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

freakonomics.com

291–300 of 355 posts

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

#291

Earlier quoted context omitted.

That's why I was emphasizing "one way" and "can begin". Clearly viral infection may be a distal factor but it is not the proximate cause of Alzheimer's... which is quite conclusively due to protein aggregates.

I don’t find any of it conclusive. Protein aggregates seem like the effect, with many causes.

Yes, exactly. Whether it APOE mutation, traumatic injury, metabolic dysfunction, Herpes infection, or some other inflammation that upregulates kinases, you end up with hyperphosphorylated tau which in turn forms the neurofibrillary tangles that destroy nutrient transport in neurons and eventually kills them.

"Neuron death by protein aggregates" is the best way to define Alzheimer's. Anything more specific refers to only one of those aforementioned causes; anything less is just "brain don't work no more."

These clickbait headlines are so frustrating, especially since the article itself explains the tau mechanism and all the progress that has been made in understanding the disease.

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

#292

Earlier quoted context omitted.

The comment you were replying to was talking about funding. If you could develop a scientifically plausible model to defend the "burning fossil fuels is not so bad, actually" thesis, your funders would include the oil companies and the greater petrochemical industry. There is a lot more money to fund projects there than... anywhere else in the world, really, by a wide margin.

well oil companies funded "lead fuels are safe" research... ...and it really did backfire (in public relations, politics, etc) now... I don't think they can actually fund 'research-for-their-profit' -- I mean, would you believe "petro is good for earth" research coming from oil companies, even after the 'lead is good or neutral' research?

Yes.

Not uncritically, but if the research presents a logically consistent hypothesis, and evidence supporting it, then it would be worth following up on with independent groups and if it remains consistent to scrutiny then it should be accepted.

That's how science works.

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

#293

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-sequitur

Not sure what you are trying to achieve with comments like this, besides intentional gas lighting.

Could've commented with links to scientific articles or papers that disprove my theory.

Instead you chose to be ... this?

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

#294
post #274

Earlier quoted context omitted.

> It's much like climate science today: any dissent at all, even just questioning the predictions of catastrophe, immediately brands you as a heretic. I'm not sure I understand this. We've added hundreds of gigatons of carbon to the atmosphere. There's no mystery here, it's basic physics and chemistry that this will change things, and it's accepted that we don't know exactly _how_ things will change. The alternative:…

Yes, there is overwhelming evidence of climate change. And that we are causing it. However research into what we humans can do to ameliorate it is verboten. For example https://www.scientificamerican.com/article/fertilizing-ocean... was an actual experiment that found a low cost way to both remove lots of CO2, and improve a fishery. But that line of research has been shut down. Likewise research into the current impa…

From your link:

> Not geoengineering

> The project is also unlikely to bury much if any carbon dioxide for one simple reason: metabolism. As other iron fertilization experiments have shown, it is relatively easy to get plankton to bloom, but it is harder for that bloom to sink to the bottom of the ocean, where it takes CO2 with it.

This project is a net carbon emitter by design.

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

#295
post #249
post #40

Earlier quoted context omitted.

The Amyloid hypothesis persisted for so long because we didn't have any obvious counterarguments since it is so hard to do studies on the brain. Which also means that it's not a bad hypothesis . What happened is we got the tools to start studying viral associations with other diseases and ... whooops ... suddenly there are associations. The shingles and RSV vaccines seem to affect dementia while others like influenza…

An obvious counter hypothesis is the amyloid is produced to counter an infectious agent. It is a reaction to that, not the cause. I think HSV-1 has been hypothesised. I'm not that up on it, just saying there are alternatives.

Which is only relevant if you actually find an infectious agent doing something in the right place, which so far we have not.

The vaccine prevention connection for example AFAIK is just pure statistics: you get the shingles vaccine, your population level Alzheimer's risk drops but we have no direct evidence of why this should be.

Its entirely possible we later find it has no effect and it's a population level quirk of people who were likely to get a shingles vaccine until that research - conversely the cost of just getting one is incredibly low (hence why I did, in relation to that exact data).

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

#296
post #274

Earlier quoted context omitted.

Yes, there is overwhelming evidence of climate change. And that we are causing it. However research into what we humans can do to ameliorate it is verboten. For example https://www.scientificamerican.com/article/fertilizing-ocean... was an actual experiment that found a low cost way to both remove lots of CO2, and improve a fishery. But that line of research has been shut down. Likewise research into the current impa…

From your link: > Not geoengineering > The project is also unlikely to bury much if any carbon dioxide for one simple reason: metabolism. As other iron fertilization experiments have shown, it is relatively easy to get plankton to bloom, but it is harder for that bloom to sink to the bottom of the ocean, where it takes CO2 with it. This project is a net carbon emitter by design.

Do you really think that adding iron releases net carbon? That would be hard to explain chemically.

The worst case scenario laid out in that article is that most of the carbon absorbed, was later rereleased. So net zero carbon, not net carbon emitter.

I've seen other reports of that exact experiment that estimated a significant net carbon sink. The actual experiment failed to make measurements that lets us know which actually happened.

Regardless, we've certainly demonstrated that, at least sometimes, there is significant net carbon capture, at low cost. Given the certainty of global damage at present, I believe that this justifies continued experimentation. Even if it means accepting possible risk to local ecosystems. The local ecosystem can generally recover. The planet, not so much.

