[HN Gopher] FDA head asks for investigation into Aduhelm drug ap...
       ___________________________________________________________________
        
       FDA head asks for investigation into Aduhelm drug approval
        
       Author : tima101
       Score  : 128 points
       Date   : 2021-07-10 15:54 UTC (7 hours ago)
        
 (HTM) web link (www.businessinsider.com)
 (TXT) w3m dump (www.businessinsider.com)
        
       | loa_in_ wrote:
       | Unfortunately the link is unavailable in Poland:
       | https://imgur.com/a/48MFia6
        
       | vmception wrote:
       | Is the aduhelm company publicly traded? Seems like a lot of fun
       | volatility upcoming on binary outcomes
       | 
       | If I was a gambling man, which I am, I would add this to my paid
       | newsletter and call it investing (with contradictory and
       | nullifying disclaimers of course)
        
       | [deleted]
        
       | quickthrowman wrote:
       | > Recent advances in amyloid imaging have made it possible to
       | observe Ab amyloid accumulation in the patient's brain. As a
       | result, it has been found that there are many normal patients
       | with amyloid deposits, and also AD patients with very few amyloid
       | deposits (Edison et al., 2007; Li et al., 2008). [0]
       | 
       | How long is it going to take for the scientists who have built
       | their career on the amyloid hypothesis to die out so new ideas
       | can be investigated?
       | 
       | [0]
       | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797629/#s3titl...
        
         | anonuser123456 wrote:
         | One has to only look at the dumpster fire that is the USDA
         | nutritional guidelines to know "never".
        
           | AnimalMuppet wrote:
           | "Die out". Everybody dies eventually. It's just a long
           | process waiting for science to progress by funerals.
        
             | quickthrowman wrote:
             | Indeed, plate tectonics (sort of, Wegener had the idea but
             | no evidence/proof) and hand washing for doctors/surgeons
             | both faced widespread opposition, just off the top of my
             | head.
        
               | ficklepickle wrote:
               | mRNA is another example
        
             | heavyset_go wrote:
             | Not to worry, there are plenty of opportunists who will
             | line up to carry the torch once the older ones die.
        
       | peytn wrote:
       | Great. Speaking from first- and second-hand experience, the FDA
       | is way more loosey-goosey than people think as long as you're
       | paying the right people.
        
         | eddynol wrote:
         | Cuz it's a hard job. Try telling someone in a position of
         | serious power who is going to loose his kid next year to back
         | off. Who wants that job? Put your hand up.
        
           | mperham wrote:
           | What's the alternative? Allow snakeoil? Now insurance has to
           | cover it, incentivizing the creation of more ineffective
           | drugs? Trust in efficacy is critical.
        
           | WarOnPrivacy wrote:
           | Pharma lobbyists gained enough control over FDA oversight to
           | get a failed Alzheimer's drug approved.
           | 
           | I'll put my hand up to perform ethically at my job and not
           | allow regulatory capture.
        
             | throwawaygh wrote:
             | _> Pharma lobbyists gained enough control over FDA
             | oversight to get a failed Alzheimer 's drug approved._
             | 
             | We'll see. What's playing out now is exactly how robust
             | institutions work. Individual components can be corrupted,
             | but the institution has a whole holds because of checks and
             | balances.
             | 
             | Here, one individual component of the FDA was compromised,
             | but other checks-and-balances are coming to bear (namely,
             | inclusion of Scientific Advisors in the review process,
             | public records, and political accountability at the top).
             | 
             | When an unconstitutional law is passed, it's law. Until a
             | court strikes it down. If an unconstitutional law is passed
             | and then struck down by a court, that's not the system
             | failing. That's individuals within the institution failing
             | but the institution as a whole working exactly as intended.
             | 
             |  _> I 'll put my hand up to perform ethically at my job and
             | not allow regulatory capture._
             | 
             | But that's not what he asked you to volunteer for. He
             | didn't ask you to perform ethically at a job. He asked you
             | to actually go get a PhD, do a post-doc or two, and then
             | turn down well-paying industry jobs to work at the FDA and
             | get demonized all day. Which, speaking as someone who has
             | turned down similar types of government jobs because I
             | could make 5x in the private sector, is quite a bit more of
             | a sacrifice than I think you realize. (This isn't meant to
             | excuse unethical behavior, btw, it's just that your comment
             | is literally not responsive to GP's and GP is exactly right
             | -- those jobs suck and if we want fewer failures like this
             | one maybe we, the people, as the employer, should be at
             | least paying market rate.)
        
