with a promising technology -- or in this case, an experienced drug-discovery team -- is launching with a novel structure tailored to the new reality of the biotech business. The firm is Inception Sciences, and its two founders, Brad Bolzon and Peppi Prasit, are fresh off the pending sale of Amira Biosciences to Bristol-Myers Squibb, which you can read about here.

The next edition of "The Pink Sheet" Daily will have a more detailed explanation of Inception, which, like the movie, is a bit tough to get the old noggin wrapped around. In general, however, Inception follows in the footsteps of other biotechs that want to:

- Keep the platform or discovery technology in a holding company and the development-stage assets in separate corporate entities, thus creating the opportunity for more streamlined acquisitions.

- Let investors invest "a la carte."

- Find a way to return cash to investors faster without selling the underlying science.

There are several variations on the theme, as our little ditty above indicates. Amunix has created a half life-extension technology now behind products in two spin-outs: Versartis and Diartis. There's also Nimbus Discovery, which our START-UP colleagues wrote about here, and the antibody platform firm Adimab and its clone Arsanis.

Still, not everyone can hum the tune: the extra layers of administration and bureaucracy can be too much for a lean biotech with inexperienced backers. But in a business where the people with the cash are growing ever-more impatient, it's not a trend going away soon.

once upon a time...

Once upon a time (last night) we met up with our friends Jenn and Todd...

At one of our favorite restaurants on the whole planet...

(We're classy like that.)

While we waited for our food, Jenn took a photo of us...

It turned out surprisingly well. Not because of Jenn. She's a photographer. That was no surprise. Because of me. I am inherently non-photogenic. Matt is always perfectly photogenic. It's sickening, really.

We ordered (and ate disgusting amounts of) wings...

and pizza...

(We're classy like that.)

After a nice, relaxing, glutenous dinner, we went back to Jenn and Todd's for dessert. Jenn rode with us and Todd went to pick up their three boys from a local VBS.

And then... THEN...

All you-know-what broke loose.

There was furniture jumping...

Ceiling fan shooting...

(That fan was going full blast... impressive.)

and all out chaos...

I then began hyperventilating and crying to Jenn, "I don't want three boys. Save me. I don't want three boys..." I was a sad and ugly sight.

Ant then... THEN, Matt got in on the action...

And I realized something. Within the next six to twelve months, I'm going to have FOUR little boys.

I'M DOOMED.

The End.

avoiding all the other things i should be doing

This is one of those posts where I'm sitting down to blog not having anything in mind to blog about. Partly I feel that I'm not blogging enough lately (self-imposed guilt) but mostly I'm avoiding all the other 1,425,671 things I could be doing instead that would be much less fun. 


I made my friend Gaye's zucchini bread again last night and also some yellow squash muffins. I think that probably does it for my squash and zucchini this year. I froze two more cups of the shredded zucchini and will probably do the chocolate zucchini bread again down the road. I also have a recipe for zucchini cookies that I'm wanting to try. I'm not sure why I'm developing a likeness to baking at the same time I'm trying to get in shape, but I will tell you this - flour, butter, sugar, and eggs and running do not mix. Today is Week 4 Day 1 (or it may be tomorrow, we have plans tonight) and I'm fairly certain I'm going to die. The running requirement really jumps up this week, and have I mentioned it's still 1,000 degrees outside? And the bugs? Oh, the bugs. Always nice to add bugs smacking you in the face and getting in your eyes and mouth to the pouring sweat and inability to breathe because of the humidity. I love July and August in the south.


Jonah really got hurt last night. You may have seen me tweet about it. He was just walking and holding his water cup in one hand. He lost his footing or tripped or something and slammed down on the ground HARD. His one empty hand took the full force of his weight and slid across the floor when he fell. Needless to say, the skin is completely off one half of his palm and the other half is broken bunched up skin that slid from the rest of his hand. EB is a cruel disease. Between that and what's going on with Tripp, I went to bed sad and depressed last night. It's weird how after two and a half years it can still take me by surprise. Just like that, the skin was gone. I'm putting Bactroban and Desitin on it and wrapping his entire hand except for his fingers. He's so tender with it, holding it up like a casted arm and using his left wrist instead of his hand to do things. I'm heartbroken about it, but thankful that he even has the ability to heal.


I have a doctor's appointment this afternoon and then my Mom is keeping Jonah tonight so we can go out to dinner and have dessert with some friends. I've been getting out so much lately, I'm going to be spoiled. I'm so thankful for my mom and how present she's been this summer. I'm dreading her having to go back to school. But that means it will be closer to Fall, so I guess I can't want summer to stay and cuss at it to go at the same time. In a few weekends, my three siblings and I are going camping, just the four of us. I can't remember the last time it was just the four of us, nor can I remember the last time I've been camping, so I'm really looking forward to it. HOWEVER, it will be the first weekend I've been away from Jonah (there was one night that Matt and I got away from dinner time one night to about 10:00 the next morning), so part of me feels a little panicked. Not that Matt and his parents can't handle things/dressing changes around here, but I'm a little scared of how dependent I am on Jonah. I've already informed my sister that they can't laugh or make fun of me if I cry several times throughout the weekend.   With Granny and Grandaddy here, I doubt Jonah will even notice that I'm gone. That's a good thing.


