Health Sector Investing: Exclusive Interview With Alzheimer's Expert
Stock-Markets / Healthcare Sector May 04, 2009 - 04:01 PM GMTBy: Q1_Publishing
Good morning, Long time readers of Andrew’s know what he’s about.
He says, “Our readers will only stay with us if we provide great ideas, new perspectives, and deep and thoughtful research. To be the best we have to learn from the best.”
These aren’t cliché’s we hang on posters around the office though. It’s something we truly strive for. With that, I’d like to let you know I have something special for you today.
Andrew has been researching healthcare a lot lately. While doing his usual research, one of the experts Andrew sought out was William Thies, Ph.D., Chief Medical and Scientific Officer of the Alzheimer’s Association. Although not everyone Andrew speaks with is willing to go “on record,” Dr. Thies was.
I’ve read it and can tell you it’s like sitting in the room with one of the world’s leading experts on one of the world’s fastest growing diseases. I don’t mean to sound heartless either, but the investment opportunity in Alzheimer’s is almost as big as the problem.
In this exclusive one-on-one Dr. Thies reveals:
-What the next generation of drugs is likely to be
-What companies recognize as one of “the great opportunities” in Alzheimer’s
-What one company has identified as a potential way to improve people with Alzheimer’s
-How soon we could expect the next generation of treatments to come online
And plenty more…
You can read the interview below.
Regards,
Carly Walton
Publisher, Q1 Publishing
Andrew Mickey: I’d like to start with some of the basics of Alzheimer’s disease. So to get an idea of what we’re facing here, I’d ask how big is this problem and how big could it get?
Dr. William Thies: Well, in terms of the size of the problem, the problem is already big. There are over five million Americans with Alzheimer’s disease.
Looking at the demographics for the second half of the century, we are likely to have as many as three times that number by 2050. People are living longer and the post World War II baby boom population has yet to go through the ages where they are most likely to develop the disease. That’s going to give us a substantially larger number of Alzheimer’s patients.
Of course, any discussion of the number of patients has to be coupled with the cost. Alzheimer’s is a very expensive disease. Alzheimer’s patients become fully dependent on others for their care. We know that’s a very expensive proposition.
There is also an increased utilization of medical resources. If we compare a patient that does not have Alzheimer’s with one who does – all else being equal - the Alzheimer’s patient is going to cost about three times as much than a person without Alzheimer’s.
So we not only have large numbers but we have huge cost that we can project through about 2050.
That’s why we believe we really have to do something different here in terms of treatment and, especially, prevention. We simply won’t be able to afford to deal with it. We won’t have that manpower to deliver the care that will be necessary. We need a different solution.
Andrew Mickey: With numbers like that, it’s easy to see how Alzheimer’s could be a very big stressor on the health care system from both availability and cost perspectives. Is this something which could be the proverbial straw which breaks the camel’s back?
Dr. William Thies: Yes. It certainly has the potential to bankrupt the health care system.
When you think about that in real terms you realize that suddenly you are affecting everybody, it doesn’t make any difference whether you have Alzheimer’s, or if it’s in your family, you are going to struggle because the entire system is going to be so overwhelmed that it won’t function.
The healthcare system is a limited resource system. If you suddenly stop up all those resources it’s going to have an impact.
Andrew Mickey: Okay, that’s a pretty good explanation of the kind of situation that we are facing. How much is spent annually on developing new preventions and treatments? Can you tell me what the ratio of prevention/treatment is? Where is most of the research money headed, treatment or prevention?
Dr. William Thies: We have to look at all the parts because there is a lot of crossover. The next generation of drugs is likely to be mostly what are called “disease modifying” drugs. These drugs change the rate of development of the disease. We’re fairly certain that Alzheimer’s disease is pathologically developed as much as 10 or 15 years before symptoms occur. This suggests to us that we have a big window of opportunity for prevention with the same medications that are now being developed for treatment.
There is a lot of investment here. I’m being fairly vague because most of the investment in looking for new therapies for Alzheimer’s happens at the corporate level. These larger companies don’t always give full disclosure on how much money they spend and on what, but the estimate is that there might be as much as $2 to $3 billion being spent on developing new treatments.
That $3 billion estimate includes everybody who invests. The Alzheimer’s Association - that’s us - big pharmaceutical companies, and smaller biopharmaceutical companies all make up that number.
I think the one thing we have to emphasize here is, $3 billion sounds like a lot of money, but frankly, it isn’t enough for the size of the problem we face. The National Institutes of Health puts about $400 million into Alzheimer’s research each year. Funding for cancer and is about $5 billion and funding for heart disease is about $2 million annually. So you can see that there is a considerable gap between what have been the traditional problems with healthcare and the new one that is emerging.
Andrew Mickey: So when it comes down to the actual treatment there are a lot of unknowns. What area is research focusing on which has the potential to make a serious impact on the problem?
