Adumbrations Of Aducanumab

https://astralcodexten.substack.com/p/adumbrations-of-aducanumab   Lots of people have been writing about aducanumab, but this Atlantic article in particular bothers me. Backing up: aducanumab, aka Aduhelm, is a new “Alzheimers drug” recently approved by the FDA. I use the scare quotes because it’s pretty unclear whether it actually treats Alzheimers. It definitely treats beta-amyloid plaques, and beta-amyloid plaques are kind of nasty-looking brain structures that seem to be related to Alzheimers somehow. But we’re not sure exactly how they’re related, they might not be related in a way where removing them treats Alzheimers, and the best studies don’t find that the drug helps patients feel better or remember things more. Aducanumab doesn’t meet normal FDA standards for approval, but the FDA approved it anyway under one of their many “fast track” programs for promising drugs. This has been pretty roundly criticized, because although aducanumab might or might not work, it definitely costs $50,000/year/patient. Even if it worked great, that would be a hard pill to swallow (no pun intended, Aduheim is an IV infusion), but it’s especially galling since it might not work at all. Doctors will probably prescribe it despite its questionable value, and someone will end up paying the extraordinary price tag. (Who? Nobody knows. The patient? Insurance companies? Taxpayers? Unrelated patients at the same hospital? Could be anyone! The whole point of the US health insurance system is to make sure nobody ever figures out who bears any particular cost, so that there's no constituency for keeping prices low. If you check your bank account one day and find it's down $50,000 for no reason, I guess you were the guy who ended up on the hook for this one. Sorry!)