A question of medical research
or "Does it matter that Aduhelm costs fortunes more than Ivermectin"
I have come across two medical research controversies in the past few weeks. The first regards the approval of Ivermectin for semi-experimental treatment of COVID-19. The second regards the approval of Aduhelm for semi-experimental treatment of Alzheimer’s disease.
First, Ivermectin. There is a more detailed evaluation on our website, but in short:
Ivermectin is an anti-parasitic, used to treat river blindness, lice, and other parasitic diseases since the 1980s.
The idea that Ivermectin can treat COVID (a virus) is very popular politically with some groups. It has been promoted by politicians in Latin America, by Ron Johnson in the United States, and recently Intellectual Dark Web celebrity Bret Weinstein has been indefatigable in promoting it.
Unlike other chemicals, such as bleach or warfarin, there is some reason to believe Ivermectin could be effective.
The research on its usage as treatment is inconclusive, and largely done on small samples.
While it almost certainly is not as effective as vaccines, there is no proof it is not effective enough to be used as a treatment of last resort.
For some reason, nobody has bothered to do a conclusive test of its efficacy, and the studies that have been done tend to take six months or longer to complete. A good study should only need to take a month.
Next, Aduhelm. In short:
Aduhelm is a new drug, a potential treatment for Alzheimer’s disease.
Aduhelm was approved on the basis of “accelerated approval”. It causes a reduction in “amyloid”, but has not been shown to effectively treat Alzheimer’s.
There are accusations of malpractice in the approval; three members of an official advisory committee resigned in protest over the decision.
It will take at least 3-5 years for any study to show results; Aduhelm is not a “miracle drug” that immediately reverses the impact of Alzheimer’s.
There is an additional factor that needs to be considered here, the third-rail of Medicine. Cost.
It is not immediately clear what Ivermectin costs. We estimate $20 for treatment of a symptomatic COVID patient.
It is immediately clear what Aduhelm costs; in fact it is the headline story. The list price is $56000 per year.
If you do not feel this orders-of-magnitude price difference is important, you are why medical costs are out of control in the United States.
So what is to be done?
Congress can (and should) act to prevent a situation where 1% of US medical spending goes to Aduhelm, before it is shown to be effective against Alzheimer’s. I recommend a new rule where any drugs with a cost of over $500 per-month must be explicitly authorized by Congress before Medicare or other health-insurance companies are required to cover them.
The scientific community needs to be reminded that “good science” and “getting research papers published” are often contradictory objectives. We note XKCD 1574.
The Intellectual Dark Web needs to be reminded that the solution to a lack of conclusive proof on a topic is to obtain that proof, not to promote conspiracy theories that claim the proof is being suppressed.
Postscript: There is the question of censorship. Youtube has an extremely detailed policy regarding content that is allowed on the topic of “COVID medical claims”. Our sense is that the policy is necessary but over-done. A three-state censorship system is necessary; some topics must be completely forbidden, but others merely need be discouraged (say, through de-listing from recommendations). We further note that if you are making serious medical claims, you probably want to use some forum other than Youtube for reasons unrelated to “censorship”.