9 ms·

As that last-linked blog post makes clear, I don’t find that evidence compelling, and most certainly not compelling enough to approve the drug as it stands. But

As that last-linked blog post makes clear, I don’t find that evidence compelling, and most certainly not compelling enough to approve the drug as it stands. But with the way the FDA is behaving these days, God only knows what’s going to happen. People are investing on just that basis, although rarely stated in quite those words. But if you can look at the ruins of all the attempts to show efficacy with anti-amyloid antibody therapies and decide that the Biogen/Eisai data represent a real ray of hope, you have a sunnier disposition than I do. I share the cynicism! Early drugs targeted amyloid plaques because it seemed like a good idea. But after so many failures, I can't think of any reason so much time and money is spent on a failed hypothesis other than hoping for a false positive. Because a false positive, even with very modest results, would result in a ridiculously profitable drug given the complete lack of Alzheimer's treatments we currently have.

melling 7y ago
Because there’s very little money is invested in Alzheimer’s research. People were very conservative in their choices. We were spending a lot more on AIDS research 20 years ago than on Alzheimer’s today: https://www.ncbi.nlm.nih.gov/books/NBK222902/ https://www.ncbi.nlm.nih.gov/books/NBK222902/ This produced great results for AIDS, which many people thought would never be treatable. Anyway, medical research is expensive. Considering the number of people who will get Alzheimer’s and the cost to deal with the disease, you would have thought we’d have been spending more on research for the past several decades. Maybe soon we will all agree that it’s probably worth investing more on research?
- SAI_Peregrinus 7y ago
  FYI, AIDS is an acronym (though the periods are dropped) for Auto-Immune Deficiency Syndrome. So all four letters are capitalized.
  - Udik 7y ago
    Acquired, not Auto.
  - v0x 7y ago
    In British English, however, only the first letter is capitalized if it is reads a word, so it would be Aids.
    - catblast 7y ago
      This is true, but these rules don’t usually get applied in the (medical) sciences. cf anything published by the NHS.
- jcranmer 7y ago
  According to your link, we spent $1.9 billion in 1999 on AIDS research. You don't have a link for Alzheimer's today, but this link claims we're spending $2.5 billion in 2019 on Alzheimer's: https://www.alz.org/get-involved-now/advocate/research-funding https://www.alz.org/get-involved-now/advocate/research-fundi...
  - pmiller2 7y ago
    $1.9 billion in 1999 dollars adjusted for inflation is $2.93 billion in today's dollars.
    - deleted 7y ago
      [deleted]
  - melling 7y ago
    “ We have propelled the federal government to rise to this challenge, resulting in a more than six-fold increase in federal Alzheimer’s and dementia research funding since 2011 ” Your article says we’ve had a 6x increase. So, we’re approaching 1999 levels not accounting for inflation? I believe we’re at around $35 billion for AIDS research. https://www.kff.org/hivaids/fact-sheet/u-s-federal-funding-for-hivaids-trends-over-time/ https://www.kff.org/hivaids/fact-sheet/u-s-federal-funding-f... So AIDS is still 10x greater?
    - jcranmer 7y ago
      Your site says $2.6 billion for AIDS research. Most of the $35 billion is for treatment, both local and in support for global treatment programs. By comparison, we spend closer to $200 billion/year on Alzheimer's treatment. Managing patients who are in severe cognitive decline is not cheap.
- at-fates-hands 7y ago
  > We were spending a lot more on AIDS research 20 years ago than on Alzheimer’s today: I still remember in the early aughts when my professor was part of a research group in 1995 that found a genetic link in Germans from Russia with Alzheimer’s. At the time it was heralded as a huge break through. 25 years later and The needle has barely moved on their research and accomplishments. In reports published today in the journal Science, researchers say they have isolated a defective Alzheimer’s gene culled from an 8-year-long investigation of several Volga German families, including two from Eastern Washington. Discovery of the gene, and a protein it produces, could speed development of drugs to combat the brain-destroying disorder. https://www.spokesman.com/stories/1995/aug/18/pioneer-families-key-in-alzheimers-find-research/ https://www.spokesman.com/stories/1995/aug/18/pioneer-famili... Seeing your loved ones suffer through Alzheimer’s is one of the most agonizing and depressing things I've had to experience.
