Why diagnosing Alzheimer’s today is so difficult, and how we can do better | Hacker News Reader

Why diagnosing Alzheimer’s today is so difficult, and how we can do better

gatesnotes.com

32 pointsuptown12 comments

I didn’t realize Bill Gate’s dad has Alzheimer’s.

I’m not sure why this disease gets relatively little funding. If Gates’ funding leads to early detection, say 10-15 year early, maybe it’ll raise awareness so it gets more government funding.

My Mom is showing early signs of dementia, and every neurologist we talked with said the same thing Gates suggests: get an early baseline test.

There's only one problem. Neither she or my dad will get one...

Hopefully, Bill Gates can throw some weight behind acceptance of these tests as both dementia and Alzheimer's seem to show signs of responsiveness to simple changes in behavior...like walking every day.

It might be that simple or not... without access to the test data over time it's hard to make solid arguments.

"Mom, you need to go for a walk today," just doesn't sound very scientific, but "Mom, Bill Gates says you need to go for a walk today," might just work.

The problem is it's kind of a catch 22. It's hard to get drugs to work without early diagnosis and there's no real point in early diagnosis without there being drugs that work.

> and there's no real point in early diagnosis without there being drugs that work.

A lot of health issues can be managed through lifestyle modifications if they're detected early enough.

Alzheimer's isn't one of them.

Alzheimer's actually gets a lot of funding, but mostly for therapeutics, not diagnostics: it gets a lot of funding from NIH, and neurodegenerative disease treatments get the third or fourth most VC and big pharma funding (after cancer, rare disease and maybe infectious disease)

However none of the drugs really work, and ppl think one reason is bc patients are diagnosed too late

Diagnostics get very little funding in general, not just in Alzheimer's. Calling yourself a "diagnostics" company is a good way to get ignored by VCs. You have to do a lot of expensive studies to prove that they work, the bar is quite high to getting insurers to pay for them, and pricing power is low. Most insurers will only pay for a novel diagnostic if it saves them money. So you have high development cost and low profit potential

>Calling yourself a "diagnostics" company is a good way to get ignored by VCs. [...] So you have high development cost and low profit potential

What can regulatory agencies do to alleviate this?

The regulation for many diagnostics is actually fairly light. There's a class of diagnostics called "lab developed tests" that essentially aren't regulated by FDA

The development cost is high because you need good data to convince doctors that tests work, and also to convince payers. Payers have proven to be the real gatekeepers for many diagnostics rather than FDA

The NIH has a $1.9B budget for alzheimer's dementia research for 2018, That's including the $400MM+ budget increase that congress gave them this year.

There is nothing small about government funding in this area, and Gates additional funding will be a drop in the bucket to what the government is already doing.

It's good that he's putting up his own funding, as it'll give a different set of eyes and money to the problem. But don't get that confused with the government and the NIH not putting some serious research funding behind the problem.

What if you could diagnose with an eye scan? http://optinadx.com

Disclaimer: I'm an investor in Optina Diagnostics

interesting ! could you describe the key technology behind optinadx to a layman, in some more detail ?

I'm not affiliated with Optina and I don't know specifically what they're doing, but the classic symptom of Alzheimer's is the formation in the brain of amyloid plaques - and it appears to be the case that they also form on the retina, and can thus be detected by appropriate optical scans.

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