Dr. William Thies: To put it in context, modern Alzheimer’s science is relatively new. While the disease was formally described a little over 100 years ago, for much of that time, it was regarded as a minor neurological phenomenon.
The reason for that was because the first cases that were described were in people who were very young; they were about 60 years old or a little younger. Researchers were constantly looking for the 50 year old with Alzheimer’s. Now we know that they are obviously fairly rare. So with life expectancies being lower back then, it wasn’t much of a focus.
During the time I went to school, if a younger patient came in and had Alzheimer’s everybody wanted to see that person. At the time, we thought you might never see somebody like that again in your whole career.
The fact is that starting in the late 60s and early 70s, pathologists started to look at these younger cases and all the people who were getting the similar symptoms. Although they were a bit younger than most Alzheimer’s patients, they were regarded as just normal aging individuals. And you could expect older people to get the same kind of symptoms because that is what was thought to be just what happened to all older people.
What the scientists came to recognize is the pathology in this younger group labeled as Alzheimer’s and the older group of the population was exactly the same. In fact, the problem with Alzheimer’s was that it was age dependant and it increased with increasing age.
Practically overnight the disease went from being a minor neurologic backwater problem to becoming a really big public health problem. Now, people could anticipate what was going to happen with the population.
Since about 1970 there has been a significant increase of investment in Alzheimer’s science. During the 60s there was virtually no investment in Alzheimer’s science, this ramped up in the 70s and built a whole infrastructure of researchers and ideas and definitions –there really wasn’t a clear definition of Alzheimer’s until 25 years ago.
If we look at what has happened in the meantime, there has been a great deal of basic science work done that has looked at parts of the fundamental pathology of Alzheimer’s. Some of the fundamentals of the genetics are now known, and while they have been instructive, we really do recognize that the true hallmarks of the disease are the two brain lesions that Dr. Alzheimer identified. These are the so called plaques and tangles, and are the major foundation for the disease.
We now know the chemistry of what makes up those lesions -- and we know a fair amount about the metabolism of amyloid and tau, which are the basic materials. We have some ideas about where we may go to adjust the abnormal accumulation of them in the brain, as well.
The thing we don’t know is the absolute cause of Alzheimer’s disease. If there was a single identifiable event which led to Alzheimer’s, it would be a lot easier. We don’t know if there is a single event or, if there is one, we don’t know what it is. If there was an event, it would happen so far away from the appearance of symptoms it would be nearly impossible to pinpoint it.
Let me explain it like this. Sometimes it’s hard to remember what you had for lunch yesterday. Does that mean you have Alzheimer’s? Is it an early warning sign? Probably not. Now try and recall specific points of your life 15 years ago. Tough to do, right? Well, that’s what Alzheimer’s patients would have to be able to do to determine any early warning signs.
All that makes the determining warning signs and precursors virtually impossible to identify. The cause of the disease is highly variable.
There are other variables too. Some people will go through the total course of the disease in a few years. Other people may live as much as 20 or 25 years with a slowly developing form of the disease. Given that variation and the fact that the next generation of medication will be aimed at adjusting that course, it’ll be just as tough.
You can sort of imagine the kinds of problems that exist with doing a clinical trial with those medications that were highly variable to the population.
The most recent thing that we are beginning to learn about is how to better diagnose Alzheimer’s. Ever since it was first discovered, we made the diagnosis by talking to people. That could be changing, but it’s going to take a while.
We need a precise way to gather disease-specific information but we don’t yet have a good biomarker for Alzheimer’s. People are working very hard trying to identify that biomarker. This would be some sort of measure of the biological process that can not only identify the disease, but also be able to track the course of the disease. This would drastically increase the rate at which we would find new medications and drastically reduce the complications of treatment before the disease sets in.
Andrew Mickey: Has there been much progress in Alzheimer’s biomarkers? If so, what biomarkers are you looking for and where you are looking for them?
Dr. William Thies:A biomarker in general is some sort of biological marker of the disease and its progression. So if we looked across Alzheimer’s and the several things people are working on, they are looking for imaging biomarkers using technologies such as PET and MRI scans, and they are looking for chemical biomarkers -- that ,may be something that appears in cerebrospinal fluid, blood or urine. And they’re looking for them sort of in that order of priority.
Obviously urine is most convenient to get samples from. Blood would be the next most convenient. And cerebrospinal fluid would be the most complex to collect but tends to give you the best samples.
Andrew Mickey: Can you give us some examples of other well known and proven biomarkers?
Dr. William Thies: A biomarker is something that allows you to identify the disease and track it. They also allow you to track the effectiveness of...
To continue this interview and read more on Dr. Thies and Alzheimer’s, stem cells, what companies recognize as one of “the great opportunities,” and more? Follow this link.
Good investing,
Andrew Mickey
Chief Investment Strategist, Q1 Publishing
Q1 Publishing is committed to providing investors with well-researched, level-headed, no-nonsense, analysis and investment advice that will allow you to secure enduring wealth and independence.
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