  - vikramkr 7y ago
    Sorry to hear about your experiences with Alzheimers. That gene, presenilin 2, is part of the amyloid processing complex and plays a role in the amyloid hypothesis (which is highlighted by the news article and the paper itself, https://science.sciencemag.org/content/269/5226/970, https://science.sciencemag.org/content/269/5226/970,) meaning that the very study that this hacker news thread is about, as well as hundreds of other studies and trials, are all investigating this hypothesis. Unfortunately, while the article you've linked says that this discovery helped "solve the mystery of early onset AD," it so turns out that the proposhed mechanism did not live up to scrutiny. Could this protein have different effects (such as a role in calcium ion leakage as later papers suggest)? Perhaps, and it might prove a crucial part of treating alzheimers in the long run, but it doesn't look like that research was in any way overlooked. Research is hard, it's only been a couple decades since new potential mechanisms of action of that gene were identified, and this is a complex disease, but the needle is moving.
- olliej 7y ago
  A huge amount is invested in Alzheimer’s, but comparing to aids and hiv isn’t a reasonable thing to do: HIV and AIDS kill people, and they do so quickly. There’s also a foothold on how to treat it - whereas for Alzheimer’s we don’t even have an understanding of what actually causes it. Once we know the actual cause I suspect we’ll see research funds skyrocket.
  - jgust 7y ago
    > Once we know the actual cause I suspect we’ll see research funds skyrocket I agree with your hypothesis, but saying it out loud seems backwards. In an ideal world, wouldn't we see research funds rise now in order to discover the cause (the hard part) rather than for the treatment (the less hard part).
    - olliej 7y ago
      no - there's a huge amount of research already happening, but the biggest cost in drug development occurs after you have a target. The reason funding appears low, is because the expensive parts of drug discovery are late in the process - things like the large scale trials, etc. I would not be surprised if (I have not looked it up) a significant contributor to the amount spent on research in HIV is on late stage trials, because realistically at this point the majority of new HIV drugs should actually work, and you need the large scale tests to see if the drugs work better.
      - chupa-chups 7y ago
        I'd like to see sources please, since I don't believe that claim. The years and years of research of many teams all over the world should exceed the amount of money required for large-scale trials by orders of magnitude. Please note that I don't speak of an individual research team but of all teams globally combined working on that goal.
        vikramkr 7y ago
        I'm sure that for any given drug you'll see a pattern of later research costing more, but as a field, unless we happen to get lucky early on with figuring out the basic science (which we clearly didn't with neurodegeneration), we'll need years (or decades to centuries - emperor of all maladies is an excellent read into the amount of work and time it took to understand cancer to the level we do now) to understand what to spend money on drugs on, and we'll have to pay for all the dead ends there too.
- vikramkr 7y ago
  Frankly, I don't think we necessarily need more money in Alzheimer's research. We just need to stop burning that cash on amyloid drugs and clinical trials for amyloid drugs. What the whole saga of oncology over the past few decades has revealed is that understanding the actual cause and pathology of a disease is crucial to unlocking new treatments and cures - it wasn't until we understood cancer as a cellular disease that we developed chemotherapy, and it wasn't until we understood it as a genetic disease and characterized the role of the immune system that we began making progress with targeted therapies and immunotherapies. We don't understand neurodegeneration yet, and we're probably lumping together hundreds of different disease pathologies under the name "alzheimers," each needing a different treatment approach. If we took the money we've been burning on the same dead end and redirected it to basic research, that might be what best helps crack the code.
deleted 7y ago
[deleted]