Have any of you ever been to Great Wolf Lodge? I'm wanting to plan a short trip (maybe two days or so) in the Fall. I was thinking that Great Wolf might be good because Jonah could maybe do the swimming/water stuff that he's missed out on this summer because we'd be indoors. AND we could just go right back to our room without having to put him wet in a car seat (he'll have to "swim" with his bandages on) to do dressing change. I'm just wondering if there is enough to keep him entertained knowing that he won't do the forts or the slides or anything. I don't want to spend the money and go if he can't participate. Things to keep in mind: he can't climb yet, he'll have to wear his bandages (meaning we'll have to do all the water stuff at one time, because we can't do multiple bandage changes), and he can't wear a life jacket. I don't know. Maybe it would be more for me than for him, getting to play with him and watch him enjoy the water like that. I just want a short fall vacation to celebrate the end of summer and let Jonah have a different/new experience, but I don't want to go and spend the money for him to have very little he can do and for us to feel frustrated (making our lives a lot more difficult for an expensive not-fun vacation) if that makes any sense. 


I'm rambling now. I've got to get Jonah's lunch stuff ready, switch the laundry, etc etc, so I better go. Thanks in advance for your Great Wolf/any other short toddler-friendly vacations input!

mapp class today

Our second MAPP class was today, and I have to say, I really enjoyed it. I don't know if "enjoy" is the right word, just because you're dealing with really hard stuff, but I learned a lot and had no temptation to fall asleep, even on only five hours from last night (and believe me when I say, I'm an eight hour girl). We did a really powerful "close your eyes imagine" activity where the instructor told us to imagine someone came and took us away from our family to go live with a new family. And the new family was so excited that we were coming and had waited so long for us. But we had to leave our old family. Then after 12 months, we were taken back to our old family. A year having passed. 12 months of memories without them and their memories without me. Anyway, I'm doing it no justice, but it was really powerful in conveying the array of emotions a foster child could possibly feel coming into your home. Today's class was about losses and attachments, and it just really made me think. The second half of class was about ways to help children manage their behaviors. I know I'm up to the challenge, but this is going to be a hard one for me, and I was really thankful for all the practical, good stuff they gave us today. All of that to say that I'm really thankful, even though it means hours away from Jonah and having to pull him out of bed at 6:45 to do bandage changes, that we have to do this. I'm glad to get some training but even more than that, I so desperately want to have compassion for our children and try to figure out where they're coming from. I know these classes will help me so much in having a better grasp on that.


And in unrelated news, I present to you Jonah. Our little stockbroker. 

(Sorry for the blur. When I'm trying to catch a quick shot, I don't have time to get my settings right, and HE WILL NOT HOLD STILL for anything. But he is a stockbroker, after all. He doesn't have time for my shenanigans.)

Latest from Courtney

You guys are amazing!! I can't even keep up with all of the support! I will never be able to explain how much this means to me and my family. I am amazed at the way God is using my little boy to touch lives. What a blessing he is. 


I am SO sorry to say that Facebook only allows you to have 5000 friends (I would never have DREAMED that this would happen)- but I we have reached the limit and it will not let me add any more people:( So I have now made my page public so that everyone who wants to can keep up with Tripp. I am so very humbled at the amount of requests, messages, and posts that I have received. I hope you all know how touching it has been to know that so many people love my little boy. I am so grateful. 


Tripp is about the same. We have made a tiny bit of progress with his pain medicine. He is starting to seem a little more comfortable during the day. Baths and diaper changes are still extremely painful. He is on a very large amount of pain and anxiety medicine. He is rocking constantly and getting more love than you could ever imagine. I am SOOO thankful that he can be home in his environment where he is comfortable. Thank you all again and again for the continued support you have shown us. We are blesses beyond words. Please continue to pray that GOD's WILL be done. Whether that is Tripp being fully healed here on Earth, or fully healed in Heaven.

Courtney's Facebook Page HERE.

this and that... again. Again.

I really want to say something clever about these photos, but I got nothin'. Not sure what my problem is. Maybe it has something to do with minimal adult socialization and the 1,000 degree temperature outside. Not sure. But anyway, here are some photos. Jonah is cute. That is all.

I wasn't torturing him. He wanted my camera. The camera is a definite off limits. And not many things are, so I don't feel bad about it. Even when he gives me the old "life is so unfair" fake cry. I'm an oak.

