Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

freakonomics.com

Post reply on HN
Print view View original

51–60 of 355 posts

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

#51

Post by rcxdude »

CodeWriter23 wrote: post #45
Aurornis wrote: post #34

Earlier quoted context omitted.

Alzheimer’s is a good example of a disease where we don’t have great scientific understanding on the underlying causes, but that doesn’t stop individuals from believing they understand it better than the scientists.

Actual Scientists are calling it Type-3. But these are the same scientists that are actually reversing Type 2 diabetes without expensive drugs. Of course they exist outside the pharma narrative, and they don't have any uncurious attack dogs willing to defend their narrative-busting results.

>and they don't have any uncurious attack dogs willing to defend their narrative-busting results.

Well, they seem to have some champions here...

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

#52

Post by hackitup7 »

tsherb wrote: post #32
beaned wrote: post #25

I'm surprised that better science never resulted from that lady who could smell it.

Joy Milne, for the uninitiated: https://www.npr.org/sections/health-shots/2020/03/23/8202745...

This is one of the craziest articles I've ever read. I feel like this should be a major ongoing news story...

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

#53

Post by notepad0x90 »

I'll say that I know nothing about this, but just commenting on the economics of it all: Cancer and HIV have been at the forefront of disease research, in terms of public interest and financial investment, and cancer is more like an umbrella of similar diseases than a single disorder. HIV is manageable these days, and cancer research is slowly seeing leaps in progress.

Alzheimer is very important, and affects a very large number of people, it is getting lots of research funding and attention, but perhaps not enough? If it takes a certain combination of time, human-hours, money, and lots of smart people being interested in doing research in that field. Is the economics of disease research that simple? it is unknown what numeration of those variables is required to tackle Alzheimers, but if it is a lot more than cancer for example, then it might be decades or more away from being well understood.

I hate to say it, but cancer and HIV feel more like things we can get, Alzheimers feels like something only old people get, and it's to easy to forget that we'll get old, and it's hard to think our older loved ones might be affected. If no one in your sphere has been affected, it's harder to prioritize the disease.

My opinion is, money is the biggest obstacle, and I don't mean money for research, but money for education for researchers, and the talent pipeline. If higher education (at least for medicine) was literally free, that'd be a start. then you need lots of people getting paid to do the research independently. Right now, it feels like most disease research is being done by big pharma, so they can find the next insulin they can use to maximize profits. The incentives are all wrong on all sides, for potential researchers, the public and R&D companies.

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

#54

Post by casey2 »

panabee wrote: post #13

TLDR: gatekeepers stifled exploration and innovation. When a topic only has a limited number of experts, those experts become gatekeepers. Those gatekeepers directly or indirectly control research funding. Gatekeepers necessarily harbor biases, some right and some wrong, about how the field should progress. For Alzheimer's, some gatekeepers were conflicted and potentially directed the field in the wrong direction. On…

In most engineering fields we don't give the monopoly to people until they have actually demonstrated success beyond a reasonable doubt. There will always be groups of people claiming that the math/methods they happen to know are the best at explaining some behavior (even now there is that learning mechanics paper on top page)

The takeaway is to stop pretending that we can do good science when the ambiguity is so high, the majority of funding should go to people working on more concrete problems. We never locked in on vacuum tubes because the downsides were so obvious and the upsides of silicon transistors (if they could be made to work) were also obvious even to people outside the field, where your talent comes from. At the very least funders can't allow shifting goalposts, make them up front answer questions about the drugs. That will give you something to estimate the value of the drug and then when they come back with study after study outside the ranges they gave, you lower their funding. E.g. This is supposed to work on someone who was stage 2 and stop progression and then 5 years later it only "works" for stage 1 patients.

Strange breakthrough ideas can't even exist in the current system structurally, so going this route is the only logical choice. Which begs the question, why aren't clinical trials a private venture already? Governments are burning billions of taxpayer dollars for either nothing or cynically to keep the boomers alive and voting even longer, while 1/5 children are obese. For the rest of us we've socialized the risk and privatized the profits.

