Category: 3. Business

Paris – Ontario Teachers’ Pension Plan Board (“Ontario Teachers’”) today announced it has signed a definitive agreement to sell its stake in Diot-Siaci, a leading European corporate insurance brokerage group, to Ardian.

Ontario Teachers’ invested in Diot-Siaci in 2021, supporting the successful merger between Diot and Siaci Saint Honoré. Since then, the business has grown significantly in scale and geographic reach. Ontario Teachers’ also supported the Group across several strategic value creation areas, including:

• Accelerating revenues from ~€700M to €1B+, helping establish a leader in European corporate insurance with strong positions in the Middle East and Africa;
• Supporting the merger and integration of the two entities;
• Advancing an M&A strategy focused on international expansion and niche verticals such as HR consulting;
• Moving up the value chain through vertical integration, notably via the transformative Nasco acquisition in reinsurance, as well as MGAs and the London market.

Inaki Echave, Head of EMEA Private Capital at Ontario Teachers’, said, “We’re proud to have supported Diot-Siaci following the merger between Siaci Saint Honoré and Diot four years ago. Since our entry in 2021, its revenues have multiplied by 1.5 times to reach EUR1 billion, and today we can say Diot-Siaci is a leader in the European corporate insurance broker market, which we have helped expand into the Middle East and Africa. This is another great example of our partnership with management teams in our financial and insurance services portfolio of investments, where we have a demonstrated track record of success over the last three decades.”

Ontario Teachers’ investment in Diot-Siaci is part of its global C$13 billion Financial Services & Insurance portfolio, a core sector of focus for the Private Capital division, which has completed 15 investments in the sector globally, with 13 of these investments led or co-led by Ontario Teachers’.

The transaction is expected to close later this year, subject to regulatory approvals and customary closing conditions.

The National Comprehensive Cancer Network (NCCN) updated their Clinical Practice Guidelines in Oncology for the treatment of patients with small cell lung cancer (SCLC) to include new additions involving Lambert Eaton myasthenic syndrome (LEMS), amifampridine (Firdapse), and the tests for PQ- and N-type voltage-gated calcium channel (VGCC) antibodies.^1,2

The revisions include symptom specificity for LEMS, defined by proximal muscle weakness and autonomic dysfunction. Additionally, the guidelines now recommend diagnosis through a neurological evaluation, preferably in conjunction with a neurologist, which may include testing for PQ- and N-type VGCC antibodies. Moreover, the guidelines state that amifampridine should be considered as a treatment in consultation with a neurologist. The latter two revisions can be found housed in the guidelines under “Signs and Symptoms of Small Cell Lung Cancer” (SCL-A 2 of 2) and “Principles of Supportive Care” (SCL-D), respectively.

“Early diagnosis of LEMS in SCLC is critical, as it may enable patients to have better outcomes if their LEMS symptoms are effectively treated while fighting SCLC.¹ Accurate identification through VGCC antibody testing and comprehensive neurological evaluation is essential,” William Andrews, MD, FACP, chief medical officer of Catalyst stated in a news release. “The NCCN Guidelines are a trusted standard for guiding treatment decisions, and we believe this update will drive greater awareness. Ultimately, it will help patients, caregivers, and health care providers make more informed choices when addressing this serious unmet need.”

Approximately half of LEMS cases are tied to an underlying malignancy, and in most cases SCLC. Data suggest that LEMS occurs in 3% of patients with SCLC. An internal health case database from Catalyst of SCLC claims found that 90% of patients with LEMS and SCLC were undiagnosed with the former condition, bearing the brunt of SCLC treatment while experiencing disease-related symptoms.