______________________________

I haven't heard from Courtney today. I texted her but haven't heard back. I know she's completely overwhelmed, but if I get any update I'll let you know. I'm assuming things are the same meaning that Tripp is in excruciating pain unless on mega doses of pain meds. A huge prayer movement has started (continued?) for him. You can join Facebook prayer groups HERE or HERE and check out the Prayer Vigil Facebook/Real Life event for him HERE.

In less sad news, John (Ivan) and Carson are orphans no longer! The Cannells returned to Eastern Europe after their 10 day waiting period, and the boys are both in their custody now (per her FB update; the blog hasn't been updated yet). They will soon get to finally come home. You guys were instrumental in getting them there. Thank you so very much. Words sound cheap. You've helped change (and save) their lives.

It is important to remember in the good and bad, that God is good. All of the time. Things in this world do not make sense. Tripp should not have to be suffering so much. Carson and Ivan should not have been abandoned and left in orphanages for the first parts of their lives. But God can bring good out of anything as he proves over and over and over again. I'm glad to serve a God who knows our journeys and has already gone before us. We could never do it on our own. Praise God we don't have to.

DOTW: It's Hot, Hot, Hot

There's nothing like a big deal to get the blood pumping, especially given the lassitude-inducing temperatures hitting most of the US. And just as journos were reminiscing about the good ol' days of hostile then friendly pharma-biotech tie-ups, Express Scripts and Medco deliver a deal with enough uncertainty to keep tongues wagging for months -- or at least until the FTC makes a ruling on whether the marriage merits its blessing.

Who knew pharmacy benefits could be so sexy?

As "The Pink Sheet", WSJ, Fortune, and other pubs have noted, anti-trust concerns are the primary question for investors. And given Medco's stock price mid-day July 22 -- shares were up 18% relative to the day before news of the tie-up broke but still well below Express Scripts' $71.36-a-share offer -- the market clearly believes this ain't a deal that will definitely get done.

Aside from the "Will they? Won't they?" questions tied to FTC, there are plenty of other uncertainties bubbling up (like apple pie fresh from the oven or hot asphalt on the Garden State Parkway). For starters, how will this deal impact drug companies and the kinds of rebates they need to offer to get their drugs covered by such a PBM behemoth? Ross Muken of Deutsche Bank estimates Express Scripts and Medco together process a whopping 35% of all US prescriptions and the WSJ's "Heard on the Street" column pegs the rebates both PBMs collected in 2010 at around $12 billion.

That's a lot of dough -- and could be a reason FTC will eye the merger sympathetically. Rebates after all get passed on to customers -- the employers and health plans who contract with the likes of Express Scripts and Medco to manage their pharmacy spend. Theoretically, the ability to negotiate better rebates means greater control over drug costs, one of the major factors tied to spiraling health care spend. Not surprisingly that was a message management from both PBMs played up in their joint conference call announcing the deal.

Of central interest to drug makers ought to be how a combined Express Scripts-Medco will negotiate rebates for specialty drugs like cancer medicines. Pharmas have doubled down on nichier areas because the high unmet medical need and grievous nature of diseases like cancer, lupus, and rheumatoid arthritis has -- at least historically -- offered tremendous pricing freedom. That's starting to change; the increasing number of oncologics for renal cell cancer, for instance, means payers can choose -- based on efficacy and cost -- which medicines to prioritize without being crucified for denying care. With so much profit stemming from specialty medicines, drug makers are sure to be wary about the negotiating power of an enlarged Express Scripts: more rebating to get coverage for their meds will definitely start to eat into profits.

We'll have more to say about the implications for specialty drug spend in the coming issue of "The Pink Sheet", even as we try to understand another key unknown: how will this merger impact personalized medicine initiatives already underway at both companies?

With integration plans likely focused on simply making this massive entity work logistically, how much energy will be devoted to the interesting (but admittedly not explicitly bottom-line focused) research efforts spearheaded by Felix Frueh and company at Medco Research Institute? Paradoxically any de-emphasis on those initiatives ought to give drug cos something to cheer about. Frueh's team after all has helped resurrect warfarin use and the group looks to be doing the same thing in RA with methotrexate.

With so many questions, it's no wonder debate about the deal has reached a fevered pitch. While we dig for answers, bide your time with a spin through biopharma's latest wheeling and dealing. It's ...