               | WarOnPrivacy wrote:
               | > But that's not what he asked you to volunteer for. He
               | didn't ask you to perform ethically at a job. He asked
               | you to actually go get a PhD, do a post-doc or two, and
               | then turn down well-paying industry jobs to work at the
               | FDA and get demonized all day.
               | 
               | That doesn't seem to be what he asked. He asked us to
               | _Try telling someone in a position of serious power who
               | is going to loose his kid next year to back off._
               | 
               | It isn't clear what losing a kid has to do with qualified
               | officials approving a failed Alzheimer drug, ostensibly
               | in blatant and clear violation of their own protocols.
               | Presented with that non-sequitur, I chose to restate the
               | event in play.
        
         | pfisherman wrote:
         | What experience have you had? How many INDs, 510ks, etc have
         | you worked on? Because this does not line up with my experience
         | at all. IME FDA is very anal about even the appearance of the
         | conflict of interest, and loosey-goosey is the last descriptor
         | you would ever want to use for any interaction with FDA.
         | 
         | That being said, informal interactions where FDA talks you
         | through regulatory options do happen for high priority / unmet
         | need diseases, but there the "friendlies" are compartmentalized
         | away from the those who review the applications.
         | 
         | My guess is that the review will show that someone from FDA met
         | with the company to facilitate the application because
         | Alzheimer's is a priority disease, but strict
         | compartmentalization from the review process was maintained. If
         | not, then someone is getting fired.
        
         | rgrieselhuber wrote:
         | What does that mean for the Covid vaccines?
        
           | seriousquestion wrote:
           | Maybe nothing, maybe a lot. Big pharma has huge influence in
           | the government. The vaccines are authorized under emergency
           | use, which is predicated on not having alternatives. That
           | there is a campaign to discredit cheap off patent
           | alternatives (Ivermectin) is at least concerning.
        
             | pjc50 wrote:
             | Ivermectin is not and cannot be a vaccine. Even the people
             | promoting it only claim an improvement in symptoms. And
             | I've not seen an explanation of how it's alleged to work?
        
             | khuey wrote:
             | There's a "campaign to discredit cheap off patent
             | alternatives" because they don't actually work and people
             | are going out and poisoning themselves with pills made for
             | horses.
        
               | seriousquestion wrote:
               | Taking a horse quantity of any drug is unwise, even one
               | that won the 2015 Nobel Prize (Ivermectin). It still
               | needs large scale RCTs for Covid-19 use, but there are
               | some small trials that at least indicate it should be
               | taken seriously and not outright discredited and smeared.
               | 
               | "Meta-analysis of randomized trials of ivermectin to
               | treat SARS-CoV-2 infection" - "there was a 56% reduction
               | in mortality; p=0.004 .. with favorable clinical recovery
               | and reduced hospitalization."
               | 
               | https://academic.oup.com/ofid/advance-
               | article/doi/10.1093/of...
               | 
               | "Ivermectin was associated with decreased mortality in
               | patients with COVID-19... The certainty of evidence for
               | mortality reduction was low."
               | 
               | https://www.sciencedirect.com/science/article/pii/S187140
               | 212...
        
               | Mountain_Skies wrote:
               | Of course. Veterinary pharmaceuticals have very different
               | manufacturing standards, approvals, and dosages. It's
               | unfortunate that so many have been pushed into this path
               | by authoritarians who have in under a year turned the
               | medical establishment's credibility into a pile of dust.
        
               | WarOnPrivacy wrote:
               | I see a choice of going down the Invermectin rabbit-hole
               | where the framing and presentation feels a lot like an
               | MLM campaign (except saturated w/ conspiracy) - or
               | walking into a local store and getting sound ~95%
               | efficacy w/ a pair of free Moderna shots.
               | 
               | The latter really seems more compelling to me.
        
               | seriousquestion wrote:
               | These shots are not FDA approved yet. Usually that's
               | compelling enough to look for and consider alternatives.
               | Especially existing cheap off patent drugs that have been
               | used billions of times over the course of decades and
               | recently won the Nobel Prize. If that plus many doctors
               | and small trials indicate promise with Covid-19, we
               | should take that seriously. That's all.
               | 
               | "The Moderna COVID-19 Vaccine is a vaccine and may
               | prevent you from getting COVID-19. There is no U.S. Food
               | and Drug Administration (FDA) approved vaccine to prevent
               | COVID-19."
               | 
               | https://www.fda.gov/media/144638/download
               | 
               | None of this is to say that the vaccines aren't safe or
               | shouldn't be used. They should be, especially for those
               | at risk. The vaccines may well be better than Ivermectin
               | and so far it appears that way. But there is some nuance
               | here and it's valid if people want an alternative until
               | the shots are FDA approved and have long term data. Many
               | are not engaging in critical thinking when it comes to
               | this issue and suddenly have complete trust of big
               | pharma. Which I find bizarre.
        