Other Notable Guideline Updates

In terms of pathologic assessment, bullet 8 of section SCL-B 1 of 2 (“Principles of Pathologic Review”) was adjusted to remove the number of daily cigarettes as a threshold (<10 cigarettes/day). The update now states that comprehensive molecular profiling via blood, tissue, or both can be considered in rare cases, particularly for patients with extensive-stage or relapsed SCLC who do not smoke tobacco, lightly smoke, have remote smoking history, or have diagnostic or therapeutic dilemma, or at time of relapse—if not previously done, because this may change management.²

Regarding imaging, footnote e within section SCL-1 (“Initial Evaluation and Staging”) was amended, now stating that brain MRI is more sensitive than CT for identifying brain metastases and is preferred over CT.

With respect to treatment, under section SCL-E 1 of 6 (“Principles of Systemic Therapy”) the guidelines moved carboplatin at an area under the curve 5 or 6 on day 1 and etoposide 100 mg/m² on days 1, 2, 3 from other recommended regimen to preferred as primary or adjuvant therapy for patients with limited stage disease.

Additionally, a fifth sub-bullet was added to section SCL-F 2 of 7 (“Principles of Radiation Therapy”), noting the significant survival benefit associated with adjuvant durvalumab (Imfinzi) in patients who have not progressed after the completion of chemoradiotherapy. The addition was added with the caveat that the optimal dose and schedule of radiation therapy in the context of immunotherapy is at present, undefined.

To read more about the NCCN’s guideline updates published throughout 2024, click here.

To learn more about LEMS, check out this OncLive Insights program, featuring David Gerber, MD, and Steven Vernino, MD, PhD.

References

1. Lambert Eaton Myasthenic Syndrome (LEMS) Antibody Testing and Treatment Recommendations Added to NCCN Clinical Practice Guidelines for Small Cell Lung Cancer (SCLC). News release. Catalyst Pharmaceuticals, Inc. August 6, 2025. Accessed August 7, 2025. https://ir.catalystpharma.com/news-releases/news-release-details/lambert-eaton-myasthenic-syndrome-lems-antibody-testing-and
2. NCCN. Clinical Practice Guidelines in Oncology. Small cell lung cancer, version 1.2026. Accessed August 7, 2025. https://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf

As governments and companies clash over how satellite constellations such as Starlink should be regulated, a paradox is emerging: regulatory efforts designed to constrain unauthorized satellite operations may inadvertently strengthen the market position of the very players they seek to control.

When satellites operate without permission

At the heart of the growing debate in satellite governance is a simple question: Can a satellite system beam signals into a country or provide a service without that country’s explicit consent?

This new struggle is unfolding at the International Telecommunication Union (ITU), the often-overlooked multilateral UN body responsible for coordinating global telecommunications. At stake are the rules for cross-border satellite operations, and whether global connectivity will be governed through enforceable, equitable frameworks, or left to the priorities of dominant private actors and a handful of vocal states, with questionable human rights records.

International law—particularly the ITU Radio Regulations, which are binding international treaty provisions—affirms national sovereignty over the radio spectrum on which satellite internet relies. Yet, new-generation Low-Earth Orbit (LEO) satellite companies like Starlink complicate its enforcement. Unlike the traditional geostationary systems, LEO satellites orbit the Earth rapidly (in about 92 minutes) and continuously traverse multiple national jurisdictions each day. With no formal enforcement mechanisms at the ITU, this evolving landscape risks disrupting established coordination practices, often referred to as ‘spectrum sovereignty’: the principle that states manage spectrum use within their borders.

These disruptions could in turn lead to dangerous interference across critical infrastructure and essential services, highlighting the persistent tension between global coordination needs and national regulatory authority.

This issue became a concrete flashpoint in September 2022, when Iranian authorities detected that Starlink terminals were operating without authorization inside Iran. The terminals, apparently smuggled into the country, were providing unlicensed service in violation of national rules. Iran’s response was systematic: filing complaints with the US Federal Communications Commission (FCC), the UN Security Council, and multiple UN bodies, without a concrete solution. Eventually in 2023, Iran escalated the matter to the ITU’s Radio Regulations Board, a specialized body that interprets the ITU radio regulations and mediates disputes regarding harmful interference and procedural violations that cannot be solved between parties. The Board focuses on reviewing this subset of issues, to maintain neutrality in the cases they accept to be discussed and prevent the process from becoming politicized.