AMAG/Allos: Mergers of equals can be a hard sell to shareholders (remember Biogen and Idec?). Thus it's hardly surprising that Wall Street -- and pundits -- reacted quickly and skeptically to the proposed merger between AMAG and Allos, announced July 20. Execs from both companies argue the deal helps their one-product companies move into the black, and speeds growth, helping to overcome the disappointing launches of the iron deficiency therapy Feraheme (AMAG), and oncology drug Folotyn (Allos). The companies plan to combine their sales forces to sell both drugs, via a combined team of about 75 reps. In addition, the companies claim they can achieve cost synergies of between $55 million to $60 million, by cutting R&D and administrative overhead. Yet it's hard to see the synergies afforded by two very different products. Can the sames sales reps really detail both products given the lack of overlap? Folotyn, after all, is a high-priced drug aimed at specialist doctors and a small patient population, while Feraheme has a much broader patient population and prescriber base. Thus, analysts worry the proposed merger resulted because the companies lacked any better options. (It's a case of 1+1 not even equaling 2, let alone the 3 you'd want to get to justify the integration upheaval.) It will be interesting to see if shareholders get fired up about the merger in the coming weeks; it wouldn't be surprising if significant AMAG investors like Palo Alto Investors and Adage Capital Partners objected. These firms could just as easily argue a dividend is more likely to add value than the proposed merger. --Lisa LaMotta and EFL

Pfizer/Icagen: Pfizer announced July 20 plans to buy its partner Icagen, which develops sodium ion channel modifiers for pain, as part of efforts to bolster the big pharma's capabilities in this therapeutic area and expand its newly created Neusentis research unit. Under the terms of the deal, Pfizer will acquire the outstanding 8.3 million shares of Icagen it does not already own for $6 per share. The deal is valued at $56 million, including the 11% of Icagen Pfizer already owns, the firms said. Recall the two companies have been partners since 2007 when they entered into a collaboration for the discovery, development and commercialization of compounds that modify three sodium ion channels. Over the next two years, Pfizer invested $38 million upfront, including $15 million in equity and $11 million in R&D funding. Meantime, Pfizer clearly believes there is significant market potential in new pain meds; just months after CEO Ian Read announced a restructuring to refocus Pfizer around its innovative core, the drug maker established Neusentis in Cambridge, England to develop new therapies for pain, sensory disorders and regenerative medicines. Ruth McKernan, who heads the newly minted CNS group, told "The Pink Sheet" DAILY Pfizer was increasingly interested in potential new therapies targeting ion channels. Based on this, she claims a strategic partnership with Icagen "made more sense" than relegating the biotech to working on just one or two programs. --Jessica Merrill

Allergan/Vicept Therapeutics: Wasn't it only last week that J. Michael Pearson, CEO of Valeant, notched two acquisitions in his quest to build that specialty-focused, anti-R&D outfit into an dermatological power-house "bigger than anyone else's"? Looks like Allergan is going to give Valeant a run for its money. The maker of Botox has been building its medical dermatology portfolio, and the acquisition this week of privately-held Vicept Therapeutics aids this ambition, providing the bigger spec pharma with V-101, a Phase II daily topical cream to treat the redness associated with rosacea. Under the terms of the deal, Allergan has agreed to pay $75 million upfront plus another $200 million in regulatory and development milestones. Vicept investors are also eligible to receive undisclosed payments should certain sales milestones be reached. That's a tidy -- and quick -- exit for Vicept's backers, which include Sofinnova, Vivo Ventures, and Fidelity Biosciences. The VCs only staked Vicept two years ago with a $16 million Series A, meaning the upfront payment alone affords them a 4.6x step-up on their venture dollars. (Add in the known earn-outs and the theoretical return jumps to around 17x.) With the entrance of Valeant as a prime derm player, the number of potentially interested acquirers of products in this space continues to increase. Long-considered a pharmaceutical back water with innovation essentially meaning reformulation of existing medicines into topicals, dermatology is enjoying a renaissance. Who knows? With a few more exits like Vicept's, this particular TA could have VCs crooning "I've got you under my skin."--EFL

BMS/Amira: The latest addition to Bristol-Myers Squibb’s pipeline-refreshing “string of pearls” strategy is Amira Pharmaceuticals, which BMS acquired July 21 for $325 million up-front. The deal, which could bring in another $150 million in milestone payments, centers on Amira’s fibrotic disease holdings, including idiopathic pulmonary fibrosis and scleroderma treatment AM152. Scheduled to enter Phase II later this year, the drug is one of several racing to become the first approved IPF treatment in the US. BMS also gets Amira’s autotaxin program, which has shown preclinical promise in neuropathic pain and cancer metastases. The acquisition represents a strong exit for Amira stakeholders including Avalon Ventures, Prospect Venture Partners, Versant Ventures and Novo Ventures, which have supplied Amira with $28 million in two rounds since 2005. The deal doesn’t cover certain Amira assets which will be spun out, however; a new LLC shell company has been organized to collect ongoing revenues from an existing partnership with GSK around a Phase II asthma treatment, and another has been set up for its unpartnered asthma and COPD programs, which Avalon’s Kevin Kinsella said are likely to be sold. BMS will retain San Diego-based Amira’s key scientific staff following the deal. – Paul Bonanos

Image courtesy of flickrer Lori Greig via a creative commons license.