               | exmadscientist wrote:
               | > Many are not engaging in critical thinking when it
               | comes to this issue and suddenly have complete trust of
               | big pharma.
               | 
               | I wasn't first in line to get any of these vaccines.
               | Distrust of anything new is pretty rational!
               | 
               | But hundreds of millions of doses delivered, with a
               | complication rate significantly less than the disease
               | itself... that's pretty powerful evidence, no?
               | 
               | Especially compared against drugs that have yet to
               | convincingly beat placebos in any large trial?
               | 
               | Personally, I find it bizarre that anyone can weight
               | those two sets of evidence so differently.
        
               | seriousquestion wrote:
               | Yes, but you also have to weigh the fact that we don't
               | know what the long term effects may be. Some people would
               | rather trust their immune system, with or without drugs
               | that have been in use for decades. That's not my personal
               | calculation, but I can see why others would net out that
               | way. Particularly women who are concerned about the
               | possible effects on fertility.
        
               | khuey wrote:
               | When the FDA finally grants full approval to the vaccines
               | the goalposts will just move again to something else.
        
               | pjc50 wrote:
               | The 2015 prize was for its use against worms:
               | https://www.isglobal.org/en/healthisglobal/-/custom-blog-
               | por...
               | 
               | It's not clear how that relates to respiratory medicine.
        
               | jollybean wrote:
               | Folks you need to realize the difference between
               | 'material discussion' within the scientific community
               | etc. and 'drug populism' i.e. people making stuff up on
               | Twitter and that information flowing to millions.
               | 
               | Nobody is 'smearing' the drug or even the people talking
               | abot it.
               | 
               | They're saying 'stop telling the public about it because
               | it's not approved yet and potentially dangerous'.
               | 
               | Whatever Donald Trump says - people believe. And they
               | will go out in droves, self diagnose, self medicate,
               | demand doctors prescribe them the 'cure' (when the doctor
               | knows they shouldn't) etc..
               | 
               | And the amount of stupid conspiratorial memes that come
               | up are pretty shocking. I avoid FB fro this reason and
               | TikTok had a bunch of that for a bit, but I think they've
               | shut down Ivermectin talk.
               | 
               | I quite like Joe Rogan, but he's not a doctor, and
               | neither is his partner in goofydom Brett Weinstein, they
               | have zero medical credibility on the issue, they should
               | straight up not be talking about the drug.
               | 
               | If there is some kind of coverup, or there's hard
               | evidence and the FDA is refusing to look at it, or if
               | someone in Big Pharma bribed someone else ... then that's
               | a story, but this is not that.
               | 
               | Oxford has just launched a trial for Ivermectin, and
               | there are others. When the results come in, and if it
               | works and is safe, then CNN et. al. will talk about it
               | and parameterize it appropriately. We'll all hear about
               | it pretty quickly.
               | 
               | The CDC can't stop Joe Rogan from talking about it and
               | the haven't tried, but they can say 'STFU' until we have
               | done the _actual_ science, which is reasonable.
        
               | pumpkinandspice wrote:
               | > I quite like Joe Rogan, but he's not a doctor, and
               | neither is his partner in goofydom Brett Weinstein, they
               | have zero medical credibility on the issue, they should
               | straight up not be talking about the drug.
               | 
               | By this logic, this applies to every single person that
               | aren't doctors who shouldn't be talking about the vaccine
               | or the drugs. This includes data scientists and
               | politicians. I've watched Dr. Pierre Kory's full
               | interview with Brett and seems clips of his testimony in
               | front of the senate. He is extremely credible and should
               | have a voice in this as a COVID-19 critical care doctor
               | and who has done meta analysis of the drug
               | (https://covid19criticalcare.com/wp-
               | content/uploads/2020/11/F...). I think people like Joe
               | and Brett help amplify voices of people like Dr. Pierre
               | Kory similar to politicians who amplifies Dr. Fauci
        
               | jollybean wrote:
               | So I think you might be misunderstanding my point a bit.
               | 
               | Scientists and Doctors should be talking about it in
               | scientific forums and communities. Politicians should be
               | reiterating the 'current consensus'.
               | 
               | People shouldn't be talking about it in public / tabloid
               | forums because the information is vague, misrepresented
               | and will be taken entirely out of context.
               | 
               | I totally support people taking contrarian positions.
               | 
               | I think we should probably assign people towards being
               | 'The Devil's Advocate'.
               | 
               | The issue is not 'freedom of expression and open
               | dialogue' - it's one of 'crude populism and
               | misinformation'.
               | 
               | It's about how information is propagated, and how people
               | react to it.
        