melling 7y ago

Because there’s very little money is invested in Alzheimer’s research. People were very conservative in their choices. We were spending a lot more on AIDS research 20 years ago than on Alzheimer’s today: https://www.ncbi.nlm.nih.gov/books/NBK222902/ https://www.ncbi.nlm.nih.gov/books/NBK222902/ This produced great results for AIDS, which many people thought would never be treatable. Anyway, medical research is expensive. Considering the number of people who will get Alzheimer’s and the cost to deal with the disease, you would have thought we’d have been spending more on research for the past several decades. Maybe soon we will all agree that it’s probably worth investing more on research?

SAI_Peregrinus 7y ago
FYI, AIDS is an acronym (though the periods are dropped) for Auto-Immune Deficiency Syndrome. So all four letters are capitalized.
- Udik 7y ago
  Acquired, not Auto.
- v0x 7y ago
  In British English, however, only the first letter is capitalized if it is reads a word, so it would be Aids.
  - catblast 7y ago
    This is true, but these rules don’t usually get applied in the (medical) sciences. cf anything published by the NHS.
jcranmer 7y ago
According to your link, we spent $1.9 billion in 1999 on AIDS research. You don't have a link for Alzheimer's today, but this link claims we're spending $2.5 billion in 2019 on Alzheimer's: https://www.alz.org/get-involved-now/advocate/research-funding https://www.alz.org/get-involved-now/advocate/research-fundi...
- pmiller2 7y ago
  $1.9 billion in 1999 dollars adjusted for inflation is $2.93 billion in today's dollars.
  - deleted 7y ago
    [deleted]
- melling 7y ago
  “ We have propelled the federal government to rise to this challenge, resulting in a more than six-fold increase in federal Alzheimer’s and dementia research funding since 2011 ” Your article says we’ve had a 6x increase. So, we’re approaching 1999 levels not accounting for inflation? I believe we’re at around $35 billion for AIDS research. https://www.kff.org/hivaids/fact-sheet/u-s-federal-funding-for-hivaids-trends-over-time/ https://www.kff.org/hivaids/fact-sheet/u-s-federal-funding-f... So AIDS is still 10x greater?
  - jcranmer 7y ago
    Your site says $2.6 billion for AIDS research. Most of the $35 billion is for treatment, both local and in support for global treatment programs. By comparison, we spend closer to $200 billion/year on Alzheimer's treatment. Managing patients who are in severe cognitive decline is not cheap.
at-fates-hands 7y ago
> We were spending a lot more on AIDS research 20 years ago than on Alzheimer’s today: I still remember in the early aughts when my professor was part of a research group in 1995 that found a genetic link in Germans from Russia with Alzheimer’s. At the time it was heralded as a huge break through. 25 years later and The needle has barely moved on their research and accomplishments. In reports published today in the journal Science, researchers say they have isolated a defective Alzheimer’s gene culled from an 8-year-long investigation of several Volga German families, including two from Eastern Washington. Discovery of the gene, and a protein it produces, could speed development of drugs to combat the brain-destroying disorder. https://www.spokesman.com/stories/1995/aug/18/pioneer-families-key-in-alzheimers-find-research/ https://www.spokesman.com/stories/1995/aug/18/pioneer-famili... Seeing your loved ones suffer through Alzheimer’s is one of the most agonizing and depressing things I've had to experience.
- vikramkr 7y ago
  Sorry to hear about your experiences with Alzheimers. That gene, presenilin 2, is part of the amyloid processing complex and plays a role in the amyloid hypothesis (which is highlighted by the news article and the paper itself, https://science.sciencemag.org/content/269/5226/970, https://science.sciencemag.org/content/269/5226/970,) meaning that the very study that this hacker news thread is about, as well as hundreds of other studies and trials, are all investigating this hypothesis. Unfortunately, while the article you've linked says that this discovery helped "solve the mystery of early onset AD," it so turns out that the proposhed mechanism did not live up to scrutiny. Could this protein have different effects (such as a role in calcium ion leakage as later papers suggest)? Perhaps, and it might prove a crucial part of treating alzheimers in the long run, but it doesn't look like that research was in any way overlooked. Research is hard, it's only been a couple decades since new potential mechanisms of action of that gene were identified, and this is a complex disease, but the needle is moving.
olliej 7y ago
A huge amount is invested in Alzheimer’s, but comparing to aids and hiv isn’t a reasonable thing to do: HIV and AIDS kill people, and they do so quickly. There’s also a foothold on how to treat it - whereas for Alzheimer’s we don’t even have an understanding of what actually causes it. Once we know the actual cause I suspect we’ll see research funds skyrocket.
- jgust 7y ago
  > Once we know the actual cause I suspect we’ll see research funds skyrocket I agree with your hypothesis, but saying it out loud seems backwards. In an ideal world, wouldn't we see research funds rise now in order to discover the cause (the hard part) rather than for the treatment (the less hard part).
  - olliej 7y ago
    no - there's a huge amount of research already happening, but the biggest cost in drug development occurs after you have a target. The reason funding appears low, is because the expensive parts of drug discovery are late in the process - things like the large scale trials, etc. I would not be surprised if (I have not looked it up) a significant contributor to the amount spent on research in HIV is on late stage trials, because realistically at this point the majority of new HIV drugs should actually work, and you need the large scale tests to see if the drugs work better.
    - chupa-chups 7y ago
      I'd like to see sources please, since I don't believe that claim. The years and years of research of many teams all over the world should exceed the amount of money required for large-scale trials by orders of magnitude. Please note that I don't speak of an individual research team but of all teams globally combined working on that goal.
      - vikramkr 7y ago
        I'm sure that for any given drug you'll see a pattern of later research costing more, but as a field, unless we happen to get lucky early on with figuring out the basic science (which we clearly didn't with neurodegeneration), we'll need years (or decades to centuries - emperor of all maladies is an excellent read into the amount of work and time it took to understand cancer to the level we do now) to understand what to spend money on drugs on, and we'll have to pay for all the dead ends there too.
vikramkr 7y ago
Frankly, I don't think we necessarily need more money in Alzheimer's research. We just need to stop burning that cash on amyloid drugs and clinical trials for amyloid drugs. What the whole saga of oncology over the past few decades has revealed is that understanding the actual cause and pathology of a disease is crucial to unlocking new treatments and cures - it wasn't until we understood cancer as a cellular disease that we developed chemotherapy, and it wasn't until we understood it as a genetic disease and characterized the role of the immune system that we began making progress with targeted therapies and immunotherapies. We don't understand neurodegeneration yet, and we're probably lumping together hundreds of different disease pathologies under the name "alzheimers," each needing a different treatment approach. If we took the money we've been burning on the same dead end and redirected it to basic research, that might be what best helps crack the code.

deleted 7y ago

[deleted]