4 ms·

In either case it makes a lot of sense to start dosing patients with anti-fungal medication and see if their symptoms improve. Usually you do not give fungicide

by x5n1 11y ago

In either case it makes a lot of sense to start dosing patients with anti-fungal medication and see if their symptoms improve. Usually you do not give fungicide to patients because it has a lot of side-effects but those drugs are readily available and easily prescribed.

msandford 11y ago
It's worth a try, especially if they're pretty far advanced. Doctors have the whole "first do no harm" thing that makes prescribing stuff randomly on hope not really an option. Now if patients start clamoring for it that's another story. But until it's shown that antifungal medicine does more good than harm (who knows, maybe killing all the fungus somehow leaves a void that bacteria could come fill) it's probably best not to do so widely.
pygy_ 11y ago
Not sure why you got downvoted. It would have to be done in double blind trials vs placebo, but it would be a great way to test the causal link between fungi and symptoms. You'd have to make sure the fungicides cross the blood brain barrier in patients.
- protomyth 11y ago
  Haven't we studied the effects of Alzheimers enough not to need the control group? I worked in clinical trials and one study still haunts me knowing what happened to the control group.
  - nonbel 11y ago
    Sure, it fits right in with the plan to get rid of those pesky controls when testing painkillers too: "Drug companies have a problem: they are finding it ever harder to get painkillers through clinical trials. But this isn't necessarily because the drugs are getting worse. An extensive analysis of trial data1 has found that responses to sham treatments have become stronger over time, making it harder to prove a drug’s advantage over placebo. [...] For companies trying to develop treatments, one remedy might be to compare new drugs against their best competitors instead of against placebo — or to go back to conducting smaller, shorter trials." http://www.nature.com/news/strong-placebo-response-thwarts-painkiller-trials-1.18511 http://www.nature.com/news/strong-placebo-response-thwarts-p...
    - protomyth 11y ago
      My sarcasm detector is busted, are you for or against control group in this situation?
      - nonbel 11y ago
        Perhaps you are basing this on the incorrect premise that Alzheimer's is understood at all. It isn't, and worse essentially no progress has been understanding it for many years. For example, the purpose of APP (amyloid precursor protein) remains mysterious. The same speculations are thrown around now as by the guy who discovered it in the 1980s. At some point you need to start considering that something is seriously wrong with the research methods or theories. This fungal idea is good to explore, but the evidence provided here is not convincing at all.
    - zaroth 11y ago
      Comparing old vs new is how it's done in cancer research. It's inhumane to prescribe placebo to someone in serious pain. You give them the old or the new, and they report how they felt. In this case, since there is no concept of old or new, it's an entirely new class of treatment. So you give the current best-practice treatment without anti-fungal, and you give the same with anti-fungal. Anyone in the study is agreeing at the onset that they have a 50/50 chance they will either get the current best practice, or the exact same thing but also the anti-fungal. These are volunteers who are helping move the anti-fungal research forward for everyone, in exchange for a chance of getting early access. They can also leave the study at any time after starting, but if they are in the anti-fungal group they would lose access to it if they did. If that's not enough, there are cases (e.g. in cancer research) of de-blinding the study when there's a clear/strong positive effect and providing early access to all enrolled if it becomes obvious the new treatment is widely beneficial. So I think we have the theory behind the ethics fairly well wrapped on how to roll out these drugs. I don't think in practice it works so well, the studies are often poorly run and poorly administered making them extremely more costly than they should be.
      - protomyth 11y ago

by x5n1 11y ago

msandford 11y ago

It's worth a try, especially if they're pretty far advanced. Doctors have the whole "first do no harm" thing that makes prescribing stuff randomly on hope not really an option. Now if patients start clamoring for it that's another story. But until it's shown that antifungal medicine does more good than harm (who knows, maybe killing all the fungus somehow leaves a void that bacteria could come fill) it's probably best not to do so widely.

pygy_ 11y ago

Not sure why you got downvoted. It would have to be done in double blind trials vs placebo, but it would be a great way to test the causal link between fungi and symptoms. You'd have to make sure the fungicides cross the blood brain barrier in patients.

protomyth 11y ago
Haven't we studied the effects of Alzheimers enough not to need the control group? I worked in clinical trials and one study still haunts me knowing what happened to the control group.
- nonbel 11y ago
  Sure, it fits right in with the plan to get rid of those pesky controls when testing painkillers too: "Drug companies have a problem: they are finding it ever harder to get painkillers through clinical trials. But this isn't necessarily because the drugs are getting worse. An extensive analysis of trial data1 has found that responses to sham treatments have become stronger over time, making it harder to prove a drug’s advantage over placebo. [...] For companies trying to develop treatments, one remedy might be to compare new drugs against their best competitors instead of against placebo — or to go back to conducting smaller, shorter trials." http://www.nature.com/news/strong-placebo-response-thwarts-painkiller-trials-1.18511 http://www.nature.com/news/strong-placebo-response-thwarts-p...
  - protomyth 11y ago
    My sarcasm detector is busted, are you for or against control group in this situation?
    - nonbel 11y ago
      Perhaps you are basing this on the incorrect premise that Alzheimer's is understood at all. It isn't, and worse essentially no progress has been understanding it for many years. For example, the purpose of APP (amyloid precursor protein) remains mysterious. The same speculations are thrown around now as by the guy who discovered it in the 1980s. At some point you need to start considering that something is seriously wrong with the research methods or theories. This fungal idea is good to explore, but the evidence provided here is not convincing at all.
  - zaroth 11y ago
    Comparing old vs new is how it's done in cancer research. It's inhumane to prescribe placebo to someone in serious pain. You give them the old or the new, and they report how they felt. In this case, since there is no concept of old or new, it's an entirely new class of treatment. So you give the current best-practice treatment without anti-fungal, and you give the same with anti-fungal. Anyone in the study is agreeing at the onset that they have a 50/50 chance they will either get the current best practice, or the exact same thing but also the anti-fungal. These are volunteers who are helping move the anti-fungal research forward for everyone, in exchange for a chance of getting early access. They can also leave the study at any time after starting, but if they are in the anti-fungal group they would lose access to it if they did. If that's not enough, there are cases (e.g. in cancer research) of de-blinding the study when there's a clear/strong positive effect and providing early access to all enrolled if it becomes obvious the new treatment is widely beneficial. So I think we have the theory behind the ethics fairly well wrapped on how to roll out these drugs. I don't think in practice it works so well, the studies are often poorly run and poorly administered making them extremely more costly than they should be.
    - protomyth 11y ago