               | raphlinus wrote:
               | It's not holding up so well in RCT's, like this one[1]
               | that was just discussed on TWiV 778[2].
               | 
               | BTW, I've joined the legions who are addicted to TWiV.
               | It's a time commitment for sure, but it's fascinating how
               | different the perspective is on important topics (like
               | delta variant) than the mainstream press.
               | 
               | [1]: https://bmcinfectdis.biomedcentral.com/articles/10.1
               | 186/s128...
               | 
               | [2]: https://www.microbe.tv/twiv/twiv-778/
        
               | Mountain_Skies wrote:
               | Did you have the same amount of confidence in your
               | opinion when the lab leak theory was forbidden to
               | discuss? If people are going to farm stores for medicine,
               | that's a reflection on the absolutely deplorable state of
               | credibility that the medical establishment has earned
               | themselves over the past year. Doing more of the same
               | isn't going to magically make trust in authority
               | reappear, it's going to erode it even more.
        
             | phonypc wrote:
             | Even if ivermectin were as effective as some people would
             | like to believe, and widely used for COVID, it wouldn't be
             | an alternative to the vaccines in the sense of preventing
             | their emergency use authorization.
        
               | Mountain_Skies wrote:
               | Perhaps but being honest instead of resorting to the
               | smear tactics of the past year would help start
               | rebuilding the ruins of the medical establishment's
               | credibility. What good is it to keep pushing out
               | disinformation "for the public's own good" when it
               | results in more and more people looking to alternative
               | (and often very dubious) sources of medical advice?
               | 
               | What we need is a policy of absolute honesty with a one-
               | strike-and-your-out-forever punishment for any health
               | authority that engages in propaganda, even if they had
               | good intentions. Credibility matters. It matters a lot.
               | All of these coy little word games and character
               | assassinations being conducted in the name of the common
               | good is achieving the exact opposite result. As it stands
               | now, the credibility of the medical community might be
               | forever tarnished especially since there appears to be no
               | attempt to get it back but rather endless doubling downs
               | on the slime tactics that should be to exclusive province
               | of political campaign directors and used car salesmen.
        
               | wizzwizz4 wrote:
               | > _What we need is a policy of absolute honesty with a
               | one-strike-and-your-out-forever punishment for any health
               | authority that engages in propaganda, even if they had
               | good intentions._
               | 
               | Won't work, unless there are multiple health authorities
               | - but the average person isn't going to keep track of the
               | reputation of multiple small health authorities, so the
               | authorities will have comparatively less reputation at
               | stake.
               | 
               | You are onto something, though. Consider fleshing it out
               | a bit before reading what other people are talking about.
               | (ROT13: cerqvpgvba-onfrq zrqvpvar)
        
               | jollybean wrote:
               | The problem is people irrationally believe that a
               | 'vaccine is unsafe' but at the same time 'some other drug
               | is safe' and might therefore take the drug.
               | 
               | My father is kind of scared of the COVID vaccine -
               | understandable.
               | 
               | But he gets his 'flu shot' (and a bunch of other things)
               | by the doctor all the time.
               | 
               | He has zero problem running all the other tests, taking
               | pills and taking the 'flu shot' which is _literally a
               | vaccine_!
               | 
               | But he also reads stupid conspiracy theory stuff on
               | Facebook and watches Fox News, and I believe to this day
               | he has not been vaccinated.
               | 
               | That's how powerful misinformation can be.
               | 
               | My bet is that he'll probably take Ivermectin if he's
               | heard about it on Facebook a bunch of times as being that
               | 'safe drug that the government tried to hide'.
               | 
               | My father is not a dumb man, and neither are most of the
               | people involved in this - but about 40% of the population
               | can't effectively deal with information. They will take
               | the drug depending whether Biden or Trump told them to
               | take it.
        