Iran’s argument centered on ‘spectrum sovereignty,’ invoking the principle that each country controls radio frequencies within its borders—and they had a point. Under ITU procedures, satellite operators, like any other spectrum user, must coordinate service areas and obtain national approval before transmitting into a country. These sustained diplomatic efforts led Iran, and eventually Russia, to successfully force inclusion of ‘unauthorized satellite operations’ as Agenda Item 1.5 at the 2023 World Radiocommunication Conference (WRC). The WRC is the ITU’s quadrennial global forum where countries define international radio spectrum regulations and future agenda items for discussion. Or put plainly, Starlink’s perceived non-compliance with established rules led a bilateral technical violation to escalate into a multilateral regulatory precedent that will fundamentally shape the future governance of satellite connectivity, and not necessarily to the benefit of the open internet.

While Iran and Russia are hardly champions of the open internet, both countries maintain highly restrictive digital policies, and their technical arguments about regulatory compliance inadvertently highlighted genuine concerns about the importance of upholding international spectrum coordination agreements. Failure to do so risks not only market distortion or internet interference, but also severe disruptions to critical infrastructure systems including aviation communication, rail operations, emergency services, and smart city functions, where precise spectrum usage is essential to public safety and coordination.

The emerging response to Starlink’s disruptive practice of operating without national consent has become the most contentious issue in satellite governance. But as regulators work to address this challenge, they are discovering that the solution may create new problems.

The ironic twist of non-compliance

The ITU’s regulatory response reveals an unexpected problem. Starlink’s non-compliance is enabled by current regulations that assume cooperative behavior and lack strong enforcement mechanisms. Iran’s and other nations’ response—pushing for stronger rules—creates new barriers for operators who were already playing by the rules. This dynamic becomes clear when examining how the two major players in the commercial satellite market approach compliance.

Starlink sells directly to consumers and has repeatedly operated without explicit government authorization, including in Sudan, Namibia, South Africa and Cuba. OneWeb (now owned by Eutelsat, the French satellite operator) operates as a wholesale provider, working through local Internet Service Providers (ISPs) and following traditional authorization processes. OneWeb, like other providers, has demonstrated that compliance with the current ruleset is technically straightforward. In ITU meetings, the European company has shown how easily it can disconnect unauthorized users from its network. Now, it appears Iran is rubbing this fact in everyone’s face to show that compliance is simple.

Starlink does not do what could easily be done, and current regulations do not force it to. As a result, Iran is now pushing for stronger enforcement mechanisms on the entire satellite sector. It is important to note that discussions at the ITU-R (International Telecommunication Union Radiocommunication Sector) do not and cannot target individual companies; the ITU-R operates at the level of service categories and technical standards. In this case, the debate is framed around the broader class of Non-Geostationary Earth Orbit (NGEO) satellite systems—which includes multiple operators and constellations—rather than any single provider. Thus, the unintended consequence is that new rules could create compliance burdens that would make it harder for operators like OneWeb to compete, while doing little to constrain Starlink’s market dominance.

The enforcement challenge and its global stakes

In 2025, the debate over satellite connectivity, sparked in part by Iran’s detection of unauthorized Starlink terminals operating within its borders, has continued to gain momentum at the ITU. What began in 2023 as a country-specific concern has since escalated into a formal agenda item (Agenda Item 1.13) for the upcoming World Radiocommunication Conference (WRC-27). This agenda item is meant to study and potentially define global regulatory frameworks for Non-Geostationary Satellite Systems (NGSOs), including how their signals are coordinated, limited, or excluded across national borders.

