4 ms·

They have failed to prove efficacy in a trial. Why believe it has a 3% chance of working? Do you think arbitrary chemicals have a 3% chance of curing some disea

by jolux 5y ago

They have failed to prove efficacy in a trial. Why believe it has a 3% chance of working? Do you think arbitrary chemicals have a 3% chance of curing some disease, even when it has yet to be shown? There’s absolutely no reason to believe this.

tootie 5y ago
It's not a random drug. It's proven to reduce plaques. The phase 3 trials were inconclusive in proving that it improved patient outcomes which is certainly a bad sign but it's absolutely possible that future trials would show different results. I'm not saying the FDA is definitely right. I'm admittedly out of my depth on this topic. All I'm saying is this blog glossed over the severity of the problem they are trying to solve. Dementia is absolutely terrifying. My parents have already told me to euthanize them if it ever happens to them. I'd absolutely let them try this unproven therapy before doing that.
- jcranmer 5y ago
  Derek Lowe's blog has an entire category for Alzheimer's that talks about the sordid history of drug candidates: https://blogs.sciencemag.org/pipeline/archives/category/alzheimers-disease https://blogs.sciencemag.org/pipeline/archives/category/alzh... Of particular note is that he, like most practitioners, is of the opinion that the record of unmitigated failure of amyloid blockers is that it means that the theory that reducing amyloid plaques improves outcomes should now be considered discredited. See, e.g., https://blogs.sciencemag.org/pipeline/archives/2019/01/30/another-alzheimers-antibody-fails-there-will-be-more https://blogs.sciencemag.org/pipeline/archives/2019/01/30/an... and https://blogs.sciencemag.org/pipeline/archives/2018/06/12/an-alzheimers-statement https://blogs.sciencemag.org/pipeline/archives/2018/06/12/an...
- deleted 5y ago
  [deleted]
- vkou 5y ago
  The goal of medicine is not reducing plaques, the goal is treating Alzheimer's. If the drug reduces plaques, but doesn't cure Alzheimer's, it's not a 'bad sign'. It simply means the drug doesn't work. P-value hacking over and over again[1] until we finally get a study that shows us that the drug works is not the solution. [2] [1] https://xkcd.com/882/ https://xkcd.com/882/ [2] Unless the problem we are solving is "We have too much money that we need to spend on snake oil."
  - tootie 5y ago
    I get it, I'm just saying it's not like they're selling essential oils or healing crystals. Reducing plaques could at least plausibly have some benefit. And I'm not arguing necessarily that the FDA are therefore justified, I'm just saying it's not fair to compare this to diet supplements. I was pointed to some other posts by this same guy about how bearish he is on amyloid plaque reduction as a plausible therapy which would have been useful context.
    - jolux 5y ago
      > I get it, I'm just saying it's not like they're selling essential oils or healing crystals. You might have more of an argument here if this drug was only going to cost as much as essential oils or healing crystals, ironically. Would you suggest somebody go into debt for treatment with this product? It's likely to be quite expensive.
- jolux 5y ago
  This is an epistemologically leaky argument. The goal of an Alzheimer’s drug is not to reduce amyloid plaques, it’s to treat Alzheimer’s. There is, as of now, no evidence that it does so. Giving people false hope of treating a horrible disease does actually seem more unethical than not giving them the treatment at all.
- wins32767 5y ago
  Do you think you should be taxed so that everyone's parents can try this unproven therapy for ~56k a person a year?

by jolux 5y ago

tootie 5y ago

It's not a random drug. It's proven to reduce plaques. The phase 3 trials were inconclusive in proving that it improved patient outcomes which is certainly a bad sign but it's absolutely possible that future trials would show different results. I'm not saying the FDA is definitely right. I'm admittedly out of my depth on this topic. All I'm saying is this blog glossed over the severity of the problem they are trying to solve. Dementia is absolutely terrifying. My parents have already told me to euthanize them if it ever happens to them. I'd absolutely let them try this unproven therapy before doing that.

jcranmer 5y ago
Derek Lowe's blog has an entire category for Alzheimer's that talks about the sordid history of drug candidates: https://blogs.sciencemag.org/pipeline/archives/category/alzheimers-disease https://blogs.sciencemag.org/pipeline/archives/category/alzh... Of particular note is that he, like most practitioners, is of the opinion that the record of unmitigated failure of amyloid blockers is that it means that the theory that reducing amyloid plaques improves outcomes should now be considered discredited. See, e.g., https://blogs.sciencemag.org/pipeline/archives/2019/01/30/another-alzheimers-antibody-fails-there-will-be-more https://blogs.sciencemag.org/pipeline/archives/2019/01/30/an... and https://blogs.sciencemag.org/pipeline/archives/2018/06/12/an-alzheimers-statement https://blogs.sciencemag.org/pipeline/archives/2018/06/12/an...
deleted 5y ago
[deleted]
vkou 5y ago
The goal of medicine is not reducing plaques, the goal is treating Alzheimer's. If the drug reduces plaques, but doesn't cure Alzheimer's, it's not a 'bad sign'. It simply means the drug doesn't work. P-value hacking over and over again[1] until we finally get a study that shows us that the drug works is not the solution. [2] [1] https://xkcd.com/882/ https://xkcd.com/882/ [2] Unless the problem we are solving is "We have too much money that we need to spend on snake oil."
- tootie 5y ago
  I get it, I'm just saying it's not like they're selling essential oils or healing crystals. Reducing plaques could at least plausibly have some benefit. And I'm not arguing necessarily that the FDA are therefore justified, I'm just saying it's not fair to compare this to diet supplements. I was pointed to some other posts by this same guy about how bearish he is on amyloid plaque reduction as a plausible therapy which would have been useful context.
  - jolux 5y ago
    > I get it, I'm just saying it's not like they're selling essential oils or healing crystals. You might have more of an argument here if this drug was only going to cost as much as essential oils or healing crystals, ironically. Would you suggest somebody go into debt for treatment with this product? It's likely to be quite expensive.
jolux 5y ago
This is an epistemologically leaky argument. The goal of an Alzheimer’s drug is not to reduce amyloid plaques, it’s to treat Alzheimer’s. There is, as of now, no evidence that it does so. Giving people false hope of treating a horrible disease does actually seem more unethical than not giving them the treatment at all.
wins32767 5y ago
Do you think you should be taxed so that everyone's parents can try this unproven therapy for ~56k a person a year?