               | seriousquestion wrote:
               | Your father is erring toward things that have been proven
               | over time. The flu shot has decades of use and data. So
               | does Ivermectin (the open question is how effective it is
               | wrt Covid-19). They are proven safe. They are FDA
               | approved, Covid shots are not. It is perfectly rational
               | to seek treatments that are FDA approved and have been
               | used for decades.
        
               | pumpkinandspice wrote:
               | 100% agree that 40% or even more now can't effectively
               | deal with information, nor can think critically for
               | themselves. It's so politicized that you are either camp
               | A or B (liberal or conservative). One side being 'vaccine
               | is the only way' and the other is 'vaccine unsafe, other
               | drugs are safe'. There seems to be very little people in
               | the middle who can say 'vaccines are generally safe but
               | we don't know the long term side effects so we must look
               | at alternatives now for those that choose not to take it
               | or cannot take it for medical reasons'. Also it's
               | important for people to assess their own risk profile to
               | make the decisions for themselves (if they decide not to
               | take it).
        
               | khuey wrote:
               | > The problem is people irrationally believe that a
               | 'vaccine is unsafe' but at the same time 'some other drug
               | is safe' and might therefore take the drug.
               | 
               | It's wild to see people grasping at random anti-
               | parasitics as some sort of miracle cure when (if you're
               | over the age of the 12 and in the US) you can literally
               | walk into any pharmacy and get a real miracle cure for
               | free.
        
           | WarOnPrivacy wrote:
           | Nothing, I believe. Every drug approval isn't suspect. Just
           | the ones where pharma lobbyists get to spend the power they
           | bought thru beefy campaign contributions.
           | 
           | Also - Covid vaccines were under intense public and medical
           | scrutiny, during every bit of their development.
           | 
           | Good government and transparency tend to go together.
        
           | pjc50 wrote:
           | A lot of simultaneous trials have been run globally, and the
           | only contra indication so far seems to be a slight clot risk
           | with AstraZeneca.
           | 
           | You might be able to buy off the FDA, but it's a lot more
           | work to buy off all the regulatory authorities of the world,
           | at short notice.
        
         | dang wrote:
         | If you're going to make a comment like that it would be much
         | better to share some of the experiences you're talking about--
         | it would add substance, and be much more interesting.
        
       | gnicholas wrote:
       | > _The drug in question, Aduhelm, was approved by the agency last
       | month and has caused an uproar in the scientific community. Three
       | of the agency 's scientific advisors resigned following the
       | decision._
       | 
       | Is this sort of thing common? Seems like an investigation is
       | definitely warranted if this type of resignation is a rare as I
       | would imagine it be.
        
         | Exmoor wrote:
         | I'm sure there have been many controversial FDA decisions
         | before, but this one seems significantly different. The
         | reactions from normally even-keeled medical journalists have
         | been blistering [0] and it's apparently already set a precedent
         | that has resulted in other similar therapies which have also
         | not shown any sign of improving outcomes, starting to be
         | approved as well [1].
         | 
         | [0]
         | https://blogs.sciencemag.org/pipeline/archives/2021/06/08/th...
         | 
         | [1]
         | https://blogs.sciencemag.org/pipeline/archives/2021/06/24/op...
        
           | jrochkind1 wrote:
           | I think the FDA board resignations and general scientist
           | outcry is notable and not routine, but it didn't set the
           | precedent on it's own, it's been a trend long in development.
           | 
           | From January 2020 (17 months before aduhelm approved):
           | 
           | https://www.npr.org/sections/health-
           | shots/2020/01/14/7962270...
           | 
           | FDA Approves Drugs Faster Than Ever But Relies On Weaker
           | Evidence, Researchers Find
           | 
           | > Almost half of recent new drug approvals were based on only
           | one pivotal clinical trial instead of the two or more that
           | used to be the norm, according to the study published Tuesday
           | in JAMA, the journal of the American Medical Association. And
           | the reliance on surrogate measures -- stand-ins for presumed
           | patient benefits -- has increased. In the case of cancer
           | drugs, a surrogate measure could be shrinkage of tumors
           | instead of improvements in survival after treatment.
           | 
           | > ...Drugmakers also began paying the FDA fees to fund the
           | review process after AIDS activists protested the agency's
           | sluggishness in the 1980s... "There is some concern about the
           | incentives that this is created within the FDA," Darrow says.
           | "And whether it has created a culture in the FDA where the
           | primary client is no longer viewed as the patient, but as the
           | industry."
           | 
           | ["surrogate measures" is a complaint with aduhelm approval,
           | when they say there was no "evidence showing the drug slowed
           | the disease", they mean the approval was based only on
           | surrogate measures.]
        