Under ITU rules, satellite services must already be authorized by each country to operate within its borders. The key distinction in current debates is not whether authorization is needed, but how that authorization is technically enforced and whether stricter, verifiable mechanisms should be required. We saw how many Member States are now calling for stricter controls over how satellite internet operates across borders. Proposals include requiring satellite operators to set up control centers that can shut off terminals in real time, systems to track the physical location of each user terminal, and technologies to prevent satellite signals from reaching countries where the service isn’t authorized. These measures would require satellite constellations, especially those providing near-global coverage, to develop more complex infrastructure, potentially limiting how flexibly and widely they can operate.

The ensuing technical discussions reveal the global stakes of efforts to bolster enforcement and regulation of satellite connectivity, in the ITU and beyond. As we observed during ITU meetings, these new proposals face strong resistance from countries hosting major satellite operators and industry representatives, who argue such measures are impractical and risk ‘stifling innovation.’ Such proposals may indeed not be technically or economically feasible for all operators, depending on their satellite systems and coverage geography. This is likely to lead to a situation in which stricter rules and enforcement mechanisms create significant burdens for operators with limited global coverage or real-time control capabilities, precisely those who were already following authorization processes.

Whereas the phrase ‘stifling innovation’ is often used liberally by tech companies protecting their vested interests, in this particular case the worry seems valid. In this scenario, the focus on constraining one dominant player is leading to interventions that may unintentionally entrench its position. Put differently, regulators are proposing rules that assume all operators have the same massive scale and advanced technical capabilities as Starlink—and this is simply not the case.

By designing rules around the scale and behavior of mega-constellations, these obscure but binding regulatory ITU frameworks risk creating structural challenges for diverse or emerging actors. The rule-breaker, meanwhile, continues to operate largely unaffected. Even more concerning, the regulatory response to rule-breaking may end up consolidating power among the rule-breakers. Industry concerns about the strictest proposals focus on feasibility and cost, particularly affecting smaller operators as opposed to giants like SpaceX and Amazon’s upcoming Kuiper constellation. As other LEO satellite companies approach commercial viability, the rules established now will determine whether satellite connectivity becomes a diverse, competitive market or remains dominated by a handful of mega-players.

Watch this space

What’s emerging from the ITU negotiations is a fundamental question about space-based digital infrastructure. Will satellite connectivity be governed through frameworks that ensure diverse participation and fair access, or will it be determined by the priorities and capabilities of a few dominant private actors? This question sits at the center of a political power struggle over control of orbital infrastructure. The outcome will define whether regulatory accountability and infrastructure diversity can be upheld in an era increasingly shaped by commercial satellite mega-constellations.

What is clear is that global connectivity cannot be left to a handful of political actors with incentives to keep their societies digitally isolated, nor to the vagaries of dominant private actors operating as if only the sky is the limit.

Patients with chronic spontaneous urticaria (CSU) face a higher humanistic and economic burden, including worse quality of life and greater health care utilization, compared with those with atopic dermatitis and psoriasis, emphasizing the need for new treatments and improved clinical management, according to an article published in the Journal of Dermatological Treatment.¹

CSU, atopic dermatitis, and psoriasis are common inflammatory skin conditions that significantly impact patients’ quality of life (QOL). While psoriasis management has advanced with a variety of systemic therapies, including traditional options such as methotrexate, cyclosporine A, and acitretin, these older treatments often come with notable limitations.²

Similarly, the standard of care for atopic dermatitis involves topical corticosteroids and moisturizers, though newer treatments such as dupilumab (Dupixent; Regeneron Pharmaceuticals and Sanofi) and Janus kinase inhibitors are emerging.³ Effective management of atopic dermatitis also requires clear, simple treatment plans to ensure patient adherence, including proactive treatment and trigger reduction to minimize flare-ups.

Repurposed biologics for other conditions have generally failed to treat urticaria, with the notable exception of dupilumab, which is now approved for patients whose chronic spontaneous urticaria is not well-managed by standard antihistamines.⁴ For patients with autoimmune-related urticaria, a biopsy showing neutrophilic infiltrates may indicate they would respond better to medications such as dapsone, hydroxychloroquine, or colchicine rather than antihistamines or omalizumab (Xolair; Novartis Pharmaceuticals and Genentech).