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

#297
post #296

Earlier quoted context omitted.

From your link: > Not geoengineering > The project is also unlikely to bury much if any carbon dioxide for one simple reason: metabolism. As other iron fertilization experiments have shown, it is relatively easy to get plankton to bloom, but it is harder for that bloom to sink to the bottom of the ocean, where it takes CO2 with it. This project is a net carbon emitter by design.

Do you really think that adding iron releases net carbon? That would be hard to explain chemically. The worst case scenario laid out in that article is that most of the carbon absorbed, was later rereleased. So net zero carbon, not net carbon emitter. I've seen other reports of that exact experiment that estimated a significant net carbon sink. The actual experiment failed to make measurements that lets us know which…

You think the chemical compounds were just magiced into the ocean with no carbon intensity. It literally says carbon will not be absorbed and that geoengineering is not the goal.

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

#298

Earlier quoted context omitted.

I think you are wrong, for several reasons. From the human perspective, researchers are people, and they do have their incentives. Making a breakthrough, of any kind, is important for them - even if for their career (but many do genuinely care and want to help humanity as a whole). From marketing and sales perspective, look at what happen to pharma companies capitalization when Ozempic appeared: a relatively small El…

Which illnesses have been cured? Diabetes, cancer? > From the human perspective, researchers are people, and they do have their incentives. Making a breakthrough, of any kind, is important for them - even if for their career (but many do genuinely care and want to help humanity as a whole). Researchers are people, but they are paid and directed. They can't go off and do what they like. The corporation directs them, a…

Even without understanding pharmaceutical research, your claim to understanding business strategy is braindead: there is not 1 pharmaceutical company. And many pharmaceutical companies work on treatments for the same conditions and diseases.

Why would any competitor sit on a cure for a condition there opponents can only treat when in the short term you'd post amazing next quarter profits, and in the long term you'd financially diminish that competitor in the market place even if we grant the position that you are somehow able to find treatments that aren't cures (others have explained ably why this isn't how it works).

Everything looks like a conspiracy when you don't understand anything.

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

#299
post #273
post #266

Earlier quoted context omitted.

That systematic review is unfortunately severely flawed. They pooled the old anti-amyloid antibodies (which everybody agrees are inefficacious) and were never used outside clinical trials, with the new anti-amyloid antibodies, that does show modest efficacy in reducing the speed of progression. While these two classes of drugs target the same molecule, they are developed to target amyloid-beta in very different forms…

The point of systematic reviews is to be un-biased. So if their question is whether targeting Aβ amyloid is a valid approach they have to include the unsuccessful trails as well as those purported to be successful. As to the trials specifically for Lecanemab and Donanemab, the benefits are not claimed to be either strong or large, even by those who support it. The current support these receive is more aligned with th…

I don’t quite follow the reasoning behind this being “unbiased”. Studies must be designed to answer specific research question. What is the question being asked by the study in question. If the question being asked is whether AB the right target (in humans), then it would need to consider other forms of human evidence, such as genetic evidence, alongside alternative explanations of failure — bad molecule, wrong isoform, bad cohort selection, etc.

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

#300
Most of these comments are spot on. We seeded (and continued to fund) the most recently approved Alzheimer's drug on the market about 15 years ago and fought an uphill battle the entire way. The entire industry - other than what seems about a dozen neuroscientists - were fully bought into the plaque scam, and many still are. As I mentioned in a different thread some time ago, the best way to think about plaque is like gravestones in a cemetery. If you remove the gravestones, the dead bodies are still there.

We were introduced to the head of neuroscience at Houston Methodist as part of our due diligence process; his entire career was built upon the removal of plaque from the brain and would not even consider an alternative theory. We ran into this for years. It made funding the trials very difficult. We were totally ignored by all the Alzheimer's charities and orgs (ie Seth Rogan's for example). Only the Michael J. Fox foundation contributed early on.

However, our drug, now known as Zunveyl, was a pro-drug of already on the market Galanatmine, which was the second most commonly prescribed drug in the world for this disease (about $6BN/yr). Our pro-drug almost eliminated the side effects of Galanamine (nausea, vomiting) and enabled us to increase dosage high enough to actually get enough molecules into the brain. It was (is) awesome. Some of our first clinical trials were healthy young adults - they did extremely well. I don't think I can share the actual results but I hope that we (or someone) can fund a study to get approval for "regular people" usage one day given how well this test went. Later tests went just a well but only thanks to the "fast track" program were we able to even get to market.

Even today after being on the market for about a year now, the market uptake is slow due to insurance company approvals. We are getting reorders like crazy but often new patients get denied initially and then doctors have to appeal and then they get approved. This has been taking about 6 months on average and is brutal for people with the disease (and their families). Since getting a drug to patients is actually a (sadly and surprisingly) large sales and marketing expense, the company (Alpha Cognition) is focusing on long-term-care centers for now, but we had always hoped that this would be available much more broadly and much faster. Several of the early investor's parents were alive and afflicted with this disease when we started, but have since passed away. I hope that we can get this out and help others - faster.

The mother company that spun this out is also working on other molecules to try to stop Alzheimer's itself, rather than "only" help with symptoms but as always funding is a challenge. Clinical trials must be done correctly and are thus expensive.

Been living this battle for 15+ years and hoped that this can shed a little light on how things have been.

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