           | wyxuan wrote:
           | Nitpick, I have a great deal for respect for Derek but he
           | isn't a journalist (and nor does he claim to be).
           | 
           | It's just a column.
           | 
           | But that's not to say the reactions from journalists weren't
           | critical. Adam from Stat had some choice words about the
           | decision.
        
             | timy2shoes wrote:
             | My personal opinion: I respect the opinion of a medicinal
             | chemist working in the field of drug discovery more than I
             | do a journalist. The insider who works in the field
             | understands the issues and problems of getting drugs to
             | market more than an outsider.
        
             | mcguire wrote:
             | In other words, it's a column by a guy who spent his career
             | in drug discovery. Not merely a journalist.
        
             | pjc50 wrote:
             | I'm not sure that's a useful distinction, it's not a
             | chartered profession. Someone who writes a weekly column
             | for money is a journalist in the way that someone who
             | writes software for money is a programmer.
        
               | eli wrote:
               | There's a pretty big distinction in the journalism world.
               | It's more like saying anyone who uses a computer for work
               | is a programmer.
        
           | ElViajero wrote:
           | I hope that the FDA has learned from the U.S. Federal
           | Aviation Administration and the Boeing 737 MAX catastrophy.
           | Credibility is easy to be lost and hard to be gained again.
        
         | DubiousPusher wrote:
         | It's especially conspicuous given how lucrative this specific
         | drug is expected to be.
         | 
         | The drug Humira for example is a drug with a similar cost and
         | schedule that is used to treat chronic auto-immune diseases.
         | Humira was similarly a first of its kind drug that for the
         | disorders it is used to treat. It became perhaps the most
         | lucrative drug in U.S. history eventually leading to the
         | company that made it spinning it off into its own company. It
         | has sent pharmas across the world scrambling to enter the
         | market, with many of them doing quite well too. And dementia is
         | an even bigger market than autoimmune disease.
        
         | db48x wrote:
         | 90% of all drug candidates that are brought to the FDA for
         | approval fail one of the FDA's required studies. It is probable
         | that some of the 10% that pass and are approved are marginal,
         | and someone at the FDA has to make a judgement call. Thus it is
         | likely that occasionally a drug is approved which later turns
         | out to be ineffective or even dangerous. But it seems to happen
         | fairly rarely, and it's quite rare that people resign in
         | protest.
        
           | hanselot wrote:
           | In reality mail-in emergency authorized gene therapy related
           | mortality-cases are extremely rare and the FDA and WHO are
           | bastions of integrity and truth. In fact, you will find that
           | all the agents at the FDA have been secretly engaged in a
           | campaign to "secure" the approval process, to protect our
           | democracy and society from the evils of critical thought and
           | reason.
        
           | amanaplanacanal wrote:
           | It looks like in this case it was known to be ineffective
           | when it was approved. I thought the FDA was supposed to
           | protect us from snake oil like this?
        
             | mcguire wrote:
             | When this came up originally here on HN, the point was made
             | that it was known to be effective in reducing plaques
             | (IIRC; against a symptom anyway), but was not known to be
             | effective or ineffective against Alzheimer's.
        
             | lazide wrote:
             | They are - it's also a thing that corruption happens. There
             | has been a lot more corruption than usual the last 4+ years
             | in gov't offices, and it will be a long time before it's
             | all identified.
        
               | l33t2328 wrote:
               | What evidence is there that there has been an abnormal
               | amount of corruption?
               | 
               | What is the normal baseline?
        
               | uvnq wrote:
               | It may also just be that more corruption is being
               | exposed.
        
               | kbelder wrote:
               | I suspect the baseline is measured in outraged Twitter
               | posts per hour.
        
               | Supermancho wrote:
               | This is _some_ data about corruption over the years
               | 
               | https://trac.syr.edu/tracreports/crim/646/
        
               | WarOnPrivacy wrote:
               | FDA's state of compromise goes a lot farther back than 4
               | years.
               | 
               | ref: https://www.forbes.com/sites/matthewherper/2016/09/2
               | 0/approv...
        
               | naasking wrote:
               | Just go back to the history of anti-depressants 20+ years
               | ago. Technically they don't work any better than placebo.
        
