The Business of Aducanumab

I’ve written before about how the makers of the controversial drug Aducanumab are selling hope for $56,000/year, but after thinking and reading more about the topic, I’ve become even more convinced that whatever hope they are selling isn’t actually for patients, but for cash-strapped medical centres and drug companies.

Consider this article in JAMA Neurology. As far as I can tell, the author is a very decent person and accomplished physician. But I find it painful to consider the mental somersaults required to portray a positive scenario out of an astoundingly bad decision by the authorities:

Even opponents of the FDA’s decision, and there are many, ruefully concede that it could be the solution to our lack of a business model. Its delivery as an infusion means physicians will receive approximately 4% in revenue from the drug’s $56 000-per-patient annual cost. There is also revenue from the imaging studies and visits to evaluate for possible adverse effects. Funds will flow into memory centers.

And later on in the article:

As this happens, we will have support to hire more colleagues. Our work will of course focus on “whether aducanumab is right for you.” We will talk about its risks, uncertain benefits, the co-pay, coordinating the imaging visits, how to watch out for signs of brain edema and microhemorrhages, and APOE testing, but this education can expand to other topics such as how to organize a day that is safe, social, and engaged. That is exciting.

Wow, how exciting!

In particular, that part about how they will (of course!) focus their work on whether aducanumab is right for patients, well, let’s put it this way, if I desperately needed to believe in some nonsense, that’s exactly what I would say to myself in the mirror.

Much better is this follow-up article, again in JAMA Neurology, about ‘What the Aducanumab Approval Reveals About Alzheimer Disease Research’. It focuses on the lack of Black patients in aducanumab trials, but makes a broader point about the need for more inclusive research in general.

Something is horribly wrong with the healthcare system in America. The fact that an unproven drug like aducanumab can be recommended for use shows what happens when you prioritise profits over the welfare of patients.