This article is unfair, unbalanced and, because it has a platform in Science, dangerous. \1 Alzheimer's disease: The right drug, the right timehttp://science.sciencemag.org/content/362/6420/1250 …
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Clinging to old models of #Alzheimer's disease, it perpetuates the myth that progress is best made by pursuing #amyloid reduction methods. The facts simply do not bear out this meandering stream of magical thinking. \2
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The authors start with the
#A/T/N framework to build their case, making their argument even more of a house of cards, built layer upon insubstantial layer. A/T/N is a textbook case of circular logic, not a research platform. \3Show this thread -
And the bottom floor of this house of cards is the original
#AmyloidCascadeHypothesis, which we have tested, time and again, and proven to be at best incomplete and at worst flat-out wrong. \4Show this thread -
Right drug/right time is just kicking this dented can down the road. The authors admit reducing amyloid is useless once "downstream pathologies become self-sustaining" This is a new addition to the ACH and further weakens its value. \5
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It means any anti-amyloid therapy will be useful only for pre-symptomatic subjects with no amyloid deposits. Implication: start therapy at age 50 and then continue for 30-40 years. \6
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Plus, given these numbers, even if reducing amyloid were beneficial, why develop *passive* immunotherapy? We'll bankrupt the healthcare system. Sound medicine says 'no'; Wall Street and PhARMA say 'please'. \7
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For too long we've refused to listen to our own data. Without a lot of handwaving, amyloid in any state of aggregation is a weak candidate for a cause of AD. Yet we continue investing billions of clinical research dollars in it. \8
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These massive expenditures crowd out many other candidates with far better potential to lead to clinically meaningful insights. This includes work needed to help persons with AD *now* plus those who will get it despite no amyloid. \9
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