             | db48x wrote:
             | Yea, that's what I mean. If the evidence was merely
             | equivocal, as in there was some evidence in favor but not
             | as much as expected, then nobody would have resigned. In
             | this case their last study was "halted for futility", which
             | makes the approval pretty egregious.
        
           | gnicholas wrote:
           | What I couldn't tell was whether the "scientific advisors"
           | are FTEs or some other role. It would take a lot for someone
           | to give up a government job/pension, so three resignations of
           | that nature would be incredible. But if these are just part-
           | time consultants, the statement would be less notable.
        
             | sgent wrote:
             | These are outside advisors, probably about 1/2 of them or
             | more are academics as well as patient advocates, etc. They
             | maybe paid some amount, but its not their primary income
             | source.
        
             | wiredearp wrote:
             | If it's a fake drug that's been priced at a level to break
             | American health care [1], they could potentially be this
             | kind of employee that actually care or perhaps they just
             | considered the corruption too obvious even for the FDA and
             | wanted to clear themselves of charges.
             | 
             | [1]
             | https://www.theatlantic.com/ideas/archive/2021/06/aduhelm-
             | dr...
        
             | jdavis703 wrote:
             | Government STEM positions tend to be under paid vs the
             | private sector. A lot of these people are taking a pay cut
             | because they want to serve the greater good or work on an
             | interesting problem.
        
         | elil17 wrote:
         | A government agency requesting an investigation into its own
         | actions from an inspector general is not that weird. It can
         | happen for a variety of reasons.
         | 
         | Sometimes, the agency is confident that it handled things
         | correctly, so they want an auditor to come in to prove it to
         | the public and reassure everyone that nothing untold happened.
         | Other times, the agency suspects internal wrongdoing but lack
         | the resources to investigate it without disrupting their day-
         | to-day operations. It can also be a political move from a
         | presidential appointee when they suspect that the investigation
         | will uncover that it was their predecessors fault.
         | 
         | At the end of the day, though, inspectors general have wide
         | latitude to investigate what they choose. HHSOIG would probably
         | have investigated this anyway, so it's just a good PR move for
         | the agency to invite the scrutiny.
        
         | loceng wrote:
         | In 2011 an ex-FDA advisor who had voted to approved LASIK eye
         | surgery, published a letter to FDA asking them to immediately
         | recall LASIK as there was data they were ignoring that they
         | shouldn't have been ignoring;
         | https://www.phillyvoice.com/former-fda-adviser-lasik-dangers...
        
       | Exmoor wrote:
       | Full headline (presumably cut for HN length restrictions) is:
       | 
       | > The head of the FDA is calling for an investigation into her
       | agency's controversial decision to approve a new Alzheimer's drug
        
         | WarOnPrivacy wrote:
         | That decision was so overtly concerning, I already knew what
         | the headline was about.
         | 
         | I'm suspect that a lot of lesser, bad behavior had to go
         | unchallenged, for us to wind up with a decision that was this
         | blatantly corrupt.
        
         | dang wrote:
         | The HTML doc title fits the 80 char limit so we've switched to
         | that.
        
       | fnord77 wrote:
       | > _we have investigated ourselves and have found no wrong-doing!_
        
       | lend000 wrote:
       | The baseline reaction I'm seeing from commenters is appalling.
       | This drug has been shown to NOT be particularly dangerous in
       | clinical trials, while having a biochemical effect on amyloid
       | protein buildup, which has strong correlations with degenerative
       | brain diseases. It's another tool in the arsenal. There's no
       | evidence that it cures one of the worst diseases around, but that
       | shouldn't be the requirement for whether the public (only after
       | having it prescribed by a medical doctor, mind you), has access
       | to a drug.
       | 
       | How can you be pro-Marijuana and then not trust doctors to have
       | another tool in their arsenal? The FDA should exist to prevent
       | fraud and monitor quality, and nothing else. In this case, it
       | would be highly reasonable to restrict the claims of the drug
       | based on the study. But to ban it? What gives you or them the
       | right to protect people from themselves?
        
         | burnished wrote:
         | Probably the appalling upfront profit motive driving it. Yeah,
         | I think thats probably it.
        
           | lend000 wrote:
           | Yes, how dare they try to sell a bioactive compound that cost
           | billions to produce for... money! Especially to willing
           | buyers only after prescribed by a medical doctor!
           | 
           | In your fantasy world, I suspect there isn't a lot of
           | technological progress.
        