Patients with CSU often face significant socioeconomic burdens, including high health care costs and lost productivity, due to their limited treatment options. To compare these burdens, researchers used real-world data from the 2019 US National Health and Wellness Survey (NHWS).¹

From a total of 74,994 survey respondents, the study identified 371 individuals with CSU, 549 with atopic dermatitis, and 2061 with psoriasis. The findings revealed that patients with CSU were significantly younger, with a mean age of 41.7 years, than those with atopic dermatitis or psoriasis.¹

Women made up a larger proportion of respondents with atopic dermatitis (76.1%) than those with CSU (59.8%) or psoriasis (57.3%) (P < .001). The CSU group had the highest rates of full-time employment and university degrees. However, they were the least likely to be currently receiving treatment, with a lower proportion of treated patients compared with the atopic dermatitis and psoriasis groups (54.2% vs 72.5% and 68.3%, respectively; P < .001).¹

Patients with CSU reported a significantly worse health-related QOL than those with atopic dermatitis or psoriasis. All 3 groups had mental and physical health scores that were lower than the general US population norm of 50. However, the CSU cohort consistently had the lowest scores. For example, their average mental component summary (MCS) score was 41.3 and their physical component summary (PCS) score was 42.1, both of which were statistically lower than the scores for patients with atopic dermatitis (MCS 44.8; PCS 47.8) and psoriasis (MCS 45.3; PCS 47.7).¹

The study found that CSU had a greater impact on QOL than either atopic dermatitis or psoriasis. Specifically, the dermatology-related QOL score for CSU was 9.4, which was more than double the scores for atopic dermatitis (4.0) and psoriasis (3.5). Further, a larger proportion of respondents with CSU reported symptoms of mild to severe anxiety and depression.¹

Patients with CSU experienced significantly greater work- and non-work-related activity impairment compared with those with atopic dermatitis and psoriasis. The average percentage of work time missed was nearly 3 times higher for the CSU group (19.9%) than for the AD (7.2%) and PSO (7.3%) groups (P < .001 for both).¹

A higher percentage of patients with CSU reported visiting a health care provider compared with those with psoriasis (97.3% vs 92.8%). The study also found that patients with CSU were more than twice as likely to visit an emergency room and over 3 times more likely to be hospitalized in the past 6 months than those with atopic dermatitis (AD) or PSO. All of these differences were statistically significant.¹

This study’s findings have several limitations common to internet-based surveys. The results may be skewed by selection bias, as some groups have limited internet access, and by response bias from voluntary participation. Additionally, the data rely on self-reporting, which can be inaccurate, and the cross-sectional design prevents the study from establishing cause and effect.¹

“Our study shows that CSU, atopic dermatitis, and psoriasis all impair patient quality of life, and CSU may generate the highest impairment if inadequately controlled,” study authors concluded.¹

References

1. Soong W, Patil D, Rodrigues J, et al. Burden of chronic spontaneous urticaria relative to atopic dermatitis and psoriasis in the United States. J Dermatol Treat. 2025;36(1). doi:10.1080/09546634.2025.2517384
2. Ponikowska M, Vellone E, Czapla M, Uchmanowicz I. Challenges psoriasis and its impact on quality of life: challenges in treatment and management. Psoriasis (Auckl). 2025;15:175-183. Published 2025 May 1. doi:10.2147/PTT.S519420
3. Schoch JJ, Anderson KR, Jones AE, et al. Atopic dermatitis: update on skin-directed management: clinical report. Pediatrics. Published online May 19, 2025. doi:10.1542/peds.2025-071812
4. Santoro C. Personalizing urticaria treatment through the evolving role of biomarkers and biopsies. The American Journal of Managed Care^®. July 8, 2025. Accessed August 5, 2025. https://www.ajmc.com/view/personalizing-urticaria-treatment-through-the-evolving-role-of-biomarkers-and-biopsies