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

#55

Post by anon84873628 »

tsherb wrote: post #32
beaned wrote: post #25

I'm surprised that better science never resulted from that lady who could smell it.

Joy Milne, for the uninitiated: https://www.npr.org/sections/health-shots/2020/03/23/8202745...

Which is about Parkinson's, not Alzheimer's, and did lead to some new science.

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

#56

Post by josh-wrale »

tempest_ wrote: post #50
iwalton3 wrote: post #48

I have a kind of outlandish hypothesis that needs more research before it can be taken seriously, but it basically says that the cause and effect are backwards. Mental atrophy due to less learning/thinking, isolation, loss of meaning and purpose happens first. The sleep down regulation and decay of mental circuitry comes after. Would explain why treating the physical symptoms doesn't work. Protective against the prob…

> Mental atrophy due to less learning/thinking, isolation, loss of meaning and purpose happens first. Except early onset Alzheimers happens and it also happens to plenty of people for which none of those are true.

Example: Claude Shannon

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

#57

Post by anon84873628 »

hackitup7 wrote: post #52
tsherb wrote: post #32

Earlier quoted context omitted.

Joy Milne, for the uninitiated: https://www.npr.org/sections/health-shots/2020/03/23/8202745...

This is one of the craziest articles I've ever read. I feel like this should be a major ongoing news story...

Because of Joy, scientists developed a simple, non-invasive, three-minute skin swab test that analyzes sebum to diagnose Parkinson's. In laboratory settings, this test has shown an accuracy rate of over 90%.

Unfortunately that insight hasn't led closer to a cure.

It also turns out sort of bad to tell people they have a horrible neurodegenerative disease 10 years before the major symptoms start.

Why isn't everyone's mind blown? Well for the cynical explanation, look at the state of science education and what people said about Artemis, vaccines, etc. or optimistically, there are too many mind blowing discoveries to treat them all fairly.

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

#58

Post by josh-wrale »

cookiengineer wrote: post #44

...because Alzheimer is a dormant side effect of a virus, not of a messenger chemical. But that doesn't go well in studies and "self populism" of what funded research wanted to hear. If you study effects and not causes due to lack of measurements for reproducibility in any field of research, that's what comes out. Also check out how the new and promising correlation started by observing the Wales eligibility for mand…

Not always. Genetic causes are known.

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

#59

Post by solumunus »

notepad0x90 wrote: post #53

I'll say that I know nothing about this, but just commenting on the economics of it all: Cancer and HIV have been at the forefront of disease research, in terms of public interest and financial investment, and cancer is more like an umbrella of similar diseases than a single disorder. HIV is manageable these days, and cancer research is slowly seeing leaps in progress. Alzheimer is very important, and affects a very…

The potential profits from an Alzheimer’s treatment are extremely high, I doubt it’s being overlooked.

> and it's hard to think our older loved ones might be affected

A large proportion of people don’t need to think about it because they have witnessed the horrific effects on loved ones first hand.

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

#60

Post by hattmall »

hx8 wrote: post #18
robwwilliams wrote: post #8

Earlier quoted context omitted.

The focus is definitely on scientific fraud, but what makes the fraud so easy in this case is singing and selling the same song that the big teams are singing and selling. You can fly under the radar AND get funded, and if you are “lucky” become an ultra big shot like Masliah at NIA.

I don't buy the fraud explanation as the full explanation. Other areas of medicine (stem cell) has had bigger incidents of fraud on top of other major headwinds, and still has made more progress. Fraud is everywhere and we still move forward in most arenas.

In ALZ and the plaque cartel the fraud was foundational and the overwhelming source of funding for research was tied to supporting that hypothesis. The big issue, even if you have a competing theory, is that the diagnostic criteria relies heavily on the plaque and presence of indicators. So you get a group of people who have elevated plaque and MCI, but many people have elevated plaque without MCI, and just as many people have MCI without elevated plaque.

So if your cure is targeting something different but the group of people you have are selected from this cohort of maybe afflicted people then it's really hard to get a significant result. Plus you tend to be dealing with old people, that have other health issues that MCI isn't causing to get any better.

Post reply on HN