             | tsimionescu wrote:
             | Yes, actually, how dare they sell a substance with no known
             | effect on any disease as 'Alzheimer's medicine', just
             | because they might lose some money if they don't? How dare
             | they market this to desperate people willing to try
             | anything?
        
         | quickthrowman wrote:
         | > How can you be pro-Marijuana and then not trust doctors to
         | have another tool in their arsenal?
         | 
         | It doesn't cost $55,000 a year to smoke weed, and if nothing
         | else weed will get you high. Most people have a problem with
         | Medicare paying for this drug, not people taking the drug
         | itself.
        
           | lend000 wrote:
           | And if someone created a strain and tried to sell it for 55k
           | a year, you would then support the FDA banning it, instead of
           | letting people decide for themselves?
           | 
           | You're right about Medicare, though. A socialized healthcare
           | system creates negative incentives (for example, banning
           | things that might be costly, instead of letting the market
           | direct that item to people willing to pay more).
           | 
           | I always struggle to relate to many people's infantilism. You
           | aren't a baby, and other adults aren't babies. If people can
           | vote, sign up for the military, etc., then they can make a
           | decision about their own body given accurate information.
        
             | quickthrowman wrote:
             | The FDA does not regulate marijuana strains. If someone
             | wants to pay $55,000 for weed so be it, but socialized
             | medicine shouldn't pay for treatments with no efficacy.
        
               | lend000 wrote:
               | After accurately describing the problem, would you now
               | say that the real root of the problem is our socialized
               | healthcare system, or having choice in drugs?
        
             | tsimionescu wrote:
             | It's not a matter of infantilism. Calling this substance
             | 'medication' when it has not been proven to have any affect
             | at all on any disease is simply fraud. Marketing it as
             | medication will be like marketing homeopathic junk as
             | medicine.
        
             | heavyset_go wrote:
             | > _And if someone created a strain and tried to sell it for
             | 55k a year, you would then support the FDA banning it,
             | instead of letting people decide for themselves?_
             | 
             | Are they making medical claims that aren't backed up by
             | evidence?
        
         | pg_bot wrote:
         | The problem with this particular drug is that there is no
         | evidence that it leads to longer or better lives for the
         | patients who have taken it. Therefore there is no real reason
         | to prescribe it for Alzheimer's, but it will be prescribed and
         | it will cost American taxpayers billions.
        
           | alasdair_ wrote:
           | The solution seems to be to ban medicare/medicaid from paying
           | for any treatment that isn't proven to work.
        
             | tsimionescu wrote:
             | It's not just a problem for Medicare/medicaid. BioGen will
             | be allowed to push this through their marketing to
             | desperate patients and caregivers, who will nag their
             | doctors into prescribing it, even though they could just as
             | well drink a glass of water.
        
         | tsimionescu wrote:
         | > while having a biochemical effect on amyloid protein buildup,
         | which has strong correlations with degenerative brain diseases.
         | 
         | That correlation has actually been turning out to be very weak.
         | The very studies conducted to test this drug are some of the
         | proof (reducing amyloid buildup doesn't affect disease
         | progression), And there is also mounting proof from brain
         | imaging that Amyloid buildup exists in the brains of many
         | people with no mental problems.
         | 
         | And in general, if we _know_ the drug does nothing at all, why
         | allow the company to force doctors to prescribe it (by
         | marketing to desperate patients)?
         | 
         | The drug can still be used in new research. But unless and
         | until research shows that it has an effect on some disease, it
         | should be illegal to market it as medication. At best it could
         | be sold as a supplement, for those gullible enough to try it.
        
           | lend000 wrote:
           | > it should be illegal to market it as medication
           | 
           | That's exactly what I stated. But banning substances outright
           | is anti-science and anti-freedom. Just prevent fraud, and
           | make sure it isn't poison.
        
             | tsimionescu wrote:
             | FDA approval is needed to seek something as medication. If
             | they want to package it as a supplement, they can sell it
             | today.
        
         | phnofive wrote:
         | The risk/benefit model is broken here: Some risk and no
         | benefit. I'm not going to even address the cost - the benchmark
         | for benefit is incredibly low. All BioGen needed to show was
         | that their drug delayed progression of cognitive impairment for
         | a few months, and they couldn't do it.
         | 
         | The FDA acknowledged as such in their conditional approval,
         | weakly suggesting expanded access might allow BioGen to
         | demonstrate this in a larger population. This would lead
         | Medicare to pay for an extensive, unethical study fueled by
         | nothing more than the hopes of desperate patients and their
         | caregivers.
        
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