Live data from Hacker News

Why has there been so little progress on Alzheimer's disease?

freakonomics.com

201–210 of 355 posts

Re: Why has there been so little progress on Alzheimer's disease?

#201

Earlier quoted context omitted.

... which kind of points to the indicator that "Alzheimer != Alzheimer", implying that too many diseases with the same side effects are categorized together? A lot of virological and parasitical components have historically been wrongly associated with genetic markers, too. Toxoplasmosis parasite comes to mind. [1] https://en.wikipedia.org/wiki/Toxoplasmosis [2] https://en.wikipedia.org/wiki/Toxoplasma_gondii

Non-sequitur

Non-diagnostician

Re: Why has there been so little progress on Alzheimer's disease?

#202
post #75

The company I work at has been building a dementia prevention program covered by most insurance plans in the US. Our clinicians work directly on helping understand risk of neurodegenerative disease and help tailor personalized plans to improve outcomes. A recent lancet study concluded that around 45% of dementia cases are preventable [0] Happy to answer any questions people have. https://www.betterbrain.com Disclaime…

What is your approach towards nutrition ? Meaning which exact diet do you expect to help in mental health?

Different person, unrelated to the above advertisement but:

Sometimes any diet.

Mental health struggles can exacerbate, (and be exacerbated by!) forgetting to eat, not wanting to eat,

forgetting or passing up the things that keep you in homeostasis, choosing the less correct things because of an emotional response, a physiological response in a “diminished” state.

Re: Why has there been so little progress on Alzheimer's disease?

#204
post #191

"Do not attribute to malice what can be attributed to incompetence" and all of that, but... Alzheimer's (like a gazillion other diseases) is a product of senescence, and senescence is a subject that faces strong ideological headwinds. That leaves the medical system in a situation where they want to treat the symptoms (the diseases) instead of the root cause, and treating the set of symptoms that we call Alzheimer's i…

The single best predictor of Alzheimer’s disease is chronological age. Yet of NIA’s $4.5B FY2025 budget, about 60% goes to Alzheimer’s and related dementias; only 9% to the Division of Aging Biology, which funds the basic mechanisms of aging itself.

The insider joke is that the “A” in NIA stands for Alzheimer’s. The deeper and sadder joke: when you fit cognitive trajectories within the subset of people who go on to develop AD, about half of the variance in their test scores is accounted for by chronological age alone.

We’re spending seven times more on the disease than on the clock — and the disease is mostly the aging clock.

Go figure.

Re: Why has there been so little progress on Alzheimer's disease?

#205
post #67

Earlier quoted context omitted.

> The FDA's approval process is stymied by a CYA culture that fails to adopt the risk profile it needs to in order to potentially save large contingents of sick and dying. Except the history of FDA approval here is that it has been too accepting of drug candidates for Alzheimers with very weak evidence of efficacy and serious side effects. This particular field would probably be better off if the FDA took a harder po…

I would like to see the FDA get rid of their binary "Approved" approach. Instead, at the start of a treatment on a patient, an analysis must be done of all available data, and the treatment only allowed if the error bars put it within the realm of the best treatment available. That means at the start when not much data is available, it is easy to give it to a patient. But over time as more data comes in it gets harde…

This does happen. SAEs are reported in real time, and they do halt trials sometimes. Also, there is often a condition of approval that requires ongoing data collection for adverse events post-approval.

Re: Why has there been so little progress on Alzheimer's disease?

#206

https://www.statnews.com/2019/06/25/alzheimers-cabal-thwarte... "Despite being described as a “cabal,” the amyloid camp was neither organized nor nefarious. Those who championed the amyloid hypothesis truly believed it, and thought that focusing money and attention on it rather than competing ideas was the surest way to an effective drug. It has not worked out that way. Research focused on amyloid, and the developmen…

This is similar to what we see in software architecture. There's a team that picks a framework or pattern early, then builds everything on top of it, and by the time evidence shows up that the foundation was wrong. Now, switching costs are so high that it's cheaper to keep building on the broken foundation than to start over. The amyloid hypothesis reminds me of technical debt. The "cabal" wasn't conspiring, but they were just rationally protecting their sunk costs, same as any engineering org that can't migrate off a bad database choice.

Re: Why has there been so little progress on Alzheimer's disease?

#207
post #191

"Do not attribute to malice what can be attributed to incompetence" and all of that, but... Alzheimer's (like a gazillion other diseases) is a product of senescence, and senescence is a subject that faces strong ideological headwinds. That leaves the medical system in a situation where they want to treat the symptoms (the diseases) instead of the root cause, and treating the set of symptoms that we call Alzheimer's i…

As a society we are so used to seeing our grandparents and parents die that thinking otherwise is near impossible. I wish we saw ageing as a disease it is, instead of a "natural therefore good" thing.

Yes, and less than $1 billion/year spent on the basic biology of aging by NIH/NIA. Funding for research on the root causes of aging is decimal dust compared to distal consequences such as cancers, cardiopulmonary diseases, renal failure, immune diseases, Alzheimer’s, etc.

NIH is great at tactical research but terrible at strategic research, and politicians do not help much ;-)

Re: Why has there been so little progress on Alzheimer's disease?

#208

Earlier quoted context omitted.

Pretty clearly not. It would seem that beta amyloids correlate with Alzheimer's, but do not cause it. The problem us "consensus science". You could get funding to research beta amyloids, but not to research any competing hypotheses. It's much like climate science today: any dissent at all, even just questioning the predictions of catastrophe, immediately brands you as a heretic.

"Consensus science" is science.

Yes, though when the consensus doesn't work for predictions then it is a matter of time until it stops being science.

Re: Why has there been so little progress on Alzheimer's disease?

#209

Earlier quoted context omitted.

> Autopsies of brains of Alzheimer's patients were rife with amyloid Do you want think carefully about how this can possibly suggest this is a causal link? > People with mutations that caused amyloid got Alzheimer's earlier than others. People with mutations in those genes got a particular type of inherited alzheimers early, this says nothing about the cause of general Alzheimers.

Correlation is not causation but it's a pretty good idea to start with how blindingly obvious differences in brains affected with the disease might be related with the disease. There's also evidence that it precedes the symptoms of the disease. And it's also not a good idea to suppose that you are dealing with unrelated effects without good reason. Mutations->more amyloid->earlier symptoms should be considered indica…

Im not gonna try to correct you because its probably going to be futile, but I implore you to paste this thread into chatgpt and ask where you could be wrong in your logic.

Correlation not causation is all the more important in a topic like this; nothing you said suggests amyloid causes alzheimers or just forms because of it.

Re: Why has there been so little progress on Alzheimer's disease?

#210
post #30

They had a biological model. They had multiple drugs that were showed activity against that model, and effectiveness in humans. Problem was, the model was wrong. Pharma’s burned billions chasing this as it’s possibly the biggest market imaginable. Whether it was fraudulent or just incorrect is a different question. We don’t know all of the details of human biology. We don’t even know what all we don’t know. Most gues…

A wrong model is not the same thing as fraud, and biology is full of plausible models that later turn out to be incomplete or misleading

While true, there are a bunch of very influential results in Alz science that turned out to be fraud.
Post reply on HN